Vomiting. Aches and pains. Low oxygen levels. Shallow breathing. Difficulty walking. What illness do all of these symptoms, among several others, allude to?
It’s not an infection or a neurological disease. It’s also not the flu, something doctors seeing patients presenting these symptoms originally thought. Instead, it’s the newly discovered vaping-related illnesses that are stumping doctors across the U.S.
When e-cigarettes first hit the market, the future of the devices wasn’t on the minds of the manufacturers, distributors or consumers. At first, the devices were not wildly popular among young people as a “healthier” alternative to smoking cigarettes.
The main purpose of these devices was to help cigarette smokers stop smoking cigarettes by offering a healthier way for them to get their nicotine fix. They allowed long-time cigarette smokers to slowly quit smoking without the health and behavioral implications of simply quitting cold turkey. The thought that the devices would cause a nicotine addiction, as well as severe health complications in a new generation, was far from the minds of manufacturers and the public.
This thought was short-lived, and it soon became apparent that the use of these products did, in fact, come with health complications. Around mid-summer 2019, vaping-related illnesses started to present across the U.S. in large enough numbers to cause concern. The Centers for Disease Control (CDC) launched a multi-state investigation into the illnesses on Aug. 1, working closely with the U.S. Food and Drug Administration (FDA), other public health partners and clinicians to determine what exactly is causing these illnesses.
These entities know that the illnesses are caused by vaping, but they are not exactly sure what aspect of the vaping is causing patients to present with such severe symptoms.
According to Dr. Christopher Lau, who is part of UPMC Hamot’s Comprehensive Lung Center, the CDC started to see cases of vaping-related illnesses pop up across the U.S. sporadically at the beginning of 2019. Then, around June or July, it started to notice that the number of cases across the country was increasing.
“That’s really when you started to hear about some of these cases in the newspapers and in media,” Lau said. “They were initially more in the larger hospitals. I think the first patients I saw in the hospital were at the end of August or beginning of September.”
Lau said that he started to see cases of these illnesses in Erie around the time of the reported peak in the illnesses. Since then, there has been a steady rise in the number of people suffering from vaping-related lung diseases and illnesses. From Oct. 3 to Oct. 10, the number of reported cases in the U.S. rose from around 800 to over 1,000. However, it is still unclear as to exactly what component of the e-cigarettes and vapes is causing the illness.
Michelle Hall, a public health educator at the Erie County Department of Health, said currently between 10-49 cases are under investigation in Pennsylvania. One of these has been reported a death by Pennsylvania Health Secretary Rachel Levine. The reason for the number being so vague, Hall says, is that the cases are still being investigated.
“I would like to stress that all reports are currently under investigation,” Hall said. “With the number being so fluid right now, we cannot give an exact number at this time.”
The CDC reports that national and regional findings suggest that the vaping-related illnesses are due to patients’ history of using products containing Tetrahydrocannabinol (THC). THC is a lipid, or a fat, and is the main psychoactive compound in cannabis.
Most patients who present with the symptoms of vaping-related illnesses use vaping products that contain THC frequently, which is leading experts to hypothesize that these products play a role in the outbreak of illness.
“With a lot of these cases, they’re still trying to figure out all of the details,” Lau said. “A lot of the cases had similarities between people using both e-cigarettes with nicotine and e-cigarettes with THC. Because some patients were using both products, it wasn’t clear at the very beginning what was causing the symptoms.”
One product that Lau has heard the name of from several patients is “Dank Vapes” THC products. “Dank Vapes” is a counterfeit brand of THC products that has no obvious regulated production or distribution. But, because of its common packaging, people who purchase the products online think that it is a reliable source for vape cartridges.
“One patient that I had recently said that he just got a new one right before the onset of his symptoms,” Lau said. “So, it kind of fits the pattern that these batches are being made randomly. It’s not a licensed facility that is making these.”
Although it is unclear what part of these cartridges are the exact cause of vaping-related illnesses, there is one thing that the medical community knows for sure: oil should never be inhaled. This is a fact that has been known for years. Before e-cigarettes and vapes hit the market and people started presenting with symptoms that stem from usage of them, there was a disease, called lipoid pneumonia, that is well-known within the medical community.
The disease typically affects children, who are more likely to accidentally aspirate oil-based substances. However, Lau said a small number of adults have presented with the illness because they would accidentally aspirate essential oils that they rubbed under their nose.
“We have seen some evidence of lipoid pneumonia in some patients, but that’s not the only presentation from a pulmonary perspective,” Lau said. “That just goes to show that you definitely don’t want to be inhaling these oil-based substances. In theory, the only thing you want to inhale into your lungs is air.”
The imminent threat of these vaping-related illnesses has caused many users to quit out of fear for their health. As of Oct. 1, 1,080 cases of vaping-related illnesses had been reported in 48 states and the U.S. Virgin Islands. The CDC says that 18 of those cases are confirmed deaths from 15 states. These statistics have been scaring young people who started using e-cigarettes and vapes into quitting, calling hotlines that were originally designed to help people quit smoking.
Jenna Schall, a sophomore respiratory therapy major at Gannon University, said that she used to vape, as did her friends. However, she said that she came to realize how bad it was for her health, so she quit while she was ahead. Schall said that she is still baffled by the fact that people vape and use e-cigarettes, despite knowing the health risks that come with it.
“A few years ago we did not have the research and results that we do now, so I believe we are more likely to predict them today,” Schall said.
Similarly, Hanna Swanson, a sophomore physician assistant major at Gannon, said that the outbreak of vaping-related illnesses was what pushed her to quit. She had been contemplating quitting Juuling for almost six months, and the notion that it could land her in the hospital made her finally decide to pull the plug on her bad habit.
“Juuling affected my life in such a negative way,” Swanson said. “I spent thousands of dollars on pods and replacing lost Juuls. I relied on it too much. When I didn’t have nicotine, I was agitated and moody.
“Now, whenever I feel the negative affects of my nicotine addiction, I chew nicotine gum so that I don’t become agitated. There are some bad days, but I’ve felt pretty decent so far.”
Although it wasn’t guaranteed that Swanson would fall ill from using only using nicotine-based Juul pods, she figured it was better to be safe than sorry.
At the moment, there is not much evidence toward whether it is nicotine products or THC products that are causing people to be hospitalized. The CDC suspects that the main cause is the lungs being subject to chemical exposure, so although the medical community suspects the THC products are the main cause, nicotine products also could be a culprit.
Despite the threats from the Trump administration to ban e-cigarettes and vapes completely, regulation seems to be the best solution to many individuals in the medical community. In Pennsylvania, the Erie County Department of Health is working to educate the community on the potential dangers of vaping. While the eventual outcome of cigarette smoking is known, that of vaping is not. So, the best thing that can be done right now is education, Hall said.
“With vaping, we have to make informed decisions and remember that correlation is not causation, but the fact of the matter is that there are so many unknowns,” Hall said. “What we do know is that these products can cause irreversible lung damage and disease.” To Lau, completely banning them means running the risk that people continue to use the unsafe, unregulated products. Regulation, however, means that vaping would become safer than it is now.
“If you regulate something, you can control it,” Lau said. “But, that’s more of my personal opinion. The simplest thing right now is that you don’t want to be vaping any THC products. There is no evidence out there that suggests they are deemed safe.”
To put things in perspective, Lau compared the situation revolving around e-cigarettes in the U.S. to that in Canada.
Because the national government regulates the production and sales of marijuana products, including e-cigarettes and vape cartridges, they haven’t seen as many vaping-related illnesses as we have in the U.S.
In the U.S., THC products aren’t federally regulated. Regulation of such products is up to each individual state. Because of this, the regulation isn’t as tight as it would be if it was federal, and more unsafe, unregulated products are slipping through the cracks.
Schall sides with those who believe in regulation of these products. Her experience and what she has learned through her major has led her to think that regulation, not a complete ban, is the solution,
“I believe we should regulate them because the more you use e-cigarettes, the more likely these diseases are to occur,” Schall said.
One idea for regulation is to take flavored cartridges off the market completely. This way, young adults and teenagers, who the companies that sell the flavored cartridges market to, will be less inclined to buy the unflavored nicotine cartridges.
This will eventually lead them to quit vaping altogether, because the vapors they inhale won’t taste as good.
Juul Labs, which commands the e-cigarette industry with more than 70% of the market, replaced its CEO in September with a veteran of Big Tobacco. It also said that it would not fight fight the Trump administration in banning flavored e-cigarettes.
Both of these moves were made in hopes that the e-cigarette giant would one day be able to stay solvent if sales of unflavored nicotine cartridges remained steady while being regulated.
“The companies who make the e-cigarettes are saying that there are adults who are using them and are able to quit smoking cigarettes, which we know are more harmful than e-cigarettes,” Lau said. “That’s why there hasn’t been a complete ban. There’s some evidence to suggest using an e-cigarette can help you stop smoking,”
Still, some say that e-cigarettes should be completely banned because of the health complications that come with it.
Despite being a religious Juul user for over a year, Swanson still thinks that the best option is to ban the products while we still can.
“If vapes and Juuls are killing people, I think it’s only humane to stop the production of them,” Swanson said. “If you compare the affects of cigarettes to e-cigarettes, cigarettes kill people over an extended period of time.
“We have been aware of that for a long time, so people know the consequences when they smoke their first cigarette. For Juuls and vaping devices, most of the people who started didn’t know that there were any consequences at all. It’s so fresh that we can end it before it gets even worse.”
The big question amid this outbreak is: should we have seen this coming? With the history of health complications that comes from smoking cigarettes and cigars, should we be so surprised that e-cigarettes are also unhealthy?
According to Hall, the proof is in the science.
“Our lungs were not made to inhale anything other than clean air,” Hall said. “You increase your risk for developing ailments with inhaling anything other than air.
“While many of these companies put information out that vaping was safer, we have to stress that no matter what, safer does not mean safe.”