Our phone has been ringing off the hook recently as customers call to ask concerned questions about the mysterious vaping illness that's been sweeping across the United States.
According to the Centers for Disease Control and Prevention (CDC), the vaping-related lung disease has now been linked to 450 possible cases across 33 states and has claimed the lives of five people. Symptoms range from shortness of breath, fever, nausea to vomiting and dizziness with most patients requiring hospitalization.
"Among the patients that were hospitalized, over half of the patients required intensive care management and 32% of the patients required mechanical ventilation to help their breathing," said the CDC. Some patients have had to remain in the hospital for weeks at a time and others have been left with permanent lung damage. Oddly, many of the patients have been young people in their teens and 20's with a "median age of 19 years and the majority have been men."
The CDC issued a warning to the public on August 30, 2019 strongly recommending that people avoid purchasing black market vaping products, or consider avoiding vaping altogether, as well as discouraging individuals from adding any substances to their electronic cigarettes (such as legal or illegal drugs or other adulterants).
"To date, no single substance or e-cigarette product has been consistently associated with illness," the CDC stated.
However, since that original warning, the investigation has progressed. While there are still no definitive answers, the CDC seems to be narrowing down the list of suspected causes.
For one thing, the CDC appears to be pretty certain that the phenomena is something new, not just a latent epidemic that no one noticed until now. Using something called "syndromic surveillance" to search emergency room visits over the past several years produced support the idea that the illness was newly emerging, mostly appearing since June of this year. Although the CDC cautioned that the conclusions were preliminary, it did say that the sydromic search results suggest that the mystery illness is something new.
"I think this is probably going to be associated with illegal products," former FDA commissioner Dr. Scott Gottlieb told the New York Times. "It’s not like the major manufacturers have suddenly changed their ingredients. It’s probably something new that has been introduced into the market by an illegal manufacturer, either a new flavor or a new way to emulsify T.H.C. that is causing these injuries."
Indeed, early in the investigation, the link between THC-containing products and the illness was hard to miss. Most, although not all, patients reported vaping THC recently or THC along with nicotine-containing products. A much smaller number claimed to only have been vaping nicotine products without the use of THC.
"It is important to note that exposure information is self-reported and sometimes limited by a patient’s recollection or ability and willingness to share information," noted the CDC, which is a diplomatic way of pointing out the fact that it's perfectly possible that ALL the patients stricken by the illness had been vaping THC but, understandably, perhaps not all of them were willing to admit it.
But why, exactly, would a THC vape be causing such extreme symptoms?
"Based on the clinical and laboratory evidence to date, we believe that a chemical exposure is likely associated with these illnesses," said Dana Meaney Delman, the CDC's incident manager stated at a press conference on Friday. In other words, some sort of chemical adulterant that has made its way into the products seems to be to blame.
Dr. Delman stressed that they needed more information to determine the specific products or substances involved, however, she did mention the culprit that a number of investigations at the state level have already zeroed in on: vitamin E acetate.
In fact, on Thursday, the New York State Department of Health issued its own press release stating that "vitamin E acetate is now a key focus of the Department's investigation."
Vitamin E acetate is an oily substance and that right there could prove to be the answer to the puzzle. Having been in the e-juice manufacturing industry for a decade now, we are well aware that inhalation of any kind of oil is just not a good idea. Even small amounts of oil in the lungs can cause lipoid pneumonia, producing symptoms similar to those being described in the media.
And, indeed, Dr. Daniel Fox with WakeMed mentioned lipoid pneumonia at the CDC press conference while reporting on the investigation that has been taking place in North Carolina.
"During the work-up and the history, all the patients that we saw had used or consumed THC through their...e-cigarette. And that seemed to be a common feature... All of our patients underwent evaluation, and after the clinical evaluation we found a certain type of pneumonia that was noninfectious. It’s called lipoid pneumonia. Basically, ...it can occur when either oils or lipid-containing substances enter the lungs," he said.
While the investigation continues and the CDC cautions that all conclusions are only speculative and preliminary, it seems there's a good chance that oil based contaminants are, at least in part, to blame for the illness.
A few recommendations:
Stay safe and happy vaping!
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