The Centers for Disease Control and Prevention, concerned about the health of Americans following over 450 cases of mysterious lung illnesses linked to vaping, which has led to three deaths so far, is urging people to stop vaping until a full investigation is conducted.
“While this investigation is ongoing, people should consider not using e-cigarette products. People who do use e-cigarette products should monitor themselves for symptoms (e.g., cough, shortness of breath, chest pain, nausea, vomiting, abdominal pain, fever) and promptly seek medical attention for any health concerns,” the CDC said. “Regardless of the ongoing investigation, people who use e-cigarette products should not buy these products off the street and should not modify e-cigarette products or add any substances that are not intended by the manufacturer. E-cigarette products should never be used by youth, young adults, pregnant women, or adults who do not currently use tobacco products.”
According to a statement from Indiana’s health department on Friday, a third reported death was a resident of the state. The department said the death, of an individual older than 18 years, was confirmed Thursday.
The Wall Street Journal reported that a fourth person who died was an elderly person in Minnesota, according to that state’s health department. It said the person, who had a history of lung disease, was hospitalized with a severe lung injury associated with vaping an illegal marijuana-related product and died last month after developing other conditions.
It has been estimated that 13.8 million people in the U.S. were users of nicotine e-cigarette as of June, according to Marlboro maker Altria Group Inc. The company estimated that more than seven million now use e-cigarettes exclusively.
The V.I. Department of Health said this week that the illnesses associated with vaping had arrived in the territory. “There is also a growing number of cases in the Virgin Islands that are being investigated,” disclosed Dr. Esther Ellis, epidemiologist for D.O.H.
The CDC said initial findings point to clinical similarities among those affected. Patients report similar exposures, symptoms and clinical findings and these align with the CDC health advisory released last week. While many of the patients, but not all, reported recent use of THC-containing products, some reported using both THC- and nicotine-containing products. A smaller group reported using nicotine only.
No evidence of infectious diseases has been identified in these patients, therefore lung illnesses are likely associated with a chemical exposure, the CDC said. However, it is too early to pinpoint a single product or substance common to all cases, according to authors of articles published today in the CDC’s Morbidity and Mortality Weekly Report (MMWR) and the New England Journal of Medicine.
“We are committed to finding out what is making people sick,” said Robert R. Redfield, MD, director of the Centers for Disease Control and Prevention. “All available information is being carefully analyzed, and these initial findings are helping us narrow the focus of our investigation and get us closer to the answers needed to save lives.”
CDC, FDA, and state partners are combining information about e-cigarette exposures, results from FDA testing of product samples, and clinical testing results to identify a cause or causes of these illnesses.
“The FDA appreciates the continued collaboration between our federal and state public health partners to get to the bottom of these distressing incidents and gather more information about any products or substances used. We are leaving no stone unturned in following any potential leads and we’re committed to taking appropriate actions as the facts emerge,” said Acting FDA Commissioner Ned Sharpless, M.D. “Our laboratory is working closely with our federal and state partners to identify the products or substances that may be causing the illnesses and have received more than 120 samples from the states so far. The FDA is analyzing these for a broad range of chemicals but no one substance, including Vitamin E acetate, has been identified in all of the samples tested. Importantly, identifying any compounds present in the samples will be one piece of the puzzle but won’t necessarily answer questions about causality, which makes our ongoing work critical.”
CDC said it launched a multi-state investigation into the lung illnesses on August 1, 2019, and has worked closely since then with FDA, states and other public health partners, and clinicians to determine the cause. As of today, more than 25 states have reported possible cases of lung illnesses associated with use of e-cigarette products (e.g., devices, liquids, refill pods, and cartridges).
Richard Evangelista, commissioner of D.L.C.A., informed the public that “Operation Fake Green”, “a joint effort between D.L.C.A and D.O.H.,” was initiated on Thursday. According to V.I. environmentalists, after receiving information from D.O.H.’s epidemiology department about possibly tainted vaping products that were possibly manufactured in China and contained contaminants, the environmental health department moved forward with implementing the operation.
A task force comprised of officials from the V.I. Taxicab Commission, the V.I. Fire Service, the V.I. Department of Planning and Natural Resources, and the V.I. Department of Justice accompanied D.L.C.A. enforcement officers and D.O.H. environmental health officers to various retail stores in both districts to confiscate counterfeit vaping products.
Retail stores, wholesale warehouses, and vape shops across the territory were inspected and as of Thursday, the task force had removed approximately 5,000 questionable vaping products from store shelves and warehouses. Approximately 4,000 of the apparatuses were confiscated on St. Thomas and approximately 1,000 on St. Croix. Of the 5,000 products confiscated, it has been confirmed by V.I. environmentalists that 95-98 percent are tainted.
Ms. Ellis explained that it is difficult to tell the counterfeit from the real product, and the only way to properly identify the fake product is to remove the cartridge from the box. “The regulated product is clear, and the counterfeit product is yellow,” she said giving an example. The color yellow does not represent all counterfeit products, Ms. Ellis clarified this morning.
“Anyone who uses e-cigarette products should not buy these products off the street (e.g., e-cigarette products with THC, other cannabinoids) and should not modify e-cigarette products or add any substances to these products that are not intended by the manufacturer,” CDC officials said Friday. E-cigarettes can contain harmful or potentially harmful substances, including nicotine, heavy metals (e.g. lead), volatile organic compounds and cancer-causing chemicals. Some e-cigarette products are used to deliver illicit substances and may be acquired from unknown or unauthorized sources.