Vaping mystery creates cloud of concern

A worldwide call to end vaping has left an entire population of consumers waiting for answers.

Health officials have been unable to provide them so far.

To date, 530 people nationwide have developed vape-related lung illnesses, killing eight. The Centers for Disease Control and Prevention is investigating the root of the outbreak but has not pinpointed a cause. The agency can say with certainty only that the number of deaths is likely to rise.

The Food and Drug Administration, meanwhile, has opened a criminal probe to determine whether illegally produced vape juice containing cannabis-derived ingredients might be the missing link that connects the patients.

The Idaho Department of Health and Welfare reports four state residents between the ages of 15 and 30 have been hospitalized because of vaping-related illnesses. North Idaho, so far, has been spared: Panhandle Health Public Information Officer Katherine Hoyer confirmed no reported cases of vaping-related illnesses. But, as Hoyer warned, the unknown is no reprieve from danger.

“Vaping and e-cigarettes really have not been around long enough for us to know what the long-term effects are going to be,” she said. “There is absolutely no safe level of use for youth.”

Hoyer’s mention of youth comes as the New England Journal of Medicine released the results of a survey last week reporting one in nine high school seniors vape nicotine on a near-daily basis. A quarter of high school seniors said they had vaped within the previous month, up from 20% last year. A fifth of 10th graders and 9% of eighth-graders reported vaping within the last year.

The Coeur d’Alene School District “is deeply concerned about the rise in use of e-cigarettes and vaping devices, particularly among teenagers,” Communications Director Scott Maben said. “Given the number of reported cases of pulmonary illness among users of these products, and the associated CDC investigation, we encourage families to talk with their children about the risks of using vaping devices and electronic cigarettes.”

Across the country, states are racing to pass anti-vaping legislation that would curtail the distribution of certain flavors of vape juice, such as cotton candy, bubble gum and strawberry. Regulators contend e-cigarette manufacturers are targeting young people through marketing campaigns and flavors directed specifically to children. Other countries with stricter regulations have not seen vaping-related illnesses develop in nearly the same numbers. India — the second-largest new market for e-cigarette and vaping manufacturers, with 1.2 billion potential new customers — banned use of the products Wednesday.

Like Hoyer, Maben said there simply wasn’t enough information to take informed steps.

“I’m not aware of any data we have that tracks how many of our students use or have used a vaping device in our district,” Maben said. “Anecdotally, we have seen a rise in use, especially in our high schools...There has been an inverse correlation between vaping and smoking, based on national trends. As tobacco use has decreased, vaping has increased.”

The Idaho Department of Education conducts a risk-behavior survey which asks, among other topics, vaping-related questions. The most recent survey results, however, are from 2017.

“Young users may think vaping is harmless and nothing at all like smoking cigarettes,” Maben said. “But the products often contain a lot of nicotine, as well as other harmful substances that users are unaware of.”

CDC officials suspect some of those substances — THC, CBD and the chemicals used to cut or extract them — might be the cause of the outbreak, though no specific substance, product or brand has been consistent among those who became sickened.

“Anyone who uses e-cigarettes or vapes should not buy products off the street,” Hoyer said, “such as THC or other cannabinoids [from the marijuana plant]. And they should not modify their device. They should not add any products that were not intended by the manufacturer.”

Maben stressed that, aside from the health risks, district policy prohibits the use of e-cigarettes and vaping products on school property. Idaho law dictates anyone under the age of 18 can be cited by law enforcement as a minor in possession. “The manufacturers of vaping devices have made them ever-smaller and easier to conceal,” he said, “which has made it easier for students to use them undetected in bathrooms, hallways and even classrooms. They can exhale the vapor into hoodies or sleeves, or just hold it in for a few seconds until the vapor dissipates. Newer devices produce smaller vapor clouds or no vapor at all. A few years back, these devices would make some noise when being operated. Now they are virtually silent.”

Niki Forbing-Orr of the Idaho Department of Health and Welfare said the safest course of action is to — at least temporarily — abandon the product.

“Our two main goals at the Department of Health and Welfare are to reduce risk and stop disease,” Forbing-Orr said. “The best thing you can do to protect yourself right now is to stop vaping altogether.”

The CDC has issued warnings to health districts and schools, indicating what symptoms and substances consumers should be aware of. The agency is also asking people who develop the illness to track exactly which substances, products, manufacturers and cartridges or pods were used.

The speed of the outbreak is giving health professionals reason for concern, as well. Three weeks ago, 215 people reported vape-related pulmonary illness. Today, the count of 530 is a number experts believe will only rise. Since Wednesday, the number of Idaho patients doubled.

Hoyer said the disease presents differently, depending on the patient, but that many patients afflicted in this outbreak reported coughing, shortness of breath, chest pain, nausea, vomiting, diarrhea, fatigue, fever or abdominal pain, often in one combination or another.

Development of the disease ranges anywhere from two days from inhaling to several weeks. Three quarters of those afflicted are male, according to the CDC. Two thirds are between the ages of 18 and 34.

“One of the frightening things about this is, this [outbreak] is happening in otherwise-healthy adults. It’s happening to young adults,” Forbing-Orr warned. “It’s happening to people who shouldn’t be sick.”