By Shirin Ali
Medill Reports

Some 2,602 hospitalizations and 57 deaths nationwide are now associated with e-cigarettes and vaping since the outbreak began in summer 2019, reported the Centers for Disease Control and Prevention earlier this month in a status update.

The CDC also revealed Illinois has some of the highest concentration of e-cigarette and vaping associated lung injury (EVALI) hospitalization rates in the country. The Illinois Department of Public Health estimates over 30 counties across Illinois have reported cases of EVALI, with the most recent count at 214 cases and five deaths.

The American Lung Association started working with Illinois law makers this month to include e-cigarettes in a modified Smoke Free Illinois Act. This would ban the use of e-cigarettes and vaping in public spaces, similar to the restriction required for traditional cigarettes.

“Getting e-cigarettes added to the smoke-free Illinois law is one of the American Lung Association’s big priorities in the spring session,” said Jill Thompson, an association division manager. at the American Lung Association.

As the CDC continues to monitor EVALI cases nationwide, many different substances and product sources are under federal investigation. The CDC recommends consumers stop using all e-cigarette or vaping products, and that anyone who continues to use an e-cigarette or vaping product should carefully monitor themselves for EVALI symptoms and see a healthcare provider immediately if they develop symptoms as outlined by the CDC.

According to the CDC, e-cigarettes have been in the U.S. marketplace since the mid-2000’s and by 2007, consumption was rapidly growing. It wasn’t until summer of 2019 that an outbreak of severe lung impairment and deaths occurred and a surge in hospitalizations due to e-cigarette and vaping use. By September 2019, hospitalizations due to EVALI hit a national high. Though hospitalizations have since declined, the number of EVALI causes has yet to return to pre-outbreak levels.

The severity of EVALI cases can vary, with symptoms ranging from shortness of breath, dizziness and nausea to more severe reactions mimicking chemical burns of the lungs.

“It seems like there are a lot of different patterns of injury that we’re seeing in individuals who have this condition. The way that people present, how severe it is, is more typical of the fact that all of us humans are unique individuals and we respond differently to different insults to our bodies,” said Dr. Mark Yoder, associate professor of medicine and section chief of pulmonary medicine at Rush University Medical Center.

What causes EVALI is still unclear, with the CDC blaming vitamin E acetate as an ingredient associated with this vaping-related illness. Federal investigators haven’t identified other specific causes. Vitamin E acetate is found in meat, fruits and vegetables and can be taken as a dietary supplement. Ingesting vitamin E acetate as a supplement usually does not cause harm, but according to the CDC, when inhaled it may interfere with normal lung function.

E-cigarettes have been marketed as a safer alternative to smoking traditional tobacco cigarettes and as a way to ease out of smoking. But the CDC acknowledges there is still too much unknown about this relatively new method of smoking. In September 2019, Ned Sharpless, acting commissioner of the CDC, issued a statement acknowledging the lack of information surrounding how e-cigarettes can affect a person’s body.

“We do not yet know how dangerous these products are when used over the long term; we do not know if they are truly effective at helping addicted adults quit smoking traditional cigarettes; we do not know what to what extend they can serve as a ‘gateway’ to the use of combustible cigarettes,” Sharpless said.

The lack of real data on the effects of using e-cigarettes is also fueling confusion for how medical professionals should treat the illness.

“Some people will get better. Just putting them on a ventilator, letting their lungs rest, (they) heal from it and they’ll get better, said Dr. Maria Mithaiwala, emergency medicine physician and graduate of Lake Erie College of Osteopathic Medicine in Bradenton, Florida. “But some people die from it. Depending how severe the damage is,”

Thompson explained that the lack of research on e-cigarettes and vaping creates a dangerous gray area for consumers. “E-cigarettes are not an FDA-approved method for quitting smoking,” she said. “We always follow the guidance of the FDA and we only recommend FDA-approved quit smoking methods, like nicotine patch and like the nicotine gum.”

Another misconception about e-cigarettes and vaping is that the lack of smoke creates less harmful secondhand smoke. However,  U.S. Surgeon General Jerome Adams warns that e-cigarette aerosols can contain nicotine and other volatile compounds. Children are particularly vulnerable to these chemicals because of their developing lungs and nicotine is known to be harmful to adolescent brain development.

“E-cigarettes are fairly new to the market; they’ve only been around for about 10 years. In terms of science and testing, that’s not a long time. We don’t have enough research to know exactly what it can do to lung health,” Thompson said.