As people continue to debate the causes of an acute lung illness linked to vaping—and the actions needed to stop it—victims are still dying. On Monday, health officials in Tulare County, California reported that a resident died after developing lung injuries linked to vaping. The death marks the seventh similar fatality reported as of now, among hundreds more cases documented across half the country.
According to Tulare County officials, the person died over the weekend, following weeks of medical care for their condition, now known as vaping-associated pulmonary injury or VAPI. The person’s identity was not disclosed, though it is known they were over 40 and that they had other underlying health complications.
“With sadness, we report that there has been a death of a Tulare County resident suspected to be related to severe pulmonary injury associated with vaping,” said Karen Haught, Tulare County public health officer, said in a statement released Monday evening.
The county has so far documented three local cases of VAPI, while California as a whole has reported 73 suspected cases, according to the California Department of Public Health. The Centers for Disease Control, as of last week, said there have been 380 cases of VAPI reported nationally from 36 states and one territory (a higher earlier estimate included possible cases that were under investigation). Kansas, Illinois, Indiana, Minnesota, and Oregon have also reported deaths, but California is the first state with more than one death.
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People with VAPI have experienced symptoms including cough, shortness of breath, and chest pain, as well as less common symptoms such as nausea and vomiting. All had a recent history of vaping. Most have said they used products containing THC or cannabis, such as concentrated THC-rich waxes and oils, often purchased through the black market.
Despite this common link between many victims, health officials have been reluctant to assign blame to one specific cause. In Haught’s statement Monday, for instance, she warned that “any use of e-cigarettes poses a possible risk to the health of the lungs and can potentially cause severe lung injury that may even lead to death.”
Some of this skepticism is perhaps warranted. Many of the victims have self-reported using both nicotine and THC products, while about one-fifth have reported using only nicotine. And though some states have linked the use of one particular substance—a synthetic, greasy form of vitamin E likely capable of causing pneumonia when inhaled—to nearly all cases in their area, no consistent link to any one chemical or product has emerged nationally, according to the CDC. In the Oregon death, the victim is thought to have used THC oil purchased from a legal vape shop, rather than off the black market.
But critics have pointed out that victims whose symptoms have only been linked to nicotine may be reluctant to admit their use of THC, particularly if they’re underage or live in states where recreational cannabis is still illegal. Some public health experts have also criticized the CDC and other health agencies for unnecessarily scaring e-cigarette users by not being more clear about the link between illicit THC products and VAPI. Anecdotally, some users have said they’re switching back to tobacco cigarettes—an almost certainly worse option for staying lung-healthy over the long term.
In response to these cases, as well as growing rates of teen vaping, the federal government has recently proposed a ban on legally sold flavored e-cigarettes, following the lead of several states and cities that have passed or are contemplating their own restrictions. Some experts and doctors have similarly criticized the proposal as useless for actually preventing future cases of VAPI, saying it’s more likely to push users into buying black market e-cigarette products—the very products thought to be more dangerous.
The CDC, for its part, has effectively declared these cases a public health emergency. This week, it activated its emergency operations center—last implemented during Hurricane Florence in 2018—to manage its response and coordinate with doctors and health agencies.