Medical experts and federal health officials on Friday warned the public about the dangers of vaping and discouraged using the devices as the number of people with a severe lung illness linked to vaping has more than doubled to 450 possible cases in 33 states. The number of deaths linked to vaping rose to four from two on Friday.
The Indiana Department of Health announced the third death, and hours later, officials in Minnesota confirmed that a fourth person had died. The Los Angeles County Department of Public Health said Friday that it was investigating a possible fifth death, saying that the fatality was "associated with the use of e-cigarettes."
"There is clearly an epidemic that begs for an urgent response," Dr. David Christiani of the Harvard T.H. Chan School of Public Health wrote in an editorial published Friday afternoon in The New England Journal of Medicine.
The editorial called on doctors to discourage their patients from using electronic cigarettes and for a broader effort to increase public awareness about "the harmful effects of vaping."
Officials from the Centers for Disease Control and Prevention echoed that call in a briefing.
"While this investigation is ongoing, people should consider not using e-cigarette products," said Dr. Dana Meaney-Delman, who is leading the CDC's investigation into the illness.
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The recent rise of acute lung illnesses linked to vaping has deepened concerns about the safety of the devices. E-cigarettes were intended to help smokers quit traditional cigarettes by providing a way to satisfy an addiction to nicotine without the deadly toxins that come from burning tobacco.
But in 2018, vaping among American teenagers increased and large numbers of young people who had never smoked started using e-cigarettes. They were especially attracted to sleek devices made and marketed by Juul Labs, which now dominates the market. A 2018 survey sponsored by the federal government found that 21% of high school seniors had vaped within the previous 30 days, compared with 11% a year earlier.
Now young people are being sickened by the new wave of lung illnesses. CDC officials said they believe that some "chemical" is involved as the cause, but they have not identified a single responsible "device, product or substance," Meaney-Delman said.
Christiani wrote in The New England Journal editorial that it was not yet clear which substances were causing the damage. E-cigarette fluids alone contain "at least six groups of potentially toxic compounds," he wrote, but he noted that many of the patients had also vaped substances extracted from marijuana or hemp. The mixed-up stew of chemicals might even create new toxins, Christiani suggested. The journal also published a study of two clusters of 53 cases in Wisconsin and Illinois.
The first case of the mysterious lung illness, in Illinois, came in April, indicating that the syndrome emerged earlier than the mid-June date that federal officials have often cited as the time the afflictions began.
The patients studied in Illinois and Wisconsin were typically "healthy, young, with a median age of 19 years, and a majority have been men," said Dr. Jennifer Layden, chief medical officer and state epidemiologist for the Illinois Department of Public Health. A third were younger than 18.
The journal article about the Illinois and Wisconsin patients said that 98% were hospitalized, half required admission to the intensive care unit, and a third had so much trouble breathing that they needed to be placed on ventilators.
Indiana on Friday confirmed a third death from a severe lung illness linked to vaping. A short time later, officials in Minnesota confirmed a fourth. The patient, who was 65, had a history of lung disease, but state officials said his acute lung injury was linked to "vaping illicit THC products."
Two other people -- one in Illinois, the other in Oregon, both of whom were adults -- have died from what appears to be the same type of illness, health officials in those states have said.
Patients typically have showed up in emergency rooms with shortness of breath after several days of flulike symptoms, including high fever.
In a severe case in Utah, a 21-year-old man had such serious lung damage that even a ventilator could not provide enough breathing help. Doctors had to connect him to a machine that pumped oxygen directly into his bloodstream to keep him alive.
"We were flying in the dark with this kid," said Dr. Sean Callahan, a pulmonologist and critical care specialist at the University of Utah, and an author of a letter about six vaping patients in Utah that was published Friday in The New England Journal of Medicine.
"I thought he was going to die," Callahan said. "I kept thinking, his parents were there, if this were me and my wife, how crushed we would be for something that is completely avoidable. I worry that these products are really geared toward young people and kids, and we need a call to ban these things. That's my call to action as a father and a doctor."
A Section on 09/07/2019