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Approximately 12 million Americans use e-cigarettes or vaping devices. These tools convert liquid, frequently flavored or laced with nicotine, into an inhalable aerosol. In 2019, a severe lung disease outbreak was linked to this smoking alternative. Across all states except Alaska, more than 2,000 individuals fell seriously ill, and nearly 40 lost their lives. The illness causes alarming damage, yet despite extensive efforts, health authorities are still grappling with identifying its causes and sudden emergence.
7. The Initial Case
The earliest instances of this condition trace back to April. However, it wasn’t until June 11 that medical professionals recognized they were facing an unidentified ailment. On that day, a teenager was admitted to the Children’s Hospital of Wisconsin, presenting symptoms like breathing difficulties, fever, and significant weight loss.
Initially, the medical team suspected a lung infection. Given the teenager’s active lifestyle as a BMX biker, it seemed plausible that he had inhaled harmful particles outdoors, irritating his airways. There was also a slight possibility of a rare form of pneumonia. However, tests ruled out these assumptions. After multiple scans and a surgical procedure, it became clear that his lungs were not infected. Instead, the evidence pointed to the inhalation of a toxic substance that caused physical harm.
Within a month, three more teenagers arrived at the same hospital exhibiting symptoms similar to the biker’s, such as coughing, exhaustion, breathing difficulties, diarrhea, and vomiting. Like the initial case, their airways were inflamed and bleeding. The mysterious lung disease deeply concerned doctors, particularly when three out of the four patients required intensive care.
While searching for a link between the boys, doctors discovered no commonalities except one—they all used vaping devices. This was puzzling, as vaping had been popular for years. If this trendy smoking alternative was to blame, why were users only now falling ill? No clear answers emerged. The only certainty was that the condition, temporarily named EVALI, was a deadly, non-contagious outbreak. Even more troubling, it was entirely unprecedented.
6. Lungs Resembling Gas Attack Victims
The Mayo Clinic uncovered a shocking revelation. Like many other medical institutions, their experts were urgently investigating the cause of the vaping-related illness. In a groundbreaking study, their team analyzed lung biopsies from 17 patients, some of whom had already passed away.
They anticipated finding damage linked to vaping liquids, possibly in the form of harmful fatty deposits in the lungs. Instead, they encountered a chilling and familiar sight. The lungs displayed severe chemical burns and scarring, resembling those of individuals exposed to a gas attack. The similarities between the lungs of vaping patients and victims of toxic chemical exposure were striking and undeniable.
While the Mayo Clinic experts couldn’t pinpoint the exact cause, they uncovered strong evidence suggesting that vaping was highly toxic. Potential dangers included contaminants, an unidentified but deadly byproduct, or the vaping liquid itself. Given the vast number of users, the team labeled the situation a “public health crisis” and published their findings.
5. The Connection to Marijuana
When confronting a global health threat, the Centers for Disease Control and Prevention (CDC) takes the lead. Months after the outbreak began, initial reports pointed to marijuana—not the plant itself, but THC-containing vaping products. THC is the psychoactive compound in cannabis responsible for inducing a high.
In recent years, THC’s reputation has improved, even finding a place in the health industry. However, the concerns weren’t driven by paranoia or anti-marijuana sentiment. They were based on scientific evidence. For example, 12 of the 17 patients whose biopsies were studied by the Mayo Clinic had a history of vaping cannabis oil or marijuana.
When the CDC analyzed the data and interviewed patients, the link became clearer. Approximately 85% of individuals admitted to using THC-containing vaping cartridges. Some even acknowledged purchasing these products from the black market. This was significant, as illegal THC vaping products had already been flagged for potential health risks. Notably, most fatalities linked to vaping involved individuals who had used THC-based products.
While marijuana appears to be a prime suspect, there’s no definitive proof that THC is the direct cause of the lung disease. Researchers have yet to uncover the precise mechanism that connects vaping cannabis oil to the onset of illness.
Related: Top 10 Scary Facts And Stories About Marijuana
4. A Harmful Ingredient
After the cannabis connection emerged, the CDC made a significant discovery. THC might not be the culprit after all. Instead, the danger could stem from an additive mixed with THC—vitamin E acetate. This substance is sometimes used in vaping liquids to dilute THC and fill cartridges.
Vitamin E acetate is commonly found in skincare products and as an antioxidant in perfumes. It’s also available as a dietary supplement. While safe when applied topically or ingested, inhaling this sticky substance is hazardous. Unsurprisingly, investigations by the CDC and FDA revealed vitamin E acetate in nearly all lung samples and vaping products from affected patients. The majority of this problematic oil was detected in THC-based and black-market vaping products.
While a honey-like substance clinging to the inside of an e-cigarette is acceptable, discovering the same sticky residue in human lungs is deeply troubling. However, it also offered a glimmer of hope. Researchers confirmed that the acetate found in the lungs could replicate the respiratory symptoms associated with EVALI.
Identifying the toxin marked a significant breakthrough, and its alignment with symptoms was nearly perfect. However, this was merely a step forward, not a solution. The discovery left major questions unanswered. If vitamin E oil is the cause, it remains unclear how it triggers the disease or why the issue only emerged in April 2019.
3. Global Resistance
After the deaths in the US, several countries grew wary of e-cigarettes. Singapore and India imposed bans, while Japan permitted vaping but prohibited nicotine-containing e-liquids. China announced plans to strictly regulate the practice. If China enacts a ban, it would deal a significant blow to the industry, as a third of the world’s smokers reside there.
India’s comprehensive ban on the production, trade, sale, and storage of vaping products eliminated a massive market of 1.3 billion potential users. Despite claims that vaping aids smoking cessation, India rejected the notion, joining critics and many US states in arguing that flavored liquids are enticing more children to start smoking.
India enforces its anti-vaping laws so strictly that violators face up to a year in prison. This includes advertising vaping products or even handing someone a vaping device. The global shift away from vaping is a setback for tobacco companies that invested billions in the technology to offset declining cigarette sales. Interestingly, vaping advocates accuse India of imposing the ban to safeguard its tobacco industry rather than public health. As one of the world’s largest tobacco producers, the country risks losing thousands of jobs and a significant revenue source if vaping overtakes traditional cigarettes.
2. Britain’s First Fatality
Professor Stanton Glantz, director of the Centre for Tobacco Research Control & Education in San Francisco, is a vocal opponent of smoking-related public health risks. He played a key role in uncovering 90 million pages of confidential tobacco industry documents.
Glantz criticizes Britain’s stance on vaping, particularly Public Health England’s belief that the illness is an American issue. PHE argues that Britain is safe because it banned vitamin E acetate. However, Glantz notes that the chemical hasn’t been definitively identified as the cause. Even the CDC and FDA acknowledge that some patients fell ill without using cannabis oils or products containing significant amounts of vitamin E oil. A larger issue remains unresolved.
PHE appears to overlook the broader problem. Cases have emerged in multiple countries, including Britain, where incidents predated the US outbreak. A year ago, doctors in Birmingham treated a young woman with symptoms now linked to vaping. Unaware of the impending 2019 crisis, they suspected her vaping habit was the source of the fatty lipids found in her lungs.
Even more concerning, Britain recorded the first vaping-related death nine years before the US crisis. Despite this, Public Health England (PHE) continues to promote e-cigarettes as a smoking cessation tool. Terry Miller (57) followed this advice in 2010, only to suffer from lung damage caused by vaping oil. His autopsy report highlighted the dangers, stating, “It was believed he developed lipoid pneumonia from inhaling oil-blended concentrated nicotine through the device.”
1. The Mysterious Factor X
Addressing the outbreak isn’t as straightforward as eliminating vitamin E oil from vaping products. Health experts acknowledge that the illness may stem from multiple factors rather than a single cause. Even the heating mechanisms in vaping devices remain under suspicion. For instance, a Pennsylvania study revealed that harmless oils like vegetable glycerin and propylene glycol can become toxic when vaporized—both of which are common base oils in vaping cartridges.
The unsettling reality is that the vaping industry remains largely unregulated, operating in a Wild West-like environment. With hundreds of chemicals in these products, many could contribute to the disease. The sheer number of unidentified ingredients makes it nearly impossible to distinguish safe vaping products from potentially dangerous ones.
Online videos exacerbate the problem. A growing number of DIY tutorials teach users how to modify vaping devices with substances they weren’t designed to handle. This trend adds unnecessary complexity for investigators, who must now analyze an ever-expanding list of substances. The FDA is already scrutinizing over 900 products and devices while systematically investigating the black market supply chain.
In addition to unidentified additives and reckless online tutorials, another significant challenge is the lack of comprehensive patient histories. Currently, one of the most effective methods to understand the disease involves documenting the substances each patient vaped and the duration of their usage. Unfortunately, those who have passed away—potentially the most informative cases—can no longer provide details about their vaping habits.
