Medical Examiner

What’s Going on With These Mysterious Vaping-Related Illnesses?

There are now more than 450 cases, and no clear explanation of what exactly is to blame. The CDC’s advice to e-cigarette users hits the right note of caution.

Two people wearing mirrored sunglasses and ripping huge vape clouds.
Photo illustration by Slate. Photo by Getty Images Plus.

Stop vaping—that’s the recent message from Milwaukee’s health department and several doctors in response to a mysterious epidemic of lung problems (and worse) that seem tied to e-cigarette use. In July, a patient in Oregon who had used a vape from a cannabis dispensary came down with a “severe respiratory illness” and died. In August, the same thing happened to a patient in Illinois who had been vaping THC (the stuff in pot that makes you high)—he died after a similar bout of illness. The Centers for Disease Control and Prevention has so far identified more than 450 potential cases of a severe, pneumonialike illness that it suspects are associated with vaping, and at least three additional deaths, possibly more. It’s worrisome, yes. But imploring everyone to put down their vapes immediately isn’t really the best way to help. It could even do some harm.

Suddenly landing in the hospital with respiratory illness is far—far—from a typical outcome from vaping. “You have to keep in mind that nicotine has been vaped for years with no such adverse effects being reported,” says Lynn Kozlowski, a professor at the University at Buffalo who studies tobacco use. If there’s something so acutely dangerous about vaping in general, we’d have seen these kinds of deaths before, he points out. It would be a reason to be hyper skeptical of vapes if they “had been on the market for six months, and these things were happening.”

Blaming vaping at large here is kind of like responding to a string of bad car accidents by suggesting that we better all start avoiding all cars in response, rather than considering what specific factors might have contributed to that specific set of crashes. Because what we know so far suggests a more specific problem. While there are potential cases in a number of states, many of the cases appear to be clustered, as medical correspondent Sanjay Gupta points out on CNN. This suggests that the problem might be a contaminant affecting specific local supplies of e-liquids, or a few shipments of vapes themselves. Or maybe, somethings gone wrong with altered vape cartridges—some of the folks who got sick were vaping cannabis or THC, and had bought bootleg products. (This is part of why, if you’ve been using the same vape for a while, and you buy it through a reputable store, you shouldn’t be too worried.)

Yes, that’s all frustratingly vague and speculative. That’s because no one really knows what about the vapes are causing the problems—just that these people all had lung issues and vaping in common. The correlation between vaping and these illnesses is still just that: a correlation, with no proven causal link. The CDC says that current evidence suggests these cases aren’t an infectious illness, and antibiotics have failed to make people better. While this being somehow related to vaping is a good educated guess, it’s still possible the cause will be something else entirely, perhaps another action (possibly one that’s also associated with vaping).

This uncertainty could be cause to hold off on blanket statements that demonize what can be a harm reduction tool for tobacco smokers. The CDC itself is artfully treading this line in a notice on its investigation. Its recommendation is appropriately conservative, but not draconian: It suggests that people who vape should “consider refraining,” or that they should see a doctor if they notice anything unusual. “If you are concerned about these specific health risks, consider not using e-cigarette products,” the CDC notes. The Oregon Health Authority is takes a similar tone: “For people who are currently using one of these products, we certainly want to monitor yourself for symptoms,” Dr. Ann Thomas, a public health physician, said in a statement.

But the story about the illnesses, and the admonishments to stop vaping, has taken off perhaps partly because it fits the narrative that was already spinning about an uptick in vaping among teens, a trend that has caused a bit of moral panic. The recent deaths and illnesses provide a striking addition to the case against e-cigarettes, never mind if they’re unlikely to affect the average vaper. If you’ve been anti-vaping all along, now certainly feels like a good time to remind people of that, and feel incredibly rational. Even with the relatively measured bottom-line recommendations, the CDC and OHA do also take the opportunity to push the messaging that vaping is unhealthy. Which is true: Vaping involves inhaling nicotine, which creates a dependency, as well as a suite of other chemicals besides air—the long term effects of which are still being sorted out. Even Kozlowski, who takes a nuanced view of vaping, notes: “it’s been my view for a long time that if you can go without using nicotine, great, that’s preferable.”

So how scared should you be about this spat of vaping-related sickness? Worry is understandable: after all, even if the number of vapes affected is very limited, it’s still impossible to know for sure which ones are dangerous. If you’re someone who’s been longing for a psychological push to quit nicotine, maybe a little paranoia around these illnesses will be beneficial. And perhaps it will keep some folks from ever taking up nicotine in the first place. But what about people who are, even still, struggling to quit? Even with this news supplementing an already tough list of accusations against e-cigarettes, we shouldn’t ignore the role vaping plays in the lives of many former smokers. In almost all known cases, vaping is still much better for lungs than smoking. “You have to keep in mind, what’s the alternative?,” says Kozlowski. The worst outcome of all the worry about this undefined threat is that people would retreat to something we know is incredibly harmful: cigarettes.