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Vaping-related illnesses look suspiciously like pneumonia, so much so that hundreds of patients were misdiagnosed.

But why all the sudden cases?

Alarm bells went off and the doctors started talking to each other. That's How Doctors Uncovered the Vaping Crisis.

Health authorities now count 530 confirmed and probable cases of the vaping-related illness across 38 states and one U.S. territory. Eight people have died, the authorities say, the latest in Missouri.

The Centers for Disease Control and Prevention and the Food and Drug Administration are probing what causes the illness and which chemicals and devices were used by patients. The FDA is conducting a criminal probe. The CDC, along with doctors and state and local health officials, have urged vapers to stop, or at least stay away from vaporizers, cartridges and liquids sold on the street.

“Once you see the connection, you can’t unsee it,” said Frank Leone, a pulmonologist at Penn Medicine. “The assumptions that would have guided care a month ago no longer do.

Patients suffer from shortness of breath, coughing and chest pain, and some also experience gastrointestinal issues, fever and weight loss. Most chest X-rays or CT scans show hazy, white opaque areas in the lungs, but there’s typically no infection. Almost all patients are hospitalized, and many require help breathing.

Symptoms and Usage

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Misdiagnosis

When patients showed up with halting breaths and chest pain, doctors and nurses commonly diagnosed pneumonia, a condition they saw often.

“They’re similar to other lung diseases,” said Meghan Fitzpatrick, a pulmonologist at the University of Pittsburgh Medical Center East. “Until late summer, this wasn’t an entity that was on our radar.”

Federal Regulation

On August 8, 2016, the US Food and Drug Administration (FDA) regulated electronic cigarettes products as tobacco products and banned sales to minors. The FDA classifies e-cigarettes as drug delivery devices and subject to regulation under the Food, Drug, and Cosmetic Act (FDCA). The Trump administration is working on plans to ban e-cigarette liquid flavors.

State Regulation

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13 states, 2 territories, and 841 municipalities have outlawed vaping in smoke-free public areas, as of April 2019. High schools and some middle schools throughout the US have been revising their tobacco rules to ban vaping on school grounds.

Trump Moves to Ban Flavored Vaping Products

On September 11, Trump Moved to Ban Flavored Vaping Products to Discourage Young People from E-Cigarettes

Michigan, New York Outlaw Vape Flavors

On September 18, the Chicago Tribune reported Michigan joins New York in outlawing vape flavors. Overseas, India prohibits all e-cigs, while Juul sales are halted in China.

Walmart Bans E-Cigarettes

The Rolling Stone reports Walmart Bans E-Cigarettes

In the midst of a nationwide vaping-related illness epidemic that has resulted in at least eight deaths, Walmart has decided not to stop selling e-cigarettes, the company announced Friday.

While the cause of the vaping-related epidemic is unknown, some of the cases have involved black-market THC cartridges cut with vitamin E acetate, a substance most often used in skin cream that is extremely toxic if inhaled. Black-market THC vape cartridge manufacturers have been known to add vitamin E acetate as a thickening agent to vaping fluid, and three companies that sell such agents have been subpoenaed by the New York State Health Department.

In a call with reporters, Mitch Zeller, director of the Food and Drug Administration’s Center for Tobacco Products, denied that vitamin E acetate was the sole culprit behind the epidemic. “There’s no one compound, ingredient, constituent, including Vitamin E acetate that is showing up in all of the samples tested, and I’ll just need to leave it at that more general level,” he said on Thursday.

States like Michigan and New York have passed legislation banning the sale of flavored e-cigarettes, with Governor Andrew Cuomo banning the sale of most flavored e-cigarettes on Monday. President Donald Trump has also indicated that his administration was mulling a nationwide flavored e-cigarette ban. “We can’t allow people to get sick. And we can’t have our kids be so affected,” he told reporters last week.

Questions Linger

Will banning vape flavors lead to less vaping or further complications from illicit manufacturers?

I suspect we will soon find out.

Mike "Mish" Shedlock