Health officials haven’t figured out the cause of the mysterious lung illness that has killed 26 people and infected 1,299 others, but they have settled on a name for it: “EVALI.”
The name, pronounced “EE-volley,” stands for “e-cigarette, or vaping, product use associated lung injury.” It comes not only as the illness shows no sign of abating, but also as officials worry that doctors will mistake EVALI for other serious infections people get around the flu season.
New guidelines released Friday by the Centers for Disease Control and Prevention tell doctors to use steroids, antibiotics, and antivirals, perhaps all at the same time, if it becomes too hard to narrow down what has made patients sick. Symptoms of EVALI, such as trouble breathing and diarrhea, can look like other illnesses.
The CDC advises doctors to ask patients with symptoms about whether they vape, in a “non-judgmental and thorough manner,” and to help them get medications or counseling to kick their nicotine addiction. Doctors should give patients a chest X-ray if they think they might have the vaping illness and should send anyone who has a low blood oxygen level to the hospital. EVALI has caused serious illness that requires intense care in the hospital.
“We are not seeing a meaningful drop-off in new cases,” Dr. Anne Schuchat, CDC principal deputy director, said in a phone call with reporters. Instead, the number of cases has continued to climb, even though officials keep urging people not to vape. Only Alaska hasn’t reported any cases.
Officials also reported that a handful of people who had been discharged from the hospital with EVALI were later readmitted. The readmissions happened within as little as five days to as many as 55 days.
It was not clear whether people took up vaping again when they left the hospital, but officials said they may have been readmitted because of an infection. Many of the people treated for vaping illnesses have been given steroids, which increase the risk of getting viral and bacterial infections.
Scientists are still bewildered about EVALI’s cause. The Food and Drug Administration has been testing hundreds of vaping devices, but they haven’t always been able to see what chemicals could be involved because a lot of the samples they get from patients who got sick no longer have any liquid in them.
“This is an extraordinarily complicated investigation,” said Mitch Zeller, director of the FDA’s Center for Tobacco Products.
Amid the outbreak, health officials have stressed that people should “particularly” avoid vaping THC, the high-causing chemical in marijuana, because most people who have gotten sick have reported using it.
At the same time, officials stress that another part of a vaping device could be responsible because people don’t always know what they’re buying. Many different vaping products are sold on the streets, and there could be something dangerous in the flavors, the cartridges, the oils, or another part of the e-cigarette.
Schuchat said she thought the investigation would find that the illness was attributable to more than one cause, and that it would still take months for them to arrive at an answer.
“I think that there will be multiple causes and potentially more than one root cause,” she said. “I do think the phenomenon we are seeing will have an explanation.”
FDA acting Commissioner Ned Sharpless warned that the agency would not go after people who use the products, but it did intend to go after any bad actors who were knowingly selling illicit, dangerous products on the street for profit.
“We would consider that to be a criminal act,” he said.
