To date, 18 people have died, and there have been 1,080 reported illnesses.

“At the moment there has not been a clear common substance,” Calvert County Health Office Dr. Lawrence Polsky said. “I think it is likely there is either a solvent or additive or maybe two or more substances or additives are showing up in higher concentrations in some non-commercially produced batches of the juice or the liquid that people vape.”

Polsky questions whether these additives are in name brand products or in them in a higher concentration, with the latter being his biggest worry.

“If what we are seeing are higher concentrations of additives that are in commercial products, what we might be seeing is the acceleration of a disease process that may have taken years or decades to show up in a matter of years or months,” Polsky said.

Polsky said the vape industry is complex and fast moving, and there have been minimal regulations on the part of the FDA.

“The evidence that the CDC show to this point is that there is a high percentage of people that have become severely ill or died there was THC in the product that they were vaping,” Polsky said, noting some were vaping a combination of THC and nicotine.

However, Polsky said a quarter of the events have not involved THC.

Polsky said they are many complicating factors in the CDC investigation to include that people do not consistently vape the same products exclusively, vaping multiple brands. “We know that there are people that brew their own batches of vape juice — there’s no way to know what’s going into that,” Polsky said.

Polsky said over 80% of users of flavor vapors are under the age of 21 and points to a recently released CDC report that over 3 million middle schoolers and high schoolers used flavored vaping products in the last 30 days.

“This is far from a trivial impact on the health of adolescents and young adults,” Polsky said.

Polsky has been actively working to reduce tobacco consumption in state’s young adults and served as the legislative chair of the Maryland Association of County Health Officers. He worked with state lawmakers to rally support around two companion bills to raise the minimum age to 21 for an individual to purchase tobacco products in the state, which went into effect last week.

“There are adults who are established smokers, trying to switch off of tobacco use for something that may be less harmful for them. Less than 20% of the people that used flavored vaping products fit into that category,” Polsky said.

For established smokers, Polsky said, “the flavors are not necessary to help the transition.”

Polsky also said there is no clear evidence that vaping products are safer.

“Given the severe illnesses that we have seen, every additional chemical, which includes flavoring, is potentially going to increase each person’s health hazards, Polsky said.

He recommends that established smokers vape a non-flavored product with the smallest amount of nicotine.

“For cereals and candies — things that were meant to be ingested in your stomach, those were never intended to be aerosolized,” Polsky said concerned for long-term effects.

For those who are truly trying to quit Polsky recommends going with products like nicotine patches, gums and prescription medicines.

Polsky does acknowledge there are people trying to improve their health by doing something that appears to be less of a risk to them and that their needs should not be ignored.