associated press File

A man smokes an electronic cigarette in Chicago. One person in Illiniois has died from a vaping-related illness; 193 people across the country have been sickened. Virginia has recorded three confirmed cases.

It’s official.

Now we know: Vaping illnesses have struck in Virginia.

In Illinois, one person has died.

In just this month and last, 193 people across 22 states reported vaping-related maladies. The symptoms included cough, shortness of breath and fatigue, and occasionally gastrointestinal illness, including vomiting and diarrhea. Antibiotics were not effective, but steroid therapies did help some people.

Authorities have long warned that vaping poses hidden hazards. But who listened?

The dangers are exacerbated by several factors. Vaping has been marketed as a safer alternative to traditional tobacco use. More than that, it has been marketed through gimmicks — such as candy flavors — that make it appear innocent, even almost wholesome. Young vapers have been drawn in by the fiction that they’re serving their bodies well by avoiding the lure of tobacco.

But because vapes — also known as e-cigarettes — contain nicotine and because they are easy and even enjoyable to use, vapers may indulge so often that they actually inhale more nicotine than if they were to smoke conventional cigarettes. Meanwhile, some medical authorities also worry that they might prove to be a gateway to cigarette smoking.

Nicotine — whether it comes from conventional cigarettes, chewing tobacco, or vaping — is especially harmful to young brains. The Centers for Disease Control warns that nicotine can become addictive, and that addiction alters brain development. That’s why a device that makes it easy to ingest nicotine, early and often, is so alarming to medical experts.

And now that marijuana is becoming more mainstream, some vapes also deliver THC, one of the cannabanoids in marijuana. Some of those sickened had been vaping THC. The industry blamed those illnesses on black-market products.

Additionally, vapes can be contaminated with toxic metals such as lead and chromium and with other poisons such as arsenic. The toxins might be in the vape’s liquid from the beginning, or might be conveyed by the heated coil that turns the liquid into an inhalable gas.

“CDC has been warning about the identified and potential dangers of e-cigarettes and vaping since these devices first appeared,” said Robert R. Redfield, CDC director, in a news release. “E-cigarettes are not safe for youth, young adults, pregnant women, or adults who do not currently use tobacco products.”

With the new data on vape-related illnesses — including the three victims in Virginia — it’s becoming clearer that the dangers are real. The risks are no longer theoretical but are being experienced by men and women — many of them young — across the continent.

When medical experts warn against vaping, maybe now people will listen.

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