Alexander Mitchell never expected that vaping would place him inches from death’s door. At 20 years old, Mitchell was an avid hiker and in seemingly perfect health. But then, one day, he had severe nausea, chest pains, and couldn’t breathe. He ended up in the hospital under critical care. Doctors in Utah were baffled until they spotted abnormal immune cells in his lungs. They diagnosed Mitchell with acute respiratory distress syndrome and attributed his lung failure to vaping.

According to a Washington Post article, Mitchell’s condition is related to a rare pneumonia often caused by inhaling oil-based liquids, like mineral oil. Based on the symptoms and damage, doctors suspect that Mitchell’s condition is linked to inhalation of vaping liquids from an e-cigarette.

Not much is known about the dangers associated with vaping. What is known is that e-cigarettes sometimes explode and that a myriad of studies show that vaping damages cells, causes cancer, and impedes lung function.

However, in the last two months, there has been a frightening surge in respiratory illnesses that may be related to vaping. Twenty-two states have reported serious, rapid onset, respiratory illnesses–some of which have resulted in severe, permanent lung damage. Like Mitchell, many of the patients are young and reported to be in perfect health before experiencing these symptoms. The state of Illinois reported the first death from what is now suspected to be a vaping-related lung condition.

E-cigarettes are designed to heat a liquid, usually containing nicotine, to the point of vaporization. The vapors are then inhaled to deliver the nicotine into the body. Vaping liquids can be oil-based and can contain a variety of chemicals—many of them undisclosed and unknown to users. E-cigarettes are also used for inhaling cannabis products.

The CDC reported they could find no evidence of infectious disease associated with the “outbreak” and, instead, revealed that in each case, the patients had reported e-cigarette use. The CDC is currently working with health officials in the states which reported similar conditions, including CA, CT, IL, IN, IA, MN, MI, NC, NJ, NM, NY, PA, TX, UT, WI and additional states pending verification. The CDC is looking for a correlation between the vaping in these states and the lung disease itself.

The connection between Mitchell’s illness and the rare pneumonia caused by inhaling liquid fumes seems to point to e-cigarettes as a possible cause. If inhaling the fumes of an oil-based liquid could cause a deadly pneumonia, it makes sense that vaping similar liquids could cause deadly respiratory damage in e-cigarette users.

Finding the exact cause of this deadly condition will not be easy. The CDC must first identify if the e-cigarette products, or the e-cigarette liquids, are causing the condition(s). This is made even more difficult because e-cigarettes are basically unregulated—there are no restrictions, and no standardization for the composition of vaping liquids. Each and every product has a different mix of chemicals, oil-based liquids, and other ingredients that may or may not be harmful.

One reason for the source identification difficulty is that the FDA, under Scott Gottlieb, delayed implementing e-cigarette product approvals in 2016. This gave the market players free reign to release any type of product to the public. That short-sighted decision is now blamed for the out-of-control rise in e-cigarette use among teens—especially for the Juul product which captured 75% of the market with its very high levels of nicotine and history of advertising to youth.

Under its temporary new leadership, the FDA is teasing that it would like to move e-cigarette product approval deadlines forward. However, the acting commissioner, Ned Sharpless, M.D., stated that the ongoing lawsuits related to regulation may impede accelerated implementation. Unfortunately, the new message only mimics the weak regulation of the past, which includes “warning letters,” rather than “strict compliance;” “guidance” rather than “rules;” and “development of future regulations” instead of immediately accelerating the enforcement of regulations that were approved and authorized four years ago.

While the FDA continues to hem and haw, the states and large cities are implementing their own consumer protection measures, including a ban of e-cigarette sales by the City of San Francisco. In addition, and more disturbing, is that unsuspecting consumers will continue to be exposed to dangerous products that should have been, and could have been, made safer several years ago.

Because the FDA didn’t do its job, we now have a new epidemic on our hands—perhaps caused entirely by the new chemicals introduced into the unregulated liquid pods sold by e-cigarette companies, including Juul. Sean Callahan, a University of Utah pulmonologist, associated with Alexander Mitchell’s case, put it best: “To see patients this sick, this is extremely alarming.”

People who experience any type of chest pain or difficulty breathing after using e-cigarettes or vaping in the weeks or months prior to these symptoms should seek immediate medical attention. Health officials and families should also report the incidents to the CDC and to the FDA’s Safety Reporting Portal.