SAN RAFAEL (CBS SF) — A 45-year-old woman has died from complications related to the use of e-cigarettes, the fourth death in California from vaping related illness, Marin heath officials announced Wednesday.

Nationwide, 40 deaths in 24 states and the District of Columbia have been linked to the use of e-cigarettes since the Centers for Disease Control and Prevention began tracking the vaping health threat earlier this year. This was the fourth vaping associated death in California since July 2019.

“With sadness, we report that there has been a death in our community suspected to be caused by severe lung injury associated with vaping,” said Marin County Public Health Officer Dr. Matt Willis in a press release.

Hours later, Chief Deputy Coroner Roger Fielding identified the deceased as 45-year-old Amanda Arconti, who died at Novato Community hospital.

He said the exact cause of Arconti’s death has yet to be determined.

In September, as case counts rose nationally, Marin County Public Health sent out a warning recommending that residents cease e-cigarette use and vaping until the cause of the outbreak could be determined.

In response to growing concerns about safety and increasing rates of vaping among Marin youth, many Marin County cities and towns banned the local sale of flavored tobacco and vaping products in 2019, following the County’s adoption of an ordinance in 2018.

“The message is simple: it’s not safe to vape,” said Willis. “Until we have a better understanding of the cause of this outbreak, it’s best to avoid these products entirely.”

Figures show nearly one-in-three 11th graders in Marin County reported using e-cigarettes on a regular basis, more than double the number two years ago.

Most of these local ordinances do not go into effect until January 2020.

Meanwhile, Gov. Gavin Newsom has launched a $20 million public campaign to raise awareness about the dangers of vaping nicotine and cannabis products.

President Donald Trump also said his administration will propose banning thousands of flavored e-cigarette products to stifle the recent rise in vaping-related deaths and underage vaping.

While the specific products or compounds that cause lung injury after ecigarette use are not yet known, the CDC has found Vitamin E acetate is likely to be contributor in some cases. Vitamin E is an oil-based vitamin that is sometimes added to vaping liquids, especially those containing the psycho-active cannabis compound THC. However, many confirmed cases of lung injury have not been tied to this compound.

Symptoms of vape-associated pulmonary injury (or VAP) include shortness of breath, coughing, chest pain, nausea, fever, vomiting or diarrhea.

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