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If e-cigarette or vaping product use is suspected as a possible etiology of a patient's severe pulmonary disease, obtain detailed history regarding Substance(s) used: nicotine, cannabinoids (e.g., marijuana, THC, THC concentrates, CBD, CBD oil, synthetic cannabinoids [e.g., K2 or spice], hash oil, Dank vapes), flavors, or other substances - Substance source(s): commercially available liquids (i.e., bottles, cartridges, or pods), homemade liquids, and re-use of old cartridges or pods with homemade or commercially bought liquids - Device(s) used: manufacturer

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In some organisms, a host RNA-dependent RNA polymerase (RdRp) uses the single-stranded RNA (ssRNA) templates removed from the primary siRNAs to synthesize mobile secondary siRNA duplexes for amplification and spread of the silencing signal throughout host tissues 5,6