Disinfectants in the SARS-COV-2 pandemic: Intrinsic toxicity and caused by fake news

Abstract

Introduction. In order to prevent the spreading of the COVID-19 infection, the World Health Organization (WHO) and the National Institute of Health (ISS) recommend the use of disinfectants such as 3% hydrogen peroxide, 70% hydroalcoholic solutions and 0,1% hypochlorite, underlining the importance of hands disinfection in the prevention of COVID-19 virus. The pharmacist role is fundamental in order to have a correct and efficient communication of evidence- based information and in distributing such preventive devices. The aim of this article is to highlight all the risks connected to the three products due to their possible toxicity. This occurs for several reasons: wrong use of the products guided by the fear of be infected, misinformation or bad information. The article also wants to clarify the doubts generated by fake news, help optimise the use of the products, and finally disseminate evidence-based information in order to prevent chemical-clinical risks in health workers, patients and general users. Materials and methods. A review of the national and the international literature on databases (PubMed, Google Scholar and Micromedex) and on the official sites of the Ministry of Health,Higher Institute of Healthand World Health Organization, using the following keywords: “hand sanitizers”, “disinfection”, “COVID-19”, “toxicity”, “methanol”, has been carried out. We took into consideration case reports, systematic reviews and articles published in 2020, as well as articles published in newspapers and in specialized magazines. Results. The need to intensify hand antisepsis practices caused a considerable increase of the sale of alcohol-based hand sanitizers, with a consequent overexposure of such products. Therefore, an increase of reports of accidents associated with their use to the Poison Control Centres has been occurred. The use of products of poor quality or non-authorised products by the Ministry of Health concurred to this situation. Case reports describe gastrointestinal and ocular toxicity, from alcoholic solutions by accidental ingestion of hand disinfectant gel and by the voluntary and conscious intake of alcohol in order to prevent an infection from COVID-19. As far as the hydrogen peroxide is concerned, there were no acute reactions due to hyper use. A case was reported on the acute toxicity of sodium hypochlorite by the United State Poison Centre, concerning a woman who experienced dyspnoea accompanied by mild hypoxemia after washing food with 10% hypochlorite solution, vinegar, and hot water, having inhaled the vapours released into the air. Conclusions. This review shows that the overuse of disinfectants, fed by disinformation, fake news, and a prolonged use, has significantly increased the risk of toxicity for two of the recommended disinfectants. During such complex moment, it would be desirable to encourage reports of adverse reactions and to enhance information activities addressed to the citizens. Pharmacists have to carry out these activities as their duty within commissions, such as the one which controls hospital infections, both in the whole buying process and in relation to patients and other health workers.