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Good hand hygiene, in conjunction with social distancing and mask-wearing, is a vital component of a regimen to minimize transmission of COVID-19. Thorough hand washing with soap and water provides appropriate hand sanitizing, but in the absence of soap and water, use of commercially available hand sanitizing gels and foams containing ≥60% alcohol (either ethanol or isopropyl alcohol) has been proven to be effective. Methanol is not an acceptable substitute, partly because of its potential toxicity. Nonetheless, upwards of 65 methanol-containing hand sanitizers have made their way into the U.S. market.
From May through June 2020, 15 cases of methanol poisoning due to ingestion of methanol-containing hand sanitizers were reported in Arizona and New Mexico. All patients had a history of ingesting alcohol-based hand sanitizer. In these cases, presentation included visual disturbance, seizures, gastrointestinal involvement, altered mental status, and anion-gap acidosis with blood pH varying from 6.70 to 7.23. Four patients died and three others were discharged with new visual impairment.
Yip L et al. Serious adverse health events, including death, associated with ingesting alcohol-based hand sanitizers containing methanol — Arizona and New Mexico, May–June 2020. MMWR Morb Mortal Wkly Rep 2020 Aug 14; 69:1070. (https://doi.org/10.15585/mmwr.mm6932e1)
Comment
All of the above alterations and outcomes are well known effects of methanol poisoning. The FDA is moving to have methanol-containing sanitizers removed from the market. However, recipes for creating homemade sanitizers abound, and suggestions have been made to the public that ingestion of products intended only for surface use might ward off SARS-CoV-2 infection. While all persons affected in this report were adults who might be presumed to have alcohol use disorder, clinicians should be on the lookout for signs of alcohol and methanol toxicity in children, in whom lower doses might be highly deleterious.