Cleaning and Disinfectant Chemical Exposures and Temporal Associations with COVID-19

National Poison Data System, United States, January 1, 2020-March 31, 2020

Arthur Chang, MD; Amy H. Schnall, MPH; Royal Law, PhD; Alvin C. Bronstein, MD; Jeanna M. Marraffa, PharmD; Henry A. Spiller, MS; Hannah L. Hays, MD; Alexandra R. Funk, PharmD; Maria Mercurio-Zappala, MS; Diane P. Calello, MD; Alfred Aleguas, PharmD; Douglas J. Borys, PharmD; Tegan Boehmer, PhD; Erik Svendsen, PhD

Disclosures

Morbidity and Mortality Weekly Report. 2020;69(16):496-498. 

In This Article

Abstract and Introduction

Introduction

On January 19, 2020, the state of Washington reported the first U.S. laboratory-confirmed case of coronavirus disease 2019 (COVID-19) caused by infection with SARS-CoV-2.[1] As of April 19, a total of 720,630 COVID-19 cases and 37,202 associated deaths* had been reported to CDC from all 50 states, the District of Columbia, and four U.S. territories.[2] CDC recommends, with precautions, the proper cleaning and disinfection of high-touch surfaces to help mitigate the transmission of SARS-CoV-2.[3] To assess whether there might be a possible association between COVID-19 cleaning recommendations from public health agencies and the media and the number of chemical exposures reported to the National Poison Data System (NPDS), CDC and the American Association of Poison Control Centers surveillance team compared the number of exposures reported for the period January–March 2020 with the number of reports during the same 3-month period in 2018 and 2019. Fifty-five poison centers in the United States provide free, 24-hour professional advice and medical management information regarding exposures to poisons, chemicals, drugs, and medications. Call data from poison centers are uploaded in near real-time to NPDS. During January–March 2020, poison centers received 45,550 exposure calls related to cleaners (28,158) and disinfectants (17,392), representing overall increases of 20.4% and 16.4% from January–March 2019 (37,822) and January–March 2018 (39,122), respectively. Although NPDS data do not provide information showing a definite link between exposures and COVID-19 cleaning efforts, there appears to be a clear temporal association with increased use of these products.

The daily number of calls to poison centers increased sharply at the beginning of March 2020 for exposures to both cleaners and disinfectants (Figure). The increase in total calls was seen across all age groups; however, exposures among children aged ≤5 years consistently represented a large percentage of total calls in the 3-month study period for each year (range = 39.9%–47.3%) (Table). Further analysis of the increase in calls from 2019 to 2020 (3,137 for cleaners, 4,591 for disinfectants), showed that among all cleaner categories, bleaches accounted for the largest percentage of the increase (1,949; 62.1%), whereas nonalcohol disinfectants (1,684; 36.7%) and hand sanitizers (1,684; 36.7%) accounted for the largest percentages of the increase among disinfectant categories. Inhalation represented the largest percentage increase from 2019 to 2020 among all exposure routes, with an increase of 35.3% (from 4,713 to 6,379) for all cleaners and an increase of 108.8% (from 569 to 1,188) for all disinfectants. Two illustrative case vignettes are presented to highlight the types of chemical exposure calls managed by poison centers.

Figure.

Number of daily exposures to cleaners and disinfectants reported to U.S. poison centers — United States, January–March 2018, 2019, and 2020*,†
*Excluding February 29, 2020.
Increase in exposures to cleaners on January 29, 2020, came from an unintentional exposure to a cleaning agent within a school.

*Total cases include 1,282 probable cases, and total deaths include 4,226 probable associated deaths.

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