Calls to Poison Centers About Cleaners and Disinfectants Rose as COVID-19 Arrived, 2020

This report covers the first months of the COVID-19 pandemic in the United States, in early 2020.

Washington State reported the first U.S. laboratory-confirmed case of COVID-19 on January 19, 2020, and by April 19, 720,630 cases and 37,202 deaths had been reported to CDC. CDC recommended cleaning and disinfecting frequently touched surfaces, with precautions, to help slow the spread of SARS-CoV-2. To see whether cleaning advice from public health agencies and the media was linked to more chemical exposures, CDC and the American Association of Poison Control Centers compared calls to the National Poison Data System (NPDS) for January–March 2020 with the same months in 2018 and 2019. The country's 55 poison centers give free, round-the-clock expert advice on exposures to poisons, chemicals, drugs and medications, and upload call data almost in real time.

What the calls showed

• Totals: poison centers received 45,550 calls about cleaners (28,158) and disinfectants (17,392) in January–March 2020, 20.4% more than in the same period of 2019 (37,822) and 16.4% more than in 2018 (39,122).
• Timing: daily calls about both kinds of product jumped sharply at the beginning of March 2020.
• Ages: the rise occurred in every age group. Children 5 and younger accounted for a large share of calls in each of the three years (39.9% to 47.3%).
• Products: of the increase from 2019 to 2020, 3,137 more calls involved cleaners and 4,591 more involved disinfectants. Bleach accounted for most of the rise among cleaners (1,949 calls, 62.1%). Among disinfectants, non-alcohol disinfectants and hand sanitizers accounted for the largest shares; the report gives the same figure for each, 1,684 calls or 36.7%.
• Inhalation rose more than any other route of exposure: up 35.3% for cleaners (from 4,713 to 6,379 calls) and 108.8% for disinfectants (from 569 to 1,188).

Two cases

• A bleach mixture: after hearing on the news that groceries should be cleaned before eating, a woman soaked her produce in a sink of 10% bleach solution, vinegar and hot water. While cleaning her other groceries she noticed a strong chlorine smell, then began having trouble breathing, coughing and wheezing, and called 911. At the emergency department she had mildly low blood oxygen and wheezing, improved with oxygen and bronchodilators, and went home after a few hours.
• Hand sanitizer: a preschool-aged child was found unresponsive at home next to an open 64-ounce bottle of ethanol-based hand sanitizer. Her family said she became dizzy after drinking some, fell and hit her head. Her blood alcohol level was 273 mg/dL; most state laws set 80 mg/dL as the limit for driving under the influence. She had no injuries on imaging, spent a night in pediatric intensive care, and went home after 48 hours.

What it means

The poison center data cannot prove the exposures were caused by efforts to prevent COVID-19, and they undercount poisonings because they include only people who called. But the rise coincided with heavy media coverage of the pandemic, reports of shortages of cleaning and disinfecting products, and the start of some stay-at-home orders.

More use of cleaners and disinfectants brings more chance of misuse: using more than the label says, mixing products, skipping protective gear, or using them without enough fresh air. To prevent harm:

• Always read and follow the label.
• Dilute only with room-temperature water unless the label says otherwise.
• Never mix chemical products.
• Protect your eyes and skin.
• Make sure the area is well ventilated.
• Store chemicals out of children's reach.

Sources

• Chang A, Schnall AH, Law R, et al. Cleaning and Disinfectant Chemical Exposures and Temporal Associations with COVID-19 — National Poison Data System, United States, January 1, 2020–March 31, 2020. MMWR Morb Mortal Wkly Rep 69(16); posted as an Early Release on April 20, 2020. https://www.cdc.gov/mmwr/volumes/69/wr/mm6916e1.htm
• The report was written by CDC with poison center partners; its figure and social media graphic are not reproduced here.