In the era of COVID-19, hand sanitizer has become such an ever-present commodity that we have come to take its virtues — and its safety — for granted.
Drinking them could cause blindness, liver and kidney damage or death. So could slathering it on one’s skin, since it passes quickly through the skin and into tissues beneath. Children are particularly vulnerable to potential harm from the stuff.
The culprit is methanol, a poor cousin of isopropyl alcohol or ethyl alcohol, the approved active ingredients in hand sanitizing products. Starting in late July, the FDA began detecting what it called a “sharp increase” in hand sanitizers that claimed to be made with ethyl alcohol but were contaminated by methanol.
Methanol smells, feels, tastes and evaporates like ethyl alcohol, the inebriate that spikes cocktails, and isopropyl alcohol, which cleans wounds and soothes muscles. While ethyl alcohol has two carbon atoms and isopropyl alcohol has three, methanol has just one.
When consumed or absorbed through the skin, methanol's first effects — including confusion, heavy breathing, slurred words and altered perception — will be familiar to anyone who has sat on a barstool for too long.
But when metabolized by the human body, methanol makes formic acid and formaldehyde, both of which attack the nervous system. The optic nerve is the first line of defense to fall, and a victim of methanol poisoning will often begin to experience “snowy” vision and potentially permanent blindness. In fact, this is the origin of the term "blind drunk."
In some cases, death by poisoning can ensue.
Sometimes called wood alcohol, methanol is widely used in antifreeze, varnishes, cologne, copying machine fluids, paint and fuel. It can also be the unintended product of alcohol production when quality control is lacking.
Around the world, methanol is widely consumed as an intoxicant but also used in suicidal self-poisoning. Case studies abound in the medical literature of patients who treat fever, pain and other afflictions with topical applications of methanol, and wind up hospitalized.
Dr. William Banner, medical director of the Oklahoma Center for Poison and Drug Information, said that so far, tainted hand sanitizer has not caused a notable uptick in calls to poison control centers.
But as hand sanitizer becomes Americans’ go-to defense against coronavirus infection, health officials know it is being misused. Parents are slathering it not just on children's hands but on their faces, arms and bodies as well, a practice Banner discouraged. Those in search of a buzz are knowingly tippling it. Children and teens are tasting it out of curiosity or on a dare.
When sanitizer is tainted with methanol, such misuse could pose immediate dangers. And for children, who weigh much less than adults but have nearly as much skin, a dose of methanol could cause a rapid concentration to build up in tissues, Banner said. That could spell disaster, he warned.
A report published Wednesday by the Centers for Disease Control and Prevention highlighted the dangers of these products. Researchers combed through calls to poison control centers in Arizona and New Mexico in May and June and identified 15 cases of methanol poisoning tied to hand sanitizers. All of those patients were sick enough to be admitted to a hospital.
Nine of the victims required hemodialysis to restore damage to their kidneys, and six had seizures while they were in the hospital. Four of the patients died, and another four were still hospitalized eight days after the surveillance period ended. Of the seven patients who were discharged, three suffered some degree of permanent vision loss, according to the dispatch in the CDC's Morbidity and Mortality Weekly Report.
The 115 hand-sanitizer products that the FDA has recalled have been sold at both retail and online stores. All but three were made in Mexico, and those imports are now blocked from entering the United States. But they are likely still to be in circulation.
The FDA has posted a list of brands, marketing names and lots that it has recalled.
With names like Blumen, LumiSkin, Scent Theory, Born Basic and Urbane Bath & Body, they are indistinguishable from the hand sanitizers that are recommended as a way to prevent the transfer of the coronavirus from hands to mucous membranes in the nose and mouth, where they can take up residence and replicate, often to ruinous effect.
“You really can’t identify methanol by smell or sight,” said Banner, a past president of the American Assn. of Poison Control Centers.
He added that adults should be careful not to go overboard in covering their children with any hand sanitizer, since its alcohol can be absorbed through the skin.
But if a child who has been doused, or who may have sneaked away and sipped the stuff, has an unexplained change in behavior such as heavy breathing or acting inebriated, call the local Poison Control Center at (800) 222-1222. Experts there can check whether a hand sanitizer in use is among those that have been recalled.
For the record:
11:55 AM, Aug. 06, 2020: An earlier version of this article misstated the number of carbon atoms in a molecule of isopropyl alcohol. It has three carbon atoms, not two.