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Erschienen in: Critical Care 1/2020

Open Access 10.07.2020 | COVID-19 | Research Letter

Double trouble: methanol outbreak in the wake of the COVID-19 pandemic in Iran—a cross-sectional assessment

verfasst von: Hossein Hassanian-Moghaddam, Nasim Zamani, Ali-Asghar Kolahi, Rebecca McDonald, Knut Erik Hovda

Erschienen in: Critical Care | Ausgabe 1/2020

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Iran has been the epicenter of COVID-19 in the Middle East, with a total of 120,198 infected cases and 8556 deaths as of June 10 [1]. The pandemic has been complicated by the co-occurrence of a large methanol outbreak in Iran, seemingly triggered by false claims that consumption of disinfectants and alcohols could prevent and treat COVID-19 infection. According to local news, the ensuing rise in ethanol demand made bootleggers decolorate industrial alcohols containing pyridine (to deter from consumption) using bleach, before selling them as regular ethanol to Iranians.
In this research letter, we describe the scale of the Iranian methanol outbreak, based on hospitalization and mortality data collated from databases of the Iranian Ministry of Health (MOH) and Legal Medicine Organization (LMO) for the period of February 23 (first documented COVID-19 case in Iran) until May 2, 2020. MOH records indicate 5876 hospitalizations for methanol poisoning, occurring in geographical clusters, with just three (Tehran, Fars, Khuzestan) out of the total 31 Iranian provinces accounting for the majority (52.2%; n = 3068) of cases (see Table 1). In terms of mortality, MOH reported that 534 patients with methanol poisoning were confirmed dead in the hospital setting, equivalent to an estimated case fatality rate of approximately 9% (534/5876). LMO registered 800 deaths from methanol poisoning during the same period (see Table 1 and Fig. 1), comprising both in-hospital and community-based fatalities. This 33% discrepancy in deaths between MOH and LMO data (i.e., (800–534)/800 × 100) may have several explanations. For instance, LMO data also includes out-of-hospital deaths and is likely more accurate. Moreover, a hospital-based diagnosis of methanol poisoning is difficult and complicated by the lack of diagnostic equipment or physician knowledge. Therefore, methanol poisoning may go undetected in hospitals, and accurate diagnosis is—best case scenario—only assigned during a post-mortem examination, which then enters LMO statistics. In the absence of formate analyses, late presenters can become false negatives.
Table 1
Methanol poisoning cases and fatalities in Iran (23 February to 2 May 2020)
Province
Poisoning cases: hospital admissions (source: MOH)
Methanol deaths*
In hospital (source: MOH)
Total registered (source: LMO)
Tehran
1177
87
205
Khuzestan
1079
93
88
Fars
812
99
139
Razavi Khorasan
581
67
78
East Azerbaijan
483
50
75
Alborz
248
43
52
Ardebil
223
22
31
Isfahan
207
6
19
Kerman
139
0
2
Kermanshah
132
2
2
Mazandaran
100
10
28
Yazd
96
12
10
Markazi
87
4
4
Kurdestan
79
0
9
The other provinces
433
39
58
Total
5876
534
800
*Brain-dead cases considered dead
MOH Ministry of Health, LMO Legal Medicine Organization (data is available through https://​bit.​ly/​2WUBfZo)
Despite these inconsistencies, the number of Iranian poisoning cases (5876 hospitalizations from late February until early May),\ is already five times higher than the second-largest methanol outbreak in history, which was recorded in Libya in March 2013 and affected 1066 patients [2].
From our data, it is unclear how many Iranians drank adulterated alcohol for recreational purposes or as gastrointestinal “disinfectant” to prevent—or treat—COVID-19 infection. With no end to the COVID-19 pandemic in sight, it is thus paramount to educate the general public that alcohol does not protect against COVID-19, as already initiated by the WHO [3]. The United Nations rightly recognizes the international spread of “fake news” related to COVID-19 as a threat to human lives [4], as health care systems have to contend with medical misinformation of the general public.
In methanol poisoning, the efficacy of treatment is markedly reduced in delayed presentations. With 534 methanol deaths registered by MOH and 800 deaths by LMO, alongside 5876 hospitalizations, we report an estimated mortality rate in the range of 9–14%. However, this figure is preliminary and should be interpreted with great caution, until LMO and MOH release their final data. Additionally, in many more non-fatal methanol poisoning cases, adults and children are now vision-impaired or blind from this toxic alcohol.
During situations like pandemics, healthcare institutions may seem dangerous settings, which could pose a risk of viral infection. It is possible that fear of COVID-19 kept methanol poisoning victims from seeking and obtaining timely care. This highlights the importance of early identification and initiation of treatment, which can be supplemented by “active case finding” by treating physicians and public health agencies [5]. Public health messaging and strategic planning are crucial to prevent future methanol outbreaks [6].

Acknowledgements

We want to acknowledge the novel initiative by Medécins sans Frontières (MSF/Doctors without Borders) which looks at mechanisms to improve the survival of methanol poisoning victims globally. Methanol poisoning is an under-recognized issue, especially in low- and middle-income countries. For more information on the work of MSF regarding methanol poisoning, please visit https://​msf.​no/​mpi.
This study is a preliminary report and was approved by the ethics committee of Shahid Beheshti University of Medical Sciences (IR.SBMU.RETECH.REC.1398.872).
Not applicable

Competing interests

The authors declare that they have no competing interests.
Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

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Literatur
2.
Zurück zum Zitat Rostrup M, Edwards JK, Abukalish M, Ezzabi M, Some D, et al. Correction: the methanol poisoning outbreaks in Libya 2013 and Kenya 2014. PLoS One. 2016;11(6):e0157256.CrossRef Rostrup M, Edwards JK, Abukalish M, Ezzabi M, Some D, et al. Correction: the methanol poisoning outbreaks in Libya 2013 and Kenya 2014. PLoS One. 2016;11(6):e0157256.CrossRef
5.
Zurück zum Zitat Hassanian-Moghaddam H, Nikfarjam A, Mirafzal A, et al. Methanol mass poisoning in Iran: role of case finding in outbreak management. J Public Health. 2015;37:354–9.CrossRef Hassanian-Moghaddam H, Nikfarjam A, Mirafzal A, et al. Methanol mass poisoning in Iran: role of case finding in outbreak management. J Public Health. 2015;37:354–9.CrossRef
6.
Zurück zum Zitat Hassanian-Moghaddam H, Zamani N, Roberts DM, et al. Consensus statements on the approach to patients in a methanol poisoning outbreak. Clin Toxicol. 2019;57(12):1129–36.CrossRef Hassanian-Moghaddam H, Zamani N, Roberts DM, et al. Consensus statements on the approach to patients in a methanol poisoning outbreak. Clin Toxicol. 2019;57(12):1129–36.CrossRef
Metadaten
Titel
Double trouble: methanol outbreak in the wake of the COVID-19 pandemic in Iran—a cross-sectional assessment
verfasst von
Hossein Hassanian-Moghaddam
Nasim Zamani
Ali-Asghar Kolahi
Rebecca McDonald
Knut Erik Hovda
Publikationsdatum
10.07.2020
Verlag
BioMed Central
Schlagwort
COVID-19
Erschienen in
Critical Care / Ausgabe 1/2020
Elektronische ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-020-03140-w

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