Increased use of disinfectants due to the coronavirus Covid-19 pandemic, is causing concern over the links between exposure to the products and the development of respiratory health conditions.
A number of studies have reported an association between frequent use of disinfectants and cleaning products, both at home and at work, and asthma – including a recent paper by Elissa Abrams from the University of British Columbia, published in the Canadian Medical Association Journal.
Others, including a 2019 US longitudinal study conducted among nurses, also support a link with chronic obstructive pulmonary disease (COPD).
The US NGO Women’s Voices for the Earth (WVE) has warned that the "likely overuse" of disinfectants, containing substances such as quaternary ammonium compounds (quats) and chlorine bleach, might present a hidden human health risk during the outbreak.
"The last thing we need during this pandemic is an increase in respiratory conditions," WVE director of science and research, Alexandra Scranton told Chemical Watch.
According to the WHO, weakened respiratory systems put people at greater risk of becoming severely ill from the coronavirus.
Another NGO Beyond Pesticides has asked industry and regulators to pay greater attention to how disinfectants might affect those that are already more vulnerable to the virus.
"It is important that we do not exacerbate the risk to individuals in the process of avoiding or controlling the threat," said the organisation’s executive director, Jay Feldman. "The question is, how do you manage the virus without increasing risk factors. That’s something we don’t talk about enough."
Mr Feldman sees an opportunity in providing better information about "elevated risk factors" on disinfectant product labelling and marketing. "As we move through this crisis, the industry is going to have to become more attuned to these issues," he said.
Paying attention to respiratory health risks will become ever more important as people use disinfectants more widely and excessively, said Orianne Dumas, a researcher at the French National Institute of Health and Medical Research (Inserm) and lead author of the 2019 longitudinal study linking disinfectant exposure to COPD.
"It is likely that the Covid-19 pandemic will impact both individual behaviours and disinfection practices in healthcare settings. Currently, adequate levels of disinfection must be maintained in healthcare settings to protect patients and workers from infections, including Covid-19," Dr Dumas said.
"In the years to come, if cleaning and disinfection recommendations are to change, they should integrate knowledge on respiratory health risks associated with (the) risk of disinfectants and cleaning products. In healthcare settings, this may require the development of new strategies for infection control."
Proper use and low-risk products
In response to Dr Dumas' study from last year, the cleaning products industry has said that proper handling of disinfectants is essential for their safe use.
Mr Feldman, too, emphasised that "regardless of what material you’re using ... label instructions have to be followed."
Generally, WVE and Beyond Pesticides encourage the use of biocides with a low-risk profile, such as ethanol, or even non-biocidal cleaners, like soap. Enveloped viruses like Sars-CoV-2 rely on a sensitive lipid coating for protection that can be broken relatively easily, not just by biocides.
Dr Scranton sees the US lacking a resource for soaps and detergents that are effective against the virus. Not qualifying as pesticides, they are not under the EPA’s jurisdiction and hence not listed on the agency’s List N: Disinfectants for Use Against Covid-19.
"In terms of future regulatory needs: we need some sort of authoritative system to be able to declare that use of some non-pesticide products like soaps and detergents can be effective in protecting health," she says.
Meanwhile, WVE remains sceptical about new disinfectants coming onto the market quickly, without proper scrutiny.
The EPA has expedited product claim reviews and eased reporting requirements for some disinfectants, as part of efforts to increase the availability of products to fight Covid-19.
Dr Scranton has noted disinfectants claiming to be safe and effective against Covid-19, containing chemicals with little toxicity data to back this up.
"I am definitely concerned about new products like this that we don’t know much about – getting used widely – and only later down the line will we recognise the unnecessary risks they actually pose," she says.
The EPA and cleaning products industry are currently making efforts to crack down on counterfeit disinfectants and products making false claims.