Critical Reviews in Toxicology

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Consequences of chemical impact of disinfectants:

safe preventive measures against COVID-19

Nagendra Kumar Rai , Anushruti Ashok & Butchi Raju Akondi

To cite this article: Nagendra Kumar Rai , Anushruti Ashok & Butchi Raju Akondi (2020):
Consequences of chemical impact of disinfectants: safe preventive measures against COVID-19,
Critical Reviews in Toxicology, DOI: 10.1080/10408444.2020.1790499

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CRITICAL REVIEWS IN TOXICOLOGY
https://doi.org/10.1080/10408444.2020.1790499

REVIEW ARTICLE

Consequences of chemical impact of disinfectants: safe preventive measures

against COVID-19
Nagendra Kumar Raia, Anushruti Ashokb and Butchi Raju Akondic
a
Department of Neuroscience, Cleveland Clinic, Cleveland, OH, USA; bDepartment of Pathology, Case Western Reserve University, Cleveland,
OH, USA; cDepartment of Clinical Pharmacy and Pharmacology, Ibn Sina National College for Medical Studies, Jeddah, Saudi Arabia

ABSTRACT ARTICLE HISTORY

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 Received 11 May 2020
(SARS-CoV-2) has created a significant threat to global health. It originated in Wuhan, China and caused Revised 28 June 2020
a total of 83,483 confirmed cases and 4634 deaths until June 2020. This novel virus spread primarily Accepted 29 June 2020
through respiratory droplets and close contact. The person-to-person transmission by direct transmit-
KEYWORDS
tance through cough, sneeze, droplet inhalation, and contact spreading from dry surfaces contami- Coronavirus; COVID-19;
nated with secretions of nose, mouth, and eyes of an infected person has been proven about SARS- disinfectant; sanitizer;
CoV-2 transmission. As disease progressed, a series of complications tends to develop, especially in crit- toxicity
ically ill and immunocompromised patients. Pathological studies showed representative features of
acute respiratory distress syndrome (ARDS) and implications on multiple organs as well. However, no
specific antiviral drugs or vaccines are immediately available for the treatment of this lethal disease.
The efficacy of some promising antivirals needs to be investigated by ongoing clinical trials. In current
circumstances, supportive care, precautions, and social distancing are the only preventive options to
ameliorate COVID-19. To disinfect the environment, mainly chemical disinfectants are being used
robustly. However, due to panic state, fright, and unawareness, people are using it violently, which can
have an adverse effect on human health and environment. This review discusses about the potential
harmful effect of disinfectants, if used inappropriately. Here, we will also discuss safe preventive
options as an alternative to robust use of disinfection methods to fight against COVID-19.

Table of contents
Introduction ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 1 deaths were reported worldwide. USA is currently the most
Disinfectants against coronavirus ... ... ... ... ... ... ... ... ... ... ... 2 affected country with 2,590,334 positive cases and 128,111
Toxic effect of disinfectants ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3 total death (Worldometer 2020). The sudden outbreak of
Safe preventive measures ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 4 COVID-19 shook the entire scientific community, and
Outstanding questions ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 researchers across the world are working tirelessly to under-
Concluding remarks ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 5 stand the virus and its properties to design intervention strat-
egies to treat and prevent the disease.
Acknowledgements ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6
Coronaviruses are a large family of viruses that usually
Declaration of interest ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6
cause mild to moderate upper-respiratory tract illnesses, like
References ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 6
the common cold. Among this family, there are two serious
and fatal coronaviruses, which were transmitted from animals
to humans and have induced respiratory illness and massive
Introduction death in affected individuals lately (NIAID 2020). These
include SARS coronavirus (SARS-CoV) which emerged in
The outbreak of coronavirus disease 2019 (COVID-19), which November 2002 and induced severe acute respiratory syn-
originated in Wuhan, China, in December 2019, has been drome (SARS); and MERS coronavirus (MERS-CoV), which
declared a public health emergency of international concern caused Middle East respiratory syndrome (MERS) in 2012
by the World Health Organization (WHO 2020b). WHO (Coronaviridae Study Group of the International Committee
announced the official name of the virus as “the COVID-19 on Taxonomy of Viruses 2020; Zaki et al. 2012). The
virus,” previously known as “2019-nCoV”, or “Wuhan Coronavirus Study Group of the International Committee on
Coronavirus” (WHO 2020b). Within the first three months of Taxonomy of Viruses confirmed that the current virus is a
the outbreak, this epidemic spread rapidly around the coun- variant of the SARC-CoV. Therefore, this committee named
try and the world and became a global pandemic. As of June the new pathogen as SARS-CoV-2 (Coronaviridae Study
2020, a total of 10,057,565 confirmed cases and 500,382 Group of the International Committee on Taxonomy of

CONTACT Nagendra Kumar Rai [email protected] Department of Neuroscience, Lerner Research Institute, 9500 Euclid Avenue, Cleveland 44195, OH, USA
ß 2020 Informa UK Limited, trading as Taylor & Francis Group
2 N. K. RAI ET AL.

Viruses 2020). SARS-CoV-2 unlike its previous counterparts, Table 1. Viability of SARS-CoV-2 on various surfaces.
SARS-CoV and MERS-CoV, or anything the world has encoun- Surface Viability time (h)
tered before both in terms of virulence and severity of the Aerosol 3
infection. SARS-CoV-2 is a positive-sense single-stranded RNA Glass, countertop, plastic, stainless steel 72
Cardboard, paper, fabrics 24
virus, which harbors the largest genome among currently
known RNA viruses, with a genome length of about 26–32 kb
(Forni et al. 2017). It has an average diameter of 100 nm and materials (Table 1; van Doremalen et al. 2020) in temperature
are spherical or oval shaped. There are large spikes of viral ranges between 4  C and 70  C (Alex Chin et al. 2020).
membrane glycoproteins on the surface. Under the electron Thus, the immediate environment of an infected individual
microscope, these negatively stained virus particles show a can also serve as a potential source of transmission, if a
typical crown-like shape, thus known as coronavirus (Neuman healthy individual touch the contaminated surface or object
et al. 2006). and then touches their own mouth, nose, or eyes. Recent
Epidemiological studies showed that COVID-19 mortality studies indicate that people who are infected but do not
rate was higher in older population, particularly in males and have symptoms likely also play a role in the spread of
immunocompromised individuals (Zhou et al. 2020). Major COVID-19 (Cai et al. 2020).
risk factors include advanced age with underlying comorbid- At present, there are no definitive cure and specific anti-
ities such as hypertension, diabetes, cardiovascular disease, viral therapeutics and vaccine available for SARS-CoV-2.
cerebrovascular disease, allergic diseases, asthma, severe Therefore, all measures to supplying public health rely on
obesity, and chronic obstructive pulmonary disease (COPD) preventing the spread of the virus by respiratory droplets,
(Huang et al. 2020; Wang et al. 2020; Yang et al. 2020). SARS- close contact, and disinfecting surfaces and to provide sup-
CoV-2 has an incubation period of 1–14 days, mostly ranging portive care to the patients. Disinfection is one of the best-
from 3 to 7 days (Guan et al. 2020). The most common symp- practice measures used to destroy viral/bacterial pathogens
toms are fever, fatigue, and dry cough, followed by head- in households and community settings and reduces the
ache, nasal congestion, sore throat, myalgia, and arthralgia in spread of infection. In current circumstances, due to rising
mild to moderate patients (Xu et al. 2020; Zhang et al. 2020). demand, panic buying, hoarding, and misuse of disinfectants
Shortness of breath, might be accompanied by or progress might result in adverse outcomes to human health and envir-
to hypoxemia usually in the second week of the illness (Guan onment in the future. This article will summarize the long-
et al. 2020). Gastrointestinal symptoms, such as nausea, vom- term adverse effect of various disinfectant that is frequently
iting, and diarrhea, are observed especially in the children being used to combat COVID-19. We will also discuss about
(Tan et al. 2020; Zheng et al. 2020). Severe pneumonia was the alternative preventive measure which is convenient to
observed in 10–20% of patients, and respiratory injury will use and have minimum or zero risk to the public health and
inevitably develop into acute respiratory distress syndrome environments.
(ARDS) during 8–14 days of the illness (Chen et al. 2020; Li
et al. 2020). ARDS, as the main cause of respiratory failure, is
Disinfectants against coronavirus
associated with high morbidity and mortality. On patho-
logical examination, the involved lung lobe showed obvious Disinfection with the use of chemicals and sterilization
alveolar edema, proteinaceous exudates, and reactive pneu- method is a common practice to remove pathogenic micro-
mocyte hyperplasia, accompanied by mild inflammatory infil- organisms. Disinfection is a procedure that involves the use
tration in the early stage of infection (Li et al. 2020). SARS- of a chemical agent to eliminate virtually all recognized
CoV-2 additionally caused damage in liver and myocardium, pathogenic microbes, but not necessarily all types (e.g. bac-
and showed elevated levels of aminotransferase, creatine kin- terial endospores) present on inanimate objects. Sterilization
ase, and myoglobin level, also increased troponin in critical is the complete elimination or destruction of all forms of
patients (Guan et al. 2020; Huang et al. 2020; Yang et al. microbial life and is mostly carried out in health-care facilities
2020). It was recently documented that, in addition to sys- by using physical or chemical method. Steam under pressure,
temic and respiratory symptoms, 36.4% of severely affected dry heat, UV-light, ethylene oxide (EtO) gas, hydrogen perox-
patients with COVID-19 also develop neurological symptoms, ide gas plasma, and liquid chemicals are the principal steriliz-
including headache, disturbed consciousness, paresthesia, ing agents used in healthcare facilities (CDC 2008). In
and encephalopathy (Wu et al. 2020). Additionally, autopsy addition, thorough cleaning is also essential before disinfec-
reports have revealed brain tissue edema and partial neur- tion and sterilization. Cleaning is the removal of visible soil
onal degeneration in deceased patients (Xu et al. 2020). particles (inorganic and organic materials), from objects and
There are two main routes of transmission of the SARS- surfaces and is normally accomplished manually or mechanic-
CoV-2: infected respiratory droplets and contact transmission ally using water with detergents or enzymatic products. If
(Wu et al. 2020). Respiratory droplets are generated when an these inorganic and organic materials remain on the surfaces,
infected person coughs or sneezes. When a healthy person it interferes with the effectiveness of disinfection and steril-
comes in close contact with affected individual, that person ization processes (CDC 2008). Because of certain limitations
is at high risk of being exposed to potentially infective of sterilization methods, disinfection method became the
respiratory droplets (Guo et al. 2020). Current evidence sug- widespread and commonly used method in the hospitals,
gests that SARS-CoV-2 containing droplets may remain viable household area (kitchens and bathrooms), and outdoor space
for hours to days on surfaces made from a variety of to kill infectious microorganisms. Major advantages of
 CRITICAL REVIEWS IN TOXICOLOGY 3

disinfectant are the wide-availability, cost-effective, range of Table 2. List of EPA-certified product ingredients against coronaviruses.
usage on most surfaces and objects without need of any Effective contact
mechanical equipment. A large number of chemical disinfec- Active ingredients time (min) Formulation type
Quaternary ammonium (Quats) 10 Dilutable
tants are used in the health care and household setting that
Hydrogen peroxide 10 Dilutable
include alcohols, chlorine, and chlorine compounds (bleach), Isopropanol 0.5 Wipe
formaldehyde, glutaraldehyde, standard and improved hydro- Sodium hypochlorite 10 Dilutable
Octanoic acid 2 Dilutable
gen peroxide, iodophors, peracetic acid, phenolics, and qua- Phenolic 10 Dilutable
ternary ammonium compounds (Quats). Commercial products Ethanol 2 Ready-to-use (RTU)
based on these chemicals are considered unique and must Triethylene glycol 5 Pressurized liquid
L-lactic acid 10 RTU
be registered with the US Environmental Protection Agency Peroxyacetic acid 1 Dilutable
(EPA) or cleared by the Food and Drug Administration (FDA) Glycolic acid 10 Impregnated materials
(CDC 2008). Hydrogen peroxide 5 Dilutable
Citric acid 1 RTU
EPA and the Centers for Disease Control and Prevention Hypochlorous acid 10 RTU
(CDC) recognize that certain viruses can be ranked with Ammonium carbonate 6 RTU
respect to their tolerance to chemical disinfectants. With this
approach, viruses are divided into three subgroups based on
size and their relative resistance to inactivation. First, envel- hydrogen peroxide, alcohol, and glutaraldehyde. All of these
oped viruses (easiest to inactivate such as coronavirus); large were linked with an increased risk of chronic obstructive pul-
(50–100 nm) non-enveloped viruses (such as adenovirus and monary disease (COPD), asthma, and eye irritation on health
rotavirus, harder to inactivate than enveloped viruses); and workers and individuals when used regularly (Casey et al.
small (<50 nm) non-enveloped viruses (hardest to inactivate 2017; Dumas et al. 2019; Weinmann et al. 2019). Chemical
such as rhinovirus). SARS-CoV-2 is an enveloped virus con- residues left on a surface can become airborne and inhaled,
taining lipid membrane, which is easier to inactivate with the and often contribute to poor indoor air quality with conse-
use of disinfectants and cleaning methods (Cascella quences for the asthmatic, allergic, or sensitive people (IOM
et al. 2020). 2000). These residues contain chemicals that can cause can-
During COVID-19 public health emergency, EPA is continu- cer, reproductive disorders, respiratory ailments (including
ing its efforts to provide critical information on surface disin- occupational asthma), eye and skin irritation, central nervous
fectant products that can be used to protect the health of system (CNS) impairment, oxidative damage, and other
individuals. There is a wide array of excellent disinfectants human health effects (Choi et al. 2020). Quats have been
certified by EPA that can offer a range of characteristics to shown to possibly cause fertility issues in male and female
kill coronaviruses that are being used worldwide for disinfec- reproductive processes (Melin et al. 2016). In the US,
tion, mainly in healthcare settings (Kampf et al. 2020). There researchers estimate that 5% of childhood cancer and 30% of
is no prefect or ideal disinfectant until now. Table 2 summar- childhood asthma are related to chemical exposures
ized the list of effective chemical disinfectants that claims for (Landrigan et al. 2002).
use against coronavirus (EPA 2020). Almost all the chemical During COVID-19 pandemic, there are plenty of rumors
disinfectants are composed of some type of soap, oil, or sur- and misinformation circulated on the social media platform
factant, either natural or manmade. The majority of products against coronaviruses. People are panicked and, in their rage
used to disinfect contain the active ingredient quaternary of anxiety and fear taking extreme actions. It has been
ammonium (Quats) while others contain mixtures of hydro- reported that few people applied disinfectant on their skin
gen peroxide, peroxyacetic acid, isopropanol, ethanol, sodium and washed food products with disinfectants such as bleach
hypochlorite, octanoic acid, phenolic, triethylene glycol, L-lac- and hand sanitizer, also tried to ingest them (Chang et al.
tic acid, or glycolic acid (Table 2). In most instances, a given 2020). These types of extreme actions could be dangerous
product is intended for a specific purpose and is to be used and can cause serious health issues like permanent blindness,
in a certain manner. Therefore, the label should be read care- seizures, coma, permanent damage to the nervous system or
fully to ensure that the right product is selected for the death. Bleach solutions are very harsh on the skin and can
intended use and applied in an efficient manner. cause irritation on the skin, eyes, and other parts of body.
Additionally, caution must be exercised to avoid hazards with Few cleaning products contain caustic materials, and their
the use of cleaners and disinfectants. Otherwise, disinfectant accidental ingestion causes severe gastrointestinal toxicity
can cause different types of toxicity upon mishandling, (Arevalo-Silva et al. 2006; Sawalha 2007). Bleach ingestion is
inappropriate storage, or extensive regular application. reported to cause hypernatremia, hyperchloremia, ARDS, and
lung injury (Bracco et al. 2005). It has also been stated that
exposure of chlorine bleach causes mucosal erosions, gastro-
Toxic effect of disinfectants
intestinal irritation, ear, nose, and throat lesions, and asthma
As COVID-19 spreads across the globe, the increased use of symptoms (Medina-Ramo n et al. 2005). Glutaraldehyde and
disinfectants might lead to worldwide secondary disasters in ethylene oxide have been shown to cause serious lung dis-
human health and ecosystems. Extensive research has been ease (Dumas et al. 2019).
done previously at exposure to most frequently used disin- COVID-19 situations created havoc, and people are using
fectant compound, that is, quats, sodium hypochlorite, several kinds of disinfectant simultaneously to clean their
4 N. K. RAI ET AL.

home and surroundings. Recent survey identified important by thorough rinsing after the cleaning step is an absolute
knowledge gaps in the safe preparation of cleaning and dis- necessity.
infectants among adults (Gharpure et al. 2020). Serious Alcohol-based hand sanitizers (ABHRs) are recommended
undesirable effects may result due to the mixing of different by CDC for hand hygiene and have been effective against
cleaning products, as this can generate hazardous fumes/ viruses. The chemical constituents of hand sanitizers normally
gases. Chronic exposure to these gases can induce asthma include 60–90% ethyl alcohol or isopropyl alcohol along with
and chronic bronchitis (Medina-Ramo n et al. 2005). The mix- glycerol, and additional chemical ingredients for fragrance or
ing of bleach with ammonia-based cleaners causes the pro- color (Boyce and Pittet 2002). These constituents while using
duction of chloramines and possibly ammonia that can often get aerosolized due to vigorous and frequent rubbing
volatilize (Cohle et al. 2001). On the other hand, when bleach and may generate potential threat to skin and eyes and can
was mixed with an acid-based cleaner, it could release gas- cause allergic and irritant contact dermatitis, mild to moder-
eous chlorine or hypochlorous acid, which if inhaled, even in ate inflammatory effect, similar to allergic conjunctivitis
small amounts, may cause acute lung injury (Bracco et al. (Shetty et al. 2020).
2005; NRC 2004). In addition, chlorine disinfectants could Although COVID-19 is spread by the airborne route, air
combine with nitrogen, forming chloramine or N-nitrosodi- disinfection of cities and communities is not recommended
methylamine, which have been identified as carcinogens by CDC. The widespread practice of spraying disinfectants
(NRC 2004). Mixing bleach and alcohol creates chloroform, and alcohol in the sky, on roads, vehicles, and personnel has
which is toxic and dangerous when inhaled or when it comes not been proven to reduce the risk of COVID-19. These
in contact with the skin (Medina-Ramo n et al. 2005). To avoid chemicals can get into sewage systems and can pollute
this challenge, there should be proper information available drinking water resources (Zhang et al. 2020). Both the direct
in the public domain about the toxic effect of disinfectants, runoff and indirect sewage effluents will eventually end up in
when used in combination, wearing skin and eye protection lakes and rivers, putting aquatic ecosystems and wild life at
for potential splash hazards, ensuring adequate ventilation, risk (Sedlak and von Gunten 2011). Increased chlorine disin-
and storing and using chemicals out of the reach of children fectant level can directly harm organisms by destroying their
and pets (CDC 2020a). cell walls or damaging their proteins by oxidation (Sedlak
The ingredients used in commercial disinfectants are and von Gunten 2011). Secondly, the chemicals in the disin-
strongly encouraged by the EPA to be “biodegradable.” fectants can bond with other materials to form harmful sec-
There are many advantages of biodegradability for cleaning
ondary by-products, such as trihalomethanes or halo acetic
products; however, several implications are also associated
acids (Sedlak and von Gunten 2011). These by-products have
with it. Those “biodegradable” disinfectants on the surface
been shown to be very toxic to aquatic organisms (Liu and
when not rinsed properly after use, will leave an active chem-
Zhang 2014). China uses ozone against SARS-CoV-2 in hospi-
ical residue. This will make a surface act like an adhesive and
tals or home. High exposure of ozone and secondary air pol-
attract dirt, dust, grease, grime, flesh, and pollens, which pro-
lutants on the residents could lead to serious health risks
vide a food source for mold and other microbes. Therefore, a
(Destaillats et al. 2006). Some of the cleaning products con-
well-executed cleaning and sanitization program should
tain persistent, bio accumulative, and toxic chemicals (PBTs),
strictly consist of two steps: cleaning and then application of
which classified as hazardous waste, and/or otherwise con-
a disinfectant/sanitizer.
tribute to environmental pollution during their manufacture,
For example, the structure of benzalkonium series (quats)
use, or disposal (Klecka et al. 2009).
disinfectant is based on a permanently positively charged
Along with chemical disinfection, UV-disinfection is
ion. If a surface is not thoroughly rinsed and made free of
another practical sterilization method against microbes.
anionic detergent residue prior to quat application, then quat
During COVID-19, some people also tried UV-light to disinfect
becomes electrically neutralized and its anti-microbial action
can be totally inactivated. The complex detergent–quat resi- themselves. The efficacy of UV-disinfection against SARC-CoV-
due provides nutrients for the growth of bacteria and 2 is yet to be discovered. Though exposure of UV-light or
microbes (Gallia County Health Department 2011). If allowed LED light cannot be used on humans to inactivate the
to grow, these microbes may colonize, forming communities COVID-19 virus. It would cause burning and potentially skin
called bio films (CMM 2013). These bio films tend to thrive cancer.
on environments where moisture and soil are in constant
contact on a surface, notably food service areas, locker Safe preventive measures
rooms, restrooms, and similar places. Soap scum in a shower
is an example of such type of residue buildup. If a surface, While scientists across the globe are evaluating candidate
whether it be a floor or a countertop, feels slippery or slick remedies and vaccines to treat and prevent the novel cor-
because of moldy biofilms, lead to increased slip-and-fall onavirus, at this time there are no medications or vaccines
risks, the cause of 15% accidental deaths, according to the available for COVID-19 infection approved by the FDA.
US Occupational Safety and Health Administration (OSHA) Researchers are investigating new drugs, and drugs that are
(CMM 2013). These residues pose not only a health and already approved for other health conditions, as potential
safety risk to building occupants but can also become one of treatments for COVID-19 (FDA 2020a). Unfortunately, there is
the major risk factors behind early degradation of the build- plenty of misinformation or false/fraudulent news reachable
ings (CMM 2013). Therefore, removal of any chemical residue on the Internet and social media about the possible cures for
 CRITICAL REVIEWS IN TOXICOLOGY 5

COVID-19. Some of these purported remedies include herbal Frequent and proper hand hygiene is one of the most
therapies, vitamin C, teas, essential oils, tinctures, and silver important methods used to prevent infection with the
products such as colloidal silver. FDA had warned companies COVID-19 virus. SARC-CoV-2 has a viral envelope which
for selling fraudulent products to treat COVID-19, and stated makes it potentially susceptible to surface active agents such
that there is no scientific evidence that any of these alterna- as soap and alcohol. Therefore, we should wash our hands
tive remedies can prevent or cure the illness caused by often with soap and water for at least 20 s, and after contact
COVID-19 (FDA 2020b). with a person who is sick (CDC 2020b). If soap and water are
Covid-19 is transmitted from person-to-person by contact, not readily available and hands are not visibly dirty, hand
and from coughing that produces infected aerosols in the air sanitizer that contains at least 60–95% alcohol can be used
that can land to the person or various surfaces. The only best instead, according to modified WHO formulations (Kratzel
way to prevent SARC-CoV-2 transmission is by following pre- et al. 2020). However, if hands are visibly dirty, always wash
cautions from the credible source of information such as hands with soap and water. Alcohol-based hand sanitizers
CDC, WHO or state health department (CDC 2020b; WHO can reduce the number of germs on the hands, but they do
2020a). According to their guidelines, regular cleaning of fre- not eliminate all types of germs. Hence, soap and water are
quently touched surfaces, daily in household common areas more effective measures than hand sanitizers (CDC 2020b).
(e.g. tables, hard-backed chairs, doorknobs, light switches, The spread of the COVID-19 has spurred a surge in sales
phones, tablets, touch screens, remote controls, keyboards, of personal protective equipment (PPE), cleaning, disinfection
handles, desks, toilets, sinks) along with thorough hand and sanitizing products. WHO stated that there are world-
washing is highly recommended (CDC 2020a). In the previous wide shortages of PPE, respirator, and other protective equip-
section of this review, we discussed that frequent use of dis- ment, and that puts health-care workers at risk (WHO 2020c).
infecting chemicals and its exposure resulted in respiratory PPE such as medical mask and N95 respirators should be rec-
illness, asthma, allergy, and other hazardous effects. ommended only for healthcare worker and other first res-
Therefore, during COVID-19 it is not advisable to frequently ponders. CDC recommends that people should wear a cloth
use disinfectant around non-patients care area, which can face covering to cover their nose and mouth in the commu-
induce similar respiratory illness symptoms that can be con- nity setting. A cloth face covering is not intended to protect
fused with COVID-19. CDC’s Healthcare Infection Control the wearer but may prevent the spread of virus droplets and
Practices Advisory Committee (HICPAC) also introduced aerosol from the wearer to others (Clase et al. 2020). This
guidelines to minimize exposure to disinfectants, including would be especially important in the event that someone is
elimination or substitution of the chemical, engineering or infected but does not have symptoms (WHO 2020a).
administrative controls, or unnecessary use of personal pro- To this date, many drugs are under clinical trial. However,
tective equipment (PPE) in health-care facilities to prevent we do not know when the vaccine will be available for use.
environmental contamination (CDC 2008). It has been found Therefore, its high time we should include hand hygiene and
that public is also ignorant about the effective formulation of safe disinfection methods in our daily routine to prevent any
disinfectant and its recommended time to kill the virus, form of infection. By incorporating these preventive meas-
which can hamper the process of disinfection and ultimately ures, we can protect our health, improve indoor air quality,
adverse the health condition of the residents. In Table 2, we and can safeguard outdoor environment as well from COVID-
have summarized the EPA-certified disinfectant and their 19 (Figure 1).
effective time and right formulation to use against surface
coronaviruses. Outstanding questions
Cleaning with environmentally preferable solutions, such
as free-rinsing water cleaners are equally effective yet far kin- Furthermore, substantial research is required to clarify the
der to the environmental surface to eliminate health and toxic side-effect of each specific disinfectant. The high mor-
safety risks. By cleaning a surface with free-rinsing cleaners, tality rate of COVID-19 provides evidence that disinfections,
chemical residues will not have the chance to build up. hand hygiene compliance, and social distancing alone cannot
HICPAC also confirmed that thoroughly cleaning environmen- prevent the spread of SARS-CoV-2. This underpins the neces-
tal surfaces with water and detergent are effective and suffi- sity for extensive research about structural and pathogenic
cient procedures (CDC 2008). Rubbing alcohol or diluted features of SARS-CoV-2, which can aid in the production of
bleach can be used on some surfaces like marble, limestone, effective therapies and vaccines to control this disease.
or terrazzo countertops or floors (Kampf et al. 2020).
During COVID-19, social distancing has emerged as an
Concluding remarks
effective measure to restrain the spread of infections.
Therefore, it is advised to maintain distancing (at least six COVID-19 is now a global health threat, and the number of
feet apart) and avoid touching surfaces or our eyes, nose, confirmed new cases and deaths is increasing every single
and face with unwashed hands. We should avoid close con- day. Vaccine and drug development are under clinical trial,
tact with people who are sick and should stay home or self- but it will take time. There is already a high level of anxiety
isolate when felt sick. To prevent the spread via respiratory over the potential spread of coronavirus, which enable
droplets, we should cover our cough or sneeze with arm/ improper usage of disinfectant and consumption of fraudu-
elbow, not with hand (CDC 2020b). lent drugs, which might result in adverse effect on the
6 N. K. RAI ET AL.

Figure 1. Schematic representation shows an overview of toxic effect of improper use of disinfectant and safe alternatives against COVID-19 infection.

human health and environment. Since the SARS-CoV-2 can responsibility for the writing and content of the manuscript. None of the
remain in the air and on surfaces for few hours to several authors have been involved in legal or regulatory matters related to the
contents of the paper.
days, in addition to observing individual hygiene tips such as
regular hand washing and avoiding close contact or open
space, cloth covering or PPE wearing in the crowded areas,
and proper disinfection of frequently touched surfaces is References
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