Exposure to hand sanitisers and other cleaning products in Victoria, Australia during the COVID-19 pandemic.

BACKGROUND: In response to the COVID-19 pandemic, there was increased promotion and use of topical antiseptics (especially hand sanitisers) and cleaning products to reduce transmission of the SARS-CoV-2 virus. This study describes unintentional exposures (oral or ocular) to these substances by children during the first year (2020) of the COVID-19 pandemic compared to the previous year (2019). METHODS: This was a retrospective observational study of unintentional exposures reported to the Victorian Poisons Information Centre for the period 1 January 2019 to 31 December 2020. Substances included topical antiseptics (including hand sanitisers), bleach, multipurpose cleaners, disinfectants and high-percentage ethanol products. We analysed data for two age groups; under 5 years and 5 to 14 years. RESULTS: Oral exposures (ingestion or buccal) to topical antiseptics increased from 435 in 2019 to 882 in 2020 in the under 5 age group, with peak call numbers in 2020 coinciding with peaks in active COVID-19 daily case numbers. Oral exposures in older children (5-14 years) were lower (23 and 77 in 2019 and 2020, respectively). No children had moderate or severe symptoms at the time of the call to the Poisons Centre. Ocular exposures to topical antiseptics more than doubled from 2019 to 2020 (from 20 to 53 among children under 5 years, and 8 to 18 in older children). The majority of children with ocular exposure presented with mild symptoms; one had moderate symptoms. Changes in exposures to disinfectants, bleach and cleaners were smaller and not consistent with peaks in active COVID-19 cases. CONCLUSIONS: Unintentional oral exposures to topical disinfectants (mainly hand sanitiser) by young children increased during the COVID-19 pandemic and were more prevalent during periods of increased COVID-19 cases. While there were no cases of severe harm identified, the high number of exposures suggests that appropriate use and storage of hand sanitisers should be promoted.

Outcomes for emergency department patients with suspected and confirmed COVID-19: An analysis of the Australian experience in 2020 (COVED-5).

OBJECTIVE: The aim of the present study was to describe the characteristics and outcomes of patients presenting to Australian EDs with suspected and confirmed COVID-19 during 2020, and to determine the predictors of in-hospital death for SARS-CoV-2 positive patients. METHODS: This analysis from the COVED Project presents data from 12 sites across four Australian states for the period from 1 April to 30 November 2020. All adult patients who met local criteria for suspected COVID-19 and underwent testing for SARS-CoV-2 in the ED were eligible for inclusion. Study outcomes were mechanical ventilation and in-hospital mortality. RESULTS: Among 24 405 eligible ED presentations over the whole study period, 423 tested positive for SARS-CoV-2. During the 'second wave' from 1 July to 30 September 2020, 26 (6%) of 406 SARS-CoV-2 patients received invasive mechanical ventilation, compared to 175 (2%) of the 9024 SARS-CoV-2 negative patients (odds ratio [OR] 3.5; 95% confidence interval [CI] 2.3-5.2, P < 0.001), and 41 (10%) SARS-CoV-2 positive patients died in hospital compared to 312 (3%) SARS-CoV-2 negative patients (OR 3.2; 95% CI 2.2-4.4, P = 0.001). For SARS-CoV-2 positive patients, the strongest independent predictors of hospital death were age (OR 1.1; 95% CI 1.1-1.1, P < 0.001), higher triage category (OR 3.5; 95% CI 1.3-9.4, P = 0.012), obesity (OR 4.2; 95% CI 1.2-14.3, P = 0.024) and receiving immunosuppressive treatment (OR 8.2; 95% CI 1.8-36.7, P = 0.006). CONCLUSIONS: ED patients who tested positive for SARS-CoV-2 had higher odds of mechanical ventilation and death in hospital. The strongest predictors of death were age, a higher triage category, obesity and receiving immunosuppressive treatment.

Epidemiology and clinical features of emergency department patients with suspected COVID-19: Insights from Australia's 'second wave' (COVED-4).

OBJECTIVE: The aim of the present study was to describe the epidemiology and clinical features of patients presenting to the ED with suspected and confirmed COVID-19 during Australia's 'second wave'. METHODS: The COVID-19 ED (COVED) Project is an ongoing prospective cohort study in Australian EDs. This analysis presents data from 12 sites across four Australian states for the period from 1 July to 31 August 2020. All adult patients who met the criteria for 'suspected COVID-19' and underwent testing for SARS-CoV-2 in the ED were eligible for inclusion. Study outcomes included a positive SARS-CoV-2 test result, mechanical ventilation and in-hospital mortality. RESULTS: There were 106 136 presentations to the participating EDs and 12 055 (11.4%; 95% confidence interval [CI] 11.2-11.6) underwent testing for SARS-CoV-2. Of these, 255 (2%) patients returned a positive result. Among positive cases, 13 (5%) received mechanical ventilation during their hospital admission compared to 122 (2%) of the SARS-CoV-2 negative patients (odds ratio 2.7; 95% CI 1.5-4.9, P = 0.001). Nineteen (7%) SARS-CoV-2 positive patients died in hospital compared to 212 (3%) of the SARS-CoV-2 negative patients (odds ratio 2.3; 95% CI 1.4-3.7, P = 0.001). Strong clinical predictors of the SARS-CoV-2 test result included self-reported fever, sore throat, bilateral infiltrates on chest X-ray, and absence of a leucocytosis on first ED blood tests (P < 0.05). CONCLUSIONS: In this prospective multi-site study during Australia's 'second wave', a substantial proportion of ED presentations required SARS-CoV-2 testing and isolation. Presence of SARS-CoV-2 on nasopharyngeal swab was associated with an increase in the odds of death and mechanical ventilation in hospital.

COVID-19 and toxicity from potential treatments: Panacea or poison.

Since December 2019, coronavirus disease (COVID-19) has been increasingly spreading from its origin in Wuhan, China to many countries around the world eventuating in morbidity and mortality affecting millions of people. This pandemic has proven to be a challenge given that there is no immediate cure, no vaccine is currently available and medications or treatments being used are still undergoing clinical trials. There have already been examples of self-medication and overdose. Clearly, there is a need to further define the efficacy of treatments used in the management of COVID-19. This evidence needs to be backed by large randomised-controlled clinical trials. In the meantime, there will no doubt be further off-label use of these medications by patients and practitioners and possibly related toxicity.