Alcohol Poisoning Outbreak in Iranian Adult Population During the COVID-19 Pandemic: A Prospective Cross-sectional Linkage Study from 13 Toxicology Referral Centers in Iran

Background: We aimed to investigate the epidemiology of the methanol poisoning outbreak that occurred during the COVID-19 pandemic in Iran based on the data available from 13 referral toxicology centers and the Iranian Legal Medicine Organization (LMO).

Methods: This descriptive, cross-sectional linkage study was conducted on the data collected from thirteen referral toxicology centers throughout the country as well as administrative data obtained from the Iranian LMO, which provided us with the death tolls from toxic alcohol poisonings between February and June 2020, i.e., during the initial months of the COVID-19 epidemic in Iran.

Results: A total of 795 patients were hospitalized due to alcohol intoxication, of whom 84 died. Median [IQR] age was 32 [26, 40] years (range: 19 to 91 years). Twenty non-survivors presented with a GCS >8, six of whom were completely alert on presentation to the emergency departments. Males (718 cases; 90%) were more commonly admitted compared to females (P<0.001). Age was significantly different between the survivors and non-survivors (39 vs. 31 years, P<0.001). Dialysis was performed in 582 (73.2%) of the patients. Among the survivors, 491/711 (69.1%) had no sequelae on discharge, whereas 131/711 (18.3%) had visual disturbances and 8/711 (1%) had neurological complications.

Conclusion: Public health education can decrease the number of victims of methanol poisoning during the pandemic. Lack of access to high-quality and standardized ethanol or hand sanitizers during the pandemic may result in more methanol poisoning outbreaks, especially in countries with limited access to legal alcoholic beverages. This should be taken into account when harm reduction for alcohol use is the goal.