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      Driving under the influence of alcohol during the COVID-19 pandemic

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          Abstract

          Aim

          The main objective of this study was to evaluate the effects of the COVID-19 pandemic on the pattern of alcohol use in drivers.

          Materials

          and methods. At the National Institute of Legal Medicine from Bucharest, we performed a retrospective study on toxicology reports between January 1st , 2019 and December 31st, 2020. Breath alcohol concentration (BrAC) was tested using Dräger breathalyzers by police units at the scene, and blood alcohol concentration (BAC) was evaluated using headspace gas chromatography. Most drivers gave two blood samples, separated by a one-hour interval, case in which they could request a retrograde extrapolation of the BAC at the time when they were stopped in traffic.

          Results

          The distribution of the number of cases depending on the month showed a sharp decline in the first six months of the lockdown, with a slow upward trend afterward. Mean overall values for BrAC were 0.49 +/-0.40 mg/L, for 1 st sample BAC - 1.15+/-0.99 g/L and for 2 nd sample BAC - 1.29+/-0.81 g/L. Mean values obtained for BrAC were 0.48+/-0.39 mg/L before the pandemic and 0.52+/-0.43 mg/L during the pandemic. The increase was similar in absolute numbers in both male and female drivers (0.03 versus 0.04 mg/L respectively for BrAC and 0.02 g/L for both genders for 1 st sample BAC). However, the percentage increase was significantly higher in women. There were 253 cases in which BrAC had values between 0.01 and 0.05, of which 138 occurred before the pandemic and 115 during the pandemic, the increase being highly statistically significant. The percentage of drivers with BAC levels below and above 0.8 g/L (the threshold value for which DUI is a felony in Romania) were similar before and during the pandemic.

          Conclusions

          During the lockdown, the number of alcohol tests in traffic has decreased significantly. This reduction was not associated with statistically significant changes in BrAC or BAC. We have seen a substantial increase in the number of minimally elevated BrAC and negative BAC cases, changes that could be caused by an increased use of alcohol-based hand sanitizers.

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          Most cited references21

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          Testing a new alcohol-free hand sanitizer to combat infection.

          K B Gerenraich, P Wadhams, Thomas Dyer (1998)
          Universal precautions require that perioperative health care personnel wash their hand before and after all patient contact. Time constraints, however, can make adhering to universal precautions, including proper hand washing, difficult. Some perioperative health care workers, therefore, routinely use rise-free hand sanitizers to supplement normal hand washing. This study evaluated immediate and persistent antimicrobial effectiveness of two alcohol--containing hand sanitizers and a novel surfactant, allantoin, benzalkonium chloride (SAB) hand sanitizer using a federally approved effectiveness protocol. Results indicate that all three products were equally effective after a single application. After repeated use, the alcohol-containing sanitizers did not meet federal performance standards, and the alcohol-free sanitizer did. These properties and others illustrated in this article indicate that the nonflammable, alcohol-free SAB hand sanitizer is the most favorable of the rise-free hand sanitizer formulas for normal hand washing.
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            Does the clinical use of ethanol-based hand sanitizer elevate blood alcohol levels? A prospective study.

            A Rosin, M. Patel, Joseph M A Miller … (2006)
            Ethanol-based hand sanitizers (EBHSs) are used in most health care facilities in the United States. Infection control personnel advocate the use of generous quantities of EBHS before and after contact with patients. Although it is assumed that little systemic absorption of ethanol occurs during EBHS use, many alcohols are absorbed to varying degrees via the transdermal route. Ethanol intoxication by employees in the medical workplace is a potentially serious finding, and it is of forensic and medical-legal importance to elucidate the effects of frequent use of EBHS upon serum blood ethanol levels (BELs). To investigate the effect of frequent use of EBHS upon serum blood ethanol concentrations, we prospectively studied 5 volunteers undergoing frequent application of EBHS. Enrolled subjects applied 5 mL of the product (62% denatured ethyl alcohol manufactured by Kimberley-Clark, Roswell, GA) to both hands and rubbed until dry. This activity was repeated 50 times over 4 hours. Participants had their blood drawn before as well as after completing the study. Each participant was without alcohol exposure during the 12 hours preceding the study. Five volunteers were enrolled. All had an initial blood ethanol level of less than 5 mg/dL. All 5 participants completed the 4-hour study. There were no noted adverse reactions during the study. Blood ethanol level upon completion of the 50 applications of EBHS was less than 5 mg/dL in all 5 study participants. The results of this study demonstrate that use of ethanol-based hand sanitizers, when frequently used in accordance with labeling, do not raise serum blood ethanol levels.
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              Is Alcohol in Hand Sanitizers Absorbed Through the Skin or Lungs? Implications for Disulfiram Treatment

              Colin Brewer, Emmanuel Streel (2020)
              ABSTRACT Aim In view of the increase in the use of ethanol-containing hand sanitizers throughout the world due to the current COVID-19 pandemic, we wished to review the possible risks to patients treated with disulfiram, following a case report in which an apparent DER (disulfiram–ethanol reaction) was attributed to the cutaneous absorption of alcohol from hand sanitizers as well as by inhalation of vapour. Method Simple experiments to assess the levels of absorption by each route separately. Results Our results strongly suggest that while amounts of alcohol sufficient to cause a DER may be inhaled when hand sanitizers are used in confined spaces, absorption can be avoided by dispersal of the fumes, and absorption from the skin alone does not occur in pharmacologically significant quantities. Conclusion Warnings about absorption of alcohol through the skin from hand sanitizers and products such as perfumes, deodorants and after-shave (whose use is often warned against when disulfiram is prescribed) should be modified accordingly.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Forensic Sci Int
                Journal ID (iso-abbrev): Forensic Sci Int
                Title: Forensic Science International
                Publisher: Elsevier B.V.
                ISSN (Print): 0379-0738
                ISSN (Electronic): 1872-6283
                Publication date PMC-release: 23 October 2021
                Publication date (Electronic): 23 October 2021
                Electronic Location Identifier: 111076
                Affiliations
                [a ]Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
                [b ]National Institute of Legal Medicine, Bucharest, Romania
                Author notes
                [* ]Correspondence to: Sos.Vitan Barzesti 9, 042122 Sector 4 Bucuresti, Romania
                Article
                Publisher Item ID: S0379-0738(21)00396-0 Publisher ID: 111076
                DOI: 10.1016/j.forsciint.2021.111076
                PMC ID: 8539202
                PubMed ID: 34736051
                SO-VID: b98c9a03-746e-4e28-8a0c-a04c4c8665d3
                Copyright © © 2021 Elsevier B.V. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 30 July 2021
                Date revision received : 19 October 2021
                Date accepted : 21 October 2021
                Categories
                Subject: Article

                ScienceOpen disciplines: Forensic science
                Keywords: alcohol,drivers,covid-19,pandemic,breath alcohol concentration,blood alcohol concentration
                Data availability:
                ScienceOpen disciplines: Forensic science
                Keywords: alcohol, drivers, covid-19, pandemic, breath alcohol concentration, blood alcohol concentration

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