Rubbing alcohol

CB is a 35-year-old man presenting to the emergency room unconscious. His mom tells the admitting nurse that she found him on the floor with an empty bottle of rubbing alcohol in his hand. CB had read on the Internet that alcohol disinfects the SARS-CoV-2 virus. Afraid that he had been infected after touching his face at the grocery store, CB found a bottle of 91% rubbing alcohol and started drinking it.

Immediately after drinking the entire bottle, CB felt confident. He wasn't going to be infected this time. Someone on the Internet said it'll burn a little on the way down, but in his mind the benefits of disinfecting himself outweighed that burn. As the minutes passed, CB started feeling dizzy. The floor started spinning. He collapsed. His mom heard the noise and found him unconscious on the floor. She called for 911 as he's brought to the emergency room where we are now.

Rubbing alcohol's real name is isopropyl alcohol. Iso- meaning equal, propan-, which is a prefix, denoting the quantity of 3 and referring to the number of carbons, and alcohol meaning a chemical moiety of 1 oxygen bound to 1 hydrogen.

Long chains of carbon are oil. Oil doesn't mix with water at all, but alcohol groups interact with water because water is also made of hydrogen and oxygen. Both the name isopropyl alcohol and its structure not only tells us everything that we need to know about what's happening to CB, but it also tells us why drinking disinfectant isn't going to cure anyone of the virus.

How do alcohols disinfect? Well, they disturb proteins. On the surface of the SARS-2 virus are crown-shaped spikes. The word corona means crown, crown virus. These spikes are how SARS-2 virus infects people, and they're made of protein. If alcohols interfere with proteins and SARS-2 infects people using a protein, then rubbing alcohol should disinfect SARS-2 virus.

Seventy percent rubbing alcohol is a better disinfectant on surfaces than 91%. More doesn't appear to be better here. If 70% is alcohol, then the other 30% is water. Extra water helps to target these proteins. But while 70% isopropanol disinfects viruses on surfaces, it's not going to disinfect viruses inside the body, and here's why.

Anything that you swallow goes into your stomach and then absorbs into your liver. The liver breaks things down into forms that the body can handle. This is called metabolism. Humans evolved a very specific way of metabolizing alcohols. In the liver, there's something called alcohol dehydrogenase, de- meaning the removal of hydrogen, and -ase describing an enzyme, which is a protein that does chemical reactions (-ase is like lactase, which is an enzyme that breaks down milk sugar).

The body has no use for rubbing alcohol. It wants to get rid of it. To do that, it needs to make it easier to react with, in the hopes that a final product easily dissolves in water and can be collected by the kidneys to be urinated out. When alcohol dehydrogenase processes isopropanol it becomes acetone, which is the chemical name for nail polish remover.

Okay. If someone is exposed to SARS-2 virus and they get infected, it ends up in both of their lungs. We've already established that drinking rubbing alcohol is going to pass it into the liver where it's broken down to acetone. Acetone is a disinfectant too, so why wouldn't it end up in the lungs to fight the virus?

Well, this brings us to a concept called distribution. Once something is broken down by the liver, it enters the circulation. Human body has a large volume of water and blood, so that acetone is going to get diluted in that huge volume. Drinking a bottle of 91% rubbing alcohol will overload alcohol dehydrogenase in the liver. The acetone floating around will cause temporary brain problems, but it won't be concentrated enough to hit any virus in the lungs. Okay, so that's rubbing alcohol.

How about 60% liquor, like vodka or rum? Well, the alcohol that humans drink for fun is different. It's named ethanol. Ethan- means two. The CDC says that 120 proof, or 60% alcohol, can disinfect SARS-2 virus. But that disinfection happens outside the body, not inside.

Ethanol's broken down by alcohol dehydrogenase in the liver. Anything with an alcohol group gets processed by this enzyme. The result is acetaldehyde. This is what causes someone to become red when they drink and it also causes hangovers.

Acetaldehyde isn't a disinfectant and the body wants to get rid of it, so acetaldehyde is broken down again into acetate, which is a very weak vinegar and also not a disinfectant. Vinegar can be a disinfectant, but when it's weakened like this it isn't.

Drinking 60% liquor won't cure anyone of COVID-19 if SARS-2 virus is already in the body. Inhaling it won't cure the disease either. It would bypass the liver. It would bring a first pass of alcohol right to the brain. We don't have good data on this. But at 60%, that's going to negatively impact your brain, provided it doesn't damage the mucous membranes and lungs in the first place.

Alcohol inhalation misuse can cause acute respiratory distress syndrome, which is what happens in severe COVID-19 disease. The only analogy I have for inhaling really concentrated ethanol in hopes of disinfecting SARS-2 virus in your lungs is that it's like lopping off your leg to clip a toenail. No benefit at all and all risk, so don't do it.

The final, alcohol. There were news reports of people in Iran drinking industrial-strength alcohol, a prominent one being methanol, methan- being the prefix meaning one. In the body, alcohol dehydrogenase turns methanol into formaldehyde. This chemical was used to embalm mummies.

Formaldehyde is a disinfectant, but it's also a poison. Instead of weak vinegar, formaldehyde gets broken down a second time to become methanoic acid, which causes blindness. The acid part spills into the blood, causing acidemia, acid presence in blood. In high enough amounts in blood, acids can cause the heart to stop beating, meaning that no alcohols are good enough for curing COVID-19 inside humans. They should be good enough to disinfect surfaces outside the body in the right concentrations, which brings us back to CB.

Acetone -- nail polish remover -- causes mild nervous system effects. The body can't break it down any further because of the balance part from the word iso-. The chemistry says that these bonds are too hard to break in humans, so it's a matter of time for CB's body to work to eliminate it in his urine.

With supportive care, he came out of his coma and was sent home a day later. It's good that he ended up being okay, but it's not good that the hospital had to use those resources during this pandemic. There are other patients who come in critically ill, and then there's CB because he drank rubbing alcohol. Don't be like CB.

How about another disinfectant? AC is a 40-year-old man presenting to the emergency room with drooling and vomiting. He tried to speak, but he couldn't. An exam of his mouth and throat found swelling, redness, and ulcers inside. In the emergency room, doctors immediately stick a tube with a camera down his throat. Swelling and inflammation were so bad that they couldn't find his vocal cords.

A longer tube was stuck down his throat to look at his stomach. Burns and dead tissue were found in the inner lining of his esophagus, confirming that AC is suffering from caustic burn injury because he accidentally swallowed industrial-strength bleach, thinking that it would cure him of the virus.

He later claimed that he thought it was dilute and watered down before drinking it, which is plausible, and here's why. Bleach is a really good disinfectant. Household bleach is sodium hypochlorite. If you take away the hypo-, sodium chlorite is industrial-strength bleach.

This brings us to a concept called equilibrium. Household bleach is around 6% sodium hypochlorite. The rest is mostly water. In this mixture, water interacts with the sodium and the hypochlorite. If we break it down, bleach is multiple chemicals living together in a balanced state called equilibrium.

These chemicals are sodium hydroxide, which is a base. A base is something that takes hydrogens. This is opposite to an acid, which is something that gives hydrogens, and this balance is complete because bleach produces hypochlorous acid in solution. These quickly kill bacteria and viruses, but they're not the only thing that bleach kills.

Human cells are enclosed by a layer of molecules that have long chains of fats. Sodium hydroxide from the bleach doesn't just take a hydrogen from these fats, it strips off long chains of it. Doing this actually ends up making soap. Immediately on contact, bleach rips open cells, spilling their contents out, but it's not done here.

Proteins live on the surface of cells, meaning that they're freed once that fat layer is stripped off. Sodium hydroxide and hypochlorous acid from bleach neutralize these proteins, all of this immediately consuming the bleach solution. By the time it gets to the stomach it's not really bleach anymore.

It's a mix of soap, salt, and dead liquefied tissue. This is why it doesn't cure COVID-19. It consumes itself on the way down because it reacts with everything that it touches. It never gets to the lungs, but if someone somehow did inhale it, it would strip off all the cells of the windpipe and the lungs, causing burns there too. Again, lopping off your leg to clip a toenail.

AC developed narrowing in his esophagus because scar tissue grew over time. He had to undergo multiple procedures where a balloon was put in his esophagus and inflated to keep it open, and he was maintained on a liquid diet because there were permanent scars.

Alcohol and bleach are surface disinfectants. They don't disinfect inside the body. They only cause harm, without any benefit at all.

How about other things? Some people say eating garlic is going to help fight SARS-2 virus. Well, it's probably not going to. Garlic has some antimicrobial properties and this could be because of a chemical named allicin. There could be more chemicals, and that's fine. When you see something like this in a chemical, you can assume that it's going to interact with sulfur in the body. Where's sulfur? It's in proteins, just like the SARS-2 virus spike. But inside the body, it's going to get broken down when you eat it.

You might say that garlic can boost the immune system. Okay, suppose that's real, and maybe it is. How are you going to measure that? And there's no role in treating a critically ill patient today with that. "I don't need to wash my hands because I ate garlic today." No, stop.

The only documented case of garlic doing anything for COVID-19 is a report from China in Zhejiang province, where a woman ate 3 lbs. of garlic. This is what happened to her throat. She couldn't speak because it was inflamed. That's it

Don't get me wrong, I like my garlic. But if I have fever and I'm starting to become short of breath right now in March 2020, I'm not going to be eating more garlic hoping that it all goes away and neither should you.

There's also more talk about ginger. Look, SARS-2 virus broke out in China. Chinese people today still practice traditional Chinese medicine, mixed with variations on Western standards of care. If ginger worked, they would have used it and SARS-2 virus wouldn't have spread like this. But it did spread like this.

Finally, essential oils. These have kind of become the butt of jokes -- and I know people probably want me to rag on them -- but they do actually have compounds that have demonstrated some antimicrobial activity, but the game changes once these things are inside the body. That's the overarching theme for everything involving disinfecting this virus. The scientific phrase for this is in vivo, from Latin meaning "inside life."

These things are broken down into things that don't disinfect, and if they do, they're not in the right amounts to disinfect. They end up causing more harm than good in the body. For essential oils, the reality is that the manufacturers of these oils have a wide variability in how much of the active chemicals are in their formulation. One manufacturer might have more of one thing than the other. One may have less than the other. It's not reliable and it's not enough to cure COVID-19 disease, and it could do harm in falsely elevating your confidence that it has eliminated a virus when it actually hasn't.

I can't say the name of this thing [image of white powder], but there's nothing disinfectant about this. There's nothing disinfectant about any of its metabolites. The ending of its name, -caine, actually refers to anesthetics, meaning that they usually function on nerves to numb an area.

Vitamin C. There isn't great evidence for it on cold and flu, which are different illnesses than COVID-19. If you're going to take it, follow the directions on the label. Don't double it up. The general consensus is this. Lots of things can kill SARS-2 virus outside of the body. They don't kill the virus inside the body because the game changes in vivo. At best, they don't mess with COVID-19 disease like garlic and ginger, and at worst, they cause somebody to go blind, and someone's heart to stop beating like methanol. At worst, it liquefies and strips off the inner lining of your throat and stomach, like bleach.

Or at worst, it does nothing and gives someone self-confidence that they're clear of the infection when they're actually not. Then they go out and spread it around the community because they think they're virus-free. Don't be that person.

Wash your hands after you come back home. Wash them after you touch anything that came from outside of your house. When you wash, keep the soap on your hands for 20 seconds while rubbing them together thoroughly. It's even better if you wash them a second time again for another 20 seconds right after, and then dry your hands with a clean towel.

That's all benefit for prevention with little risk. But if you do feel fever and cough and body aches, then get that checked out. Don't pretend nothing is wrong if you feel sick. It doesn't matter what age you are. This is very important. #alertnotanxious. Check out Heme Review. Take care of yourself and be well.

"Dr. Bernard" is a licensed physician and clinical adjunct professor at the University of Illinois. See more of his videos on his "Chubbyemu" YouTube channel.

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