Which disinfectant is to be used in cases of suspected or contracted SARS-CoV-2 coronavirus (COVID-19, for coronavirus disease 19)?

In our globally connected world, the new coronavirus (SARS-CoV-2), which has been present in China since December 2019, has now also arrived in Europe. The new SARS-CoV-2 multiplies primarily in the throat, but also in the deeper respiratory tract. It is mainly transmitted via droplet or contact infection. After an incubation period of up to 14 days, the symptoms of the disease can be quite unspecific in some cases, ranging from subclinical and mild courses with a cough, runny nose, scratchy throat, shortness of breath, muscle/joint pain and fever (in rarer cases also nausea and diarrhea) to pneumonia and severe respiratory problems. As with an infection with influenza viruses, older people (>60 years) and people with comorbidities such as chronic obstructive respiratory disease, heart disease, kidney disease or diabetes mellitus are particularly at risk. Immunosuppressed people (e.g. after transplantation or cancer treatment) are also at increased risk of contracting a SARS-CoV-2 infection.
The development of antivirals and vaccines will take some time - even though intensive research is currently being carried out at full speed.
For this reason, hygiene measures are currently the most relevant for the prevention of SARS-2 coronavirus-related illnesses. The most important measures at present are compliance with general hygiene measures, such as thorough hand washing, coughing and sneezing etiquette and keeping your distance from people who are ill.
In the medical field, hand and surface disinfection, together with other suitable basic hygiene measures, reduces the risk of transmission of infectious agents and therefore makes a significant contribution to preventing infections. However, it is not easy for users of disinfectants to select a suitable product from the sole list of active ingredients such as ethanol, hydrogen peroxide or sodium hypochlorite [1], especially as other active ingredients such as isopropanol (2-propanol) are also possible. In contrast, the products on the disinfectant lists evaluated by independent experts, such as the German VAH [2] and RKI [3] lists, offer safety for the user. The lists are based on national test methods (DVV/RKI guidelines) as well as European standards and the respective requirements for listing [4, 5]. In Europe, three efficacy ranges are available for the declaration of virus-effective disinfectants, which are defined by different test viruses.
Disinfectants with "limited virucidal" efficacy are already sufficient against enveloped viruses. For coronaviruses - including SARS-CoV-2 - or influenza viruses, which are all enveloped viruses, a disinfectant with limited virucidal efficacy is therefore sufficient.
Disinfectants with "limited virucidal PLUS" efficacy also protect against the currently occurring noroviruses and rotaviruses that cause diarrhea. For highly resistant, non-enveloped viruses such as enteroviruses (which cause hand-foot-and-mouth disease, for example), "virucidal" agents are required.

Hand hygiene
For public areas such as offices, nurseries or schools, we recommend thorough hand washing [6, 6a]. If carried out correctly, this is an effective and sensible infection prevention measure. With influenza viruses, it has been shown that even soap and water inactivate the virus after 20 seconds [7].
When dealing with people in the home who have a SARS-CoV-2 infection (laboratory-confirmed), the use of hand disinfectants with a limited virucidal spectrum of activity is recommended, especially if the household includes people at risk (e.g. immunosuppressed or elderly people with underlying illnesses).
As an alternative to commercially available hand disinfectants, alcoholic solutions prepared in pharmacies in accordance with standard approval 2 propanol 70% (v/v) [8] or the ethanol-based WHO formulation I or 2 propanol-containing WHO formulation II [9, 10] can also be used.
The efficacy against enveloped viruses has been proven for both the WHO formulations and the 70% isopropanol solution according to standard approval [11, 3].

Surface disinfection
The SARS-1 coronavirus from 2002/2003 can multiply on smooth surfaces for up to 6 days [12], on paper the virus remains infectious for much less time [13]. Comparative studies between SARS-CoV-1 and SARS-CoV-2 are currently being carried out (personal communication Prof. Rabenau). Due to the structural similarity and close relationship of the viruses, it can be assumed that there will be no significant differences.
When dealing with people in the home who have a SARS-2 coronavirus infection (laboratory-confirmed), disinfecting surfaces that have been touched by the sick person and through which the viruses can spread with one of the listed disinfectants with a limited virucidal spectrum of activity can limit the spread of the viruses in the immediate environment of those affected. Due to the risk of fire and explosion, the use of alcohol-based solutions is only permitted for small areas under certain conditions [14]. Such measures should be preceded by a consultation with the attending physician or the public health department for an individual risk assessment.
Summary:

All disinfectants with proven limited virucidal efficacy are suitable for inactivating coronaviruses (including SARS-CoV-2). Products with the limited virucidal PLUS and virucidal spectrum of activity can also be used. Suitable products can be found in the lists of the VAH and the RKI. Alternatively, 2 Propanol 70% (v/v) according to standard approval and WHO formulations I and II can be obtained from pharmacies for hand disinfection. Disinfection measures are only necessary in medically justified cases. For healthy people, regular and thorough hand washing for at least 20 seconds is one of the most important hygiene measures to protect against infection with the novel coronavirus SARS-CoV-2.

Authors

M. Eggers, I. Schwebke, B. Geisel, M. Suchomel, H.F. Rabenau

PD Dr. Maren Eggers eggers@labor-enders.de
Dr. Bertram Geisel bertram.geisel@rps.bwl.de
Ass.-Prof. Dr. Miranda Suchomel miranda.suchomel@meduniwien.ac.at
Dr. Ingeborg Schwebke SchwebkeI@rki.de

Sources

[1] https://www.ecdc.europa.eu/sites/default/files/documents/coronavirus-SAR.
[2] Disinfectant list of the VAH, https://vah-online.de/de/desinfektionsmittel-liste
[3] Disinfectants and disinfection methods (as of October 31, 2017, 17th edition). Bundesgesundheitsbl Gesundheitsforsch Gesundheitsschutz 60, 1274-1297, https://www.rki.de/DE/Content/Infekt/Krankenhaushygiene/Desinfektionsmit...
[4] Disinfectant Commission in the Association for Applied Hygiene (VAH) (2015) Requirements and methods for VAH certification of chemical disinfection procedures. Status: 15.06.2019, loose-leaf collection.
[5] https://www.rki.de/DE/Content/Infekt/Krankenhaushygiene/Desinfektionsmit...
[6] https://www.infektionsschutz.de/haendewaschen/
[6a] https://www.infektionsschutz.de/mediathek/infografiken.html
[7] https://www.rki.de/DE/Content/Infekt/Krankenhaushygiene/Erreger_ausgewae...
[8] https://www.bfarm.de/DE/Arzneimittel/Arzneimittelzulassung/Zulassungsrel...
[9] World Health Organization. WHO guidelines on hand hygiene in health care: first global patient safety challenge clean care is safer care. Geneva : WHO, 2009
[10] https://www.baua.de/DE/Angebote/Aktuelles/Meldungen/2020/pdf/Allgemeinve...
[11] Siddharta et al. Virucidal Activity of World Health Organization-Recommended Formulations Against Enveloped Viruses, Including Zika, Ebola, and Emerging Coronaviruses. J Infect Dis. 2017; 215(6):902-906.
[12] Rabenau et. al. Stability and inactivation of SARS coronavirus. Med Microbiol Immunol. 2005;194(1-2):1-6.
[13] Lai et al. Survival of Severe Acute Respiratory Syndrome Coronavirus. CID 2005; 41: e67-e71
[14] TRGS 252 Hazardous substances in medical care facilities. https://www.baua.de/DE/Angebote/Rechtstexte-und-Technische-Regeln/Regelw...

For more information, see among others:
- https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/nCoV.html
- https://www.krankenhaushygiene.de/ccUpload/upload/files/2020_01_31_Coron...
- https://www.krankenhaushygiene.de/ccUpload/upload/files/2020_01_31_Coron...
- https://www.who.int/gpsc/5may/Guide_to_Local_Production.pdf