How a rash of methanol poisonings in Thunder Bay led to a national recall of hand sanitizer

The first patient diagnosed with methanol poisoning came in at about 6:00 p.m. on Oct. 8, nephrologist Dr. Rory Silverberg recalled.

Despite having worked at the Thunder Bay Regional Health Sciences Centre for three years, it was his first case of methanol poisoning. But Dr. Silverberg knew what to do, so he treated the patient with dialysis and headed home for the night.

After dinner and a movie with his girlfriend, Dr. Silverberg got a call about a second patient diagnosed with methanol poisoning, so he headed back to the hospital to provide treatment.

There would be a total of four diagnosed methanol poisonings that night.

Click here to listen along as Thunder Bay health professionals trace the methanol poisonings back to one product.

Dr. Zaki Ahmed, the chief of staff at the Thunder Bay Regional Health Sciences Centre, said they may see one or two cases of methanol poisoning in the city each year, so four in 24 hours came as a shock.

After treating his two patients, Dr. Silverberg put a call in to the Thunder Bay District Health Unit to warn them of the high number of cases; he then started asking questions.

"So the first guy; he told me hand sanitizer, but that was the only thing he was drinking. And he told me he was getting it from a Dollarama. 

"The second patient, once he was a little bit more lucid, said that he was drinking many different things, but one of those things was hand sanitizer. So I said, where did that come from? And it was also from the Dollarama," Dr. Silverberg said.

Public health officials begin their investigation

Meanwhile, the next day, health officials at the Thunder Bay District Health Unit jumped into action.

Kandace Belanger is the manager of the street outreach nursing team.

She said her team, which includes the harm reduction nurses, started putting calls out to shelters and other organizations in the city working with vulnerable populations. They also made warning cards and fanned out across the city to spread the word about possibly contaminated hand sanitizer.

"It was an alert that there might be tainted hand sanitizer products and to not consume any hand sanitizer products, and it basically just gave [people] information about symptoms of methanol poisoning and what can happen."

Another team at the health unit began the detective work to find out which hand sanitizer product might be tainted with methanol.

"What you got to remember is that on the Friday, October 9, we didn't actually know what brand we were looking for. The only thing that we were told in terms of a clue as to what the hand sanitizer might be is that one of the patients mentioned he thought the hand sanitizer may have come from the Dollarama at Northwood Mall," said Lee Sieswerda, manager of environmental programs at the health unit.

The search narrows to two products

So they sent a public health inspector out, and he returned with two different brands.

"They were Purell, which I'm sure everyone's familiar with, and Daily Shield, which none of us had ever heard of before," Sieswerda added.

The team scoured the internet, searching for any suggestion that either brand may be tainted or if there were any reports of counterfeit products. They reached out to Ontario Health and Health Canada to see if they had any idea. 

They also had another question.

"What's the limit? Like, not having any experience with methanol and hand sanitizer before, we weren't really sure whether or not, you know, maybe a little bit of methanol would be okay, or if there should be absolutely zero."

No one seemed to have any answers. The only thing the health unit team could find was a provisional upper limit set by the U.S. Environmental Protection Agency of 630 parts-per-million.

So Sieswerda arranged to send samples of both hand sanitizers to private health laboratories in western Canada to get them tested.

As they waited for the test results, they made a key discovery on Oct. 16 that would lead them directly to the source of the methanol poisonings.

A nationwide recall advisory is issued

After the night of Oct. 8, three more people were admitted to hospital with methanol poisoning. 

"One of the nurses found a partially consumed bottle of Daily Shield in the backpack of one of those patients that was admitted for methanol poisoning." 

The health unit wasted no time. They sent health inspectors out to every Dollarama and pharmacy in the district to start pulling Daily Shield hand sanitizer products from the shelves. Sieswerda also spoke with a Health Canada investigator that Friday, who agreed there was likely enough evidence to issue a nationwide recall.

The federal agency did issue a recall advisory on Oct. 18, and after receiving the test results, they expanded the recall to all stores that carried the Daily Shield hand sanitizer on Oct. 28.

The results from the private laboratory came back to the Thunder Bay health unit on the Monday.

"The Purell that we tested was perfect. It was 70 per cent alcohol, as advertised, and there was no methanol in it, said Sieswerda.

But the Daily Shield on the other hand, Sieswerda added, "even though it says it was advertised on the bottle as being 70 per cent alcohol, it was actually only 42 per cent alcohol. So it wasn't even an effective sanitizer. But more importantly, it also contained about 11 per cent methanol."

Sieswerda said 11 per cent methanol amounted to 11,200 parts-per-million, well above the provisional limit of 630 parts-per-million.

Methanol has similar effects, but more deadly than alcohol

The problem is that human bodies can't break down methanol in the same way they break down alcohol, but if drinking methanol, "you would feel drunk; you'd get that same kind of high," said Dr. Silverberg.

When the body breaks down methanol, it forms toxic products that can cause blindness, cause movement disorders, and, if too much is consumed, it can cause death.

The hospital's chief of staff, Dr. Ahmed, said the prevalence of hand sanitizer consumption has increased during the pandemic.

"Up till more recently, it was fairly expensive to buy hand sanitizer and to drink that. So it wasn't that prevalent… but since we've had COVID, hand sanitizers have become much more prevalent.

"Now, if you walk into any store, there's hand sanitizers available both for sale and for use… but it's that increase in availability and the fact that the prices have dropped quite significantly that makes it a lot more palatable," said Dr. Ahmed.

The health unit's Sieswerda added that this case could be turned into an argument for tighter regulations on important products being imported into Canada — the hand sanitizer sold under the Daily Shield brand was later discovered to have been imported from Mexico.

But he said the most important lesson is about the need for collaboration across the health sector, and the way collaboration can save lives.

"Everybody really worked hard together to alert each other. And then the collaboration was pretty much seamless in terms of everybody cooperating and working together to get the product off the shelf, to alert the vulnerable population and to track down the company responsible."