Abstract
While it remains much too early to determine precisely how alcohol use might affect risk for or progression of COVID‐19, any efforts to connect the dots from past alcohol research would suggest it wise for nondrinkers and low‐risk drinkers to maintain that status during this public health crisis. It's already known that disaster can result in increased alcohol consumption based on the work of Deborah Hasin, Ph.D., after 9/11 (see “Alcohol and isolation: Experts comment on drinking behavior during COVID‐19,” ADAW March 30; https://onlinelibrary.wiley.com/doi/10.1002/adaw.32670).
Bottom Line…
Research offers compelling evidence that problematic alcohol use could expose individuals to greater risks during the COVID‐19 crisis.
While it remains much too early to determine precisely how alcohol use might affect risk for or progression of COVID‐19, any efforts to connect the dots from past alcohol research would suggest it wise for nondrinkers and low‐risk drinkers to maintain that status during this public health crisis. It's already known that disaster can result in increased alcohol consumption based on the work of Deborah Hasin, Ph.D., after 9/11 (see “Alcohol and isolation: Experts comment on drinking behavior during COVID‐19,” ADAW March 30; https://onlinelibrary.wiley.com/doi/10.1002/adaw.32670).
Although the understanding of the effects of acute exposure to alcohol on immune function remains somewhat unclear, the research clearly points to binge drinking or chronic excessive drinking suppressing immune function, says M. Katherine Jung, Ph.D., director of the Division of Metabolism and Health Effects at the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
“It modifies the system at a number of points,” Jung told ADAW. “If you binge, it suppresses your ability to defend against infection.”
Delivering that message even to lower‐risk users of alcohol might prove valuable at a time when the vast majority of Americans have faced major upheaval to their typical work and family lives in recent weeks. Spikes in alcohol sales as stay‐at‐home orders were being enacted across the country last month, along with survey results suggesting a troubling tendency toward at‐home drinking during work hours, indicate a high probability that some lower‐risk drinkers could move into a higher‐risk category.
“We have no idea of the scope of what we're going to be dealing with at the end of the bell curve,” Lawrence Weinstein, M.D., chief medical officer at American Addiction Centers (AAC), told ADAW. However, “We hypothesize that we may see an acceleration of the progression of illness. A process that often may take years to unfold may be compressed during the pandemic.”
Relevant research findings
The NIAAA's Jung points to several studies that have clarified alcohol's effects on lung physiology and have described the processes within the immune system that alcohol modifies.
A meta‐analysis led by Evangelia Simou of the UK Centre for Tobacco and Alcohol Studies (University of Nottingham) and published in 2018 in the journal Chest reviewed 17 observational studies encompassing more than 177,000 individuals. It found that all measures of high alcohol consumption relative to low consumption were associated with a significantly increased risk of acute respiratory distress syndrome (ARDS). The association was mainly attributable to the effects of an alcohol abuse history, the research team reported.
Around half of the individuals who develop ARDS in the United States have a history of alcohol abuse, according to research. A research project led by Darren Boé of the Division of Pulmonary Sciences and Critical Care Medicine at the University of Colorado Denver and published in the November 2009 issue of the Journal of Leukocyte Biology reported a 65% mortality rate from ARDS among individuals with alcohol abuse. Among ARDS survivors, alcohol abuse was associated with an increased duration of mechanical ventilation.
Last November, a review published online in the Journal of Clinical Medicine discussed how alcohol consumption leads to immunological modulation at multiple levels. Led by Shinwan Kany of the Department of Radiology and Nuclear Medicine at Otto von Guericke University Magedeburg in Germany, the review stated that while the precise explanation for alcohol's immune‐suppressing effects remains elusive, it has been proven that chronic alcohol use leads to disturbances of immune function pertaining to a variety of conditions, including bacterial and viral infections.
All of this points to ominous signals, given the current understanding about groups with underlying conditions who appear to face a difficult prognosis if they contract COVID‐19. The addiction field already has the historical knowledge that alcohol use disorder is associated with a higher propensity for community‐acquired pneumonia, Jung said.
There is interest in learning more about whether the susceptibility to respiratory illness as a result of alcohol misuse differs greatly by age or gender, Jung said. Research has shown that women appear to be more susceptible to alcohol‐related organ damage, even after controlling for the amount of drinking in relation to body weight, she said.
Consumption trends of concern
While it is difficult to pinpoint actual alcohol consumption trends over the past several weeks, buying patterns in the period around which people became more confined to their homes offer an indicator of consumer intent. According to Nielsen research, U.S. alcohol sales for the week ending March 21 rose 55% from the same period a year earlier, with spirits sales outpacing wine and beer sales with a 75% increase over the comparable 2019 period.
In an indication that consumers were stockpiling alcohol in anticipation of a lengthy lockdown, Nielsen officials reported this month that by the week of March 28 the increase in alcohol sales had slowed to 22%. In its initial reporting last month, Nielsen stated that online alcohol sales were up 243%.
AAC's http://Alcohol.org resource offered similar indications this month in its reporting of results of a survey it conducted of 3,000 individuals who are now working from home. The survey found that around one‐fifth of these individuals chose to stockpile alcohol for their period of self‐isolation as a higher priority than other food and beverage items.
In addition, 35% of survey respondents said they believe they will drink more alcohol than usual during this self‐isolation period. Thirty‐two percent said they would be more likely to drink at home during work hours than they would during the workday in their typical work environment.
The survey broke down the latter responses by state, with Hawaii showing the highest likelihood of at‐home drinking during work hours (67% of respondents) and Arkansas showing the lowest likelihood (8%). Many of the states hardest hit by COVID‐19 showed percentages in the 30s range (30% in Washington, 35% in New Jersey and 38% in New York, for example).
This leads AAC's Weinstein to conclude, “We will see downstream implications of this for quite a long time. Treatment organizations will need to be prepared for some time.”
The picture will be particularly bleak, he says, if government regulators return to their traditional mindset post‐pandemic, placing obstacles back into play that impede the provision of virtual services or the delivery of care by licensed providers across state lines.
Jung's takeaway message for individuals who already drink at potentially harmful levels is that it might be sensible to scale back at this time of uncertainty. For low‐risk drinkers, staying at the moderate drinking limits of one drink a day for women and two for men would be wise. And for nondrinkers, “If you don't drink, don't start,” she said.