Table 3.

Gaps, concerns, and solutions in the care of patients with ALD/AUD

Category	Specific gaps and concerns	Potential solutions
Pandemic related	• Increased risk of COVID-19 transmission • Excessive and unreliable information • Economic crisis	• Establishment and adherence to preventative guidelines set forth by global/locoregional authorities • Creation of central and locoregional disaster management plans in advance of calamity • Public messages from authorities addressing key aspects of disaster management including trusting information from reliable sources only • Early availability of financial assistance from federal/central authorities • Incentivize companies with existing infrastructure to manufacture items of greatest needs • Increase funding in public health sector to promote research efforts for decreasing the disease burden and communal impact
Healthcare related	• Restricted access to healthcare facility • Limited beds/staffing/resources • Treatment-related challenges in ALD patients with superimposed COVID-19 infection	• Increase availability and access to telehealth/virtual visit platforms • Increase availability and utilization of home health • Ensuring prescription refills are available to patients • Redistribution of resources focusing on patients with high-risk comorbid conditions • Adherence to established hospital-driven management protocols and creation of newer ones as per the need • Multidisciplinary care approach/e-consults • Increase collaboration with researchers across the globe and sharing of evidence-based practices • Increase outreach • Availability of clinical trials
Patient and population related	• Fear of going to a healthcare facility due to greater risk of being exposed to the COVID-19 virus • Vulnerable groups — young, elderly, females, minority groups, educationally and economically disadvantaged, patients with comorbid conditions, patients on steroids/immunosuppression therapy • Social isolation • Domestic violence • Economic stress	• Utilization of telehealth platforms/virtual visits/ home health • Patient education via utilization of paper and electronic media (newspapers, magazines, TV, radio, webinars, etc.) • Consideration for participation in clinical trials • Policies should be crafted with special considerations for vulnerable groups • Change in platforms of supportive care from physical to virtual instead of eliminating altogether • Virtual support/educational programs specially targeting vulnerable sub-groups • Availability of hotline for help/guidance/counseling • Companies should consider opening up of virtual jobs rather than dissolving the positions altogether • Prioritize outreach for vulnerable groups
Post-pandemic related	• Downstream effects of substance abuse (alcohol, smoking, etc.)   i) Physical effects (alcohol-related disorders, cardiovascular diseases, obesity, worsening of preexisting chronic conditions)   ii) Psychosocial effects of substance of abuse intake (alcohol, smoking, etc.) • Economic devastation	• Active screening for substance-related physical and psychological problems and domestic violence at patient’s first encounter after pandemic (at all levels of care — primary or advanced care settings) • New job opportunities or conversion of on-site jobs to remote platforms to allow greater accessibility • Local support for small businesses