Alcohol‐Associated Liver Disease Before and After COVID‐19—An Overview and Call for Ongoing Investigation

Abstract

The Coronavirus Disease-2019 (COVID-19) pandemic has exacted a heavy toll on patients with alcohol-associated liver disease (ALD) and alcohol use disorder (AUD). The collective burden of ALD and AUD was large and growing prior to the COVID-19 pandemic. There is accumulating evidence that this pandemic has had a large direct effect on these patients and is likely to produce indirect effects via delays in care, psychological strain, and increased alcohol use. Now a year into the pandemic, it is important that clinicians fully understand the effects of the COVID-19 pandemic on patients with ALD and AUD. To fill existing gaps in knowledge, the scientific community must set research priorities for patients with ALD regarding their risk of COVID-19, prevention/treatment of COVID-19, changes in alcohol use during the pandemic, best use of AUD treatments in the COVID-19 era, and downstream effects of this pandemic on ALD. Conclusion: The COVID-19 pandemic has already inflicted disproportionate harms on patients with ALD and ongoing, focused research efforts will be critical to better understand the direct and collateral effects of this pandemic on ALD.

Impact of COVID-19 on the liver and on the care of patients with chronic liver disease, hepatobiliary cancer, and liver transplantation: An updated EASL position paper

“…Collectively, these data paint a bleak picture and highlight the immense current and future burden of morbidity and mortality precipitated by COVID-19-associated alcohol consumption [124]. This should provide additional impetus to urgently re-establish alcohol support services and to implement evidence-based population-level interventions such as minimum unit pricing and taxation of alcohol [125,126], which is also a key consideration in the EASL Lancet Liver Commission [127].…”

“…Lastly, simulation modelling in the United States has estimated that a single year of increased alcohol consumption during the pandemic may result in 8,000 additional deaths from ALD, 18,700 cases of decompensated cirrhosis, 1,000 cases of HCC, and 8.9 million disability-adjusted life years between 2020 and 2040 [ 123 ]. Collectively, these data paint a bleak picture and highlight the immense current and future burden of morbidity and mortality precipitated by COVID-19-associated alcohol consumption [ 124 ]. This should provide additional impetus to urgently re-establish alcohol support services and to implement evidence-based population-level interventions such as minimum unit pricing and taxation of alcohol [ 125 , 126 ], which is also a key consideration in the EASL Lancet Liver Commission [ 127 ].…”

Alcohol-Related Deaths During the COVID-19 Pandemic

“…The aging of China's population is a major contributor to the epidemic of diabetes in China, with older adults representing one of the fastest-growing segments of the patient population with diabetes. [2][3][4][5] Thus, comprehensive actions are needed to address China's national diabetes burden from health, economic, and social perspectives. In Reply Dr Tu and colleagues raise some methodological questions about the field surveys that collected the data used in our study 1 and how to interpret some of the reported results.…”

COVID-19 and liver disease

“…Expanding the LT indication for acute alcoholic hepatitis in recent years93 94 has certainly contributed to this shift in the epidemiology of LT waiting lists. In the COVID-19 era, aggravating factors such as the psychological burden and delays in healthcare have contributed to an increase in alcohol use disorder, as suggested by some reports 95…”