The burden of alcohol on health care during COVID‐19

Abstract

Alcohol's impact on global health is substantial and of a similar order of magnitude to that from COVID‐19. Alcohol now also poses specific concerns, such as increased risk of severe lung infections, domestic violence, child abuse, depression and suicide. Its use is unlikely to aid physical distancing or other preventative behavioural measures. Globally, alcohol contributes to 20% of injury and 11.5% of non‐injury emergency room presentations. We provide some broad comparisons between alcohol‐attributable and COVID‐19‐related hospitalisations and deaths in North America using most recent data. For example, for Canada in 2017 it was recently estimated there were 105 065 alcohol‐attributable hospitalisations which represent a substantially higher rate over time than the 10 521 COVID‐19 hospitalisations reported during the first 5 months of the pandemic. Despite the current importance of protecting health‐care services, most governments have deemed alcohol sales to be as essential as food, fuel and pharmaceuticals. In many countries, alcohol is now more readily available and affordable than ever before, a situation global alcohol producers benefit from and have helped engineer. We argue that to protect frontline health‐care services and public health more generally, it is essential that modest, evidence‐based restrictions on alcohol prices, availability and marketing are introduced. In particular, we recommend increases in excise taxation coupled with minimum unit pricing to both reduce impacts on health‐care services and provide much‐needed revenues for governments at this critical time.

Alcohol controls in the aftermath of the COVID‐19 pandemic in India: Commentary on Stockwell et al.

“…We read Stockwell et al . 's recommendations [1] for alcohol policy in current times with interest and some concern. The suggestion that the ‘COVID‐19 crisis provides the perfect time to confront dysfunctional societal relationships with alcohol’ echoes a sentiment recently heard in India: that the drinking population had got used to abstinence during the six week state of lockdown‐induced‐prohibition without demur or incident; and that the government should not lose this opportunity to press on with prohibition.…”

Time for carefully tailored set of alcohol policies to reduce health‐care burden and mitigate potential unintended consequences?

“…We are grateful for these insightful commentaries on our article [1] discussing the burden of alcohol on health‐care services during COVID‐19 [2–4]. Each provides rich detail on the interplay between policies introduced to reduce viral spread, associated policies around alcohol supply, alcohol consumption and harms in the authors' own countries (Mexico, India and South Africa).…”

“…Our first point in response—and this was the major initial impetus for the commentary—is that this was not a sound justification for a policy of continuing or increasing alcohol supply or reducing prices. We were not in fact advocating alcohol prohibition, merely pointing out that if there is a concern about the pressure on health‐care services then, given the relatively tiny contribution of alcohol withdrawal cases versus the totality of alcohol's impact on hospitalisations and emergency room visits, there would be greater benefit in this regard from completely turning off the alcohol taps [1]. The case of prohibition in India is instructive here, with reports of brief spikes in cases of alcohol withdrawal to a doubling of the normal rate for a few days, rapidly followed by lower levels than pre‐prohibition and then to zero cases within 1 month [8].…”

“…The case of prohibition in India is instructive here, with reports of brief spikes in cases of alcohol withdrawal to a doubling of the normal rate for a few days, rapidly followed by lower levels than pre‐prohibition and then to zero cases within 1 month [8]. Hard data on the prevalence of other types of alcohol‐attributable hospital and emergency room presentations from Canada and the US bear this out, while incidentally showing the overall burden from all types of acute and chronic alcohol‐related harms to be at least the same order of magnitude in many countries as the current burden from COVID‐19 [1].…”

A timely piece that resonates with the South African experience: Commentary on Stockwell et al.

“…Stockwell et al . [1] describe the ways in which alcohol use poses special problems in relation to the COVID‐19 pandemic in terms of increasing the risk for community transmission, increasing the risk of worse outcomes for heavy drinkers with compromised lungs, and increasing risks of interpersonal violence, especially family violence and self‐harm at a time people have been encouraged to self‐isolate. They correctly conclude that the burden is substantially greater from alcohol.…”