Hepatitis caused by alcohol skyrocketed 50% in Spain during the pandemic. The findings come from a new study using data of Spanish Registry of Alcoholic Liver Disease.
The increase in alcohol consumption, the burdening of the health system due to COVID-19, and the weakening of support networks during the pandemic have hit the most vulnerable groups hard.

Alcoholic hepatitis cases shot up 50% during the coronavirus pandemic. The increase in alcohol consumption during the pandemic has led to an increase in cases and mortality of patients, as per El Nacional reporting.

The consequences of the coronavirus pandemic are still dragging on just 3 years after the declaration of the pandemic. Although the impact of COVID-19 on society, and especially on people’s health, is subsiding, it will take a long time to determine the full extent of the damage. Various aspects are being investigated.

Now, a group of specialists has revealed that cases of hepatitis caused by alcohol increased up 50% after the outbreak of the pandemic.

According to experts, these data provide insights into the serious consequences caused by the confinements, the burden on the health system and the loneliness that some people experienced. All three elements of the pandemic have lethal interactions with alcohol.

Rising alcohol hepatitis
Cases of hepatitis caused by alcohol increased up 50% after the outbreak of the pandemic.

One of the authors of the study, Elisa Pose, a hepatologist at the Hospital Clínic de Barcelona, explained to El País:

… this type of hepatitis is the most serious form of clinical presentation of alcoholic liver disease and is associated with high mortality. It is developed by people with chronic, intense alcohol consumption and who, in addition, usually already have underlying liver disease.”

Elisa Pose, hepatologist, Hospital Clinic de Barcelona

A study published in March 2022 revealed drastic increases in severe alcohol-related hepatitis requiring inpatient management, specifically in patients under the age of 40 and in women during the COVID-19 pandemic in the United States. These findings illustrate escalating alcohol harm that has far-reaching and long-lasting implications for the already strained health care system extending for beyond the COVID-19 pandemic timeframe.

And already in October 2021, a cross-sectional study examined trends in new waiting list registrations and liver transplantation for alcoholic hepatitis before and during the COVID-19 pandemic in the US. This study provided compelling evidence of an alarming increase in alcoholic hepatitis linked with increasing heavy alcohol use during COVID-19.

50% more cases after confinement

The study used data from the Spanish Registry of Alcoholic Liver Disease (REHALC), the most important source of information in Spain on this type of disease. The REHALC monitors the activity of 30 large and medium-sized hospitals throughout the country. These health centers care for 22% of the Spanish population – close to 10 million people.

To extract these results, researchers analyzed all cases of alcoholic hepatitis that were treated in the 30 hospitals between 2015 and 2021. The total number of cases have been divided into two groups:

  1. those that were treated before the pandemic, and
  2. those alcoholic hepatitis cases that were treated after the pandemic.

The results reveal that, in the years prior to the coronavirus pandemic, hospitals treated an average of 14 cases of alcoholic hepatitis per month.

After the pandemic broke out alcoholic hepatitis cases shot up to 21, and from then on the trend kept growing. The study shows that from March 2020 to December 2021, the centers cared for 460 people with this disease.

The data from the study not only demonstrate the increase in alcoholic hepatitis cases, but also the severity of the cases and the mortality they caused, a fact that is related to the increase in alcohol consumption, combined with lack of capacity of the health system to respond properly.

For example, of the total cases treated before the pandemic, 26% died one year after being diagnosed. But after the pandemic broke out the number of fatal alcoholic hepatitis cases shot up to 31%.

Factors for the increase in cases of alcoholic hepatitis

There are multiple factors driving the rise in alcoholic hepatitis cases and deaths.

The researchers point to the increase in alcohol consumption as the main factor in the growth of cases. The study also included research carried out in the United States that reveals that sales of alcoholic beverages increased by almost 20% as of March 20, 2020, and has been maintained for the following two years.

Per capita consumption of alcohol, measured as gallons of pure alcohol per person, increased by 2.9% in 2020. This was the largest increase in more than 50 years, since a 3.4% increase in 1968.
The annual total number of alcohol deaths increased from 78,927 (2019) to 99,017 (2020) to 108,791 in 2021.

Big Alcohol lobbying and policy interference led many state governments in the United States to worsen their alcohol laws among others by allowing alcohol home delivery. As a result, alcohol use increased in the U.S. and now the country is facing rising death and disease rates due to alcohol-related causes. 

In some groups, such as younger people and those who are used to drinking [alcohol] only in a social context, consumption in general decreased due to confinement,” said David Fraguas, the coordinator of the Mental Health Center of the Central district of Madrid, as per El Nacional.

But in groups with chronic [alcohol] consumption and a history of [alcohol use disorder], there was a very significant increase, the largest that has occurred in a long time.”

David Fraguas, coordinator, Mental Health Center, Central district of Madrid

Experts say that the pandemic was even worse for the most vulnerable groups, such as people with more mental health problems, people with fewer resources, people who are more socially isolated and people with a history of alcohol use disorder. These people were precisely those who needed the most help to deal with the consequences of the health crisis. But they found themselves deprived from one day to the next of many support networks.

Need for alcohol policy solutions

The Spanish, as well as the U.S. findings highlight the need for public health interventions around alcohol.

For example, alcohol deaths in the United States have been rising over the years. The COVID-19 pandemic and the products and practices of the alcohol industry have accelerated this trend even more during the pandemic. The rising alcohol deaths and the heavy alcohol policy influence by Big Alcohol demonstrate the decades-long alcohol policy failures of the federal and state U.S. governments. 

The rise in alcohol deaths in the U.S. is a symptom of a failing alcohol policy system in the country. One example of this alcohol policy failure is the erosion of alcohol taxes over the years and tax breaks given to Big Alcohol instead of protecting the public interest.

study from Boston University School of Public Health found that inflation has eroded U.S. alcohol tax rates by 70% since 1933.

Despite this, the United States Congress continued to give the alcohol industry a large tax break in December 2019, resulting in a loss of billions of dollars for the government.

  • Without the tax breaks, the Distilled Spirits Council (DISCUS) would have paid $275 million in higher taxes.
  • A beer industry group claims they would have to pay $130 million in higher taxes.
  • California wineries alone would have paid $150 million in higher taxes.

All of this money represents wasted tax revenue for the government, money that could have been used to improve the lives of people and communities that are severely harmed by widespread alcohol harm across the nation.

Adding fuel to the fire, the alcohol industry systematically lobbied to worsen state alcohol policies during the COVID-19 pandemic to permit alcohol home delivery. Thus, increasing alcohol use in the U.S. and maximizing Big Alcohol profits at the cost of the health and well-being of the people in the U.S. 

As a result of Big Alcohol lobbying, 35 states introduced cocktails-to-go laws during the COVID-19 pandemic, allowing pickup and home delivery of alcohol by on-premise alcohol sales places such as restaurants, bars, and pubs. 

Out of these 35 states, 

  • 18 states and Washington D.C. have made the worsened alcohol laws permanent, and 
  • 14 states have further extended the rules.

Additionally, in the U.S., all but three of the 50 federal states gave liquor stores a lockdown exemption, many classifying the businesses – along with grocery stores and pharmacies – as a COVID-19 essential service. 

The case of the U.S. is a warning sign for Spain. Both the Spansih and the U.S. government need to urgently improve alcohol policies to protect people and communities from the harms caused by the products and practices of the alcohol industry. Increasing alcohol taxation and rethinking alcohol delivery laws are two aspects the countries needs to pay immediate attention to. 

Additionally, Spain can use the World Health Organization‘s SAFER technical package. It provides a blueprint for the most effective alcohol policy solutions to prevent and reduce alcohol harm.

  1. Strengthen restrictions on alcohol availability
  2. Advance and enforce driving under the influence counter measures. 
  3. Facilitate access to screening, brief interventions and treatment.
  4. Enforce bans or comprehensive restrictions on alcohol advertising, sponsorship, and promotion. 
  5. Raise prices on alcohol through excise taxes and pricing policies.


El Pais: “Las hepatitis causadas por el alcohol se dispararon un 50% en España durante la pandemia

El Nacional: “Los casos de hepatitis alcohólicas se dispararon un 50% durante la pandemia del covid