Is another public health crisis brewing beneath the COVID-19 pandemic?
Special COVID-19 Commentary
Evidence indicates associations between exposure to mass traumatic events and increased alcohol consumption and related harms following the crises. However, there is limited evidence available to inform alcohol policies during such events.
In this commentary, the researchers present the range of government actions to limit alcohol availability during the coronavirus pandemic in provinces and territories across Canada.
Liquor retailers, including both private and government-run retailers, have been designated as essential services in all jurisdictions, operating under an evolving set of rules. From a public health perspective, keeping liquor retailers open during pandemic-related lockdown restrictions is a delicate decision which poses new risks and considerations about the best strategy for minimizing alcohol-related harms.
The researchers discuss the need to strike a balance between supplying public access to alcohol, particularly to those living with dependence, and unintentionally sending the message that alcohol is essential in our lives and encouraging consumption.
Given the far-reaching effects of alcohol on health, social, psychological, economic, and work safety outcomes, the researchers describe international guidance for minimizing alcohol-related harms and suggest that a nuanced and evidence-informed discussion about the considerations and impacts of alcohol control measures during a public health emergency should be undertaken.
Public access to alcohol has been a somewhat neglected yet important topic during the novel coronavirus 2019 disease (COVID-19) pandemic.”Erin Hobin and Brendan Smith, Public Health Ontario, in: Canadian Journal of Public Health volume 111, pages392–396(2020)
Evidence consistently shows a positive relationship between exposure to mass traumatic events, such as a terrorist attack or natural disaster, and increased population-level alcohol consumption following the crises…”Erin Hobin and Brendan Smith
there is limited evidence available to guide governments’ response to manage public access to alcohol during such events.”Erin Hobin and Brendan Smith
Given the far-reaching effects of alcohol on health, social, psychological, economic, and work safety outcomes, a nuanced and evidence-informed discussion about the considerations and impacts of regulatory measures controlling alcohol access during a public health emergency should be undertaken.”Erin Hobin and Brendan Smith
From a public health perspective, keeping off-premise liquor retailers open during pandemic-related lockdown restrictions is a delicate decision which, while mitigating some risks, adds others, and poses considerations and questions about the best strategy for minimizing alcohol-related harms.”Erin Hobin and Brendan Smith
Health and substance use experts acknowledge the challenge in striking a balance between supplying public access to alcohol, particularly for those dependent on alcohol to avoid withdrawal, and unintentionally sending the message that alcohol is essential in our lives and encouraging consumption.”Erin Hobin and Brendan Smith
Alcohol harm during the pandemic
- 19% of Canadians aged 12+ (5.7 million people) reported heavy alcohol consumption (4+ drinks on one occasion for women and 5+ for men) at least monthly (Statistics Canada 2018);
- Since the start of COVID-19 lockdown restrictions, jurisdictions in Canada are witnessing massive surges in alcohol sales, by as much as 40% in British Columbia government-run liquor retailers;
- Physical retailers report long line-ups and stockpiling, and online retailers are overwhelmed with orders;
- Another consideration for dealing with busy retail outlets is how best to manage retail employees’ health and safety, as jurisdictions are now reporting that employees of government-run liquor retailers are infected with COVID-19;
- In Canada, rates of emergency department visits attributable to alcohol are increasing (Myran et al. 2019);
- In 2015–2016, hospitalizations entirely caused by alcohol outnumbered heart attacks (Canadian Institute for Health Information 2017);
- Chronic alcohol use disorder is already the top condition contributing to hospitalizations entirely attributable to alcohol in Canada (Canadian Institute for Health Information 2017);
- International studies suggest as much as a 30% increase in this type of hospitalization following a mass traumatic event (Moise and Ruiz 2016);
- Heavy alcohol use is associated with increased susceptibility to respiratory infections, as well as acute respiratory distress syndrome, which could put additional strain on limited healthcare resources (Kershaw and Guidot 2008).
Long-term effects of pandemic on alcohol harm
The longer-term effects of the pandemic on alcohol use and related harms are another consideration, as evidence suggests outcomes could include a range of harms such as:
- Further normalizing home alcohol use;
- Reinforcing or introducing alcohol use as a way to self-medicate symptoms of stress, anxiety, and boredom, and;
- Increasing alcohol dependence (Cerda et al. 2011; Keyes et al. 2011; Moise and Ruiz 2016).
Preliminary data suggest that similar trends may already be occurring in Canada, as a national survey found 19% of Canadians aged 15–54 reported increases in their weekly alcohol consumption during the first phase of the COVID-19 pandemic (Statistics Canada 2020).
The economic burden of alcohol use in Canada is already $14.6 billion annually, exceeding that from all illicit substances combined and is similar to or, by some estimates, greater than tobacco (Canadian Substance Use Costs and Harms Scientific Working Group 2018).
Solutions proposed by public health experts
The World Health Organization (WHO) and other public health experts have offered recommendations for limiting alcohol use during the pandemic (World Health Organization Regional Office for Europe 2020).
- Uphold existing regulations restricting access to alcohol during the COVID-19 pandemic;
- Implementing alcohol rationing, or capping transactions to control the quantity of alcohol being purchased;
- For instance, PEI and Newfoundland have implemented such measures successfully;
- This solution has been successfully applied to other consumer goods during the COVID-19 pandemic that pose no health risk to consumers, such as toilet paper in supermarkets;
- Reminding the public of alcohol use guidelines and recommended limits on the quantity and frequency of consumption;
- Making vital substance use disorder services available during an emergency;
- Mental health services should prepare for a surge in need as a result of the pandemic and physical distancing measures (World Health Organization Regional Office for Europe 2020);
- Implementing public awareness campaigns to encourage people to quit alcohol, consume less, or at least not use more alcohol than usual.
The solution to implement public awareness campaign to encourage quitting or reducing alcohol use may be particularly important in Canada, as Canadian alcohol use culture is largely formed around changes in routine, such as on weekends, during job layoffs, and at other times people are off work (Paradis et al. 2009).
Managing the psychological response to a mass traumatic event is one of the most critical factors in a society’s ability to recover.”Erin Hobin and Brendan Smith, Public Health Ontario, in: Canadian Journal of Public Health volume 111, pages392–396(2020)
Going forward, it is important to monitor alcohol sales and alcohol-attributable harms during and following the COVID-19 crisis. Understanding the range and pattern of these harms can aid in optimizing interventions and improving disaster preparedness and responses in the future.”Erin Hobin and Brendan Smith
… it will be critical to track the status and evaluate the impact of the revised alcohol regulations after the COVID-19 restrictions end. While the measures were largely implemented to minimize physical contact and therefore COVID-19 transmission, some revisions have been made to support businesses by introducing new channels for the public to access alcohol. If these measures are not reversed post-pandemic, they have the potential to increase population-level alcohol consumption and corresponding harms.”Erin Hobin and Brendan Smith