The Intersection of Alcohol and COVID-19
Liquor stores are an essential service, though it may surprise you to learn why.
On the morning of March 17th, 2020, Premier Doug Ford informed the public that Ontario, the province in which I live, declared an emergency under section 7.0.1(1) of the Emergency Management and Civil Protection Act. Amidst all the current chaos that is the COVID-19 pandemic, this declaration forced certain establishments and businesses to shut down, namely: schools, daycares, indoor recreational centers, libraries, theatres, and all restaurants and bars servicing the public (outside of providing takeout). Included in this order was the prohibition of all organized in-person events containing 50 or more participants.
This comes as Canada is grappling with the current reality of the novel Coronavirus in other countries, and the voracity with which it continues to spread through ours. Prime Minister Justin Trudeau is making a fierce effort to heed advice by the World Health Organization and hopefully avoid suffering similar fates as countries like China, Italy, South Korea, and Spain.
On March 23rd, 2020, Premier Doug Ford made a follow-up announcement that an order had been made forcing all non-essential businesses in Ontario to shut down by midnight the following day. A list of “essential” businesses was released later that day, with the expectation that any business not on the list was forced to temporarily shut down. Among these essential businesses were those of supply chains, wholesale sale of food and pet food, distribution of goods, medical and veterinary services, as well as liquor stores.
Though CTV News reported on March 23rd that liquor stores would stay open because they “are generally viewed as grocery-type goods,” there are other more important reasons why the sale of alcohol must be considered essential. And I’m not arguing for the access of liquor because I enjoy drinking alcohol — I haven’t had a drink in two years, though in the spirit of full disclosure I do not personally have issues with alcohol. I just know far too many people who do.
Liquor stores are essential for many reasons, most important of which are (though it may seem counterintuitive) rooted in health.
“Whether we care to admit it or not, there are many people in our community who have significant dependence issues with respect to alcohol,” Toronto’s Medical Officer of Health, Eileen de Villa, explained. “I think we have to be very conscious of that fact and be aware that if that substance, that provision, is no longer available, that that would lead to pretty significant health consequences.”
But not everyone seems to understand the implications of this. In response to the news that liquor stores will remain open, people have left the following comments online:
“Why… so they get can drunk and be less capable of following the guidelines of social distancing?”
“And the clerks risk their life so you can have a drink!”
“This is ridiculous. I do not see how alcohol is essential. All I see is the potential for causing more problems in the home, both financially and physically. This is the government putting earning before health.”
“Wouldn’t it just be horrible if an lcbo employee got covid19 from a raving drunk who just had to go out in public to get his fix...”
“Of course they’re letting liquor stores stay open, booze is heavily taxed!”
And of course, the slew of concerning but not unexpected comments, such as:
“That’s fair. Can’t lock us up with our kids for god knows how long and take away our booze.”
“That’s all that remains to do when everything else is closed and you can’t go anywhere!”
To better put drinking into perspective, let me first share a few facts.
Alcohol is responsible for the premature deaths of roughly 2.8 million people worldwide each year — making it one of the largest risk factors of its category. You’re more likely to die prematurely from alcohol than you are from homicide, indoor air pollution, low physical activity, secondhand smoke, and drug use. Not only does alcohol itself cause health issues, but it can also exacerbate more than 200 pre-existing issues. According to the Global Burden of Disease Study, 11.68 people per 100,000 died prematurely in Canada due to alcohol in 2017, compared with 19.83 people per 100,000 in the United States.
The World Health Organization classifies the harmful use of alcohol or alcohol use disorder as being “a pattern of psychoactive substance use that is causing damage to health,” and alcohol dependence syndrome as “a cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance or a class of substances takes on a much higher priority for a given individual than other behaviours that once had greater value.”
Alcohol use disorder is an umbrella term; the DSM-V updated their definition in 2013 by combining harmful alcohol use with alcohol dependence. People can have mild, moderate, or severe alcohol use disorder depending on the severity of their symptoms — among which can include suffering withdrawal from the substance, showing evidence of tolerance, and persisting with use despite its harmful consequences. The National Institute on Alcohol Abuse and Alcoholism estimates that roughly 15 million people in the United States have an alcohol use disorder, which is about 5.8% of the population.
Suffice it to say that a significant amount of people in our communities, and worldwide, misuse alcohol — many to the point of depending on it. But did you know that alcohol withdrawal can actually be life-threatening? According to research published in the Industrial Psychiatry Journal, withdrawal can include symptoms such as “autonomic arousal, hallucinations, seizures and delirium tremens (DT).” The research goes on to state that withdrawal delirium carries a mortality rate of about 8%, and Wernicke’s Encephalopathy has a mortality rate of roughly 20%.
“Withdrawal can kill you,” Joshua Lee, an addiction specialist at New York University Langone Medical Center, told Quartz. “Alcohol withdrawal is the classic example, where you can have autonomic instability, increased heart rate, increased blood pressure, your heart’s working overtime, your circulatory system is going haywire, your brain freaks out, and you can have seizures that are unstoppable without treatment.”
If we shut down liquor stores during this pandemic, and people can’t have access to alcohol, then withdrawal syndrome can easily send a high number of people into medical emergency departments, overwhelming healthcare staff and monopolizing resources that would otherwise be needed to treat coronavirus patients, while also unnecessarily exposing many more people to the contagious virus. Treating alcohol withdrawal takes time. It often includes treating patients with magnesium supplementation, as chronic drinking is known to cause issues with metabolizing the mineral; as well as providing fluids intravenously, utilizing sedation and physical restraints, supplementing thiamine and as well as various other vitamins, and administering benzodiazepines such as Lorazepam to help ease the body through the withdrawal process.
It’s also important to note that more people rely on alcohol during an emergency than in general. According to Michael Chaiton, associate professor at the Dalla Lana School of Public Health and researcher at the Centre for Addiction and Mental Health (CAMH) in Toronto, an increase in substance use during emergencies such as our current pandemic is the norm. “It’s often people coping by using substances,” he told Global News. “These substances offer an immediate source of control. Having a drink or smoking can make you feel better right away.”
And many people will slip into addiction (or relapse) in order to deal with trauma. This notion is consistent with a Cornell University study on the effects of the September 11th terrorist attacks on firefighters: respondents who were front-line during the World Trade Centre attacks were found to be at an increased risk for alcohol addiction, compared with the control group who were not front-line. Another study revealed nearly 30% of rehab patients interviewed reported an increase in alcohol after the attacks.
An additional point to consider when discussing alcohol and COVID-19 is the fact that during this imposed period of social distancing and working from home, many people have lost direct access to their recovery communities. Countless individuals depend on daily or weekly Alcoholics Anonymous (AA) meetings, and while there are many people are getting creative and having their meetings online (for instance, Alcoholics Anonymous has a web page for online groups), the risk of relapse is still a huge concern.
I think we could all afford to be a bit more compassionate with one another during these trying times, if not for empathy’s sake, then at least in the name of harm reduction and support for healthcare workers. Overloading our hospitals at this time would be the easiest way to achieve the most disastrous outcomes that are entirely preventable. Everyone is scared, and none of us know with any certainty exactly what we’re up against. We can choose to see the common threads in that, or we can choose to hone in on the differences.
The choice is ours to make.
If you or someone you know are struggling with substance use or addiction, in Canada you can access FREE virtual care at www.caccf.ca; you can also browse this list of resources to find services in your area. If you’re in the US, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1–800–662–4357.