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Alcoholism, a condition characterized by excessive and prolonged alcohol consumption, has numerous adverse health effects, which are exacerbated in the context of the SARS-CoV-2 pandemic. The relationship between alcohol consumption and susceptibility to COVID-19 is complex and multifaceted. First, alcohol weakens the immune system, reducing the body’s ability to fight infections, which increases the risk of contracting severe respiratory illnesses such as COVID-19. Furthermore, chronic alcohol consumption can lead to underlying medical conditions, such as liver and cardiovascular diseases, which are known risk factors for developing severe COVID-19 complications. The behavior of people with alcoholism also contributes to a higher risk of exposure to the virus. People who abuse alcohol may have reduced adherence to preventive measures, such as social distancing and mask use, thus increasing the likelihood of infection. Likewise, alcohol consumption in public places or at social gatherings increases the probability of virus transmission. During the pandemic, stress and anxiety have led to increased alcohol consumption in some populations, exacerbating mental and physical health problems. This increase can create a vicious cycle where alcohol consumption and the risk of COVID-19 infection negatively reinforce each other.
Keywords: alcoholism; Effect of alcoholism; covid-19 virus; pandemic; impact; Effectofalcoholism; covid-19virus
Whilealcoholcanbeconsumedsociallyandinmoderation,duringtheearlystagesofthepandemic,socialmediapostsspreadmisinformationclaimingthat alcohol consumption could strengthen the immune systemandprotectagainstthevirus[1]. Thismisinformationlikelycontributedtoanincreaseinalcohol consumption.However,alcoholisaharmfulsubstance thatnegativelyimpactsmostofthebody’sorgans,increasingtheriskofhealthdamagewitheachconsumption[2].Chronicconsumptionaffectsallcomponents oftheimmunesystem[3].Ethanolcanstronglyinteractatdifferentlevels,affectingbothinnateimmunity (phagocytosis,naturalkillercells,complement)and, aboveall,adaptiveimmunity[4]. Numerousstudies haveshownthatalcoholconsumptioncausesasevere decreaseinlymphocytesinboththeshortandlong term[5],affectingthebody’sabilitytofightdiseaseby suppressingwhitebloodcellfunctionandtriggeringa chronicinflammatoryresponse[6],withalterationsobservedinIgAandIgMimmunoglobulins[7].TheWHO statesthateverydrinkconsumedincreasestheriskof harm.Excessivealcoholconsumptionalsoincreases theriskofdevelopingacuterespiratorydistresssyndrome[8].Italsoaffectscognition,perceptionofreality,anddecision-making,whichcanleadtoriskybehaviors,suchasfailuretomaintainphysicaldistancing, noncompliancewithhygieneguidelines,andincreased socialinteractionstherebyfacilitatingthespreadofthe virus[9].
To analyze and evaluate the impact of alcohol consumptiononindividualswhouseitasaprotectivemeasureagainsttheSARS-CoV-2virus(COVID-19).
Areviewstudywasconductedusingtheinternational PubMeddatabaseandCrossRefMetadataSearchto analyze14articlespublishedduringthepandemicand research related to the effects of alcohol on the immunesystem.Thefollowingkeywordsandcombinationswereused:COVID-19,alcohol,immunity,alcohol consumption,andimmunesystem;datafromtheNationalHealthandNutritionSurveys(Ensanut)forthe years2018and2020werealsousedtodeterminethe prevalenceofcurrentandexcessivealcoholconsumptionamongadolescentsandadultsduringthatperiod.
Acomprehensiveanalysisof10scientificstudiesonalcoholconsumptionduringthepandemicrevealedasignificantincreaseinalcoholintake,particularlyamong peoplewithapre-existingpredispositiontoalcohol abuse.Althoughsomeindividualsreducedtheirconsumptionforfinancialreasons,aconsiderableportion ofthepopulationcontinuedtoconsumelargeamounts ofalcohol.Thestudiesalsohighlightedthatthosewho maintained or increased their alcohol consumption wereathigherriskofcontractingCOVID-19,developingmoreseveresymptomsofthedisease,andexperiencing multiple risks and negative effects on their healthandimmunesystem.Belowarestatisticsillustratingtheimpactofalcoholconsumptionduringthe COVID-19 pandemic. These data provide a detailed overviewofhowthepandemichasinfluencedpatterns ofalcoholconsumption.InMexico,theprevalenceof alcoholconsumptionamongadolescentsin2018and 2020didnotchangesignificantlyandremainedabove 20%: 21.7%in2018and21.3%in2020. Intheanalysisstratifiedbysex, nosignificantchangeswereobservedbetweenthetwomeasurements,withratesof 18.3%and19.2%amongfemalesin2018and2020,respectively,and25.1%and23.4%amongmales(Figure 1,PanelA).Nosignificantchangeswereobservedin excessivealcoholconsumption,whichstoodat2.7% amongwomenand4.9%amongmenin2020(Figure 1,PanelA).Amongadults,asignificantincreaseinthe prevalenceofalcoholconsumptionwasobservedbetween2018and2020.Whenstratifiedbysex,asignificantincreaseintheprevalenceofconsumptionwas observedamongwomen,risingfrom33.5%in2018to 42.5%in2020(Figure1,PanelB).Theprevalenceof consumptionamongmendidnotchangesignificantly betweenthecomparisonyears:65.9%and67.1%for 2018and2020,respectively(Figure1,PanelB).Regardingpatternsofexcessivealcoholconsumption,asignificantdecreaseofapproximately50%wasobserved amongbothwomen(11.1%in2018and5.5%in2020) andmen(from36.7%to18.3%for2018and2020,respectively)(Figure1,PanelB).
The Pan American Health Organization (PAHO) has made a technical tool available to countries that allows them to determine the percentage of the populationwithanunderlyingconditionthatcouldput thematriskofdevelopingsevereCOVID-19. Table1 showsthecomorbiditiesonwhichthisinformationis based,drawnfromPAHO’sownworkandguidelines publishedbyotherorganizationssuchastheWHO[11], inthistable,alcoholismrankstenthamongthemost commoncomorbidities.
Ontheotherhand,thecomprehensivereportonCOVID- 19fromtheMinistryofHealth(thelatestversionavailable,withdataasofFebruaryandpublishedinMarch 2022)includesthedistributionofcomorbiditiesamong
Table 1. UnderlyinghealthconditionsassociatedwithsevereCOVID-19 1.Cardiovasculardisease 2.Chronickidneydisease 3.Chronicrespiratorydisease 4.Chronicliverdisease 5.Diabetes
6.Cancerswithdirectimmunosuppression 7.Cancerswithpossibledirectimmunosuppression duetotreatment Source:Author’selaborationusinginformationfromPAHO’s“COVID-19andComorbiditiesintheAmericas,” publishedonFebruary10,2021,Washington,D.C.Availableathttps://iris.paho.org/handle/10665.2/53253
deceasedindividualsaged60andolder.Figure1shows thatalcoholismrankstenthamongthecomorbidities associatedwiththehighestnumberofdeathsamong olderadults(11).
AlcoholconsumptionduringtheCOVID-19pandemic raisessignificantconcernsduetoitspotentialimpact onpublichealthandindividualwell-being.Inaddition tothetraditionalrisksassociatedwithexcessivealcoholconsumption,suchasdamagetotheimmunesystemandincreasedvulnerabilitytoinfections,alcoholinducedbehaviorcaninterferewiththeadoptionof preventivemeasurestoreducethespreadofthevirus [8][9][10][11].Limitedaccesstoalcoholduetogovernmentrestrictionscanhavebothpositiveandnegativeconsequences,butitiscrucialtoaddressalcoholconsumptionfromapublichealthperspectiveand promoteawarenessoftherisksassociatedwithitsexcessiveuse[8].Furthermore,itisessentialtoensure access to mental health services and treatment for
8.HIV/AIDS 9.Tuberculosis(active) 10.Alcoholism 11.Sicklecelldisease 12.Smoking 13.Hypertension 14.Severeobesity(bodymassindexgreaterthan orequalto40)
(accessedMay2022)
thoseexperiencingalcohol-relatedproblemsduring thepandemic.Ultimately,acomprehensiveapproach isneededtoaddressthechallengesposedbyalcohol consumptionduringthisunprecedentedtime[10][11].
Alcoholismnotonlyposesathreattothephysicaland mentalhealthofthosewhosufferfromit,butitcan alsoheightentherisksassociatedwithCOVID-19.From weakeningtheimmunesystemtoincreasingsusceptibilitytorespiratoryinfectionsandseriouscomplications,theharmfuleffectsofalcoholcanexacerbatethe impactsofthepandemic.Furthermore,druginteractionsandadditionalmentalhealthchallengesfurther aggravatethissituation.Itiscrucialtorecognizetheimportanceofseekinghelptoovercomealcoholismand takingpreventivemeasurestoprotectoneselfandothersfromthevirus.Ultimately,addressingalcoholism notonlybenefitsindividualhealthbutalsocontributes tothecollectivefightagainstthespreadanddevastatingeffectsofCOVID-19[8][10]. Thefrequencyof alcoholconsumptionwasobservedamongyoungpeopleandthosewithhigherlevelsofeducation,butarisk associatedwithalcoholconsumptionwasalsoidentified[12]. RiskfromalcoholconsumptionwithnegativeconsequenceswhencontractingCOVID-19[12] [13][14].
Acknowledgements: To my former students* who, duringmyPublicHealthclasses,workeddiligentlyon research projects that are now reflected in publicationssuchasthisoneintheBachelorofMedicineand Surgeryprogramatthe[UAEH]AutonomousUniversity oftheStateofHidalgo,Mexico.
Conflictofinterest: Theauthorsdeclarethatthereis noconflictofinterestregardingthepublicationofthis article.