As the pandemic sends thousands of recovering alcoholics into relapse, hospitals across the country have reported dramatic increases in alcohol-related admissions for critical diseases such as alcoholic hepatitis and liver failure.
But the pandemic has dramatically added to the toll. Although national figures are not available, admissions for alcoholic liver disease at Keck Hospital of the University of Southern California were up 30 percent in 2020 compared to 2019, said Dr. Brian Lee, a transplant hepatologist who treats the condition in alcoholics. Specialists at hospitals affiliated with the University of Michigan, Northwestern University, Harvard University, and Mount Sinai Health System in New York City said rates of admissions for alcoholic liver disease have leapt by up to 50 percent since last March.
Leading liver disease specialists and psychiatrists believe the isolation, unemployment, and hopelessness associated with COVID-19 are driving the explosion in cases.
“There’s been a tremendous influx,” said Dr. Haripriya Maddur, a hepatologist at Northwestern Medicine. Many of her patients “were doing just fine” before the pandemic, having avoided relapse for years. But subject to the stress of the pandemic, “all of a sudden, [they] were in the hospital again.”
Across these institutions, the age of patients hospitalized for alcoholic liver disease has dropped. A trend toward increased disease in people under 40 “has been alarming for years,” said Dr. Raymond Chung, a hepatologist at Harvard University and president of the American Association for the Study of Liver Disease. “But what we’re seeing now is truly dramatic.”
Maddur has also treated numerous young adults hospitalized with jaundice and abdominal distension emblematic of the disease—a pattern she attributes to the pandemic-era intensification of economic struggles faced by the demographic. At the same time these young adults may be entering the housing market or starting a family, they find that entry-level employment, particularly in the vast, crippled hospitality industry, is increasingly hard to come by. “They have mouths to feed and bills to pay, but no job,” she said, “so they turn to booze as the last coping mechanism remaining.”
Socially, the “stress of the pandemic has, in some ways, particularly targeted women,” said Dr. Jessica Mellinger, a hepatologist at the University of Michigan. Lower wages, less job stability, and the burdens of parenting tend to fall more heavily on women’s shoulders, she said.
“If you have all of these additional stressors, with all of your forms of support gone—and all you have left is the bottle—that’s what you’ll resort to,” Mellinger said. “But a woman who drinks like a man gets sicker faster.”
“The pandemic has brought out our uneasy relationship with alcohol,” said Dr. Timothy Fong, an addiction psychiatrist at UCLA. “We’ve welcomed it into our homes as our crutch and our best friend.”
Some physicians, like Maddur, are concerned that the stressors leading to increased alcohol consumption and liver disease may stretch well into the future—even after lockdowns lift. “I think we’re only on the cusp of this,” she said. “Quarantine is one thing, but the downturn of the economy, that’s not going away anytime soon.”
Others, like Lee, are more optimistic—albeit cautiously. “The vaccine is coming to a pharmacy near you, COVID-19 will end, and things will begin to get back to normal,” he said. “But the real question is whether public health authorities decide to act in ways that combat [alcoholic liver disease].
“Because people are just fighting to cope day to day right now.”