CME INDIA Presentation.

What is the effect of alcohol on COVID?

Asks Dr Prabhat Agarwal from Agra.

CME INDIA DISCUSSION:

Dr N K Singh: Is it not like – Drink and drive đŸ‘č

Dr BASAB Ghosh, Agartala: Desperate to know that at this time of COVID positivity all around, what to advise.

Dr Rajan Chaudhary, Patna: Sanitises mind and body.

Dr Harish Darla Mysore: Also, your purse.

Dr Rajan Chaudhary, Radiologist, Patna: Not if you are in Haryana, Goa or Andamans! Govt. endorsed otherwise why would they open these vends first?

Dr Meena Chhabra, Diabetologist, Delhi: My patients calling desperately. Can I drink today? Its the 12th day or 13th day or whatever.

Dr Prabhat Agarwal, Agra: Can it be given on 3rd day of COVID positivity?

Dr Gaurabh Gupta, New Delhi: COVID can kill but lack of alcohol must not kill a patient.

Dr Sunendra Kumar, DM Neuro, Ranchi: Alcohol will definitely decrease the anxiety levels of the patient and give a relaxing sleep. Though only to be used in moderation.

Dr Vikash, Bokaro: Will COVID increase severity of alcoholic hepatitis?

  • When this pandemic started, myth developed that drinking alcohol prevents COVID-19. Many people still believe that as sanitizers are used to kill corona virus, drinking wine is the surest way to kill those viruses harbouring in nose, throat and mouth. No scientific study is available to validate it. Alcohol is not an immune-booster rather a known immune-suppressant. Not only in India, but European countries, Iran, Thailand, Georgia and in many countries, still it is believed as most popular Corona protector. It is known that 180 people in Iran died after consuming unrecorded alcohol in March, after mistakenly believing that it would protect them during the COVID-19 outbreak. Because religious law prohibits alcohol in Iran, people try to buy alcohol illicit way, and there is considerable evidence of toxicity of such purchases
  • In Thailand, there happened a Farewell party, and as reported by scientific community, only those who drank a shared alcoholic beverage got affected. It is well-established that the virus is shed in oral pharyngeal secretion and sputum, so it is no surprise that individuals who shared drinking all got infected. This incident is an eye opener to crush this myth.
  • Scientific literature review clearly concludes that during the COVID pandemic, drinkers should be advised to abstain or to limit their consumption to one drink a day. This has been reflected in the advice given by the World Health Organization.
  • It is well known that lockdown in India, precipitated a health crisis in heavy drinkers unable to access their daily dose. Severe alcohol withdrawal cases and suicidal incidents were reported.

Alcohol ban patterns in lockdown

  • Greenland announced a ban on alcohol only in their capital, Nuuk.
  • In Mexico, the sale of alcohol in some municipalities is limited to certain hours
  • India banned the sale of all alcohol beverages across the country with no exceptions, during the lockdown.
  • Kerala has one of the highest rates of alcohol consumption amongst all the Indian states. The first confirmed case of COVID-19 in India was in Kerala in South India. In contrast to most other parts of the country, the State Government of Kerala initially started off with listing all types of liquor as ‘essential goods.’ Thus, exempting it from the state level lockdown. It allowed alcohol to be sold at state-run BevCo outlets. When the nationwide lockdown was announced, the State Government, decided to shut all liquor stores and bars in the state. Reports of drinkers dying by suicide started emerging in the media. Then  State Government decided to make alcohol available in limited quantities by issuing special passes for drinkers or by producing a doctor’s prescription to purchase liquor. However, the Kerala High Court stayed the State Government’s order, opining that the government’s decision was “a recipe for disaster” (Source: Various News Agencies)
  • Through most of the lockdown in India, only the sale of ‘essential goods’ is allowed, and alcoholic beverages are not considered as essential goods (except in state of Punjab), raising the question of how essential goods are defined.
  • Thus, the combination of the lockdown with the banning of alcohol created a situation where drinkers could go into dangerous withdrawal and not have access to appropriate help, or relapse, which in turn could put them at risk due to consumption of illicit alcohol.

Alcohol as a potential risk factor for pneumonia

Postulated mechanisms:

  • Reduces oropharyngeal tone leading to an increased risk of aspiration of microbe.
  • Modifies alveolar macrophage function and malnutrition.
  • Simou et al. in a recent meta-analysis of 14 studies identified an 83% increased risk of community acquired pneumonia among people who consumed alcohol or in higher amounts, relative to those who consumed no or lower amount of alcohol, respectively. (Simou E, Britton J, Leonardi-Bee J. Alcohol and the risk of pneumonia: a systematic review and meta-analysis. BMJ Open 2018;8:e022344.)
  • There is robust evidence that alcohol increases the risk of pneumonia.

What to say to patients?

  • Strengthen the mind by alternatives like meditation, yoga etc.
  • Reduce alcohol intake (no more than one drink/ day).
  • It would increase the incidence of viral pneumonia, as per existing studies.
  • Older subjects with other comorbidities should completely abstain from alcohol.

Any new study on links with COVID severity with alcohol intake?

A systematic review and meta-analysis have shown no link:

Alcohol and COVID

Source:  MingLiu et al, Drinking no-links to the severity of COVID-19: a systematic review and meta-analysis. 2020 Aug; 81(2): e126–e127.Published online 2020 May 28. doi: 10.1016/j.jinf.2020.05.042

  • This small sample sized study focused on the outcomes of the incidence of severe or non-severe COVID-19 disease between drinking and non-drinking patients.
  • It showed that drinking is not related to the severity of COVID-19. However, this study did not consider the volume and time of drinking.

CME INDIA Take Home Message

  1. If patient has well recovered and crossed the critical period of 9 to 10 days, post-COVID alcohol intake should be allowed to mild to moderate intake only. No scientific data exists to support it but as mind must be calmed to boost immunity and deterioration in mental health is also a big concern these days.
  2. Available meta-analysis does not show link between prior alcohol intake and severity of COVID-19.
  3. During COVID infection, no alcohol should be allowed as previous studies have shown clearly that it predisposes to viral and bacterial pneumonia.
  4. COVID is likely to increase the severity of alcoholic hepatitis.


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