COVID-19 Hangover: A Rising Tide of Alcohol Use Disorder and Alcohol-Associated Liver Disease.

Da, Ben L; Im, Gene Y; Schiano, Thomas D

The coronavirus disease 2019 (COVID-19) pandemic has had a tremendous global impact since it began in November of 2019. However, there are concerns that the COVID-19 pandemic will not affect all equally and some populations will be particularly vulnerable. Relevant to liver disease, patients with alcohol use disorder (AUD) and alcohol-associated liver disease (ALD) may be amongst the populations that are the most severely impacted. The reasons for this include being at a higher risk of severe COVID-19 infection due to a depressed immune system and high-risk underlying comorbidities, the injurious effect of COVID-19 on the liver, the inability to attend regular visits with providers, diversion of hospital resources, and social isolation leading to psychological decompensation and increased drinking or relapse. As a result, we fear that there will be a dramatic rising tide of alcohol relapse, admissions for decompensated ALD, and an increase in newly diagnosed patients with AUD/ALD post-COVID-19 pandemic. Liver centers should implement pre-emptive strategies such as telehealth and aggressive patient outreach programs now to curb this anticipated problem. Liver transplant programs need to consider offering some leniency to patients with AUD/ALD who cannot obtain alcohol treatment due to the current situation. In conclusion, we expect that the COVID-19 pandemic will be especially detrimental to patients with AUD/ALD and actions need to be taken now to limit the scope of this anticipated problem.