The Role of Alcohol Biomarkers in Detecting a Physician's COVID-19-Related Acute Stress Response: A Case Report.

Polles, Alexis G; Jacobs, William S; Brazle, Chad; Merlo, Lisa J

OBJECTIVES Alcohol biomarkers are used to detect alcohol exposure in clinical and forensic settings. This includes professional health program (PHP) monitoring of healthcare workers in recovery from substance use disorders. Here we present the case of a physician whose positive alcohol biomarker test result was complicated by a traumatic stress response to frontline work during COVID-19. METHODS An anesthesiologist under PHP monitoring for substance use disorder and depression was interviewed extensively, urine and blood biomarkers were obtained, and longitudinal structured and semi-structured interviews related to anxiety, depression, posttraumatic stress, and cravings were used to monitor responses to the unanticipated death of a patient who succumbed to COVID-19. RESULTS After an initial positive ethylglucuronide (EtG) and ethylsulfate (EtS) toxicology test result, all subsequent testing was negative. Standardized assessments and clinical interviews provided documentation of a post-traumatic stress reaction. The physician described compulsive sanitizing of hands/arms and mask with highly concentrated ethanol-based products. CONCLUSIONS Inhalation of ethanol vapors is a possible explanation for the initial positive EtG/EtS results. To our knowledge, this case represents the highest reported levels of EtG/EtS likely due to workplace exposure. The importance of rapid intervention to thoroughly assess positive toxicology testing and its source(s) cannot be overstated, particularly as it relates to frontline healthcare workers during the pandemic. The PHP monitoring process provides an opportunity to promptly detect healthcare workers in distress, allowing for efficient connection to supportive resources and/or treatment when indicated, and possibly preventing escalation of symptoms or disease recurrence.