Cees Goos, European Centre
Covid-19 has had and will continue to have, at least for the time being, a huge impact on many aspects of life. We are continuously being confronted with the negative consequences of the pandemic for our economy, welfare, mobility, health systems, social life, public health, mental health etc. In view of the significant negative influence which alcohol consumption has on public health and social welfare, we briefly review the relationship between Covid-19, alcohol consumption and alcohol-related harm.
Alcohol as disinfectant
Particularly in the beginning of the pandemic rumours were circulating that consuming high-strength alcoholic beverages could kill the Covid-19 virus. Thanks to the special information and education efforts of health agencies and the WHO (WHO, 2020), this myth is no longer virulent. It is, on the contrary, beyond doubt that rather than being perhaps beneficial in preventing or healing Covid-19, the opposite is true. While alcohol (at a concentration level of at least 60%) on the skin works as a disinfectant, within the body it captures the body’s immune system and increases the risk of adverse health outcomes. Moreover, people who have an alcohol-use disorder are particularly vulnerable to additional severe mental and psychosocial distress when, because of Covid-19 measures, they find themselves placed in self-isolation or without their normal social contacts.
Impact on alcohol business
Among alcohol producers and alcohol marketeers there is currently, much alike among all industries worldwide, great concern that the pandemic may lead to substantial decreases in the overall sales – and in the concomitant losses in financial profits. Indeed, after the initial reaction by the public to stockpile alcoholic beverages there are now signs that, overall, people are consuming less. Global sales are expected to decline by 12% this year (Valinsky, 2020).
This overall reduction in sales and consumption does not come as a big surprise. The hospitality sector with its bars, public inns, hotels and restaurants and other public outlets for alcoholic beverages (estimated to be good for some 40% of out-of-home spending on alcohol) has obviously suffered from lockdowns or other restrictive measures for business and thus experienced a decline in overall consumption. Alcohol sales during travel in duty free shops, at flights and cruises has come to an almost complete standstill.
Shifts in consumption
At the same time, however, sales of alcohol have shifted substantially from on-premise to in-home. In the US, as elsewhere, alcohol seems to be one of the fastest growing e-commerce sectors among consumer-packed goods. Online sales increased there in March 2020 fivefold, as compared to the same month of the previous year (Smitt, 2020). In the UK, in the same month sales of alcohol in supermarkets and corner shops jumped up by 22% (Finlay & Gilmore, 2020).
Reasons for shifts
Some research has been done on this shift in consumption patterns and the reasons behind it. For example, in the Netherlands it was found that 17-22% of respondents had reduced their consumption while 11-21% had increased their consumption. Between 55 and 69% of the interviewed mentioned that their consumption had remained stable (Voogt et al., 2020). Similar figures come from the UK: more than one in 3 of the 1,555 persons surveyed in a study, mentioned that, since the lockdown, they either had stopped drinking or reduced how often they drink. However, around 21% mentioned that they had been drinking more frequently and 15% of the drinkers said that they had been drinking more per session (Alcohol Change UK, 2020). In a study undertaken in the US, American adults are reported to have been drinking alcoholic beverages 14% more often during the pandemic (Pollard, 2020).
Among the reasons for increased consumption given by respondents figure anxiety for becoming infected by Covid-19, loneliness, psychosocial distress, boredom, financial insecurity, and depression. On the other hand, the lower consumption among specific groups of the population is likely to be linked to decreased financial ability to buy, or to the decreased physical availability of alcohol (closed bars and pubs).
Alcohol facilitating virus spread
The role of alcohol in facilitating the spread of the virus is widely recognized. Public authorities in many countries and communities have therefore taken measures to restrict the availability of alcohol by, for example, ordering pubs and restaurants to close entirely or to be open only for limited hours, and through closing parks and other public places which had become alternative places for drinking.
There is an abundance of examples of such measures. The government of South Africa (a country belonging to the world’s 10 largest number of Covid-19 cases) banned the sale of alcohol by the end of March 2020. It was lifted under the pressure of the alcohol industry and the hospitality sector in early June, followed soon by a reported surge of coronavirus cases, compounded by a wave of alcohol-related violence and accidents. Upon this, the ban was re-instated mid-July; however, to be loosened again in August (York, 2020). In Scotland, all pubs and restaurants across central Scotland are to be closed under new measures (BBC News, 2020). The city of Utrecht closed its main parks between 22:00 and 06:00 for 3 weeks in the beginning of October 2020 after young people had been drinking there excessively (Algemeen Dagblad, 2020). A time-based alcohol sales ban to reduce alcohol availability in restaurants and bars was proposed by the Federal Government of Germany (BPA, 2020).
The precise effects of the pandemic on harmful drinking are not entirely clear yet: A study carried out in Australia finds that harmful drinking decreased during social distancing measures. Younger drinkers in the sample decreased their consumption the most, but there was a small increase in consumption among middle-aged women. However, drinkers experiencing high levels of stress reported a relatively higher shift in harmful consumption compared with those with low levels of stress (Callinan et al., 2020).
More harmful drinking
According to the British Liver Trust, alcohol abuse has increased significantly during the Covid-19 pandemic: A 500% rise in calls to its help line service was recorded since lockdowns began in March 2020 (BBC News, 2020). The Royal College of Psychiatrists issued a warning that addiction services in England could struggle with ‘soaring’ numbers of people misusing alcohol. The College estimates that in June 2020 more than 8.4 million people in the country were drinking at higher-risk levels, up from 4.8 million in February 2020 (Royal College, 2020). Among addiction services it is widely recognized that lockdowns present a significant risk factor for increasing alcohol consumption among people with alcohol use disorders and risk of relapse for those who were previously abstinent.
A relationship between alcohol use and domestic violence, though very complex, has often been demonstrated. Estimates vary between countries. In the United States of America, and in England and Wales, victims believed their partners to have been drinking prior to a physical assault in 55% and 32% of cases, respectively (WHO, 2006). The mix caused by Covid-19 measures of increased social isolation, financial insecurity, job loss, increased time living in tight housing situations together with increased consumption of alcohol at home, represents surely a dangerous combination.
Responses by the industry
Being confronted with seriously declining sales and profits, the alcohol industry is responding through various strategies including intensified digital media marketing, boosting online alcohol retail and alcohol delivery, pushing for temporary relaxations in alcohol availability to become definite, and through corporate social responsibility activities such as producing hand sanitizer and information education campaigns about alcohol and Covid-19. Some beer producers are utilizing the opportunity to promote their non-alcoholic beer.
Response of health and welfare services
Addiction services, like most other health services, have seen a decrease in the numbers of patients attending or being treated in many countries. Many addiction treatment services have rapidly moved their support and treatment services to online. However, professionals in the addictions’ field have also reported about significant barriers such as clients being unable to access support remotely delivered via digital platforms. Other clients who need help are hesitant to contact addiction services in view of Covid-19 restrictions. Especially for them, alcohol harms tend to persist or become worse (IAS, 2020). In the continuing Covid-19 crisis and its aftermath it will become more and more important to make sure that addiction services and community welfare services will not be curtailed (Gilmore, 2020).
“During the Covid-19 pandemic, we should really ask ourselves what risks we are taking in leaving people under lockdown in their homes with a substance that is harmful both in terms of their health and the effects of their behaviour on others, including violence” says Carina Ferreira-Borges, Programme Manager, Alcohol and Illicit Drugs Programme, WHO/Europe (WHO, 2020).
Alcohol consumption can never be a cure against Covid-19. On the contrary, alcohol consumption has a negative effect on the immune system; it aggravates psychosocial distress and inclination to domestic violence associated with lockdown situations in people with alcohol use disorders. The period of Covid-19 associated isolation is likely to lead to increased alcohol use in at-risk individuals. Greater investment in alcohol treatment services and community mental health services is needed. Tackling alcohol-related harm must be part of overall national recovery plans.
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