INTRODUCTION:

The real-world impact of alcohol abuse reaches far beyond the financial costs. When a loved one has a problem with alcohol, it can affect their marriage and their extended family. There's also the larger impact on the community, schools, the workplace, the health care system and on society as a whole.

As chaotic scenes of crowds thronging newly re-opened liquor shops in India went viral this week, some women’s rights experts warned that moves to lift a ban on alcohol would fuel domestic violence.

But most countries that have introduced booze bans have done so to minimize the risk of people gathering and spreading coronavirus. India reopened alcohol shops at the weekend after shutting them on March 24.

Facing the COVID-19 (new coronavirus disease) pandemic, the countries of the world must take decisive action to stop the spread of the virus. In these critical circumstances, it is essential that everyone is informed about other health risks and hazards so that they can stay safe and healthy.

GENERAL MYTHS AND FACTS ABOUT ALCOHOL AND COVID-19:

MYTH: Consuming alcohol destroys the virus that causes COVID-19.

FACT: Consuming alcohol will not destroy the virus, and its consumption is likely to increase the health risks if a person becomes infected with the virus. Alcohol (at a concentration of at least 60% by volume) works as a disinfectant on your skin, but it has no such effect within your system when ingested.

MYTH: Drinking strong alcohol kills the virus in the inhaled air.

FACT: Consumption of alcohol will not kill the virus in the inhaled air; it will not disinfect your mouth and throat; and it will not give you any kind of protection against COVID-19.

MYTH: Alcohol (beer, wine, distilled spirits or herbal alcohol) stimulates immunity and resistance to the virus.

FACT: Alcohol has a deleterious effect on your immune system and will not stimulate immunity and virus resistance COVID-19.

ALCOHOL USE DISORDERS AND COVID-19:

Alcohol use disorders are characterized by heavy alcohol use and loss of control over alcohol Intake. Although they are among the most prevalent mental disorders globally, they are also among the most stigmatized.

People with an alcohol use disorder are at greater risk of COVID-19 not only because of the impact of alcohol on their health but also because they are more likely to experience homelessness or incarceration than other members of the population. It is therefore essential, under the current conditions, that people who need help because of their alcohol use get all the support they need.

IMPACT ON ALCOHOL INTAKE DURING COVID -19:

DRINKING AND DOMESTIC ABUSE:

Although the two often go hand in hand, alcohol is not the root cause of domestic violence. Domestic abuse charities emphasize that it is about power and control and is a choice an abusive partner or family member makes. Alcohol should never be seen as a cause or an excuse, they say.

However, the World Health Organization says alcohol can be a contributing factor. It may increase the frequency and severity of violence and be more likely to result in injury. The World Health Organization says alcohol use reduces self-control and leaves people less capable of negotiating tensions within relationships.

Excessive drinking by one partner can also exacerbate financial difficulties, childcare problems and other family stressors. Societal beliefs that alcohol causes aggression can even encourage violent behavior after drinking, and also lead to drinking being used as an excuse for violence.

Victims interviewed in studies done around the world often mention their abusers had been drinking before an incident. In one study in South Africa about 70% of abuse victims identified alcohol and other drug abuse as the main risk factor.

IMPACT ON ALCOHOL INTAKE:

The Centers for Disease Control and Prevention (CDC) is estimates that 40 percent of the cost of excessive alcohol consumption is paid by federal, state, and local governments.

The CDC estimates that these figures are all underestimated because alcohol's involvement in sickness, injury, and death is not always available or reported. These figures also do not include some medical and mental health conditions that are the result of alcohol abuse.

The biggest cost is loss of workplace productivity. Healthcare costs, crime and law enforcement, as well as motor vehicle crashes are also among the top alcohol-related expenses.

Indian charities working with victims of domestic violence say their phones have been ringing off the hook during lockdown. Mumbai charity Sneha has seen a four-fold increase in calls with many women reporting a rise in abuse after their husbands lost their jobs. “There is no difference in their treatment of women really. They would abuse the women when they had alcohol, and now they are abusing them because they don’t,” said programme director Nayreen Daruwalla.

Four major hospitals contacted by the Thomson Reuters Foundation said the number of women seeking treatment for domestic violence injuries had not changed significantly. But physician Harish Pathak of Mumbai’s King Edward Memorial Hospital predicted admissions would increase following the opening of liquor stores. “Intimate partner violence and alcohol has a very close relation,” he said.

HEALTHCARE COSTS OF ALCOHOL ABUSE:

Alcohol consumption is a risk factor in numerous chronic diseases and conditions, and alcohol plays a significant role in certain cancers, psychiatric conditions, and numerous cardiovascular and digestive diseases. Additionally, alcohol consumption can increase the risk of diabetes, stroke, and heart disease.

An estimated $28 billion is spent each year on alcohol-related health care.

ALCOHOL-RELATED AGGRESSION AND VIOLENCE:

Along with unintentional injury, alcohol plays a significant role in intentional injuries as a result of aggression and violence. Alcohol has been linked to physical violence by a variety of research studies.

On top of the healthcare cost of alcohol-related intentional violence in the United States, the estimated annual cost to the criminal justice system is another estimated $25 billion.

EFFECT OF ALCOHOLISM ON THE FAMILY:

The social impact of alcohol abuse is a separate issue from the financial costs involved, and that impact begins in the home, extends into the community, and often affects society as a whole, much like the financial impact does.

ALCOHOLISM AS A FAMILY DISEASE:

Research on the effects of alcohol abuse on families shows that alcohol abuse and addiction play a role in intimate partner violence, causes families' financial problems, impairs decision-making skills, and plays a role in child neglect and abuse.

As with the financial costs of alcohol abuse, studies have found occasional binge drinking can affect families also. One study revealed that "spousal violence is more likely not only when a partner is alcohol dependent or a problem drinker, but also when the partner is an infrequent drinker who occasionally drinks heavily."

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

EFFECTS OF ALCOHOL ABUSE ON CHILDREN:

Fetal alcohol syndrome (FAS) is one of the most common direct consequences of parental alcohol use in the United States, caused by alcohol consumption by the mother during pregnancy. Children with FAS display a variety of symptoms, many of which are life-long and permanent.

Children who grow up in a home with a loved one dealing with alcohol addiction may be affected as well; they are at significant to develop alcohol use disorders themselves.

Growing up in a home where at least one parent has a severe alcohol use disorder can increase a child's chances of developing psychological and emotional problems.

PREVENTIVE MEASURES OF COVID – 19 CASES:

SAFE COMMUNITY PRACTICES:

Sowmya Swaminathan, Chief Scientist at World Health Organization, who earlier headed the Indian Council of Medical Research, has warned that with large-scale movement of migrants following the sudden lockdown, the disease may spread in rural areas. Rural populations live far from tertiary hospitals and any strategy of testing and management that is based on large hospitals is not likely to be effective or sustainable. What then?

In this scenario, the role of personal and community behavior emerges as extremely critical for managing the pandemic. We know that physical distancing and hand-washing will have significant impact on slowing the spread of the epidemic. As the epidemic is evolving, fear of disease (may-a-times unfounded) as well as that of stigmatization also affects individual and collective behaviors. Merely imposing restrictions will not promote safe behavior.

There is a fear among the public health circles that excessive focus on managing coronavirus is likely to diminish care of people suffering from other health conditions, and result in higher mortality. The fear is not unfounded. We know from previous epidemics that reduced access to care, medicines and diagnostics for people with life-threatening conditions, such as TB, which in India causes about 1,200 deaths per day, can lead to an increase of deaths from these underlying conditions.

In Guinea, one of the countries at the epicenter of the 2014-2015 Ebola epidemic, reduced health services led to a 53 per cent decrease in the diagnosis of TB, and a doubling of the mortality rate from it from direct and indirect impacts on TB health services, according to a paper published 2006 in the International Journal of Infectious Diseases.

PRIMARY CARE MANAGEMENT:

India has an extensive network of about 25,000 primary health centers and 5,300 community health centers spread across all regions and States. In addition, large numbers of private and non-governmental organizations provide primary healthcare in urban and rural areas. At this juncture, they can play a critical role in managing the epidemic and providing continuity of services. An investment in strengthening primary healthcare at these times will also go a long way in rejuvenating and creating resilient health systems.

RECOVER AT HOME:

It is advisable that most patients with probable or confirmed coronavirus infection rest and recover at home. However, they need to be counselled and followed up with for deteriorating symptoms, and supported for home isolation. More than 90 per cent of all such patients could be managed at households with support of the primary health care providers. Primary healthcare providers can also triage the patients requiring tests or ‘visit’ the health center’s over phone.

SUPPORTIVE CARE AND OXYGEN:

PHCs, CHCs and small nursing homes and hospitals can also play a significant role in caring for a large proportion (about 70 per cent) of the remaining patients who need supportive care, but do not require critical care. Standard protocols and oxygen would be essential for such care, and should be provided urgently. Regular availability of oxygen would save many lives from other respiratory or cardiac causes now and later.

EXPAND DETECTION:

Laboratory tests are still conducted at the district hospitals, which dissuades many people from getting tested, and increases the risk of transmission in transit or at hospitals. Primary healthcare providers can offer sample collection closer to families and communities. Such samples can be transported to the laboratories. It would require immediate training of primary healthcare staff in collecting samples and setting up a system for transportation.

PROVIDE CONTINUITY OF HEALTHCARE:

During the epidemic, there are early signs that outpatient and “routine” services are restricted within the public and private sector. Because of the lockdown, there is also a difficulty in accessing healthcare for many patients in rural areas. For those with chronic illnesses, such as tuberculosis, diabetes and hypertension, restricted access to drugs and services could be life-threatening. By the nature of being closer to the communities, PHCs and other primary care providers can significantly ameliorate the situation.

To perform all of the above functions, there is an urgent need for the States to ramp up the primary healthcare systems. It would go a long way in not only managing the epidemic but also strengthening the health systems in the medium and long run.

Through the Billion Press. Mohan, formerly of the child health and health systems portfolio at UNICEF India, is a pediatrician, public health expert and co-founder of Basic Health Care Services. Mor is a visiting scientist at The Banyan Academy of Leadership in Mental Health.

CONCLUSION:

The coronavirus disease continues to spread across the world following a trajectory that is difficult to predict. The health, humanitarian and socio-economic policies adopted by countries will determine the speed and strength of the recovery. People-to-people, cultural and travel exchanges have all been restricted. Consuming alcohol will not destroy the virus, and its consumption is likely to increase the health risks if a person becomes infected with the virus. Children with FAS display a variety of symptoms, many of which are life-long and permanent.

REFERENCES:

1. Food and nutrition tips during self-quarantine. Copenhagen: WHO Regional Office for Europe; 2020 (http://www.euro.who.int/ en/health-topics/health-emergencies/coronavirus-covid-19/novel-coronavirus-2019-ncov-technical-guidance/foodand-nutrition-tips-during-self-quarantine/_recache).

2. How to stay physically active during COVID-19 self-quarantine. Copenhagen: WHO Regional Office for Europe; 2020 (http:// www.euro.who.int/en/health-topics/health-emergencies/ coronavirus-covid-19/novel-coronavirus-2019-ncov-technical-guidance/stay-physically-active-during-self-quarantine).

3. Alcohol does not protect against COVID-19; access should be restricted during lockdown (http://www.euro.who.int/en/health-topics/disease-prevention/alcohol-use/news/news/2020/04/alcohol-does-not-protect-against-covid-19-access-should-be-restricted-during-lockdown).

4. www.scroll.in/article/961208/covid-19-lockdown-will-indias-move-to-ease-alcohol-restrictions-fuel-domestic-abuse.

5. https://www.livemint.com/news/india/covid-19-to-impact-out-of-home-alcohol-consumption-report-11589271764985.html.

Received on 23.05.2020 Modified on 22.07.2020

Int. J. of Advances in Nur. Management. 2020; 8(4):341-344.

DOI: 10.5958/2454-2652.2020.00076.1