Drinking More Than Usual During the COVID-19 Pandemic?

From Zoom happy hours to “wine o’clock” memes floating around on social media, the pressure to grab a drink to take an edge off your pandemic anxiety can sometimes feel strong. Not being able to visit friends or enjoy many out-of-home activities leaves some people feeling like they don’t have much else to do, so why not enjoy a glass of wine—or two or three?

Indeed, data from Nielsen indicates people are drinking more. For the week ending May 2, total alcohol sales in the U.S. were up by more than 32% compared to the same week one year ago. These figures have some medical experts worried.

The World Health Organization (WHO) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have issued communications warning people to avoid excessive drinking, saying it may increase COVID-19 susceptibility and severity. Beyond that, alcohol consumption is already a major public health problem in the U.S., the NIAAA says. According to the Centers for Disease Control and Prevention (CDC), from 2006 to 2010, “excessive alcohol use was responsible for an annual average of 88,000 deaths, including 1 in 10 deaths among working-age adults aged 20 to 64 years.” And studies have linked alcohol consumption to an increased risk of breast and other cancers.

While it is too soon to definitively know the effects of the pandemic on drinking patterns or how alcohol consumption impacts COVID-19, Yale Medicine experts say there are logical concerns based on what has already been proven about how alcohol changes the human body.

“No. In general, because we know that alcohol has a negative impact on the lungs and the immune system, we believe it will be associated with more severe cases of COVID-19 disease,” says David Fiellin, MD, director of the Yale Program in Addiction Medicine. “Alcohol can damage the intestinal lining, which then allows bacteria to enter the body more easily. That can ‘rev up’ the inflammatory response, which is also a big part of COVID-19 disease.”  

Rajita Sinha, PhD, director of the Yale Stress Center, agrees. “Those with alcohol use disorder—and binge and heavy social drinkers—have alterations in their cytokines [small proteins released by cells that mediate the immune response] that can directly impact inflammation,” says Sinha. “This tells us that our immune system is not functioning in the best way. This is important when we want it to be ready to fight COVID-19, or to not catch it. All of that is dependent on having a good immune system.”

Specific to the immune system, alcohol can also cause bone marrow suppression, Dr. Fiellin says. “We get many of our cells—including white blood cells, which help defend against disease—from bone marrow. If your bone marrow is suppressed, then you are not going to have as many functioning white blood cells,” he explains.

Dr. Fiellin also notes that alcohol can slow the function of cells (responsible for clearing pathogens from the lungs) that line the respiratory tract. And if those cells aren’t functioning properly, SARS-CoV-2 virus particles could have easier access to the lungs.

Perhaps most worrisome, studies show that chronic high alcohol consumption can significantly increase the risk of acute respiratory distress syndrome (ARDS), a potentially fatal respiratory condition in which fluid accumulates in the lungs. Severe COVID-19 illness can lead to ARDS.

“When someone has ARDS, it can become hard for the lungs to exchange oxygen, and that’s when people end up on ventilators,” Dr. Fiellin says.

The NIAAA divides drinking into several categories, including abstinence (no drinking), moderate, high risk, heavy episodic (binge), and alcohol use disorder (which itself can be rated as mild, moderate, or severe).

Moderate drinking is up to one drink (about 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits) per day for women and two drinks for men. High-risk drinking for women is the consumption of four or more drinks on any day or eight or more drinks per week. For men, it is five or more drinks on any day or 15 or more drinks per week. Binge drinking is defined as women consuming four or more drinks in about two hours, or five or more drinks for men.

Women, Dr. Fiellin notes, metabolize alcohol less efficiently than men, meaning they have higher concentrations of it in their blood when they drink the same amount.

But alcohol use disorder, Dr. Fiellin explains, typically means someone has a physical dependence on alcohol. “If they stop drinking, they start to feel sick. Their heart rate goes up. They get anxious. They get tremors,” he says. “Individuals with an alcohol use disorder are unable to control their drinking despite the negative impact it is having on their life. They can have cravings for and a preoccupation with alcohol.”

Many people pick up a drink as a way to relieve stress and don’t realize that those initial, relaxing effects are short-lived and that alcohol actually stimulates the body’s stress response, says Sinha.

“If you don’t normally drink a lot, a little will feel good. But soon, you’ll feel sleepy as the sedative effects take hold,” Sinha explains. “People who drink regularly, though, don’t feel those sedative effects as much, which means they have adapted to consuming higher levels of alcohol, and they are driven to drink more when they are stressed.”

That can mean that someone who normally has one or two drinks a day may start drinking three more regularly. “Drinking is sneaky like that,” she adds.

Plus, it may seem that alcohol helps you fall asleep more easily, but it actually leads to more interrupted sleep. “You may wake up a few hours later as the effect of the alcohol wears off,” Dr. Fiellin says.

Another important thing to note is how alcohol modulates your mood, says Sinha. “As you drink more, you start to have more irritability and emotional reactivity because it can blunt your ability to regulate. The flip side of feeling good is feeling bad, and the more you drink, the more of the bad side that comes out,” she says. “And depression is very common in people who have alcohol use disorder.”

While red wine is often touted as having heart-protective elements, there is no safe level of alcohol use when it comes to increasing your risk of alcohol-related illnesses, Sinha says. “With every drink we consume, that risk will increase. People may have heard that resveratrol, which is in wine, may be a component of good health, but that one good component doesn’t negate the other negative aspects,” she says.

Dr. Fiellin agrees. “Alcohol is a toxin, and it can make heart cells function poorly, resulting, over time, in cardiomyopathy [a disease of the heart muscle that makes it harder to pump blood],” he says. “In addition, for those with an alcohol use disorder, increased adrenaline, which is seen in alcohol withdrawal, can result in heart arrhythmias, including atrial fibrillation, or fast and irregular heartbeats.”

If you think your drinking is a problem, Dr. Fiellin recommends touching base with your primary care physician to discuss your concern. “Your doctor can help you monitor your drinking, and one useful strategy is a trial period of cutting down or abstinence. If you are not able to do that, that is evidence that you may need some help,” he says. “You can try this over a period of two to four weeks. It’s not necessary to hit rock bottom for most people to have insight into how alcohol is having negative effects on their life.”

NIAAA also has a helpful treatment navigator, he notes. The organization provides information and resources for people with questions and worries about alcohol use, and it also can help people find treatment, if needed.

But stopping drinking does not make the stressors of life disappear. Sinha advises finding healthier ways to cope. “Talk to family or friends on Zoom. Develop a hobby. Try singing, drumming, exercise, whatever. The reason yoga, meditation, and mindfulness have taken off is because they are great ways to manage stress,” she says. “It’s hard since we have such a drinking culture. If you are drinking at really low levels, then your risks are low. But if you notice how much you are wanting a second, third, or fourth drink, you might want to find nonalcoholic alternatives or think about getting help.”

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