As heavy drinking rose during the COVID-19 pandemic, deaths and hospitalizations for liver disease also jumped, according to WSU research

The well-documented increase in drinking alcohol during the COVID-19 pandemic coincided with a rise in people with life-threatening liver disease going to the hospital or dying, according to recently published research led by a Washington State University clinician and educator.

The report, published in the American Journal of the Medical Sciences in June, used national hospital admissions data to determine that diagnoses of alcohol-related hepatitis increased nearly 13% between 2019 and 2020, the first year of the COVID-19 pandemic. Deaths increased nearly 25%, with 11,455 people dying of the disease at hospitals in 2020, up from 8,725 in 2016.

The data alone does not show that increased drinking from the pandemic caused the jump in cases, but the findings do align with the observed increase in sales of liquor, beer and wine as people were forced to stay home and avoid crowds beginning in March 2020, said Kris Kowdley, the paper’s senior author and a member of the clinical faculty at WSU’s Elson S. Floyd College of Medicine.

“What we’ve seen is that there’s been almost an epidemic of alcohol-related disease, especially in young people,” Kowdley said. The largest jumps seen in alcohol-related hepatitis, an inflammation of the liver caused by heavy drinking that can lead to organ failure and death, were among young women, Kowdley said, adding to research that suggested that group experienced the largest increase in alcohol consumption when lockdowns began.

The most apparent symptom of the disease is jaundice, a yellowing of the skin that indicates the liver is not properly filtering waste products in the body. Other symptoms include loss of appetite, nausea, fever, fatigue and abdominal pain or tenderness. Fluid can also build up in the abdomen, causing a condition known as ascites.

Other agencies have been studying the effects of the pandemic on alcohol consumption and related health concerns. The Washington Post reported Thursday that data from the National Institute on Alcohol Abuse and Alcoholism found consumption had reached its highest level in 2021 since the late 1980s, with an average of 2.8 gallons per person annually for Americans older than 21.

Kowdley said it appeared the pandemic created “a perfect storm” for an increase in alcohol-related illnesses, by increasing stress that people use alcohol to relieve and separating them from people and places that might curtail their drinking.

“If there’s a component of anxiety and depression that might be exacerbated due to the pandemic, it’s worsened by social isolation,” Kowdley said. “Then we add to that the easy availability of alcohol.”

The research should also show that patients, individually, are not solely to blame for the onset of the illness, Kowdley said. While the Mayo Clinic reports that alcohol-related hepatitis is more likely to affect chronic drinkers, it also notes that “the relationship between drinking and (the disease) is complex.”

Kowdley said he hopes the data will lead to conversations about other treatments for alcohol dependence, including counseling, promising medication to reduce cravings and revising some rules for liver transplantation. Rules that are in place for some transplants, including requiring abstinence for six months prior to a procedure, are rooted in stigmas about liver illness that prevent people from receiving care, Kowdley said.

“I think there’s reason to be optimistic,” he said.

Kowdley said future data should be able to show if a lessening of social isolation will have a positive effect on hepatitis cases.

“There’s a growing recognition that it takes a village,” he said. “We’re not stigmatizing, but focusing on the full complement of care needed.”