Doctors have reported high increases in hospitalizations due to alcoholic-related liver diseases during the coronavirus pandemic. A Kaiser Health News article describes admissions jumping by 30% or 50% at university hospitals across the country since March.
And Michigan doctors are seeing it too.
Alcoholic liver disease, or ALD, is a serious condition that can lead to a buildup of fats and the inflammation or scarring of the liver. Liver damage can lead to cirrhosis, alcoholic hepatitis, chronic hepatitis and liver cancer. The beginning side-effects include bleeding, eyes turning yellow or stomach swelling. It can be fatal.
Dr. Jessica Mellinger is an assistant professor at the University of Michigan who studies hepatology and liver diseases.
She says the trend of ALD cases has been increasing for a long time, and the pandemic has “accelerated” it. Pre-pandemic hospitalizations due to alcoholic-related liver diseases have doubled over the past decade.
“We're seeing a trend that was already a public health emergency, really becoming a public health emergency where we're having 30, 40, 50% increases,” she said. “And the numbers of these patients coming in more recently have been kind of coping with some of the some of the issues with how we responded to the pandemic from a societal perspective, with lockdowns, etc.”
The numbers of alcoholic-related disease admissions increases during the pandemic are not official yet, nationally or statewide. Mellinger and several other universities are in the process of researching it, but she said in Michigan Medicine, the number of admissions for alcoholic hepatitis (the most severe form of ALD) increased 33% from 2019 to 2020, through the months March to June. This is similar to what Northwestern University reported, she said.
Other hospitals in Southeast Michigan noticed the rise, too.
Dr. Dilip Moonka is the medical director of Henry Ford's liver transplant program. While Henry Ford does not yet have the numbers, Moonka said he has seen a pandemic “bump” since March.
“We’ve been sort of seeing national increases in general. And then you throw coronavirus into the mix and it just made things much worse,” he said.
“We and the transplant community, as a whole, have been very impressed by the increase in patients with alcoholic hepatitis. [It] is very palpable.”
A Beaumont Health spokesperson told Michigan Radio there was not a major increase – 160 more codes related to ALD in 2020 than the 2,240 patients seen across Beaumont Health in 2018. But Dr. Mohamad Al Sibae, the medical director of the liver transplant program at Beaumont Health, said hospital codes assigned to patients do not always tell the whole story since another diagnosis could have been used.
He said in his experience, his hospital was seeing more instances of liver diseases – acute and chronic. Al Sibae also explained because alcoholic-related liver disease is a progressive disease, the continue uptick of alcohol consumption could result in long-term increases in liver diseases.*
Hints of the problem can be seen in the state’s purchases: according to a survey by American Addiction Centers, Michiganders consumed almost 1,000 drinks per person in 2020. Heavy drinking is defined by the Center for Disease Control as “averaging more than 14 drinks per week in the past year for men and more than 7 drinks per week for women.”
Mellinger says there is a combination of heavy-drinkers who have been developing cirrhosis over a long time and people who had less-severe drinking before COVID, but picked it up and developed alcoholic hepatitis.
And the factors for the increase range. Certain patients, she said, were coping with the stress of losing jobs, financial issues, health issues, anxiety and depression.
The isolation that comes from social distancing can separate some individuals from addiction recovery groups and can lead to some relapsing into drinking habits they haven’t had for years.
“Addiction to alcohol and recovery from that really often mandate or often requires people to be in alcohol counseling, to go to inpatient rehab, to go to intensive outpatient programs, where they're doing counseling and group therapies for many hours a day, several days a week. They're meeting with people at meetings or other community recovery group meetings. They're connecting with other people who are supporting their sobriety,” Mellinger said.
“So I think what happened with the COVID, and with our response to the COVID pandemic with lockdowns was that it isolated people. It kind of cut people off from their recovery supports that they had, [like] counselors, therapists, groups, etc. and then put people in their homes, under enormous stress.”
A changing demographic
For many, the people often "most associated" with alcoholic-liver disease were older men. But that's not the case for physicians.
Moonka and Al Sibae both said they were seeing more young patients with alcoholic hepatitis.
Moonka’s transplant patients, in general, are sometimes younger who did not realize they were drinking at a level that was damaging their liver.
“They've never had a liver-related problem. And they just hit a tipping point where they became jaundice and started developing signs of liver failure.”
Al Sibae said he has seen an increase among all age groups, even before the pandemic. But it was among younger patients, 20s to 30s, that he was seeing the most rise.
“I can tell you [that] alcoholic liver disease, there's an increase in younger patients even before the pandemic, and I do believe the pandemic has accelerated that,” he said. “Unfortunately, a lot of those patients are young and acute alcoholic hepatitis could be severe, could be dangerous, and patients, they could lose their life over it.”
According to Mellinger’s 2018 study, people aged 25-34 experienced the highest average annual increase in cirrhosis-related morality, driven entirely by alcohol-related liver disease from 1999 to 2016. There was an average increase of around 10% each year.
And the demographics are shifting genders, as well.
Mellinger says young college-age women or women in their thirties are becoming more and more likely to not only develop cirrhosis but alcohol use disorder in general.
Women, Mellinger explained, do not process alcohol the same way men do. They also have less body water, meaning there will be higher concentrations of alcohol in their blood if drinking the same amount as men.
According to the study, women’s rate for alcohol-related cirrhosis rose by 50% between 1999 to 2016. It was 30% for men.
These increases before the pandemic can be attributed to socioeconomic issues, like the economic crisis of the mid-2000s. Alcohol use swung upwards, but can often be overshadowed by the opioid epidemic, Mellinger said.
“There’s also very much, I would say, a cultural attitude around drinking in our country. That it's not a big deal,” she said. She points to shot glasses sold in hospitals and wine referred to as “mommy-juice.”
“I think there's a lack of kind of understanding about how severe these alcohol use disorders can really be and how damaging," she said. "We don't really have an image in our mind of women being alcohol use disorder individuals.
Mellinger said the issue of alcohol misuse was getting more and more attention pre-pandemic but said there could have been more time to discuss solutions during the pandemic.
“Certainly, everybody's been very focused on a whole host of important issues. But lives lost to addiction are also lives lost.”
You can learn about ALD resources at Michigan Medicine's website.
You can also reach for help by calling helplines such as American Addiction Centers at 1-877-884-9088 or the Substance Abuse and Mental Health Services Adminstration at 1-800-662-4357.
“There's a lot of different options available to kind of meet people where they are and one of the silver linings of the pandemic and our response to it has really been the flourishing of telehealth and video,” she said.
“So don't be afraid to ask your doctor for help. Don't be afraid to reach out."
Correction*: A previous version of this article stated liver transplants were halted at Beaumont Health. Liver transplants were paused during spring 2020, but have since resumed.