By Kotie Geldenhuys
Families across the world have been affected by the COVID-19 pandemic which will likely have a long-lasting impact on public health and our well-being. Traditionally, alcohol abuse, which is already a public health concern in many countries across the world, including South Africa, dramatically increases during pandemics and disasters. According to the US National Institute on Alcohol Abuse and Alcoholism (NIAAA), previous disasters, such as 9/11 and Hurricane Katrina, saw an increase in alcohol abuse as people believed that it helped them to “ease” the stress of the events and anxiety about the future. During the COVID-19 pandemic we have noticed how alcohol abuse has the potential to further complicate an already difficult period (NIAAA, 2020).
During the first part of 2020, even before the world realised what the impact of the COVID-19 pandemic would be, the World Health Organisation (WHO) warned that alcohol use during the pandemic may potentially exacerbate health concerns and risk-taking behaviours. When some US states issued stay-at-home orders as a mitigating strategy for COVID-19 transmission, there was a 55% increase in national sales of alcohol for the week ending 21 March 2020, compared to the corresponding period in 2019. Online sales increased by 262% from 2019 (Pollard et al, 2020). The USA was not the only country showing an increase in alcohol sales and abuse. In May 2020, Sky News reported that alcohol sales in the UK had increased by 67% before they went into lockdown, with many drinking at home in isolation (Sky News, 2020). A survey from the Australian Alcohol and Drug Foundation found that 12% of Australians began consuming alcohol on a daily basis since the coronavirus pandemic had begun (Mandal, 2020).
South Africa imposes an alcohol ban
When the President of South Africa, Mr Cyril Ramaphosa, announced that a full national lockdown was to start at midnight on 26 March 2020, which included a total ban on alcohol sales, South Africans streamed to liquor outlets to stock up on their liquid gold for the period they had to stay at home. When the initial alcohol ban was lifted on 1 June 2020, albeit under strict conditions, liquor outlets saw another rush. What might have been a reason for celebration for alcohol lovers, was much more of a nightmare for emergency rooms in some provinces which came under massive strain due to the lifting of the ban on the sale and consumption of alcohol. An orthopaedic surgeon working at a Durban private hospital had to treat a man whose finger had been bitten by his wife during a drunken fight. This doctor confirmed the spike in trauma cases, as did a trauma specialist at a Durban state hospital who said that trauma unit cases tripled in one week in June 2020. This doctor was quoted as having said that “we have seen an explosion in stabbings, accidents and assaults. It’s a nightmare. All are linked to unbanning alcohol” (Medical Brief, 2020a).
On 12 July 2020 and without prior warning, Mr Ramaphosa reinstated the prohibition on the sale of alcohol with immediate effect. Dr Zweli Mkhize, the Minister of Health said at the time: “When the alcohol restrictions were lifted ... facilities reported up to 60% of increase in trauma emergencies admissions and up to 200% increase in ICU on trauma admissions.” The idea behind the renewed ban was to free up approximately 50 000 beds in public hospitals over the following eight weeks (Medical Brief, 2020b). On 17 August 2020, the suspension of the sale of alcohol was lifted subject to certain restrictions and in November 2020 restrictions on the sale of alcohol were eased further.
Why do people turn to alcohol during pandemics and disasters?
According to Dr George Koob, the Director of NIAAA in the USA, there are many reasons why people increase their alcohol consumption during pandemics as we have seen during the COVID-19 pandemic. Reasons include anything from using alcohol to relieve the stress of being unemployed to feelings of isolation during physical distancing. “More people may use alcohol and people may drink more heavily to cope with stress, sleep disturbances and even boredom, increasing their risk for alcohol use disorder and other adverse consequences,” he said. Although alcohol temporarily dampens the brain and the body’s response to stress, feelings of stress and anxiety not only return, but worsen, once the effect of alcohol wears off. Over time, excessive alcohol consumption can cause adaptations in the brain that intensify the stress response. As a result, drinking alcohol to cope can make problems worse and one may end up drinking to fix the problem that alcohol caused (NIAAA, 2020).
Dr Adriane Dela Cruz, a psychiatrist who specialises in drug and alcohol addiction in the USA argues that people have long turned to alcohol to try to relieve everyday stress, and the pandemic has pushed up anxiety levels for many people. “There are all these uncertainties: ‘Will I still have a job? When will my kids go back to school? When can I see my family again and hug them?’” she said and added that anxiety is not solely responsible for fuelling excessive drinking during pandemics. With an increasing number of people who had to work from home and self-isolate, researchers witnessed that some of these people experienced loneliness and boredom, which are two additional potential triggers for excessive alcohol use. Dr Dela Cruz said: “This cultural idea that alcohol is a good way to deal with problems is disheartening. If it’s one drink, it’s totally fine. But I’m worried when drinking becomes the routine, go to solution” (Chistensen, 2020).