Bottle on the beach in Barcelona in July 2021, on the first night back from the curfew due to the pandemic. JUAN BARBOSA
Coronavirus infections have caused 120,000 deaths and close to a million hospitalizations in Spain since March 2020. But the impact of the pandemic on society and the health system has been so intense that it will be a long time before researchers can estimate with some precision the real magnitude of the damage that the health crisis has caused to citizens.
A group of specialists has now focused on a small part of this new reality and the results obtained are worrying: cases of alcoholic hepatitis shot up 50% after the outbreak of the pandemic in March 2020. A growth that, according to experts, reveals the profound consequences that confinements, the saturation of the health system and the weakening of support networks had on broad layers of the population.
“This type of hepatitis is the most serious form of clinical presentation of alcoholic liver disease and is associated with high mortality.
It is developed by people with chronic, intense alcohol consumption and who also usually already have an underlying liver disease”, explains one of the authors of the study, Elisa Pose, a hepatologist at Hospital Clínic (Barcelona).
The study is made with data from the Spanish Registry of Alcoholic Liver Disease (REHALC), the largest source of information in the country on these ailments, since it monitors the activity of 30 large and medium-sized hospitals in almost all the autonomous communities.
These centers serve close to 10 million people, 22% of the Spanish population.
The researchers have analyzed all the cases of alcoholic hepatitis treated in the 30 hospitals between January 2015 and December 2021. And they have divided them into two groups or cohorts: those treated before and after the start of the pandemic in Spain.
The results show that, in previous years, the health centers included in the study treated an average of 14 cases of alcoholic hepatitis per month, a figure that shot up to 21 (50% more) from that moment on, with a marked upward trend.
That is, from March 2020 to December 2021, the centers treated 460 people for this disease.
The data also shows that not only were there more cases, but that they were more serious and caused higher mortality, something attributable to higher consumption and the weakening of the health system.
Among all those treated before the pandemic, 26% died after one year of hepatitis, a percentage that increased to 31% during the health crisis.
“It is the first European study that quantifies the impact of the pandemic on the incidence and mortality attributable to alcoholic hepatitis.
It was a phenomenon that we had noticed in hospitals and that studies carried out in the United States showed.
But now we know the dimension of the problem in Spain and we can know how important it has been”, says Elisa Pose, who is also one of the people in charge of REHALC.
The research will be presented this Thursday at the congress of the Spanish Association for the Study of the Liver (AEEH), which is being held this week in Madrid.
The first factor that influenced this increase was increased alcohol consumption, according to the authors.
An investigation carried out in the United States, included in the study, reveals that total sales of alcoholic beverages increased by close to 20% as of March 2020 and that this increase was maintained in the two subsequent years.
There are no comparable data in Spain, but all the experts confirm that the pandemic and the lockdowns had the same global effect, especially among the most vulnerable population.
“In some groups, such as younger people and those who usually drink only in a social context, consumption in general decreased due to confinement.
But in groups with chronic consumption and a history of abuse, there was a very significant increase, the largest that has occurred in a long time”, explains David Fraguas, coordinator of the Mental Health Center of the Central district of Madrid.
This person in charge considers that the reasons for the phenomenon are several and interrelated: “One is the use of alcohol as a way of coping with the anxiety and frustration of the moment.
Another, greater access due to the interruption of activities and social relationships that kept these people busy with tasks unrelated to alcohol.
And, finally, the loss of follow-up of these patients, the relapses and the new diagnoses not made”.
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David Fraguas illustrates the problem with a piece of information.
The mental health center that he coordinates lost half of its staff in March 2020, destined to reinforce the overloaded staff of hospitals.
“All mental health devices try to continue serving the maximum population possible, mainly the most serious cases.
But for many months it was impossible to maintain the previous activity.
This caused many chronic patients or those who were in the initial phases of follow-up to disconnect ”, he laments.
The blow was double for the most vulnerable groups, regret the experts.
People with more mental health problems, fewer resources, more socially isolated and with a history of alcohol abuse, precisely those who needed the most help to face the consequences of the health crisis, found themselves deprived of many networks from one day to the next. support.
And the consequent increase in consumption punished them much more severely due to their previous worse state of health.
“In a population already punished by previous liver damage, a 10% increase in consumption translates into a much more significant rise in pathologies such as alcoholic hepatitis.
Small increases in vulnerable groups give rise to large health impacts”, sums up David Fraguas.
M. is a woman, she is 46 years old and lives in the metropolitan area of Barcelona.
She asks not to reveal her full name because she has not yet "taken the step" of presenting herself "before society as an alcoholic."
“I've been living with alcohol since high school, sometimes better and sometimes worse, but it was supposed to be within some control,” she says.
M. does not like therapies.
"I've started them several times, but for some reason I can't and don't want to follow them."
Her great support, she continues, was her family doctor.
"I went from time to time.
She listened to me, did tests on me, and warned me that my liver was beginning to suffer.
So she drank less for a few months.
It was like my alert and my safety cushion, ”she recalls.
“Everything broke with the pandemic”
With the start of the pandemic, "everything broke."
“I stayed home alone and isolated myself.
I couldn't speak or see my doctor for two or three months.
She had caught the coronavirus and she was very sick.
Then we talked on the phone a few times, but I was already sick.
She then retired.
I started spending weeks at home, drinking almost all the time.
M. says she was saved by an accident, alcohol related but she doesn't want to give details.
“I spent two weeks in the hospital.
The doctors told me that she would recover from the accident, but that it would not last long if she did not stop drinking.
I have cirrhosis, but I have been saved from hepatitis.
I have not completely stopped, but I drink much less and, although it has been difficult for me, I have been returning to my life before the covid.
I have another family doctor and we are talking about what to do, ”she clinches.
Jaume Sellarés is a family doctor and director of the Sardenya Primary Care Center (Barcelona).
“There is a group of patients who need to enter drug addiction programs, but when you ask them they say no.
Our role then is to monitor them, minimize the damage and accompany them in the process of assuming the problem and looking for formulas to solve it.
This is what was abruptly interrupted by the pandemic, despite all the efforts we made to avoid it and continue to accompany them, ”he laments.
The experts consulted agree that, little by little, the situation is beginning to be reversed.
“Our study ends in December 2021. We have to expand it to see if in 2022 the trend naturally returns to the pre-pandemic situation.
Our impression in the daily clinic is that progress is being made.
Patient follow-up is increasing, people who had started drinking again are returning to the programs to quit... But the impact has been very important and we will continue to notice the consequences for years to come”, concludes Elisa Pose.
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