key: cord-0969730-o2r82r1y
authors: Lebin, Jacob A.; Mudan, Anita; Wu, Alan H.B.
title: Chronic alcohol use does not protect against COVID-19 infection
date: 2020-11-14
journal: Am J Emerg Med
DOI: 10.1016/j.ajem.2020.11.024
sha: d02dca831c9df6d9486807894a266a1cad767988
doc_id: 969730
cord_uid: o2r82r1y

nan

We performed a retrospective, single center, cohort study examining the incidence of infection in patients who presented to an urban public hospital emergency department between May 1 and July 31, 2020 who received testing for COVID-19 when widespread testing was available. At this institution, COVID-19 testing was performed at clinician discretion based on patient risk factors, symptoms, or institutional disposition requirements (hospital admission, shelter placement, congregate living situation, psychiatric evaluation). We defined two cohorts: all patients who presented to the emergency department and patients who presented to the emergency department with a history of chronic alcohol use. Subjects were included in the chronic alcohol use cohort based on the presence of any positive serum ethanol level during the study period and if they had a documented history of alcohol withdrawal, alcohol use disorder, alcoholic cirrhosis, or more than three emergency department visits related to alcohol use in the prior calendar year based on retrospective chart review. Chart review was completed by two authors, JAL and AM, who were not blinded to the study hypothesis. All data abstracted by manual review were confirmed by both reviewers. Full consent between authors was required for inclusion. If consensus was not reached, the case was adjudicated by another reviewer.

Nasopharyngeal swabs were tested for the presence of SARS-CoV-2 infection via polymerase chain reaction-based methods. We then compared the incidence of COVID-19 infection in patients presenting to the emergency department and patients with a history of chronic alcohol use. Institutional review board approval was obtained for all study procedures. Incidence rates were compared using  2 analysis.

Overall, a total of 5419 unique subjects received a COVID-19 test in the emergency department during the study period. Within this cohort, 161 subjects met criteria for chronic alcohol use. The J o u r n a l P r e -p r o o f incidence of COVID-19 in the general emergency department population was 5.66% (307/5419).

The incidence of COVID-19 among subjects with a history of chronic alcohol use was 4.97% (8/161). There was no significant difference between cohorts (absolute difference 0.69%,  2 =0.140, 95% CI -3.88-3.21). Demographic and clinical characteristics of the chronic alcohol use cohort are shown in Table 1 .

In this sample of emergency department subjects, chronic alcohol use was not associated with a decreased incidence of COVID-19 infection. To our knowledge, these are the first data to directly address this widespread myth and provide evidence to discredit the notion that frequent alcohol use can prevent COVID-19 infection.

The study limitations include the retrospective design at a single institution. The proportion of patients with a history of chronic alcohol use may be underestimated due to limitations of the electronic medical record used to define this cohort. Similarly, we were unable to account for other potential confounders, such as medical co-morbidities, housing status, or frequent contact with crowded indoor spaces. Testing thresholds evolved over the study period as institutional knowledge and protocols changed, although this would be present in both cohorts.

These data only address one myth in a sea of falsehoods. While public health entities have attempted to counter misinformation by disseminating evidence-based recommendations, the rapid proliferation of misinformation has undoubtedly resulted in additional harm to patients. It remains the responsibility of the medical community to continue working to counter potentially harmful remedies, myths, and fake news. 

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