Between smart working, reduced physical activity following the closure of gyms and swimming pools, and anxiety, the covid-19 pandemic has worsened people’s lifestyle. And there are those who have taken refuge in alcohol, as Edo Polidori, director of the Operational Unit of Pathological Addictions of Rimini and Forlì, explained in a previous interview with ForlìToday. And recently experts from 19 scientific societies gathered in the “Permanent Forum on the national health system in the post Covid” which took place in Rome announced that the coronavirus pandemic “risks following an epidemic of diseases caused by incorrect lifestyles, from tumors to rheumatological pathologies, up to cardiovascular ones such as heart attack and stroke. The consequences of the long months of lockdown are clear “.
Paolo Muratori, head of Internal Medicine at the “Morgagni-Pierantoni” hospital in Forlì and associate professor of Internal Medicine at the Department of Sciences for the Quality of Life of the University of Bologna, she is well versed in liver disease. Has the covid-19 pandemic seen an increase in hospital services for alcohol-related illnesses?
I would distinguish two well-defined phases, the first that of the lockdown actually saw a reduction in alcohol-related services, as well as all other specialist medical services in general by virtue of the lockdown and the fear on the part of patients to approach the hospital environment for the risk of contagion; in the first months of 2020 the presence of “non-covid” patients in the emergency room and internal medicine wards was significantly reduced, as the fear of attending risky environments such as hospitals involved access to the emergency room only in cases objectively and acutely severe; from late spring 2021 a certain “hospital” normality began again so that even patients with chronic diseases related to alcohol abuse have resumed being patients present in our wards
What are the diseases that caused by improper lifestyles?
Liver diseases linked to incorrect lifestyles are basically two; that in which there is a conspicuous and constant intake of alcohol in which the patient develops the so-called Ash (acronym which stands for Alcohol SteatoHepatitis), that is a chronic liver disease sustained by the pro-inflammatory action of alcohol; and then there is instead the Nash (Non Alcholic SteatoHepatits) in which, despite the patient’s clinical history being negative for alcohol intake, an inflammation of the liver linked to metabolic reasons develops, so much so that the prototype patient affected by Nash has a well defined (basically obese, often diabetic, with high blood pressure values, and the presence of hypercholesterolemia and hypertriglyceridemia; he is therefore a patient in whom an important role in the genesis of his problems is played by unhealthy lifestyles, i.e. sedentary lifestyle and unhealthy diet correct and which must therefore be framed in its complexity and in a multidisciplinary context; unfortunately we are not equipped with the magic pill that treats the inflammation of the liver of these patients but we need to teach them to take care of themselves in terms of food and physical activity.
How long does it take for the symptoms of these diseases to appear?
It is often decades before symptoms of chronic liver disease manifest; the problem is that when they do manifest they are generally symptoms related to liver cirrhosis or its complications and this means that we are in an advanced stage of the disease with a liver extremely scarred.
Is the percentage of consultations for alcohol-related gastrointestinal and liver disease also high during this period?
I would say that the trend of alcohol related liver diseases is constant; but surely there will not be an inversion of the prevalence of these pathologies until strategies and preventive measures are put in place to dissuade young people from the use and abuse of alcohol; what we see in the hospital are not the effects of an acute and occasional alcohol intake but the effects of many years of alcohol use that often has its (wrong) roots also in the cultural sphere.
Considering that some patients experiencing alcohol-related illnesses do not require prompt hospitalization, is it possible that alcohol-related health problems may be even more frequent than observed?
Surely, as we said before, it takes a long time for liver problems linked to alcohol abuse to occur so that what we see in the wards or in the clinic is only the tip of the iceberg.
Does alcohol and ethanol in particular worsen the damage caused by Covid-19, thus worsening the condition of fatty livers?
Let’s say that alcohol facilitates Covid-19 making people more fragile both under the immune profile and under the profile of general kinesthesis being often connected to problems of malnutrition and hypovitaminosis; and as we have seen in recent months, when Covid-19 finds more fragile subjects, it tends to be more dangerous and aggressive.
What is the therapeutic path that a patient with alcohol-related problems undergoes?
A patient hospitalized for alcohol-related complications is often a patient who already has his own SerD (Dependency Service), so the contact between us health professionals and Serd in these cases becomes automatic to confront us and have a complete picture of the patient’s problems. We remind you that often the patient with alcohol-related problems is also a patient with a history of active or previous toxic addiction, so for us health professionals having contact with the colleagues of the Serd is essential to establish the most appropriate path for the patient also according to the his compliance with therapy and the socio-economic conditions that characterize him
Suggestions for a large project dedicated to prevention?
As mentioned earlier, the problem of alcohol is also and above all of a cultural nature, so that one does not always have the perception of how harmful it can be; having said this so that the prevention project is first of all credible and then feasible, it cannot fail to start from the “upper floors” of politics
Finally, let’s debunk a fake news of those that can be read on social networks: ethanol neither ‘disinfects’ nor eradicates the Covid virus. And at the same time it does not increase the immune defenses …
I absolutely confirm that alcohol does not involve any form of disinfection or any benefit to the fight against Covid-19, indeed if taken in a chronic and incongruous way it makes the patient more fragile from an immunological point of view and therefore more defenseless in the face of the virus.