Alcohol use disorder as a potential risk factor forCOVID‐19 severity: A narrative review

Abstract

In Dec. 2019‐January 2020, a pneumonia illness originating in Wuhan, China, designated as coronavirus disease 2019 (COVID‐19) was shown to be caused by a novel RNA coronavirus designated as severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). People with advanced age, male sex, and/or underlying health conditions (obesity, type 2 diabetes, cardiovascular disease, hypertension, chronic kidney disease, and chronic lung disease) are especially vulnerable to severe COVID‐19 symptoms and death. These risk factors impact the immune system and are also associated with poor health, chronic illness, and shortened longevity. However, a large percent of patients without these known risk factors also develops severe COVID‐19 disease that can result in death. Thus, there must exist risk factors that promote exaggerated inflammatory and immune response to the SARS‐CoV‐2 virus leading to death. One such risk factor may be alcohol misuse and alcohol use disorder because these can exacerbate viral lung infections like SARS, influenza, and pneumonia. Thus, it is highly plausible that alcohol misuse is a risk factor for either increased infection rate when individuals are exposed to SARS‐CoV‐2 virus and/or more severe COVID‐19 in infected patients. Alcohol use is a well‐known risk factor for lung diseases and ARDS in SARS patients. We propose that alcohol has three key pathogenic elements in common with other COVID‐19 severity risk factors: namely, inflammatory microbiota dysbiosis, leaky gut, and systemic activation of the NLRP3 inflammasome. We also propose that these three elements represent targets for therapy for severe COVID‐19.

Chronic alcohol consumption and COVID‐19 infection risk: A narrative review

“…Furthermore, one explanation for age as a risk factor for severe COVID‐19 is the decreased diversity of microbiota in the elderly people (Dhar & Mohanty, 2020). Consistent with a recent review, AUD may result in a predisposition to COVID‐19 infection due to a severe preexisting impairment of the gut, as similarities in the gut profile have also been found in already known risk groups (Forsyth et al, 2022). In addition, the bidirectional connection of gut and liver via the gut–liver axis, as well as the connection to the brain established by the gut–brain axis, highlights the impact of gut dysbiosis on other important organs for both AUD and COVID‐19.…”

COVID-19, Possible Hepatic Pathways and Alcohol Abuse—What Do We Know up to 2023?

“…Malnutrition and metabolic syndrome constitute other underlying issues [240,241]. The development of leaky gut and microbiota dysbiosis can be perceived as cofactors [242,243]. Alcohol together with COVID-19 modifies the content of microbiota and alters the permeability of intestinal cell junctions.…”

“…Finally, the integrity of the epithelium becomes disrupted, leading to alveolar epithelial dysfunction and decreased concentration of pulmonary an- Malnutrition and metabolic syndrome constitute other underlying issues [240,241]. The development of leaky gut and microbiota dysbiosis can be perceived as cofactors [242,243]. Alcohol together with COVID-19 modifies the content of microbiota and alters the permeability of intestinal cell junctions.…”

Alcohol: Immunomodulatory effects and cancer

“…For example, alcohol use increases the incidence of infections, such as pneumonia, caused by antibiotic-resistant bacteria, HIV infection, and tuberculosis 6 . Furthermore, chronic alcohol consumption significantly increases the probability of developing acute respiratory distress syndrome 7 and may also modify susceptibility and worsen COVID-19 infection 8,9 .…”