Alcohol Sales and Alcohol-Related Emergencies During the COVID-19 Pandemic

Background: During the coronavirus disease 2019 (COVID19) pandemic, many regions across the world recommended stay-at-home orders, closure of public spaces, and physical distancing to reduce community transmission (1). These measures contributed to isolation and anxiety, with recent surveys indicating increased subsequent consumption of alcohol (2). Although drinking can lead to temporary relief of stress, alcohol misuse is a leading cause of mortality worldwide, contributing to about 3 million deaths annually (1). Objective: To examine changes in alcohol sales and alcohol-related emergencies after the onset of the first wave of the COVID-19 pandemic. Methods and Findings: We examined alcohol sales and alcohol-related emergencies in Ontario, Canada (population, 14.7 million), from 1 July 2018 to 30 June 2020. A lockdown was declared on 17 March and ended on 24 July 2020, with the province ordering the closure of bars, restaurants, and other nonessential businesses soon thereafter. In contrast, alcohol stores were deemed essential and remained open. We obtained alcohol sales data in Canadian dollars (weekly, then aggregated to monthly) from the Liquor Control Board of Ontario, the government agency overseeing retail sales in the province for more than 99% of spirits, 83% of wine, and 31% of beer. We obtained data on monthly alcohol-related emergency visits from the Ontario Ministry of Health. Alcoholrelated emergencies were grouped into 4 diagnostic subcategories: psychiatric, gastrointestinal, intoxication, andmiscellaneous. We compared alcohol sales and alcohol-related emergencies during the first months of the COVID-19 pandemic (March to June 2020) with those in the corresponding months in the prior year (March to June 2019). This study was approved by the University of Toronto's research ethics board. Alcohol sales totaled $5.537 billion from 1 July 2019 to 30 June 2020, of which $1.885 billion was from March to June 2020. In contrast, sales totaled $5.156 billion from 1 July 2018 to 30 June 2019, of which $1.617 billion was from March to June 2019. Year-to-year monthly increases in alcohol sales were highest at the onset of the pandemic, with $462 million in sales in March 2020 versus $335 million in March 2019—equal to a 38% relative increase (Figure 1). We observed 76189 alcohol-related and 5628577 total emergency visits from 1 July 2019 to 30 June 2020, and 83509 alcohol-related and 6275679 total emergency visits from 1 July 2018 to 30 June 2019. The average monthly number of alcohol-related emergency visits from March to June 2020 was 5496 (95% CI, 5423 to 5569), versus 7102 (CI, 7019 to 7184) fromMarch to June 2019, reflecting a 23% (CI, 21% to 24%) relative decrease during the lockdown (Figure 2, top). Accounting for the 32% decline in overall emergency visits from March to June 2020 compared with March to June 2019, the rate of alcohol-related emergency visits was 15.2 per 1000 visits (CI, 14.7 to 15.7) in March to June 2020 compared with 13.4 per 1000 visits (CI, 12.9 to 13.9) in March to June 2019, equal to a 13% relative increase. Most alcohol-related visits in both years were categorized as psychiatric complications from alcohol use (Figure 2, bottom).