Coronavirus disease 2019 (COVID-19) pandemic has upended our health care system resulting in unprecedented morbidity, mortality. It is now clear that several host risk factors like age, obesity and comorbidity impact rate of infection and severity of disease leading to hospital ICU admission and death. Risk factors that promote exaggerated immune/inflammatory response to the virus that is the cause of the severe and fatal disease outcome must be identified. One such factor could be alcohol use disorder (AUD) because: (1) Alcohol is by far the frequently used drug in the United States, especially in those with increased socioeconomic (SES) adversity (another risk factor for COVID-19 death); (2) AUD is already an established risk factor for poor outcomes in hospitalized adults with influenza, a similar respiratory virus to COVID-19, and Acute Respiratory Distress Syndrome (ARDS) ? the primary cause of death in COVID-19 and (3) Both alcohol and shift work negatively impacts immunity and inflammatory response to pathogens. Shift work has been associated with worse alcohol effects and increased cardiovascular disease, diabetes, and obesity ? all risk factors for severe COVID19. Accordingly, we will study that increased alcohol consumption is an independent risk factor to increase the incidence and severity of COVID-19 and that circadian misalignment is a key co- factor decreasing resiliency of the host immune system to infection. Establishing this association is an urgent unmet need because one key group of vulnerable populations during this pandemic is healthcare workers, who are on the front lines for exposure and the ability of the US to protect healthcare workers is critical to successful mitigation and suppression efforts to control the pandemic. We have formed a collaboration with the American Nursing Association (ANA) and propose to conduct an electronic questionnaire survey of its 200,000 members to determine the impact of alcohol consumption and circadian misalignment on COVID19 disease course. Our survey includes a demographic form (age, BMI, race, gender, Zip code to assess SES), alcohol use disorders identification test (AUDIT), health-related quality of life (SF-8), Munich Chronotype questionnaire (MCTQ) or MCTQ (shift), PROMIS 8 sleep and structured COVID-19 questionnaires.
Aim 1 : Determine if alcohol consumption increases incidence or severity of COVID-19 in nurses and elucidate interaction with other risk factors. We will determine if increased alcohol use and misuse are associated with poorer health outcomes related to COVID-19 and if socioeconomic status, age, BMI, race, or pattern of alcohol use modify the risk and/or are an independent predictor for poor health related outcomes. In addition, we will use latent class analysis (LCA) to examine different alcohol groups related to poor outcomes.
Aim 2. Determine if circadian misalignment increases incidence or severity of COVID-19 and whether it modify alcohol effects on COVID disease course. We will use the MCTQ and MCTQ (shift) Questionnaires to assess chronotype ? diurnal preferences manifested in sleep/wake preferences. This study will result in new insights into the role of alcohol, diet and shiftwork factors on COVID-19 pathogenesis and thus in new insights for potential prevention and treatment of severe COVID-19 illness.
Covid-19 is a new viral disease causing severe pneumonia and other critical illness beginning in Dec. 2019 that has become a world pandemic. Little is known about cofactors mediating susceptibility to severe forms of COVID-19 illness. This study will only investigate nurses who work with COVID-19 patients and become infected with the virus. It will use questionnaires that the nurses fill out online to evaluate how cofactors like alcohol use and sleep patterns and shift-work and diet may affect the susceptibility and clinical course of COVID-19 infections in this group. Information from this study will yield new insights into COVID-19 pathogenesis that could aid with prevention and treatment for COVID-19 patients.
