| Summary: | # Background
Treatment seeking for people with alcohol use disorders (AUD), injecting drug use and viral hepatitis is low, and has worsened during the coronavirus disease 2019 (COVID-19) pandemic. Deferring clinical care and increasing drug and alcohol use exacerbate the risks of progression for individuals with chronic liver disease from viral hepatitis and/or alcohol-related liver disease (ALD). We explored the impact COVID-19 epidemic may have on patients with chronic liver disease and suggested mechanisms to protect this at-risk population during and after the pandemic.
# Methods
We searched PubMed, EMBASE, and Google Scholar for published articles and grey literature and synthesized information about the impact COVID-19 has on patients with chronic liver disease, specifically related to impacts and opportunities to prevent viral hepatitis and ALD.
# Results
The COVID-19 pandemic has caused significant disruption of clinical management of patients with liver disease, but also to alcohol and drug services, needle and syringe programs (NSP), hepatitis B (HBV) screening, and treatment efforts. Social isolation and pandemic-related anxiety have caused an increase in alcohol and drug use. COVID-19 pandemic disruptions may lead to an increase in the incidence of viral hepatitis and ALD, but also cause patients to undertake risky behaviours. The pandemic impacts people with chronic conditions such as HBV to defer medical visits or undertake screening tests. These factors may worsen rates of decompensation for patients with cirrhosis, for whom these deleterious impacts are believed to stay for some time after the pandemic. Interruption in screening, treatment, and monitoring services during the period disrupts chronic disease management of viral hepatitis and ALD and increases the risk of worsening the clinical course of liver disease and delayed diagnosis of hepatocellular carcinoma.
# Conclusions
Successful mitigation of the impact of COVID-19 on the incidence of viral hepatitis and alcoholic liver disease requires adaptive approaches to reach people with injecting drug use and AUD including community-based networks, fixed site and mobile NSP, mail delivery systems, the use of telehealth, and other digital media for promoting and implementing alcohol harm reduction during and after the COVID-19 pandemic.
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