Alcohol and Circadian Disruption in Shift Workers Decreases their Resiliency to COVID-19

Abstract: Coronavirus disease 2019 (COVID-19) pandemic has upended our health care system resulting inunprecedented morbidity, mortality. It is now clear that several host risk factors like age, obesity andcomorbidity impact rate of infection and severity of disease leading to hospital ICU admission and death. Riskfactors that promote exaggerated immune/inflammatory response to the virus that is the cause of the severeand 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 increasedsocioeconomic (SES) adversity (another risk factor for COVID-19 death); (2) AUD is already an establishedrisk factor for poor outcomes in hospitalized adults with influenza, a similar respiratory virus to COVID-19, andAcute Respiratory Distress Syndrome (ARDS) - the primary cause of death in COVID-19 and (3) Both alcoholand shift work negatively impacts immunity and inflammatory response to pathogens. Shift work has beenassociated with worse alcohol effects and increased cardiovascular disease, diabetes, and obesity - all riskfactors for severe COVID19. Accordingly, we will study that increased alcohol consumption is an independentrisk 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 urgentunmet need because one key group of vulnerable populations during this pandemic is healthcare workers, whoare on the front lines for exposure and the ability of the US to protect healthcare workers is critical tosuccessful mitigation and suppression efforts to control the pandemic. We have formed a collaboration with theAmerican Nursing Association (ANA) and propose to conduct an electronic questionnaire survey of its 200,000members to determine the impact of alcohol consumption and circadian misalignment on COVID19 diseasecourse. Our survey includes a demographic form (age, BMI, race, gender, Zip code to assess SES), alcoholuse 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 ifalcohol consumption increases incidence or severity of COVID-19 in nurses and elucidate interactionwith other risk factors. We will determine if increased alcohol use and misuse are associated with poorerhealth outcomes related to COVID-19 and if socioeconomic status, age, BMI, race, or pattern of alcohol usemodify the risk and/or are an independent predictor for poor health related outcomes. In addition, we will uselatent class analysis (LCA) to examine different alcohol groups related to poor outcomes. Aim 2. Determine ifcircadian misalignment increases incidence or severity of COVID-19 and whether it modify alcoholeffects on COVID disease course. We will use the MCTQ and MCTQ (shift) Questionnaires to assesschronotype - diurnal preferences manifested in sleep/wake preferences. This study will result in new insightsinto the role of alcohol, diet and shiftwork factors on COVID-19 pathogenesis and thus in new insights forpotential prevention and treatment of severe COVID-19 illness.