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The Ontario government’s inclusion of liquor stores as an essential service permitted to stay open in the time of coronavirus set off a firestorm online.

Many questioned why alcohol sales would be allowed to continue amid a global health emergency.

But with 3.2 per cent of the population having reported alcohol abuse or dependence, and nearly 15,000 deaths attributable to alcohol, Canadians are missing the point — a number of points, according to experts.

“Alcohol dependency can be psychologically and physiologically. If the supply is cut off for that population of people, it can be potentially catastrophic,” said Elaine Hyshka, a researcher and assistant professor with the School of Public Health at the University of Alberta.

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“Not everyone with alcohol use disorder who abstains from drinking will experience medical complications, but for the smaller proportion that does, it can be life-threatening,” Hyshka explained.

“They can go into withdrawal, which can cause seizures and other different psychiatric complications.”

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Canada’s health system is already under immense pressure.

The influx of COVID-19 cases has driven parts of the country to look at new ways to meet the demand for treatment, containment and testing. In some provinces, physicians have been brought out of retirement. In others, specialized nurses are being rapidly retrained and redeployed where they’re needed most.

Some health care workers are operating out of parking lots, testing people with mild symptoms of the respiratory virus in a drive-thru setup.

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As Prime Minister Justin Trudeau put it on Tuesday, COVID-19 is “the biggest public health crisis our country has ever seen.”

It’s putting Canada’s health care system to the test, said Craig Janes, director of the University of Waterloo’s School of Public Health.

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For a system that runs “pretty much close to capacity” under normal circumstances, he says the surge in demand caught many by surprise.

“I think everyone’s been a little bit flat-footed by the speed at which this pandemic has come upon us,” he said.

“Canada has some surge capacity, but not a lot. It’s a very real concern. That’s why we’re getting lockdowns, because we don’t want to see the kind of surge that has doctors making decisions about who lives and who dies.”

While the decision to keep liquor stores open is a “complicated” one, driving more people to emergency rooms and clinics is “the last thing we want with what’s going on,” he said.

“This isn’t the time to be moralistic about this,” Janes said. “There are people who do depend on alcohol, for better or for worse, and we don’t want to put them in a position where they’re putting pressure on a system that’s already at capacity.”

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In 2017, the rate of hospitalizations caused entirely by alcohol in Canada was comparable to the rate of hospitalizations for heart attacks, according to data compiled by the Canadian Centre for Substance Use and Addiction (CCSUA).

Of those, middle-aged adults between the ages of 45 to 64 made up half of the cases. Older people are also more likely to get seriously ill from COVID-19 and are at a higher risk of death.

But the risks associated with closing liquor stores go beyond those already struggling with addiction, said Catherine Paradis, the leading expert on alcohol at CCSUA.

This week, Canada has seen a trickle of announcements from premiers ordering so-called non-essential services to close to curtail the spread of the coronavirus. The gradual tightening of provincial measures has triggered bouts of panic-buying across the country, including alcohol.

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When Quebec Premier Francois Legault announced the province’s three-week “pause,” some Quebecers rushed to line-up outside provincially run liquor stores, prompting the agency in charge to quickly clarify that the stores would remain open.

“The panic-buying, the stockpiling, it can cause excessive drinking,” said Paradis.

“We’ve found that for many people, having more alcohol in their immediate surroundings increases their frequency of drinking and the quantity of alcohol they consume per occasion.”

Canada’s Low-Risk Alcohol Drinking Guidelines recommend no more than 10 drinks a week for women (no more than two a day), and no more than 15 drinks a week for men (no more than three a day).

It’s something Canadians should remember during this unpredictable time, said Paradis, because the risks behind regular alcohol haven’t changed just because our day-to-day has.

“Alcohol is no ordinary commodity to have around our houses at the moment,” she said.

“It’s not just those with alcohol use disorder. After a few drinks, our reflexes are not the same, our ability to react with folk is not the same. When you consider that in a situation when families are together 24/7, even among regular drinks, there’s a chance for detrimental effects.”

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The World Health Organization says that during times of crisis — natural disasters, wars and epidemics — the risk of gender-based violence escalates. In China, once the epicentre of the coronavirus outbreak, Axios found that the number of domestic violence cases reported to local police tripled in February compared the year before.

Activists there claim it’s a direct result of the stringent lockdown measures forced upon the country to stall the virus’ spread.

“Alcohol is associated with a lot of chronic diseases,” she said. “It’s important to connect with love ones who you feel might be at risk. It’s a real concern at the moment.”

Ultimately, the decision to keep alcohol available to Canadians isn’t black and white, Paradis said, but it’s the right move for the time being.

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“There’s a lot of grey zone. We don’t know which variables were put into the equation that led our government to make this decision, whether from an economic perspective or a health perspective,” she said.

“Alcohol is multidimensional and the impacts of drinking are, too. We need to take all of that into consideration.”

— with files from the Canadian Press