Some provinces are weighing whether to keep liquor stores open during the COVID-19 pandemic, but the decision is fraught with complications that include serious health questions.

Public health officials who may contemplate shutting down retail outlets are faced with several dilemmas, ranging from the huge pre-closure lineups that could result during a time of social distancing, to the significant and even fatal dangers of alcohol withdrawal.

The Nova Scotia Liquor Corp. this week instituted reduced hours to allow for more cleaning and is limiting how many people are allowed in stores at one time.

Alcohol sales in Nova Scotia subsequently tripled amid panic buying. But the NSLC has given no indication it plans to close locations, although spokesperson Beverley Ware acknowledged Friday things are "very fluid."

"This is really an unprecedented situation," she said in an interview, noting the Crown corporation is following the guidance of public health officials.

NLSC stores have seen a rush on purchasing amid incorrect "rumours" of impending closures, Ware said. Alcohol sales for the week are up an astounding 216 per cent over the same week last year, she said, and cannabis sales are 110 per cent higher.

Nova Scotia public health officials have ordered businesses ranging from bars to hair salons to shut down in an effort to slow the spread of the virus, and on Friday announced there are now 15 confirmed and presumed COVID-19 cases in Nova Scotia.

Lines formed Wednesday at P.E.I. Liquor and cannabis retail stores, a day ahead of COVID-19-related closures. (Isabella Zavarise/CBC)

Some provinces have taken the drastic step of shutting down liquor outlets. P.E.I. announced Wednesday it was closing government-owned liquor stores the next day, but the move was marred by long lineups that quickly formed outside many locations.

Those who work in the addictions field have started planning for the possibility that people dependent on alcohol in Nova Scotia could be cut off from their supply due to store closures or quarantine requirements.

"The problems can be very substantial if someone suddenly shuts down and stops drinking," said Dr. Dave Martell, an addictions specialist in Bridgewater, N.S.

"The alcohol withdrawal that results in that is quite serious."

The consequences can include seizures, some even potentially fatal, he said. The concern, he said, is those going through alcohol withdrawal will end up in hospital, draining health-care resources away from the pandemic.

Part of the discussion now, Martell said, is how doctors and nurses might, in a safe way, medically treat people going through withdrawal who have to self-isolate at home or are sick. Certain sedatives are effective, he said, but their use should be monitored closely.

He praised Nova Scotia public health officials for their "very strong leadership."

Hi Deanna, we have no plans to close and we have plenty of stock. We are asking customers to please not panic buy and put added stress on our employees. Thank you. —@theNSLC

This week, Dr. Heather Morrison, P.E.I.'s chief public health officer, said she was "disappointed" by the lineups for booze on the Island, but acknowledged that "perhaps we underestimated that alcohol is considered essential for some people."

She later apologized for some of the communication around the store closures, noted concerns around alcohol-use disorder and withdrawal, and said work was underway on other ways to sell cannabis and liquor, such drive-up or online.

The Newfoundland and Labrador Liquor Corp. has also announced stores will close to walk-in traffic on Saturday. It said the plan was to allow customers to order by phone or online, and pick up items at specific stores.

On Thursday, B.C. Liquor stores began operating with reduced hours and limiting the number of people allowed in stores at one time.

In Nova Scotia, the NSLC offers online ordering where someone can pick up at the store. Ware said that due to the huge in-store sales, front-line and warehouse staff are "working flat out."

She also warned there are social issues and "unintended consequences" if stores were to close in the province, including that some people may start producing alcohol illegally.

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