The Role of Alcohol Biomarkers in Detecting a Physician's COVID-19-Related Acute Stress Response: A Case Report.

Objectives: Alcohol biomarkers are used to detect alcohol exposure in clinical and forensic settings. This includes professional health program (PHP) monitoring of healthcare workers in recovery from substance use disorders. Here we present the case of a physician whose positive alcohol biomarker test result was complicated by a traumatic stress response to frontline work during COVID-19.

Methods: An anesthesiologist under PHP monitoring for substance use disorder and depression was interviewed extensively, urine and blood biomarkers were obtained, and longitudinal structured and semi-structured interviews related to anxiety, depression, posttraumatic stress, and cravings were used to monitor responses to the unanticipated death of a patient who succumbed to COVID-19.

Results: After an initial positive ethylglucuronide (EtG) and ethylsulfate (EtS) toxicology test result, all subsequent testing was negative. The physician described compulsive sanitizing hands/arms and mask with highly concentrated ethanol-based products. Standardized assessments and clinical interviews provided documentation of a COVID-19-related post-traumatic stress response. He was connected to additional therapeutic support services and monitoring continued.

Conclusions: Inhalation of ethanol vapors was initially accepted as a possible explanation for the positive EtG/EtS results, though the physician later acknowledged that limited alcohol beverage consumption occurred 6 days prior to the positive test, further complicating its interpretation. Detection of aberrant behavior through ongoing monitoring helps to protect both healthcare workers and the patients they serve.