The covid-19 pandemic has brought into focus the importance of understanding the interplay between the pathogen and the populations and systems that it threatens. In the UK there are significant underlying vulnerabilities that shape the impacts of the pandemic: for example, a large sector of society relies on the gig economy for employment; the health and social care system is already managing the effects of austerity and Brexit; and many people are already living in poverty. As we move through the phases of our response to covid-19 and adopt radical changes to ways of living, such as enforced lockdowns and 12 weeks of self-isolation for high-risk individuals, it is important that we consider the unintended impacts of such measures, and potential ways to mitigate these. One important example is gambling and gambling-related harms, and the potential for gambling products and events to contribute to the spread of infection. 

While some forms of gambling may experience sharp downturns, others (which are potentially higher in intensity, stakes and/or risk of addiction) may rise quickly. Dramatic changes in how people are working and socialising, and the economic hardship such changes may imply, are likely to impact on people’s gambling and interactions with gambling products and marketing. For some people managing gambling addiction, working from home (or undergoing a hiatus from temporary work) potentially removes some of the safety nets that may help them in managing their gambling consumption. These include, supervision and support from managers and other colleagues, online blocking software, and the demand of work activities. Working from home may also induce increased usage of gambling apps or websites, in part because boredom stimulates gambling, but also because social distancing and isolating at home will lead to increases in exposure to advertisements via television, online, and social media. 

This may have particularly significant implications for children and young people who are now likely to spend more time than ever before online. Previous evidence suggests that motivations for gambling among young people include winning money, socialising, and to preoccupy themselves; and all of these motivations may be increased for some people during this period of “suppression.” Online gambling may be more problematic than land-based outlets, and the introduction of young people to gambling experiences often occurs in the home setting, with early onset of gambling being a risk factor for problems later in life. More broadly, the impacts of temporary cancellation of many sporting events and the loss of associated betting opportunities are unknown and require monitoring. In response to the cancellation of sports fixtures, gambling companies have increased television advertisements for online casino products and some are encouraging use of these products via social media, as well as esports betting. One gambling company reports that there is evidence of increased use of online casino and slot games, which they believe may compensate for reductions associated with cancellation or postponement of sporting events.

A major recession is almost certainly on the horizon and this downturn could affect gambling too. In response to the 2008 global financial crisis, certain forms of gambling, such as lottery and scratch card purchases, increased among those who reported financial difficulties. Although levels of problematic gambling (as measured by the Problem Gambling Severity Index) did not appear to increase, changes in gambling-related harms were not measured and therefore remain unexplored. While the direct transferability of these findings to the current situation are limited, it may be relevant to consider those who are vulnerable during this time and who may see gambling as a way to escape economic hardship.

Gambling has the potential to exacerbate prior debt, and lead to further harms to individuals and others. As many people are already managing heavy debt burdens (some of which are gambling-related), the economic instability caused by the pandemic may exacerbate what was an already challenging and precarious situation. Debt itself is a risk factor for physical and mental ill-health. It may be important to strengthen efforts to inform people that turning to gambling during this time is not a safe or reliable source of financial support, and to warn them of the potential risks of harm, such as debt and addiction. The National Lottery could review its marketing strategies during this time and consider how it can avoid exacerbating any financial harms, while a mandated requirement to set time and loss limits could be applied to gambling websites and apps. Indeed, in a recent letter, over 20 UK Members of Parliament, two Lords and an gambling addiction expert called for the Government to pressure online gambling firms to implement mandatory limits on betting deposits and betting stake limits, cease VIP schemes, place a moratorium on advertising, and release internal data to support monitoring for harm, during the covid-19 crisis. Measures can also be applied to land-based venues. For example, in an effort to reduce coronavirus spread, on the 13th of March Finland’s gambling monopoly firm cancelled all organised customer events, shut down all betting machines (most of which feature touch screens), and closed all outlets. Similar measures are now being implemented globally, for example, in the State of Nevada in the US, in the UK, and in South Africa, as part of wider lockdown responses.

There is every likelihood that the crisis will increase suicide rates in the UK and this rise may be partly linked to rising levels of debt which, in turn, may be associated with gambling. Alcohol use and poor mental health are also known risk factors for suicide, and this is particularly troubling given that the duty price of alcohol was frozen in the recent UK Government budget, meaning the real price of alcohol will fall. Doctors in the UK are calling for an increase in the price of alcohol to reduce demand on the National Health Service (NHS). Alcohol consumption can also affect immune responses and increase susceptibility to pneumonia. Of note, both alcohol and problem gambling are associated with intimate partner violence, and there are already reports from multiple regions globally of pandemic-related rises in cases of domestic violence. Alcohol, gambling, debt, isolation, and economic uncertainty are a toxic mixture which may precipitate a wider mental and physical health crisis. 

Understandably the focus is on containing and slowing the spread of the virus, treating those who become infected, and strengthening public health responses and healthcare provision. The interplay between the virus, its context, and the wider repercussions of the measures implemented, also need attention. There is so much that is uncertain, but we need to consider potential wider indirect risks and take action to prevent harm where we can. There are actions that we can take to protect those who are vulnerable to covid-19 infection as well as those who are potentially made more vulnerable by our actions to contain the pandemic, and by the subsequent economic repercussions.

May CI van Schalkwyk, NIHR Doctoral Fellow, London School of Hygiene and Tropical Medicine

Danny Cheetham, Expert by Experience and member of the Gamvisory Panel

Aaron Reeves, Associate Professor, University of Oxford

Mark Petticrew, Professor of Public Health Evaluation, London School of Hygiene and Tropical Medicine

Competing interests: Nothing to declare