The consumption of alcohol in a population is usually monitored through individual questionnaires, forensics, and toxicological data. However, consumption estimates have some biases, mainly due to the accumulation of alcohol stocks. This study's objective was to assess alcohol consumption in Slovakia during the COVID-19 pandemic-related lockdown using wastewater-based epidemiology (WBE). Samples of municipal wastewater were collected from three Slovak cities during the lockdown and during a successive period with lifted restrictions in 2020. The study included about 14% of the Slovak population. The urinary alcohol biomarker, ethyl sulfate (EtS), was analyzed by liquid chromatography-tandem mass spectrometry (LC-MS/MS). EtS concentrations were used to estimate the per capita alcohol consumption in each city. The average alcohol consumption in the selected cities in 2020 ranged between 2.1 and 327 L/day/1000 inhabitants and increased during days with weaker restrictions. WBE can provide timely information on alcohol consumption at the community level, complementing epidemiology-based monitoring techniques (e.g., population surveys and sales statistics).

Department of Inorganic Technology Faculty of Chemical and Food Technology Slovak University of Technology Radlinského 9 812 37 Bratislava Slovakia

Department of Zoology and Fisheries Faculty of Agrobiology Food and Natural Resources Czech University of Life Sciences Kamýcka 129 165 00 Praha 6 Czech Republic

Institute of Chemical and Environmental Engineering Faculty of Chemical and Food Technology Slovak University of Technology Radlinského 9 812 37 Bratislava Slovakia

Istituto di Ricerche Farmacologiche Mario Negri IRCCS Department of Environmental Health Sciences Via Mario Negri 2 201 56 Milan Italy

London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health Keppel Street London WC1E 7HT UK

Ministry of Health of the Slovak Republic Limbová 2 837 52 Bratislava Slovakia

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