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ANALYSIS OF COVID19 RELATED DEATHS AMONG HEALTH CARE WORKERS

Salelkar Swapnil1, Saroj Salelkar2

1Medical officer , 2Medical officer ESI

Summary

Coronavirus disease 2019 (COVID-19), is a disease caused by SARS-CoV-2. It has been declared as a global pandemic by WHO and has affected 213 countries and territories with total cases more than 2,356,414 million as of 21st April. 160,120 deaths have been reported, with overall mortality rate of 6.79%. Health Care Workers (HCW) including doctors, nurses, paramedics and other supporting health workers are at the front line of the COVID-19 outbreak response. In some countries, up to 10% of the health care workers are infected by the coronavirus infection. This study was based on data available online. It was conducted with an aim to analyse the mortality among healthcare workers in Covid-17 affected areas.

Keywords: - Health care workers (HCW), Coronavirus, COVID19.

INTRODUCTION

Coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2 has affected 213 countries and territories with total cases accounting more than 2,356.414 million as of 18 April and 160,120 deaths, with overall mortality rate of 6.79% .1

Coronavirus infections continue to grow and as they do, health workers are getting ill. In some countries, up to 10% of health care workers are being infected by coronavirus.2 Health workers including doctors, nurses, paramedics and other supporting health workers are at the front line of the COVID-19 outbreak response and are at very high risk of getting infected.

• Delayed recognition of COVID-19 symptoms and lack of experience in dealing with respiratory pathogens.

• Exposure to large numbers of patients in long shifts with inadequate rest periods.

• Lack of personal protective equipment.

• Lack of measures to prevent the spread within hospitals.

Above all, they are also at risk of, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence.2

The National Health Commission of the People’s Republic of China has reported that as of February 24, 2020, a total of 3387 of 77,262 patients with Covid-19 (4.4%) in China were health care workers or others who worked in medical facilities. Of these (3387), 23 had died from Covid-19. Of these 17 were men and six were women. The median age of the 23 health care workers who died was 55 years (range, 29 to 72).3

Eleven of these persons had been rehired after retirement, and at least five were known to have had a chronic condition such as hypertension, atrial fibrillation, or post-polio syndrome. Thirteen were physicians who provided direct patient care (5 practiced in community health centers or in private clinics, 3 practiced Chinese medicine, 2 were internal medicine physicians, 2 were physicians in respiratory medicine, and 1 was a gastroenterologist); 8 were surgeons (including 3 ophthalmologic surgeons); 1 was an electrocardiography technician; and 1 was a nurse.3 (Mingkun Zhan, 2020)

Nearly 17,000 health care workers have been infected with the new coronavirus in Italy; more than two-thirds of them were women.4

In the United States, only 3% (9,282 of 315,531) of reported cases were among HCWs and the median age was 42 years (interquartile range [IQR] = 32–54 years), 6,603 (73%) were female and at least 27 had died. 5

Methodology: - A comprehensive list of all health care workers who had died of COVID19 up to 18 April 2020 was compiled from Medscape6, FNOMCeO7 and various online press releases8,9,10,11. The available data was limited to age, specialty and country in which HCWs were working at the time of death. The data was compiled in a single MS excel sheet and duplicate entries were screened out. HCWs were further group into broad categories like doctor, dentist, nurse, paramedics, pharmacist, lab technician, supporting staff etc. Details of exact category for some HCWs was not available. These were grouped in the broad category HCWs-NA.

Data was analyzed with SPSS software.

Results: There were 593 COVID19 related deaths among HCWs reported until 20 April 2020. They were in ages of 21 to 99 years. Highest deaths were seen in the age group of 61-70 (22.9%) and lowest in the age group of 21 to 40 years. Age details were not available for around 30.4% of the healthcare workers.

Table 1. Death among HCWs according to Age group
AGE(YRS)		Frequency	Percent	Cumulative Percent
	NA	180	30.4	30.4
	21-30	17	2.9	33.2
	31-40	26	4.4	37.6
	41-50	63	10.6	48.2
	51-60	105	17.7	65.9
	61-70	136	22.9	88.9
	71-80	52	8.8	97.6
	81-99	14	2.4	100.0
	Total	593	100.0

Table 2. Death of HCWs according to work categories
HCWs CATEGORY		Frequency	Percent
	DENTIST	18	3.0
	DOCTOR	367	61.9
	DRIVER	2	.3
	HCWS-NA*	24	4.0
	HOME CARE WORKER	1	.2
	LAB TECHNICIAN	3	.5
	NURSE	111	18.7
	PARAMEDIC	45	7.6
	PHARMACIST	8	1.3
	PHYSIATRIST	1	.2
	SUPPORTING STAFF	13	2.2
	Total	593	100.0

*HCWs-NA- Missing data on category/specialty they were working was not available.

Table 2 shows that 61.9% (367/593) of the reported deaths were among doctors of various specialties, followed by 18.7% (111/593) among nurses and 3% (18) among dentist. Of 593, 4% HCWs data on their subgroup category was missing.

Highest death among HCWs of 593 reported cases was from, Italy 22.3% (132); followed by USA of 19.7% (117); Iran 13.8% (82); China 4.2%; Indonesia 4%, Philippines 3.9%, Mexico 3.2%; Brazil 2.9%; Spain 2.7% and India 1.2%. The rest of the countries reported a rate below 1% according to available data.

Further analysis shows that highest COVID19 related death was among General Practitioners i.e.22.4% (133) of this 39.85% were above 60years of age, followed by Medicine specialists 5.4% (32), Surgeons 3.5%(21), Dentist and Paramedics 3% each (18), Pediatricians 2.7% (16), Cardiologists 2%(12), Pathologists and Gynecologists 1.9% (11) each.

Conclusion:

General practitioners are the first point of contact with patient which could probably be reason for highest death rate among GPs. In addition, lack of PPE, incomplete knowledge about COVID19 management and age above 60years with comorbidities could be another contributing factor. However, the exact reasons for the same needs to be further investigated. Further, there was an increased risk of COVID19 deaths, among doctors and HCWs of 60yrs and above. This may be due to preexisting comorbid conditions, which could not be analyzed due to lack of data.

Limitation: -

Although care was taken to compile data from authentic online sources, any discrepancy in the data source will reflect on the results of the study.
As the data available was limited, detailed analysis could not be carried out.
As the corona virus is a novel and still evolving infection, the results and conclusions of the study may change over time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest

References

[https://covid19.who.int/], accessed April 21, 2020
What's needed now to protect health workers: WHO COVID-19 briefing. [https://www.weforum.org/agenda/2020/04/10-april-who-briefing-health-workers-covid-19-ppe-training] accessed April 11, 2020.
Mingkun Zhan, Yaxun Qin, Xiang Xue, Shuaijun Zhu. Death from Covid-19 of 23 Health Care Workers in China. https://www.nejm.org/doi/full/10.1056/NEJMc2005696. Accessed on April 21, 2020.
Nearly 17,000 Italian health workers infected with virus: Study. https://www.straitstimes.com/world/europe/nearly-17000-italian-health-workers-infected-with-virus-study. Accessed on April 19 2020.
Characteristics of Health Care Personnel with COVID-19 —United States, February 12–April 9, 2020 MMWR / April 17, 2020 / Vol. 69 / No. 15
In Memoriam: Healthcare Workers Who Have Died of COVID-19. https://www.medscape.com/viewarticle/927976. Accessed on April 21, 2020
https://portale.fnomceo.it/elenco-dei-medici-caduti-nel-corso-dellepidemia-di-covid-19/. Accessed on 21 April 2020.
Tributes paid to nine further nurses who have died in pandemic https://www.nursingtimes.net/news/coronavirus/tributes-paid-to-nine-further-nurses-who-have-died-in-pandemic-14-04-2020/. Accessed on April 18, 2020
Over 100 doctors and nurses have died combating coronavirus across the world. https://www.newsweek.com/coronavirus-deaths-infections-doctors-nurses-healthcare-workers-medical-staff-1496056. Accessed on April 18, 2020.
Dozens of Iranian Doctors Died During Iran’s Coronavirus Crisis. https://iran-hrm.com/index.php/2020/03/31/dozens-of-iranian-doctors-died-during-irans-coronavirus-crisis/ accessed on April 18, 2020.
These are the NHS workers who have died from coronavirus. https://www.telegraph.co.uk/news/0/nhs-workers-died-coronavirus-frontline-victims/ April 21, 2020.

Introduction

At present one Primary health centre covers about 30,000 or more population. With Primary functions of preventive, promotive and curative health service delivery to the community through its subcentres. The most peripheral institutional facility is the subcentre, which is run by one male and female multipurpose worker. In most places there is one subcentre for about 5000 population. (1)

Each subcentre is visited by medical officer from Primary Health centre on fixed week days for fixed hours for providing clinical services and supervision of National programs.

Primary Health Centre Sankhali is situated in the Bicholim Taluka of North Goa, which covers approximately 40,000 populations. There are seven sub-centres under PHC Sankhali, Karapur, Amona, Harwalem, Surla, Velgem, Pali and Sankhali-Virdi. Each subcentre serves approximately 5000- 6000 population. There are specific week days allotted to each subcentre to be visited by PHC doctor to provide clinical services and to supervise implementation of various health programs e.g. Amona Subcentre will be visited by doctor on every Thursday except on public holidays.

Aim:

To Study the utilization of the clinical services at Subcentre.

Methodology:

In this study only clinical service provided by doctor at 2 of the 7 sub centres has been evaluated, other services has not taken into consideration. Data regarding age, sex and provisional diagnosis of individuals treated at subcentre, Karapur and Harwalem was collected from November 2012 and Jan 2013. Data was entered in Excel sheet and analysed with SPSS software.

Result:

Harwalem subcentre is visited on every Tuesday and Karapur on every Friday except on Public Holidays. Total of 13 visits were available for each subcentre from November 2012 to January 2013. Of this 9 (69%) visits were made to Harwalem Subcentre, two visit missed due to Public holidays and two because of some official work. At Karapur all 13 visits were made.

There were total 447 visits by patients at both the centres, of which majority were females 337(75.4%). Of the total females, most i.e. 219 (64.99%) were from Karapur centre. Also male OPD attendance at Karapur subcentre was 73 (66.36%) compare to Harwalem centre 33.64%. On an Average 17 and 22 patients visit Harwalem and Karapur Sub-centre every week days respectively. Children below 10 years visiting from both the subcentre were 14.1% and 55.7% of patients were from age group of 31- 60 years. Only 19.5% of patients were above 60 years of age.

Of the total visits, 139(31.1%) were for ARI and 114(25.5%) for Hypertension, Bodyache and Backache were 10.7 %( 48), 4.7% (21) were COPD patients. Most of the bodyache and backache i.e. 40 patients were female, 34.53% of ARI cases were among children less than 10 years old.It has been also observe that there is no card system at Subcentre and patient clinical details are maintain in OPD register.

Discussion:

Both the subcentre are 3-4km from primary health centre, still OPD attendance at subcentre is an average 17-22 patients. It has also been found that maximum 40 patient had visited the Karapur subcentre. Most of the patients who are visiting subcentre are residing in and around subcentre within 500m-1km radius. Each subcentre covers approximately 5000 population, but clinical services utilisation from subcentre is by villagers staying near subcentre. This may be because:

1. Doctor visits once a week, only clinical and limited investigation facility available.

2. Most patients visiting subcentre are women probably because men go to work.

3. Old patients who cannot afford to go to the Primary Health Centre come to the subcentre.

In our study 19.5% of patients were above 60 years utilising subcentre OPD services, whereas in survey conducted by ICMR among the population aged 60 years and above 11.3% were utilising Subcentre health services(2).

Important finding of this study is that the Subcentre facility is mostly underutilised and utilisers are mostly women and elderly who are residing in immediate vicinity of the subcentre.

Recommendation:

Since the OPD services are under utilise, this can be further improved by applying the following:

1. OPD card system can be introduced with provision of monthly medication to Hypertension, DM and COPD patients.

2. Provision of monthly blood collection facility at subcentre- Those patient requiring monthly or routine monitoring of blood profile like FBSL, lipid profile, renal function test and others can be provided to patients by collecting blood at subcentre on monthly basis and sending for analysis at Govt. Lab at PHC.

3. Improve IEC activities to increase utilisation of services at Sub centre especially by patients with chronic illness like diabetes and hypertension, this would also decrease patient load at PHC.

4. Location of subcentre should be at strategic point, so that maximum patients can avail services.

Acknowledgement: I gratefully acknowledge help provided by Subcentre ANM staff Ms. Bharati Betkikar, Mrs. Diksha Parsekar, Ms. Poonam Palkar and Mrs. Pratima Gaonkar.

Bibliography

1. Kishore, J. National Health Programs. 6th. ed : Century Publication, 2006.

2. Indian Council of Medical Research. http://icmr.nic.in/final/hcra_1.html [Cited: february 14, 2013.].

Dr.Swapnil Salelkar MBBS DPH PDCR

Medical Officer-Sankhali-Goa PHC

nil3483@gmail.com

Dr.Saroj Salelkar MBBS DPH PDCR

Insurance Medical Officer- ESI Dispensary

Bicholim-Goa