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.
*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
- 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.
