Clinician Deaths From COVID-19: 'A Crisis on a Staggering Scale'

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More than 7000 healthcare workers worldwide have died of COVID-19, according to a new analysis released this month by Amnesty International. The group called it "a crisis on a staggering scale."

Mexico has had the most healthcare workers affected (1320 deaths), followed by the United States (1077), the United Kingdom (649), and Brazil (634).

According to a recent report from the Pan American Health Organization (PAHO), Mexico and the United States account for almost 85% of deaths in the Americas. The director of PAHO, Carissa F. Etienne, MBBS, said the Americas have the largest number of healthcare workers infected with COVID-19 in the world.

Incomplete Data

It's difficult to make direct comparisons between countries, Samuel Ponce de León, MD, response program coordinator for the health research program on COVID-19, the National Autonomous University of Mexico, Mexico City, told Medscape. There is wide variance in the economic, social, and healthcare infrastructure, differences in healthcare worker training, as well as different data-gathering and surveillance systems in each country.

Amnesty International, which offers an interactive global map of updated cases, does note that the detailed record of healthcare worker deaths in Mexico is exemplary. "Such transparency is essential, and all countries should be making this kind of detail available; it may also go some way to explaining the disturbing figures from Mexico relative to other countries."

In some countries, the number of deaths among healthcare workers may reflect the severity of the pandemic. In other countries, the cause may be more a matter of lack of training or access to appropriate personal protective equipment (PPE) or COVID-19 testing. Furthermore, different countries define "healthcare worker" differently.

The Amnesty International data come from multiple sources, such as commemorative pages, lists of medical associations and unions, and even obituaries published in the media.

For example, Peru's data are from the Medical College of Peru; for Brazil, data are from the Sao Paulo Medical Union; in Bolivia, data are provided by the Federal Council of Nursing and the Trade Union Confederation. Chile and Argentina provide their own official government data. Venezuela's data come from the nongovernmental organization Doctors United of Venezuela. The source of data for Ecuador, Uruguay, and Puerto Rico is cited as Medscape in the Amnesty International report.

Even in the United States, Amnesty notes that an investigation by The Guardian and Kaiser Health News at one point identified almost twice as many deaths (1077 vs 670) as reported by the Centers for Disease Control and Prevention.

Risk Factors for Infection

Being on the front line of healthcare is a risk factor around the world, but healthcare professionals are affected to different degrees in different locations.

Ponce de León sees two phases of risk for Mexico. In the first phrase, risk was due to insufficient PPE and lack of training in how to use protective gear. Mexico currently has a sufficient, although not optimal, amount of PPE, he said, but the country hasn't yet provided all of the necessary training in the use of PPE and risk mitigation.

He stressed that Mexico is a country with poor medical infrastructure. During the pandemic, the availability of ventilators quadrupled, but in some areas, COVID-19 training was provided "in a very superficial, fragile way, both in the management of precautions and personal protective equipment."

Ponce de León noted another aspect that has a negative impact: "It may not be so apparent, but all infection prevention and control programs have had their budgets cut or have disappeared."

He added that antibiotic protocols are not consistent, and "there are indicators of a high rate of complications from bacterial infections acquired within the hospital by patients with COVID-19."

Mexico is facing a huge challenge, Ponce de León said. "We will have to maintain continuous support with supplies and education. There is a bit of magical thinking involved. Mexican society has difficulty recognizing risks; even doctors, despite the epidemiological situation, sometimes they don't recognize COVID-19 in their patients," he added.

Mental and Psychological Effects

A Brazilian group investigated the health of healthcare workers on the front lines. The risk for infection caused intense psychological distress, expressed in generalized anxiety and sleep disorders, fear of getting sick, and fear of infecting colleagues and relatives.

Several factors contribute to the psychological stress of those who provide direct care to patients with COVID-19, according to a report published in JAMA earlier this year:

• Emotional strain and physical exhaustion in caring for a growing number of acutely ill patients of all ages whose conditions can deteriorate rapidly;

• Caring for coworkers who may become seriously ill and sometimes die from COVID-19;

• Shortage of PPE, which increases fear of exposure to coronavirus at work, causing serious illness;

• Concern about infecting family members, especially older, immunocompromised, or chronically ill relatives;

• Shortage of respirators and other critical medical equipment for the care of critically ill patients;

• Anxiety about taking on new or unfamiliar clinical roles, as well as expanded workloads in caring for COVID-19 patients;

• Limited access to mental health services to manage depression, anxiety, and psychological distress.

The PAHO report recommends improving occupational health programs so as to improve working conditions. It recommends that health programs provide a fair wage for healthcare workers; ensure that they work regular shifts; and, in the event of illness, provide resources, help, and financial support.

Medscape is compiling a memorial list to commemorate those who have fallen from COVID-19 with information from friends, colleagues, and families who have shared details about those who have died in the service of patients infected. Please help us ensure this list is complete by submitting names with an age, profession or specialty, and location through this form.

This article was translated and adapted from Medscape's Spanish Edition.

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Cite this: Clinician Deaths From COVID-19: 'A Crisis on a Staggering Scale' - Medscape - Sep 17, 2020.