COVID-19 Symptoms and Deaths Among Healthcare Workers, United States

Shao Lin; Xinlei Deng; Ian Ryan; Kai Zhang; Wangjian Zhang; Ese Oghaghare; DeeDee Bennett Gayle; Benjamin Shaw

Disclosures

Emerging Infectious Diseases. 2022;28(8):1624-1641. 

In This Article

Abstract and Introduction

Abstract

We evaluated whether demographics and COVID-19 symptoms predicted COVID-19 deaths among healthcare workers (HCWs) in the United States by comparing COVID-19 deaths in HCWs with 3 control groups (HCW nondeaths, non-HCW deaths, and non-HCW nondeaths) using a case–control design. We obtained patient-level data of 33 variables reported during January 1, 2020–October 12, 2021, in all US states. We used logistic regression analysis while controlling for confounders. We found that persons who were ≥50 years of age, male, Black, or Asian experienced significantly more deaths than matched controls. In addition, HCWs who died had higher risks for the most severe clinical indicators. We also found that the most indicative symptoms were preexisting medical conditions, shortness of breath, fever, cough, and gastrointestinal symptoms. In summary, minority, male, and older HCWs had greater risk for COVID-19 death. Severe clinical indicators and specific symptoms may predict COVID-19–related deaths among HCWs.

Introduction

COVID-19 is one of the longest-lasting and largest global pandemics in history,[1] but its typical symptoms and relevant clinical predictors are still unknown. By March 2022, >79 million Americans had contracted COVID-19, and >963,000 had died.[2,3] Multiple studies have found that older adults[4,5] and persons with chronic medical conditions, such as diabetes, hypertension, and renal failure, were particularly susceptible to contracting COVID-19.[6,7]

Healthcare workers (HCWs) are another highly susceptible subpopulation[8–10] because of their time spent caring for COVID-19 patients.[11] Of importance, 40% of HCWs identify as a racial minority; of those, 16% are Black, 13% Hispanic, and 7% Asian/other.[12–14] Kirby reported that doctors from racial and ethnic minority communities were twice as likely to deal with patients without access to personal protective equipment (PPE) than White colleagues.[15] Available data suggest that Black persons are more likely to hold jobs considered essential (e.g., HCW, medical assistant, food preparation, home care aide) than their White counterparts. In addition, ethnic minorities work disproportionately in the top 9 occupations exposed to COVID-19 and, therefore, are at high risk for infection.[16] However, they are less likely to publicly express their workplace safety concerns for fear of job loss.[17]

The initial surge in COVID-19 cases led to a profound increase in HCWs' exposure to the virus. However, the extent to which increased exposure in HCWs led to increased risk for death—and which demographic characteristics, severity indicators, and symptoms best predict this risk—remains unclear. Most previous research has used non-HCWs as controls, leading to biases due to differences in occupation, education, and treatment accessibility. In addition, a nationwide study evaluating COVID-19 symptoms and deaths among HCWs is lacking, especially one that accounts for the second and third COVID-19 surges.

To fill these knowledge gaps, we used COVID-19 surveillance data from the Centers for Disease Control and Prevention (CDC) to compare the differences in demographic characteristics and symptoms between HCWs who died and those who did not (HCW deaths and nondeaths) and compared to the general population (non-HCW deaths and nondeaths). We also examined the temporal trends of COVID-19 infection and deaths in HCWs versus the general population.

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