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


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

In This Article


Among 6,271,313 laboratory-confirmed COVID-19 cases reported during January 1, 2020–October 12, 2021, by CDC, 7.02% (440,044) were in HCWs. The fatality rate among HCWs was 0.33% versus 24.64% for non-HCWs. The percentages we report represent the proportion of each specific variable (numerator) among HCW deaths or 1 of the 3 control groups (denominator) (Table 1). A total of 1,469 HCW deaths were reported among 440,044 cases. The proportion of male HCWs was significantly higher in HCW deaths (39.21%) compared with HCW nondeaths (control 1: 18.64%), although it was still lower than for non-HCWs (55.03% for deaths [control 2] and 48.93% for nondeaths [control 3]). The percentage of persons in the 50–59-year age group among HCW death cases was 28.05% and in the 60–69-year group, 37.51%; these rates were higher than those from all 3 control groups (8.08%–17.24% in the 50–59-year age group and 8.36%–17.24% in the 60–69-year group). The percentage of Hispanic persons in the HCW deaths category (19.71%) was not significantly different from other reference groups except for control 3 (30.89%). Furthermore, the percentages of Black (27.17%) and Asian (21.47%) persons in the HCW deaths category were greater than those in all 3 control groups (Black, 13.39%–15.66%; Asian 4.37%–7.58%).

Of note, we found that COVID-19 deaths among HCWs increased from March to June. June and then July–August contained the most HCW COVID-19 deaths compared with all controls: 27.30% versus 7.86%–12.18% in June and 42.56% versus 25.99%–28.12% in summer.

We conducted multivariate analysis for HCW deaths compared with 3 reference groups (Table 2 and Table 3). We calculated odds ratios (ORs) by severity indicators and COVID-19 related symptoms after adjusting for sex, age group, race/ethnicity, dominant periods of SARS-CoV-2 variants, and vaccination start time. All 6 severity indicators for COVID-19 were consistently higher in HCW death cases than in the 3 control groups (OR 1.24–230.94). The highest ORs occurred for mechanical ventilation, followed by intensive care unit admission, acute respiratory disease symptoms, hospitalization, pneumonia, and abnormal chest radiograph. In addition, compared with control 1, HCWs deaths showed significantly increased ORs for multiple symptoms, including specific preexisting medical conditions (OR 6.44, 95% CI 4.95–8.39), followed by shortness of breath, fever, subjective fever, cough, nausea/vomiting, and diarrhea (ORs 1.47–6.06; p<0.05). Chills, myalgia, and abdominal pain in HCW deaths group were not significantly different from those in the control groups. However, sore throat, running nose, and headache were significantly lower in the HCW deaths group than in the control 1 and control 2 groups. Those results remained significant and of similar magnitudes (<5% changes) after Bonferroni test adjustment (Table 1, Table 2 and Table 3). However, 4 severity indicators among HCWs (hospitalization, pneumonia, abnormal chest radiograph, and acute respiratory disease symptoms) became statistically nonsignificant compared with control 2 after the Bonferroni correction.

We compared the temporal patterns of COVID-19 infections and deaths among HCWs with those in the general population (Figure). Three surges of COVID-19 infections and deaths occurred in the United States around April 2020, July 2020, and November 2020–January 2021. Although infections peaked during November 2020–January in the general population, the highest death numbers occurred in the first surge (April 2020). Of note, the temporal trend of COVID-19 infections among HCWs was similar to that among the US general population. However, the COVID-19 deaths among HCWs declined after April 2020 and remained flat, whereas 2 subsequent death surges occurred among the general population.


Comparison of COVID-19 cases and deaths among HCWs and in the non-HCW population, United States, January 2020–October 2021. A) Confirmed cases in HCW. B) HCW deaths. C) Confirmed cases in the non-HCW population. D) Confirmed deaths in non-HCW population. HCW, healthcare worker.