Study Shows Deadly Toll on MDs of Pandemic's Early Wave

Marcus A. Banks

February 06, 2023

The beginning of the COVID-19 pandemic featured scrambles for personal protective equipment in hospitals throughout the United States. Healthcare workers were among the most vulnerable in those early days, as they could not shelter in place and they interacted with many patients affected with the disease.

An investigation that was published in April 2021 by The Guardian and Kaiser Health News found that more than 3600 US healthcare workers who responded to COVID-19 had died by then. Almost one third were nurses, and close to one fifth were physicians. A new study published today in JAMA Internal Medicine confirms that more US physicians died from March 2020 to December 2021 than usual.

"Several colleagues passed away during the pandemic," said Sterling Ransone, Jr, MD, the immediate past president of the American Academy of Family Physicians, who was not involved in the latest research. "The study confirms a lot of things that most physicians have felt."

For the analysis, Mathew Kiang, ScD, MPH, of Stanford University, and colleagues ― including JAMA editor-in-chief Kirsten Bibbins-Domingo, MD, PhD, MAS, an epidemiologist at the University of California, San Francisco ― examined death rates for US physicians using the American Medical Association's (AMA's) Deceased Physician File. From March 2020 to December 2021, of approximately 800,000 physicians who practiced monthly, 4511 physicians died, per the AMA.

That was 622 more deaths (95% CI, 476–796) than would have been expected on the basis of mortality rates prior to the pandemic. Roughly two thirds (65.3%) of the deaths were of men.

In December 2020 alone, 70 more physicians died than expected. After April 2021, however, the rate of excess deaths returned to prepandemic levels. The leveling off occurred around the time vaccines became widely available, Kiang and co-authors note. In addition, personal protective equipment had become more available.

"There is 'something' going on with physicians and with widespread vaccination within physicians and among patients they treat," Kiang told Medscape Medical News in an email.

"Immunization and good public health hygiene made a huge difference," Ransone added.

Older physicians (aged 75–84) were much more likely to die than younger colleagues (45–64), mirroring trends in the overall population. Even so, the rates of deaths were still much lower than in the overall population, the study found.

"We can be relieved that excess deaths among physicians was not even higher than it was, given their importance in our COVID-19 response. I also believe excess deaths in the overall population was far too high," Kiang said.

In all age groups, physicians who provided direct patient care were more likely to die than active clinicians who did not provide direct care. Eighty-one (range, 27–136) more physicians aged 45–64 years who provided direct care died than would have been expected. By comparison, 13 (range, 1–26) doctors in this age group who were not actively practicing died. Among physicians aged 65–74 years, there were 108 (range, 52–163) excess deaths among actively practicing physicians, and -8 (range, -29 to 13) excess deaths among actively practicing physicians who did not provide direct care. Among physicians aged 75–84, there were 85 (range, 46–125) and 10 (-12 to 32) excess deaths, respectively.

Among physicians who were not active in any capacity, excess mortality rates were especially high at every age level.

Planning Ahead

Ransone recalled that during the pandemic, he had to wear a single-use surgical mask for days. At one point, his health system in Deltaville, Virginia, received a shipment of personal protective equipment from the national stockpile, but the equipment turned out to be dry-rotted and unusable. Most medical personnel eventually received the equipment they needed to protect themselves. Both Ransone and Kiang expressed concern about preparedness for a future pandemic.

Ransone called for stockpiles of personal protective equipment that are more reliable than the spoiled shipment he encountered, perhaps buttressed with domestic manufacturing.

Kiang noted that policies about masking and testing have been inconsistent during the pandemic, and he fears that such confusion could happen again in the absence of effective planning.

"I think in general we are underprepared for the next epidemic, whatever it may be, in terms of both equipment and consistent policies," Kiang said.

Kiang and Ransone report no relevant financial relationships.

JAMA Intern Med. Published onine February 9, 2023. Full text

Marcus A. Banks, MA, is an independent journalist based in New York City who covers health news with a focus on new cancer research. He has bylines in Cancer Today, The Scientist, Medscape, Gastroenterology and Endoscopy News, Slate, TCTMD, and Spectrum.

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