April 14, 2021

The staggering toll of Covid-19 on health care workers

Daily Briefing

    As calls mount for the federal government to track Covid-19 deaths among health care workers, an investigation by The Guardian and Kaiser Health News has found that more than 3,600 American health care workers died in the first year of the Covid-19 epidemic.

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    Over 3,600 health care worker deaths in one year

    The investigation, called Lost on the Frontline, monitored who among the health care workforce died—and why—to provide a "window into the workings…of the U.S. health system during the Covid-19 pandemic, KHN reports. The project, which launched April 2020, ends this month after a full year in operation.

    Among other findings, the project found that:

    • People of color were significantly more likely to die during the pandemic than white health care workers. Overall, two-thirds of the people identified as having died from Covid-19 were people of color, and more than a third of health care workers who died were born outside of the United States, including a disproportionally high number of workers from the Philippines.
    • Lower-paid workers and those who handled patient care, such as nurses and support staff members, were significantly more likely to die during the pandemic than physicians.
    • More than 50% of those who died were younger than 60, and the median age of death was 59. In comparison, the median age of death from Covid-19 among the general population is 78.
    • Twice as many health care providers who worked in nursing homes died as did workers in hospitals. Overall, just 30% of the deaths were among health care workers at hospitals, and very few were among workers at well-funded academic medical centers, the investigation found.

    The project also found that deaths have dropped substantially since Covid-19 vaccines were made available to health care workers in December 2020. Case rates have dropped among health care workers as well, with one study published in March finding that just four of 8,121 fully vaccinated staff members at the University of Texas Southwestern Medical Center became infected with the coronavirus.

    Many deaths may have been preventable, project suggests

    According to the project, many factors contributed to the high death rate among health care workers, but several consistent—and largely preventable—issues increased their overall fatality risk. For instance, the project found that CDC guidance on masks, which originally stated that hospitals should reserve high-performance N95 masks for intubation procedures and that surgical masks were good enough for everyday patient care, likely left thousands of health care workers at risk.

    The investigation also found that widespread shortages of masks and other personal protective equipment (PPE), a lack of Covid-19 testing, and poor contact tracing contributed to health care workers' increased risk of death.

    The Department of Labor also "took a hands-off approach to workplace safety" among health care settings despite complaints, according to the investigation.

    The investigation identified 4,100 safety complaints filed by health care workers with the Occupational Safety and Health Administration (OSHA), the majority of which regarded PPE shortages. While some of the complaints were investigated and closed, health care workers continued to die at those facilities, the investigation found.

    Some health care employers also failed to report the deaths of their health care workers to OSHA, with the investigation finding that more than a third of workplace Covid-19 deaths were not reported to the agency.

    Calls mount for federal government to track health care worker deaths

    The Lost on the Frontline project is the most comprehensive accounting of health care worker deaths in the United States, KHN reports. While CDC does collect some data on such deaths, the agency has acknowledged that its own record—listing just 1,527 deaths among health care workers—is an undercount because of limitations on how the agency gathers information.

    However, calls from health experts and union leaders have grown for the government to begin tracking health care worker deaths more thoroughly.

    For instance, Harvey Fineberg, a leading health policy expert, said his ideal approach to tracking health care worker deaths would include a nationwide record. "There would be a combination of a selective look backward to gain more accurate tabulations of the past burden, and a system of data-gathering looking forward to ensure more complete counts in [the] future," he said.

    Zenei Triunfo-Cortez, a president of National Nurses United, said the number of health care workers who have died of Covid-19 is "an unacceptable tragedy" exacerbated by a lack of federal data. "We as nurses do not deserve this—we signed up to take care of patients, we did not sign up to die," she said.

    Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and chief medical advisor for the White House's Covid-19 response, said he believes there's a role for federal agencies in tracking deaths among frontline health care workers.

    "We certainly want to find an accurate count of the people who died," he said. "That's something that I think would fall under the auspices of the federal government, likely [HHS]."

    A spokesperson for HHS said the department currently has no plans to begin counting health care worker deaths.

    However, Triunfo-Cortez said the White House and certain federal agencies seem increasingly willing to engage and listen.

    "We have been working with the Biden administration and they have been receptive to the changes we are proposing," Triunfo-Cortez said. "We are hopeful that they will start to mandate the reporting of deaths, because if we don’t have that data how can we know how effective we are being in stopping the [epidemic]?" (Spencer/Jewett, The Guardian/Kaiser Health News, 4/8; Pilkington, The Guardian/Kaiser Health News, 4/8).

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