The saying that healthcare workers “occupied the front lines” in the war against COVID-19 comes more clearly into focus thanks to a research letter in JAMA Internal Medicine, which found that more physicians died during the early days of the pandemic than would have under normal circumstances.
“From March 2020 through December 2021, American physicians experienced 622 more deaths than expected,” wrote researchers with Stanford University and the American Medical Association. “There were no excess deaths among physicians after April 2021, coinciding with the widespread availability of COVID-19 vaccines.”
The excess mortality rate in the general population surpassed the excess physician mortality rate across all age groups. However, the research letter states that working physicians had lower mortality rates than active physicians even though working physicians had more of a chance of being infected by the virus.
“The findings suggest that personal protective equipment use, vaccine requirements, infection prevention protocols, adequate staffing and other workplace-based protective measures were effective in preventing excess mortality,” the research letter said. “Additionally, increased excess deaths among older active physicians providing direct patient care suggest that workplace policies should prioritize mitigating risk in this group.”
The research letter comes at a time when society is struggling to find a new normal and coexist with endemic COVID-19—and whatever’s coming next. “Not if, but when,” is the mantra of healthcare experts, often alluding to concerns about growing resistance to antibiotics.
Mathew V. Kiang, ScD, of the department of epidemiology and population health at Stanford University School of Medicine and the research letter’s corresponding author told Fierce Healthcare that “we are trying to return to an old normal but there are still 500 COVID-19 deaths per day—an enormous number that would have been unthinkable pre-pandemic. How much preventable death, especially among vulnerable groups, we as a society are willing to accept is something I don’t think science can answer. In terms of this study, this also won’t be the last epidemic we face.
"I think the lesson here is that we need to do a better job protecting those frontline healthcare workers," Kiang said.
Richard Stefanacci, an adjunct professor in the Jefferson College of Population Health at Thomas Jefferson University, told Fierce Healthcare that “before we face the next pandemic we need to be ready with PPE and appropriate preventive measures. Further than that, we need to adjust by assessing the risks versus benefits on an individual basis moving forward.”
As far as getting back to a pre-pandemic normal, Stefanacci said that he’s “shocked how quickly we have gotten back to normal in some areas while we have been slow to return in others. Travel for example has returned to almost no one wearing masks while in nursing homes we still require masks on our residents which has significant negative impact on their quality of life. Also, healthcare workers continue to wear masks with no end of that in sight.”
Kiang noted that “early on in the pandemic, there was a shortage of personal protective equipment for providers, early tests were not readily available, there was no vaccine, and national policy—if there was any—was ever-changing. I think in that context, hospitals needed to protect themselves and their patients as much as possible. In terms of current hospital policies, I think the lessons we learned about what worked and what didn’t work should stay with us.”
Stefanacci argued that “blanket policies” won't do.
“We need to get to the place where the costs of prevention equal or are less than the benefits,” said Stefanacci. “This means that when the risk is especially low such that masking benefits are limited, then we move to eliminate masking. But where risks are high, we continue.”
The findings in the research letter did not surprise Stefanacci, he said.
“Not at all,” he said. “In the early phase of the pandemic, the mortality was much more significant due to a more virulent COVID strain, in the face of no vaccines, treatments, even PPE as a result since healthcare providers on the frontline were more likely to have direct contact.”
The counting and recounting of deaths because of COVID-19 continues as researchers sift through data collected during the pandemic. A recent study by researchers from Boston University and the University of Pennsylvania says that 268,176 people died from the disease in the first two years of the pandemic whose death certificates listed different causes.
In addition, there’s long COVID, a wild card in mortality and morbidity rates that presents a challenge to providers and payers alike and could possibly be a problem for years to come depending on how susceptible children and adolescents are to it.
Studying this topic was personal for Kiang, he said. He said that he’s “lost people to COVID-19 but not doctors. My wife is an emergency medicine physician and I have many friends who are physicians, so I did see firsthand the way the pandemic stretched an already overworked group. We heard so many stories of deaths, burnout, and leaving medicine altogether. This is terrible for doctors but also has ramifications for the general population who depend on healthcare workers during the pandemic.”