Deaths from COVID-19 in healthcare workers in Italy—What can we learn?

ABSTRACT

On April 16, 2020, the Italian National Institute of Health (ISS) reported that 16,991 healthcare workers (HCWs) had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). On April 17 the latest estimate of medical doctor deaths reached 119, which is 57.8% of total HCW deaths;followed by nurses 16.5% (n = 34), nurse aides 8.3% (n = 17) and dentists 5.8% (n = 12) (Fig. 1).3 The COVID-19–related deaths include 2 nurses who committed suicide due to unsustainable pressure at work.4 No other country has seen the same elevated number of doctor deaths;China, where the epidemic began in December, had fewer.5 General practitioners seem to be the worst hit among all medical specialties, registering 32% deaths (n = 66) (Fig. 1).3 This high rate could reflect their presence in the first line of defense for anyone presenting with the initial symptoms. Nurses and midwives together are the most represented with 43.2% (n = 6,988) of all infected HCWs, followed by doctors 22% (n = 3,574) divided between hospital doctors 19% (n = 3,071), general practitioners 0.8% (n = 130) and other doctors 2.3% (n = 373).1 Data for the healthcare context in which the infections presumably occurred are available for 11,738 HCWs;of these, 70.9% have contracted COVID-19 while serving in hospitals or in emergency care services (ambulance assistance).1 Interestingly, according to the National Federation of Orders of Surgeons and Dentists (FNOMCeO) registry,2 general practitioners accounted for the highest number of HCW deaths (Fig. 1) despite being the least infected group (as reported in the latest ISS analysis).1 Furthermore, according to the National Federation of Professional Nursing Orders (FNOPI), 32% of the nurse deaths by April 16, 2020, initially contracted the virus while on duty in nursing care homes where personal protective equipment (PPE) was mostly lacking, and 50% were working in nonhospital healthcare facilities.4 The sheer intensity of the COVID-19 outbreak in Italy, the recruitment of elderly retired doctors and shortages of PPE, particularly in nonhospital care, might be among relevant factors contributing to the elevated number of fatalities among HCWs in this country. [...]it is essential to carry out another retrospective epidemiological investigation and a prospective study to identify the main risk factors contributing to COVID-19–related deaths in the different HCWs categories in order to produce viable schemes for their protection.