July 28, 2020
Health care workers in primary care settings have a higher risk of death from COVID-19 than their counterparts in hospital settings, according to research out of the University of Pennsylvania.
A report published in the Journal of the American Board of Family Medicine details the findings of a global study that assessed 1,004 COVID-19 deaths among health care workers. The fatalities included in the study occurred on or after May 13.
The study used crowdsourced data from the medical website Medscape, which maintains a list of health care worker deaths worldwide and requires confirming documentation for each report.
During the early months of the coronavirus pandemic, risks were higher in "front line" hospital settings that were experiencing a shortage of personal protective equipment and a sudden influx of patients.
Since then, hospitals have generally become better supplied and have developed more rigorous protocols for protecting staff.
"Front line physicians including anesthesiologists, ICU specialists, emergency room physicians and nurses form a much smaller group of COVID-19 cases, likely due to better access to personal protective equipment," said senior study author Dr. Basavana Goudra, a clinical associate professor of anesthesiology and critical care at Penn.
Since May 13, the study found that nearly 55% of the COVID-19 deaths in the Medscape sample occurred among physicians in all settings. On average, they were about 62 years old. Among the physicians who died, the largest subset – 26.9% – were family medicine, general practitioner and primary care doctors.
Physicians who were more likely to be on the front line in hospitals only represented 7.4% of physician deaths in the Medscape group.
Goudra and the rest of the Penn team believe the higher number of fatalities in primary care settings may be due to the fact that these doctors are likely to see patients with early-stage, mild or asymptomatic cases of COVID-19, while still highly contagious. They believe these doctors are less likely to have sufficient personal protective equipment, if any.
The researchers noted that the Medscape sample is limited and likely comprises an incomplete list of health care workers who have died from COVID-19. Furthermore, standards for reporting deaths and classifying deaths varies from country to country.
Still, the study points to the changing landscape of risk in the health care field and the need for greater precautions among primary care doctors.