When the COVID-19 pandemic began, the world was caught off guard and left unprepared with how to handle this novel infection. As a result, it exacted a toll many would never have imagined possible. COVID-19 has killed nearly 1.1 million people in the U.S., according to the Centers for Disease Control and Prevention’s data tracker. Yet despite the essential role of physicians in the pandemic response, little has been known about excess mortality among doctors, according to a research letter published in JAMA Internal Medicine.
For the study, “Excess Mortality Among Physicians During The COVID-19 Pandemic,” researchers from Stanford University School of Medicine and the University of Southern California, Los Angeles used data from the AMA Masterfile and the corresponding Deceased Physician File to calculate excess deaths from March 2020 through December 2021 among U.S. physicians 45–84 years old.
All told, 4,511 physicians died during this early phase of COVID-19—622 more deaths than would have occurred had the pandemic not happened.
Excess physician deaths peaked at 70 in December 2020 among all active physicians, followed by a rapid drop in 2021 when safe and effective vaccines became available. No excess deaths among physicians occurred after April 2021, which coincided with the widespread availability of COVID-19 vaccines, meaning that nearly 50 U.S. doctors more than expected died each month during this phase of the pandemic.
“Measuring excess mortality allows us a partial view of the collateral damage caused by the pandemic,” said Lindsey Carlasare, research and policy manager for the AMA and an author on the research letter along with Kirsten Bibbins-Domingo, MD, PhD, MAS, editor-in-chief of JAMA® and JAMA Network..
“Beyond the deaths directly attributable to the virus, we see the extended impact by quantifying the number of physicians deceased beyond what would have been expected under normal circumstances,” Carlasare said.
Active physician age played a role
Physicians who provided direct patient care during the pandemic had excess deaths per 100,000 person-years of 10 in the youngest group and 182 in the oldest group. Nonactive physicians had the highest excess death per 100,000 person-years compared with doctors who provided direct and nondirect patient care. This was still a substantially lower excess mortality rate than what was experienced in the general population.
“The huge rate of excess mortality among the general population compared to physicians—even ones who are not actively practicing and therefore not at a higher risk of being exposed to SARS-CoV-2—shows how much better we could have done in our response during the pandemic,” said Mathew Kiang, ScD, MPH, lead author and assistant professor in the Department of Epidemiology and Population Health at Stanford University School of Medicine.
Yet, Kiang noted, “despite higher workplace protections, there were still excess deaths among physicians, and we need to think about how we can protect front line workers in the future.”
Prevention protocols stood the test
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Active physicians had lower excess death rates than nonactive doctors and the general population despite having higher risk for contracting SARS-CoV-2 infection throughout the pandemic.
What this suggests is that personal protective equipment (PPE) use along with vaccine requirements, infection-prevention protocols and other workplace-based protective measures were vital for preventing excess mortality among physicians.
“Our findings demonstrate not only the tragedy that is the hundreds of physicians deceased due to COVID-19, but it also adds to the body of evidence showing that reasonable measures, such as providing adequate access to PPE, infection-prevention protocols and better staffing are integral in preventing excess mortality,” Carlasare said.
Younger physicians were excluded from the study because they experienced fewer than five deaths a month during the study period. Of the excess physician deaths, 65.3% were men and 34.7% were women, the study says. While excess mortality among physicians was lower than in the general population, doctors still faced another battle. During the first year of the pandemic, physicians in the U.S. saw a rise in workplace stress while trying to make sense of COVID-19. They also experienced higher rates of burnout.
