It's been nearly three years since the COVID-19 pandemic began in the U.S., and the public health emergencies that were declared by the Trump Administration and renewed several times by the Biden Administration are scheduled to end on May 11, 2023. At least 1.1 million Americans have perished from coronavirus infections, with excess deaths data indicating that absent the pandemic, the vast majority would still be living. Early on, stories of doctors and nurses having to wear garbage bags as personal protective equipment and reusing the same N-95 mask for days on end drove a narrative that health care professionals were heroes, wading into battle against the virus like soldiers under enemy fire or firefighters rescuing people from a blazing home. We were working longer hours under unusually stressful circumstances, and despite precautions, many front-line health care workers became infected on the job, particularly before the first vaccines became available in December 2020. But how many U.S. physicians made the ultimate sacrifice for their service, like the late Li Wenliang, the Chinese ophthalmologist who sounded the alarm during the early days of the Wuhan outbreak?
Although we may never have a precise answer, a Research Letter in JAMA Internal Medicine recently shed light on it. Researchers used information from the American Medical Association Masterfile and Deceased Physician File to compare expected with observed deaths among U.S. physicians aged 45 to 84 years from March 2020 through December 2021. Results were stratified by age group, practicing vs. non-practicing, and provision of direct patient care. Overall, among an average of 785,000 physicians, 4511 deaths occurred over the period of analysis, representing 622 more deaths than otherwise would have been expected in the absence of the pandemic. In my group (age 45-64, active physician providing direct patient care), 652 deaths occurred, 81 more than expected. Notably, no excess physician deaths occurred after April 2021, when vaccines for adults had become widely available.
Some study findings were unsurprising: for example, excess mortality was higher among older than younger physicians. Nonactive physicians had slightly more excess deaths than active physicians (providing direct patient care or not). In all age groups, excess death rates were substantially lower than those among the US general population. While the study was not designed to determine the reasons for these disparities, it's easy to understand why: active physicians tend to be wealthier and healthier than inactive ones and the general population, and taking COVID-19 seriously from the start, they were more likely to get vaccinated and boosted and (during the time period of the study) to wear masks in public places.
That physicians and other health professionals had advantages over other "front-line" workers doesn't detract from the heroism that I witnessed in those pre-vaccine days, when every time I went to work part of me was terrified of inadvertently catching and bringing back home a potentially lethal virus with no effective treatment. Although the end of the public health emergency doesn't mean the end of the pandemic (today more than 1,000 infected patients are hospitalized in Pennsylvania alone), we are certainly in a much better place than we were. Health care works best when health care workers don't have to be heroes.
