By Gary Evans, Medical Writer

Although healthcare workers (HCWs) literally bear witness to death, who tolls the bell for them?

It turns out that there is no official death count for HCWs who have died of COVID-19. Ask how many of these heroes have put their lives on the line and lost them in the process, and you enter a maze of incomplete reports collected from limited jurisdictions, mixed with extrapolations, and models confounded with variables.

“We don’t know how many healthcare workers have died as a result of COVID, let alone how many have died of it acquired at work,” says Matthew Wynia, MD, MPH, FACP, Director of the Center for Bioethics and Humanities at the University of Colorado. “We really are flying blind here a lot of the time because we don’t have standardized reporting systems where all of the states are using the same metrics.”

Wynia is the co-author of a recent government report that the Department of Health and Human Services (HHS) requested as a rapid assessment of the healthcare mortality issue.

“Other information that is often missing is pregnancy, race and ethnicity, what type of job were they doing, did they have adequate PPE, or was their hospital in the midst of a surge and they were overwhelmed and running out?” Wynia says. “All of those questions we really just can’t answer because we don’t have that information on any kind of national basis.”

The HHS requested data on deaths related to COVID-19 due to occupational exposure directly to COVID-19, as well as deaths that “could reasonably be attributed to conditions exacerbated by COVID-19,” such as suicides. “The absence of a uniform national framework and inconsistent requirements across states for collecting, recording, and reporting HCW mortality and morbidity data associated with COVID-19 impairs anyone’s ability to make comparisons, do combined analyses, or draw conclusions about the scale of the problem,” the report concludes. “Promulgation of a robust national data reporting system, including collection of data on circumstances and interventions that may raise or lower risk, as well as data on where the infection occurred, would support the adoption of effective mitigation strategies and policies to reduce COVID-19 mortality and morbidity in HCWs.”

As of March 1, 2021, the Centers for Disease Control and Prevention (CDC) reported 415,123 COVID-19 cases and 1,370 deaths in HCWs. These data almost certainly represent an undercount, as the CDC details the hamstrung database from which they were drawn. COVID-19 status was collected from 21.5 million people, but healthcare occupational status was known for only 18% — 3.9 million of them. For the 415,123 cases of COVID-19 among healthcare personnel, death status was available for 330,792 (80%)

An investigative journalism project documented 2,900 HCW deaths from March through Dec. 23, 2020.

“There are estimates that are really low and there are estimates that are really high — and that fact alone is really concerning,” Wynia says. “It really means that the best studies on this are ones that are being done by newspapers right now looking through death notices and finding this woman was a nurse, this person was a respiratory therapist, and counting them up that way. If that is the best we can do, it is kind of pathetic.”