Since December, 2019, an outbreak of a novel coronavirus pneumonia (COVID-19) occurred
in Wuhan (Hubei, China)
. Recent paper in this journal also described the clinical and computed tomographic
imaging features of novel coronavirus pneumonia caused by COVID-19
. During nearly two months of fighting against the epidemic, health workers were under
great physiological and psychological pressure in China
. For example, due to wearing protective clothing, many health workers avoided drinking
water and wore adult diapers for a long time, so that some of them fainted under hypoxia
. Previous studies showed that stress could increase the risk of infection
as well as induce ventricular arrhythmia, and thus sudden cardiac death
. As a result, the medical staff in the front-line fighting against the novel coronary
pneumonia were facing high risks of virus infection and sudden death. In 2003, more
than 1000 health workers were attacked by severe acute respiratory syndrome (SARS)
and 124 deaths were observed in China. As of Mar 16, 2020, 24 health workers had died
during the outbreak of COVID-19 infection in China.
We retrieved information on 24 deceased cases of health workers based on official
reports from governmental institutes, as well as reports from news sites. Information
available on public data included gender, age, cause of death, location city, date
of disease onset, date of admission, date of death, and hospital levels they worked.
We grouped cases into three groups based on the cause of death, which included COVID-19
infection, sudden death, and traffic accident groups. Mann-Whitney U test was applied
to compare continuous variables because the data was non-normal distribution, and
Fisher exact test was used for categorical variables because the data number was limited.
13 (54.2%) cases died of COVID-19 infection, 8 (33.3%) suffered from sudden death
including cardiac arrest, myocardial infarction, and other non-confirmed diseases,
and 3 (12.5%) died in traffic accident during work time or after work (Table 1
). The basic information of all the deceased health workers was listed in Fig. 1
A. The median age was 50.5 years (IQR: 36.25-56.5), ranging from 26 to 69 years. A
total of 72314 patient record showed that 81% of dead cases were aged 60 years or
older, and 12.7% were aged 50 to 59 years
. The median age of deceased medical staff was obviously younger than that of general
population, because medical staff were mostly in employment who were younger than
60 years. Up to 83.3% of deceased medical workers were males, and no sex difference
occurred among COVID-19 infection group, sudden death group, and traffic accident
group. In the group of infection, 11 deceased cases (84.6%) were males. Zhang reported
that the overall case fatality rate of male patients (rough estimate: 2.8%) was significantly
higher than that of female patients (rough estimate: 1.7%)
. In the group of sudden death, 7 cases (87.5%) were males. Previous study revealed
that, at 45 years of age, lifetime risks for sudden cardiac death were 10.9% for men
and 2.8% for women
, which was similar to the results in our study. Above data suggested that males had
higher risks of death due to COVID-19 infection and sudden death than females.
Demographics of deceased medical workers in China by Mar 16, 2020.
COVID-19 infection (n=13, 54.2%)
Sudden death (n=8, 33.3%)
Traffic accident (n=3, 12.5%)
Z/χ2 (P /Fisher P)
Age, Median (IQR) -yrs
Male, No. (%)
Hubei resident, No. (%)
Wuhan resident, No. (%)
Community hospital, No. (%)
Onset to admission, Median (IQR)-days
Admission to death, Median (IQR)-days
Onset to death, Median (IQR)-days
A) Death date, demographics, and death cause of medical workers in China by Mar 16,
2020. Infection with COVID-19 marked with blue, sudden death marked with purple, and
traffic death marked with red. B) The new number of deceased medical workers with
confirmed COVID-19 infection at admission per 5 days (marked with blue), new number
of medical workers with sudden death per 5 days (marked with purple), and new number
of medical workers with traffic accident per 5 days (marked with red).
Transmission of COVID-19 occurred in the hospital setting. In the group of COVID-19
infection, there were more medical staff working in Hubei province (84.6%) and Wuhan
city (69.2%), which was consistent with the result of 63% of infected medical staffs
were in Wuhan in recent report
. Due to serious situation of COVID-19 infection in Hubei, more nosocomial infection
and death happened in Hubei than other provinces. As of February 11, 2020, 3019 cases
had been observed among health workers, of whom there have been 1716 confirmed cases.
Among health workers infected, 14.8% of confirmed cases were classified as severe
or critical, and 5 deaths were observed
. Among all the deceased medical staff with COVID-19 infection, the median of period
from disease onset to hospital admission was 2 days (IQR: 1-5.5), and the median of
period from admission to death was 26 days (IQR: 21.25-36.5) (Table 1). Based on the
admission date of staff with COVID-19 infection and the death date of staff with sudden
death, the new number of deceased health workers per 5 days was listed in Fig. 2.
Attacked infection mostly occurred on January, and the sudden death mainly happened
from Jan 23 to Feb 10, 2020.
Furthermore, there were more health workers suffering from sudden death or traffic
accident, who worked in community hospitals. Sudden death due to huge work and lack
of rest happened since Jan 23, 2020, when comprehensive measures for epidemic prevention
and control were taken nationwide. Massive work including temperature measure, door
to door visit, medicine delivery, patients transfer, disinfection, and etc., had been
completed by community or village medical workers. Some village doctors even lived
and ate in the village clinics. On Feb 22,2020, Chinese government took a series of
measures to protect and support health workers in front line, such as improving the
quality of life, strengthening personal protection, arranging rest in turns, and relieving
mental stress. Afterwards, the incidence of accidental death decreased significantly.
In summary, there were more males in the fatality of health workers, more sudden death
happening to community health workers, and more death due to COVID-19 infection occurring
in Hubei health workers during the outbreak of COVID-19 infection in China.
Declaration of Competing Interest