With the death of nephrologist Luis Sulbarán in Zulia state, 43 deaths were reported among health personnel by COVID-19, until the afternoon of Thursday, August 6. This would be equivalent to 22% of the 195 victims officially reported by the Presidential Commission for COVID-19 of the Nicolás Maduro administration. Only in the state of Zulia there are 28 deaths from this cause.
Dr. Freddy Pachano, director of postgraduate medicine at the University of Zulia, tweeted on August 1 that he believed that in Zulia and its capital Maracaibo it was the area with the most doctors killed by COVID-19 in the world while the statistician Felix Seijas warned that on August 3 that having 20% deaths among health personnel showed the need for inputs (of bioprotection) and “of an administration that cares about people.”
The Cocuyo Effect Data and Factchecking Unit made a review of the available statistics and studies to find similarities and differences between the figures of other countries in the region and the world.
National situation
Repeatedly, the organization Médicos Unidos de Venezuela, the Health Advisory Committee of the National Assembly and various trade union organizations of health personnel have warned of the lack of sufficient protective material and sanitary conditions in hospitals to avoid contagion.
According to the deputy José Manuel Olivares, by August 3 there were at least 174 unreported deaths. If true, health personnel would represent 11.6% of all deaths, reaching a total of 369 deaths (195 deaths officially registered until August 5 and 174 not reported)
According to the report of the United Nations Office for Humanitarian Affairs (OCHA) in Venezuela, for July 11, there were 212 infected staff members. The text indicates that the contagion would probably be due to the lack or inappropriate use of protective equipment. At that time, the monitoring carried out by Efecto Cocuyo had 18 deaths. So the case fatality rate among health personnel (taking 212 doctors with COVID-19 as a reference) would reach 8.5%.
Doctors without doctors
On May 6, BBC Mundo published a report called “Will I be the next to die?”: The dramatic testimony of the doctors who have been infected with covid-19 in Latin America”For which they interviewed three doctors in Ecuador and Peru who worked on the front lines.
The Ecuadorian College of Doctors said that 21 of the 1,500 infected doctors had died. This placed the profession at 1.4% of lethality, when comparing the deaths with the cases diagnosed among doctors. The first doctor, who remained anonymous, in Guayaquil, said that the State acted very slowly and that the hospital where he works was not ready when many patients began to arrive.
According to epidemiologist Carlos Alberto Coral, a specialist in tropical diseases at a hospital in Iquitos, in northern Peru, 70% of doctors showed symptoms of the disease. Therefore, the staff began to decrease, so they decided that the recovering staff would be the one who would take care of the still sick doctors, but regretted to reveal that it was only outpatient care because an area for the care of the sick health personnel had not been prepared. .
Mailin Cinthia Wong Ponce, a doctor who worked in her rural area in Los Ríos, Ecuador, said that when the cough and fever appeared, they only told her that she should isolate herself. She was attended by her boyfriend’s parents. Both she and the anonymous doctor said they lost four of their teachers to the new coronavirus.
This seems to be repeating itself in Venezuela. The journalist Esteninf Olivares denounced on August 3, a resident pediatric doctor at the Vargas Hospital was rejected by his own colleagues when he began to show symptoms. The nurses prepared a record to transfer him to another hospital when they learned that he was hospitalized by one of his colleagues. This doctor he was reprimanded “for not warning on time” although the incident happened at 1 in the morning.
Comparing with Peru and Ecuador
As of June 15, there were officially 3,929 deaths from COVID-19 in Ecuador. Of them, 45 were health personnel, including 32 doctors, which was equivalent to only 1.14% of the deaths in that country. However, by July 6, the Ecuadorian Medical Federation denounced that this was underreporting and that there were 130 dead doctors. This would raise mortality among health personnel to 4.2%. Venezuela would double this rate, but the 26-day difference between the data does not make them comparable.
Santiago Carrasco, president of the Ecuadorian medical union, then demanded that the government of Lenín Moreno provide enough bioprotection equipment. In a letter published June 23 warned about the state of the public health system as well as the lack of payments for its members.
For its part, according to the Medical College of Peru for July 29 there were 103 deceased doctors, especially in the Loreto, Lima and Piura areas, areas with the highest number of infections. The union also counted 2,837 infected, including 73 who are in intensive care. The dean of the union, Miguel Palacios, demanded that same day the government of Martín Vizcarra the purchase and delivery of bioprotection material.
This implies that Peru registers a lethality of the virus among doctors of 3.5%. This without considering the rest of the health personnel. So although it seems that we also far exceeded them, the difference of one week makes it doubtful.
World comparison
A study published on May 15, 2020 by the University of Oxford evaluated the death by COVID-19 of 278 doctors in 21 countries, including Mexico, Honduras and Brazil, finding that although at least some data was missing in 108 cases, the average age was 63.7 years, that 90% were men and that the majority of the deceased 42.5% were from medicine general and emergency; However, they found respiratory scientists, internists, anesthesiologists, epidemiologists, infectious diseases, odontologists, otorhinolaryngologists and ophthalmologists.
Among the cases studied, 121 doctors from Italy and 43 from Iran led. Among the conclusions of the study is that doctors of any specialty can die of COVID-19 and that the lack of protective equipment are the most common causes of death and that it should be considered to exclude older doctors from front-line work.
A correspondence note published by the first 100 deaths of doctors in Italy last May 1 (although the deaths were reached April 9th) reveals that they were 69 years old on average, 95% were men and 60% were in the Lombardy region and the most affected in the European country. However, doctors were only 0.58% of the 17,300 deaths in that country.
Other countries
Another study, which reviewed the cases of infected health personnel in Germany, published on July 17 In the International Journal of Environmental Research and Public Health, it found that as of May 25, there were 12,393 reported cases of COVID-19 in Germany among staff working in health centers. 73% were women and 27% men, while 20 deaths were recorded, which gave a mortality of 0.2% while the country had one of 4.6%.
Considering also other health care centers such as nursing homes for the elderly, the total contagions of health personnel amounted to 8,935 cases for a total of 11.9% of the 178,570 cases in Germany at that time. In these places, mortality rose to 0.5%.
Venezuela would have 28 times more mortality among health personnel from Italy and Germany.
Associated deaths
Considering a different corner of the world, as of July 13, 108 doctors had died in India, the country that accumulates the third largest number of infections in the world behind the United States and Brazil. The figure is not official but comes from a study done by Dr. Rajeev Jayadevan, President of the Indian Medical Association. According to their study, which is not official, the average age among deceased is 56.3% while 73% were general medicine practitioners.
For the researcher, deaths among health personnel have a greater list of circumstances. From previous pathologies to working conditions: long hours of work without breaks, work stress, unexpected sudden deterioration, working without bioprotection equipment and low availability of it, inadequate testing facilities, shortage of hospital beds and insufficient beds for care intensive.
Professor Jayadevan also included four violent deaths related to the pandemic: three from road accidents and one from suicide, considering the need for psychological care and a change in working hours. Likewise, a correspondence letter from professors from the Sapienza universities of Rome and Oxford included an analysis of deaths among health personnel in Italy to two nurses who committed suicide due to overwork. Although they used data until mid-April, they revealed that no country had suffered so many deaths from doctors in the world.
Conclusions
Venezuela shows higher rates in incidence and mortality in its health personnel, ranging between 11.6% and 22% of deaths (depending on whether only official deaths or the reported underreporting are considered) until August 6 and a fatality 8.5% of those infected until July 11.
However, underreporting -because of the lack of sufficient molecular evidence- of cases and deaths in each country, the very policy of measuring deaths (including or not suspects) that does not allow to compare lethalities between countries and the numerical inconsistencies of the recovered and the asymptomatic in Venezuela, as well as the lack of global statistics on affected health personnel, limit comparisons.
That is, the deaths of health personnel would be reduced proportionally compared to the rest of the victims of COVID-19 if the methodology or underreporting of mortality is adjusted (as has already happened in several Latin American countries such as Chile, Peru and Ecuador).
On the other hand, in the studies consulted, the relationship between higher mortality among health personnel and failures in the availability of bioprotection equipment appears constant, but also due to the lack of training in its proper use and the novel circumstances of excessive Workload.
Another common element was finding highest mortality among health personnel in areas with the highest number of cases: Northern Italy, China’s Hubei province, Loreto region in Peru and Guayas in Ecuador, as is happening in Zulia, where 24 health personnel workers have died.
According to the monitoring carried out by Efecto Cocuyo on 33 doctors who died until August 6, the average age is 68.1 years. Furthermore, men represent 81.8% of cases. In other words, older doctors and a greater proportion of women were dying in Venezuela than in the rest of the 21 countries observed, including three Latin Americans, by Oxford scientists.
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