Article Text

Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review
  1. Soham Bandyopadhyay1,
  2. Ronnie E Baticulon2,
  3. Murtaza Kadhum1,
  4. Muath Alser3,
  5. Daniel K Ojuka4,
  6. Yara Badereddin5,
  7. Archith Kamath1,
  8. Sai Arathi Parepalli1,
  9. Grace Brown1,
  10. Sara Iharchane6,
  11. Sofia Gandino6,
  12. Zara Markovic-Obiago1,
  13. Samuel Scott1,
  14. Emery Manirambona7,
  15. Asif Machhada8,
  16. Aditi Aggarwal1,
  17. Lydia Benazaize1,
  18. Mina Ibrahim8,
  19. David Kim1,
  20. Isabel Tol1,
  21. Elliott H Taylor1,
  22. Alexandra Knighton1,
  23. Dorothy Bbaale9,
  24. Duha Jasim1,
  25. Heba Alghoul10,
  26. Henna Reddy1,
  27. Hibatullah Abuelgasim1,
  28. Kirandeep Saini1,
  29. Alicia Sigler11,
  30. Leenah Abuelgasim1,
  31. Mario Moran-Romero12,
  32. Mary Kumarendran1,
  33. Najlaa Abu Jamie13,
  34. Omaima Ali1,
  35. Raghav Sudarshan1,
  36. Riley Dean14,
  37. Rumi Kisyova8,
  38. Sonam Kelzang15,
  39. Sophie Roche1,
  40. Tazin Ahsan16,
  41. Yethrib Mohamed1,
  42. Andile Maqhawe Dube17,
  43. Grace Paida Gwini17,
  44. Rashidah Gwokyala18,19,
  45. Robin Brown1,
  46. Mohammad Rabiul Karim Khan Papon16,
  47. Zoe Li20,
  48. Salvador Sun Ruzats21,
  49. Somy Charuvila1,
  50. Noel Peter1,
  51. Khalil Khalidy10,
  52. Nkosikhona Moyo17,
  53. Osaid Alser1,22,
  54. Arielis Solano23,
  55. Eduardo Robles-Perez24,
  56. Aiman Tariq25,
  57. Mariam Gaddah26,
  58. Spyros Kolovos27,
  59. Faith C Muchemwa28,
  60. Abdullah Saleh29,30,
  61. Amanda Gosman29,
  62. Rafael Pinedo-Villanueva31,32,
  63. Anant Jani1,
  64. Roba Khundkar1,8
  1. 1Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK
  2. 2Philippine General Hospital, University of the Philippines Manila College of Medicine, Manila, Metro Manila, The Philippines
  3. 3Kasr Al Ainy School of Medicine, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
  4. 4Department of Surgery, University of Nairobi College of Health Sciences, Nairobi, Kenya
  5. 5Faculty of Pharmacy, Al Azhar University-Gaza, Gaza, State of Palestine
  6. 6Dipartimento di medicina clinica e sperimentale, University of Insubria, Varese, Lombardia, Italy
  7. 7University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
  8. 8North Bristol NHS Trust, Westbury on Trym, Bristol, UK
  9. 9Mbarara University of Science and Technology, Mbarara, Mbarara, Uganda
  10. 10Islamic University of Gaza, Gaza, State of Palestine
  11. 11Shriners Ambulatory Clinic, Tijuana, Mexico
  12. 12Department of Plastic Surgery, Hospital General Dr. Manuel Gea Gonzalez, National Autonomous University of Mexico, Mexico City, Mexico
  13. 13Palestinian Ministry of Health, Gaza, State of Palestine
  14. 14University of California San Diego, La Jolla, California, USA
  15. 15Gelephu Central Regional Referral Hospital, Gelephu, Bhutan
  16. 16Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh
  17. 17National University of Science and Technology Faculty of Medicine, Bulawayo, Zimbabwe
  18. 18Gulu University Faculty of Medicine, Gulu, Uganda
  19. 19Oxford Brookes University, Oxford, Oxfordshire, UK
  20. 20Swansea Bay University Health Board, Port Talbot, Neath Port Talbot, UK
  21. 21University of Huddersfield, Huddersfield, Kirklees, UK
  22. 22Harvard Medical School, Boston, Massachusetts, USA
  23. 23ConnectMed International, Dominican Republic, Dominican Republic
  24. 24Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico
  25. 25Jinnah Post Graduate Medical Centre, Karachi, Pakistan
  26. 26Lancaster Medical School, Lancaster University, Lancaster, Lancashire, UK
  27. 27Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Oxford University, Oxford, Oxfordshire, UK
  28. 28Parirenyatwa Hospital, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
  29. 29Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
  30. 30Office of Global Surgery, University of Alberta, Edmonton, Alberta, Canada
  31. 31Centre for Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
  32. 32MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, Hampshire, UK
  1. Correspondence to Roba Khundkar; roba.khundkar{at}


Objectives To estimate COVID-19 infections and deaths in healthcare workers (HCWs) from a global perspective during the early phases of the pandemic.

Design Systematic review.

Methods Two parallel searches of academic bibliographic databases and grey literature were undertaken until 8 May 2020. Governments were also contacted for further information where possible. There were no restrictions on language, information sources used, publication status and types of sources of evidence. The AACODS checklist or the National Institutes of Health study quality assessment tools were used to appraise each source of evidence.

Outcome measures Publication characteristics, country-specific data points, COVID-19-specific data, demographics of affected HCWs and public health measures employed.

Results A total of 152 888 infections and 1413 deaths were reported. Infections were mainly in women (71.6%, n=14 058) and nurses (38.6%, n=10 706), but deaths were mainly in men (70.8%, n=550) and doctors (51.4%, n=525). Limited data suggested that general practitioners and mental health nurses were the highest risk specialities for deaths. There were 37.2 deaths reported per 100 infections for HCWs aged over 70 years. Europe had the highest absolute numbers of reported infections (119 628) and deaths (712), but the Eastern Mediterranean region had the highest number of reported deaths per 100 infections (5.7).

Conclusions COVID-19 infections and deaths among HCWs follow that of the general population around the world. The reasons for gender and specialty differences require further exploration, as do the low rates reported in Africa and India. Although physicians working in certain specialities may be considered high risk due to exposure to oronasal secretions, the risk to other specialities must not be underestimated. Elderly HCWs may require assigning to less risky settings such as telemedicine or administrative positions. Our pragmatic approach provides general trends, and highlights the need for universal guidelines for testing and reporting of infections in HCWs.

  • review
  • infections
  • diseases
  • disorders
  • injuries
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Handling editor Soumyadeep Bhaumik

  • Twitter @SohamBGlobal, @ronibats, @Zwl21, @OsaidalserMD, @RafaPinedo_HE, @robakhundkar

  • Contributors RK is the guarantor. RK and SB conceived the project. SB, RK, and AJ contributed equally to the design of the project. All authors contributed to the collection of the data. SB, REB, MA, DKO, YB, AK, SAP, GB, DK, SC, MK, AJ, AM and RK drafted the manuscript. All remaining authors extensively reviewed the manuscript. All authors have approved the final manuscript and are willing to take responsibility for appropriate portions of the content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on request. All data relevant to the study are included in the article or uploaded as supplementary information. Any further data are available on request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.