Coronavirus: 20% of US doctors aged 55-64 could be vulnerable to infection, predict experts
Across the US, people, and particularly those who are older than 60 years of age, are being asked to stay at home and practice social distancing to slow the spread of infection and help avoid overwhelming hospitals that are expected to encounter shortages of needed equipment and personnel soon.
Since older individuals are at a higher risk of serious illness from the virus, what is further worrying is that there are large numbers of older nurses and physicians, who, if they were not in the healthcare workforce, would be staying at home to minimize their risk of exposure, say US experts. Instead, many older clinicians are reporting for work every day. According to their analysis, a substantial portion of physicians, hospital-based registered nurses, non–hospital-based registered nurses, are 55 years of age or older in the US.
Of the approximately 1.2 million physicians in the US, an estimated 230,000 or 20% are aged 55 to 64 years and an estimated 106,000 or 9% are aged 65 years or older, shows the analysis by researchers from the Montana State University College of Nursing, Bozeman; Dartmouth College, Hanover, New Hampshire; and the National Bureau of Economic Research, Cambridge, Massachusetts. The findings have been published in JAMA.
The analysis shows that among the nation’s nearly 2 million registered nurses employed in hospitals, an estimated 370,000 or 19% are aged 55 to 64 years, and an estimated 55,000 or 3% are aged 65 years or older and thus, “at even greater risk of complications and mortality from COVID-19.”
Of the approximately 1.2 million registered nurses employed outside of hospital settings, who could be called in to assist as hospital needs increase, even higher percentages are aged 55 to 64 years (24%) or aged 65 years or older (5%), says the research team.
Recent estimates from the US Centers for Disease Control and Prevention (CDC) suggest that the rates of hospitalizations, intensive care unit admissions and deaths among reported COVID-19 cases in the US are substantially higher among patients older than 45 years compared with younger patients. The case-fatality rates exceed 1.4% among patients aged 55 to 64 years and they exceed 2.7% among those aged 65 to 74 years, say experts.
The CDC says that among 44 cases with known outcomes, 15 (34%) deaths were reported among adults aged 85 years and above, 20 (46%) among adults aged 65-84 years and nine (20%) among adults aged 20-64 years.
The researchers say that as the effects of COVID-19 are currently strongly regional, it is also important to consider how the ages of the nursing and physician workforces vary across the US. The analysis shows considerable differences. Some of the areas with the most registered nurses and physicians aged 55 and older are among the most severely affected by the virus, says the team.
The researchers explain while areas with relatively older registered nurses do not necessarily have relatively older physicians, Camden, New Jersey, Fort Lauderdale, Florida, and Orange County, California, are among the top five areas with the oldest registered nurse and physician workforces.
Among registered nurses, the 25 areas range from nearly one-third (31.7%) aged 55 years and older in Boston, Massachusetts, to less than 1 in 5 (19.3%) in Miami, Florida. “The top three ranked areas, in terms of having an older registered nurse workforce (including Camden, New Jersey, and eastern Long Island, New York), have had or are near sites of considerable COVID-19 infection (as of March 23, 2020),” says the study.
As far as physicians are concerned, there is even more variation between the area with the oldest physicians including Camden, New Jersey (38.9%), and the youngest that includes Houston, and Texas (19.4%).
“It is reassuring that large numbers of older nurses and physicians are caring for patients today. These clinicians have decades worth of knowledge, experience, and relationships with coworkers that will be needed now more than ever when large numbers of patients are hospitalized with COVID-19,” says the team. These clinician leaders are critical, especially because many of these older clinicians have experience with disasters, triaging, decision making, and managing staff and resources in “times of great stress,” say experts.
They, however, caution that conversely, should these older nurses and physicians become infected and required to stay home, or if they become patients, the ramifications could be significant. This will be not only in terms of the loss of their clinical expertise and presence when it is needed the most, “but the loss of leadership, judgment, and maintaining morale.”
The researchers emphasize that the recent report of two critically ill emergency physicians infected by COVID-19 is a “sobering reminder of the vulnerability of the US’s health care workforce.”
The novel coronavirus pandemic has already overwhelmed the health systems of several countries and it is also projected to overburden the health system in the US. So far, over 164,530 cases have been reported from across the US and over 3,000 have died.
The authors of the current study say while hospitals and other organizations ramp up their preparations, this is the time to determine whether there may be different roles for older clinicians that will ensure they can contribute over the long-term course of the pandemic. “This is not to suggest that these older nurses and physicians should necessarily be precluded from providing clinical care or should be isolated, but rather to consider if their direct clinician duties can be shifted to emphasize roles with less risk of exposure,” says the team.
They explain that these roles may include various activities, such as consulting with younger staff, advising on the use of resources, being readily available for clinical and organizational problem solving, helping clinicians and managers make tough decisions, talking with families of patients, advising managers and executives, being public spokespersons, and liaising with public and community health organizations. “In addition, hospitals will want to prepare for the effect that a severe illness or death of a colleague will have on their staff in terms of morale,” they add.
Older clinicians are likely to have an even larger role in the months ahead as more regions address workforce shortages by requesting that retired physicians and nurses consider returning to the workforce during the COVID-19 outbreak, as has recently occurred in New York City, the state of Illinois, and Great Britain. New York Governor Andrew Cuomo, for example, has urgently appealed for medical volunteers to deal with the rising number of cases. “Even before the governor’s appeal, close to 80,000 former nurses, doctors and other professionals were stepping up to volunteer,” says an Associated Press (AP) report.
Accordingly, says the research team of the current study, hospitals, and other care delivery organizations, including state and local health departments, should carefully consider how best to protect and preserve their workforce, “with careful consideration involving older physicians and nurses.”