What Can a List Tell Us?

Medscape, a medical website, has a long list of “health care providers” who have died recently in ways that are somehow related to COVID-19.

Some facts about this list that might not be completely apparent, so before we drive into an analysis we need to list some cautions and caveats.

This list is rather random and is basically a bunch of user driven posts, not a comprehensive and curated list. It doesn’t represent everyone who passed away from COVID-19 who was also at some point in their lives working as a health care provider.

Most of the people on this list are not from the United States, although some are. Italy, Brazil, England and Spain are well-represented.

Although all the people on this list died, some did not die specifically of work-related COVID-19.

Some did not die of COVID-19 itself, but more or less during the COVID-19 event (of accidents, suicides, heart attacks and so on) and many were retired health care workers who coincidentally died of COVID-19 contracted in the community or their assisted living facilities.

That last is important information. To repeat, a large number of these people did not die as a result of their workplace activities, but due to be in a higher risk category such as being elderly and contracting the virus in the community.

Given these caveats, is there anything useful to be derived from examining this list?

Let’s see.

We went through the first few pages of this list and noted down the reported age and gender (if listed or determinable from name) of each person, going in the list’s alphabetical order. We also ended up dividing the genders into nursing and non-nursing positions, for a reason that will be apparent in a moment.

The Data

Non-nursing, male by age decade of reported death

20s   30s   40s    50s    60s   70s   80s+    Total

2       2        11     16      43     20    9          103

Nursing, male by age decade of reported death

2      2          7       6        1         0    0             18

Non-nursing, female by age decade of reported death

20s   30s   40s    50s    60s   70s   80s+

0       1        2        3       12     1       0            19

Nursing, female by age decade of reported death

1       5        7        5        12     1       1            32

Totals by decade

20s  30s  40s  50s  60s  70s  80s+  total

  5     10    27   30    68    22   10       172

There’s actually a lot to unpack even in this small and simple data set. First, you may notice that the deaths of nine males 80 and over were reported and only one female death. This seems to reflect the difference in job history derived from gender roles and gender discrimination, especially 50 or 60 years ago. When Dr. So-and-so, former director of the Institute for something, dies at 90 from COVID-19 contracted at his care home, it gets picked up by the news, while when Ms. So-and-so, retired nursing assistant does so, it is only of interest to her family and friends.

Overall, too, there are many more males than females on the list. Although males are slightly more likely to die of a COVID-19 infection than females, it’s not that much of a difference. Perhaps a more subtle sexism plays a part, with people being more attentive to male actions, or the readers of Medscape are more attentive to physicians, who can skew more male than, say, nurses (most of the people who visit this website are not physicians, but they might have an interest in physicians; “fanboys” if you will) and thus more likely to forward death notices that involve physicians.

What does the age of death tell us? Most, if not all, of the people in their 70s and 80s were retired and contacted COVID-19 in their communities. But what of the younger folks?

According to the New York City department of health, 642 of their confirmed, recorded deaths there from COVID-19 infections were in people less than 45 years of age, out of a total of 15,983. That’s 0.4% of the deaths, or to put it another way, of 1000 people that died, only four of them were under 45.

Contrast that with our small data set, in which 42 of 172 were less than 50, and 21 of those were actually less than 45. That’s 24 and 12 percent respectively. To put it another way, according to this list, out of 1000 people that died, 120 would be less than 45.

Why the discrepancy? Probably the biggest reason, as mentioned above, is that this list is developed from reader-forwarded news stories. The media can’t seem to wrap their heads around the idea that this viral event doesn’t need any more terrorizing and hyping, so they scour the world for “interesting” obits; i.e. younger, healthier people dying. You’ve undoubtedly noticed this in your own news feeds. Not a lot of “Woman in Pennsylvania nursing home, 90, dies of coronavirus” headlines, are there? We have then the double whammy of news stories focusing on the unusual, and readers noticing the unusual and forwarding them to Medscape.

There is still some concerning possibilities here, though. Remember how we separated “nursing” positions, that is RNs, LPNs, midwives, nurse’s aides, and so on, from non-nursing positions? Nursing positions represented 50 of 172 (29 percent) reported deaths but 24 of 42 (57 percent) reported deaths under 50.

Again, there are all kinds of reporting problems at play here. But it might not be too far of a stretch to say that workers who provide direct, hands-on patient care or spend a lot of time in that environment are at greater risk than people who work in a health care job that is more administrative or removed from direct contact. And how many of these direct care workers have actually been infected? If they are actually dying at a rate that New York City’s much more complete data supports—that 4 out of every 1000 deaths is in the under 45 year age group many more people are infected than die—at least 98 for every death overall, and much less in the younger groups, then how many nurses and similar personal have actually had COVID-19? And are the implications of this good or bad?

And finally, let’s look at the real elephant in the room here. Look at that 60-69 age group!

68 of the 172 deaths we looked at involve people in this age group, or 40 percent of that total. There are plenty of over-60 workers at the hospital where this writer works, but they aren’t 40 percent of all the workers there.

And this skew is despite there being nothing very “exciting” about a 65-year-old dying of COVID-19 and thus encouraging media attention. And unlike the 70 and up crowd, most of these people are probably still working.

The big question, of course, is should they be? Here we have a toxic combination of individuals at higher risk due to their age, and a high exposure environment. Perhaps, when there is a significant respiratory virus event going on, the over-60s workers should get sent home from the hospital.

But here is one of those situations where response theater and social necessities interfere with possible best practices. Probably those workers don’t want to go home. They like working and maybe they need the paycheck. Due to age discrimination laws, it would be impossible to force them. And the hospitals didn’t hire them for charity, they actually depend on these workers to get the work done.

So, will our response be to pretend that there is nothing to be done? Governments seem fine with telling us to stay out of gyms and parks, which costs them nothing up front, but would they be willing to pay at-risk workers to stay home? Would the hospitals be willing to have their other workers work overtime or take on new duties, or would they be willing hire new staff?

Or is this the point at which economics trumps lives and we are just going to quietly draw a veil over the whole situation?