Mortality among healthcare workers in Indonesia during 18 months of COVID-19

  1. Lenny L. Ekawati
  2. Ahmad Arif
  3. Irma Hidayana
  4. Ahmad Nurhasim
  5. M. Zakiyuddin Munziri
  6. Karina D. Lestari
  7. Amanda Tan
  8. Firdaus Ferdiansyah
  9. Fikry Nashiruddin
  10. Qorinah E.S. Adnani
  11. Halik Malik
  12. Tri Maharani
  13. Andy Riza
  14. Monalisa Pasaribu
  15. Khairul Abidin
  16. Adhi A. Andrianto
  17. Nursalam
  18. A.V. Sri Suhardiningsih
  19. Ade Jubaedah
  20. N.S. Widodo
  21. Henry Surendra
  22. Herawati Sudoyo
  23. Adrian D. Smith
  24. Philip Kreager
  25. J. Kevin Baird
  26. Iqbal R.F. Elyazar

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Abstract

The impact of SARS-CoV-2 infections upon Indonesian health care workers (HCWs) remains unclear, as mortality data specific to HCWs is not systematically collected or analyzed in this setting. This report describes findings from a systematic collation, abstraction and analysis of HCW fatalities during the first 18 months of COVID-19 in Indonesia. HCW who died during the period of March 2020 to July 2021 across Indonesia were identified on Pusara Digital , a community web-based digital cemetery database dedicated to HCW. We calculated mortality rates and death risk ratio among HCWs and the general population. Qualitative methods explored concerns regarding mortality among HCWs. The analysis suggests that at least 1,545 HCWs died during the study period. The death of males and females HCWs were almost equally distributed (51% vs. 49%). Most were medical doctors and specialists (535, 35%), nurses (428, 28%), and midwives (359, 23%). Deaths most frequently occurred in the age group of 40 to 59 years old with the median age of 50 years (IQR: 39-59). At least 322 (21%) deaths occurred with pre-existing conditions, including 45 who were pregnant. We estimated a minimal HCW mortality rate in Indonesia at 1.707 deaths per 1000 HCW during the first 18 months of COVID-19. Provincial HCW mortality rates ranged from 0.136 (West Sulawesi) to 5.32 HCW deaths per 1000 HCWs (East Java). HCW had a significantly higher mortality rate than the general population (RR = 4.92, 95% CI 4.67 – 5.17). The COVID-19 event in Indonesia resulted in the loss of many hundreds of HCWs, most of them being senior physicians, nurses, and midwives. The HCW death rates is 5-times higher than everyone else. The sheer sparseness of the workforce requires more protective steps and a national systematic surveillance of occupational mortality is urgently needed in this setting.

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  1. ScreenIT

    SciScore for 10.1101/2022.04.27.22274334: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsField Sample Permit: Ethical approval: This study was approved by the Health Research Ethics Committee of the National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia (LB.02.01/2/KE/620/2020).
    IRB: Ethical approval: This study was approved by the Health Research Ethics Committee of the National Institute of Health Research and Development, Ministry of Health, Republic of Indonesia (LB.02.01/2/KE/620/2020).
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data were entered into an Excel database with limited access and password protected facility.
    Excel
    suggested: None
    Data were analyzed using Stata statistical version 12 (StataCorp, College Station, TX, USA)
    Stata
    suggested: (Stata, RRID:SCR_012763)
    StataCorp
    suggested: None
    Coding and analysis were conducted by using NVivo version 12 (QSR International Pty Ltd, released in 2018).
    NVivo
    suggested: (NVivo, RRID:SCR_014802)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has limitations within which our findings need to be interpreted carefully. First, the individual data were obtained from Pusara Digital records. There were 35% of missing age and approximately 48% of vaccination status were inaccessible. Second, age and gender distribution of HCWs in Indonesia are publicly unavailable. Consequently, we were unable to calculate standardized age and gender mortality rate and improve the interpretation of the relative risk compared to the general population at risk from COVID-19. Last but not least, content analysis emphasizes on words and involves subjective interpretation, which may diminish the context and affect the reliability of the results. Finally, this study suggests that the COVID-19 pandemic confirms the high priority need of strong healthcare systems against any emerging pandemic threats. Further transformation in advanced molecular diagnostic research and technology, rapid community surveillance and epidemiological and clinical studies, integrated data management, data transparency and data analysis, information technology for supply chain, trainings, communication, workforce management is crucial to protect and response next epidemic.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2022.04.27.22274334v1 on medRxiv