infection and mortality of healthcare workers worldwide

1Bandyopadhyay S, et al. BMJ Global Health 2020;5:e003097. doi:10.1136/bmjgh-2020-003097

Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review

Soham Bandyopadhyay ,1 Ronnie E Baticulon,2 Murtaza Kadhum,1 Muath Alser,3 Daniel K Ojuka,4 Yara Badereddin,5 Archith Kamath,1 Sai Arathi Parepalli,1 Grace Brown,1 Sara Iharchane,6 Sofia Gandino,6 Zara Markovic- Obiago,1 Samuel Scott,1 Emery Manirambona,7 Asif Machhada,8 Aditi Aggarwal,1 Lydia Benazaize,1 Mina Ibrahim,8 David Kim,1 Isabel Tol,1 Elliott H Taylor,1 Alexandra Knighton,1 Dorothy Bbaale,9 Duha Jasim,1 Heba Alghoul,10 Henna Reddy,1 Hibatullah Abuelgasim,1 Kirandeep Saini,1 Alicia Sigler,11 Leenah Abuelgasim,1 Mario Moran- Romero,12 Mary Kumarendran,1 Najlaa Abu Jamie,13 Omaima Ali,1 Raghav Sudarshan,1 Riley Dean,14 Rumi Kisyova,8 Sonam Kelzang,15 Sophie Roche,1 Tazin Ahsan,16 Yethrib Mohamed,1 Andile Maqhawe Dube,17 Grace Paida Gwini,17 Rashidah Gwokyala,18,19 Robin Brown,1 Mohammad Rabiul Karim Khan Papon,16 Zoe Li ,20 Salvador Sun Ruzats,21 Somy Charuvila,1 Noel Peter,1 Khalil Khalidy,10 Nkosikhona Moyo,17 Osaid Alser ,1,22 Arielis Solano,23 Eduardo Robles- Perez,24 Aiman Tariq,25 Mariam Gaddah,26 Spyros Kolovos,27 Faith C Muchemwa,28 Abdullah Saleh,29,30 Amanda Gosman,29 Rafael Pinedo- Villanueva,31,32 Anant Jani,1 Roba Khundkar1,8

Original research

To cite: Bandyopadhyay S, Baticulon RE, Kadhum M, et al. Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review. BMJ Global Health 2020;5:e003097. doi:10.1136/bmjgh-2020-003097

Handling editor Soumyadeep Bhaumik

► Additional material is published online only. To view, please visit the journal online (http:// dx. doi. org/ 10. 1136/ bmjgh- 2020- 003097).

Received 8 June 2020Revised 19 September 2020Accepted 9 October 2020

For numbered affiliations see end of article.

Correspondence toRoba Khundkar; roba. khundkar@ nds. ox. ac. uk

© Author(s) (or their employer(s)) 2020. Re- use permitted under CC BY- NC. No commercial re- use. See rights and permissions. Published by BMJ.

ABSTRACTObjectives 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

Key questions

What is already known? ► In China, studies documented over 3300 confirmed cases of infected healthcare workers in early March.

► In the USA, as high as 19% of patients had been identified as healthcare workers.

► There are no studies that perform a global examina-tion of COVID-19 infections and deaths in the health workforce.

What are the new findings? ► General practitioners were the highest risk special-ty for deaths among doctors, while the highest risk nursing specialty was mental health.

► Most COVID-19 cases and deaths were reported in the 50–59 age range, while the group aged over 70 years had the highest case fatality rate.

► Europe had the highest number of infections and deaths, but the lowest case fatality rate, while the Eastern Mediterranean region had the highest case fatality rate; by population, regions such as the Indian subcontinent and Africa reported a relatively low number of infections and deaths.

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2 Bandyopadhyay S, et al. BMJ Global Health 2020;5:e003097. doi:10.1136/bmjgh-2020-003097

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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.

INTRODUCTIONFrom a cluster of patients with pneumonia linked to a wet market in Wuhan, China in late December 2019, COVID-19 has rapidly evolved into a full- blown pandemic.1 2 At the time of writing (23 May), over 5 million people have been infected across 213 countries and territories, leading to >300 000 deaths worldwide.3 On the frontlines of this global crisis are healthcare workers (HCWs) with the substantial task of diagnosing and treating an exponentially growing number of acutely ill patients, often having to make critical decisions under physical and psychological pressure.4–6 WHO defines health workers as ‘all people engaged in actions whose primary intent is to enhance health’.7 This encompasses doctors, nurses, midwives, paramedical staff, hospital administrators and support staff and community workers, all of whom now face the occupational risk of becoming infected with COVID-19, and at worst, even death.

Ensuring the protection of HCWs is a crucial element of any country’s strategic response to the COVID-19 crisis, especially as governments rush to increase health-care capacity to cope with the surge of patients requiring urgent care. WHO has issued recommendations on the rational use of personal protective equipment (PPE) in hospital and community settings.8 Several colleges and specialty societies have formulated algorithms and guide-lines to decrease the risk of COVID-19 transmission in their fields of practice.9–13 Nevertheless, protecting HCWs remains a challenge for most countries, where short-ages of adequate PPE is a daily concern. Limited testing capacity precludes early identification and isolation of cases, leading to unnecessary occupational exposure for HCWs, particularly since a high number of patients with COVID-19 remain asymptomatic. In a vicious cycle, short-ages of HCWs may compel staff to continue working for

days on end, even under fatigue or when symptoms mani-fest, further increasing the risk of transmission.

Unmitigated, rising infection and mortality rates in HCWs will paralyse a country’s response to COVID-19, and it is bound to have a significant, long- term impact on healthcare delivery, particularly in health systems already grappling with workforce shortage due to lack of trained personnel, skilled labour migration and geographical maldistribution, even prior to pandemic times.14–17 Therefore, in order for countries to plan for the present and the future, it is important to record the number of HCWs who have been infected and have died from COVID-19. It is unclear whether data on COVID-19 infec-tion and death among HCWs globally are being collected and published.

As such, the number of COVID-19 infections and deaths among HCWs globally is unknown. The aim of this systematic review was to, therefore, estimate the number of COVID-19 infections and deaths in HCWs in every country in the world as of 8 May 2020, with further demographical analyses where data were available. This will provide a snapshot of the situation for HCWs during the early phases of the pandemic.

METHODSOverviewA systematic review on the number and proportion of HCWs who have been infected with or died from COVID-19 was conducted as per the published and regis-tered protocol18 (online supplemental appendix S1). The primary outcomes of interest were COVID-19 infec-tions and deaths in HCWs worldwide. Subgroup analyses were performed according to WHO region, country and demographic characteristics. The Preferred Reporting Items for Systematic Review and Meta- Analyses guide-lines19 were used to report the findings (online supple-mental appendix S2).

Due to the time- sensitive nature of the review and the need to report the most up- to- date information for an ever- evolving situation, there were no restrictions on language, information sources used, publication status and types of sources of evidence. Prior to the commence-ment of this study, all reviewers attended an online training and support session to ensure an accurate and standardised approach to the overall methodological process. Ongoing research support was provided for all collaborators throughout the process.

Search strategyTwo parallel searches of academic bibliographic data-bases and grey literature were undertaken.1. Bibliographic search: the search protocol for this system-

atic review was executed in MEDLINE and EMBASE, covering the period between the first reported case in the world on 17 November 2019 to 8 May 2020. The search strategy used variants and combinations of search terms related to HCWs and COVID-19 (online

Key questions

What do the new findings imply? ► Although physicians working in certain specialties may be con-sidered high- risk due to frequent exposure to oronasal secre-tions, the risk to other healthcare worker specialties must not be underestimated.

► High rates of morbidity and mortality in elderly healthcare workers may require assigning them to less risky settings such as telemed-icine, non- COVID-19 outpatient clinics or administrative positions.

► Furthermore, the disparities between regions of the world may be a true difference or it may reflect reporting and testing bias.



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supplemental appendix S3). The retrieved studies were exported, and duplicate articles were discarded. Two reviewers independently screened the titles and abstracts based on the predefined inclusion and ex-clusion criteria (online supplemental appendix S1). The full texts of the remaining articles were retrieved and screened by two reviewers independently. Any dis-agreements were resolved by a third reviewer. The ref-erence lists of all included articles were scrutinised to locate additional relevant publications not identified during the database searches. The reviewers also con-sulted with senior HCWs—identified and approached through the network of the Oxford University Global Surgery Group—across the world to identify addition-al publications.

2. Grey literature search: a grey literature search was per-formed to include sources dedicated to COVID-19 or world data. These sources included government web-sites, non- governmental websites, social media sites, media websites and preprints on medRxiv.20 Snowball searching using a web- based search engine (Google) was used to find additional documents and online sources. A pragmatic approach was taken for the grey literature search and a stepwise guide was provided to all data collectors to ensure consistency of search strategy. A full record of the conducted search is pro-vided in online supplemental appendix S3. The refer-ence list of all included documents identified through the grey literature search was examined to identify any further relevant documents and online sources missed through the above search strategy, until a satu-ration point was reached where no new sources were identified.

All searches were completed in duplicate by two reviewers independently. A third reviewer validated these searches and resolved any disparities when they arose. Lastly, governments were contacted for further informa-tion where possible. The initial search was completed on 22 April 2020. The search was then updated on 8 May 2020 for primary and secondary outcomes.

Data extractionA data extraction form (online supplemental appendix S4) was developed to collect the information necessary for data synthesis. This form was piloted by the team before its use. Data extraction was completed in duplicate by two reviewers independently. A third reviewer validated the data extracted and resolved any disagreements. Several data points were extracted, including publication charac-teristics, country- specific data points, COVID-19- specific data, demographics of affected HCWs and public health measures employed (online supplemental appendix S5). Data from each country were extracted from multiple data sources. Where the same data point was present in more than one data source, the most recently published data source was used to extract that data point. If more than one of these data sources was published on the same date and that date was the most recent, the same data

point was extracted from all the data sources in question and compared against one another. Where the data point was identical between the sources, it was included. Where there was a disagreement between the data sources in question about the value of the same data point, only the data point extracted from the data source of the highest quality was included.

Risk of bias assessmentTwo reviewers independently classified the quality of each included document using the AACODS checklist21 or the National Institutes of Health (NIH) study quality assessment tools22 (online supplemental appendix S6). Any uncertainty regarding the quality of an included document was resolved through discussion among the reviewers.

Synthesis of resultsMortality and infection numbers have been pooled. HCW infection and deaths due to COVID-19 as a proportion of total population infections and deaths respectively due to COVID-19 have been calculated. HCW deaths due to COVID-19 as a proportion of all HCW COVID-19 infec-tions have also been calculated, to get the case fatality rate (CFR) expressed as number of reported deaths per 100 cases of reported infections.

No patient and public involvementThis research was done without patient and public involvement. Their input was not sought for the design of the systematic review, the interpretation of the results or the writing or editing of this document.

RESULTSSearch and selection of studies/sourcesSearches were conducted up to 8 May 2020. The searches yielded a total of 976 potentially relevant citations. After data validation and cleansing, duplicated and irrelevant citations were removed manually. At this point, 594 cita-tions met the eligibility criteria based on our protocol (figure 1).

More specifically for the bibliographic database search, a total of 64 articles were retrieved. Ten duplicates were detected, thus 54 studies remained. After the screening of titles and abstracts based on inclusion and exclusion criteria, 15 of these progressed to full- text screening and 8 studies were included in the final analysis. The grey literature search yielded 912 citations. After screening for inclusion and eligibility, 586 citations remained and were included in the study.

Characteristics of included sourcesCharacteristics of the included sources are described in table 1 and figure 2. Overall, 594 records were included, of which 14 were journal articles. Of the remaining records, 19.5% (n=116) were government documents, 16.5% (n=98) were government websites, 48.3% (n=287) were media articles, 9.6% (n=57) were research or



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academic reports, 3% (n=18) were statistical websites and 0.7% (n=4) were primary sources. All sources were appraised per the AACODS checklist21 or the NIH study quality assessment tools,22 as shown in online supple-mental appendix S7. Primary outcomes were available for 85.1% of all countries (166/195).

OutcomesPrimary outcomesNumber of healthcare workers infected with COVID-19 worldwideAs of 8 May 2020, a total of 152 888 HCWs had been reported to have been infected with COVID-19 (figure 3). This was 3.9% of the total number of 3 912 156 patients with COVID-19 worldwide. It should be noted that 118 801 of these patients with COVID-19 were reported in coun-tries where no data on HCWs infections with COVID-19 were available. A total of 130 countries reported at least one case of HCW infection with COVID-19 (figure 3 and online supplemental appendix S8).

Number of healthcare worker deaths with COVID-19 worldwideThe total number of reported HCW deaths as of 8 May 2020 was 1413 (figure 4). This suggests that for every 100 HCWs that got infected, 1 died. This was also 0.5% of the total number of 270 426 COVID-19 deaths worldwide. It should be noted that 2922 deaths from COVID-19 were reported in countries where no data on HCWs deaths from COVID-19 were available. As of 8 May 2020, 67 countries had reported at least one HCW death related to COVID-19 (figure 4 and online supplemental appendix S8). China and Italy were

the first two countries to report HCW deaths, and the first deaths in each of these countries occurred over a month apart (online supplemental appendix S9).

Subgroup analysisCharacteristics of healthcare workers who were infected with COVID-19Although most countries released the total number of HCW deaths or infections, most published reports did not include details on the age category, ethnicity or role of workers. The data in table 2 are based on a smaller number of countries that made these data available.

The overall median age of the reported HCWs who were infected was 47.3 years (range: 18–84), 71.6% of whom were women. The overall median age of the HCWs who died was 56.2 years (range: 18–84), 29.2% of them women. The CFR for men and women were 9.47 and 1.55, respectively. Nurses were the largest HCW group with COVID-19 infection (38.6% of those infected). However, doctors were the largest group of HCWs who died (51.4%). Ethnicity data for deaths were available for Australia, France and the UK and showed 73 deaths in white HCWs and 106 deaths in non- white HCWs. Ethnicity data for infections were only available from the USA and showed 2743 infections in white HCWs and 1058 in non- white HCWs.

AgeAge- stratified figures were not available for most coun-tries. Data were only available for 14 058 of the 152 888

Figure 1 Preferred Reporting Items for Systematic Review and Meta- Analyses flow chart of the source selection process.



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(9.2 %) reported HCW infection cases and 343 of the 1413 (24.3%) reported HCW deaths as a result of COVID-19. Of all countries, 15% reported age- related information for COVID-19 cases and 17% reported information on COVID-19 deaths. The majority of infec-tions was reported in the 50–59 age range. The lowest reported number of infections were in the group aged

over 70 years. However, this age group had the highest CFR (table 3).The majority of deaths were also reported in the 50–59 age range, with the lowest number reported in the 18–29 age group.

SpecialitiesSpeciality- related data were only available from 14 coun-tries: Argentina, Australia, Austria, Bahamas, Cameroon, Canada, China, Colombia, France, Germany, Ghana, Guyana, Turkey and UK (13% of all data). General prac-titioners (GPs) appear to be the largest group of doctors who died while mental health nurses constituted the

Figure 3 Cumulative number of reported COVID-19 infections in healthcare workers worldwide over time and total number of reported cases of COVID-19 infections in healthcare workers worldwide on 8 May 2020.

Table 1 Characteristics of included sources

Number Percentage (%)

Publication type

Journal article 14 2.4

Government document 116 19.5

Government websites 98 16.5

Media articles 287 48.3

Research/Academic reports 57 9.6

Statistical websites 18 3.0

Primary sources 4 0.7

Countries with no data for primary outcome

29 14.9

Angola

Barbados

Belize

Bolivia

Cote d'Ivoire

Djibouti

Dominica

Eritrea

Iraq

Jordan

Liechtenstein

Luxembourg

Malawi

Maldives

Mauritania

Monaco

Nicaragua

North Korea

North Macedonia (formerly Macedonia)

Norway

Oman

Paraguay

Qatar

Slovakia

Solomon Islands

Syria

Tonga

Turkmenistan

United Arab Emirates

Figure 2 Summary of quality assessments of all 594 sources. NIH, National Institutes of Health.



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largest group of nurse subspecialists who lost their lives to COVID-19 (table 4). There were 30 reported deaths in the UK among doctors, one- third of which were GPs.

WHO regionsThe highest number of COVID-19 infections of HCWs were reported in Europe (119 628, 78.2%), while the lowest number was reported in Africa (1472, 1.0%) (figure 5). The same regional pattern was observed regarding deaths: Europe reported the highest number of deaths (712, 50.4%) and Africa the lowest (17, 1.2%) (figure 5). Although the highest number of deaths were reported in Europe, the number of infections was also so large that Europe was the region reporting the lowest CFR. The highest CFR is seen in the Eastern Mediterra-nean region (5.7 deaths per 100 infections), followed by South East Asia (3.1 deaths per 100 infections) (table 5).

Figure 4 Cumulative number of reported COVID-19 deaths in healthcare workers worldwide and total number of reported cases of COVID-19 deaths in healthcare workers worldwide.

Table 2 Characteristics of healthcare workers with COVID-19 infection and deaths

Characteristic Infection Death

Agei. Median age: 47.3 years (n=14 058) Median age: 56.2 years (n=343)

Range: 18–84 years Range: 18–84 years

Sexii. Male: 28.4% (n=5806) Male: 70.8% (n=550)

Female: 71.6% (n=14 656) Female: 29.2% (n=227)

Level (number)iii. Student: <0.1% (n=13) Student: 0.3% (n=1)

Trainee: <0.1% (n=2) Trainee: 0.6% (n=2)

Qualified: 99.9% (n=36 081) Qualified: 96.4% (n=350)

Retired: <0.1% (n=10) Retired: 2.7% (n=10)

Type of HCWiv. Doctor: 31.3% (n=8688) Doctor: 51.4% (n=525)

Nurse: 38.6% (n=10 706) Nurse: 25.3% (n=259)

Midwives: <0.1% (n=9) Midwives: 0.9% (n=9)

Allied health professionals: 23.1% (n=6394) Allied health professionals: 12.2% (n=125)

Support staff: 6.8% (n=1899) Support staff:7.2% (n=74)

Administrators: <0.1% (n=29) Administrators: 2.8% (n=29)

Admission to intensive care unitv. n=1158 NA

i. Data from 15% of all countries; ii. Data from 21% of all countries; iii. Data from 7% of all countries; iv. Data from 13% of all countries; v. Data from 10% of all countries

i. Data from 17% of all countries; ii. Data from 21% of all countries; iii. Data from 13% of all countries; iv. Data from 22% of all countries.

HCW, healthcare worker; NA, not available.

Table 3 Distribution of infections, deaths and case fatality in healthcare workers—data do not include cases with unknown age

Age band (years) Infections Deaths CFR* (%)

18–29 1301 14 1.1

30–39 2356 20 0.8

40–49 3942 45 1.1

50–59 4812 123 2.6

60–69 1569 112 7.1

70+ 78 29 37.2

*CFR is the number of reported deaths per 100 cases of reported infections.CFR, case fatality rate.



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CountriesOn 8 May 2020, Spain reported the highest cumulative number of COVID-19 infections in HCWs in the world at 30 663 (20% of all HCW infections). This is followed closely by Italy (23718) and the Netherlands (13884). Italy reported the highest cumulative number of deaths in HCWs due to COVID-19 at 220 (figure 6). At least 10%

of all COVID-19 deaths were among healthcare workers in five countries: Guyana, Venezuela, Afghanistan, Costa Rica and Kazakhstan. Full numbers and CFRs for all countries can be found in online supplemental appen-dices S8 and S9. The COVID-19 infection peak varies from country to country with China and Italy demon-strating some of the earliest peaks. HCW infections and deaths reflect this as can be seen in online supplemental appendix S9. Some countries are only at the early stages of COVID-19 infection.

DISCUSSIONHere, we present the first systematic review to date exam-ining the number of COVID-19 infections and deaths among HCWs across 195 countries during the early phases of the pandemic, when the USA and Europe were thought to be the epicentres of the pandemic. We conducted this search to estimate the infection and mortality burden among all individuals involved in the care of patients with COVID-19—from diagnosis to treat-ment and rehabilitation. In addition, we hoped to iden-tify any factors associated with the risk of infection and death in HCWs.

There is an important need to address the incidence of COVID-19- related illness in HCWs globally. Failure to address infection and mortality among HCWs has the potential to further increase transmission of COVID-19 within healthcare facilities and their wider communi-ties.23 24 The resulting shortage of HCWs may impair the quality of the provision of health services nationally both during the acute phase of the pandemic, and in the long term. Occupational risks in the workplace must be minimised if not altogether eliminated. Moreover, a clear

Table 4 Healthcare worker mortality by subspecialty (data available for only 13% of all deaths)

Nurses Medicine: 15 COVID-19 ward 4

Intensive care units 3

Acute admission 3

Adult care 2

Palliative 2

Cardiology 1

Surgery: 1 Orthopaedics 1

Other: 26 Mental health 14

Care home 8

Community 2

Dental 1

Disability 1

Doctors Medicine: 45 General practitioner 18

Emergency medicine 5

Internal medicine 4

Paediatrics 3

Geriatrics 3

Neurology 2

Pathologist 2

Haem- oncology 1

Infectious disease 1

Microbiology 1

Nephrology 1

Psychiatry 1

Respiratory 1

Anaesthetics 1

Gastroenterology 1

Surgery: 14 Obstetrics and Gynaecology 3

Ophthalmology 2

Ear, Nose and Throat 2

Urology 2

Cardiothoracic 1

Endocrine surgery 1

General surgery 1

Orthopaedics 1

Vascular 1

Other: 6 Director 2

Public health 1

Unknown 3

Figure 5 COVID-19 infections (A) and deaths (B) in healthcare workers in WHO regions.



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pathway must be present for the early diagnosis and treat-ment of HCWs suspected to have contracted COVID-19. It is essential that measures are put in place to ensure that HCWs are continually protected.

Key findingsA total of 152 888 infections and 1413 deaths were reported. The overall infection and death trends among HCWs followed that of the general population. Infec-tions were mainly in women, but deaths were mainly in men. Infections were seen more in nurses, deaths more in doctors. Within the data available, GPs were the highest risk specialty for deaths among doctors, while the highest risk nursing specialty was mental health. It is possible that there was less PPE available in the commu-nity, with confirmed cases in hospital wards being

prioritised, or that the high flow of patients through GP services has led to an increased risk of viral transmission. It may just reflect the higher number of GPs compared with hospital doctors. Mental health specialists may also be lacking PPE.25 Many mental health nurses also work in the community and often work in close proximity to patients, which may increase their risk of exposure. The majority of infections and deaths were reported in the 50–59 age range, while the group aged over 70 years had the highest CFR. Europe had the highest number of infections and deaths, but the lowest CFR, while the Eastern Mediterranean region had the highest CFR. By population, regions such as the Indian subcontinent and Africa reported relatively low numbers of HCW infection and death.

Table 5 Total number of reported infections and deaths in WHO regions

WHO region Infections Deaths CFR* (%)Healthcare workers COVID-19 deaths/Total population COVID-19 deaths (%)

Africa 1472 17 1.2 0.06

Eastern Mediterranean 2779 159 5.7 0.44

Europe 119 628 712 0.6 1.40

Americas 19 903 395 2.0 4.58

South- East Asia 1999 62 3.1 0.20

Western Pacific 7107 68 1.0 0.06

Total 152 888 1413 0.92 0.52

*CFR is the number of reported deaths per 100 cases of reported infections.CFR, case fatality rate.

Figure 6 Number of reported healthcare worker infections and deaths due to COVID-19 per country up to 8 May 2020.



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These trends must be considered in the context of the paucity of data, and the natural history of the disease. The differing COVID-19 infection curves in different countries is evident in the reporting trends; some coun-tries were at the beginning of the HCW infection peak, while some were beyond. The first reported case of COVID-19 in Africa was nearly a month after the first case in Europe, and Africa was slightly behind Europe in its disease course; their lower reported numbers of HCW infection is therefore unsurprising, as they are also reporting lower rates of infection overall. If this continues as the epidemic in Africa progresses, it will be necessary to consider what lessons can be learnt. Further-more, reporting varies significantly between countries. The USA, one of the countries most severely affected by the pandemic, had not reported data about this topic for over 1 month. While other countries, such as the Philip-pines, provide daily updates. The availability and quality of testing and guidelines for COVID-19 testing varies greatly across countries, which further limits the reli-ability of the observed trends. Estimating the percentages of HCWs infected by COVID-19 is crucial for adjusting infection prevention policies applied in the healthcare system to reduce viral transmission.

LimitationsThe primary limitation of this systematic review was the quality of the data available to us. A wide range of data was used, including grey literature, which made it diffi-cult to normalise datasets. Furthermore, different coun-tries were at different stages of their epidemics when we collected data. Data from countries at different stages of their epidemics are not comparable. To make data comparable between different countries we would have needed to batch them according to when their epidemics started, but clear information about this was unavailable. As countries move past the peak of the virus and life begins to move back to normality, increased availability of high- quality data should allow us to conduct more exten-sive quantitative analysis of HCW infections. A retrospec-tive analysis would allow countries to be matched at the same stage of the pandemic—thus allowing a like- for- like comparison.

For our primary analyses, a key limitation was the heterogeneity in HCW classification. Differences here made it difficult to accurately compare data between the countries because, for example, some countries may include all allied healthcare professionals in their numbers, others may not, which could result in reporting inaccurate proportions of HCWs infected by COVID-19. Additionally, there was limited access to accurate data about confounding variables, such as availability of testing for COVID-19 in different countries, which could have influenced infection and mortality rates among HCWs. Due to lack of testing, many cases of COVID-19 are diagnosed as ‘atypical pneumonia’ in some coun-tries and thus do not feature in published figures for COVID-19 cases or deaths. Given the lack of robust data

across different variables, including confounding factors, it was not possible to establish causative or even correla-tive links between the different variables collected and we were, therefore, limited to descriptive analyses.

RecommendationsCOVID-19 infections and deaths among HCWs necessi-tate provision of adequate and appropriate PPE. Infec-tion control training must be provided for those working on the frontlines of the COVID-19 outbreak response, especially among redeployed HCWs with little experi-ence in the clinical management of infectious diseases.26 Regulative and supportive measures must be put into place to ensure compliance with infection control poli-cies in the workplace at all times.

The first step to achieve this would involve appro-priate measures for identifying and registering those who have been infected as soon as possible (box 1). Our study clearly highlights the lack of universal access to early identification measures and infection registration processes across healthcare systems in the world during the early phases of the pandemic. The testing guidelines, access and reporting systems vary hugely across countries and are not merely a reflection of country level health-care expenditure, although this is an important factor and further highlights inequalities between high- income countries (HICs) and low- income and middle- income countries (LMICs). The unavailability of relevant data in a timely manner (which was seen in both HICs and LMICs) makes it difficult to estimate the true burden of infection and effectively plan management strategies. It also inhibits an attempt to learn from those countries beyond their peak and plan timely preventative measures in those who are yet to experience the peak. We highly recommend universal guidelines to be in place for testing and reporting of infections in HCWs in a timely manner, with consideration towards an international HCW infec-tion registry .

The gender- related difference in infection and death rates in HCWs is one that has not been reported previ-ously. Many factors may contribute towards this including more nursing staff being female and more doctors being male, which may reflect differences in exposure levels, training and equipment provided or age at qualification. Further investigation of the identified trends would be recommended.

Although physicians working in certain specialities may be considered high- risk due to frequent exposure to oronasal secretions (eg, otolaryngology, anaesthesiology, dentistry),27 the risk to other specialties who work in other healthcare settings, including clinics and mental health facilities, must not be underestimated. The high rate of morbidity and mortality in elderly HCWs may require assigning them to less risky settings such as telemedicine, non- COVID-19 outpatient clinics or administrative posi-tions.28 HCWs who report possible symptoms and those who have had unprotected exposure to patients with COVID-19 must be prioritised for testing. HCWs must



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be offered flexible working hours to avoid overwork, and psychological intervention plans must be implemented to help HCWs in coping with physical and psychological stress.29

Despite the limitations, our analyses do provide a broad coverage of the data available across the world. The data were run through risk of bias assessments to ensure that an acceptable standard across all datasets was maintained, so that we could compare them. The descriptive analyses also importantly point to the lack of reliable data in so many countries due to lack of infra-structure to quickly and robustly capture data on HCWs and other aspects of healthcare systems that could affect COVID-19- related morbidity and mortality among them. The countries whose datasets had a low risk of bias could serve as examples and provide best practice for countries lacking robust data collection policies and data collection systems. Our pragmatic approach in this study provides general trends to provide rapid informa-tion in response to widespread urgent calls from HCWs worldwide.

Author affiliations1Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, Oxfordshire, UK2Philippine General Hospital, University of the Philippines Manila College of Medicine, Manila, Metro Manila, The Philippines3Kasr Al Ainy School of Medicine, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt4Department of Surgery, University of Nairobi College of Health Sciences, Nairobi, Kenya5Faculty of Pharmacy, Al Azhar University- Gaza, Gaza, State of Palestine6Dipartimento di medicina clinica e sperimentale, University of Insubria, Varese, Lombardia, Italy7University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda8North Bristol NHS Trust, Westbury on Trym, UK9Mbarara University of Science and Technology, Mbarara, Mbarara, Uganda10Islamic University of Gaza, Gaza, State of Palestine11Shriners Ambulatory Clinic, Tijuana, Mexico12Department of Plastic Surgery, Hospital General Dr. Manuel Gea Gonzalez, National Autonomous University of Mexico, Mexico City, Mexico13Palestinian Ministry of Health, Gaza, State of Palestine14University of California San Diego, La Jolla, California, USA15Gelephu Central Regional Referral Hospital, Gelephu, Bhutan16Sheikh Hasina National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh17National University of Science and Technology Faculty of Medicine, Bulawayo, Zimbabwe18Gulu University Faculty of Medicine, Gulu, Uganda19Oxford Brookes University, Oxford, UK20Swansea Bay University Health Board, Port Talbot, UK21University of Huddersfield, Huddersfield, UK22Harvard Medical School, Boston, Massachusetts, USA23ConnectMed International, Dominican Republic, Dominican Republic24Instituto Mexicano del Seguro Social, Ciudad de Mexico, Mexico25Jinnah Post Graduate Medical Centre, Karachi, Pakistan26Lancaster Medical School, Lancaster University, Lancaster, UK27Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Oxford University, Oxford, UK28Parirenyatwa Hospital, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe29Department of Surgery, University of Alberta, Edmonton, Alberta, Canada30Office of Global Surgery, University of Alberta, Edmonton, Alberta, Canada31Centre for Statistics in Medicine, University of Oxford, Oxford, UK32MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK

Twitter Soham Bandyopadhyay @SohamBGlobal, Ronnie E Baticulon @ronibats, Zoe Li @Zwl21, Osaid Alser @OsaidalserMD, Rafael Pinedo- Villanueva @RafaPinedo_HE and Roba Khundkar @robakhundkar

Box 1 Implications for policy and practice

Protecting all healthcare workers (HCWs) from infection and mortality must be a core element of any pandemic response. It is essential for the welfare of the HCWs themselves as well as healthcare systems more generally because of the critical role HCWs play during pandemic responses—an increase in HCW infection and mortality puts patients at risk, increases the burden on non- infected HCWs and will generally impede safe, efficient and effective delivery of high- quality care.

Learning from the COVID-19 pandemic has, so far, pointed to important lessons that need to be addressed in the next 6–12 months to prepare for potential second waves of COVID-19 and which will also help to build the general resilience of pandemic responses.

► Measures must be put in place to ensure that all HCWs on the frontline of pandemic response are continually protected: – Infection control training must be provided for those working on the

frontline of the pandemic response, especially among redeployed HCWs with limited experience in the clinical management of infec-tious diseases.

– Regulative and supportive measures must be put into place to ensure compliance with infection control policies in the work-place at all times.

– Adequate supply chains, and stores of personal protective equip-ment (PPE) must be ensured.

– Adequate and fair distribution mechanisms must be implement-ed to ensure healthcare organisations can efficiently get the PPE needed for their HCWs.

► A clear pathway must be present for the early diagnosis, protection and treatment of HCWs suspected to have been infected:

– Mechanisms must be put in place to ensure the latest guidelines on diagnosis are implemented. Additionally, adequate supply chains and distribution mechanisms to procure and distribute, respectively, diagnostics efficiently must be arranged.

– Pathways to ensure early identification and registration of infect-ed HCWs should be implemented.

– Pathways must be put in place to ensure infected HCWs are iso-lated to prevent them from spreading the infection.

– Treatment based on current best practice for the infection should be delivered to infected HCWs.

► Vulnerable HCWs at high risk of infection/mortality should be given less risky deployments (eg, telemedicine consults, non- COVID-19 outpatient clinics or administrative positions) whenever possible. If this is not possi-ble, they should be prioritised for protective measures and early testing.

► HCWs should be offered flexible working hours to avoid overwork, and psychological intervention plans must be implemented to help HCWs in coping with physical and psychological stress.

In the medium to long term, we highly recommend universal guidelines be designed and implemented for HCW classification as well as testing and reporting of infections in HCWs in a timely manner, with consideration towards an international HCW infection registry to facilitate estimations of the true burden of infection, which can inform the design and implementation of effective management strategies. To promote equity across high- income countries and low- income and middle- income countries, we recommend international agreements be put in place on the equitable distribution of accessible knowledge, PPE, diagnostics and treatment as well as data collection and analytic capacity.



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Acknowledgements The authors would like to thank Professor Kokila Lakhoo (Nuffield Department of Surgical Sciences, University of Oxford, UK) for her advice that helped refine the aims and objectives of this article.

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.

Open access 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: http:// creativecommons. org/ licenses/ by- nc/ 4. 0/.

ORCID iDsSoham Bandyopadhyay http:// orcid. org/ 0000- 0001- 6553- 3842Zoe Li http:// orcid. org/ 0000- 0003- 1129- 3200Osaid Alser http:// orcid. org/ 0000- 0001- 6743- 803X

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Infection and mortality of health care workers worldwide from COVID-19: a scoping

review

Citation

Soham Bandyopadhyay, Aditi Aggarwal, Archith Kamath, David Kim, Duha Jasim, Grace

Brown, Henna Reddy, Hibatullah Abuelgasim, Isabel Tol, Leenah Abuelgasim, Murtaza

Kadhum, Najlaa Abu Jamie, Omaima Ali, Osaid Alser, Sai Arathi Parepalli, Samuel Scott,

Sophie Roche, Sofia Gandino, Sara Iharchane, Yethrib Mohamed, Alexandra Knighton,

Lydia Benazaize, Eve Thangaraj, Dorothy Bbaale, Zara Markovic-Obiago, Kiran Saini, Mary

Kumarendran, Elliott Taylor, Mariam Gaddah, Khalil Khalidy, Mohammad Rabiul Karim

Khan Papon, Daniel Ojuka, Justino Regalado, Arturo Viniegra, Sonam Kelzang, Emery

Manirambona, Riley Dean, Alicia Sigler, Tazeen Ahsan, Faith Muchemwa, Mario Moran

Romero, Luciano Nahas, Amanda Gosman, Abdullah Saleh, Ronnie E. Baticulon, Kokila

Lakhoo, Anant Jani, Roba Khundkar. Infection and mortality of health care workers

worldwide from COVID-19: a scoping review.

Review question(s)

Our primary aim is to perform a scoping review to estimate the number and proportion of

health care workers who have become infected with COVID-19 in every country in the

world.

Our secondary aims are:

(1) to establish health care worker mortality rate linked to COVID-19 in every country in the

world, and

(2) to identify factors that could be linked to levels of infection and mortality of health care

workers between countries.

Searches

A full systematic search of bibliographic databases will be performed - Embase and

MEDLINE. All databases will be searched from 17th November 2019 to 22nd April 2020

without language restriction for all terms related to health care workers and COVID-19

(Appendix S1). The search results will be merged, and duplicate citations will be discarded.

Titles and abstracts will be screened by two reviewers independently based on the pre-

defined inclusion and exclusion criteria. The full text of the remaining articles will be

retrieved and screened by two reviewers independently. Conflicts are to be resolved by

mutual agreement or by a third reviewer. The reference lists of included documents will be

examined to identify any further relevant documents missed through the above search

strategy.

A grey literature search of WHO documents, government documents, and non-governmental

organisation documents will also be conducted. Social media sites, media websites, and

google will be utilised to find these documents and cross-reference sources. All documents

BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any relianceSupplemental material placed on this supplemental material which has been supplied by the author(s) BMJ Global Health

doi: 10.1136/bmjgh-2020-003097:e003097. 5 2020;BMJ Global Health, et al. Bandyopadhyay S

will be collected by two reviewers independently. The reference lists of included documents

will be examined to identify any further relevant documents missed through the above search

strategy. The inclusion of the documents and data extracted from them will be compared

between the two reviewers and validated by a third reviewer.

The search strategy outlined above will be performed by individuals who have experience in

research methodologies. All reviewers will attend an online training and support session

delivered by SB and RK before performing any searches. The Preferred Reporting Items for

Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR)

guidelines will be used to write and report the findings

Inclusion Criteria:

Types of study to be included

All studies, synopses of studies, synthesis, synopses of synthesis, and summaries are eligible

to be included. Primary data – where available – will be eligible for inclusion

Studies will be excluded if they do not use real human data or do not state their methodology.

Condition(s) or domain(s) to be included

The infection and mortality of health care workers associated with COVID-19 in all country

settings. For the purposes of this review, a country is that which is recognised by the United

Nations (UN) to be a sovereign country.

Participants/population to be included:

Inclusion:

• Health care workers. For the purposes of this review, a health care worker is one who

delivers care and services to the sick and ailing either directly as paramedics, nurses

and doctors, or indirectly as aides, helpers, laboratory technicians, and medical waste

handlers.

Exclusion:

• Animal studies

• Statistical modelling

Intervention(s), exposure(s)

COVID-19 in a health care worker

Comparator(s)/control



Not applicable

Context

This review includes settings at all levels of development. It considers low-, middle-, and

high-socio-demographic index (SDI) countries

Main outcome(s)

1. COVID 19 infections in healthcare workers (a) worldwide and (b) by country

2. Healthcare workers deaths related to COVID 19 (could be with or from) (a) worldwide

and (b) by country

*Measures of effect

There is no restriction on time to mortality outcome

Additional outcome(s)

Demographics of health care workers who have been (a) infected with and (b) died from

COVID-19

Factors that could be linked to infection and mortality of health care workers with COVID-19

*Measures of effect

Not applicable

Data extraction (selection and coding)

Using a pre-designed and pre-piloted data extraction form, data from each included document

will be collected by two independent reviewers. Conflicts in data collection will be resolved

by a third reviewer. From all included documents information will be extracted on study

design, study setting, study population, participant demographics, timeframe of the study,

date of publication, public health measures implemented, health care worker infected with

COVID-19, health care worker mortality related to COVID-19, and information for

assessment of the risk of bias.

Risk of bias (quality) assessment

Two reviewers will independently classify the risk of bias in each included document using

the risk of bias in randomised trials 2 (ROB 2) tool, risk of bias in non-randomised studies

(ROBINS I) tool, assessing the methodological quality of systematic reviews (AMSTAR)

tool, and AACODS checklist as appropriate. Documents will be graded as high (bias is very



likely due to essential errors), moderate (no essential deficiencies, but not all criteria are met),

low (bias is unlikely), or unclear.

The reviewers will discuss and resolve any disagreements with the level of bias in a study.

Strategy for data synthesis

A random effects model will be used to pool mortality and infection rates. Where possible,

associations will be analysed by computing and/or pooling this estimation using a random

effects meta-analysis.

Health care workforce deaths due to COVID-19 as a proportion of total population deaths due

to COVID-19 will be calculated. Health care workforce deaths due to COVID-19 as a

proportion of all health care work force COVID-19 infections and health care workforce

deaths due to COVID-19 as a proportion of the total healthcare workforce will be calculated

and compared to publicly available total population data. Prevalence and risk ratios will be

given.

Analysis of subgroups or subsets

Where possible, subgroup analysis will be by region (by world bank), SDI status (low SDI

country, middle SDI country, and high SDI country), age range (18-29; 30-39; 40-49; 50-59;

60-70), gender (male/female), ethnicity, type of healthcare worker, sub-specialities, and level

of training.

Contact details for further information

Soham Bandyopadhyay

[email protected]

Organisational affiliation of the review

Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences,

University of Oxford

Review team members and their organisational affiliations

Dr Soham Bandyopadhyay. Oxford University Global Surgery Group, Nuffield Department

of Surgical Sciences, University of Oxford

Dr Aditi Aggarwal. Oxford University Global Surgery Group, Oxford University Hospitals

NHS Foundation Trust

Mr Archith Kamath. Oxford University Global Surgery Group, University of Oxford

Mr David Kim. Oxford University Global Surgery Group, University of Oxford

Ms Duha Jasim. Oxford University Global Surgery Group, University of Oxford



Dr Grace Brown. Oxford University Global Surgery Group, Oxford University Hospitals


Ms Henna Reddy. Oxford University Global Surgery Group, University of Oxford

Ms Hibatullah Abuelgasim. Oxford University Global Surgery Group, University of Oxford

Dr Isabel Tol. Oxford University Global Surgery Group, Oxford University Hospitals NHS

Foundation Trust

Ms Leenah Abuelgasim. Oxford University Global Surgery Group, University of Oxford

Mr Murtaza Kadhum. Oxford University Global Surgery Group, London

Ms Najlaa Abu Jamie. Gaza

Ms Omaima Ali. Oxford University Global Surgery Group, University of Oxford

Mr Osaid Alser. Oxford University Global Surgery Group, Harvard

Ms Sai Arathi Parepalli. Oxford University Global Surgery Group, University of Oxford

Mr Samuel Scott. Oxford University Global Surgery Group, University of Oxford

Ms Sophie Roche. Oxford University Global Surgery Group, University of Oxford

Ms Sofia Gandino. Italy

Ms Sara Iharchane, Italy

Ms Yethrib Mohamed. University of Oxford

Ms Alexandra Knighton. University of Oxford

Dr Lydia Benazaize. Oxford University Global Surgery Group, Oxford University Hospitals


Dr Eve Thangaraj. Oxford University Global Surgery Group, Oxford University Hospitals


Dr Dorothy Bbaale. Uganda

Dr Zara Markovic-Obiago. Oxford University Global Surgery Group, Oxford University

Hospitals NHS Foundation Trust

Dr Kiran Saini. Oxford University Global Surgery Group, Oxford University Hospitals NHS

Foundation Trust

Ms Mary Kumarendran. Oxford University Global Surgery Group

Mr Elliott Taylor. Oxford University Global Surgery Group, Nuffield Department of Surgical

Sciences, University of Oxford

Dr Mariam Gaddah. Oxford University Global Surgery Group

Dr Emery Manirambona. Oxford University Global Surgery Group

Dr Khalil Khalidy. Gaza

Dr Daniel Ojuka. Kenya

Dr Mario Moran Romero. Mexico

Dr Luciano Nahas. Mexico

Dr Justino Regalado. Mexico

Dr Arturo Viniegra. Mexico

Dr Sonam Kelzang. Bhutan

Dr. Tazeen Ahsan, Upazilla health complex, Jessore, Bangladesh

Dr Mohammad Rabiul Karim Khan Papon. Sheikh Hasina National Institute of Burn and

Plastic Surgery, Dhaka, Bangladesh

Dr, Alicia Sigler, Tijuana, Mexico

Dr Abdullah Saleh. University of Alberta, Canada



Dr. Ronnie E. Baticulon, University of the Philippines College of Medicine – Philippine

General Hospital, Philippines

Professor Faith Muchemwa, University of Zimbabwe College of Health Sciences, Zimbabwe

Professor Amanda Gosman, University of California San Diego

Professor Kokila Lakhoo. Oxford University Global Surgery Group, Nuffield Department of

Surgical Sciences, University of Oxford

Dr Anant Jani. Oxford University Global Surgery Group

Dr Roba Khundkar. Oxford University Global Surgery Group, Nuffield Department of

Surgical Sciences, University of Oxford

Type and method of review

Epidemiologic, Meta-analysis, Narrative synthesis, Systematic review

Anticipated or actual start date

20 April 2020

Anticipated completion date

10 May 2020

Funding sources/ sponsors

Not applicable

Conflicts of interest

None

Language

English

Country

Not applicable

Stage of review

Review Ongoing

Subject index terms status

Subject indexing assigned by CRD



Subject index terms

These are assigned by the CRD

Details of any existing review of the same topic by the same authors

Appendix S1

• health care practitioner

• health care professional

• health care provider

• health care worker

• health personnel

• health profession personnel

• health worker

• healthcare personnel

• healthcare practitioner

• healthcare professional

• healthcare provider

• healthcare worker

• health care manpower

• health care work force

• health care workforce

• health labor force

• health labour force

• health manpower

• health work force

• healthcare labor force

• healthcare labour force

• healthcare manpower

• healthcare work force

• healthcare workforce

• medical manpower

• doctor

• medical practitioner

• physician associate

• physicians

• practitioner

• private physician

• nurse

• nurses’ aides

• nursing aid



• nursing aide

• nursing assistants

• orderlies

• porters

• healthcare assistants

• physician assistant

• advanced clinical practitioner

• advanced practice clinician

• advanced practice professional

• allied health provider

• clinical associate

• limited-license practitioner

• mid-level practitioner

• mid-level provider

• non-physician practitioner

• non-physician provider

• physician extender

• care coordinator

• health care coordinator

• healthcare coordinator

• medical dispatcher

• accredited social health activist

• ASHA (accredited social health activist)

• ASHA workers

• auxiliary health worker

• barefoot doctor

• health practitioner

• health aides

• health officers

• medical auxiliary

• hospital personnel

• hospital employee

• hospital staff

• hospital staffing

• hospital worker

• personnel, hospital

• hospital administrator

• hospital volunteer

• medical staff

• hospital auxiliary worker

• hospitalists



• coroner

• medical assistant

• medical chaperone

• medical expert

• medical staff

• physician assistant

• psychotherapist

• physiotherapist

• occupational therapist

• pharmacist

• allied health personnel

• paramedical personnel

• para medical personnel

• paramedical assistant

• paramedical manpower

• paramedical professional

• paramedical staff

• psychiatric aides

• medical student

• student nurse

• corona

• coronavirus

• COVID

• COVID-19

• SARS-CoV-2

• pandemic



PRISMA 2009 Checklist

Section/topic # Checklist item Reported on page #

TITLE

Title 1 Identify the report as a systematic review, meta-analysis, or both. 1

ABSTRACT

Structured summary 2 Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number.

2

INTRODUCTION

Rationale 3 Describe the rationale for the review in the context of what is already known. 3 - 4

Objectives 4 Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).

4

METHODS

Protocol and registration 5 Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.

4

Eligibility criteria 6 Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered,

language, publication status) used as criteria for eligibility, giving rationale. 4

Information sources 7 Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.

4

Search 8 Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.

Appendix S3

Study selection 9 State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).

4-5

Data collection process 10 Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.

5

Data items 11 List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.

5; Appendices S4 and S5

Risk of bias in individual studies

12 Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.

5; Appendix S7

Summary measures 13 State the principal summary measures (e.g., risk ratio, difference in means). 5




Synthesis of results 14 Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis.

5

Page 1 of 2

Section/topic # Checklist item Reported on page #

Risk of bias across studies 15 Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies).

5

Additional analyses 16 Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.

5

RESULTS

Study selection 17 Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.

5-6

Study characteristics 18 For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations.

5; Appendices S4, S5, and S7

Risk of bias within studies 19 Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12). Appendix S7

Results of individual studies 20 For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.

Appendices S8 and S9

Synthesis of results 21 Present results of each meta-analysis done, including confidence intervals and measures of consistency. 5-11

Risk of bias across studies 22 Present results of any assessment of risk of bias across studies (see Item 15). 6

Additional analysis 23 Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item 16]). 8-11

DISCUSSION

Summary of evidence 24 Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).

11-13

Limitations 25 Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).

12

Conclusions 26 Provide a general interpretation of the results in the context of other evidence, and implications for future research. 13

FUNDING

Funding 27 Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.

14



Appendix S3: Search Strategy executed in MEDLINE and EMBASE

1. health care practitioner.ti,ab

2. health care professional.ti,ab

3. health care provider.ti,ab

4. health care worker.ti,ab

5. health personnel.ti,ab

6. health profession personnel.ti,ab

7. health worker.ti,ab

8. healthcare personnel.ti,ab

9. healthcare practitioner.ti,ab

10. healthcare professional.ti,ab

11. healthcare provider.ti,ab

12. healthcare worker.ti,ab

13. health care manpower.ti,ab

14. health care work force.ti,ab

15. health care workforce.ti,ab

16. health labor force.ti,ab

17. health labour force.ti,ab

18. health manpower.ti,ab

19. health work force.ti,ab

20. healthcare labor force.ti,ab

21. healthcare labour force.ti,ab

22. healthcare manpower.ti,ab

23. healthcare work force.ti,ab

24. healthcare workforce.ti,ab

25. medical manpower.ti,ab

26. doctor.ti,ab

27. medical practitioner.ti,ab

28. physician associate.ti,ab

29. physicians.ti,ab

30. practitioner.ti,ab

31. private physician.ti,ab

32. nurse.ti,ab

33. nurses aides.ti,ab

34. nursing aid.ti,ab

35. nursing aide.ti,ab



36. nursing assistants.ti,ab

37. orderlies.ti,ab

38. porters.ti,ab

39. healthcare assistants.ti,ab

40. physician assistant.ti,ab

41. advanced clinical practitioner.ti,ab

42. advanced practice clinician.ti,ab

43. advanced practice professional.ti,ab

44. allied health provider.ti,ab

45. clinical associate.ti,ab

46. limited-license practitioner.ti,ab

47. mid-level practitioner.ti,ab

48. mid-level provider.ti,ab

49. non-physician practitioner.ti,ab

50. non-physician provider.ti,ab

51. physician extender.ti,ab

52. care coordinator.ti,ab

53. health care coordinator.ti,ab

54. healthcare coordinator.ti,ab

55. medical dispatcher.ti,ab

56. accredited social health activist.ti,ab

57. ASHA (accredited social health activist).ti,ab

58. ASHA workers.ti,ab

59. auxiliary health worker.ti,ab

60. barefoot doctor.ti,ab

61. health practitioner.ti,ab

62. health aides.ti,ab

63. health officers.ti,ab

64. medical auxiliary.ti,ab

65. hospital personnel.ti,ab

66. hospital employee.ti,ab

67. hospital staff.ti,ab

68. hospital staffing.ti,ab

69. hospital worker.ti,ab

70. personnel, hospital.ti,ab

71. hospital administrator.ti,ab



72. hospital volunteer.ti,ab

73. medical staff.ti,ab

74. hospital auxiliary worker.ti,ab

75. hospitalists.ti,ab

76. coroner.ti,ab

77. medical assistant.ti,ab

78. medical chaperone.ti,ab

79. medical expert.ti,ab

80. medical staff.ti,ab

81. physician assistant.ti,ab

82. psychotherapist.ti,ab

83. physiotherapist.ti,ab

84. occupational therapist.ti,ab

85. pharmacist.ti,ab

86. allied health personnel.ti,ab

87. paramedical personnel.ti,ab

88. para medical personnel.ti,ab

89. paramedical assistant.ti,ab

90. paramedical manpower.ti,ab

91. paramedical professional.ti,ab

92. paramedical staff.ti,ab

93. psychiatric aides.ti,ab

94. medical student.ti,ab

95. student nurse.ti,ab

96. corona.ti,ab

97. coronavirus.ti,ab

98. COVID.ti,ab

99. COVID-19.ti,ab

100. SARS-CoV-2.ti,ab

101. Pandemic.ti,ab

102. 1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or

21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39

or 40 or 41 or 42 or 43 or 44 or 45 or 46 or 47 or 48 or 49 or 50 or 51 or 52 or 53 or 54 or 55 or 56 or 57 or

58 or 59 or 60 or 61 or 62 or 63 or 64 or 65 or 66 or 67 or 68 or 69 or 70 or 71 or 72 or 73 or 74 or 75 or 76

or 77 or 78 or 79 or 80 or 81 or 82 or 83 or 84 or 85 or 86 or 87 or 88 or 89 or 90 or 91 or 92 or 93 or 94

or 95

103. 96 or 97 or 98 or 99 or 100 or 101

104. 102 and 103

105. Limit 104 to yr = “2019 – Current”



106. Limit 105 to humans



What search terms did you use

to find this document?Title of document Location of document



Date of publicationName of first author Country of first author



Type of publication (study,

synopses of studies, synthesis,

synopses of synthesis,

summaries)

Country being studied (if

multiple countries, create

separate rows if individual

analysis available)

Number of studies (if

synthesis, synopses of

synthesis, summaries)



Total number of healthcare

workers in the country

Date for which these figures

are trueType of study(ies)



Total population of country Total number of confirmed

COVID-19 cases in the country

Total number of confirmed

COVID-19 cases among

healthcare workers in the

country



Total number of deaths in

intensive care units (ICU)

Total number of intensive

care unit (ICU) admissions due

to COVID-19 in the country

Total number of healthcare

workers admitted to intensive

care unit (ICU) due to COVID-

19 in the country

Total number of deaths due to



Total number of deaths overallTotal number of deaths in

intensive care units (ICU)Total number of deaths overall

f deaths due to COVID-19 in the countryTotal number of healthcare workers deaths due to COVID-19 in

the country



List the ages of all healthcare

workers with confirmed cases

of COVID-19 in the country

List the ages of healthcare

workers who died due to

COVID -19 in the country

Number of male healthcare



Age



Number of female healthcare



Number of male healthcare

workers deaths due to COVID-

19 in the country

Number of female healthcare

workers deaths due to COVID-

19 in the country

Sex



Number of student healthcare



Ethnicity/race of healthcare


COVID-19 in the country (free

text)

Ethnicity/race of healthcare



(free text)



Number of trainee healthcare



Number of fully-qualified

healthcare workers with

confirmed cases of COVID-19

in the country

Number of retired healthcare



Stag



Number of student healthcare


COVID-19 in the country

Number of trainee healthcare


COVID-19

Number of fully-qualified

healthcare workers who died

due to COVID-19 in the country

Stage

Demographics



Number of retired healthcare



Number of doctors with


in the country

Number of nurses with


in the country



Number of midwives with


in the country

Number of allied-healthcare

professionals with confirmed

cases of COVID-19 in the

country

Number of support staff with


in the country



Number of administrators with


in the country

Number of doctors who died


Number of nurses who died


Role of health workers (https://www.who.int/whr/2006/06_chap1_en.pdf)



Number of midwives who died


Number of allied-healthcare

professionals who died due to


Number of support staff who

died due to COVID-19 in the

country



Number of administrators who

died due to COVID-19 in the

country

Other information (i.e.

speciality of those who died,

the exact role of the support

staff etc.)

Mean length of time from

presenting with COVID-19

symptoms to being tested for

the general population





symptoms to being diagnosed

with COVID-19 for healthcare

workers



symptoms to being tested for

healthcare workers



symptoms to being diagnosed

with COVID-19 for the general

population





symptoms to death due to

COVID-19 for the general

population



symptoms to death due to

COVID-19 for healthcare

workersNumber of hospital beds

available in the country



Infrastructure

Number of ITU beds needed

for COVID-19 patients

Number of ITU beds available

in the country

Number of hospital beds

needed for COVID-19 patients



Number of ventillators needed

for COVID-19 patients in the

country

Number of ventillators

available in the country

Number of tests for COVID-19

peformed for the general

population



Date at which testing for

COVID-19 began in the general

population

Populatio

Country-level self-isolation

advice provided [yes/no]

Contact tracing of population

implemented [yes/no]



Stay at home order issued

[yes/no]

lation level methods of control [if NO, write 0; if YES write the date at which this policy was implemented]

Mandated social distancing

[yes/no]

Travel restrictions

implemented [yes/no]



Non-essential events cancelled

[yes/no]

Non-essential services closed

[yes/no]

Education facilities closed

[yes/no]

lemented]



Date at which testing for

COVID-19 began for

healthcare workers

Healthcare workforce methods of control [if NO, write 0; if Y

Borders closed [yes/no]Contact tracing of healthcare

workers implemented [yes/no]



AACODS Checklist: Authority

[yes/no/maybe]

Healthcare workers prioritised

for COVID-19 testing [yes/no]

Elective cases re-

scheduled/cancelled [yes/no]

; if YES write the date at which this policy was implemented]



AACODS Checklist: Objectivity

[yes/no/maybe]

AACODS Checklist: Accuracy

[yes/no/maybe]

AACODS Checklist: Coverage

[yes/no/maybe]



AACODS Checklist: Date

[yes/no/maybe]

AACODS Checklist: Significance

[yes/no/maybe]



Appendix S5: The type and specific data points extracted in the systematic review process

Data extracted

Publication characteristics Title of publication

Year published

Authors

Country of origin

Type of publication

Country-specific data Total number of healthcare workers

Total population

Number of total hospital beds available

Number of intensive care unit beds and ventilators

available

COVID-19 specific data Number of nationwide cases

Number of COVID-19 tests performed

Number of intensive care unit admissions

Mortality rates

Average length time for symptoms and admission

Demographics of affected healthcare

workers

Age, sex, ethnicity, stage of training and role of each

affected healthcare worker

Public health measures Social distancing strategies

Testing, self-isolation and contact tracing

Travel restrictions

Stay at home orders

Publication characteristics Title of publication

Year published

Authors

Country of origin

Type of publication



Appendix S6: AACODS Checklist and NIH Quality Assessment Tool for Obervation Cohort and Cross-

Sectional Studies



NIH Quality Assessment Tool for Obervation Cohort and

Cross-Sectional Studies

Criteria Yes No Other

(CD, NR, NA)*

1. Was the research question or objective in this paper

clearly stated?



2. Was the study population clearly specified and defined?

3. Was the participation rate of eligible persons at least

50%?

4. Were all the subjects selected or recruited from the same

or similar populations (including the same time period)?

Were inclusion and exclusion criteria for being in the study

prespecified and applied uniformly to all participants?

5. Was a sample size justification, power description, or

variance and effect estimates provided?

6. For the analyses in this paper, were the exposure(s) of

interest measured prior to the outcome(s) being measured?

7. Was the timeframe sufficient so that one could

reasonably expect to see an association between exposure

and outcome if it existed?

8. For exposures that can vary in amount or level, did the

study examine different levels of the exposure as related to

the outcome (e.g., categories of exposure, or exposure

measured as continuous variable)?

9. Were the exposure measures (independent variables)

clearly defined, valid, reliable, and implemented

consistently across all study participants?

10. Was the exposure(s) assessed more than once over

time?



11. Were the outcome measures (dependent variables)

clearly defined, valid, reliable, and implemented

consistently across all study participants?

12. Were the outcome assessors blinded to the exposure

status of participants?

13. Was loss to follow-up after baseline 20% or less?

14. Were key potential confounding variables measured

and adjusted statistically for their impact on the

relationship between exposure(s) and outcome(s)?



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Link to data sourcelease.com/a-state-of-emergency-ino.jp/stf/seisakunitsuite/bunya/ister-viktor-orbans-address-to-the-h

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PÚBLICO. Mais de 1400 proQ COSTA RICA. Up to 80% oRadio Inzamba. Journal du 2Radio Reloj. Covid-19; Be Re

ticia/hospitais-ja-contrataram-14p-to-80-of-intensive-care-beds-a/inzamba.org/journal-du-22-avr-2j.cu/en/news/covid-19-be-respo

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Population by Country [InteSSB. Health care personnel [InStatista. Health & Pharmaceuticals [InTable 1. Global burden of COVID

eters.info/world-population/pttps://www.ssb.no/en/hesospers/w.statista.com/markets/412/health-al_burden_of_COVID-19_pan

y y y n

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y y y y




https://www.worldometers.info/world-population/population-by-country/

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The World Bank. Nurses anThe World Bank. Physicians (The World Bank. Specialist Voice of Nigeria. COVID-19 in A

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WorldAtlas. Countries With The Worldometer. Coronavirus Cases. Worldometer. 2020;1–22. Africanews. WHO COVID-19Coronavirus (COVID-19) in t

0with%20its%2077.4%20physiciawww.worldometers.info/coro20/03/22/who-covid-19-readinocuments/2010/Health_System

n y y y

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https://www.worldometers.info/coronavirus/

Manuel M. Dayrit, Liezel P. LWHO. WHO calls for healthObservatory of Human ResoPRIMARY HEALTH CARE SYSTE

e%20Philippines%20Health%2r-healthy-safe-and-decent-worces-health-caribbean-review-workfoce-hpsr/projects/AHPSR-PRIMAS

y y y y

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y m y y

y y y y

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https://www.who.int/news-room/detail/28-04-2020-who-calls-for-healthy-safe-and-decent-working-conditions-for-all-health-workers-amidst-covid-19-pandemic

Regional Office for Africa. ORegional Office for Africa. WReport of the WHO-China JoThe Gambia COVID-19 Outbreak Situa

cations/outbreaks-and-emergencies-b-and-au-deliver-critical-supplies-corce/coronaviruse/who-china-jot/uploads/2020/04/The_Gam

y y y y

m y y y

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y y y y

y y y y

WHO WHO WHO WHO



https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf

The Kingdom of Thailand Health SWeekly bulletin on outbreaks andWHO | HRH Country Web PWHO Coronavirus Disease (COVID-1

iris.wpro.who.int/handle/10665pics/disease-outbreaks/outbreaks-ant/workforcealliance/countries/https://covid19.who.int/

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https://www.who.int/docs/default-source/searo/thailand/2020-05-08-tha-sitrep-75-covid19-final.pdf?sfvrsn=4fd42c9d_0

https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports

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am/handle/10665.1/13947/WPitstream/handle/10665.1/105.int/report/libya/2017-review-healths://www.who.int/countries/lso

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rogress%20towards%20the%20health-related%20SDG%20targets.



Publication Type Journal Article Journal Article Journal Article

Reference Burrer SL, de Perio MA, Hughes MM, Kuhar DT, Luckhaupt SE, McDaniel CJ, et al. Characteristics of Health Care Personnel with COVID-19 — United States, February 12–April 9, 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 17;69(15):477–81. Canova V, Lederer Schläpfer H, PRhodes A, Ferdinande P, Flaatten H, Guidet B, Metnitz PG, Moreno RP. The variability of critical care bed numbers in Europe. Intensive Care Med. 2012 Jul 10;38(10):1647–53. Link to data source https://www.ncbi.nlm.nih.ghttps://doi.org/10.4414/smhttps://link.springer.com/article/

Type of article Cross-sectional Study Cross-sectional Study Cross-sectional Study

Was the research question on y y

Was the study population cy y y

Were all the subjects selecteNA y y

Was a sample size justificatNA NA NA

For the analyses in this papy y NA

Was the timeframe sufficient sNA y NA

For exposures that can vary NA NA NA

Were the exposure measures (y y NA

Was the exposure(s) assessen NA NA

Were the outcome measures (y y y

Were the outcome assessoNA NA NA

Was loss to follow-up after baseliNA NA NA

Were key potential confouny y y

Quality Rating Fair Good Good



https://doi.org/10.4414/smw.2020.20257

Journal Article Journal Article Journal Article Journal Article

Reusken CB, Buiting A, BleeXing Y, Mo P, Xiao Y, Zhao OHuang L, Lin G, Tang L, Yu L, Zhou Z. Special attention to nurses’ protection during the COVID-19 epidemic. Vol. 24, Critical Care. BioMed Central Ltd.; 2020. Litton E, Bucci T, Chavan Seni

https://www.eurosurveillanhttps://www.ncbi.nlm.nih.ghttps://www.ncbi.nlm.nih.ghttps://www.mja.com.au/jo

Cross-sectional Study Cross-sectional Study Review Cross-sectional Study

n y NA y

y y NA y

y y NA y

NA NA NA NA

NA NA NA NA

NA NA NA NA

NA NA NA NA

NA NA NA NA

NA NA NA NA

y y NA y

NA NA NA NA

NA NA NA NA

y y NA y

Fair Good NA Good



https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.12.2000334

https://www.ncbi.nlm.nih.gov/pubmed/32183934

https://www.mja.com.au/journal/2020/surge-capacity-australian-intensive-care-units-associated-covid-19-admissions


Phua J, Faruq MO, Kulkarni AP, Redjeki IS, Detleuxay K, Mendsaikhan N, et al. Critical Care Bed Capacity in Asian Countries and Regions. Crit Care Med. 2020;48(5):654–62. Fowler RA, Abdelmalik P, WEconomou C. Greece: Health syWang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA - J Am Med Assoc. 2020 Mar 17;323(11):1061–9. https://www.ncbi.nlm.nih.ghttps://www.ncbi.nlm.nih.ghttps://www.ncbi.nlm.nih.ghttps://www.ncbi.nlm.nih.g

Cross-sectional Study Cross-sectional Study Review Retrospective Cohort

y y NA y

y y NA y

y y NA y

NA NA NA NA

NA NA NA NA

NA NA NA y

NA NA NA NA

NA NA NA y

NA NA NA NA

y y NA y

NA NA NA NA

NA NA NA NA

y y NA y

Good Good NA Good




The Lancet. COVID-19: proteWu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases from the Chinese Center for Disease Control and Prevention. Vol. 323, JAMA - Journal of the American Medical Association. American Medical Association; 2020. p. 1239–42. Heinzerling A, Stuckey MJ, Scheuer T, Xu K, Perkins KM, Resseger H, et al. Transmission of COVID-19 to Health Care Personnel During Exposures to a Hospitalized Patient — Solano County, California, February 2020. MMWR Morb Mortal Wkly Rep. 2020 Apr 17;69(15):472–6. Li R, Rivers C, Tan Q, Murra

https://www.thelancet.comhttps://www.ncbi.nlm.nih.ghttps://www.ncbi.nlm.nih.ghttps://pubmed.ncbi.nlm.n

Editorial Viewpoint Cross-sectional Study Modelling study

NA NA n NA

NA NA y NA

NA NA y NA

NA NA NA NA

NA NA NA NA

NA NA NA NA

NA NA NA NA

NA NA NA NA

NA NA NA NA

NA NA y NA

NA NA NA NA

NA NA NA NA

NA NA y NA

NA NA Fair NA



Journal Article Journal Article

Zhan M, Qin Y, Xue X, Zhu S. Death from COVID-19 of 23 health care workers in China. Vol. 382, New England Journal of Medicine. Massachussetts Medical Society; 2020. p. 2267–8. Kang SK. COVID-19 and MERS Infections in Healthcare Workers in Korea. Vol. 11, Safety and Health at Work. Elsevier Science B.V.; 2020. p. 125–6. https://www.nejm.org/doi/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204702/

Cross-sectional Study Review

n NA

y NA

y NA

NA NA

NA NA

NA NA

NA NA

NA NA

NA NA

y NA

NA NA

NA NA

y NA

Fair NA



https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7204702/

Kang SK. COVID-19 and MERS Infections in Healthcare Workers in Korea. Vol. 11, Safety and Health at Work. Elsevier Science B.V.; 2020. p. 125–6.



Appendix S8: Supplementary figures for the number of COVID-19 infections and deaths reported in

healthcare worker per country as of 8th May 2020



Name of country COVID-19

deaths

among

healthcare

workers

COVID-19

cases among

healthcare

workers

CFR

(Deaths as

Percentage

of total

HCW

infections)

Death as

percentage

of total

population

COVID

deaths

References

Afghanistan 13 346 3.8 12.3 (1–3)

Albania 0 57 0 0 (1,4)

Algeria 8 200 4 1.7 (1,5,6)

Andorra 0 30 0 0 (1,7)

Angola Unreported

Antigua and Barbuda 0 5 0 0 (1,8,9)

Argentina 9 764 1.2 3.3 (1,10)

Armenia 0 320 0 0 (1,11)

Australia 1 481 0.2 1 (1,12,13)

Austria 1 891 0.1 0.2 (1,14,15)

Azerbaijan 0 1 0 0 (1,16)

Bahamas 1 15 6.7 9.1 (1,17,18)

Bahrain 0 59 0 0 (1,19)

Bangladesh 3 1172 0.3 1.5 (1,20,21)

Barbados Unreported

Belarus 4 Unreported N/A 3.4 (1,22)

Belgium 0 170 0 0 (1,23)

Belize Unreported

Benin 0 2 0 0 (1,24)

Bhutan Unreported

Bolivia Unreported

Bosnia and Herzegovina 1 8 12.5 1.1 (1,25,26)

Botswana 0 1 0 0 (1,27)

Brazil 30 552 5.4 0.3 (1,28)

Brunei Unreported

Bulgaria 2 192 1 2.4 (1,29)

Burkina Faso 0 50 0 0 (1,30)

Burundi 0 1 0 0 (1,24)

Cabo Verde Unreported

Cambodia Unreported

Cameroon 2 40 5 1.9 (1,24,31)

Canada 11 274 4 0.2 (1,22,32)

Central African Republic

(CAR)

0 1 0 N/A (1,24)



Chad 0 5 0 0 (1,24)

Chile 0 743 0 0 (1,33)

China 29 3,387 0.9 0.6 (1,34,35)

Colombia 8 560 1.4 2 (1,36)

Comoros Unreported

Congo, Democratic

Republic of the

0 39 0 0 (1,24)

Congo, Republic of the 0 4 0 0 (1,24)

Costa Rica 1 85 1.2 16.7 (1,22,37)

Cote d'Ivoire Unreported 85 (1,24)

Croatia 0 274 0 0 (1,38)

Cuba 0 92 0 0 (1,39)

Cyprus 0 180 0 0 (1,40)

Czechia 2 716 0.3 0.7 (1,41–43)

Denmark 1 1022 0.1 0.2 (1,41)

Djibouti Unreported

Dominica Unreported

Dominican Republic 3 135 2.2 (1,22,44–46)

Ecuador 80 3416 2.3 4.8 (1,47,48)

Egypt* 8 268 3 1.7 (1,49,50)

El Salvador 0 1 0 0 (1,51)

Equatorial Guinea 0 26 0 0 (1,24)

Eritrea Unreported

Estonia 1 128 0.8 1.8 (1,52,53)

Eswatini (formerly

Swaziland)

0 8 0 0 (1,24)

Ethiopia 0 1 0 0 (1,54)

Fiji Unreported

Finland 2 31 6.5 0.8 (1,55–58)

France 23 6019 0.4 0.1 (1,59,60)

Gabon 0 57 0 0 (1,24)

Gambia Unreported

Georgia 0 72 0 0 (1,41)

Germany 17 10609 0.2 0.2 (1,61)

Ghana 1 25 4 5.6 (1,24)

Greece 0 170 0 0 (1,41)



Grenada Unreported

Guatemala 0 16 0 0 (1,62)

Guinea 0 1 0 0 (1,63)

Guinea-Bissau 0 15 0 0 (1,24)

Guyana 1 Unreported N/A 10 (1,64)

Haiti 0 72 0 0 (1,65)

Honduras 3 6 50 3 (1,66–68)

Hungary 1 335 0.3 0.3 (1,22,69)

Iceland 0 5 0 0 (1,70)

India 4 548 0.5 0.2 (1,71)

Indonesia 55 174 31.6 5.9 (1,72,73)

Iran 119 1369 8.7 1.8 (1,74)

Iraq Unreported

Ireland 5 6586 0.1 0.4 (1,41,75)

Israel 0 294 0 0 (1,41)

Italy 220 23718 0.9 0.7 (1,76,77)

Jamaica 0 5 0 0 (1,62)

Japan 0 513 0 0 (1,78)

Jordan Unreported

Kazakhstan 17 423 4 56.7 (1,22,79)

Kenya 0 34 0 0 (1,80)

Kiribati Unreported

Kuwait 0 105 0 0 (1,81)

Kyrgyzstan 1 224 0.4 8.3 (1,22,82)

Laos Unreported

Latvia 0 40 0 0 (1,83)

Lebanon 0 12 0 0 (1,83)

Lesotho Unreported

Liberia 1 33 3 5 (1,24,84)

Libya Unreported

Liechtenstein Unreported

Lithuania 1 236 0.4 2 (1,85,86)

Luxembourg Unreported

Madagascar 0 5 0 N/A (1,24)

Malawi Unreported

Malaysia 3 325 0.9 2.8 (1,87)

Maldives Unreported

Mali 0 4 0 0 (1,88)

Malta 0 19 0 0 (1,41)



Marshall Islands Unreported

Mauritania Unreported

Mauritius 0 30 0 0 (1,24)

Mexico* 39 3410 1.1 1.4 (1,62)

Micronesia Unreported

Moldova 5 1098 0.5 2.1 (1,89,90)

Monaco Unreported

Mongolia Unreported

Montenegro 0 25 0 0 (1,91)

Morocco 3 0 N/A 1.6 (1,92)

Mozambique Unreported

Myanmar (formerly

Burma)

0 1 0 0 (1,93)

Namibia 0 2 0 N/A (1,24)

Nauru Unreported

Nepal Unreported

Netherlands 9 13884 0.1 0.2 (1,41)

New Zealand 0 155 0 0 (1,94)

Nicaragua Unreported

Niger 0 143 0 0 (1,95)

Nigeria 3 113 2.7 2.9 (1,96,97)

North Korea Unreported

North Macedonia (formerly

Macedonia)

Unreported

Norway Unreported

Oman Unreported

Pakistan 8 444 1.8 1.4 (1,98)

Palau Unreported

Palestine 0 11 0 0 (1,99)

Panama 4 0 N/A 1.8 -1,100

Papua New Guinea Unreported

Paraguay Unreported

Peru 1 237 0.4 0.1 (1,62)

Philippines 34 1934 1.8 5 (1,101)

Poland 1 1600 0.1 0.1 (1,102)

Portugal 0 2131 0 0 (1,41)

Qatar Unreported

Romania 1 2181 0 0.1 (1,41)



Russia 144 2000 7.2 8.9 (1,22,103)

Rwanda Unreported

Saint Kitts and Nevis Unreported

Saint Lucia 0 1 0 N/A (1,62)

Saint Vincent and the

Grenadines

Unreported

Samoa Unreported

San Marino 0 10 0 0 (1,104)

Sao Tome and Principe 0 32 0 0 (1,24)

Saudi Arabia 7 7 100 3.2 (1,22)

Senegal 0 27 0 0 (1,24)

Serbia 8 642 1.2 3.9 (1,22,105)

Seychelles Unreported

Sierra Leone 0 29 0 0 (1,24)

Singapore 0 66 0 0 (1,106)

Slovakia Unreported

Slovenia 0 295 0 0 (1,41)

Solomon Islands Unreported

Somalia 1 6 16.7 2.3 (1,107,108)

South Africa 2 511 0.4 1.2 (1,22,109)

South Korea 1 241 0.4 0.4 (1,110,111)

South Sudan Unreported

Spain 37 30663 0.1 0.1 (1,22,112)

Sri Lanka Unreported

Sudan Unreported

Suriname Unreported

Sweden 1 0 N/A 0 (1,22)

Switzerland Unreported

Syria Unreported

Tajikistan 0 136 0 0 (1,113)

Tanzania 0 1 0 0 (1,24)

Thailand 0 103 0 0 (1,114)

Timor-Leste Unreported

Togo 0 6 0 0 (1,24)

Tonga Unreported

Trinidad and Tobago 0 1 0 0 (1,62)

Tunisia 0 143 0 0 (1,115)



Turkey 24 7428 0.3 0.7 (1,116)

Turkmenistan Unreported

Tuvalu Unreported

Uganda 0 3 0 N/A (1,24)

Ukraine 19 2660 0.7 5.6 (1,117)

United Arab Emirates

(UAE)

Unreported

United Kingdom (UK) 163 2067 7.9 0.5 (1,118,119)

United States 202 9282 2.2 0.3 (1,22,120)

Uruguay 1 100 1 5.9 (1,121)

Uzbekistan 0 78 0 0 (1,122)

Vanuatu Unreported

Vatican City (Holy See) Unreported

Venezuela 1 0 N/A 10 (1,22)

Vietnam 0 3 0 N/A (1,123)

Yemen Unreported

Zambia 0 15 0 0 (1,24)

Zimbabwe 0 1 0 0 (1,24)

*Internal reports from government sources that have yet to be published utilised References 1 Worldometer. Coronavirus Cases. Worldometer. 2020;1–22. 2 ReliefWeb. Afghanistan: COVID-19 Multi-Sectoral Response Operational Situation Report, 6 May 2020 - Afghanistan [Internet]. [Cited 2020 May 8]. Available from: https://reliefweb.int/report/afghanistan/afghanistan-covid-19-multi-sectoral-response-operational-situation-report-6-may 3 Reuters. Exclusive: Large number of COVID-19 cases among Afghan medics spark alarm in Kabul [Internet]. [Cited 2020 May 8]. Available from: https://uk.reuters.com/article/uk-health-coronavirus-afghanistan-hospit/exclusive-large-number-of-covid-19-cases-among-afghan-medics-spark-alarm-in-kabul-idUKKBN22J2PW 4 UN Women – Headquarters. “Nurses are the real heroes,” says Albanian doctor in the front line of COVID-19 response [Internet]. [Cited 2020 May 8]. Available from: https://www.unwomen.org/en/news/stories/2020/4/feature-nurses-in-albania-on-front-line-of-covid-19-response 5 Algeria confirms 8th death from coronavirus [Internet]. [Cited 2020 May 8]. Available from: https://www.aa.com.tr/en/latest-on-coronavirus-outbreak/algeria-confirms-8th-death-from-coronavirus/1771778 6 Health. KUNA : Algeria confirms 18 deaths from coronavirus, 200 cases among health workers [Internet]. [Cited 2020 May 8]. Available from: https://www.kuna.net.kw/ArticleDetails.aspx?id=2886827&language=en



7 La defunció d’una dona de 73 anys eleva les víctimes de coronavirus al país fins a 47 [Internet]. [Cited 2020 May 8]. Available from: https://www.diariandorra.ad/noticies/nacional/2020/05/08/la_defuncio_una_dona_anys_eleva_les_victimes_coronavirus_pais_fins_74_160729_1125.html 8 A State of Emergency in Antigua and Barbuda | Caribbean Press Release [Internet]. [Cited 2020 May 8]. Available from: https://cpressrelease.com/a-state-of-emergency-in-antigua-and-barbuda/ 9 Government of Antigua and Barbuda [Internet]. [Cited 2020 May 8]. Available from: https://ab.gov.ag/ 10 Clarín. Coronavirus en Argentina: ya murieron 9 profesionales de la salud y se infectaron 764 [Internet]. [Cited 2020 May 8]. Available from: https://www.clarin.com/sociedad/coronavirus-argentina-murieron-9-profesionales-salud_0_v6nQK_fNF.html 11 Public Radio of Armenia. 320 health workers have contracted Covid-19 in Armenia [Internet]. [Cited 2020 May 8]. Available from: https://en.armradio.am/2020/05/03/320-health-workers-have-contracted-covid-19-in-armenia/ 12 Australia’s coronavirus victims: Covid-19 related deaths across the country [Internet]. [Cited 2020 May 8]. Available from: https://www.theguardian.com/australia-news/2020/apr/21/australia-coronavirus-victims-age-names-deaths-covid-19-australian-death-toll 13 ABC News. Australian healthcare workers riding the coronavirus curve are relieved as infections dwindle [Internet]. [Cited 2020 May 8]. Available from: https://www.abc.net.au/news/2020-05-04/coronavirus-frontline-health-workers/12198348 14 Profil. Medizinisches Personal: 891 mit Corona infiziert [Internet]. [Cited 2020 May 8]. Available from: https://www.profil.at/oesterreich/medizinisches-personal-891-mit-corona-infiziert/400885910 15 Schwechat. Coronavirus: Himberger Arzt nach Infektion verstorben [Internet]. [Cited 2020 May 8]. Available from: https://www.meinbezirk.at/schwechat/c-gesundheit/himberger-arzt-nach-infektion-verstorben_a4023873 16 A medical worker infected with coronavirus in Azerbaijan [Internet]. [Cited 2020 May 8]. Available from: https://ona.az/en/social/one-medical-worker-infected-with-coronavirus-in-azerbaijan-official-13629 17 The Government of the Bahamas [Internet]. [Cited 2020 May 8]. Available from: https://www.bahamas.gov.bs/wps/portal/public/gov/government/!ut/p/b1/04_Sj9CPykssy0xPLMnMz0vMAfGjzOKNDdx9HR1NLHzdTQ3MDDxDA3wcA8w9jPy9jYAKIoEKDHAARwNC-sP1o_AqMTGAKsBjhZ9Hfm6qfkFuhEGWiaMiALGJzU0!/dl4/d5/L2dBISEvZ0FBIS9nQSEh/ 18 Magnetic Media. Two More COVID-19 Deaths in The Bahamas; 15 Healthcare workers infected [Internet]. [Cited 2020 May 8]. Available from: https://magneticmediatv.com/2020/04/two-more-covid-19-deaths-in-the-bahamas-15-healthcare-workers-infected/ 19 Xinhua. 59 healthcare workers in Bahrain infected with COVID-19 [Internet]. [Cited 2020 May 8]. Available from: http://www.xinhuanet.com/english/2020-05/07/c_139038291.htm

20 নীড় পাতা [Internet]. [Cited 2020 May 8]. Available from: https://www.dghs.gov.bd/index.php/bd/ 21 Bangladesh: 11% COVID-19 cases among health workers [Internet]. [Cited 2020 May 8]. Available from: https://www.aa.com.tr/en/asia-pacific/bangladesh-11-covid-19-cases-among-health-workers/1826014



22 In Memoriam: Healthcare Workers Who Have Died of COVID-19 [Internet]. [cited 2020 May 8]. Available from: https://www.medscape.com/viewarticle/927976 (19/04/2020) %0A 23 Covid-19 cases and deaths bounce back in Belgium [Internet]. [Cited 2020 May 8]. Available from: https://www.plenglish.com/index.php?o=rn&id=53781&SEO=covid-19-cases-and-deaths-bounce-back-in-belgium 24 Situation update for the WHO African Region 5 May 2020 [Internet]. [Cited 2020 May 8]. Available from: https://apps.who.int/iris/bitstream/handle/10665/331989/SITREP_COVID-19_WHOAFRO_20200506-eng.pdf 25 COVID-19 UPDATES: Bosnian doctors start getting sick with Covid-19 [Internet]. [cited 2020 May 8]. Available from: http://ba.n1info.com/English/NEWS/a421350/COVID-19-UPDATES-More-than-450-confirmed-cases-in-Bosnia.html 26 COVID-19 claims first doctor in southern Bosnia [Internet]. [cited 2020 May 8]. Available from: http://ba.n1info.com/English/NEWS/a426731/COVID-19-claims-first-doctor-in-southern-Bosnia.html%0A 27 Voice of America. Entire Botswana Parliament Under Quarantine After Health Care Worker Test Positive for COVID-19 [Internet]. [cited 2020 May 8]. Available from: https://www.voanews.com/science-health/coronavirus-outbreak/entire-botswana-parliament-under-quarantine-after-health-care 28 G1. Casos de coronavírus e número de mortes no Brasil em 17 de abril [Internet]. [Cited 2020 May 8]. Available from: https://g1.globo.com/bemestar/coronavirus/noticia/2020/04/17/casos-de-coronavirus-e-numero-de-mortes-no-brasil-em-17-de-abril.ghtml 29 Covid-19 in Bulgaria: Day 61 [Internet]. [Cited 2020 May 8]. Available from: https://bnr.bg/en/post/101272049/covid-19-in-bulgaria-day-61 30 ABC News. Burkina Faso struggles against COVID-19 and extremist threat [Internet]. [Cited 2020 May 8]. Available from: https://abcnews.go.com/International/wireStory/burkina-faso-struggles-covid-19-extremist-threat-70344982 31 Cameroun-Coronavirus : un médecin dans un état préoccupant [Internet]. [Cited 2020 May 8]. Available from: https://www.journalducameroun.com/cameroun-un-medecin-meurt-des-suites-du-coronavirus/ 32 The Globe and Mail. Infected health-care workers the source of coronavirus outbreaks at four Ontario hospitals [Internet]. [Cited 2020 May 8]. Available from: https://www.theglobeandmail.com/canada/article-infected-health-care-workers-the-source-of-coronavirus-outbreaks-at/ 33 Chinadaily.com.cn. Latin America sees continued rise in COVID-19 cases as Argentina takes stricter measures [Internet]. [Cited 2020 May 8]. Available from: http://www.chinadaily.com.cn/a/202004/16/WS5e97fdf2a3105d50a3d16b42.html 34 Los Angeles Times. Health workers fighting coronavirus in China die of infection, fatigue [Internet]. [Cited 2020 May 8]. Available from: https://www.latimes.com/world-nation/story/2020-02-25/doctors-fighting-coronavirus-in-china-die-of-both-infection-and-fatigue 35 Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). 36 At least 8 health workers killed, 560 infected by coronavirus in Colombia [Internet]. [Cited 2020 May 8]. Available from: https://colombiareports.com/at-least-8-health-workers-killed-560-infected-by-coronavirus-in-colombia/ 37 Wikipedia. COVID-19 pandemic in Costa Rica [Internet]. Available from: https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Costa_Rica



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.[Cited 2020 May 8] .[Internet] الصحة:« 105 حالات إصابة بـ»كورونا..« بين الطواقم الطبية» 81Available from: https://alqabas.com/article/5770510--الصحة-105-حالات-إصابة-بكورونا-من-الطواقم id=5770510?الطبية82 Three more medical workers contract COVID-19 in Kyrgyzstan [Internet]. [Cited 2020 May 8]. Available from: https://24.kg/english/152109_Three_more_medical_workers_contract_COVID-19_in_Kyrgyzstan/ 83 Table 1. Global burden of COVID-19 pandemic on healthcare workers [Internet]. [Cited 2020 May 8]. Available from: https://figshare.com/articles/Table_1_Global_burden_of_COVID-19_pandemic_on_healthcare_workers/12148518/1 84 allAfrica.com. Liberia: He Survived Ebola but Not Corona, First Health Worker Succumbs to COVID-19 [Internet]. [Cited 2020 May 8]. Available from: https://allafrica.com/stories/202004200344.html 85 LRT. Coronavirus: 771 confirmed cases in Lithuania, 83-year-old doctor the latest victim [Internet]. [Cited 2020 May 8]. Available from: https://www.lrt.lt/en/news-in-english/19/1160113/coronavirus-771-confirmed-cases-in-lithuania-83-year-old-doctor-the-latest-victim 86 LRT. Coronavirus: Lithuania confirms 2 deaths, 4 new infections [Internet]. [Cited 2020 May 8]. Available from: https://www.lrt.lt/en/news-in-english/19/1175160/coronavirus-lithuania-confirms-2-deaths-4-new-infections 87 325 medical workers test positive for Covid-19 [Internet]. [Cited 2020 May 8]. Available from: https://www.nst.com.my/news/nation/2020/04/586972/325-medical-workers-test-positive-covid-19 88 Coronavirus: Four health workers test positive for coronavirus in Mali [Internet]. [Cited 2020 May 8]. Available from: https://www.panapress.com/Coronavirus-Four-health-workers--a_630636881-lang2.html 89 IPN. COVID-19 claims two more lives [Internet]. [Cited 2020 May 8]. Available from: https://www.ipn.md/en/covid-19-claims-two-more-lives-7967_1073351.html 90 AICI SUNT ȘTIRILE. Two out of ten coronavirus-infected patients are medical workers [Internet]. [Cited 2020 May 8]. Available from: https://en.publika.md/two-out-of-ten-coronavirus-infected-patients-are-medical-workers-_2661500.html 91 Standard. Radojević: Plavljanin umro usled infarkta, trenutno 34 osobe hospitalizovane [Internet]. [Cited 2020 May 8]. Available from: https://www.standard.co.me/drustvo/uzivo-konferencija-nkt-nove-informacije-o-virusu-covid-19-2/ 92 Morocco Mourns 3 Doctors Who Died Fighting COVID-19 [Internet]. [Cited 2020 May 8]. Available from: https://www.moroccoworldnews.com/2020/04/298683/morocco-mourns-3-doctors-who-died-fighting-covid-19/ 93 Wikipedia. COVID-19 pandemic in Myanmar [Internet]. [Cited 2020 May 8]. Available from: https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Myanmar 94 Stuff.co.nz. Coronavirus: Healthcare workers make up 1 in 10 of New Zealand’s Covid-19 cases [Internet]. [Cited 2020 May 8]. Available from: https://www.stuff.co.nz/national/health/coronavirus/121343628/coronavirus-healthcare-workers-make-up-1-in-10-of-new-zealands-covid19-cases 95 NIGER: COVID-19 Situation Report [Internet]. [Cited 2020 May 8]. Available from: https://reliefweb.int/sites/reliefweb.int/files/resources/UNICEF Niger COVID-19 Situation Report No. 4 - 27 April -03 May 2020.pdf



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96 Nigeria: 113 healthcare workers infected with COVID-19 [Internet]. [Cited 2020 May 8]. Available from: https://www.aa.com.tr/en/africa/nigeria-113-healthcare-workers-infected-with-covid-19/1825398 97 Bloomberg. Africa Virus News: Nigeria Aid Worker Dies of Covid-19, MSF Says [Internet]. [Cited 2020 May 8]. Available from: https://www.bloomberg.com/news/articles/2020-04-20/aid-worker-dies-of-covid-19-in-nigeria-s-war-torn-northeast 98 Virus cases among Pakistan’s medical workers increase [Internet]. [Cited 2020 May 8]. Available from: https://www.aa.com.tr/en/asia-pacific/virus-cases-among-pakistans-medical-workers-increase/1826007 99 Coronavirus Disease 2019 (COVID-19) WHO Update 28 - Question of Palestine [Internet]. [cited 2020 May 8]. Available from: https://www.un.org/unispal/document/coronavirus-disease-2019-covid-19-who-update-28/ 100 Panamá suma 146 muertes por el COVID-19 y supera los 5.000 casos de contagio [Internet]. [Cited 2020 May 8]. Available from: https://www.msn.com/es-us/noticias/otras/panamá-suma-146-muertes-por-el-covid-19-y-supera-los-5000-casos-de-contagio/ar-BB137a9B 101 Health workers with COVID-19 now at 1,934; recoveries rise to 449 [Internet]. [cited 2020 May 8]. Available from: https://www.cnnphilippines.com/news/2020/5/8/health-workers-with-covid-19-1934-.html 102 Physician’s Weekly. Coronavirus cases in Poland exceed 10,000 weeks before election [Internet]. [Cited 2020 May 8]. Available from: https://www.physiciansweekly.com/coronavirus-cases-in-poland/ 103 Coronavirus in Russia: The Latest News [Internet]. [Cited 2020 May 8]. Available from: https://www.themoscowtimes.com/2020/05/08/coronavirus-in-russia-the-latest-news-aug-29-a69117 104 Coronavirus a San Marino: scoperto focolaio nel reparto di Medicina, ma si registrano 5 nuovi guariti [Internet]. [Cited 2020 May 8]. Available from: https://www.sanmarinortv.sm/news/attualita-c4/coronavirus-a-san-marino-scoperto-focolaio-nel-reparto-di-medicina-ma-si-registrano-5-nuovi-guariti-a186478 105 Serbia reports a total of 5,994 coronavirus cases [Internet]. [Cited 2020 May 8]. Available from: https://www.srbija.gov.rs/vest/en/154514/serbia-reports-a-total-of-5994-coronavirus-cases.php 106 The Straits Times. 66 healthcare workers infected but none likely in the course of work, Politics News & Top Stories [Internet]. [cited 2020 May 8]. Available from: https://www.straitstimes.com/politics/66-healthcare-workers-infected-but-none-likely-in-the-course-of-work 107 Somali health workers contract COVID-19 [Internet]. [Cited 2020 May 8]. Available from: https://www.aa.com.tr/en/africa/somali-health-workers-contract-covid-19/1807013 108 Somaliland Standard. Somalia: Nurse succumbs to Covid-19 [Internet]. [Cited 2020 May 8]. Available from: http://somalilandstandard.com/somalia-nurse-succumbs-to-covid-19/ 109 Over 500 S. African health workers contract COVID-19 [Internet]. [Cited 2020 May 8]. Available from: https://www.aa.com.tr/en/africa/over-500-s-african-health-workers-contract-covid-19/1831768 110 Kang SK. COVID-19 and MERS Infections in Healthcare Workers in Korea. Vol. 11, Safety and Health at Work. Elsevier Science B.V.; 2020. p. 125–6. 111 Ministry of Health & Welfare : News & Welfare Services > Press Release View Content [Internet]. [Cited 2020 May 8]. Available from: https://www.mohw.go.kr/eng/nw/nw0101vw.jsp?PAR_MENU_ID=1007&MENU_ID=100701&page=1&CONT_SEQ=353968



https://www.themoscowtimes.com/2020/05/08/coronavirus-in-russia-the-latest-news-aug-29-a69117

https://www.themoscowtimes.com/2020/05/08/coronavirus-in-russia-the-latest-news-aug-29-a69117

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https://centralasia.media/news:1610428/

Appendix S9: Supplementary figures for the COVID-19 infections and deaths over time

