COVID‑19 and healthcare workers: morbidity, mortality, and long-term consequences

Relevance. Healthcare workers were among the most vulnerable groups during the COVID‑19 pandemic. High morbidity, considerable mortality, and frequent long-term consequences of the disease – including post-COVID syndrome, respiratory and psychoemotional disorders – necessitate a comprehensive assessment of occupational risks and medical outcomes in this population. An objective evaluation of the scale and factors influencing the health of healthcare workers during the pandemic is essential for the development of a sustainable system of prevention, occupational safety, and strategic planning in the healthcare sector, especially under recurring epidemic threats.

Materials and Methods. The study was conducted within the largest departmental healthcare network in Russia – JSC «Russian Railways» (covering 75 regions, approximately 60,000 employees). A total of 16,344 confirmed cases of COVID‑19 among medical personnel were analyzed for the period 2020–2022. Morbidity and mortality rates were assessed across professional, gender, and age groups. Additionally, 7,805 expert assessments of occupational causation were evaluated, including 2,583 postmortem examinations. Standard epidemiological methods were used: incidence rate calculations, intergroup comparisons, statistical analysis, and significance testing across different periods of the pandemic.

Results. The average COVID‑19 morbidity among healthcare workers was 93.2±1.5 per 1,000 employees, significantly higher than in all other personnel at Russian Railways (65.3±0.9 per 1,000; 1.43 times higher, p<0.0001), and higher than the national average (73.4±1.1 per 1,000; 1.27 times higher, > 0.0001), and higher than the national average (73.4±1.1 per 1,000; 1.27 times higher, p<0.0001) ). The highest risk of infection was among physicians – 381.4±15.2 per 1,000, which was 1.96 times higher than that of non-medical personnel (194.1±8.5 per 1,000; p 0.0001). Among nursing staff, the morbidity rate was 298.2±12.7, and among junior personnel – 221.3±9.8, both significantly higher than among non-medical staff (1.54 times, p <0.0001 and 1.14 times, p <0.01, respectively). The case fatality rate among healthcare workers was 0.70%±0.13%, which was 2.8 times higher than among the rest of the organization’s staff (0.25%; p <0.0001) . In the 7,805 expert assessments conducted, a direct occupational link to COVID‑19 was confirmed in 63.8% of postmortem and 67.8% of non-postmortem cases. The vast majority of those infected were women (89%), with an average age of 53.1±2.3 years. The age group 40–60 years accounted for 59% of all cases.

Conclusions. COVID‑19 had a significant occupational impact on healthcare workers. The results underscore the urgent need for comprehensive protective measures, including the provision of personal protective equipment, vaccination, regular health monitoring, post-COVID rehabilitation, psychological support, and formal legal recognition of COVID‑19 as an occupational disease when risk factors are confirmed.

1. Official data of Rospotrebnadzor. Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing. (In Russ.). https://www.rospotrebnadzor.ru Date of access: 01.06.2025.

2. Stopcoronavirus. Official information portal. (In Russ.). https://xn 90aivcdt6dxbc.xn – p1ai Date of access: 01.06.2025.

3. European Centre for Disease Prevention and Control. SARS-CoV 2 variants of concern. https://www.ecdc.europa.eu/en/covid 19/variants-concern Date of access: 02.06.2025.

4. Akimkin V.G., Semenenko T.A., Ugleva S.V. et al. COVID 19 in Russia: Epidemiology and Molecular Genetic Monitoring. Annals of the Russian Academy of Medical Sciences. 2022; 77 (4): 254–260. (In Russ.). DOI: 10.15690/vramn2121.

5. Briko N.I., Kagramanyan I.N., Nikiforov V.V. et al. The COVID 19 pandemic. Measures to combat its spread in the Russian Federation. Epidemiology and Vaccinal Prevention. 2020; 19 (2): 4–12. (In Russ.).

6. Yaskova O.A. First results of laboratory testing for SARS-CoV 2 antibodies among medical personnel of Mezhdurechensk City Hospital. Medial. 2020; 2(26): 14–17. (In Russ.).

7. Kuzmenko S.A., Likstanov M.I., Oshlykova A.M. et al. Epidemiological features of morbidity and clinical course of COVID 19 among healthcare workers (based on analysis of patients treated in a repurposed infectious disease hospital). Medicine in Kuzbass. 2020; 19 (4): 21–24. (In Russ.).

8. Chan A. T., Nguyen L.H., Spector T.D. Study reveals the risk of COVID 19 infection among health care workers. Massachusetts General Hospital News. 2020. https://www.massgeneral.org/news/coronavirus/study-reveals-risk-of-covid 19infection-among-health-care-workers Date of access: 04.06.2025.

9. Dempsey B., Madan I., Stevelink S.A.M., Lamb D. Long COVID among healthcare workers: a narrative review of definitions, prevalence, symptoms, risk factors and impacts. Occupational Medicine. 2024. Article ID: PMC11436955. https://pmc.ncbi.nlm.nih.gov/articles/PMC11436955/ Date of access: 04.06.2025.

10. Strizhakov L. A., Marchenkov R. E., Sholomova V. I. et al. COVID 19 in medical workers: socio-demographic and clinical features in the assessment of the relationship between the disease and the profession. Preventive Medicine. 2024; 27 (2): 30–36. (In Russ.). DOI: 10.17116/profmed20242702130.

11. Pearce N., Rhodes S., Stocking K., Pembrey L., van Veldhoven K., Brickley E. B., Robertson S., Davoren D., Nafilyan V., Windsor-Shellard B., Fletcher T., van Tongeren M. Occupational differences in COVID 19 incidence, severity, and mortality in the United Kingdom: Available data and framework for analyses. Wellcome Open Research. 2021; 6: 102 (version 2 published 15 Dec 2023). DOI: 10.12688/wellcomeopenres.16845.2. https://wellcomeopenresearch.org/articles/6–102/v2 Date of access: 15.06.2025

12. Saragih I. D., Tonapa S. I., Saragih I. S., Advani S., Abdurahim S. A., Lin C.-J., Fisher M. L. Global prevalence of mental health problems among healthcare workers during the COVID 19 pandemic: A systematic review and meta-analysis. International Journal of Nursing Studies. 2021; 121: 104002. DOI: 10.1016/j.ijnurstu.2021.104002. https://pmc.ncbi.nlm.nih.gov/articles/PMC9701545/ Date of access: 15.06.2025

13. Platonova T.A., Golubkova A.A., Smirnova S. S. COVID 19 in healthcare workers: clinical characteristics during acute phase and convalescence. Journal of Epidemiology and Infectious Diseases. 2021; 11 (4): 25–30. (In Russ.). DOI: https://dx.doi.org/10.18565/epidem.2021.11.4.25–30.