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, 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.