Increased Risk of COVID-19-Related Deaths among General Practitioners in Italy

Abstract

To date, data on COVID-19-related death cases among physicians from different medical specialties are incomplete and scattered. In Italy, available data highlight that general practitioners (GPs) are, apparently, the most heavily affected group. Indeed, they currently represent 44.1% of the total COVID-19 related death cases occurred among physicians, whereas they constitute about 15% of the total number of doctors. This high proportion is most likely the consequence of a work-related contagion happening especially during the first weeks of the epidemic, and persisting also in the following weeks, after the national lockdown. There are various reasons for these higher contagion rates: GPs perform a lot of medical examinations daily, usually in close contact with patients. Especially at the beginning of the epidemic, GPs might have had scant information on the specific safety procedures for the prevention of SARS-CoV-2 transmission (e.g., there was limited knowledge on the possibility of contagions deriving from asymptomatic patients) and, moreover, the availability of personal protective equipment was insufficient. Furthermore, the risk of infection is highly increased by the virus’ characteristics, like its survival for several hours/days on different surfaces and its persistence in the air after an aerosolization process, with possibilities to be transmitted over distances longer than two meters. Following these observations, and considering the high cost in term of GPs’ lives, the COVID-19 pandemic will probably revolutionize the approach to patients in general practice. Clear and effective guidelines are absolutely and urgently needed for the refinement of adequate measures to prevent SARS-CoV-2 infections among GPs.

General Practitioners' Experiences During the First Phase of the COVID-19 Pandemic in Italy: A Critical Incident Technique Study

“…In fact, most Italian GPs still work single-handedly in solo practices that are somewhat isolated from the rest of the NHS ( 26 ). Indeed, a recent study showed how Italian GPs represent 44.1% of the total COVID-19-related deaths among doctors, and organizational issues (i.e., working alone), along with the lack of PPE, were proposed as explanations for the high burden suffered by GPs ( 27 ). Moreover, in many regions of Italy such as Lombardy, regional policies fostered a strong hospital-centric organization while primary care has been underfinanced for many years ( 28 ).…”

“…"The total lack of preparation to face the biggest emergency in the area since the Second World War with an excessively hospitalcentered vision caused the wards to become saturated within a week." (27) "Much more attention is needed on primary care, which in this emergency has been abandoned to give resources to the hospital." (73)…”

SARS-CoV-2 Seroprevalence Post-First Wave among Primary Care Physicians in Catania (Italy)

“…It is important to finalize strategies and procedures to prevent SARS-CoV-2 infection among GPs, for example, specific guidelines for GPs to safely guarantee care for patients during the spread of COVID-19. Another input could be the introduction of telemedicine procedures to reduce direct contact with patients [10,[25][26][27].…”

“…Modenese and Gobba reported that 44% of the COVID-19 related deaths among Italian physicians were GPs [ 10 ].…”

COVID-19: The Italian experience

“…The Italian health system was heavily challenged by this unexpected pandemic that represented the first health priority for the following months. As of May 26, 2020, 126 physicians among general practitioners and physicians who were in the front line died of COVID-19 infection 1 . As a result of the pandemic, the dermatologic community consistently diminished most activities, reducing by 80-90% the outpatient consultation both in public hospitals and in private offices 2 , 3 .…”