The Uncounted Casualties of a Hidden COVID-19 Epidemic in China: Cross-sectional Study on Deaths Related to Overwork

Abstract

Background During the COVID-19 response, nonclinical essential workers usually worked overtime and experienced significant work stress, which subsequently increased their risk of mortality due to cardiovascular diseases, stroke, and pre-existing conditions. Deaths on duty, including deaths due to overwork, during the COVID-19 response were usually reported on web-based platforms for public recognition and solidarity. Although no official statistics are available for these casualties, a list of on-duty deaths has been made publicly available on the web by crowdsourcing. Objective This study aims to understand the trends and characteristics of deaths related to overwork among the frontline nonclinical essential workers participating in nonpharmaceutical interventions during the first wave of COVID-19 in China. Methods Based on a web-based crowdsourced list of deaths on duty during the first wave of the COVID-19 response in China, we manually verified all overwork-related death records against the full-text web reports from credible sources. After excluding deaths caused by COVID-19 infection and accidents, a total of 340 deaths related to overwork among nonclinical essential workers were attributed to combatting the COVID-19 crisis. We coded the key characteristics of the deceased workers, including sex, age at death, location, causes of death, date of incidence, date of death, containment duties, working area, and occupation. The temporal and spatial correlations between deaths from overwork and COVID-19 cases in China were also examined using Pearson correlation coefficient. Results From January 20 to April 26, 2020, at least 340 nonclinical frontline workers in China were reported to have died as a result of overwork while combatting COVID-19. The weekly overwork mortality was positively correlated with weekly COVID-19 cases (r=0.79, P<.001). Two-thirds of deceased workers (230/340, 67.6%) were under 55 years old, and two major causes of deaths related to overwork were cardiovascular diseases (138/340, 40.6%) and cerebrovascular diseases (73/340, 21.5%). Outside of Hubei province, there were almost 2.5 times as many deaths caused by COVID-19–related overwork (308/340, 90.6%) than by COVID-19 itself (n=120). Conclusions The high number of deaths related to overwork among nonclinical essential workers at the frontline of the COVID-19 epidemic is alarming. Policies for occupational health protection against work hazards should therefore be prioritized and enforced.

Trends and Factors Associated With Risk Perception, Anxiety, and Behavior From the Early Outbreak Period to the Controlled Period of COVID-19 Epidemic: Four Cross-Sectional Online Surveys in China in 2020

“…The COVID-19 pandemic has created an unprecedented crisis ( 1 ). The first wave of the COVID-19 epidemic in China was brought under control with 3 months—from mid-January 2020 (when human-to-human transmission of COVID-19 was confirmed) to the end of March 2020 ( 2 ). COVID-19 was recognized as a Class B infectious disease by National Health Commission, and was treated as a Class A infectious disease for prevention and control on January 20, 2020.…”

Workplace Mistreatment and Health Conditions Prior and during the COVID-19 in South Korea: A Cross-Sectional Study

“…Although the National Assembly passed legislation in February 2018 to shorten work hours, with the revised law to be applied on an annual basis depending on the size of the workplace [ 41 ], more data is needed to evaluate the effectiveness of this policy. As the COVID-19 pandemic resulted in social restrictions and heavier workloads on the workforce, many researchers [ 42 , 43 , 44 ] have suggested that the increased workload among health professionals resulted in health problems such as increased levels of stress, depression, anxiety, physical exhaustion, as well as increased rates of CCVDs. While it should not be ignored that health professionals are at increased risk of infection with COVID-19, it is also essential to recognize that professionals in other fields have also been overworked during the COVID-19 pandemic, emphasizing that teleworking leads to constant overworking [ 45 ].…”

Impact of the COVID-19 pandemic on cardiovascular heart disease medication use: time-series analysis of England’s prescription data during the COVID-19 pandemic (January 2019 to October 2020)

“…difficulty in accessing services, changes in health priorities 54 including lifestyle and adherence changes, possibly difficulty of paying for prescriptions) and system factors (e.g. telehealth-5855 and reduced opportunity for follow-up in-person with patients in which medications can be discussed, perhaps concern about some drugs interacting with COVID, perhaps focus on other health areas for overworked professionals during pandemic, 56 , 57 etc.).…”