On July 29, 2020, the New York Times reported that at least 150,909 people have died of COVID-19 in the U.S. since the pandemic gained a foothold in mid-March. There is another ongoing count (in fact there are two simultaneous independent tabulations) of the number of healthcare workers lost to coronavirus. Medscape^® Nurses publishes and updates “In Memoriam: Healthcare Workers Who Have Died of COVID-19.” As of July 1^st, it listed 1,800 names from 64 countries. “Lost on the Frontline,” a collaboration between Kaiser Health News (KHN) and The Guardian, pays homage to fallen healthcare workers.* The report has identified 878 individuals and featured 164 profiles with photos and moving eulogies. What do these numbers mean? Does it mean the virus has won?

Figures and feelings

To a nation that prides itself on being invincible, the escalating death toll is a sobering reminder that political hubris does not protect us from infection. To the surviving loved ones, statistics represent the silence left by the departed. To the wounded healthcare system, the loss of so many healthcare workers leaves a void not fully captured by a graph or a chart. Judging from the average age of those who have died from COVID-19, it’s likely that a significant number of healthcare workers lost to COVID-19 were older and therefore more experienced. For this reason, I reflect on the unimaginable loss of expertise—clinical and bedside savvy—that makes patient care a marvel. At the same time, I imagine that a multitude among the living co-workers, bow in gratitude for having been precepted, coached, and mentored by those who were taken away too soon.

In any given healthcare crisis counting is good and necessary, but it’s never exact, in spite of advances in epidemiology. In fact, one nurse I know who died of COVID-19 is not found on either list mentioned previously. A study published on July 31^st in The Lancet reported that frontline healthcare workers (U.S. and U.K. subjects) were at an increased risk for a positive COVID-19 test, repudiating an earlier study done in Italy that reported infection rate among healthcare workers to be reasonably low. The bottom line is that the dead do not need analysis, they deserve acknowledgement.

Honoring healthcare worker in situ

The book The Great Influenza, by John Barry, is an authoritative account of the world’s deadliest pandemic in 1918. In this epic narrative, one can feel the horror of the outrageous number of doctors and nurses who died of influenza (the exact number is unknown), almost all of them unnamed in the book, except for one Emma Snyder, a 23-year-old nurse in Philadelphia. What I find surprising is that there is hardly any memorial dedicated to healthcare workers in any pandemic or major healthcare crisis. Sure, there are books written about heroic nurses (e.g., Angel of Bataan, We Band of Angels), but there is an absence of a permanent memorial to all healthcare workers who battled pandemics, both in historical and modern times.

I think the best place to honor fallen healthcare workers is where they have dedicated their talents—the hospital, nursing home, ambulatory surgery suite, primary care clinic, nursing school, or wherever else they worked. In the annual nurses’ week celebration, we should recite the names of staffers who have gone before us, at the place of their professional triumph. With them, we share a common geography, not found in a map, but a caring landscape, leading to and from the bedside. When we walk the halls, traverse the bedside, circulate in the operating room, and crisscross the nurse’s station, we can, to use a biblical term, bear witness to our comrades in scrubs. Perhaps, this pandemic will inspire stakeholders to take notice and start an annual day of remembrance for all healthcare workers as a tribute for lives devoted to caring and healing.

Remember us

I would like to imagine that this healthcare workers’ day of remembrance won’t (or shouldn’t) be a pizza and soda variety of celebration, but an ecumenical and sincere acknowledgement of our departed co-workers, to be able to say that in their absence, their importance is revealed. We should say their names as a proxy incantation to break the viral (or whatever is plaguing the unit at that time) spell.

Although the headlines remind us daily of the unforgiving uncertainty of medicine, what is certain is that countless of PPE-clad healthcare workers will hold the fort, taking turns to care for all patients, until the pandemic is defeated. COVID-19 continues to teach us about ourselves and our irrevocable relatedness. “Bless you” after a sneeze can have an ominous undertone. I am optimistic that years from now, we shall remember the sound of 7 o’clock and how the lockdown gave us a renewed appreciation of our colleagues and family-at-work, especially those who are no longer with us.

Fidelindo Lim is clinical associate professor at New York University – Rory Meyers College of Nursing.

*The August issue of American Nurse Journal provides excerpts from some of the tributes in “Lost on the Frontline.”