Older doctors must not be sacrificed for the greater good, warn Irene Stratton, Richard Quinton, Adrian Davis, and Graham Roberts
In addition to those already working in clinical roles, the battalions of frontline staff lined up to tackle covid-19 comprise those who have recently left or retired from the NHS. 
While everyone needs to play their part, the NHS should first look to the evidence from Italy before we ask older clinicians—those aged 50 and over—to return to the front line. If we do not, we risk staff becoming patients and blocking beds, or worse, the loss of life.
The bulletins posted by the statistical service of the Italian Ministry of Health are particularly informative when considering those most at risk. [2-6] They show that as of 30th March 2020, 94,312 people had been tested as positive for covid-19, 10,026 of whom had died (10.6%).
The data are not sufficient to estimate the proportion of deaths in each age group. However, what we can see is that men who have been tested as positive up to the age of 69 are more than twice as likely to die as women of the same age.
The age gradient is even more striking—just 20 of 6,523 people (0.3%) aged 30 to 39 who had tested positive have died, but 1,161 of 16,328 (7%) of those 60 to 69 years of age have died. We also know that in Italy 52 male medical or dental doctors and 3 females have died (excluding those known to be retired).
Given these data, workforce strategies in the NHS must do all they can to protect older staff. If we ensure that clinical contacts with patients with confirmed or suspected covid-19 are performed by younger healthcare workers—those under the age of 50—then we can hopefully reduce the number of staff who will require care if they become infected.
Older male doctors are more likely to require ventilation if they do become ill, so we must prevent them from bearing a disproportionate burden in terms of morbidity and mortality.
Similar considerations should be made when allocating roles to older members of the newly recruited NHS volunteer army.
In the coming months and years, the NHS is going to need the experience, skills, and knowledge of clinicians, nurses, scientists and other healthcare staff who are in their 50s and 60s now. We should not send them into the front line now without due consideration—we would not want the battle against covid-19 to be seen as Gallipoli for older NHS staff.
Irene Stratton is a Senior Medical Statistician at the Gloucestershire Retinal Research Group, Cheltenham General Hospital, Cheltenham, UK
Richard Quinton is a Senior Lecturer at the Translational & Clinical Research Institute, University of Newcastle-upon-Tyne, UK.
Adrian Davis is an Imperial College Visiting Professor of ENT & Audiology, UCL Honorary Professor of Hearing and Communication, LSE Visiting professor of Population Health and Anglia Ruskin university visiting professor of Hearing and Vision
Graham Roberts is a member of the HRB-Clinical Research Facility, University College Cork, Cork, Ireland and Swansea University, Swansea, UK.
- Roberts G, Quinton R and Stratton I. https://www.bmj.com/content/368/bmj.m1173/rr-0
- (No Title) [Internet]. [cited 2020 Mar 28]. Available from:https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_26…
- Caratteristiche dei pazienti deceduti positivi a COVID-19 in Italia [Internet]. [cited 2020 Mar 28].Available from: https://www.epicentro.iss.it/coronavirus/sars-cov-2-decessi-italia
- Coronavirus, i medici morti: le storie di chi si è sacrificato – Corriere.it [Internet]. [cited 2020 Mar 28]. Available from: https://www.corriere.it/cronache/cards/coronavirus-sacrificio-41-medici-chi-sono-storie-volti-sacrifici/spoon-river_principale.shtml
Competing interests: No competing interests