Critically ill healthcare workers with the middle east respiratory syndrome (MERS): A multicenter study

Abstract

BackgroundMiddle East Respiratory Syndrome Coronavirus (MERS-CoV) leads to healthcare-associated transmission to patients and healthcare workers with potentially fatal outcomes.AimWe aimed to describe the clinical course and functional outcomes of critically ill healthcare workers (HCWs) with MERS.MethodsData on HCWs was extracted from a multi-center retrospective cohort study on 330 critically ill patients with MERS admitted between (9/2012–9/2015). Baseline demographics, interventions and outcomes were recorded and compared between survivors and non-survivors. Survivors were approached with questionnaires to elucidate their functional outcomes using Karnofsky Performance Status Scale.FindingsThirty-Two HCWs met the inclusion criteria. Comorbidities were recorded in 34% (11/32) HCW. Death resulted in 8/32 (25%) HCWs including all 5 HCWs with chronic renal impairment at baseline. Non-surviving HCW had lower PaO2/FiO2 ratios 63.5 (57, 116.2) vs 148 (84, 194.3), p = 0.043, and received more ECMO therapy compared to survivors, 9/32 (28%) vs 4/24 (16.7%) respectively (p = 0.02).Thirteen of the surviving (13/24) HCWs responded to the questionnaire. Two HCWs confirmed functional limitations. Median number of days from hospital discharge until the questionnaires were filled was 580 (95% CI 568, 723.5) days.ConclusionApproximately 10% of critically ill patients with MERS were HCWs. Hospital mortality rate was substantial (25%). Patients with chronic renal impairment represented a particularly high-risk group that should receive extra caution during suspected or confirmed MERS cases clinical care assignment and during outbreaks. Long-term repercussions of critical illness due to MERS on HCWs in particular, and patients in general, remain unknown and should be investigated in larger studies.

COVID-19: a novel coronavirus and a novel challenge for critical care

“…Nosocomial transmission to other patients and transmission to HCWs has been a major feature of both outbreaks of SARS, MERS and now COVID-19 [15,21]. In one report, 41% of hospitalized COVID-19 cases were acquired in hospital, including patients who were already hospitalized for other reasons and healthcare workers [15].…”

Severe Middle East Respiratory Syndrome (MERS) Pneumonia

“…Fever at presentation, was found in 30/32 (93.8%), cough in 25/32 (78.1%), and gastrointestinal symptoms in11/32 (34.4%). Eight out of the 32 (25%) healthcare workers died (Shalhoub et al, 2018).…”

“…In one case-control study of patients with MERS, the rescue use of ECMO compared to a matched control with no-ECMO was associated with reduced in-hospital-mortality (65% compared 100%) (Alshahrani et al, 2018). Another retrospective study, found that critically ill healthcare workers who died because of MERS were more likely to have received ECMO than not, probably because the severity of pneumonia that led to use of rescue therapy, rather than use of ECMO itself (Shalhoub et al, 2018). Corticosteroids have been used frequently in MERS patients.…”

Advances in respiratory virus therapeutics – A meeting report from the 6th isirv Antiviral Group conference

“…Ribavirin and interferon α2b treatment produced promising preclinical data in rhesus macaques, including moderate reductions in viral load and partially effective prevention of progression to pneumonia when infected animals were compared with untreated infected controls (Falzarano et al, 2013). However, data on MERS-CoV infected patients treated with a combination of ribavirin and interferon (either α2a or β1) have been inconsistent depending on the statistical analysis methods used to compare the datasets (Al Ghamdi et al, 2016;Al-Tawfiq et al, 2014;Omrani et al, 2014;Shalhoub et al, 2018). The largest study that adjusted for time-varying confounders that might influence the decision to initiate ribavirin and interferon therapy did not show an improvement in mortality (Arabi et al, 2017a).…”