Particles of the Mers coronavirus are seen in a colourised transmission electron micrograph.
Reuters/New York
The biggest risk that Middle East Respiratory Syndrome will become a global epidemic, ironically, may lie with globe-trotting healthcare workers.
From Houston to Manila, doctors and nurses are recruited for lucrative postings in Saudi Arabia, where Mers was first identified in 2012. Because the kingdom has stepped up hiring of foreign healthcare professionals in the last few years, disease experts said, there is a good chance the Mers virus will hitch a ride on workers as they return home.
“This is how Mers might spread around the world,” said infectious disease expert Dr Amesh Adalja of the University of Pittsburgh Medical Centre.
It can take five to 14 days for someone infected with Mers to show symptoms, more than enough time for a contagious person to fly to the other side of the world without being detectable.
Healthcare workers “are at extremely high risk of contracting Mers compared to the general public”, Adalja said.
The threat has attracted new attention with the confirmation of the first two Mers cases in the United States. Both are healthcare workers who fell ill shortly after leaving their work in Saudi hospitals and boarding planes bound west.
About one-third of the Mers cases treated in hospitals in Jeddah were healthcare workers, according to the World Health Organisation.
Despite the risk, few of the healthcare workers now in, or planning to go to, Saudi Arabia are having second thoughts about working there, according to nurses, doctors and recruiters interviewed by Reuters.
Michelle Tatro, 28, leaves next week for the kingdom, where she will work as an open-heart-surgery nurse. Tatro, who typically does 13-week stints at hospitals around the United States, said her family had sent her articles about Mers, but she wasn’t worried.
“I was so glad to get this job,” she said. “Travel is my number one passion.”
So far, international health authorities have not publicly expressed concern about the flow of expatriate medical workers to and from Saudi Arabia.
“There is not much public health authorities or border agents can do,” said infectious disease expert Dr Michael Osterholm of the University of Minnesota. “Sure, they can ask people, ‘did you work in a healthcare facility in Saudi Arabia,’ but if the answer is yes, then what?”
Healthcare workers are best placed to understand the Mers risk, Osterholm said, and “there should be a heightened awareness among them of possible Mers symptoms.”
Neither the Centres for Disease Control and Prevention nor the Department of Homeland Security responded to questions about whether they were considering monitoring healthcare workers returning to the United States.
In the last few years, the number of expatriates working in Saudi Arabia has soared, said Suleiman Arabie, managing director of Houston, Texas-based recruiting firm SA International, with thousands now working in the kingdom.
About 15% of physicians working in the kingdom are American or European, and some 40% of nurses are Filipino or Malaysian, according to estimates by recruiters and people who have worked in hospitals there.
The majority of US-trained medical staff are on one- or two-year contracts, which results in significant churn as workers rotate in and out of Saudi medical facilities.
One Filipina nurse, who spoke anonymously so as not to hurt her job prospects, said she was “willing to go to Saudi Arabia because I don’t get enough pay here”. In a private hospital in Manila, she made 800 pesos (about $18) a day.
“I know the risks abroad but I’d rather take it than stay here,” she said. “I am not worried about Mers virus. I know how to take care of myself and I have the proper training.”
None of Arabie’s potential candidates “have expressed any concern” about Mers. Only one of the hundreds of professionals placed by Toronto-based medical staffing firm Helen Ziegler & Associates Inc. decided to return to the United States because of Mers, it said, and one decided not to accept a job in Jeddah she had been hired for.
Recruitment agencies in Manila have also continued to send nurses to the kingdom since the Mers outbreak, said Hans Leo Cacdac, the head of the Philippine Overseas Employment Administration. The government advises that returning workers be screened for Mers, Labour and Employment Secretary Rosalinda Baldoz said this week.
Expat healthcare workers now working in Saudi Arabia feel confident local authorities are taking the necessary steps to combat the spread of Mers in hospitals.
“Just today they came and put up giant posters in our hospital on Mers,” said Dr Taher Kagalwala, a paediatrician originally from Mumbai who works at Al Moweh General Hospital in a town about 180km from Tai’f city in western Saudi Arabia.
“I have not heard of or seen any healthcare workers looking to leave their jobs or return to their countries because of the Mers panic. If it was happening, there would have been gossip very soon.”
Saudi reports five new deaths from virus
Saudi Arabia has reported five new deaths from the Mers respiratory virus, bringing the death toll in the world’s worst-hit country to 168. In its latest tally, issued on Saturday, the health ministry said the total number of infections in the kingdom now stood at 529 people. Among the latest fatalities were two men aged 67 and 55 and an 80-year-old woman in Jeddah, the port city where a spate of cases among staff at King Fahd Hospital last month led to the dismissal of its director and the health minister. In addition, a 71-year-old man and another aged 77 died in Riyadh and Madinah respectively, the ministry website reported. Other nations including Egypt, Jordan, Lebanon, the Netherlands, the UAE and the United States have also recorded cases, mostly in people who had been to the kingdom.