A hospital outbreak of MERS caused emotional turmoil and stress in healthcare workers, particularly after some of their own colleagues became so seriously infected they had to be put on ventilator support, a recent study reports.1

The unusual study looked at the emotional toll and stress on healthcare workers during a 2014 MERS outbreak in King Faisal Specialist Hospital & Research Center, a 420-bed tertiary care hospital in Jeddah, Saudi Arabia. The three severely infected workers survived, but seeing their condition with the knowledge that healthcare workers had died of MERS in other outbreaks was unsettling to staff, Imran Khalid, MD, a pulmonary and critical care physician at the hospital and lead author of the study, says in an email to Hospital Employee Health.

“The healthcare workers were really disturbed to see that MERS is able to cause fatal infections in previously healthy people and transmit from asymptomatic patients,” Khalid says. “However, fears were eased once the outbreak came under control in 2014, and also since then, no more cases have been seen in our hospital. There were 12 healthcare workers who were infected with MERS. Three required ICU [treatment] but all survived and are back to work.”

The three severely infected workers suffered respiratory failure, leading to intubation and mechanical ventilation to keep them alive. Eight patients infected with MERS developed pneumonia and died during the outbreak.

“Among the various stressors related to the MERS-CoV outbreak, safety was the main concern for the staff,” Khalid and colleagues concluded in the study. “It was extremely stressful for them to see their colleagues getting intubated, patients dying in front of them from MERS, as well as the fear that they could transmit the disease to their families or friends.”

Similar concerns were expressed by healthcare workers in Toronto during the 2003 outbreak of SARS coronavirus. There were reports of workers removing all work clothes before going into their homes, afraid they would infect their families. The toll was such that a veteran Toronto nurse, who survived a SARS infection, was planning to quit when pandemic H1N1 influenza A first emerged in 2009.

“I didn’t really realize how much SARS affected me until H1N1 came out, and I thought, ‘I cannot go through this again, I just can’t,’” the nurse said.2 “I was surprised at my reaction. I love nursing and my patients, but if it meant losing my job, that would be it for me.”

H1N1 flu turned out to be milder than first feared, but at least one U.S. nurse died. Though it was not definitive whether infection was acquired in the community or the hospital, a previously healthy California nurse died of complications from H1N1 infection that included severe respiratory infection and pneumonia. (For more information, see the October 2009 issue of HEH.)

“There are still concerns regarding MERS, but they have eased as no more cases are reported in our locality,” Khalid says. “Also, fears are less now, as no healthcare worker died in our hospital.”

Khalid and colleagues surveyed 150 clinical staff who worked in high-risk areas during the April–May 2014 MERS outbreak at the hospital. The results for the 117 (78%) respondents indicate a positive attitude and the sense of an “ethical obligation” to provide care drove workers onward. The improving condition of infected colleagues and adoption of rigorous infection control precautions were reassuring to the workers, who also cited positives such as recognition by hospital administration and replenished PPE supplies. Staff followed standard (a.k.a. “universal”) precautions and wore scrubs that were disposed of at the end of the work day. They also avoided community contact in a kind of “semi-quarantine,” the study found.

“The staff, however, did feel fearful during the outbreak,” Khalid and colleagues noted. “They appreciated the extra financial compensation and recognition given to them by the hospital. They tried to limit their exposure to patients with MERS, and were reluctant to work overtime. … Seeing colleagues contracting the infection, getting sicker, and being intubated for respiratory failure was very distressing. Caring for these sick colleagues also put them under enormous emotional burden.”


  1. Khalid I, Khalid TJ, Qabajah MR, et al. Healthcare Workers’ Emotions, Perceived Stressors and Coping Strategies During a MERS-CoV Outbreak. Clinical Medicine & Research 2016;14:7-14.
  2. Ontario Nurses Association. Special report: Ten Years after SARS. Toronto. 2013:1-8: http://bit.ly/2a7H5Bk.