Random Analytica

Since my last Middle Eastern Respiratory Syndrome update (21 May 2014) there have been a number of key developments and even some improvements in data quality coming out of the Kingdom of Saudi Arabia.

The big announcement since my previous post was the addition of 113 legacy cases by the KSA Ministry of Health. Of the 113-cases, 42 were Health Care Workers and are included in the following charts.

Almost as importantly, the Saudi’s are now sharing their data with the World Health Organisation (WHO). The Disease Outbreak Notifications, or DON’s, are very comprehensive, light-years away from the Health Ministries updates of the past. With some irony I was pleased to see that Iran and the Kingdom featured together in the most recent DON. Perhaps we are seeing a form of MERS diplomacy occurring.

Here are the latest MERS by Occupation charts.

***** Please note that all infographics for this MERS-CoV article are using publically sourced information to 1200hrs 4 July 2014 (EST) *****

This first chart looks at those infected with MERS by Job Title or Function.

Key Notes:

• Retired: The largest group. There are 150-retirees (39.5% of known job titles) represented in this chart but only 2 have been confirmed (1.3%). The bulk of the retirees represented in the chart are included if they did not have a job title or function attributed to them AND if their ages are greater than the official retirement age for their home country.
• Health Care Workers (HCW): The second largest group. Includes all types of unidentified workers in the Health sector (i.e. Nurses and Doctors).
• Nurse: I have been able to identify 23-Nurses and in at least two cases, their speciality (ER & ICU).
• Farmer: Includes both Owners (9/75%) and Employees (3/25%). I suspect the higher weighting toward owners is due to the fact that they are all nationals (from KSA, Qatar and the UAE). The three farm employees that have been identified are all resident workers. Just a thought here. Rich owners get to see the doctor while residents might have a range of barriers which reduce their ability to receive primary care services or choose to work through what they might believe is a bad flu.
• Pilgrim: Of the 11-Pilgrims I have been able to identify I believe at least 8 were Umrah linked while three were potentially due to the Haj.
• Doctor: Six identified, including one surgeon and one ICU specialist.This infographic looks at those infected with MERS-CoV by Job Family. In short I think this is a key infographic for MERS as it gives you some confidence in the key narratives (i.e. that Health Care Workers are over represented in the data as an example).

Next chart, Job Families:

Key Notes:

• With the inclusion of an additional 42 Health Care Workers the Non-Participatory (156/18.6%) group (Paediatrics, Students, Retiree’s and the Unemployed) move from the largest to the second largest Job Family.
• Health Practitioners/Technical Operations (159/19.0%) or HCW as there more commonly known become the largest Job Family represented. This number includes the Nursing Assistant that was identified in Iran (but more on that later).
• Paediatrics (18/2.1%) numbers have declined since the last update when they represented just 2.8% of the data then. Still seems low and Maia Majumder picked up on this in a recent post.
• Pilgrim/Tourist (14/1.6%) has seen a slight increase due to some Umrah inclusions recently.
• Healthcare Support (6/0.7%) numbers remain static so not sure if the Saudi announcement of legacy cases conflates HCW and HCSpt numbers.
• Construction (2/0.2%) is a new inclusion from the previous update. Given the amount of building going on the in the Middle East, especially in Qatar this number seems on the very low side. I’d expect to see this number increase with more robust reporting.

Last chart.

The last chart looks at those overall main job families that are most impacted by MERS, specifically Farmers, Travellers, Paediatrics, Retirees, HCW & HCSpt (combined), Other and Unknown.

Key Notes:

• Farmer (1.7%): With only 14 confirmed cases apart from 2013 you can barely see them across an entire year, quarter or month. Numbers seem low.
• Traveller (1.7%): Like farming, numbers seem low.
• Paediatrics (2.1%): As suggested previously, no new paediatric cases since my last update so the numbers have declined somewhat.
• HCW & HCSpt (19.7%): Health Care Workers and I have also included Health Care Support Workers in this grouping as well. Numbers up on previous update due to the additional 42-cases.
• Other (2.3%): All other occupations that have been publically released. I’ve actually reduced the number in this group by one from the last update due to improved reporting from Saudi Arabia.
• Unknown (54.7%): Unknown occupations. Up slightly but with improved reporting I’m hoping that this will reduce (over time).

Final Thoughts (on the difference between a Health Care Worker and Health Care Support

Last month I tweeted that the Iranian Nursing Assistant (FT #827) should be counted as a Health Care Support worker rather than a HCW. I then got a number of return tweets from the likes of Helen Branswell, Ian M Mackay and others who disagreed with that line of thought.

When Helen and Ian ‘guide and advise’ it’s probably worth not disregarding that advice. Upon some personal review I decided that perhaps I had taken a too hard Workforce Planning line to my job functions without fully considering the clinical implications.

I have subsequently reviewed my thinking and have re-organised my data along the following lines.

Health Practitioners/Technical Operations (nee HCW) are any job title or function that is included in the Bureau of Labor Statistics SOC Occupations 29-0000 Healthcare Practitioners and Technical Occupations PLUS any clinical function that is included within the 31-0000 Healthcare Support Occupations, such as Nursing Assistants.

I am continuing to track Health Care Support personnel (there are four job titles already identified in the MERS data including Health Clinic Admin Officer, Health Domain Worker, Hospital Employee, Hospital Receptionist) as I believe the differentiation from HCW is important but I am including their data in job family charts and infographics.

In the end, I made a bad call and I thank those of you who took the time to correct my thinking.

Flublogia is certainly a community and one I truly appreciate being involved in.