COVID-19 is adding to already burgeoning rates of sepsis, say experts

SYDNEY SEPT 13 - As the world heads towards 27.5 million cases and 900,000 deaths from COVID-191, experts are calling for renewed focus on the global burden of sepsis from all causes in the lead up to World Sepsis Day on September 13.

Sepsis is the pathway to death for almost all infections, including COVID-19. It is a time-critical medical emergency that arises when the body’s response to an infection damages its own tissues and organs. It can lead to shock, failure of multiple organs, and death if not recognized early and treated promptly.

The George Institute’s Professor Simon Finfer said that severely ill COVID-19 patients are suffering the same organ failures and injuries as those affected with sepsis from other disease-causing organisms—such as bacteria, viruses including corona viruses, fungi, or parasites.

“As the pandemic progresses, we are seeing data from Italy, the USA, UK and now Australia showing that the majority of patients ventilated for COVID-19 have septic shock and up to a quarter have sepsis-induced kidney failure requiring dialysis,” he said.

“COVID-19 in its clinical form is sepsis - we see the same features in deaths from COVID, such as severe lung injury requiring ventilator support and the shutting down of the body’s major organs. But the fact that it is not widely viewed as viral sepsis shows how poorly sepsis is understood by the general public as well as many healthcare workers.”

In the first six month of the pandemic, there were 17.3 million confirmed COVID-19 infections and 673,833 reported deaths1. Yet, in the same six months in 2017 there were close to 25 million non-COVID sepsis cases resulting in an estimated 5.5 million deaths2.

Despite the fact that sepsis kills four times as many Australians as road accidents and twice as many as prostate or breast cancer, awareness remains low.

A recent survey conducted by The George Institute revealed that while six in ten (59 percent) had heard of sepsis as a medical condition, more than eight in ten (83 percent) were unaware of the link between COVID-19 and sepsis. More than one in ten were unable to name any symptoms of sepsis.

“Given that four in five cases of sepsis start outside hospital, being able to recognise the point where a seemingly simple infection is developing into life-threatening sepsis is crucial to accessing the right medical care quickly,” said Prof Finfer.

“This is particularly important for those isolated or in quarantine with mild COVID-19, as progression to sepsis often occurs after several days of milder symptoms,” he added.

There are more lessons to be learned from the longer-term battle with sepsis, especially when it comes to recovery. Like those who’ve had sepsis, many COVID-19 survivors – especially those who have spent time in ICU - are likely to feel the after-effects for some time.

“While the immediate focus with COVID patients may be on simply getting them out of hospital, we know from sepsis research that long term recovery can be challenging. We’re now starting to see more information about the lasting effects of COVID-19 as more patients move into the recovery phase,” said Prof Finfer.

Post-sepsis syndrome, which is the persistence of new or worsened physical, cognitive and/or mental health impairments after leaving hospital, is seen in up to 80 percent of patients who survive after receiving ventilator support in the ICU4.

While data specific to COVID-19 is still emerging, a small study in Italy - one of the first countries to be hit hard by the virus - found that nearly 90 percent of patients who went on to recover from COVID-19 still had at least one symptom an average of two months after their first symptoms. These were most commonly fatigue and difficulty breathing5.

With record rates of severe critical illness during the COVID-19 pandemic, the crucial role of intensive care units and the specialist medical staff who work in them has never been more visible. Prof Finfer is part of an international network of critical care experts now calling for a renewed focus on addressing the global burden of sepsis.

“The response of many governments, including Australia’s, and the wider medical community to the pandemic has been swift and wide-ranging with effective messaging to the public and healthcare workers,” he said.

“Hopefully we will get an effective vaccine and the pandemic will pass, but when it has, the increasing loss of life and health from sepsis caused by other infections will continue.

“We urge all governments, policy makers and research funders to apply the same commitment to reducing the toll of sepsis as has been applied to the control of the COVID-19 pandemic,” he added.