Sepsis and COVID-19 / Coronavirus / SARS-CoV-2
Welcome to our information page on sepsis and COVID-19 – on this page, we will share up-to-date information, stories, and insights from our network of experts. Knowledge sharing will contribute to the global fight against COVID-19.
On January 30th, the World Health Organization declared the 2019 Novel Coronavirus (SARS-CoV-2*) a global health emergency.
Since then, we have published two articles explaining the relationship between COVID-19 and sepsis, supported an ‘Charité Hot Topics’ Event on this topic, as well as incorporated it into the program of the 3rd Annual Meeting of the European Sepsis Alliance.
Questions and Answers
Can COVID-19 cause sepsis?
Sepsis is “a life-threatening organ dysfunction caused by a dysregulated host response to infection.” In the case of COVID-19, the effects on the respiratory system are well-known, with most people requiring hospital admission developing pneumonia of varying severity; however, virtually all other organ systems can be affected. Now that more scientific data are available on COVID-19, the Global Sepsis Alliance can more definitively state that COVID-19 does indeed cause sepsis. Signs of multi-organ injury typical of sepsis occur in approximately 2-5% of those with COVID-19 after approximately 8-10 days. Many patients affected by COVID-19 will die from sepsis and its complications. It is therefore vital to know and recognize early signs of sepsis, and initiate prompt treatment when diagnosed. Timely intervention saves life and organ function.
Can COVID-19 be treated?
Effective and safe treatments for COVID-19 are urgently being sought by scientists across the world. Although the first candidate vaccines began to be tested in humans in April 2020, large-scale distribution of a viable vaccine may still be a year or more away1. Treatment trials are underway with antiviral agents such as Lopinavir/ritonavir (LPV/r), Hydroxychloroquine (HCG), Hydroxychloroquine plus azithromycin, Favipiravir (FPV), Remdesivir (RDV), and with immunomodulators such as Tocilizumab, the anti-C5a antibody IFX-1, and Intravenous Immunoglobulin (IVIG). In addition, treatment with convalescent plasma (blood from individuals who have recovered from COVID-19) is being actively trialed.
However, despite these efforts, presently there are no specific treatments for COVID-19.
Are sepsis survivors at higher risk of COVID-19 infection?
Similar to sepsis, anybody can get COVID-19, but some people are at higher risk. People with a weak immune system are among the categories at a higher risk of getting COVID-19. Overall, sepsis survivors are at risk of contracting infections within a few months of their recovery. This would include any infection, including COVID-19. However, there is no scientific literature that shows a connection between surviving sepsis and developing illness from the new coronavirus.
When should one seek urgent help?
In order not to overwhelm the already strained healthcare system, the general recommendation is not to go to the hospital if only minor signs of COVID-19 appear, but rather to self-isolate and monitor the progression of the disease.
We usually recommend that people with symptoms of an infection seek medical help urgently, and ask "Could it be sepsis?”, if they also develop one of the following:
Slurred speech or confusion
Extreme pain in the muscles or joints
Passing no urine in a day
Severe breathlessness
“It feels like I’m going to die”
Skin that’s mottled, discolored or very pale
Of course, breathlessness is also a symptom of COVID-19. We would therefore suggest that at this time you seek help based on severe breathlessness only if you find that you (or another adult) are very short of breath at rest, are breathing very rapidly (more than one breath every 2 seconds), cannot say more than 2-3 words at a time or notice a bluish discoloration of the lips, fingers, or toes.
Additional Questions
If you have additional questions, please continue to submit them, we will update this section regularly.
Research
Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report
Despite the methodology having been questioned around the lack of 'blinding' (meaning clinicians knew which drug the patient was on and might therefore have been biased in their other treatments) and the reporting having some gaps, this study reports important preliminary results about the administration of dexamethasone to COVID-19 patients in the UK. The results show that dexamethasone appeared to reduce deaths by one-third in patients receiving invasive mechanical ventilation and by one-fifth in patients receiving oxygen without invasive mechanical ventilation. It did not reduce mortality in patients not receiving respiratory support, and indeed seem to increase mortality in these patients. These pre-print data therefore confirm that preventive use of dexamethasone in patients not needing mechanical ventilation does not bring benefits and might cause harm.
Author: Peter Horby et al.
Journal: MedRxive
Date of publication: June 2020
Coronavirus Infections in Children, Including COVID-19
From this review on children and coronavirus, it appears that for the SARS of 2003, the MERS-CoV as for the SARS-CoV-2, children are less often infected and less severely than adults. Also, most of the children were infected from a family member, symptomatic before them, which would lead to say that the transmission is mainly from the adult to the child more than from the child to the adult. However, in the absence of a large population study, it is difficult to know the true role of children in the epidemic.
Author: Petra Zimmermann
Journal: The Pediatric Infectious Disease Journal
Date of publication: May 2020
Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study
The study analyses a series of measures taken in Hong Kong:
wide screening for symptomatic and asymptomatic workers from other regions
systematic hospitalization of positive cases until negativation of tests
search for contact cases up to 48 hours before the first symptoms
quarantine in specific structures
measures of social distance including school closure and wearing of masks
Results: as of March 31, 715 cumulative cases of SARS-CoV-2 (621 asymptomatic and 94 symptomatic) said 386 imported cases, 142 cases unrelated to other cases and 187 secondary cases. Maintaining an R0 around 1 without the need for containment. This combination of measures has also had a drastic impact on the influenza transmission.
Author: Benjamin J Cowling
Journal: The Lancet
Date of publication: April 17th, 2020
The characteristics of household transmission of COVID-19
This study considered 105 index points and 392 contacts in households. Secondary transmission occurred in 16.4% of family contacts. The secondary attack rate was lower among children (4%) than adults (17%). It was 0% in the 14 index cases who had isolated themselves in a separate room and with a mask when symptoms appeared vs 16.9% in the opposite case. Partners were more often infected than other family members (attack rate 27.8% vs 17.3%). This study would point to a lower intra-familial transmission of the infection in children, but the debate is still open.
Author: Wei Li
Journal: Clinical Infectious Diseases
Date of publication: April 17th, 2020
The critical role of laboratory medicine during coronavirus disease 2019 (COVID-19) and other viral outbreaks.
One obvious question is whether, and eventually, how, laboratory diagnostics could efficiently contribute to counteracting this and other future viral outbreaks. There are at least three areas where in vitro diagnostics can provide essential contributions to the diagnostic reasoning and managed care of patients with suspected or confirmed SARS-CoV-2 infection.
Author: Mario Plebani
Journal: Clinical Chemistry and Laboratory Medicine CCLM
Date of publication: March 19th, 2020
Expert Insights
EXPERT: SEVERE COVID-19 ILLNESS IS VIRAL SEPSIS
Steven Simpson, MD, professor of pulmonary and critical care medicine at The University of Kansas in Kansas City and medical adviser for the Sepsis Alliance, recently explained in an interview to HealthLeaders that seriously ill COVID-19 patients have viral sepsis, confirming that a structured approach to sepsis management is essential for infection prevention and control.
"Sepsis is life-threatening organ dysfunction due to a dysregulated host response to an infection. In COVID-19 sepsis, the infection is the virus, and the life-threatening organ dysfunction is all the organs that can dysfunction, including lungs, brain, kidneys, heart, and liver. These are all organs that are classically associated with sepsis. COVID-19 that causes organ dysfunction is viral sepsis," Prof. Simpson said.
COVID-19 is adding to already burgeoning rates of sepsis, say experts
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. 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.
In COVID-19 Pandemic, People Are Dying of Sepsis, Says GSA Executive Committee Member Professor Flavia Machado at Interview With Jama Network
GSA Executive Committee member Prof. Flavia Machado was interviewed by the JAMA Network on "Coronavirus in Brazil - Report From The Front Lines".
The interview provides a very insightful overview on how Brazil is tackling the pandemic, the efficiency of treatments, and solutions adopted by hospitals to respond to the crisis. Interestingly, Prof. Machado confirmed that in most cases people are dying from refractory septic shock rather than refractory hypoxemia.
The Survivor Experience
Abdulelah Alhawsawi
As a healthcare professional (hepatobiliary surgeon), and as the leader of our national patient safety organization, you think that you have seen it all. Well, that perception had to be re-evaluated the moment I was told: “You tested positive for COVID-19…”
Coronavirus patients with even mild cases of COVID-19 are taking months to recover and suffering extreme fatigue
We report here an interesting article from Australian broadcaster ABC News, where professor Paul Garner, from the Liverpool School of Tropical Medicine, talks about COVID-19: "It's the worst illness I've ever had," he told the news program 7.30. The article confirms that the disease can cause effects on different organs. It also highlights that the recovery time post COVID-19 varies from two up to six weeks, but some patients are experiencing fatigue and breathlessness well beyond the suggested recovery period. Post viral fatigue, effects on people's exercise tolerance, on neuro-cognitive function, on the ability to concentrate, are some of the effects of the disease. These are similar to the post-sepsis symptoms.
*For simplicity, we’ll refer to the virus as COVID-19, even though it’s technically SARS-CoV-2, and the disease it can cause is COVID-19 (by analogy: HIV = virus, AIDS = the disease it can cause).