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Raising Awareness: Many roads lead to sepsis, even for COVID-19 patients

Author: Timothy G. Buchman, MD, and Steven Q. Simpson, MD, BARDA/DRIVe
Published Date: 5/15/2020 5:30:00 PM
Category: Medical Countermeasures; Response & Recovery;

COVID-19 patients who are ill enough to require admission to an intensive care unit (ICU), often suffer from a major organ dysfunction. As a pair of critical care physicians with more than 80 years of combined service at the bedside in the ICU, we have spent our entire professional lives caring for patients with life-threatening organ dysfunction resulting from infections. We recognize this condition; it’s called sepsis.

While the most widely reported organ dysfunction for COVID-19 patients involves the lungs, many of these patients also have some combination of heart and blood vessel dysfunction, brain and nerve dysfunction, blood coagulation dysfunction, and kidney dysfunction. The severity of these dysfunctions beyond the lungs and the rate at which they are occurring are remarkable—even to experienced ICU staff.

Thus far in the pandemic, ICUs worldwide are reporting that some patients who have COVID-19 severe enough to warrant admission to the ICU require at least temporary dialysis. ICU doctors, nurses, and allied health personnel think of this as life-threatening multiple organ dysfunction due to infection with the SARS-CoV-2 virus. In other words, sepsis.

These patients are far from alone. A landmark study published in Critical Care Medicine in February, found that even before the pandemic, sepsis was increasing, especially among older Americans. While most sepsis is caused by bacteria, sepsis caused by viruses (“viral sepsis”) is familiar. We treat it every year when it is caused by influenza during flu season. Even when caused by less common viruses such as Ebola, the problem – and the treatments we apply — are all aimed at “bad viral sepsis”.

Why is this important?

Timely recognition and treatment of sepsis –bacterial or viral—is key to saving lives. Everyone—professionals and the lay public—need to know the signs of sepsis and the importance of seeking medical attention when sepsis appears. The CDC offers a large collection of educational material to help healthcare providers and patients on the Get Ahead of Sepsis website.

A simple memory aid may also be useful, such as the Sepsis Alliance acronym TIME:

  • T: A high Temperature or fever
  • I: Signs of Infection, such as the dry cough, which has been a common manifestation of COVID-19 progression.
  • M: Mental confusion that is typically precipitated by the low oxygen levels commonly experienced by those affected with SARS-CoV-2.
  • E: Extremely ill, as symptoms accumulate and become more severe, including the subjective sense that things are getting worse.

While all four of these signs may not be present simultaneously, each can herald the decompensation that is sepsis. If you or someone you know has at least a couple of these symptoms, it’s TIME to seek immediate medical attention.

The foundation of sepsis care is supporting the dysfunctional organs so they can recover as the body fights off the infection. Treatments may be necessary to counteract the virus (in this case, SARS-CoV-2) as well as the progression to sepsis and managing the condition. These treatments include anti-viral treatments, immuno-inflammatory treatments, and/or organ-specific treatments. Ventilators are used to support the lungs, dialysis machines are used to support the kidneys, and anticoagulation therapy is used to prevent and treat thrombosis.

While there are general clinical guidelines for the use of such well-established treatments for sepsis, doctors are studying modifications to these treatments so that they are most effective in treating patients whose sepsis is brought on by severe COVID-19. BARDA is supporting clinical trials of some of these treatments being studied specific to COVID-19.

As scientists unravel the “why” behind specific dysfunctions caused by SARS-CoV-2—why the kidneys stop making urine, why blood clots when it should otherwise be flowing, why the lungs fill with fluid—doctors will apply that knowledge to give patients the best chance to recover.

We hasten to add that we are still learning, even as we treat patients every day in our ICUs. Like you, your families, your friends, and your colleagues, we too struggle to find the best way forward. We hope that by bringing our sepsis perspective to the public health emergency, we can help you—and the world—understand just a bit more clearly what the virus is doing and what can be done to control its effects.


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