In Canada, the risk of sepsis from COVID-19 is low for the general population, although slightly higher in people with compromised immunity or the elderly. In Canada, which has a robust health care system, and significantly improved survival rates for sepsis over the past two decades, clinicians will be able to identify and manage patients with COVID-19.
Our colleagues at the Global Sepsis Alliance (GSA) report the following:
On January 30th, the World Health Organization declared the 2019 Novel Coronavirus (SARS-CoV-2*) a global health emergency, declaring it an “unprecedented outbreak.” Legitimate concerns of a deadly pandemic have increased due to the virus continuing to spread worldwide, with cases reported in 73 countries spanning across Europe, Asia, South America, North America, and the Eastern Mediterranean Region.
As with every major public health crisis, misinformation and fear run rampant. The importance of fact-based information is tantamount. To this end, the Global Sepsis Alliance would like to provide the following answer to the question of whether COVID-19 can cause sepsis. The answer is a qualified “YES.”
The presently accepted definition of sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. From information presently available on clinical cases of COVID-19, it appears that a small percentage of COVID-19 infections can result in such organ dysfunction and death.
To date, the most reliable information on the clinical syndrome resulting from COVID-19 comes from recently published data out of Wuhan, China and was published in the Journal of the American Medical Association (JAMA) on February 7, 2020.
The most common symptoms attributed to COVID-19 infection requiring hospitalization were fever, fatigue, and a dry cough. Most cases also had low white blood cell counts and abnormal blood clotting parameters. Of patients hospitalized with COVID-19, 26% were sick enough to be treated in an intensive care unit (ICU) – of these, approximately 60% developed respiratory failure and 31% developed shock. Prolonged hospital courses were not uncommon. Fortunately, even among patients ill enough to be hospitalized with COVID-19 infection, only 4% died – meaning that even among hospitalized COVID-19 cases, nearly 96% have survived. Broader epidemiological data from both inside and outside China also support a case fatality rate of about 1%.
However, despite the attention being paid to COVID-19, it is important to realize that it is by no means the deadliest infection globally in 2020. It is not even the deadliest virus. Fewer than 3,200 deaths have been attributed in total to COVID-19. In comparison, the influenza virus has been responsible for at least 16,000 deaths in the United States alone so far in the 2019-2020 influenza season, with an in-hospital death rate near 5% – higher than the 4% in-hospital death rate seen with COVID-19 in China. As an additional frame of reference, recent estimates place the annual deaths due to sepsis worldwide in excess of 11 million.
Treatments and vaccines are being sought with urgency but are unlikely to be available within the next year. In the meantime, all individuals, particularly those in areas where the COVID-19 has already struck, should focus on the basic protective measures recommended by the WHO – handwashing, maintaining social distancing, avoiding touching one’s face, practicing proper respiratory hygiene, staying at home if feeling unwell, and obtaining prompt medical care if the triad of fever, cough, and breathing difficulty develop.
In conclusion, while the fears of a COVID-19 pandemic are legitimate, it is the view of the GSA that robust and appropriately funded healthcare systems, having already improved the survival rates for sepsis significantly over the past two decades, will be able to adequately identify and manage patients with emerging infections such as COVID-19.
Additionally, while the majority of individuals affected by COVID-19 will not develop life-threatening sepsis, the global threat posed by COVID-19 does underpin the need for all citizens and healthcare workers to ensure they are familiar with the early signs of sepsis and appreciate that sepsis can be caused by a multitude of infections, such as this novel coronavirus, other viral infections, seasonal influenza viruses, or common bacterial infections such as pneumonia, urinary tract, abdominal, or wound infections.
Never has the slogan of the Global Sepsis Alliance rung truer than now – Stop Sepsis, Save Lives.
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 the new coronavirus.
The Global Sepsis Alliance held a livestream with a panel of experts to focusing on the relationship of COVID-19 and sepsis on March 16th.
For daily updates on COVID-19, visit the https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html, which is monitoring the situation closely.
By the Public Health Agency of Canada
The World Health Organization (WHO) has assessed COVID-19 as a pandemic. The assessment by the WHO is not unexpected.
In Canada, our health system is prepared for this situation. Since the outset, the Public Health Agency of Canada (PHAC)—along with public health authorities at all levels of government across the country—have been working together to ensure that our preparedness and response measures are appropriate and adaptable, based on the latest science and the evolving situation.
At this time, PHAC has assessed the public health risk associated with COVID-19 as low for the general population in Canada but this could change rapidly. There is an increased risk of more severe outcomes for Canadians:
Our public health efforts will continue to focus on containment to delay the onset of community spread by rapidly identifying cases, meticulously finding close contacts and using tried and true public health measures such as isolation and social distancing.
In the event of community transmission, these actions will continue to interrupt chains of transmission in the community and to delay and reduce an outbreak where possible.
In order to mitigate the impacts of COVID-19, everyone has a role to play. It takes more than governments and action from the health sector to protect the health and safety of Canadians. Each of us can help our country be prepared in the event of an emergency by understanding how coronavirus spreads and how to prevent illness.
Canadians should continue to think ahead about the actions that they can take to stay healthy and prevent the spread of any illness, especially respiratory infections.
Now and always during cold and flu season, stay home if you are sick. Encourage those you know are sick to stay home until they no longer have symptoms.
Since respiratory viruses, such as the one that causes COVID-19, are spread through contact, change how you greet one another. Instead of a handshake, a kiss or a hug, a friendly wave or elbow bump is less likely to expose you to respiratory viruses.
These are the most important ways that you can protect yourself and your family from respiratory illness, including COVID-19.
What is COVID-19?
Coronaviruses themselves are not new and for the most part, they aren’t usually serious. The common cold is a coronavirus, for example. But so are more serious infections, like SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). What these infections all have in common is their symptoms: coughing, shortness of breath, difficulty breathing, and fever. When a new coronavirus is identified, it’s called a novel coronavirus until it’s given an official name.
WHAT MAKES THIS CORONAVIRUS SPECIAL?
COVID-19, which was first discovered in China in December 2019, is a new virus with no previous history. Scientists are scrambling to find the virus origins, how it behaves, and what might kill it or prevent it. Although it has similar symptoms to seasonal influenza, SARS, MERS, and other illnesses, it’s not the same. And because it’s a new virus, scientists don’t know how it is spreading and how long it will last.
HOW SERIOUS IS COVID-19, and can it lead to sepsis?
This is an interesting question because of how the news is sharing COVID-19 information. The numbers coming from the World Health Organization (WHO) and government sources are high and can be frightening. However, it seems that most people who contract the virus experience mild to moderate symptoms of coughing, shortness of breath, and fever. But as with most infections, this coronavirus is hitting some people harder than others, causing severe cases of pneumonia, which could trigger sepsis and septic shock.
Accurate statistics may be hard to obtain, as different countries have varying ways of reporting illnesses, or even identifying them. It’s possible that many people have COVID-19 but don’t know it, chalking down their symptoms to a bad cold. So far, it seems those at highest risk of complications, including sepsis, are older people and people with chronic illnesses, such as diabetes and heart disease.
TESTING FOR COVID-19
If you have any signs of COVID-19 (cough, fever, shortness of breath) and you have reason to believe you were in contact with someone who was recently in an infected area or is showing signs of illness too, speak with your doctor.
PREVENTING CORONAVIRUS INFECTIONS
The news of the fast-spreading COVID-19 has many people worried. However, this coronavirus spreads just like other respiratory viruses, like the flu. Therefore, the best way to reduce your risk of infection is by thorough and complete hand washing with soap and water, using a hand sanitizer when you’re not near a sink, and avoiding touching your face (including your eyes) when you are outside.
You may have seen people wearing masks and hear news of masks sold out at local stores. Masks are not a good protection against COVID-19 though. First, the commercially available masks are not dense enough to prevent the virus from passing through if it is in the air, if someone coughs in your face, for example. Second, most people don’t use masks properly. Masks are not meant to be reused or handled excessively. But the basic reason is really because masks are not for you to prevent catching an infection. Masks are used to prevent you from spreading one. Therefore, in many facilities, there are signs asking you to wear a mask if you show any signs of illness.
You are much more likely to contract a virus like influenza or COVID-19 through touch. As you go outside, you may touch a doorknob, an ATM, a grocery cart – all which may have the virus on them. You then touch your face and the virus is spread. Therefore, hand washing is your best defense against infections of this type.
If you have any type of infection, including a respiratory virus like COVID-19, isolate yourself from others to prevent spreading the virus. Rest as much as you can and monitor your progress. If you get worse or show any signs of sepsis, go to your local emergency room or call 911.
To learn more information on the novel coronavirus COVID-19, visit the https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html, which is monitoring the situation closely.
Information from the Sepsis Alliance
March 2, 2020