Every 3 seconds, someone in the world dies of sepsis.
Sepsis is one of the most common but least recognised illnesses in both the developed and developing world.
In late 2019, the Fifth Senedd’s Health, Social Care and Sport Committee started an inquiry into Sepsis. One Member of that Committee Angela Burns was a sepsis survivor herself. The Committee had just began hearing oral evidence in early 2020, when COVID-19 hit. Unable to continue this work, it recommended that its successor Committee consider taking the inquiry forward.
Issues raised during the inquiry still stand, including the need to raise public and professional awareness, and the current lack of support for survivors.
The world’s focus has inevitably turned to COVID-19, but on World Sepsis Day its worth reflecting not only on the severity of sepsis itself, but also the links between the two conditions. COVID-19 can cause sepsis, and the UK Sepsis Trust says:
COVID-19 is characterised in the seriously ill by an immune overreaction to the infection causing organ damage, exactly the same mechanism as in sepsis from other causes.
Research has also confirmed that there are clear similarities between the after effects of sepsis and COVID-19, or ‘long COVID’. Therefore any support being developed for long COVID could be applicable for sepsis survivors too.
What is sepsis?
Sepsis is a life-threatening condition that arises when the immune system overreacts to an infection or injury and attacks the body’s own organs and tissues. It is a medical emergency that can result in multiple organ failure and death if not treated urgently. Yet with early diagnosis it is often easily treatable.
Five people die with sepsis every hour in the UK, and it kills more than breast, bowel and prostate cancer combined.
In the UK each year there are at least 245,000 cases of sepsis, with at least 48,000 people losing their lives. The UK Sepsis Trust expects these figures to be higher during the pandemic.
What are the symptoms and after effects?
Sepsis can initially look like flu, gastroenteritis or a chest infection. There is no one sign, and symptoms present differently between adults and children.
What are the symptoms?
Symptoms in children
A child may have sepsis if he or she:
Symptoms in adults
An adult may have sepsis if they show any of these signs:
Slurred speech or confusion
Extreme shivering or muscle pain
Passing no urine (in a day)
It feels like you're going to die
Skin mottled or discoloured
Source: The UK Sepsis Trust
This short video by the UK Sepsis Trust to ‘Get Sepsis Savvy’ provides more information.
40% of all sepsis survivors suffer permanent, life-changing after effects. Some are adjusting to life with limb amputations, and many experience a variety of physical, psychological and emotional difficulties longer term (often up to 18 months) - this is known as Post Sepsis Syndrome.
The need to improve community awareness
Around 80% of episodes of sepsis in the UK occur in response to community-acquired infections.
There have been repeated calls for a public awareness campaign on sepsis, to improve recognition in the community and escalate referrals quickly. Terence Canning from the UK Sepsis Trust highlighted the need to equip the public with information on the signs of sepsis, to enable them to use this knowledge when presenting to health professionals. He also noted that healthcare staff, like GP receptionists, can play a vital role in escalating patients quickly if they are aware of the signs of sepsis:
Lack of sepsis awareness in the communities often means sick individuals are slow to access health care which causes delays in diagnosis and treatment which can be fatal or result in life changing outcomes. […]
The biggest thing around sepsis is time. Because people don't have the information to act quickly enough, they have bad outcomes.
RCN Wales and the UK Sepsis Trust pointed to the success of the ‘Act FAST’ campaign for stroke. The UK Sepsis Trust noted that like stroke, sepsis is a time critical illness, with the risk of mortality increasing by 8% for each hour that a patient with sepsis does not receive antibiotics.
Public Health Wales and the Welsh Government have previously expressed doubt about the likely effectiveness of a public awareness campaign. But in oral evidence to the halted inquiry , Public Health Wales was more positive on the issue, saying it was keen to work with the UK Sepsis Trust to explore the possibility of an awareness campaign.
There was general agreement that while progress has been made in acute settings, further work and training is needed to raise professional awareness of sepsis in other settings, particularly in primary care and communities.
The previous Committee also heard that the role of the GP must include ‘safety netting’, for example if a patient has an infection, giving them information and advice on symptoms to look out for, and what to do if they deteriorate.
According to the Royal Pharmaceutical Society Wales, treatment failure for Urinary Tract Infections (UTIs) in the primary care setting is a significant contributory factor for the rise in sepsis hospital admissions.
Support for sepsis survivors
There is a clear lack of support available for those who survive sepsis, and many are unprepared for the difficulties they face during their recovery.
It is estimated that 40% of sepsis survivors are re-hospitalised within 90 days of discharge for potentially treatable conditions in the outpatient setting.
Currently the only specific post sepsis support available is provided by the UK Sepsis Trust. The charity runs support groups and provides information and advice about recovery, but does not have the resources to support rehabilitation.
Dr Paul Morgan from Cardiff and Vale University Health Board was very critical of this stating:
Primary and community care services are ill-equipped to provide - and often largely ignorant of - the needs of sepsis survivors. The only secondary care services are those provided to amputees. This is a wholly-inadequate service provision.
There is evidence that sepsis can result in elevated levels of blood markers of inflammation for up to 1 year afterwards, no doubt contributing to the high incidence of readmissions and the increased mortality rate seen in sepsis survivors.
Stakeholders like the UK Sepsis Trust want to see information provided to sepsis patients on discharge from hospital to prepare them for what may lie ahead and signpost to support, as well as increased provision of specific support services to help survivors in their recovery.
Public Health Wales was positive about improving post sepsis support in its Committee session, saying there's a real opportunity for some great work in Wales to develop what person-centred care would look like for the survivors of sepsis. When asked about timescales, Dr Tracey Cooper, the chief executive, said that she was keen to have this up and running within 12 months.
As the pandemic hit soon after, Public Health Wales’ attention was understandably focused elsewhere. However, the need to raise awareness and provide better support to sepsis survivors has not gone away. We’re also facing the need to support those suffering from COVID after effects and living with long COVID.
Given the parallel symptom profiles between Post Sepsis Syndrome and long COVID, could the pandemic provide an opportunity to improve rehabilitation support for sepsis survivors?
With the necessary development of support services for long COVID, the UK Sepsis Trust will no doubt be calling for such support to be made available to the survivors of both serious conditions.
Article by Amy Clifton, Senedd Research, Welsh Parliament