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Latest Study News on SARS-CoV-2, COVID-19 and Sepsis

March 30, 2020

Scientists around the world are working to find ways to understand COVID-19, how to treat it and how to prevent the spread of SARS-CoV-2, the novel coronavirus that causes the disease. The result is many medical journals are publishing studies and articles about what doctors and researchers notice while treating patients. Unfortunately, people who mean well don’t always understand study results. They might misinterpret the findings or unknowingly blow them out of proportion.

“The Sepsis Alliance team is working together to constantly monitor the news, as well as articles published by peer-reviewed journals, like The LancetJAMA, and more,” said Thomas Heymann, Executive Director of Sepsis Alliance. “We will update our news as often as we can to provide our site’s visitors with the most up-to-date information on COVID-19 and how it relates to sepsis, as well as other important findings.”

How SARS-CoV-2 causes damage

First, it’s important to understand how SARS-CoV-2 affects the human body. Since it is a respiratory virus, SARS-CoV-2 enters your body through your nose, mouth, or eyes. It makes its way to some cells in your airways. There, the virus replicates – copies – itself and spreads. The infected cells cause inflammation in your airways and lungs, making it hard for you to breathe. Fluid might leak into the lung tissue, making it difficult for air to transfer to your blood for circulation. The infection could also cause complications like pneumonia. When an illness like COVID-19 causes another infection, this is called a secondary infection.

Researchers in China have had the longest amount of time to study patients with COVID-19. They found the sickest patients experienced severe shortness of breath. They also had lower than normal levels of oxygen in their blood. Other problems the patients had in common were kidney failure and sepsis.

Why COVID-19 should be taken seriously

Most people who contract the virus don’t get very ill. The result is many people don’t think COVID-19 is something to be concerned about, but they should be. “Dying from the infection is a very low probability, less than 2%,” said Steven Q. Simpson, MD, a professor of medicine at the University of Kansas in the Division of Pulmonary, Critical Care, and Sleep Medicine, and chief medical officer for Sepsis Alliance. While 2% is low, it has to be put in relation to the number of people who will become ill at some point. If 100 people became ill, 2% is only 2 people. But if 1 million people become ill, 2% represents 20,000 people.

“Over the course of the next couple of years, it is likely that most of us will have the infection,” Dr. Simpson explained. The danger is that we don’t know who will be hit the hardest or who will require intensive care and ventilation. If too many people get the virus at the same time, these seriously ill people will overwhelm the available medical resources.

Most recent studies mentioning SARS-CoV-2, COVID-19 and sepsis

The Lancet

The Lancet published an article on March 11, 2020, about a small study from China that found patients who had the poorest outcomes from COVID-19 infection were those who were older, showed signs of sepsis, and/or had blood clotting disorders. “In the current study, we found that more than half of patients developed sepsis,” wrote the authors. “Sepsis was a common complication, which might be directly caused by SARS-CoV-2 infection, but further research is needed to investigate the pathogenesis of sepsis in COVID-19 illness.”

Some people with COVID-19 develop other infections, called secondary infections, which could confuse the situation. “SARS-CoV-2 causes sepsis by itself and it can also be associated with a secondary infection, which may obviously cause sepsis,” explained Dr. Simpson.

JAMA

An article published in JAMA on February 24 also looked at the characteristics of COVID-19 patients in Wuhan, China. The authors of this article found that 5% (over 2,000 patients) of their 44,672 confirmed COVID-19 cases were critical enough to require intensive care, including ventilation.  The patients experienced respiratory failure, septic shock, and/or multiple organ dysfunction or failure.

Other findings include the age distribution of the disease:

  • 3%, 1,408 patients, were 80 years or older
  • 87%, 38,680 patients, were 30 to 79 years
  • 8%, 3619 patients, were 20 to 29 years
  • 1%, 549 patients, were between 10 and 19 years
  • 1%, 416 patients, were younger than 10 years

Another article published in JAMA on March 11 reviewed the critical care of patients who were seriously ill with COVID-19. The authors noted that a significant number of critically ill COVID-19 patients developed septic shock and organ dysfunction, such as kidney injury. These patients were at highest risk of dying from the virus. They also pointed out that while the overall mortality rate of COVID-19 is between 0.5% and 4%, it is higher among patients who are admitted to the hospital, between 5% and 15%.

“In a very short period, health care systems and society have been severely challenged by yet another emerging virus,” the authors wrote. “Preventing transmission and slowing the rate of new infections are the primary goals; however, the concern of COVID-19 causing critical illness and death is at the core of public anxiety.”

StatPearls

This article, published by StatPearls, reviews the basics of COVID-19 infection and SARS-CoV-2. The authors also mention the connection between the infection and sepsis and septic shock. “The COVID-19 may present with mild, moderate, or severe illness,” they wrote. “Among the severe clinical manifestations, there are severe pneumonia, ARDS, sepsis, and septic shock. The clinical course of the disease seems to predict a favorable trend in the majority of patients. … As a reference, the criteria of the severity of respiratory insufficiency and the diagnostic criteria of sepsis and septic shock can be used.”

The authors also pointed out that patients with COVID-19 and sepsis are at particular risk for a bad outcome.

What does this all mean?

As doctors and researchers try to learn more about SARS-CoV-2 and COVID-19, more information will surface about how many affected patients develop sepsis and how best to manage their care. In the meantime, the doctors are working with what information they do have, using their knowledge of how to treat sepsis in other patients to help the ones who have COVID-19.

 

To learn more about sepsis and this new virus, visit Sepsis and Coronavirus (COVID-19), part of our Sepsis and… library.