Swedish Orphan Biovitrum AB (publ) (SobiTM) (STO:SOBI) and the Hellenic Institute for the Study of Sepsis yesterday announced positive top line results from the Investigator-sponsored SAVE-MORE study, which assessed the effect of anakinra in moderate to severe COVID-19 pneumonia patients. Early and targeted use of anakinra in addition to current standard of care in hospitalised patients with poor prognosis prevented either death or progression to severe respiratory failure, whilst increasing the number of patients who were discharged from hospital with no evidence of COVID-19 infection.

SAVE-MORE is a large, randomised controlled trial in over 600 hospitalised patients that specifically identifies those at risk of severe respiratory failure by the measurement of elevated suPAR (soluble urokinase plasminogen activator receptor), a plasma biomarker that reflects immune activation and has been previously associated with poor prognosis in a number of conditions. The study is sponsored by the Hellenic Institute for the Study of Sepsis (HISS) in Greece and led by its President and Chairman, Professor Evangelos J. Giamarellos-Bourboulis. Giamarellos-Bourboulis is Professor of Internal Medicine and Infectious Diseases at the National and Kapodistrian University of Athens, President of the European Shock Society and Chairman of the European Sepsis Alliance. Sobi intends to discuss these results with regulatory authorities to evaluate the possibility of approval.

“This is the first study to specifically evaluate an at-risk patient population before admission to intensive care unit (ICU). The results provide a significant step forward in the search for additional treatment options to prevent progression to a more critical state,” said Professor Giamarellos-Bourboulis. “My thanks go to the many patients and clinicians who have contributed across Italy and Greece.”

Today, the Global Sepsis Alliance has announced the ‘World Sepsis Congress 2021 - Advancing Prevention, Survival, and Survivorship of Sepsis and COVID-19’, taking place live, free of charge, and completely online on April 21st and 22nd, 2021.

Over the course of two days and 15 diverse and highly relevant sessions, over 90 speakers from more than 30 countries will give trenchant talks on all aspects of sepsis, from the impact of policy, the role of artificial intelligence and big data, patient safety, and long-term sequelae through to novel trial design, the latest research, and much more. We will give equal voice to clinicians and researchers, patients and caregivers, and policymakers; as well as to those working, living, and driving change in high-income and in low- and middle-income countries.

Just as with the previous World Sepsis Congresses in 2016 and 2018 and WSC Spotlights in 2017 and 2020, this free online congress brings together highly ranked representatives of international and national healthcare authorities, non-governmental organizations, policymakers, patients, patient advocacy groups, clinical scientists, researchers, and pioneers in healthcare improvement.

The European Sepsis Alliance supports the John Snow* Memorandum. This Memorandum is a collaborative and inclusive initiative to protect public health in this COVID-19 pandemic and the work of a group of international researchers with expertise spanning public health, epidemiology, medicine, pediatrics, sociology, virology, infectious disease, health systems, psychology, psychiatry, health policy, and mathematical modeling. Said group felt moved to deliver a clear and simple message about how best to manage the COVID-19 pandemic.

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THE JOHN SNOW MEMORANDUM

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 35 million people globally, with more than 1 million deaths recorded by the World Health Organization as of Oct 12, 2020. As a second wave of COVID-19 affects Europe, and with winter approaching, we need clear communication about the risks posed by COVID-19 and effective strategies to combat them. Here, we share our view of the current evidence-based consensus on COVID-19.

SARS-CoV-2 spreads through contact (via larger droplets and aerosols), and longer-range transmission via aerosols, especially in conditions where ventilation is poor. Its high infectivity(1) combined with the susceptibility of unexposed populations to a new virus, creates conditions for rapid community spread. The infection fatality rate of COVID-19 is several-fold higher than that of seasonal influenza(2) and infection can lead to persisting illness, including in young, previously healthy people (ie, long COVID(3)). It is unclear how long protective immunity lasts(4) and, like other seasonal coronaviruses, SARS-CoV-2 is capable of re-infecting people who have already had the disease, but the frequency of re-infection is unknown(5). Transmission of the virus can be mitigated through physical distancing, use of face coverings, hand and respiratory hygiene, and by avoiding crowds and poorly ventilated spaces. Rapid testing, contact tracing, and isolation are also critical to controlling transmission. The World Health Organization has been advocating for these measures since early in the pandemic.

In the initial phase of the pandemic, many countries instituted lockdowns (general population restrictions, including orders to stay at home and work from home) to slow the rapid spread of the virus. This was essential to reduce mortality(6),(7) prevent health-care services from being overwhelmed, and buy time to set up pandemic response systems to suppress transmission following lockdown. Although lockdowns have been disruptive, substantially affecting mental and physical health, and harming the economy, these effects have often been worse in countries that were not able to use the time during and after lockdown to establish effective pandemic control systems. In the absence of adequate provisions to manage the pandemic and its societal impacts, these countries have faced continuing restrictions.

This has understandably led to widespread demoralisation and diminishing trust. The arrival of a second wave and the realisation of the challenges ahead has led to renewed interest in a so-called herd immunity approach, which suggests allowing a large uncontrolled outbreak in the low-risk population while protecting the vulnerable. Proponents suggest this would lead to the development of infection-acquired population immunity in the low-risk population, which will eventually protect the vulnerable. This is a dangerous fallacy unsupported by scientific evidence.

Any pandemic management strategy relying upon immunity from natural infections for COVID-19 is flawed. Uncontrolled transmission in younger people risks significant morbidity(3) and mortality across the whole population. In addition to the human cost, this would impact the workforce as a whole and overwhelm the ability of healthcare systems to provide acute and routine care.

Furthermore, there is no evidence for lasting protective immunity to SARS-CoV-2 following natural infection(4) and the endemic transmission that would be the consequence of waning immunity would present a risk to vulnerable populations for the indefinite future. Such a strategy would not end the COVID-19 pandemic but result in recurrent epidemics, as was the case with numerous infectious diseases before the advent of vaccination. It would also place an unacceptable burden on the economy and healthcare workers, many of whom have died from COVID-19 or experienced trauma as a result of having to practise disaster medicine. Additionally, we still do not understand who might suffer from long COVID(3). Defining who is vulnerable is complex, but even if we consider those at risk of severe illness, the proportion of vulnerable people constitute as much as 30% of the population in some regions(8). Prolonged isolation of large swathes of the population is practically impossible and highly unethical. Empirical evidence from many countries shows that it is not feasible to restrict uncontrolled outbreaks to particular sections of society. Such an approach also risks further exacerbating the socioeconomic inequities and structural discriminations already laid bare by the pandemic. Special efforts to protect the most vulnerable are essential but must go hand-in-hand with multi-pronged population-level strategies.

Once again, we face rapidly accelerating increase in COVID-19 cases across much of Europe, the USA, and many other countries across the world. It is critical to act decisively and urgently. Effective measures that suppress and control transmission need to be implemented widely, and they must be supported by financial and social programmes that encourage community responses and address the inequities that have been amplified by the pandemic. Continuing restrictions will probably be required in the short term, to reduce transmission and fix ineffective pandemic response systems, in order to prevent future lockdowns. The purpose of these restrictions is to effectively suppress SARS-CoV-2 infections to low levels that allow rapid detection of localised outbreaks and rapid response through efficient and comprehensive find, test, trace, isolate, and support systems so life can return to near-normal without the need for generalised restrictions. Protecting our economies is inextricably tied to controlling COVID-19. We must protect our workforce and avoid long-term uncertainty.

Japan, Vietnam, and New Zealand, to name a few countries, have shown that robust public health responses can control transmission, allowing life to return to near-normal, and there are many such success stories. The evidence is very clear: controlling community spread of COVID-19 is the best way to protect our societies and economies until safe and effective vaccines and therapeutics arrive within the coming months.

We cannot afford distractions that undermine an effective response; it is essential that we act urgently based on the evidence.

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*ABOUT JOHN SNOW

John Snow is considered one of the founders of modern epidemiology. He developed the water theory of transmission of cholera. In 1854, he famously persuaded authorities to remove the handle of a water pump to try to curtail transmission of cholera during an outbreak in London. He devoted much of his life to improving public health…

The Tuscany Region has presented a comprehensive document that presents strategies for sepsis recognition and treatment in the various contexts in which sepsis can occur, as well as for the prevention of this serious pathology and of the infections that cause it.

The document is the result of the work of a pool of clinical experts selected within the regional health authorities. The effort is coordinated by the Regional Clinical Risk Management and Patient Safety Centre (GRC) and the Agenzia Regionale di Sanità (ARS, Tuscany Region Healthcare Agency). The editors of the document are Giulio Toccafondi from the Quality Improvemnet Committee of GSA and Giorgio Tulli.

This document is based on the Surviving Sepsis Campaign guidelines and on evidence reported in the literature concerning microbiology, clinical care, human factors, quality and safety of care. It proposes a vision of the critical issues that sepsis brings with it to the healthcare system, a vision not attributable to a single disciplinary perspective but rather an expression of multiple viewpoints of team members. The document suggests and indicates approaches that are integrated on both a strategic-organizational level and in clinical-care practice.

The Global Sepsis Alliance welcomes the thorough work of Tuscany Region and is keen to learn about its implementation, including achievements and challenges.

This is a great example of what national, but also regional authorities can do to support their health system’s preparedness to prevent, manage and treat sepsis, as recommended in the WHA 70.7 Resolution on sepsis. The GSA strongly exhort national and regional authorities to undertake similar efforts and stands ready to support such efforts.

Since the launch of the brochure in March, we have received positive feedback across numerous countries, that confirmed the need for translating it in different languages. In the past months we have worked on a number of translations that today we make available on our website here.

This guide aims at guiding sepsis survivors and their families and at informing the general public, patients, their relatives, and healthcare professionals about sepsis. It explains that there is a need for an urgent response, considering the potential consequences of sepsis, including lifelong disabilities.

Sepsis affects the whole body, so recovery also involves the whole body. Most patients who survive sepsis will eventually fully recover. Others may face long-term consequences. It is important to know that recovery may take months or years. After-sepsis effects, often called Post-Sepsis Syndrome or Post-Sepsis Symptoms, can present very diverse consequences that sometimes appear even years later.

Severely ill COVID-19 patients and those affected by sepsis from other pathogens — such as bacteria, other viruses, fungi, or parasites — are indistinguishable on clinical grounds. Further, post-sepsis syndrome and long COVID-19 signs overlap. We hope that this guide can be of use also for those suffering long term effects of COVID-19.

The more people know about sepsis the better we can prevent it, treat it, and manage it. Please download and share the guide on social media or, if you are an organization or an authority, consider embedding it on your web site (see the Life After Sepsis Guide on the Romanian Health Ministry website here, for example).

I first came in contact with the European Sepsis Alliance in 2018 through a friend who was chairing the ESA annual meeting that year and knew of my sepsis experience.  At the ESA virtual annual meeting in March 2020, I spoke as a panelist of my experience with sepsis after previously participating in the ESA Policy and Stakeholder Engagement work group. I had fully retired, aged 69, from an international career with PwC in 2015, except for working pro bono as the Executive Director of the Belgian Chapter of Transparency International (TI B). I was then a long-term patient for colon cancer since 1990 when I had undergone a successful surgery at a leading Belgian teaching hospital.

My experience with sepsis started after a regular check-up in early 2016 when it was decided to remove what was left of my colon in a procedure that would avoid the need for a stoma. I was operated on in mid-March 2016 by a successor to the professor who had operated on me in 1990 and had followed me up until his recent retirement. He had become a good friend.

After the operation, I started to run a temperature and my blood pressure was falling. My wife queried the slow response of the medical staff in the absence out of the country of the professor who had operated. She contacted our medical friend. By then I had suffered a septic shock and was in a coma. Our friend monitored the remedial treatment, which included a second operation and the placing of a permanent ileostomy. During the three weeks that I was in the intensive care unit, I suffered a cardiovascular accident and two heart stoppages before my situation was stabilized. After two months, I was moved to an independent, specialized revalidation points clinic, Inkendaal. I was largely immobile and officially classified as handicapped in Belgium with an ileostomy, hemianopsia on the right side (120° field of vision), impaired balance (no ladders, bicycles, mopeds, etc.), residual problems with one finger and toes, and some loss of memory. I was treated at Inkendaal until January 2017, first as a resident for four months, and then three days a week as an outpatient.

Now, after four years since my septic shock, I am able to swim regularly around 500 m and walk up to 10 km with Nordic sticks. I drive around 20,000 km a year and regularly spend up to five hours gardening in our large wild garden. I had to stop working as the Executive director of TI B but I am now working again a little with them. My very successful recovery was in large part thanks to the excellent revalidation program I followed at Inkendaal.

After the 2020 ESA annual meeting, I participated in the Patient and Family Support work group. I had noted that in Belgium there was no equivalent national sepsis patient and survivor group. Through Idelette Nutma, who leads the ’Sepsis en daarna’ initiative in The Netherlands, I have been able to enlist the considerable support of Carine Nelissen, a sepsis survivor, and Hans Hellinckx, Public Policy and Governmental Affairs manager of Becton Dickinson (BD Benelux). Carine had also suffered a septic shock after becoming unwell after a minor operation to deal with a kidney stone. She required ICU treatment before recovering. Carine returned to work but now, some five years later she finds that there are still sequels, particularly becoming more easily physically tired than before. Carine, with the help of her son, has been key in developing our website and Facebook page.

Hans has been very helpful in promoting our SEPSIBEL initiative with several of his relevant contacts, as he has made it his personal ambition to put sepsis high on the Belgian political agenda. Hans facilitated the meeting with Belgian politicians who have shown their support for the idea of a national action plan against sepsis. Hans plans to inform the various experts and professional (scientific) associations of specialists and nurses (intensive care, emergency care, infection prevention, and microbiology) while calling on them to support this initiative and creating an expert reflection Task Force.

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The article above was written by Michael Clarke and is shared here with his explicit consent. The views in the article do not necessarily represent those of the European Sepsis Alliance. They are not intended or implied to be a substitute for professional medical advice. The whole team here at the ESA and World Sepsis Day wishes to thank Michael for sharing his story and for fighting to raise awareness for sepsis.

In just one week, on 9 September, the WHO and the GSA will host the “World Sepsis Congress Spotlight: Sepsis, Pandemics, and Antimicrobial Resistance – Global Health Threats of the 21st Century”. This free online congress is a great opportunity to connect to and learn from over 30 high level speakers and leading experts from around the globe.

The European Sepsis Alliance is excited to support the event and invites you to attend. Participation is free of charge and can be done from wherever you have an internet connection. To register and to find out more about the program, speakers, time zones, and much more, please visit wscspotlight.org.

Jamila Hedjal lost her son Farès to sepsis in 2018, which led her to form the France Sepsis Association.

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You set up the organization due to the tragic loss of your son Farès in 2018 - in his memory what purpose/direction does the France Sepsis Association have?

I created the France Sepsis Association in November 2018 right after the death of my son Farès, who died after a ‘septic shock’ caused by appendicitis.

I did not know the term ‘sepsis’ or ‘septic shock’ then. As I embarked on research, I discovered that sepsis – according to the WHO resolution in May 2017 – is a global health priority. It is an emergency and causes about 11 million deaths per year worldwide, thereof at least 30,000 in France, which is huge! Moreover, I understood that this pathology is little known to the general public and to some health professionals, except from intensivists, emergency room attendants, etc. Therefore, I saw the need and had great motivation to bring the France Sepsis Association to life. The primary objective should be to raise awareness and educate the general public, and health professionals, in particular general practitioners, caregivers, pharmacists, firefighters, referral nurses at the hospital, and more.

The priority is to diagnose sepsis quickly to ensure the optimal treatment because every minute counts. The earlier sepsis is recognized, the more likely one is to survive. It is absolutely urgent to educate and sensitize the general public and health professionals so they can be involved in the care journey.
This education will also involve the training of patients, families of patients, and healthcare professionals.

The France Sepsis Association is for patients and relatives affected by sepsis. It has the role of accompaniment and support in the follow-up of the care of patients with sepsis, it carries their voices in different instances to improve and ensure their comfort, and the quality and safety of care.

When did the France Sepsis Association come to be?

Officially, the France Sepsis Association was established on April 7th, 2020, during the first stages of the lockdown here in France.

Who else is involved in the France Sepsis Association?

Many people are becoming involved. Currently, most are relatives of sepsis patients and family members of those who died of sepsis, as well as resuscitation and healthcare professionals.

Have you connected with other survivors or families affected by sepsis in the process? What organizations and groups have you connected with?

Yes, absolutely, we are in contact with the families of survivors. The organizations with which we are in contact with are the Ministry of Health, the Regional Health Agency, the High Authority of Health, local authorities, hospitals, the council of the Medical Association, and of course the European Sepsis Alliance Working Group Patient and Family Support.

From your own experience, what do you feel are the current issues causing preventable deaths in France, Europe, and worldwide?

Based on my analysis, I think there are several factors:

1. The underestimation of sepsis and its fatal impact has made it impossible to attract more attention from the public authorities, as a result they are not equipped with the necessary means to stop preventable deaths.

2. The lack of knowledge of how to recognize the symptoms of sepsis combined with the lack of training necessarily lead to late treatment. The lack of safety and quality in care can also cause nosocomial infections.

3. The priority is to focus on general medicine and chronic disease specialties (for people at risk) and to implement all appropriate means in the patient’s care journey to enable the rapid diagnosis of sepsis and to ensure its timely treatment.

What do you think needs to happen to stop preventable deaths from sepsis particularly in France and Europe? What role will the France Sepsis Association play?

Sepsis must be recognized as an imminent emergency as well as cardiovascular diseases. We must act quickly! In the medical jargon, a sepsis patient without treatment in the ‘golden hour’ dies.

For this, it is necessary to inform and educate the general public and health professionals about sepsis through awareness campaigns, media coverage, advertising spots, social media, conferences, carrying out actions for all audiences – children, adolescents, adults, and elderly people.

The collaboration of all health actors, health system institutions, associations, and organizations is a key to success in effectively fighting sepsis and thus preventing deaths. It should be noted that the awareness of public authorities remains an unavoidable lever.

The France Sepsis Association will work in synergy with French, European, and other health bodies and organizations to develop information and communication on sepsis to recognize signs and severity to reduce mortality.

How can the wider network of actors leading the fight against sepsis support the France Sepsis Association in its development?

Thanks to the popularity of the Global Sepsis Alliance and the European Sepsis Alliance’s network, I’m able to learn from the knowledge and experience of other countries. The different actions carried out in all parts of the world should encourage countries like France to develop education and awareness programs on sepsis to reduce mortality. Joint actions such as World Sepsis Day in the four corners of the globe are an opportunity to fight together and have the potential to achieve a high level of awareness in the world. Moreover, a pooling and close collaboration with such a global organization with a common objective is an asset to fight with force this scourge throughout the planet.

I’m convinced that together we can raise the attention on the importance and urgency of sepsis and on its impact on the world, by addressing public authorities and the public opinion via all possible means.

Lastly, I would like to thank the GSA and the ESA for supporting me in creating the France Sepsis Association. Their work and moving sepsis stories were a source of inspiration.

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This interview was conducted by Siobhan Donnachie and Katja Couball via email on Monday, August 10th, 2020. It has been edited for clarity and brevity. A big thanks to Jamila for agreeing to speak with us.

The European Sepsis Alliance (ESA) welcomes the WHO European Work Program (EWP) 2020-2025 and believes that the program’s priorities respond to the main challenges that society is facing and that need a strong and globally coordinated response. We thank the WHO Europe Office for the opportunity to comment on the document and wish the WHO Regional Director for Europe, Dr. Kluge and his team much success in the coming years. The ESA is keen to support the EPW 2020-2025 with our pool of experts with different medical backgrounds from all over Europe.

The COVID-19 crisis reminds us that infectious diseases and sepsis present a major global health threat. It is important to note that from 2 to 5% of patients with COVID-19, and as many as 25-50% of those hospitalized, develop complications such as sepsis and septic shock, tragically contributing to the already enormous burden of deaths from sepsis. Sepsis affects yearly between 47 and 50 million people worldwide and causes 11 million deaths[1]. According to the latest estimates, sepsis affects around 3,4 million Europeans and causes almost 700.000 deaths yearly[2], the majority of which is preventable. Sepsis care must be part of standard infectious disease and pandemic response.

Therefore, ESA suggests including under Core priority 2, point 2. “Enhance country preparedness and response capacity”, national infection management plans, that would include sepsis prevention, diagnostic and treatment, as already recommended by the 2017 WHA Resolution 70.7 on sepsis.

Regarding core priority 3, point 3 “Safer health care”, ESA suggests including the promotion of early recognition systems, standardized emergency treatments, and allocation of necessary resources to prevent and treat sepsis.

You can consult ESA’s full response to the public consultation below.

[1] Global, regional, and national sepsis incidence and mortality, 1990–2017: analysis for the Global Burden of Disease Study – The Lancet

[2] Mellhammar L, Wullt S, Lindberg Å, Lanbeck P, Christensson B, Linder A. Sepsis Incidence: A Population-Based Study. Open Forum Infect Dis. 2016;3(4):ofw207. Published 2016 Dec 8. doi:10.1093/ofid/ofw207

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On Saturday, November 24th, 2018, I tragically lost my son Farès, a child just 13 years old, to sepsis caused by appendicitis.

 Farès was a brilliant student attending 4th grade of a college in the Paris region, France.

 The week preceding his death, he suffered from abdominal pain and vomiting. During this week, Farès underwent several consultations with both general practitioners and hospital doctors. Everyone came to the same medical finding. According to the doctors, Farès suffered from gastroenteritis. It was a chaotic journey!

 Finally, after the fourth doctor visit, Farès was hospitalized, but unfortunately, he did not undergo a radiological examination, only a biological assessment which showed inflammation that did not raise concern for the medical team.

 Farès had two major abdominal pain attacks in the night of his hospitalization, which were not seen as an emergency, while I kept actively requesting the presence of a doctor. Eventually the next morning, Farès had a septic shock, and even though I was present and alerted the team immediately so that he would be taken care of, the team persisted in saying that it was an anxiety attack.

 However, at this point, Farès was at only 60% oxygen saturation, his skin began to mottle and his blood pressure was low. It was then when he would have a cardiac arrest and died in front of me.

 Following this drama, I started my research on sepsis and it was then when I discovered that it is a major global public health problem. That's how I got in touch with both the Global Sepsis Alliance and the European Sepsis Alliance. Thanks to these organizations, the latter will mark the beginning of my fight.

I created the France Sepsis Association, an association of patients and families affected by sepsis whose objectives are to raise awareness among the general public and health professionals. Our goal is to avoid deaths caused by sepsis thanks to rapid treatment and early recognition by general practitioners, who should refer patients to the appropriate care unit.

My ambition is to help European and global organizations to lower the mortality rate. Sepsis deaths are preventable if taken care of early and through active education.

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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.

Besides, she noted that the usual differences between high (HICs) - and low- and middle-income countries (LMICs), where 85% of sepsis cases occur, are not so visible with COVID-19, in fact, the most affected countries are HICs. 

Prof. Machado is chair of the intensive care session of Anesthesiology, Pain and Intensive Care Department at the Federal University of São Paulo, Brazil, and CEO of the Latin America Sepsis Institute (LASI). 

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The rapid global spread of the novel coronavirus SARS-CoV-2 has caused societal, economic, and medical upheaval not seen since the 1918 influenza pandemic. As of April 7th, the World Health Organization has confirmed cases in 203 countries, areas or territories, with over 1.2 million confirmed cases and over 65,000 deaths.  Further, many experts believe these numbers to be a gross underestimate for a variety of reasons, including inadequate testing capacity and suboptimal reporting of cases. Despite extensive modeling by epidemiologists all over the world, it is not possible to accurately predict the course and duration of this pandemic. It is important that we continue to obtain objective data on which we base recommendations. A calm and rational approach from both society and individuals is necessary during these uncertain times. There remains considerable confusion regarding the differences between seasonal influenza and COVID-19 (the illness caused by SARS-CoV-2). While both viruses are capable of causing severe illness and can spread rapidly, it appears that SARS-CoV-2 is a more deadly pathogen on a case-by-case basis, can be spread during the asymptomatic phase, and is capable of much more rapid spread. The higher burden and mortality may be attributed to the fact that SARS-CoV-2 is a “newly emerged” virus, and consequently, there is very little innate immunity to it among humans, unlike with influenza where both prior infection and annual vaccination can provide protection. Overall, however, the sheer contagiousness of this new virus has led to the high morbidity and mortality seen globally – simply put, healthcare systems have been unable to cope with the number of infected persons seeking care. Indeed, a proportion of the reported deaths are due to overwhelmed medical systems rather than the virulence of COVID-19. This is a crucial factor explaining the “flatten the curve” strategy adopted by many countries. 

Now that more scientific data are available on COVID-19, the European Sepsis Alliance can more definitively state that COVID-19 does indeed 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. This is consistent with a combination of direct viral invasion and sepsis. For example, in a recently published case series of severe COVID-19 cases from the Seattle area in the United States, over 30% had evidence of liver injury and 75% had evidence of a depressed immune response¹; another series from the same region reported acute kidney failure in almost 20% of affected patients requiring ICU care ², and both series reported septic shock severe enough to require drugs to support the heart and circulation in almost 70% of patients. A recent study from China reported that in patients hospitalized with COVID-19, 28% had evidence of significant heart damage (potentially from direct invasion of cardiac muscle by the virus), resulting in heart failure and abnormal heart rhythms – this damage was associated with a five-fold increase in the risk of death³. As there are no proven therapies effective against the virus itself, it is apparent that the best COVID-19 care includes good sepsis care.

Effective and safe treatments for COVID-19 are urgently being sought by scientists across the world. Although it is hoped that the first batches of a COVID-19 vaccine will begin to be tested in humans in April 2020⁴, large-scale distribution of a viable vaccine may still be a year or more away. 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, potential treatment with convalescent serum is being attempted and trialed.

However, despite these efforts, presently there are no specific treatments for COVID-19. As such, the European Sepsis Alliance continues to strongly advocate for strict adherence to 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 fever, cough, and breathing difficulty develop together. We also recommend close attention and adherence to the restrictions on social gatherings set by local health authorities and government bodies. We encourage you to assess the particular challenges faced by the healthcare systems in your area, and if you are able to materially assist in any way (including something as simple as volunteering to be a blood donor), please do so. We are in this together. Be safe.

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This article was published on April 7th, 2020, with the most recent data from the WHO Situation Report from April 6th, 2020 - we expect both cases and deaths to rise further. The views in this news post are not intended or implied to be a substitute for professional medical advice. Special thanks to Nathan Nielsen, Niranjan ‘Tex’ Kissoon, Konrad Reinhart, Dennis Kredler, Mahawi Aljuaid, and Simon Finfer for helping to put this article together.

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References

¹ (Bhatraju PK, et al. NEJM 2020)
² (Arentz M, et al. JAMA 2020)
³ (Guo T, et al. JAMA 2020)
⁴ https://time.com/5790545/first-COVID-19-vaccine/

Sepsisfonden is a Swedish sepsis trust that started in 2015. Since the start, one of their main objectives has been to increase awareness around sepsis in Sweden.

This spring, they have launched a school project where they target young people in their awareness work, especially kids in the ages around 13 to 17. The first step has been producing a film that explains how the immune system works and what happens when you develop sepsis, embedded above.

Later this year, they will also send out a pedagogical material to all science teachers, teaching in year 8 (kids around 14 years), together with this film, and encourage them to take the time to talk about sepsis in class.

The video from the 3rd Annual Meeting of the European Sepsis Alliance is now available to watch on demand - embedded above. Please use the chapter markers (available in the description box on YouTube) to go directly to the speaker/debate you are interested in most.

Over the course of about 3 hours, we heard presentations from sepsis survivors, representatives from the European Commission and WHO, patient safety advocates, sepsis researchers, clinicians, and more. Additionally, we had two panel debates, one on the state of national sepsis plans, and one on how to build support for survivors and families.

The European Sepsis Alliance was founded under the patronage of the European Commissioner for Health and Food Safety, Vytenis Andriukaitis, at our event “Sepsis - A Call to EU Action” in March 2018 and is one of the regional sepsis alliances of the Global Sepsis Alliance.

The ESA Working Group Patient and Family Support is thrilled to release the “Life After Sepsis”-Guide - a free downloadable brochure that aims at guiding survivors and their families, who are the most vulnerable when sepsis occurs. It also wants to inform the general public, patients, their relatives, and healthcare professionals about sepsis. The brochure explains that there is a need for an urgent response to the consequences of sepsis, including lifelong disabilities. It is not intended to be a substitute for medical advice, but rather to ensure that more people are better equipped to recognize sepsis, prevent it, and cope with its long-lasting effects.

As always, we are looking forward to hearing your feedback, including suggestions for improvements.

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Update March 26th: The recording from the meeting is now available.

Original article:

The free livestream from the 3rd Annual Meeting of the European Sepsis Alliance starts on Monday, March 23rd, 2020, at 13:00 Central European Time.

Over the course of about 3 hours, we will hear presentations from sepsis survivors, representatives from the European Commission and WHO, patient safety advocates, sepsis researchers, clinicians, and more. Additionally, we will have two panel debates, one on the state of national sepsis plans, and one on how to build support for survivors and families.

The meeting takes place completely online, with all speakers, panelists, and moderators presenting from the comfort and safety of their own homes or offices. As a participant, you can join from wherever you have an internet connection, including asking live questions to the speakers and panelists.

The European Sepsis Alliance was founded under the patronage of the European Commissioner for Health and Food Safety, Vytenis Andriukaitis, at our event “Sepsis - A Call to EU Action” in March 2018 and is one of the regional sepsis alliances of the Global Sepsis Alliance.

Update March 26th: The recording from the meeting is now available.

Original article:

The 3rd Annual Meeting of the European Sepsis Alliance will take place completely online on March 23rd, 2020. There will not be a physical meeting in Brussels. Speakers and panelists will speak from the comfort and safety of their own homes or offices, and you can follow along live and for free on our website, including the ability to ask live questions to the speakers, panelists, and moderators. A sign-up is not required.

The program and the timing will stay identical (minus the welcome reception and coffee break…). We will kick-off on Monday, March 23rd at 13:00h Central European Time.

If you sign-up using the form on our website, we will notify you once the livestream starts. Again, registration is not mandatory and the stream will freely be available to anyone visiting our website. It will be embedded at europeansepsisalliance.org/annualmeeting.

The European Sepsis Alliance was founded under the patronage of the European Commissioner for Health and Food Safety, Vytenis Andriukaitis, at our event “Sepsis - A Call to EU Action” in March 2018 and is one of the regional sepsis alliances of the Global Sepsis Alliance.

Update April 7th: While the article below was factually correct at the time of publication, it has become outdated (as many things that were written or said a month ago – an updated version is available here.

Original article:

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 European 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. A majority of 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 ESA 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 World Sepsis Day Movement rung truer than now – Stop Sepsis, Save Lives.

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This article was published on March 4th, 2020, with the most recent data from the WHO Situation Report from March 3rd, 2020. The views in this news post are not intended or implied to be a substitute for professional medical advice. Special thanks to Nathan Nielsen, Luis Gorordo Del Sol, Emmanuel Nsutebu, and Simon Finfer for helping to put this article together.

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*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).

Update March 12th: The meeting will take place completely online - livestreamed to you at europeansepsisalliance.org/annualmeeting - more info here.

Update March 4th: The timing of our event has changed slightly to due logistic reasons - we now start at 13:00, with a welcome lunch and registration at 12:15. The new timing is reflected in the new program below. Sorry for any inconvenience.

Original article:

On Monday, March 23rd, 2020, the European Sepsis Alliance will hold its 3rd Annual Meeting in Brussels, Belgium. You are hereby cordially invited to join us and many prestigious speakers at this important event.

The event will provide an opportunity to hear from policymakers about how public policy can tackle sepsis, listen to updates on the fight against sepsis in countries who have undertaken significant steps, and discuss with survivors and experts what it takes to fight sepsis effectively on the national, community, and healthcare facility level.

Event Details:

• 3rd Annual Meeting of the European Sepsis Alliance

• Monday, March 23rd, 2020, 12:15 to 16:15h

• Permanent Representation of the Federal Republic of Germany to the European Union in Brussels (Rue Jacques de Lalaing 8-14, 1040 Brussels, Metro: Arts-Loi / Maalbeek)

Due to limited seating capacity, please sign up at your earliest convenience. We look forward to welcoming you at the event and have a fruitful discussion, in order to foster the fight against sepsis in Europe together!

The European Sepsis Alliance was founded under the patronage of the European Commissioner for Health and Food Safety, Vytenis Andriukaitis, at our event “Sepsis - A Call to EU Action” in March 2018.

Twice as many people are dying from sepsis worldwide than previously estimated, according to a groundbreaking study by an international team of scientists published in The Lancet today. Among them are a disproportionately high number of children in poor areas.

This study, the most comprehensive clinical study on sepsis to date, revealed 48.9 million cases of sepsis in 2017 and 11 million deaths. 1 in 5 deaths globally are associated with sepsis. Sepsis arises when the body’s response to an infection injures its own tissues and organs. It may lead to shock, multi-organ failure, and death – especially if not recognized early and treated promptly. For sepsis survivors, it can create lifelong disabilities and suffering.

It was found that about 85% of sepsis cases occurred in low- or middle-income countries – especially in Sub-Saharan Africa, the South Pacific islands, and South, East, and Southeast Asia. While sepsis incidence is higher among females than males, more than 40% of all cases are occurring in children under 5.

“I’ve worked in rural Uganda, and sepsis is what we saw every single day. Watching a baby die of a disease that could have been prevented with basic public health measures really sticks with you. I want to contribute to solving this tragedy, so I participate in research on sepsis. However, how can we know if we’re making progress if we don’t even know the size of the problem? If you look at any top 10 list of deaths globally, sepsis is not listed because it hasn’t been counted.”

— LEAD AUTHOR KRISTINA E. RUDD, M.D., M.P.H., ASSISTANT PROFESSOR AT PITT’S DEPARTMENT OF CRITICAL CARE MEDICINE”

For their analysis, Rudd and colleagues leveraged the Global Burden of Disease Study, a comprehensive epidemiological analysis coordinated by the Institute for Health Metrics and Evaluation (IMHE) at the University of Washington School of Medicine. Previous global estimates for sepsis relied upon hospital databases from select middle- and high-income countries, making them severely limited and prone to overlooking the occurrence outside of the hospital, especially in low-income countries.

“We are alarmed to find sepsis deaths are much higher than previously estimated, especially as the condition is both preventable and treatable. We need renewed focus on sepsis prevention among newborns and on tackling antimicrobial resistance, an important driver of the condition.”

— SENIOR AUTHOR MOHSEN NAGHAVI, M.D., PH.D., M.P.H., PROFESSOR OF HEALTH METRICS SCIENCES AT IHME AT THE UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE”

Although the number of cases are much higher than previously estimated, it is important to note that great international and collaborative work has been done worldwide in the past decades to fight sepsis. These efforts are conveyed in the study which examined annual sepsis incidence and mortality trends from 1990 to 2017. The study found that rates are actually decreasing. In 1990, there were an estimated 60.2 million sepsis cases and 15.7 million deaths, compared to the 48.9 million cases and 11 million deaths in 2017. However, the study highlights we still have a long way to go in the global fight against sepsis and we need to continue to build upon the work being done worldwide.

“This research confirms the urgent need for policymakers, healthcare providers, clinicians, and researchers to work together to implement robust national sepsis strategies, as called for in the 2017 WHO Resolution on Sepsis.”

— KONRAD REINHART, PRESIDENT GLOBAL SEPSIS ALLIANCE”

This research was funded by The Bill & Melinda Gates Foundation, the National Institutes of Health (grants T32HL007287, T32HL007820, R35GM119519), the University of Pittsburgh, the British Columbia Children’s Hospital Foundation, the Wellcome Trust, and the Fleming Fund.

A comprehensive press release, a template for a press release, and a contact person for media inquiries is available on the website of our friends at World Sepsis Day.