Can severe cases of COVID-19 be considered sepsis?

PUBLICATION DATE: MAY 22, 2022

By now, it has been established that COVID-19 is not just any respiratory virus. Researchers have quickly discovered that this virus is capable of directly affecting multiple organ systems, and that it can also cause a host of related complications. Among those complications are long or post-covid conditions, permanent lung damage, endothelial dysfunction, acute kidney injury, and sepsis.  

Globally, sepsis is a common pathway to death. The WHO estimates that sepsis affects 49 million people and causes 11 million deaths each year. While sepsis has been a condition that is familiar to health systems for some time, the recent pandemic has sparked the need for further investigation on whether COVID-19 in some cases, can be considered viral sepsis. Researchers state, “in clinical practice, we have noted that many critically ill patients with COVID-19 present with typical sepsis-related clinical manifestations.”

Throughout the onset of the pandemic, research has indicated that COVID-19 has unique features, however, “many of its acute manifestations are similar to sepsis caused by other pathogens.” Data indicates that the similarities between COVID-19 and sepsis comes from measurable levels of serum cytokine and chemokine, which are high in COVID-19 patients, like patients with sepsis.  

In some cases, sepsis can progress to a more severe case, often marked by characteristics such as organ failure and dysfunction. The causes of organ dysfunction in sepsis patients are complex, but ultimately result in blood being unable to provide organs with the oxygen necessary for functioning. The current understanding of organ dysfunction with sepsis mainly relies on data from patients with bacterial sepsis, because it is vastly more common than viral sepsis. This is important because it represents a knowledge gap when it comes to studying viral COVID-19 and sepsis. As emphasized in this study, “consideration of severe COVID-19 disease as a sepsis syndrome has relevance and may assist in terms of determining treatments that will modulate the immune response…limiting intrinsic damage to tissue and organs, and potentially improve outcomes.”

There are different types of sepsis depending on the causative pathogen. Sepsis can either be viral, bacterial, or fungal. “A key difference between viral sepsis and either bacterial or fungal sepsis is that, for most viral infections, specific therapies are substantially less effective than antibacterial or antifungal agents,” notes an article in the Chest journal. The authors argue that not only is there a relationship between COVID-19 and sepsis, but that severe COVID-19 can be considered sepsis.

In some instances, COVID-19 leads to sepsis, but in other cases, having COVID-19 can also increase the risk for a patient to develop other infections that can lead to sepsis inadvertently. As defined in this article, “when your body is fighting an infection, you are at heightened risk of developing another infection…your body’s reaction to the additional infection could lead to sepsis.”

Treatment for sepsis patients always requires rapid identification of the causative pathogen to start the appropriate therapy as soon as possible. However, determining whether COVID-19 patients have become septic can be challenging because many of the most common Sars-CoV-2 symptoms, such as fever and chills, difficulty breathing, pain or discomfort, and confusion can also be common symptoms of sepsis. Because appropriate therapy depends on the underlying cause of infection, diagnostics are critically important in this environment.

Through this challenging situation, physicians have gained a better understanding of how to handle different aspects of viral sepsis and have improved best practices for supportive care. These have helped to improve survival rates for critically ill COVID-19 patients and will likely provide a foundation for better supportive care as new viruses inevitably arise. However, the situation highlights the severity of the pandemic and why antimicrobials and accessibility to diagnostic tests are such a critical part of modern medicine.