Could we see a rise in amputations related to sepsis because of COVID-19?

In the wake of World Sepsis Day on 13 September 2020, Sepsis Research UK (FEAT) has warned that sepsis mortality rates could ‘soar’ as a result of the Covid-19 Pandemic, according to an article in the Scottish Herald.

A FEAT spokesperson stated that there are two main reasons that a sepsis diagnosis may be missed or delayed as a result of COVID-19:

1. there is some similarity in the symptoms of COVID-19 and sepsis, which may be confusing for both patients and medical staff; and
2. during lockdown, there are concerns that people have not been seeking medical assistance, or delaying contacting their GP, because of a fear of contracting or spreading the virus.

‘Could it be sepsis?’ - has it become a difficult question in a pandemic?

Sepsis kills 48,000 people a year in the UK, and 11 million worldwide, so early detection and treatment is paramount.

Mortality is not the only thing we should be concerned about however, as delays in diagnosing and treating sepsis can lead to life-changing injuries such as amputations. The reason for this is that sepsis sends the body’s clotting mechanism into overdrive, preventing oxygen-rich blood from reaching (usually) the extremities. This ultimately results in tissue death. Sepsis.Org estimates that 1% of all sepsis survivors in the United States undergo one or more surgical amputations of a limb or digit as a result of sepsis.

The potential overlap in symptoms between COVID-19 and sepsis is particularly concerning, as the treatment for each is very different. FEAT’s COO, Colin Graham, had the following to say in relation to the importance of ensuring sepsis remains part of differential diagnoses and triaging:

“We urge NHS executives and the Scottish Government for their support in getting the message out to all NHS staff to keep sepsis in mind as a possibility when triaging any patient at this time, so that if they have sepsis it can be quickly identified and the correct treatment given.”

Having represented clients in cases where there have been unacceptable delays in diagnosing and treating sepsis, I would completely echo this sentiment. The consequences of failing to identify/exclude sepsis early can be devastating. In a COVID-19 climate, with potential overlaps in symptoms and changing patient behaviour, it is more important than ever to raise awareness of sepsis, and particularly its early presentations.