Sepsis and COVID-19

Posted by Nurse Linda in Life After Paralysis on August 21, 2020 # COVID-19, Health

Sepsis is such an important topic that it is wise to bring it to light, especially in this time of COVID-19. We hear a lot of news about the number of individuals tested for COVID-19 and the number of people who test positive. What is not heard is information about what happens to your body after COVID-19. Nor do we hear about individuals with spinal cord injury who contract the virus. So, let's begin that discussion.coronavirus cell

First, let's review what Sepsis is. If a person gets any sort of infection or damage to any part of the body internally or externally, the body responds naturally by sending fluid and internally made antibodies to the site of the infection. This is a normal human response. Sometimes the infection thrives despite the body's natural response. Manufactured (prescription) antibodies are needed. An infection that cannot be controlled spreads throughout the body leading to Sepsis. Bacteria or viruses can lead to internal inflammation long after an infection has been cleared.

As some bacteria are becoming more resistant to manufactured antibiotics and viruses can be difficult to treat, Sepsis can become an issue for anyone. However, some people have risk factors that can make Sepsis even more dangerous for them. These include older adults, pregnant women, children under one year, those with chronic conditions like spinal cord injury and diabetes, lung or kidney disease, cancer, or weakened immune systems.

Individuals with spinal cord injury (SCI) will have susceptibilities for Sepsis due to chronic conditions such as the secondary complications of SCI. Individuals with SCI have a higher risk of developing diabetes. Decreased breathing (lung) ability can be due to effects of SCI on one, two, or all three of the muscle groups needed for strong breathing, the diaphragm, intercostal muscles (those between the ribs) and abdominal muscles. The immune system that responds to infection is controlled by the Autonomic Nervous System (ANS). The ANS can be affected by SCI by a slow response to detecting infection or a slow ability to respond to control it.

It is important to have an infection treated as soon as possible, especially if you have a spinal cord injury. This enables the body to respond effectively to destroy the infection before it becomes an issue. Most individuals with or without a spinal cord injury will not develop Sepsis, but if you do, it can be life-threatening.

Untreated Sepsis leads to septic shock, multiple organ failure, and death. Once symptoms of Sepsis occur, you have a limited amount of time to receive treatment. A Sepsis wallet card is available from the Christopher and Dana Reeve Paralysis Foundation that can be printed for free. This card can help you, and healthcare providers understand the symptoms and treatment needed for Sepsis.

The Sepsis Organization has a pneumonic for the symptoms of SEPSIS:

S Shivering, fever or very cold

E Extreme pain or general discomfort

P Pale or discolored skin

S Sleepy, difficult to arouse, confused

I "I feel like I might die" (Impending doom)

S Shortness of breath

The Sepsis Alliance uses this scheme for symptoms:

T Temperature (higher or lower than normal)

I infection (signs and symptoms of infection)

M Mental decline (confused, sleepy, difficult to arouse)

E Extremely ill (I feel like I might die, severe pain or discomfort)

Both the SEPSIS and TIME pneumonic and the Reeve wallet card can be used to direct you to get help for Sepsis. Sepsis is a 911 emergency situation. If you develop Sepsis, you need treatment quickly. Treatment includes fluids and IV antibiotics. Many individuals will recover at this point. However, Sepsis can be difficult to treat. Kidney dialysis and mechanical ventilation may be required for some individuals. Life support measures may be needed. Sometimes surgery might be done depending on your ability to oxygenate your extremities. Rehabilitation therapy may be needed to combat long term complications.

In these days of COVID-19, there is not a lot of information about what happens to individuals that contract the virus. Even people who have COVID-19 that do not need hospitalization can have long term health effects such as heart conditions, breathing problems, and kidney failure, among other issues.

COVID-19 is a virus that enters your cells, taking over the cellular replication process. Instead of the cell replicating into a new cell of the same type, the cell now makes more COVID-19 cells. Not only does the COVID-19 flourish in your body, but less of the original type cells are produced. COVID-19 is a virus which probably will be difficult to be fought off by the body of a person with spinal cord injury. This does not mean you will not survive COVID-19. Many people do get well. It does mean you could quite possibly have a bigger challenge in battling it.

Individuals that may have a worse case of COVID-19 are those who have these characteristics:

  • Older adults and children
  • Cancer
  • Chronic kidney disease
  • COPD (chronic obstructive pulmonary disease)
  • Immunocompromised state (weakened immune system) from solid organ transplant or SCI
  • Obesity (body mass index [BMI] of 30 or higher)
  • Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
  • Sickle cell disease
  • Type 2 diabetes mellitus

If you are not sure of your body mass index (BMI), you can calculate it here.

Many of the susceptible conditions of COVID-19 are the same indications as those for Sepsis. These conditions are secondary complications of spinal cord injury.

The signs of a COVID-19 infection as listed by the CDC on their website at CDC.gov are:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

COVID-19 develops 2-14 days after exposure to the virus. Someone can have the virus for a part or that whole timeframe without symptoms or knowing they are infecting others.

A few individuals will contract COVID-19 and recover without deficits. Most individuals who contract COVID-19 will have long term health complications. Despite popular belief, having COVID-19 is not like having a really bad cold or flu and then getting better. Long term effects remain.

Treatment for COVID-19 is directed toward the symptoms. Individuals may require medication for fever and muscle aches to mechanical ventilation, dialysis, and life support measures for more involved cases. Long term rehabilitation will be needed to assist with the return of function and adaption of activities of daily living.

The effects of COVID-19 are many. Since the virus is new, a US government study is being conducted to assess the long-term effects. This study is called the COVID-19 Observational Study (CORAL). It is being conducted by the National Institutes of Health (NIH) National Heart, Blood and Lung Institute (NHLBI). As an individual with spinal cord injury, if you contract the COVID-19 virus, you might choose to participate in this study as it will be critical to see how those, particularly with SCI, are affected.

Research from China indicated that individuals who have COVID-19 have had long term lung injury resulting in difficulty breathing and cardiomyopathy (muscle disease of the heart), resulting in an arrhythmias (irregular heartbeats).

Current research efforts are focused on inoculations and treatments due to the gravity of the disease and quick spread. The CORAL study will help understand long term effects. Incidental reports indicate those who survive COVID-19 may have long term issues with fatigue, shortness of breath, muscle pain, confusion, headaches, and hallucinations. Other problems include heart inflammation and muscle wasting, lung inflammation including a chronic dry cough, shortness of breath and pain with breathing. Some individuals will need breathing assistance long term. The nervous system can be affected with headaches, dizziness, trouble concentrating and recall of information. In addition, blood clots are an issue.

The symptoms and treatments of both Sepsis and COVID-19 are much the same. COVID-19 is a viral infection. Viral infections can lead to Sepsis. Until we have all the facts about COVID-19, healthcare professionals will work with the knowledge they already have to treat the Sepsis that occurs from COVID-19.

You can reduce the chances of contracting COVID-19 by practicing social distancing (at least 6 feet) and self-isolation. Wash your hands with soap and water using friction for 20 seconds or use hand sanitizer. Have caregivers do the same before touching you. Cover your mouth and nose with a mask when going out unless you have breathing difficulty or have limited use of your arms to remove the mask. Have your caregiver wear a mask for personal care and change into clean clothes as soon as entering your home. Cover coughs and sneezes. Disinfect surfaces. Wear separate shoes if walking, wipe your wheels and rims with disinfectant before entering your home. Monitor your health. If you have symptoms, call your healthcare provider or if you are having difficulty breathing, call 911. Nurse Linda

Pediatric Consideration: Children take in lots of information from overheard conversations, school, other children, caregivers, and TV. They know about COVID-19. Be sure to discuss the issue at an age-appropriate level. Their stress and worry about COVID-19 might be even bigger than yours as they might not understand what is happening, but they know it is scary, and everyone is grumpy. Their life has changed, as well. They cannot do their usual activities like play with others or go to school.

Look toward health for your child. Monitor their condition for signs of illness, provide a healthy diet, a form of exercise (which should include a range of motion), and fun. Make special days for your family to look forward to, such as a movie night or other fun family events. Even a family handwashing party can be fun.

Just as with other diseases that used to affect just older people, COVID-19 is rapidly moving down the age range. Be aware of symptoms of Multisystem inflammatory Syndrome in Children (MIS-C). This can be a very serious illness. Symptoms include all or some of the following:

  • Fever
  • Abdominal pain
  • Vomiting
  • Diarrhea
  • Neck pain
  • Rash
  • Bloodshot eyes
  • Feeling extra tired

Seek emergency medical help if your child develops:

  • Trouble breathing
  • Pain or pressure in the chest that does not go away
  • New confusion
  • Inability to wake or stay awake
  • Bluish lips or face
  • Severe abdominal pain

Treatment for COVID-19 in children is to treat the symptoms. There is currently no cure for COVID-19, but new information and treatment strategies are being discovered daily.

Prevention is the same as for adults, but children under two years or those with breathing difficulty should not wear a mask. This is because the child might rebreathe their carbon dioxide exhalations. Also, all children and teens with limited use of hands should not wear a mask for the same reason.

These are dangerous times for adults but even more so for children who might not be able to express their thoughts and fears. Provide age-appropriate information without alarming them. Be vigilant in the care of your child. Nurse Linda

Linda Schultz, Ph.D., CRRN, a leader and provider of rehabilitation nursing for over 30 years, and a friend of the Christopher & Dana Reeve Foundation for close to two decades. Within our online community, she writes about and answers your SCI-related healthcare questions in our Heath & Wellness discussion.