Are Doctors Hesitant to Diagnose Viral Sepsis?

Are doctors hesitant to diagnose viral sepsis? This is a question that applies to almost everyone in the United States as we continue to battle COVID-19.  Increasingly, healthcare providers are seeing a link between COVID-19 and sepsis, but many doctors are hesitant to diagnose it.  Why? There are several factors that may contribute to this mindset.

Pandemic Challenges Diagnosis of Viral Sepsis

The COVID-19 pandemic continues to challenge scientists, researchers, epidemiologists, healthcare providers and public health officials.  Appropriate diagnosis and treatment is paramount, even as we continue to learn more about the virus and how it affects short- and long-term health.  In fact, rapid diagnosis and treatment could reduce sepsis rates by as much as 80%.

Many believe that we must also change the definition, language and guidelines for diagnosing and treating certain syndromes that may relate to COVID-19.

In 2015, the Third International Consensus Definitions for Sepsis and Septic Shock Task Force presented an  updated definition of sepsis and septic shock.  The new definition is, according to a Medscape article written by doctors Christina Boncyk, Matthew Mart and Wesley Ely,

“inclusive of the heterogeneous causes of sepsis while emphasizing the importance of urgent recognition and diagnosis of this deadly condition.  As we continue to learn about COVID-19 and its effects within the human body, this definition is important in our communication and recognition of illness severity.

While the definition may be inclusive of COVID-19, unfortunately, the guidelines for diagnosing and treating sepsis have not changed.  That has created a gap in patient care that could be costly.  Boncyk, Mart and Ely contend,

“We must navigate through many new phenomena in this global pandemic, but our diagnostic criteria have not changed for sepsis or other syndromes of critical illness.  It is vital to patient care, both local and global, that we communicate effectively on behalf of our patients to define COVID-19 severity using established definitions, including clarifying COVID-19 as a potential cause of sepsis.”

Understanding Sepsis

Sepsis is not, in itself, an infection.  Rather, it is the body’s dysregulated response to an infection.  Sepsis can develop in anyone who has any type of infection, including:

• Bacterial
• Fungal
• Viral
• Protozoal

That includes COVID-19.  When the body has a dysregulated response to COVID-19, the patient has a form of viral sepsis.  Severe COVID-19 infections are linked to dysregulated responses in the days or weeks that follow direct viral invasion.

Because many cases of viral sepsis are missed, researchers recommend that healthcare providers perform daily evaluations to determine if sepsis is developing in patients with severe or critical COVID-19 infections.  Researchers suggest that patients be evaluated using the Sepsis-related Organ Failure Assessment score (SOFA) and the Multiple Organ Dysfunction score (MOD).

Using the SOFA and MOD scores, healthcare providers can better diagnose and begin treating sepsis before it becomes critical.

COVID-19 and Sepsis

COVID-19 frequently leads to organ dysfunction, much like sepsis and other types of pathogenic organisms.  Many of these dysfunctions are related to the body’s immunologic response to an infection.  Therefore, healthcare providers’ best chance at reducing the risk of sepsis is to stop the body’s dysregulated response using corticosteroids or remdesivir.

While the two are similar, there are some significant differences between sepsis that develops from bacteria and sepsis that develops from COVID-19.  Ultimately, however, it is still sepsis.  The differences are quantitative (measures quantity or numbers) and not qualitative (measures quality).  That means that healthcare providers have likely seen sepsis cases or similar manifestations in patients before COVID-19 actually began to infect patients in the United States.  The difference is that these manifestations are more common in the daily care of COVID-19 patients.

In Intensive Care Units (ICU), healthcare providers are on alert for complications of COVID-19 as it frequently progresses from a purely viral illness to a bacterial illness.  Unfortunately, researchers have not pinpointed when this progression actually happens.

Unlike influenza, COVID-19 lasts much longer (weeks instead of days), which means that organ damage from COVID-19 and organ damage from sepsis can occur at the same time.  Furthermore, because of the lengthy duration of COVID-19, complications often appear once the patient seems to be improving.

Are Doctors Hesitant to Diagnose Viral Sepsis?

Are doctors hesitant to diagnose viral sepsis? The answer to this question may be a “maybe.” There are some factors that may cause doctors or hospitals some degree of hesitancy in their diagnosis and care of patients with viral sepsis.

Systems Implications

There are systems implications for hospitals that report sepsis and adherence to Sepsis Management standards to the Centers for Medicare & Medicaid Services (CMS).  Hospitals can receive penalties if they fail to follow guidelines, such as administering 30-mL/kg volume expansion via intravenous crystalloid or administering broad-spectrum antibiotics.

The CMS Sepsis Management Bundle provides guidelines for healthcare providers and hospitals on how to assess, diagnose and treat sepsis.  However, these protocols are generally focused on sepsis that has a bacterial cause, not viral sepsis.  Therefore, some protocols could actually be harmful to a patient suffering from viral sepsis.  Using these protocols could cause more harm than good to patients, including increasing hypoxia.

Misconceptions

The most likely reason why doctors are hesitant to diagnose viral sepsis is because of misconceptions.  A common misconception is that sepsis is synonymous with bacterial infections – identified or not via culture.  This form of “tunnel vision” inhibits healthcare provider awareness to the numerous possible sources of viral sepsis.

For example, viral sepsis can originate from:

• Herpes Simplex Virus
• Norovirus
• Viral Meningitis
• HIV

Even though these misconceptions are clear, what is also increasingly clear is that COVID-19 is a major cause of sepsis.  Furthermore, it is a cause that includes subsequent organ dysfunction that is often seen with sepsis.

Find Out More about COVID-19 and Viral Sepsis

Most of us want to know as much as possible about COVID-19 and possible complications.  The virus has already resulted in more than eight million illnesses and 225,000 deaths just in the U.S. What’s more, sepsis is a significant factor in COVID-19 deaths, according to some reports.

If you want to learn more about COVID-19, sepsis or viral sepsis, visit the following:

• The Sepsis Alliance
• Centers for Disease Control and Prevention (CDC)
• World Health Organization (WHO)
• BIO-X from Stanford
• Nationwide Sepsis Care Study

As always, if you have questions about sepsis and medical malpractice, call MedMalFirm.com to speak with an attorney about how sepsis could be a sign of medical malpractice.  For a free consultation, call us at 877-887-4850.