We are in the midst of an epidemic that most of the public has never heard of, and doesn’t understand.
No, not Zika, not Ebola, not hospital acquired infections. From news media coverage, one would think that these infections were endangering everyone everywhere on the planet. While these are important and need to be confronted, the extent of these diseases pales compared to the everyday severe infections that plague us.
Sepsis, the body’s dysfunctional response to any type of severe infection, is epidemic, increasing by 10 percent per year, and doubling every eight years. It is now the No. 1 cause of death in hospitals in the United States, far greater than heart disease, stroke or cancer.
Between 1 million and 3 million people in the United States gets sepsis each year, and worldwide it strikes more than 26 million. Someone in the United States dies of sepsis every two minutes. Hospital costs of treating sepsis exceed that of any other condition.
These are not hospital-acquired infections: more than 80 percent are infections acquired in the community, that cause people to be admitted to the hospital in the first place. Infections like pneumonia, kidney and urinary tract infections, influenza, cellulitis, meningitis, appendicitis, gastrointestinal infections, joint infections and many others, all cause sepsis, and all can result in death.
If you or a friend or relative has been admitted to a hospital for any type of infection, they almost certainly had sepsis, whether they knew it or not. And that’s the problem. It’s likely they never heard the term sepsis associated with their infection.
Sepsis, like cancer, has many manifestations. But the word cancer is associated with its manifestations: breast cancer, lung cancer, colon cancer.
A cancer survivor always knows they had cancer, but more often than not, survivors of sepsis have no idea they had sepsis. The media and the medical community have done a poor job of associating the term sepsis with these varied infections.
Therefore, there is limited awareness of this disease, and there is no constituency to push for more funding for research into its nature and treatment.
Unbeknown to most of the public, the medical community and hospitals have been developing protocols to treat sepsis for the past decade. Great strides have been made. In many cases, like at our hospital, Santa Barbara Cottage Hospital, we have been able to develop processes and procedures that have cut the mortality from the severest forms of sepsis by as much as 66 percent.
Despite these improvements in treatment, more people than ever are dying of sepsis. This is because people are developing sepsis at an alarming rate.
There are many reasons for this increase. Sepsis can strike at any age, but the very young and the elderly are most vulnerable, and as medical advances improve the treatment of heart disease, stroke, cancer and other diseases, our elderly population is growing.
Sepsis attacks those who have compromised immune systems, and the chemotherapeutic and biologic agents we are using to treat cancer and many other diseases are creating large numbers of susceptible persons.
If that isn’t bad enough, the bacteria, fungi and viruses causing these infections are becoming more aggressive —, and more resistant to our antibiotics.
Meanwhile, due to a lack of research and development, only four new classes of antibiotics have been developed and marketed to fight them in the last 40 years. No effective medications to combat the underlying processes in sepsis have ever been developed.
Despite the enormity of the problem, due to the lack of an identifiable sepsis constituency, only a tiny fraction of a percent of our National Institutes of Health budget is spent on sepsis research.
In fact, the federal government spent 60 times more on Zika and Ebola this past year, than it did for sepsis. There have been two deaths from Ebola, and one from Zika infection in the United States since 2014, and more than 500,000 U.S. deaths from sepsis during that time.
This is not to say we should not spend the money to prevent and treat these other infections, but we are not spending nearly enough on sepsis.
While we used to think that once someone survived sepsis they returned to normal function, we now are starting to recognize many, if not most, of these patients have prolonged disability due to these infections.
Many lose their ability to live independently. Many develop cognitive or psychiatric problems, including memory disturbances, post-traumatic stress syndrome or depression.
They are also predisposed to developing recurrent sepsis, requiring hospital readmission and consuming even more resources. If we do not devote more attention and funds to understanding and combating sepsis, our health-care system will soon be overwhelmed with these patients.
What can you do? If you have read this far, you already started doing something. You know what sepsis is, and the threat it poses.
Now you can ask your local hospital if they have sepsis protocols to improve the likelihood that you or your loved ones will survive sepsis. You can ask your political representatives to allocate more funds to sepsis research.
You can become familiar with the cardinal signs of sepsis: fever, chills, shortness of breath, dizziness, rapid heartbeat, skin discoloration or rash, confusion, lethargy, disorientation and seek medical assistance immediately if you develop any combination of these. If you’ve had a serious infection leading to hospitalization, you are a sepsis survivor.
— Dr. Jeffrey Fried is a pulmonary and critical care specialist at Santa Barbara Cottage Hospital, and an associate program director of the Internal Medicine Residency Program in charge of Critical Care Education and Research. He also is a clinical professor of medicine at Keck School of Medicine of USC. The opinions expressed are his own.