Those who develop sepsis will need ICU close monitoring to prevent it developing into Covid-19 septic shock
BY DR AZLIN ITHNIN
AND ASSOC PROF DR TAN TOH LEONG
We have been living with the pandemic for the past year and still trying to adapt and live our lives as normally as we can. SARS-CoV-2, the most glamorous viral RNA of this century, is a virus from the family of coronavirus that causes the common cold symptoms which resembles its cousin the influenza virus. Both can cause a pandemic.
What is the different between influenza and Covid-19?
The influenza virus causes seasonal flu and usually involves the upper respiratory tract, ie. the nose and throat. There are different types of influenza virus which is Type A-D. However, the Influenza A viruses are the only influenza viruses that are known to cause flu pandemics.
Pandemics can occur when a new and very different type of influenza A virus emerges and has the ability to spread efficiently between people. Influenza type C infections generally cause mild flu and do not usually cause human flu epidemics. The other types of influenza virus are not really clinically significant.
The difference though between Covid-19 and the influenza virus is that influenza causes flu disease that eventually resolves without much consequences. On the other hand, Covid-19 causes a prolonged stay in the hospital, ICU and may cause death in those who are susceptible.
What are the clinical categories of Covid-19?
In the Covid-19 disease, there are five clinical stages identified. In category 1, the patient does not show any symptoms. In category 2, patients will have symptoms such as fever and sore throat, but do not have any lung involvement. In category 3 and 4, the infection involves the lungs, with or without oxygen dependency. In category 5, the patient is critically ill with multi-organ involvement.
The majority of patients present with mild disease in category 1 to 3. In patients who deteriorate, the disease often progresses to a more severe condition needing oxygen supplementation and ICU care.
This deterioration can be due to progression into sepsis, where we may get a hyper- and hypo-inflammatory stage associated with rapidly worsening pneumonia and organs failure. Other factors that can cause a patient to deteriorate may include the viral effect of the disease itself, patients with diabetes and high blood pressure, and complications such as thromboembolism (where you develop blood clots within the blood vessels) or nosocomial pneumonia (when you develop lung infection from the hospital environment).
Monitoring the illness
In order for early detect the progression of Covid-19 into sepsis, the illness is monitored using a special scoring system known as the Sequential Organ Failure Assessment or SOFA score.
SOFA score was scored based on six different organs functions. They are respiratory, cardiovascular, liver, blood hemostasis, urinary and neurological systems with each score from 0 to 4 with an increasing score reflecting worsening organ function.
Those who develop sepsis will need ICU close monitoring to prevent it developing into Covid-19 septic shock. The issue of a prolonged stay in the ICU for each Covid-19 septic shock patient causes a reduced chance for the next critically ill patient to be admitted in the ICU as well.
Thus, let us all play our part in fighting this viral pandemic by staying at home whenever possible, wear masks when we need to go out, wash our hands or sanitise them frequently and use technology advancement in our social and work activities.
May this pandemic resolve fast and may we be more prepared when the next pandemic knocks on our doors again in the future. — The Health
Dr Azlin Ithnin is Senior Lecturer and Chemical Pathologist Consultant, UKM Medical Center, Universiti Kebangsaan Malaysia (UKM) and Vice President of Malaysian Sepsis Alliance while Assoc Prof Dr Tan Toh Leong is Senior Lecturer and Emergency Medical Consultant, UKM Medical Center, UKM and President and Founder of Malaysian Sepsis Alliance.