It’s not just long Covid ...sepsis can also cause crippling symptoms for months
Yet while corona patients can get specialist help, sepsis sufferers are left struggling on their own, with experts demanding action for all intensive care patients
WHEN Laura Williams woke in the middle of the night with vomiting and diarrhoea, she assumed it was simply a tummy bug. As a podiatrist whose work took her to nursing homes around her home town, she frequently found herself in environments where infections such as norovirus — the winter vomiting bug — could spread easily.
‘I even texted my boss in the night to say I was pretty certain I’d caught norovirus and wouldn’t be in for a couple of days,’ says Laura.
But rather than making a rapid recovery, Laura, 40, felt much worse.
Alongside the gastrointestinal problems, over the next 48 hours she developed a severe headache, agonising toothache on both sides of her mouth and — terrifyingly — woke one morning to find she could hardly breathe.
‘My neck had completely swelled up overnight and my throat felt like it was closing,’ says Laura.
Within hours, she was in hospital undergoing emergency treatment for sepsis — a potentially deadly condition that affects almost 14,000 people a year in Ireland and kills around 2,500.
It had been caused by several abscesses deep inside her gums.
Sepsis occurs when the immune system overreacts to an infection. This floods the body with cytokines, proteins that make blood vessels widen, leading to a dramatic fall in blood pressure and widespread inflammation, which can result in tissue damage. It can cause organ failure and death.
Fortunately, Laura’s sepsis was caught just in time and after four days in hospital on large doses of intravenous antibiotics and steroids (to dampen the inflammation) she went home.
But her ordeal was far from over. During the following months she experienced a range of debilitating symptoms, from nightmares to exhaustion and repeated mouth and ear infections.
Her concentration was so poor she’d forget what she was saying mid-sentence, and her temperature would fluctuate so wildly that even when the heating was on full blast at work, she would be ‘shivering so much I looked like I was on a rollercoaster ride’.
She also suffered severe hair loss. More than 18 months after she became ill in February 2019, she still experiences crippling fatigue, lowered immunity and anxiety.
LAURA is one of the 50 per cent of sepsis survivors with post-sepsis syndrome — physical and psychological symptoms that can persist long after the infection.
It can lead to difficulty sleeping, fatigue, lethargy, shortness of breath, muscle or joint pain, swelling in the limbs, repeat infections, poor appetite, reduced organ function, hair loss, skin rash, hallucnations, panic attacks, depression, mood swings and memory loss among many other symptoms.
The risk is higher among people admitted to an intensive care unit and those who have been in hospital for extended periods of time.
There are clear parallels with long Covid — the persistence of similar symptoms that’s thought to affect one in ten coronavirus survivors in Ireland.
Ireland’s largest study on longCovid and heart health found that two in five patients are still experiencing headaches, and 4 per cent are still experiencing a cough. Meanwhile, the loss of sense of smell and taste is still an issue for a respective 17 per cent and 15 per cent of those who caught Covid six months down the line.
Among those who experienced new onset cardiac specific symptoms since being diagnosed with
Covid, 62 per cent reported shortness of breath and 54 per cent palpitations.
The racing driver Lewis Hamilton recently revealed he’d suffered blurred vision as a result of long Covid. This, too, is now recognised as one of the neurological problems that 85 per cent of long Covid patients experience, as a study from the Northwestern Memorial hospital in the US has found.
The difference for Laura was her prolonged symptoms were due to a bacterium from dental abscesses. If they had been caused by Covid, she would benefit from available treatment for those with long Covid symptoms such as breathlessness, fatigue, brain fog and anxiety.
Respiratory consultants, physiotherapists, GPs and other specialists are working together to help long Covid patients return to normal. As well as specific checks such as a cardiopulmonary
exercise test to measure lung strength, these patients benefit from a rehabilitation scheme after a doctor’s referral.
But campaigners are angry that post-sepsis syndrome and similar long-term complications caused by other critical illnesses, such as pneumonia, are not being given the same consideration.
‘Covid-19 can be very disabling, but post-sepsis syndrome is just as bad,’ says intensive care specialist Dr Ron Daniels.
‘About 40 per cent of survivors of sepsis experience debilitating symptoms for 12 to 18 months after infection, sometimes longer.
‘So why are we offering rehabilitation to survivors of Covid-19 but not equally disabling infections?’
The range of prolonged effects after sepsis is extensive — muscle weakness, chest pain, damaged kidneys, excessive sweating, changes in taste and vision, swollen limbs, mood swings and posttraumatic stress disorder.
Medical bodies are now calling for every intensive care patient, whatever their illness, to be routinely assessed for lasting health problems, given a rehabilitation plan and have regular meetings with different specialists to make sure they’re on track.
‘The system is unjust,’ says Dr Daniels. ‘We’re not out to diminish the need for Covid rehabilitation, but it shouldn’t be prioritised.’
HE ADDED: ‘It’s often left to GPs to pick up the pieces. Not only are they terribly busy, they don’t receive much training in post critical illness care.’
Dr Stephen Webb, president of the Intensive Care Society, says ‘tens of thousands’ of those with sepsis do not get the follow-up care they need, with ‘up to half of those with post-sepsis syndrome . . . unable to work a year later’.
Laura’s nightmare was caused by Ludwig’s angina, in which a bacterial infection in gums spread to tissues under the tongue and in the neck.
It’s not only life-threatening because it shuts off the airway, but the bacterial infection almost always leads to sepsis.
Convinced her symptoms were not serious, she opted to rest at home. But her parents, with whom she was living, became so concerned they made an emergency GP appointment at which she was told to get an emergency consultation with a dentist.
The dentist said she needed intravenous antibiotics urgently and her parents should drive her to the hospital, 15km away, rather than wait for an ambulance.
Laura, who is raising awareness of post-sepsis syndrome in her podcast Your Sepsis Stories, says: ‘My blood pressure plummeted. I remember the anaesthetist saying if I had waited for an ambulance it would have been too late.
‘I underwent emergency surgery to remove three infected teeth. When I woke up, I had tubes draining pus out of my neck and for weeks wore dressings that needed changing every five hours.
‘Yet, just two weeks after being discharged, I was back at work.’
But within months, Laura was struggling to cope with the symptoms of post-sepsis syndrome. ‘I started having full-blown panic attacks, which I’d never suffered before, and became really down and crying uncontrollably. My GP has put me on antidepressants.
‘And I get so tired sometimes I have to stop for a two-hour sleep in the car on the way home from work, even though I only live a couple of kilometres away.
‘It takes me a lot longer to get over infections and I get terrified it will turn into sepsis again, so I’m constantly checking my pulse, blood pressure and temperature.’