COVID-19 can sometimes lead to sepsis. Sepsis occurs when the body’s response to an infection, like the SARS-CoV-2 virus, injures its own tissues and organs. The immune system’s extreme reaction, not the virus itself, causes this widespread damage. This intense response can lead to multi-organ dysfunction, tissue damage, organ failure, and in severe cases, death.
The Body’s Overreaction to Infection
When the SARS-CoV-2 virus infects the body, it can trigger an excessive immune response, often called a “cytokine storm.” Cytokines are proteins that signal between immune cells, coordinating the body’s defense. In a cytokine storm, there is an uncontrolled release of these inflammatory proteins, far beyond what is needed to fight the virus.
This flood of cytokines initiates widespread systemic inflammation. Endothelial cells lining blood vessels become damaged, leading to increased vascular permeability, meaning blood vessels become “leaky.” Fluid can then leak out of the vessels and accumulate in surrounding tissues, including the lungs, potentially impairing oxygen exchange.
Systemic inflammation also contributes to dysregulated coagulation, where the blood clotting system becomes overactive. This can result in numerous small blood clots (thrombosis) throughout the body, impeding blood flow to various organs. Blood pressure can also drop dangerously low, a condition known as septic shock, as widespread inflammation and leaky vessels compromise the circulatory system’s ability to maintain adequate pressure. When organs do not receive enough blood and oxygen, they begin to suffer damage.
Identifying the Warning Signs
Recognizing the signs of sepsis is important because prompt medical attention can significantly improve outcomes. Symptoms can appear rapidly and may include changes in mental state, such as confusion or disorientation. An individual might also experience extreme pain or discomfort, often localized at the site of the initial infection, such as severe abdominal pain with a gastrointestinal infection or chest pain with a lung infection.
Fever, shivering, or feeling unusually cold are common indicators of infection and can be early signs of sepsis. However, sepsis can occur without a high fever, especially in older adults or those with weakened immune systems. Shortness of breath or difficulty breathing are significant warning signs, as the body’s increased need for oxygen due to the overreaction can lead to faster breathing.
A rapid heart rate is another common symptom, reflecting the body’s attempt to compensate for decreased blood pressure and reduced oxygen delivery to tissues. The skin might also appear pale, bluish, or mottled, and feel clammy or sweaty, particularly on the palms or soles of the feet in individuals with darker skin tones. Reduced urine output is another indicator of potential organ dysfunction. If any of these symptoms emerge, immediate medical evaluation is recommended.
Hospital Diagnosis and Treatment
Upon arrival at the hospital, a series of diagnostic tests are performed to confirm sepsis and identify the infection source. Blood tests are a primary tool, checking for evidence of infection, blood-clotting problems, and abnormal liver or kidney function. Specific markers like lactate levels, which indicate tissue hypoperfusion, white blood cell counts, inflammatory markers such as ferritin and C-reactive protein (CRP), and D-dimers, which are elevated in clotting issues, are assessed.
Imaging scans are also used to pinpoint the infection’s origin and evaluate organ damage. Chest X-rays or computed tomography (CT) scans can reveal lung infections like pneumonia and assess the extent of lung involvement. Ultrasound may be used to visualize infections in organs such as the gallbladder or kidneys, while magnetic resonance imaging (MRI) can detect soft tissue or bone infections. These scans provide a comprehensive view of the body’s internal state.
Treatment for COVID sepsis is a multi-pronged approach focused on supporting organ function and modulating the body’s immune response. Intravenous (IV) fluids are administered early to raise dangerously low blood pressure and restore circulating volume. If fluids alone are insufficient, medications called vasopressors are used to narrow blood vessels and further increase blood pressure.
Supplemental oxygen is provided, and in cases of severe respiratory distress or failure, mechanical ventilation may be necessary to support breathing. Corticosteroids, such as dexamethasone, are given to dampen the exaggerated immune response and reduce systemic inflammation. Broad-spectrum antibiotics are initiated quickly to address any potential secondary bacterial infections that can complicate viral sepsis.
Post-Sepsis Conditions and Organ Damage
Survivors of COVID sepsis may experience lasting health issues, often referred to as Post-Sepsis Syndrome (PSS). This syndrome encompasses persistent physical, emotional, and psychological challenges that can linger for months or even years after the acute illness. Common symptoms include profound fatigue, difficulty sleeping, and chronic muscle or joint pain. Many individuals also report cognitive difficulties, often described as “brain fog,” which can manifest as problems with memory, concentration, and decision-making.
Beyond these general symptoms, the initial septic event can cause specific and lasting damage to various organs. The lungs, frequently affected during severe COVID-19, may develop fibrosis, leading to ongoing shortness of breath and a heightened risk of recurrent respiratory infections. Kidneys can sustain injury, sometimes requiring long-term dialysis, and the heart may experience inflammation or a higher risk of cardiovascular events such as heart attack or stroke.
The widespread inflammation and poor blood circulation during sepsis can also lead to other complications, including nerve damage or, in rare cases, gangrene that necessitates amputation. There is a notable overlap between PSS and “Long COVID,” a condition where symptoms persist for weeks or months after a COVID-19 infection. Many individuals with Long COVID may have experienced an undiagnosed or sub-clinical septic response, as the underlying mechanisms of immune dysregulation and multi-organ dysfunction are similar.