A study published this January in The Lancet found that twice as many people are dying of sepsis worldwide than previously estimated. In 2017 alone, there were a total of 48.9 million cases of sepsis and 11 million deaths, many of them are children under the age of 5.
Eleven million equates to one out of every five deaths worldwide – a number that far exceeds other common diseases such as cancer or heart disease. The good news is that that number has decreased since 2011 where it was 15.7 million. However, the disturbing finding is that the majority of sepsis cases – 85 per cent in 2017 – occur in low- or middle-income countries, which have reduced access to hospitals, resources and staff to care for their populations.
Sepsis is a life-threatening condition that occurs in response to a severe infection. When the infection is not treated early enough, the immune system becomes imbalanced and starts to damage organs. Without antibiotics, oxygen and fluids, a person will die.
Even with adequate treatment, sepsis can leave survivors with long-term disabilities. The importance of early treatment cannot be understated. “Most cases are preventable or treatable if caught in time,” said Dr. Niranjan “Tex” Kissoon — a study co-author and professor in the UBC department of pediatrics — in a recent press release.
“Years ago, I realized that that's one of probably the most important causes of death in the world, especially with children,” he said.
Raised in Trinidad and Tobago and educated in Jamaica, he’s spent his career advocating at a global level for better management of sepsis.
“When you come from modest circumstances you've seen it, you understand starvation, you understand malnutrition, you understand and live in and hopefully understand the lack of vaccines,” he recalled, explaining how his early days influenced the direction of his career.
These early experiences influenced his work with the Global Sepsis Alliance, whose advocacy was instrumental in the 2017 adoption of a resolution to reduce the human and economic burden of sepsis at the World Health Assembly of the United Nations. After sepsis was declared a global priority, Kissoon and other experts from across the world collaborated on this study with the goal to estimate cases and deaths from sepsis throughout the world.
The study used the Global Burden of Disease study – the most comprehensive worldwide epidemiological report to date with over one billion data points from 192 countries for 282 different conditions coordinated by the Institute of Health Metrics and Evaluation at the University of Washington School of Medicine.
By leveraging this data, they were able to see that previous sepsis rates were grossly underestimated. This was in part due to the reliance on hospital data from high-income countries such as the US and Canada.
“We found that the data was there only from hospitals and hospital patients from rich countries. And many of the places where we worked, the kids died at home. They don’t even make it to hospitals. And nobody knows how many kids died and where they died,” Kissoon said.
The study findings are unprecedented as they report sepsis-related deaths from both inside and outside of the hospital and in low- to high-income countries around the world.
High-income countries spend billions of dollars on early identification and treatment of sepsis. In the US alone, sepsis contributes to half of all hospital deaths and costs the health care system over $24 billion per year. Health care spending translates into what Kissoon called “safety nets” for patients. Countries like Canada spend as much as $6,448 per person. However, places like Nigeria, Kenya and Uganda spend as little as $5 per person for health care needs. This means there is no safety net and people are falling through the gaps.
“If my child may die because of lack of food, even after the sepsis is treated, why should I treat him just to watch him suffer and die of starvation,” a woman told Kissoon during his time in Kenya and Uganda. Women often bear the weight of childcare in many countries and experience many barriers along the way. Although more hospitals and critical care resources are essential, upstream public health investments into sanitation, nutrition, housing, maternal health and vaccines have greater power to substantially lower the risk for infection and therefore sepsis.
When asked at an international conference what Kissoon would do to solve the problem with $15 billion dollars, he didn’t hesitate to say “Keep young girls in school longer and give them opportunities. That’s what you do.”
Kissoon and colleagues are hopeful it will translate into global health policy changes.
“Were putting together a report for the Secretary General. People don’t realize what is going now – those who die from coronaviruses – are also dying from sepsis.”