4th Annual Meeting of the European Sepsis Alliance - September 2021

4th Annual Meeting of the European Sepsis Alliance – September 2021

All keynotes, presentations, and panel debates from the 4th Annual Meeting of the ESA. Use these chapter markers to jump directly to a specific talk/speaker:

00:00:00 Welcome and Introduction
00:04:14 Why Europe Needs a Coordinated Effort to Implement the WHA Resolution on Sepsis (Hans Kluge)
00:10:26 The EU Response to New Scenarios, Between Emergency and Creating Resilient Health Systems (Gabrijela Kor┼że)
00:23:39 Panel: How the Fight Against Sepsis Can Help Respond to the Pandemic and Global Health Threats
01:26:24 Panel: Lack of Data and Knowledge on Sepsis: What Are the Practical Solutions to Tackle This Deficit?
02:08:34 Panel: Patient-Centric Health Systems: Leveraging Lessons from Long-COVID and Sepsis Patients
02:54:58 Closing Remarks

Change starts at

Stop Sepsis – Save Lives

Hello everybody uh i would like to Welcome you all to this annual european Sepsis alliance meeting And i know for sure that we uh have an Interesting afternoon ahead of us My name is ulrika knudsen And i am a co-founder of sepsis fondant Which is a swedish sepsis trust That we started in 2015 and we have Since been working on increasing Awareness around sepsis In the general public in sweden as well As with our politicians and the within The swedish healthcare system and of Course raise money for research around Sepsis We are also of course a part of esa and Work closely together with this Organization And my fellow co-founder and chairman of Sepsis fund and dr adam linda is part of The esa board With responsibility for the coordination Of the european research work group So today we will talk about How we can in a more cohesive way Integrate sepsis into europe's health Systems and by doing so Uh enhance their Preparedness and resilience when it Comes to sepsis Many european countries have made huge Advances when it comes to the care of Sepsis patients but unfortunately the

General attention offered to sepsis is Still rather poor and uh this undermines The efforts to improve its prevention Its recognition and management which in Turn of course is costing many lives And the kovid 19 pandemic has Furthermore put new focus on sepsis uh Since most patients admitted in the icu With coping 19 progress into viral Sepsis making sepsis the main course of Death in this pandemic So today we will discuss how sepsis Management can contribute to resilient Healthcare systems and we will also talk About the lack of knowledge And about sepsis uh the lack of Knowledge about sepsis and how we can Address that and the importance to Support sepsis patients in their Recovery And i would also like to announce that Today Esa launched Launched their first uh european sepsis Report which is an overview Of the fight against sepsis in europe Uh it shows that there are many advances Since the wha resolution in 2017 But also That only a few countries are taking Concrete actions and many more should Follow So please go and have a look at this new Report on the esa website uh and and

Please let us know and send comment Comments or questions around this this Report And also before we start uh with our First speaker i would uh like to let you Know that you can all use the chat box Um To send your questions to speakers and If the time allows it we will address These questions and please if you Put a question there specif specify to Whom your question is addressed And for the speakers and panelists i Would just like to remind you that Please mute when you're not talking and Just unmute when you want to be heard Now i'm happy to introduce our first Speaker mr hans kluge who is the Regional director for Wha europe This will be a recorded talk since mr Kluger unfortunately couldn't be here in Person he is busy preparing for the who European regional committee but uh he Was keen Uh to be present today somehow uh to Show who's continued support to esa And the sepsis issue So please stay tuned to this message From hans kluge [Music] Dear members of the european sepsis Alliance friends and colleagues It's an honor to address you on this

Occasion Your aim to increase awareness about Sepsis in the w-2 european region And that stimulate policies that prevent And impact sepsis Is close to my heart Globally sepsis is to blame For 11 million early deaths per year Of which 700 000 occur In our region Sepsis largely impacts the most Vulnerable particularly children and Those living in poverty Sepsis is a challenge even in the most Developed countries Ensuring that patients receive safe High quality care is at the center of Double cho's efforts to achieve Universal health coverage Simply put If we do not give patients and health Systems the tools to prevent sepsis we Will not achieve universal health Coverage We will continue to fight for it And this will also be our focus When marking world patient safety day Next week on september 17th The european region Has seen significant progress in recent Years but the numbers are still too high And the debts that still occur Are for the most part avoidable Who europe is gradually but firmly

Increasing its focus on quality of care And patient safety Something That is of vital importance to prevent And handle sepsis This follows the acknowledgement That there is significant room for Improvement in overreaching Fragmentation Poor continuity Supply induced over consumption Underuse inappropriate Effectiveness Insufficient patient safety are all Prevalent across the region Exacerbated by covet 19 A disease That has underlined the importance of Taking bold action on sepsis Health systems must consider a range of Interventions When improving quality of care notably By enhancing clinical practice Setting standards Engaging and empowering patients and Families Improving education of health workers Managers and policy makers Establishing continuous quality Improvement methods Performance-based incentives Legislation and regulation frameworks Earlier this year together with the Government of greece

We opened the first w office Fully focused on quality of care and Patient safety in athens That's one step That needs to be followed by many more Let me list three pathways to take us Forward First We need to up our investments in health Systems More is needed in terms of defining and Implementing standards And established guidelines Infrastructure Laboratory capacity Tools for identifying and reducing Sepsis incidence mobility and mortality Second We need to implement preventive measures Against infections Such as good hygiene practices Vaccination programs and sanitation Early diagnosis and proper clinical Management are critical To improve outcomes and reduced debts Even though sepsis onset can be acute And pose a shorter mortality burden It can also be the cause of significant Long-term Morbidity that is why sepsis requires a Multi-disciplinary approach And a prepared workforce For that to happen We need to invest in the education and

Professional development of All health workers Finally Your vision Resonates and aligns with ours The double cho's european probe of work And the objective Of leaving no one behind Our program of work Provides over 53 member states with the Opportunity to work with stakeholders Like the european sepsis alliance to Place sepsis Among public health priorities of European countries Who's european program of work is a Platform for that We know what is needed Let's make it happen Let's act now engage and collaborate To decisively prevent and treat sepsis In the double cho european region Thank you Thank you mr kluger um I would now like to introduce our next Speaker gabriella corte who is from the Permanent Representation of slovenia To the eu she is the council of public Health Pharmaceuticals and medical device Devices slovenia holds right now the European council presidency until December

And obviously they have been called to Lead a european agenda in these very Challenging times We um know that uh this is an intense Week uh as the european institution um Are negotiating on on some very Important issues so therefore we are Very grateful that you gabriella have Find time to to to join us today and Since i know that you will have to To run after your talk here today i will Give you some questions right away and If you can feel free to to answer them During your talk so as a small country Would you uh would slovenia be Supportive of an increased sharing of Resources within the eu in the health Area and do you sense an increased Appetite so to speak amongst member States to more responsibilities to the European uh commission on healthcare Related matters and also Uh from the management of the Pandemonium pandemic What are the lessons learned by slovenia And what are the next steps slovenia Might be taking to strengthen your National uh healthcare system Over to you gabriella Yeah thank you very much And first of all i would like to thanks To organizers For offering us this opportunity to Discuss and learn and actually share

Approaches of enhancing the preparedness And resilience of our health systems So firstly because implementation of Innovative solutions for resilient Health systems is the key priority topic Of slovenian presidency in the field of Health and secondly because sepsis is One of the key issues in intensive care Units also during covet 19. Another major challenge is the treatment In the treatment of sepsis is the Growing threat of amr antimicrobial Resistance As more pathogens become resistant to Available antibiotics More people are at least for developing Sepsis And there are less opportunities for Successful treatment One of the key priorities of slovenian Presidency Is also to find ways to improve Accessibility and availability of Antimicrobials And repurposed medicine In treatment of unmet medical needs Where lack of commercial interest is a Hindering factor Success of the fight against Antimicrobial resistance Relies heavily on the commitment and Willingness of governments To take actions To ensure the implementation of the

Initiatives under one health approach Including all relevant sectors of course The covet pandemic continues to be one Of the key priorities all around the World Which has moved held up on the agenda In the context of geopolitics Security and economic policy This health crisis has shown the lessons To be learned in order to be better Prepared to address the current Challenge As well as similar ones in the future Among the many lessons is that the eu And member states have to better Coordinate preparedness and response Mechanisms When faced with health emergencies As part of a wider effort to work Together toward building a strong and Resilient European health union Under the enormous pressure of the Current covet pandemic European health system have have Demonstrated their capacity to innovate And adapt when need And when resources are available for Example The use of telemedicine Accelerated significantly during the Pandemic Demonstrating that previously All obstacles can be or some obstacles

Can be indeed overcome According to the world health Organization most sepsis deaths are Preventable So to stop preventable deaths from Sepsis we must all understand What sepsis is how to recognize risk Factors and work together to bring Awareness to this health threat so that It can be treated in time To do that it is very important to Implement innovative solutions in health Systems so we will be better prepared to Prevent such cases So the european commission Dj sante eu member states and citizens Has us have a strong commitment to Protecting health and supporting Strengthening health systems Indeed strengthening health system in Phase of epidemic and other long-term Challenges like also sepsis is one of The central aims of the eu health Program and european health union Package The eu has a wide range of tools and Mechanisms for developing and Implementing health systems innovations And to support mutual member states Learning about what works and what Doesn't work This for example include Already existing program programs at eu Level like eu for health european social

Fund plus Horizon europe union civil protection Mechanism rescue and so on Um These those programs uh offer real added Value at the eu level Slovenia recognizes the untaped Potential for more effective use of Existing eu resources And seek to improve their use to support Health system resilience And to maximize health system Strengthening It also seeks to make the tools and Mechanisms to help member states easier To understand To advise on which Instruments to use at each stage of Development and to better integrate Different mechanism The ultimate aim is to help member States adapt innovations to the local Situation And provide more clarity on the relevant Eu financial mechanism this would Support the process of local change and Speed the take-up of innovations in Practice And foster more resilient health system Across the eu [Applause] So continuous and coordinated strategic Investments in health systems and Collaboration in finding innovative

Solutions Will strengthen resilience and optimize Health care in the future Uh Finally yet it's very importantly uh Slovenian presidency aim is also to Highlight global aspect in the Area of strengthening health systems Covet 19 has demonstrated the importance Of global cooperation and solidarity During common health Threats it is important to bear in mind That no country is safe until everyone Is safe And dealing with A current global pandemic as well as With the future health threats Calls for holistic inclusive And well-coordinated approach At the eu as well as the global level Last but not the least i would just like To go briefly through the our priorities Of the slovenian presidency as i already Mentioned one uh The first and The most important priority is Innovative approaches within a More resilient Health systems I mean innovative approaches in order to To To aiming Strengthen and More resilient health systems

And then the second top priority is Actually implementation of the Pharmaceutical strategy as well as the Cancer strategy its so-called cancer Beating action plan so among Pharmaceutical strategy we have the we Have specified uh the priority drug Shortages Um And then if i go further to the Legislative proposal We are negotiating the trio so-called Trio package Of eu health union that means a Legislative proposal on ema european Medicines agency legislative proposal on Ecdc this is european center for disease Prevention and control And health threats regulation So I have to say that slovenia has achieved At the end of july a great success In adopting And reaching a compromise in two Legislative proposals on ecdc and health Threats Especially ecdc will help will lead or Aim to better data collection and Knowledge sharing So actually this will be a great support And added value in a Better tackling Preparedness For future crisis

So The last Legislative proposal within this trio Package is emma legislation this can be This the this one has been adopted Already under portuguese presidency in June Uh so i'm happy to to tell you that uh We have just started ema negotiations in The parliament On the 2nd of september And we are about to start negotiations For the other two files ecdc and health Threats at the end of september so we Are sincerely hoping to finalize and to Get an agreement and compromise with the Parliament Uh by the end of the year so Now it's extremely important time we Have to Catch the momentum and Try to find As as better solution as better Compromise as possible so as another key Priority of our presidency i would like To expose also hera proposal Uh and hera proposal will be tabled on 14th of september And The discussion with account within the Council will start already on 28th of September So hera proposal also means better Preparedness for the future crisis

Better Response to that so hera proposal is The last of these let's say four Legislative proposals Of eu health union which will Mean the step further in creating a Safer and more resilient european union For every one of us So thank you for your attention and i Wish you a truthful discussion in the Coming panels thank you very much thank You so much gabriella Um there is a question i don't know if You have This from an audience here uh asking a Quick question uh can the european Commission have any impact on the Belgium government in brussels to Support current actions in the federal Parliament to develop a national sepsis Plan Do you have anything to say about that Not really Actually this will be very it's very Specific uh this balance i should answer You know yeah it's very specific uh Technical question also yeah and it's uh Actually uh this is actually this is Completely belgium you know competent so Yeah i would if they if they need if i Could check also with belgium colleagues You know i would i would be happy to Check with them and if you mail me i can Give an answer you know

Later on Well i know that you are in a hurry so We'll we'll leave you now guerilla thank You so much for taking your time to to Uh to look into our little uh event Today and and give us this really Interesting points from your from your Uh from your point of view thank you so Much gabriela thanks to you and good Luck at the panel and thank you Confidence bye bye simon thank you very Much bye Bye Now um so let's continue to our first uh Panel discussion Uh the topic for this discussion is how Uh the fight against sepsis can help Respond to the pandemic and the global Health threats So i would like to introduce our panel Moderator evangelist Are you there evangelist Uh Maybe Hello There you are hello uh evangelists are The chairman of the esa uh you're very Welcome and i think i will leave the Further introduction of the Panelists in this discussion to you Evangelists so over to you Thank you very much And uh i would like to thank you for Having the opportunity

To Address all these Main Important topics And i believe that first i need to Introduce uh Those who are with us uh today and i see And i Will please uh Would like to introduce mauricio Ciacconi professor gilalia Dr john ryan and also i see that dr Laura siegel she's with us And We Are looking forward to a very fruitful Discussion which the idea is we want to Present How The interaction between sepsis knowledge That has been developed Uh by scientists in the field the last Years has influenced kobe bank And how this interaction chi prime the Overall knowledge at the european level Of sepsis And also How can we enter into a fruitful Collaboration with the european Commission to achieve this goal With this in mind i would like to Address before starting that That For us who are

Active in the field of sepsis and of Critical care medicine The last years When it's already 20 months since we are Globally suffering from this epidemic And uh Actually together with The chairmanship of the global sepsis Alliance We did a meta-analysis in this Meta-analysis We introduced all the information That Has been Published until march 2021 And we collected Data If patients with covered 19 Are sufferers or not of sepsis in other Terms if covet 19 is a situation of Viral sepsis and we ended up with the Result that Almost 90 percent Of patients with severe covet 19 They are meeting the sepsis criteria So in other terms we do fully believe That our european sepsis alliance Now at this stage of the pandemic Can Provide And help patients more than ever And we believe that we need in this goal To be Encouraged and

Receive help and assistance by the European authorities with this in mind I would like to Start And address some questions and i would Like to Have the feedback by doc by professor Anane by Professor chikani and also by laura About What is their opinion Of If they agree with me that covert 19 is A cause of sepsis And Professor allan Afternoon evangelist and good after a Good afternoon everyone thank you very Much for giving me the opportunity to Join this uh This session and to share ideas so To get to your question well Let's remember when south korea ii Hit the first people in december 99 The common thought Was that it would be nothing But a common respiratory neural Infection However We now all have realized that it has Spread as a pandemic And then the global efforts And in particular in the research area Has

Yielded Very valuable information robust Scientific information From which one can take a simple message Research Informed the general public That actually what matters or the Driving force Towards kovid 19 That is towards getting sick from the Virus Is more related To a deregulation of the harsh response To the virus Than to the virus itself well This is exactly The common definition for sepsis So researchers During the kobe 19 Have clearly established in my opinion That when The severe form of kavin19 Are indeed Related to a deregulation of the house Response to the saskof2 virus resulting In complications Beyond the lung and the respiratory Function involving other organs And resulting in major sequels And Death and because of that understanding Then Drugs that were Investigated or routinely used

In the management of patients with Sepsis When called were then considered From the management of civilian cavite 19. And so rapidly Clinical trials Encouraged 19 patients Have investigated a number of their Drugs and Only one maybe the most spectacular Example are corticosteroids If one can remind The initial recommendation from who and The scientific comic community in January or february 2020 was against The use of corrigal series because the Common thought was that it was going to Be a classical respiratory virus Infection and people will be harmed by Corticosteroids And now after The improved Knowledge in the mechanism of the Disease And the clinical investigation of the Benefit and harm of corticosteroids Is clearly established that that drug Routinely used in sepsis in general Has proven to save lives in patients With convenient 19 further arguing That kovid19 and sepsis Belongs To the same entity

Other Immunomodulatory Treatments and other treatments like for Example anticoagulation Have shown promising effects In studies on kaveen 19 And then By turn I think strongly That this Experience coming from kovind 19 Should serve More broadly sepsis management And these Drugs Needs likely now to be investigated in Clinical trials for sepsis more broadly Beyond coffee 19. So the global effort to fight covey In my view need to be continued to fight Sepsis more broadly And in three main areas in particular First one The synergistic involvement Of experts in multiple areas of life Science not only of medical science Was of the utmost importance in the Improved knowledge for kobe 19 and that Effort should be continued to improve The knowledge and sepsis more broadly Second The fantastic financial Both public and private financial Investment

To fight against kv-19 should be Continued to fight against more broadly Sepsis And finally and third The novel approaches That has emerged in particular in acute Medicine Uh during the kaveh pandemic and i'm i'm Particularly referring to platform Trials that have proved to be very Efficient tool to rapidly get A valuable data to inform clinical Practices These tools need to be continued to Fight more broadly against sepsis and Therefore need to be supported In particular at the level of the European commission And from that suggestion Uh i will pass The microphone to My colleagues Well i would like to listen also to uh Origiconi Yes can you hear me Very well yes please Very good so um I think has already answered but the If i have to cut a long story short i Would say that uh you know the new Definitions of sexist talk about Development of organ dysfunction In uh you know in response to an Infection so

I think yes covenanting when it leads to Organ dysfunction and all those patients That reach the Uh hospital admissions they basically They are part of the family of sepsis What has been very different for us this Time compared to what was happening in The past is that Usually for us sepsis is a term that Brings together Syndromes and syndrome for many causes While this time there was a single cause Which was This virus but It's very important indeed that we do Not forget that is sepsis And especially because Kovid19 hopefully at some point will go Away But sepsis unfortunately is here to stay He's here to stay and all the issues That we've seen around the kovy 19 In terms of organ dysfunction the need For organ support And very importantly also how patients Will recover after an icu stay after Conv19 Which is very commonly referred as long Covered In the reality we knew that from Previous infections and severe sepsis And septic shock in the intensive care That can lead to post-icu syndromes so Patients take a long time to recover

We've studied that many of these Patients they found it very difficult to Return to work to a productive life So it's a major issue so uh i really Think that it's important that the Legacy of this pandemic Will also mean uh be better prepared to Cope With with sepsis um we've seen it we've Covered that the early identification of These patients and an early start of Organ support Is important for the recovery that's why Our intensive care units are being under Such a stress Because exactly what we wanted to do was To provide timely intervention timely Icu best to every patient that will Benefit from an icu bed And And that meant uh stretching our human Resources Having um Healthcare workers not working regularly In intensive care coming to work to our Intensive care unit I am the president of the european Society of intensive care medicine And i really think that if we want to Treat better sepsis in the future we Need to invest not just in technology And bad spaces But also on education and training And to have a more flexible workforce to

Be able to absorb What will be maybe not necessarily a Pandemic like this one but there will be Other crises with bacteria with other Viruses that will bring stress To our system To conclude covenanting is also shown The problem sometimes of multi-resistant Bacterial infections so sepsis Complicating Other Uh causes of sepsis so sepsis that comes On top of kovid19 And again that's a major issue that we Don't have to forget Also for the antimicrobial resistance And so on um i'm just going to conclude Also by sharing some positive however on This and the fact that we've seen with The european commission for instance the Fact that there was a lot of attention Not just on technology but also on human Resources And indeed the european commission Funded the training program Which we as european society of Intensive care medicine organize and Deliver which is called senate in space And managed to train more than 17 000 Health care workers not working Regularly in intensive care in europe to Help Icu teams i think all these experiences Are showing how much we need to invest

In intensive care In the future to to carry on looking After patients with sepsis Well thank you very much uh So Do you Is there any comment on this specific Technical medical questions coming from Uh laura singlet Or from and i think also that Julio is with us i apologize that it Seems that they my connection is not The best one Uh Yes julio yes please I am angelos and i told everybody thank You for recognizing this and Carry on this important debate regarding Uh regarding sepsis and how it is Connected with kovid I'm following this huge effort also the European sexual alliance From an organizational point of view uh Taking care of quality improvement and Patient safety In italy especially in tuscany region And during this year i'm involved in the Conversation alliance since the Beginning i had the opportunity to Interact with Lots of professionals and especially With john paula monty From sierti who Was supposed to present but i'm

Substituting her and apologize But i'm going to if it's time to do Do it now i'm going to share some slides Uh am i allowed to do that or it is Now please do that and Please do that and also i would like to Inform all of us for listening to us That julio docufondi he is responsible About to the insurance in the region of Tuscany in italy it's for us Great that he managed to find time and Join us and thank you really very much Of course appreciate your being with us Please share your stream [Music] Can you see uh yeah can you see the Screen here i've got the feedback now on My video as well thank you amangalis i'm Part of the clinical risk management Center vision security center of tuscany Region and john paula monti she's Delegate of crt In Global sexual alliance and european Sexual alliance and she's also Brilliance intensities care in miniguard Milano what i'm showing now is the actor Taking part in the tackling sepsis Effort in italy We have now showcasing two examples of The two italian federer the federal Healthcare system who started Probably as primary efforts uh the Technique of sepsis which is

Regenerative and following regenerative Scanner and on the other side of the Screen you can see agenus which is the National agency for healthcare services That she is now leading an important Project to which we are contributing Regarding the monitoring of sepsis and Of course the crt scientific society of Intensive care In italy Let me start with what regina nombadia Has been up to since 2013. Reginald was the first to formally Acknowledge the challenge of sepsis as a Complex healthcare system They develop an important decree This decree lay the groundwork for a Series of intervention they define the Targets the intervention tools methods And endpoints They really brought uh an impressive uh An impressive research and training work To all the hospitals in lombardia and Now they are really collecting the work And the results of this impressive work In fact what they did was something Really Interesting and they started to Systematically use Their current data from Discharge reports in order to have a Monitoring of the um Of the of the sepsis cases this is also The strategy that was

Used also in the global burden of sepsis It is mainly based on ict Reports code and it is used to then um Instruct A specific audit regarding the specific Criticalities that you will that you can Find in the in the clinical pathway And of course they also developed some Really impressive stuff on the sepsis Management in the terms of maternal care As you can see the effort of tuscany Regent started a little bit later but we Really followed the the path of Lombardy region we constantly work Together in sharing experiences And inputs What we did in 2019 was this important Framework document which is available in English which is called fade again fight Against sepsis call to action Is that is a framework that we develop Within a multi-disciplinary team that Was coordinated by me as a patient Certainty and human factor expert Because it was needed a really Third eye view Able to integrate the different uh Professionals and the different point of View we came up with this document that Is now used in tuscany as the main Framework for developing hospital Guidelines regarding the management of Sepsis in particular we introduce some Important key process indicator

Regarding how ambulances and emergency Department care is able to handle sepsis And also we introduce a six plus one Way of monitoring such as Six plus one means the sepsis six plus One plus one is the source control time Resource control involving the surgical Department We are also paying lots of attention to The role of the microbiology Network in order to provide provide Timely response to the need of moving as Soon as possible from an empirical Therapy to a targeted Micro antimicrobial therapy And also we are now monitoring the the As a research point of view the ost Response so not only focusing on the Antibiotic therapy but also the response From from the host and in parallel we Are carrying on the same effort that is Being carried out in lombardy there is The administrative That is the extraction of administrative Data in order to identify criticalities In the coding of sepsis in the frequency Of sepsis cases we know that it's not Something epidemiologically Strong enough in fact we are using that As a proxy to later on Start More Specific Audit and observation in the local

Context in parallel we are carrying on The the maintenance of patient security Practice regarding the implementation of Rapid response team and pediatric and Neonatal management of sepsis These two experiences of regional Lombardia and regina toscana fostered an An interesting project of the age aginus That is the National agency for research activity in Charge also for Technical report regarding the patient Security committee So this agency as a national National national arena in fact Uh 11 federal healthcare system are Joining this project and this project is Basically the what we have been done in Lumber dealer in tuscany implemented to The whole to the whole nation that is Using a specific algorithm to track Abnormal abnormal Criticalities and abdominalities in the Coding of sepsis as is using current and Administrative data and then based on That Activate some specific auditing process Using the clinical risk management and Patient safety network in italy that is Quite well Developed It is a Current research activity projects that Will uh going on also after 2022.

In parallel we are really supported by The action carried out by siati which is Really a Having a pivotal role also with the Ministry of vets in terms of proposing Uh Clinical guidelines in italy since 2017 We need to have really well-defined Clinical guidelines these clinical Guidelines are used also in terms of Patient safety and Checking The the the default uh of the system in Terms of also of Claims and Insurance Frauds but is basically an important Step that was achieved also in Cooperation with emergency medicine Society Of course crt is developing a really Good Research especially at the european Level in cooperation with the european Society and also on the national level Especially with gvt gvd is a is a Network of Researchers of intensive intensivists Collecting data these data for example Have been used uh for the definition of The ships history Study so they really provided huge Amount of data to the uh to the Definition to the new definition of

Sepsis that was used for the new Definition of sepsis And so this is my last slide accounting For what has been done by tuscany Lamberty and crt since 2012 in terms of Rising awareness We are now launching the 10th Sepsis day next uh the next Tuesday and also ciarty and lambert Division they are both active In raising awareness uh Running Impressive communication with the media Especially with newspapers and also Raising awareness having organizing Every every year really really important Uh really important happenings open to The general public so it was really Interesting to share uh to listen to you And share with My thoughts and our work with you and Really uh wishing for comments and Questions and i will stay tuned of Course thank you for your attention Now so i would like to thank you very Much and all i Uh Realize is that uh there is a big Feeling that everybody accepts that the Pandemia that we are uh Getting through has the characteristics Of what has been uh we know about Bacterial sepsis and that much of the Knowledge that has been uh and the

Criteria that we have developed so far Applies that i'm particularly grateful To Uh uh Dr choconi who's leading the European society of intensive care Medicine uh telling that and i'm also Grateful to professor gilalia about uh Adding on this and also i would like to Thank you very much for all the great Presentation of what is happening in Tuscany all The Rest All these years however i would like to Try to elaborate now more on the Interrelation About between sepsis and Covet 19 and the question is One of the Major hurdles That we have faced so far is the overall Lack of awareness about what sepsis is However for covet 19 there is global Awareness Why Because it is a pandemia and it's a Major hurdle The question however is Can All of us Inform people That The reason why so fast because if you

Can imagine that the epidemio started End of february arrived in europe last Year and all of a sudden we managed to Provide care to our patients we managed To provide treatments to our patients How much is this related To all this background work That all of us have done For almost 20 years now Because honestly i feel that If you have come across a patient That ill as a patient with covet 19 If there is no background preparation In terms of background knowledge that Has been acquired over many years it Would have been impossible to have to Help these patients so i would like to Go now to a dif with a different series Uh all three of you these questions and I would like first to ask uh president Ciacconi about How he feels about it Does Indeed be Early initiation of management Protocols the as professor arane said All The know-how about how to Do trials The networks research networks that have Been built between us all these years Was coveted 19 a time point where all These became apparent and is it high Time that we make a worthy world about

That Can i start Yes please So i i i think evangelist i think the Answer is Already In the question in a sense and i think You're absolutely right that we need to Increase the awareness on this With the global sepsis alliance with the European society of intensive care Medicine in the society of critical care Medicine Recently we published a kind of a Manifest on this exactly to talk about What would be the legacy Of kobe 19 For what concerns sepsis and the main Points of that are exactly what you say The fact that we need to recognize the Sepsis Like cancer It's an umbrella describing you know a Syndrome which is very terrigenious But and under which really there are a Series of causes and we don't have to Have a tunnel vision about these causes Because sometimes i have the feeling That kobe 19 Brought us a little bit to a tunnel Vision In the sense that we report Asymptomatic cases we report how the Pandemic is going and that's very

Important But when we come to patients with sepsis In intensive care there are many more Causes of sepsis For coming to an intensive care and the Reality we have not done that mapping Exercise very well in europe and there Are some mapping exercises that they've Done in individual countries But if we want to know what is the Global building of sepsis in intensive Care units in europe for instance that's Something that we try sometimes Systematically to do with point Prevalence studies and so on but there Is not really a formal registry At european level to look at that and i Think something like covet should prompt Us To look at Severe infections leading to intensive Care emissions in these things it's also Very important to increase the awareness Of sepsis in with lay people With the community with you know events Like these are extremely important And you know we can save lives By promoting vaccinations not just for Kovi 19 but by promoting vaccinations For pneumococcal by promoting Vaccinations for many diseases that are Preventable And we know that the uptake of those Diseases are not perfect of those

Vaccinations are not perfect at the Moment And at the same time like this was done For stroke or for my cattle infarctions And diseases that i would like to remind Everyone are very well known by the Public but they carry on a much lower Mortality compared to sepsis and we are Not even we've not even been able to Tell People that this could be sign of sepsis You know confusion being short of breath Um We don't uh you don't hear about this With the community normally i think it Requires everyone to feel about the fact That Uh you know that sepsis is out there and Is something very important And there is a lot of Misinformation and bad communication Around this sometimes If you talk about a stroke or a Myocardial infarction everyone Understand that something that can Happen to anyone If you talk about an infection there is Sometimes almost the stigma To talk about an infection well actually Infections and severe infections can Happen To anyone we can prevent them and we can Help to recognize them and to treat them Early and so this is a battle like for

Covenanting with that we can win Together also by and only by raising The awareness together with institutions Today i see i'm very pleased to see the European commission with a Very good relationship in the last 12 Months working together and We as the intensive care community we Always say we are the last line of Defense We can show what happened to people when Everything else fails but i really think The public health About preventing sepsis about Recognizing sepsis and about treating Sepsis early are really where we have to Put Our biggest efforts at the moment And of course also by Providing research finding around sepsis Not just on treatments treatments are Important But really we need to understand now What is the infrastructure to support Sepsis in even in different countries What is the availability of acute care Beds or icu beds For this and what are the causes of Sepsis different times of the year Different countries we talked before About antimicrobial resistance Very important to tackle if we don't Sort it out even if we recognize sepsis We may not have at some point the right

Tools to fight it And so This uh this legacy that covenanting is Leaving to us Is something that we need to embrace and To and to really to work with all the Policy makers to To make sure that even when covenanting Is gone we don't forget that there are Many other Infections that can lead to severe Illness and intensive care admissions Your own mute i think Before going to john ryan i would like That we Conclude The Way Uh All of us were the active physicians in The uh Research field are thinking so i would Like the comment of professor ranani on That and then i would like from john Ryan to comment Uh It is obvious that Uh all that has been used To save People from During the academia Was built from the sepsis field so i Want your comment on that but before That i would love to

Welcome for a very short comment Professor ananda and then uh You need to comment on this big question So very briefly i i My thought is that the pandemic Has brought as taking out of the dark Intensive care medicine Because of The issue of bad capacity and so on But unfortunately And has not taken out of the dark sepsis Because we missed the opportunity To communicate What at the scientific level we know The link between kovi 19 and sepsis And so we felt in my view to communicate This toward lay public And toward more poor and toward Politicians because The the issue to take sepsis out of the Dark For me is Beforehand a political issue In france We got a success in convincing the Minister of else That sepsis should be taken out of the Dark and france has reached A concrete achievement In in bringing the for one only example Is for since starting in 2022 France will report annually For france The burden for sepsis just like france

Is reporting annually the report for Perinatal perinatal mortality for uh Pregnancy immortality For a cancer and so on so now sepsis Will be uh reported and because the Politicians in france has taken the Messages of the importance to invest on On sepsis So i think That my My my main take on message here is if we Could get at the european level the European commission and parliament Really Endorsing Sepsis as the best way to prepare the World for the next pandemic Is by optimizing sepsis right now Everything we will do for sepsis right Now Will be very helpful for the next Pandemic whatever would be the next Pandemic So Now we want to start our debate and Before that we want to have the opinion From the european commission [Music] So John ryan thank you very much for Joining us it's a big honor for us and Pleasure to have you with us Oh it's a great pleasure for me to Participate and to have listened to all

Of the presentations so far And i'd like to thank you for the work Of The european sepsis alliance and The contribution that you're making to Improving standards and Improving best practices across europe So first of all my great recognition of Your work as an association and your Collective Knowledge and expertise which obviously Um [Music] By sharing together you can also Increase and increase its impact so We know that there have already been Several Practices best practices medical best Practices Already applied In intensive care and have been deployed During the covet pandemic For example Strong infection prevention and control Has really been the center of of the Response And for covet the current Epidemiological situation is Characterized by a high and stable Overall case notification And the low but slows slowly increasing That rate The variant of delta is the Big

Predominant variant at the moment but of Course we have Tried to increase our sequencing efforts Around europe You've probably read that in the last Few days the cdc has signed a contract A very large scale contract to help the Member states increase their sequencing Capacity so i would say at the moment We're really trying to focus on Keeping Infection as as low as as we can By encouraging countries to maintain Social distancing hand-washing face Masks Where Where possible We've put in place Initiatives to Encourage Safe travel by using the digital Covet pass Which includes as you know Vax proof of vaccination It includes Proof of a test test result a negative Test result or recovery certificate so We really tried to Put in place Very Reinforced Surveillance Put in place uh support to member states To keep the variants under

Strong Survey And thirdly to um To Try and Encourage The take-up of vaccination now the Vaccines as you know Um [Music] Were purchased through a common Uh purchase between the 27 member states I think that's probably worth mentioning Because it's the first time it's Happened We've purchased uh Products in the past together For example The last Product which we purchased was uh Um [Music] In relation to uh biotoxin By the member states had a need for a Rather unusual and Rare biotoxin In the context of the cbrn preparedness So in a security threat in other words We did try and purchase pandemic flu Vaccines in the past as well that was Not successful because of difficulties Around liability so really the first Successful major Joint procurement which we have managed

To do together Between the 27 was the covet vaccine and Just to say that this is uh It has provided a supply of kovi trucks Different coveted vaccines to all eu Member states exactly when they were Needed so having negotiated together We obtained the first supply as soon as They left the factories they were Delivered To the member states and the member States were able to To vaccinate their population So i don't think we can underestimate The Impact That that's hard because i have a member Of my family living in new zealand and i Can tell you it's certainly not the case In new zealand is not the case in other Parts of the world where this Effort to develop and procure vaccines Was not Achieved with the same level of speed We're continuing to Procure vaccines at the moment Because we anticipate that there will be A need For continued availability of vaccines In the autumn and maybe next year In respect of Booster doses for certain Types of population And also for the people who are not yet

Fully vaccinated for example there are Two member states where the Uh vaccination rates are less than 20 Even if the majority of Even if we have 70 percent Uh reached Uh for the major for the average of eu Members say there are still member States which are Below um below Far below the target And and therefore uh we're really Pushing this This effort To Improve Surveillance to improve the surveillance Of variants to make sure that Vaccines are rolled out and made Available to the population And By the way you may also be interested Giving your professional backgrounds To the fact that we have a therapy Strategy A therapy strategy which has the aim to Develop 10 10 new therapies for covid Before the end of the year and just to Let you know that this is a work in Progress But the european medicine agency is Currently Carrying out a rolling review on Clinical trials which are ongoing

For um cova therapies so Not only focusing on on vaccination but Also including Elements around uh development of um Of Our therapist Now Our colleague from the uh Council presidency was speaking earlier On And she referred to the need to Reinforce our european frameworks and Legislation i'd like to say a word on That if you don't mind First of all The commission Has proposed what we call a health union Package And the health union package Is an effort to identify The elements regarding cross-border Threats Which need to be strengthened On the basis of What we think are the lessons that have Been learned from the Covet pandemic so far So you were asking several speakers About You know what are the The lessons learned so far we try to Really learn lessons as quickly as Possible And one of the lessons we've learned is

The need for quicker and more reliable Data for member states So we are proposing a new legal text Which will be legally binding on the Member states and which would oblige Member states to step up their efforts For reporting of communicable diseases And health threats That's the first point the second point Is we would be hoping To improve the Risk assessment which is done by the Ecdc and you'll be hearing from Dominique monet later on in the session The idea there is that they should not In the future Focus only on The analysis which they do at the moment And which you can read online on their Website It's really An analysis carried out from the Perspective of The ecdc the idea in the future is that We will try and take on board Other angles for example The angle relating to the availability Of treatments So we would encourage our agent We would encourage our agencies to work Also Together with for example the medicines Agency or other agencies who might be Concerned with the supply of

Pharmaceutical products In order that we have a more rounded Inclusive risk assessment In order to prepare More effective counter measures and the Third aspect of the proposal is to Include To have the possibility to Make recommendations in a more Convincing way to the member states Because at the moment the members they'd Sit around in the health security Committee and they discuss what's going On but there's no real Power of decision or Adoption of common measures it's very Difficult with the way the treaty is Written To have a adoption of a common measure And And therefore You know there's a huge difference there By the way between animal health and Human health We're living through the african swine Fever uh at the moment and i can tell You my veterinary colleagues working In the same department here They have full powers In relation to Uh to uh african swine fever I i wish i had one percent of the powers Which they happen Because really um it's totally in the

Hands of the member states how they React To these cross-border threats And therefore We're proposing To Stretch Our legal powers as far as they can go Within the context of the Of the existing tree So This Health union package which The council presidency referred to is Something we're working on With the european council and with the Partners in the european parliament at The moment And i think that this will give europe The tools To improve its performance in relation To future threats I just like to say a few words angulos If i might concerning the financial Instruments because i think It's one thing to have legislation it's Another thing if we have some financial Firepower as well And there we actually There was a lucky coincidence you know When when two stars come together in the Sky Uh it's an unusual uh happening and this Actually happened early on in the

Pandemic where we realized that we We had an opportunity to make a proposal To strengthen our legislation as i've Described but we had an opportunity as Well To Shape the budget Now europe has a seven year budget You know you have a one-year budget Initially you have a one-year budget in Greece You have a one-year budget in ireland But In europe we had the benefit of having a Seven-year perspective And therefore we were able to shape The budget To match The legal proposal which we were making This is very important So at the moment for example a previous Speaker was referring to the cancer plan Which is one of the europe beating European cancer plan it's one of our big Flagship Initiatives in public health We are now Publishing calls for proposals In relation to cancer Based on this policy initiative so There's a linkage between the policy Initiative the cancer plan And the financial instruments And we're also in the few in next few

Weeks we'll be launching a cancer Mission Under the horizon europe research Program so you can see we're trying to Match The legal ambitions with the are the Policy ambitions with the financial Instruments And that brings me to another point Which is the Hera which was referred to as well by my Colleague from the council now this is An idea which you may be familiar with You may not be familiar with Following 911 in the united states They realized that most of the Manufacture of essential pharmaceutical Products Was taking place outside the united States And they thought that this was a Security risk So they created what they call the barda Which is an agency of the united states Government To Identify threats To develop the medical products to deal With those threats And then to purchase the unstuck pilot Products Now for many years europe had nothing Similar And indeed most member states had

Nothing similar And we have now Uh proposed the idea that there should Be a european Mechanism To identify Future threats To Research and develop Products to deal with those threats And thirdly To purchase and negotiate the Manufacture and stockpiling of the Products And antimicrobial resistance and Antibiotics are one of the Areas that will be covered by this Approach You will be seeing next week the Proposals from the commission To create this mechanism So next week uh i'll be able to tell you A lot more than i'm able to tell you Today But Believe me that maybe even a specific Briefing for your members on that point Might be of interest to you because It's really linked closely to the issue Of amr And infection control as well So you can see that covid Has in fact Stirred up a lot of activity at the

European union level I hope that that activity will translate Into a reinforcement of your Resources at the national level And that the political ambition that we Have To protect europe and to protect europe Citizens Will translate into A real Change and resource change At the national level as well Thank you very much I do thank you very much and uh I would Like that All these considerations uh particularly Also as how much financing on the new Steps will be we have About Uh five to ten minutes to end i would Like Some concluding remarks from Uh uh one minute if possible each of uh Dr chaconi professor amane and the Doctor tokofondi dr chaconi Hello i didn't understand a general Remark or almost a general remark and Actually has a type of answer to the Positioning uh set by john ryan I i think the what was just said i think It's a It's very important i mean i i often Finish and my presentations about uh my

Experience with kobe 19 on the fact that We cannot be unprepared twice And actually We have demonstrated unfortunately the Different ways that we managed to be Unprepared more than once And it would be i think it would be not Acceptable i don't know it would be it's Not acceptable That we leave a legacy of not being Prepared to the next generations i mean We don't know when the next pandemic Would be when the next healthcare threat Will be but i'm very positive because i Have participated in the consultations On some papers that were referred to Like the hera The european earth union I think we have a great opportunity to Help each other more in europe and to be Better prepared To be self-sufficient also very Important we've seen during the initial Part of the crisis how This put a significant stress on the System we didn't talk about personal Protective equipment for instance today Of some devices but there was also That so my message is really we cannot Be unprepared twice so we need to take This opportunity to be better prepared And as jilali was saying before if we Prepare on sepsis We will be better prepared for the next

Infectious disease threat Professor anani Yeah i will conclude with a wish I wish that the new ecdc Uh which that the New development within emea The way the wish that Uh in the horizon 2020 Calls The term sepsis be incorporated Because for example as far as i know If one goes through The whole course of Horizon 2020 Covering Apparently Whole domains in medicine The words the word sepsis Never is mentioned That is my wish My wish is that the term sepsis be Incorporated in major texts From the european commission and i think That would also have a major impact Beyond europe That would lead all the part of the World To Reach that level of knowledge awareness To tackle sepsis That is a Continuing And sustained pandemic It is an

Unrecognized sustained pandemic Dr sukafandi I can only echo what's already said by Dr kony and professor anand there is no Point in developing a really resilient Healthcare system if the threat Of the new pandemic will come from Another part of the world we really need To Strength cooperation program in order to Allow also other parts of the world to Rise the level In taking a complex all the complex Disease like like sepsis And the effort of the european union is Really important is remarkable and The surveillance of today would become The Prevention and Preparedness of tomorrow so we really Need to anticipate and to keep on really High the level of surveillance to the New Antimicrobial threats that could be Fungi or any other viral so we really Need to to Improve our microbiological In this in terms of genomic sequencing And investing on technology and Artificial intelligence to coordinate Better our effort And in the end always the humans will Make the difference so it's really Important to carry on

Meeting like this Improve our Social Socialization skills also in a world in Which that connectedness is the main One of the main opportunities so really Stay together and go on in this effort Thank you Well uh as a chairman of the european Sepsis alliance i feel Extremely happy and also extremely Privileged to share this session by Demonstrating the how important is to Keep the awareness of success however Just because all of us we Who are working as pioneers in the field For great many years we know the story Uh and i see that also John ryan has addressed some messages in The chat although the Traditionally the the chairman of the Session needs to conclude this session i Would like to ask john ryan to conclude This session by Telling uh to all of us what He The messages he sent to us and also Uh what Is the positioning of european Commission for us at As a concluding uh remark in order to Help indeed future generations you have Two minutes to conclude the session From my part thank you very much thank

You very much for for all the ideas and And commitment that i've seen during Today's session I'd like to ensure assure you that the European commission is Fully committed to Improving public health and to avoiding Future pandemics and we're really Pulling out all the stops Legal and financial in order to try and Learn the lessons and make sure that We're Reinforcing our position and the Position of the member states because We've seen That if you don't control an outbreak Like covet then the whole of society can Be closed down and you just have to i Had a meeting yesterday afternoon with The airline Sector and i can tell you If there's anyone sadder than the Medical profession it's the airline Sector because they really have Had the carpet pulled out from under Their feet On so many occasions you know they had So many hopes For uh going back to normal going but i Mean the whole of society has really Been affected so i think We have through the covert outbreak Really learned the lesson and i hope Our colleagues have learned the lesson

That if you don't have a health System that's working if you can't Control an outbreak then you have a Major problem for Business continuity and for for society As a whole and i i just hope that that Lesson And the lessons that we've learned from This event Are Are Are actually implemented And the corrections in the systems are Implemented before uh they're forgotten This is not a question of the next track Coming immediately afterwards it's more A risk in my opinion that the lessons That we have at the moment will be Replaced by something else So i think it's really important that we Embed Our knowledge and embed our experiences And embed our lessons learned Together and make sure that we make These improvements in the short term There was a remark which was made Earlier in respect to vaccination and The The importance maurizio was making there The comment about vaccination and i Think there is a point i'd like to make As well about communication and literacy There's only so much that Non-specialists can understand

About health topics and i think you've Really got to be careful As an association To develop good communication tools As we've been trying to do with the ecdc In respect of antimicrobial resistance It's absolutely not obvious to the Normal person In the street what is the difference Between a Bacteria and a virus if you haven't Studied the subject you won't know and Therefore you have to explain these Things in a way that's Legible to the population in different Cultural settings and tell them what They need to know we try to do that with The cancer code you know where we have 12 Key messages for the public about Reducing their cancer risk And i think it's really important that If you are going to go forward on Heightening knowledge and heightening The sensitivity of the public To the risk of sepsis that you actually Spell that out in in a language they can Understand and i can tell you from Having worked with the erc and the International Agency for cancer research they Developed the text It's not simple you know You you think something is simple

Because you studied it and you're a Professor and you're working on the Subject every day but really Communicating with the public is a Separate Challenge and you really need to bring In the specialists on that and of course We would be we would be eager to help You In that work as well so again thank you Very much for all your commitment and For all your ideas And we're 100 behind you thank you [Music] Thank you very much Um Evangelist do you uh have any final Thing to say yes I believe that this concludes in a Perfect way our session yep I agree i agree Well thank you all for participating um Now let's continue to the the next uh Panel uh debate or discussion um the Topic for this discussion is the lack Of Data and knowledge on sepsis and uh What are uh the practical solutions to To tackle this deficit So let me introduce our panel moderator Uh laura Gigolot Who is uh deputy coordinator of the esa Policy and stakeholder work group and

Laura is also a policy officer At health first europe which is a highly Active Multi-stakeholder platform headquartered In in belgium uh health first europe is A non-profit non-commercial Alliance of Patients and Healthcare workers Academics um healthcare experts and and Medical Technology industry So very welcome laura and i leave the Further introduction of the panelists in This discussion to you Thank you madame enrique and good Afternoon everybody uh thank you for Introducing me so accurately um again I'm Laura chivolotsa and i'm really pleased To be here today also For having been invited to moderate this Timely and Important panel sessions on the lack of Data and knowledge on sepsis First of all i would like to Congratulate All my colleagues at the european sepsis Alliance and especially to thank The coordinator of the regional sepsis Alliances mr simone mancini uh for the Excellent let's say organization but Also for the available collaboration of The for over the past

Months I'm really honored to be here today and I really uh commend not only um myself But uh also help first europe truly Uploads the work that You are doing and i feel uh really Um encouraged let's say by today's Debate And i encourage everyone in the audience Also not only the speakers and the Expert in the field of sepsis but Everyone in the audience Uh to share and really consult uh the Newly released Uh report um released by the european Sepsis alliance today because It includes a comprehensive collection Of best practices in the fight against Sepsis across europe So um i strongly invite you to go over The report and to share it within your Own network But also on social media channels So without further ado i welcome and Open This panel and i'm delighted to Introduce our panelists and please to Introduce professor adam linder who is The coordinator of the european sepsis Alliance uh working group on research Also we're welcome to dr dominic monet Who is the head of the disease program On anti-microbial resistance and Healthcare associated infections at the

Ecdc the european center For disease prevention and control and Also welcome to um the member of the European parliament christian um silvio Bouchoi i hope to pronounce it well from Romania is a member of the european um People's party uh political group in the European parliament So i really look forward to hearing your Ideas your thoughts your presentations And really the practical solutions that Are needed now Not in the future but now to um address The lack of data and knowledge on sepsis So uh without further ado now i hand the Floor uh to you professor dr adam linder For your presentation and feel free to Share also your screen and the slides Thank you Thank you so much uh laura and i also Want to express my gratitude to the European sex alliance for organizing This Fantastic event and also for inviting me To share some thoughts on The lack of data knowledge on sepsis and Some Possible Ways for forward We all know uh the Wh sho services resolution from 2017 they highlighted uh Several important points but what they Said needs to be done is to increase

Awareness that's among the public the Healthcare and the decision makers and Also Get a better estimation of the sepsis in In incidence and the quality of patient Management Of sepsis in your europe So why is this a challenge then I'm a specialist infectious diseases Working in sweden it's a small con Country But What We know that the sepsis incidents in Sweden is approximately 700 per hundred Thousand thousand this is based on one Study The doctor the lisa melhammer study Where They performed a manual chart re review Not Uh re relying on icd codes This is Actually an incident as Large as cancer in sweden Sweden But still the public only 49 of adult Sweden knows about Sepsis and also also within the health Healthcare personnel there are Huge national variations in how we Identify sepsis and also how we treat Patients and if we uh Follow them

Them up And Lastly the decision makers They they are actually quite unaware of The incidents the true incidence of Sepsis the costs of sepsis and also that We as clinicians really lack diagnostic And Therapeutic tools And also one thing is the association Between sepsis and Antimicrobial resistance is not clear To The decision makers at all times if we Did not have sepsis then antimicrobial Resistance would not be a big prob pro Problem because the big problem is when You get a life-threatening infection That you cannot treat So how can we deal with it with these Pro problems and Yeah increase awareness through national Public campaigns that could be one way For Forward that we have tried together with Sepsis fondant in sweden sweden and Actually the sepsis awareness among Adults has Increased since 2015 when we did the First Sepsis Sir survey then 21 percent of adult Sweden knew about sepsis since then we Have done uh

Sev Several national campaigns and uh trying To Inform need media about sepsis and also The gov government and uh the the last Survey we did this year was actually 49 So there was a significant increase in The knowledge of sepsis and we also Asked The pub public about Other common medical con Conditions and The the knowledge of these are very high In sweden uh approximately 90 percent Knows about acute myocardial infarctions Breast cancer stroke prostate cancer Chronic obstructive lung disease and so On So this might be a way forward and how Could we improve the quality of sepsis Management nationally In 2019 the swedish government Chose sepsis as one One of the medical conditions for a National standardized healthcare process That are about to start now in 2021 And this Includes An implementation of sepsis alerts In all Hospitals in sweden and also fall Follow-up Clinics for sepsis So this will be this has been approved

By the swedish gov gov government and Will be implemented this fall And Lastly how can we estimate the true Burden of sepsis in your your european This is something that we're working on Uh Within the european sepsis uh Alliance and we have come to the Conclusion that icd coding is not the Way for for forward they are uh Too much underestimating the true burden So we have to find a way to perform Manual chart rev uh reviews as well well And The the asap study will Now it Comprises 14 or 15 european countries and Hopefully the All european countries will be part of Of this study in In the end and the study is aiming at Mapping the incidence of sepsis and also The clinical impact of a and more amr on Uh morbidity and more mortality So the key features of this study that That we think might make it a Success if you may it's that we you use Common definitions Of in infection and this is kind of you Unique because in the sepsis definitions There is no definition of infection Making it hard to com com compare

Also we have the common definitions of Organis dysfunction proposed by the Sepsis iii And also we base it partly on Icd coding but we validate The cohort Through manual chart review And we have some results actually from a Pilot from Sweden showing that it seems to be Working and what we found was in 2019 4.6 of all Hospitalizations in sweden Had Sepsis three or four fulfill the sepsis Three um Cri Criteria so that's one in 20 patients Actually either have sepsis when when They're admitted to hospital or develop Sepsis within the hospital stay If you look at the r codes that's the Specific codes for Sepsis the incidence was 0.2 So If you just look at our codes you are Seriously uh underestimating the true Incidence of Sepsis and a codes that's codes for Different back Bacteria and bloodstream in in infection Then the in incidence once was 1.5 And we also that valid data did this in A smaller cohort from 2020 and also this

Year the Sepsis iii instance was 4.6 and if you Added copied Uh Viral sepsis by uh you caused by kobe The incidence was 6.9 So From here from from this data we could Calculate uh sepsis 3 in incidence in Sweden for 2019 and it was estimated Actually to 1 360 per hundred thousand So it's higher than pre previously and Anticipated and we also looked at the Proportion of uh antimicrobial Resistance Found in blood cultures in in these Patients and it was only present in one Percent of all the The sepsis cases in sweden sweden so we Have a relatively low Uh percentage of a amr causing sepsis So a change is pos possible we We believe we have increased at least in Sweden the public uh Awareness in six years from 20 to 50 Percent uh there are sepsis alerts and Post-sepsis clinics in introduced in the Whole of sweden sweden and the use of Pilot is a possible way for forward to Give us a true Uh Burden of in sepsis Uh in Incidents

So thank you very much Thank you very much Dr linder for Providing us with our initial but very Informative and inspiring remarks I really like the motor you uh use like A change is possible because we still Need to be Um Always positive and forward-looking as Well Um so uh i was really curious uh to come Across this interesting data and thanks A lot for sharing this Uh initial results of the pilot project In sweden which Certainly have set the ground for for Further thinking and actions in europe Uh certainly these have grasped my Attention but i hope also the one of the Audience And i also encourage the uh the people Who as who are with uh with us today Online to submit their questions and Also to share their ideas In the chat box because then i will uh Go back to it to do this chat boxer to Collect some relevant questions Uh first of all an immediate question Actually that i would like to ask you dr Linder uh you um pointed out some Very relevant keywords uh one of which Is awareness i truly believe that um Much awareness and education are really

Critical success factors in tackling uh This patient safety issue Then you also Mention all this data Coming also from sweden but New opinions how can health stakeholders Better work together to enhance The management of sepsis in health care Settings in europe Yes Thank you laura yeah i think there is It's a lot of things that Can be done i mean Again why why is the burden difficult to Estimate it's one thing is that Bloodstream infection is not the same as Sepsis it's about 20 to 30 percent of Sepsis cases have bacteria in the the Blood so we have to find Other Ways to measure Sepsis as well in Connection to uh how how we do to Today with the bloodstream in in Infections and as as i said the icd code Coding is not Working as it should Um and sepsis is not owned by one Medical specialty Services patient can turn turn up at the All different kinds of medical Or and surgical wards and in sweden for For instance Only seven percent of the sepsis

Patients end up in the icu so it's not Only an icu Matter as as well the majority of the Patients are in the regular wars or Intermediate boards and therefore we Also need to find we need to adapt the Sepsis definitions because they are Uh they only work well in the icu they Don't do not work well outside the the i Icu and i think that's a key To also Be able to estimate the true burden so We we need to implement National Sepsis management plans increase uh Awareness Talk about the connection between sepsis And antimicrobial risk resistance Uh agree on a definition on in infection That's also a problem that we have a con Condition but we we We do not Agree on what it is so we have to find a Definition for uh Sepsis that all uh Can uh Agree on more or or less So that's a few thoughts and also Electronic registration of vital Parameters and also lab Values that would also be some kind of a Future Way to Identify sepsis cases uh in in in a way

That we are not able to do to today Thank you dr linder Now Really referring back to the Link between sepsis and anti-microbial Resistance I would like also to hear About the work uh the excellent work That dr monet is uh carrying out at the Ecbc so i would like also to give the Floor now to dr Dominic monet who again is the head of Disease program on amr and hais at the Easily seen so the floor is yours and Also basically to share also your screen Dominic thanks a lot Yeah thank you laura and good afternoon Uh colleagues and and everybody and it's Um I think it was good to that you put us In in thinking mode And ecdc has been working the past uh Almost 15 years on anti-microbial Resistance and health gases in veterans Surveillance prevention control as per Our mandate But you And The organizers of this uh Webinar asks us questions and then i'm Sorry that i often don't have the whole Reply So this is a slide that i often use for Help cancer seeing infection

And it compares the defect per million And we are When we were traveling we were taking Planes and we had a short connection and Unfortunately we would you know the Luggage we would make a connection that The luggage would not make the Connection Well that's about 0.7 percent Of all luggage that would not make the Connection When we're talking about health care Associate infections It's about seven percent Of other patients that are hospitalized That will suffer a health cancer of the Infection And then we saw higher numbers for for Sepsis about one patient in 20 That would have a sepsis at least in in Sweden So we get really annoyed about our lost Luggage because we know what it is We we're aware it's something we Experience all the time And we're totally unaware about the Rates of gaseous infections and Definitely those for uh sepsis So i was looking for for data In our databases and what i could find Is data on healthcare-associated Bloodstream infections And we have performed at ecdc and the Whole team and we've coordinated this

With All the euea countries And other countries And these are point prevalent surveys of Healthcare associate infections than Antimicrobial use in european acute care Hospitals And also in long-term care facilities And these were performed in 2016-17 So on a given day in the eu eea we ended Up with the estimate that more than 10 000 patients have a Healthcare-associated bsi Or bloodstream infection And there are many more that have a Community associated bsi but these were Not measured Which mean that Each year in the eu ea about 400 000 Episodes of healthcare associated Industrial infections In the same survey there was data on The the level of Structures processes preparedness that The countries would have 74 of the acute Care hospitals had a guideline for the Prevention of healthcare-associated Bloodstream infections in intensive care Units and 65 Of the acute care hospitals at this kind Of guideline that would cover the whole Hospital And for organized training for the Prevention of healthcare associate uh

Blossom infections 54 of acute care Hospitals without certain guidelines in Intensive care units and 47 Hospital-wide We Tried a few years ago to calc or Estimate the burden of healthcare Associated infections And we were surprised to find out that Afghanistan infections In terms of burden In disability adjusted life years per Population Account for twice the burden of the Other 31 infectious diseases that that We deal with any cdc And you you see the vlc infections are Here in uh in drainage on the screen Because today we're talking about sepsis And we're talking about blossom Infection the healthcare associated Primary bloodstream infections would be Here and contribute to A very high burden much more than all The other diseases And again these are just the healthcare Associated bloodstream infections When it comes to Antimicrobial resistance Uh The burden of antimicrobial resistance Or more precisely the burden of Infections with antibody criticism Bacteria as reported by cdc

Is comparable to the burden of influenza Tuberculosis and hiv aids combined In disability adjusted Life years Per population This is of course without taking into Account consideration co covid in 2020 And we may have updates for this numbers At some point We're talking about 33 000 attributable Death due to these infections with Antibody christian bacteria Or 170 disability adjusted life years Per 100 thousand population And bloodstream infections whether They're healthcare associated or Community acquired Due to antibody crystalline bacteria Are responsible for most of the Overburden of this resistant infection So that that confirms with the Discussion that we had previously So one of the My conclusions and and reflections F can associate blustery infections Blockchain factors with antimicrobial Bacteria both result in a significant Burden Human burden tool for the eu eea Ecdc does not collect data on community Acquired bloodstream infections or on Sepsis And there's a reason for this is because There's a list of communicable diseases

And special health issues and as per the Legislation these special health issues Are nosocomial infections and Antimicrobial resistance And this list is what is the Communicable diseases and special health Issues that the countries must report to Ecdc Sepsis is not a communicable disease Sepsis is not included in the list even As a special health issue And in the hospital or other alcoholic Settings that it was mentioned sepsis is Not owned by one department And i would say it's different from Health care society infections In most hospitals now There is an infection prevention control Committee And there is a unit of people that work Full-time on infection prevention Control in the hospital to make sure That uh To prevent and control have cancer Ceiling infections and that inflammatory Resistance we don't add this for sepsis There's no sepsis committee there's no Sepsis unit Second part of my reflections We're able to and this is your point Adam and i feel free to to put it for Ear forward again we're able to Communicate effectively to the general Public on complex healthy issues such as

Cancer and to some extent about Antimicrobial resistance and we're Getting better at this So we should be able to communicate Effectively about sepsis But this is not as easy we need to Simplify the terminology And clarify the definitions If the public Hears about blossom infection septicemia Bacteremia and also about sepsis The public will be will be confused Specifically for sepsis we need the Definition which is better understood And applicable to ongoing surveillance At the local national And eu level not sure it's possible But you may get better estimates via the Survey that you you mentioned My last point is Since 2008 we had a european antibody Awareness day Since 2015 there's a world antimicrobial Awareness week that starts on the day That we had chosen for europe and Antibodies day which is 18th of november We started with a A small campaign and so we need to Like you for sepsis we need to Raise awareness For the general public And we had a quite a small budget and i Would say any research project now would Start with a budget over several years

Of 5 to 10 million euros For starting the campaign we're using Much less money now but we used about 100 000 euros Just for starting the campaign We've had uh Movies animation that were developed That have been translated with subtitles Uh in all the eu languages that have Been used by member states And then Awareness what was a snowball Starting from this So i'm sure it's possible you you could You could have a movie that said look You're feeling this way You know you you don't feel well you're Tired you're okay and you put all your Signs of sepsis and this can this can be Uh put on social media this can be put Even on tv channels as foreign microbial Resistance so it's just an idea it Doesn't need to be fancy But it's easy to do and it's easy to to Translate and we'd be happy to talk to You if you want to mirror this idea on How to communicate Thank you very much Thank you very much dr monet for Your interesting points and Contributions to the debate Now conscious of the time i just need to Give the floor to uh the member of the European parliament and mr bushoy thank

You very much for being here with us Today i know that you also have another Important commitment so the floor is Yours thank you Thank you thank you so much Uh i'm berliner very important tpp Meeting and i'm not sure if the Conditions are the best For this intervention i'd like to thank Essa for inviting uh today in the last Months i have witnessed many discussions On the implication of sepsis in the Current pandemic response And evolution But nevertheless along my activity in The parliament i have participated in Discussions on the link between The incidence of sepsis antimicrobial Resistance of sepsis and healthcare Associated infections and between sepsis And patient safety We all know that healthcare Infections are often resistant to Antibiotics and can rapidly lead to Deteriorating clinical conditions and That the antimicrobial resistance is a Major factor determining clinical Unresponsiveness to treatment and rapid Revolution evolution to sepsis and Septic shock moreover there are many Categories of patients that are at risk Especially those that are of course Affected by an infection or those that Have a serious precondition or have a

Non-communicable disease the last one Being also the major causing factor These are discussions and facts that we Know at the level of policy makers and Of course it's important to know how we Can contribute in order to support Your effort and of course the Development of an action plan because They understand that This is one of the main discussions for Today My response would be by recognizing the Problem by making a priority for from Tackling sepsis by addressing sepsis in The upcoming pharma strategy where we'll Be discussing about antimicrobial Resistance as well by raising awareness Is what it was also mentioned by the Distinguished Professor and the experts Earlier and also but by putting patient Safety first sepsis is already Recognized as an eligible action under The youth for health program I was and i am the rapporteur of the European parliament for the ufar health Program in the specific actions to Address healthcare-associated infections And anti-microbial resistance but of Course more needs to be done The policy makers need your expertise And recommendations to support Directions and boost the development Of the action plan

Implementing preventive measures against Infections such as good hygiene Practices and this was extremely Important during coronavirus and i am Sure that Medical staff but and also the general Public is now more aware about this Ensuring access to vaccination programs And vaccines Prove to be extremely efficient and the Only the only solution to stop these Pandemics and of course they are Extremely important also for other Diseases Infection prevention and control best Practices both in the community and Health care settings are key steps in Reducing the occurrence of sepsis early Diagnosis and timely and appropriate Clinical management of sepsis such as Optimal antimicrobial use and fluid Resistation are crucial to increase the Likelihood of survival even though the Onset of sepsis can be acute and poses a Short-term mortality burden it can also Be the cause of significant long-term Morbidity requiring treatment and Support Thus Sepsis requires a multidisciplinary Approach european union of course Is committed to be more active in the Health area of course health remains a Matter of subsidiarity we cannot decide

From european institutions what how each Member state are organizing their Hospitals their programs their financing But We there is a strong political support To Involve more european institutions in The health care to exchange-based Practices to coordinate better among us To have the best Approaches and the best strategies to be Implemented all over in europe to reduce The inequalities we have you for health We have the collision funds we have also The Horizon europe where health is extremely Important and research can be done even In the and also in the area of sepsis so Using this political commitment at the Eu level using the Instruments that could be could finance Some of the initiatives and efforts and Also Putting All our experience together i believe That a good progress could be achieved In the coming years thank you so much And good luck in all your work Many thanks uh Mr mickey buchoy thank you very much for Providing this um Valuable comments And You have correctly explained all these

Uh in major policy logistic files uh With the view uh really to Build the stronger and healthier also More sustainable european health union And also At the european sepsis alliance we Really hope that there will be a much Better focus on research on prevention And also management of sexism and and This will be uh also um Pursued by the let's say a stimulation Of policies to prevent sepsis And certainly we hope that the uh Upcoming work plans under the european Uh for health for the eu for health Program will basically provide the right Also platform to uh further support the Research and education training programs For healthcare professionals on sepsis So we really hope this will be uh Thoughtful not only um Under this framework but also within the Pharmaceutical strategy for europe and Other major policy files So thank you very much again and now i Would like to go back and to open also a Little bit uh The this q a session i hope to make it More let's say interactive also because I've come across a very uh interesting Questions From the audience so i personally thank The people who have submitted the Question probably i would like now to uh

Go back to the presentation of dr Monet from the ecdc And One of your Reflections at the end pointed out the Need to simplify the terminology and Also to clarify these definitions We know that there is a sepsis Definitions um by the who which is also Globally Accepted so how we can really um Push let's say or Politely the member state to implement Basically that is a common definition And also how the institutions can play a Role to create awareness among the General public Can you please uh comment on this said Dr monet you are on mute Sorry if you can please amuse yourself Thanks Yes i've done this for security Um Yes i mean i think the the study that You're planning to do and that you Obviously pilot tested in sweden Will promote the use of standardized Definitions Um So so this this is essential Now If The study is only taking place in A few

Usual suspect countries the one that Have the resources and unmotivated And only in a few hospitals in those Countries But that would not promote the use of The definition so I would Encourage you to enroll all Eu member states And ea countries all of them I know that it's a first study so i You will not get a representative sample But try to to get as many regions as Possible in involved Make that effort to enroll the the People that would not have enrolled Initially so i i think they would find Like the discussion that we had to Prepare this uh webinar We were saying that people are accepting This who definition so it's fine but They need to be known Uh there is a comment in the chat About community acquired infection that Cause 80 percent of all safeties But evcdc does not have a mandate to to Do surveillance of those So the cases of Um Blossom infections with strep pneumonia And most of them i mean they're all a Community acquired they will be measured But they will be under a strep pneumonia Infection

We don't we don't have that measurement Of all bloodstream infections Only health cancers infections Has to do with our mandate and has to do With the the list of communicable Diseases under surveillance Thank you for uh this clarification dr Monet well we know What is really um evidence for us is That sepsis is increasingly interlinked With amr and afghanistan infections Because infections which do not respond To first-line antimicrobial therapy due To amr may progress to sepsis rapidly So what we also aim to do and intent to Um to do it actually next week I remind everyone that next friday Uh there is the word the patient safety Day 2021 so in this occasion really we Intend to um better promote these Messages because i think that we need to Move in parallel um and also really Take Um urgent steps and actions Not only when it comes to sexy but Linking to also um Other Public health Challenges and certainly we will be uh Really supportive of your work and At the upcoming european antibiotic Awareness day on the 18th of november Um Now i also have a question actually uh

There was a question from the audience To dr Linder and now i will go back to it uh So basically before we mentioned a lot Uh the the word awareness Um And here there is a Question that says beyond raising Awareness and avoiding to be let's say More you know um Less concrete when we talk about this Abstract concept of awareness Um For the nurses and doctors or for Healthcare professionals how Is continuing professional development And benefits in sweden and how are also The company their competencies verifies And cross-checked This is a very um good question and it's A serious task to to do this uh in Sweden so far it's the emergency Department and the pre-hospital the am Ambulances that are Affected uh With this sepsis uh Alert Implementation and so in each province In sweden we have a sepsis Coordinator and they have a team and They they are responsible for uh Appointing local sepsis Officers or responsibles and and and They have specific training

Pro programs for their staff the next Step is that we want to implement this To to identify sepsis also in in in the Different wards and then it will be a Huge amount of Staff that needs to be trained so this This will cost money but it will also Save lives so i think in the end We will earn money Yes thank you adam well um conscious Again of the time i wish we would talk More and learn more from you because you Are really expert in this in this field I uh we arrive at the end of our uh Panel discussion Um I i truly thank you for being here for Providing these uh presentations which Have been very Inspiring and informative in my opinion And i hope Also that the audience has truly enjoyed The discussion as well uh certainly the Presentation will be available and as Well as i guess the recording so We can certainly follow up on on some Very interesting point you raised in the Near future so again thank you very much And now i will hand the floor back to um Madame Um Thank you thank you so much uh for all Of you uh for this very interesting Discussion um so

The Uh next topic uh the next um panel Debate will be Patient Centric health systems Leveraging lessons from long covered and Sepsis patients And the moderator for this panel Discussion will be silvio gerardi who is Uh representing the association Association doceti in italy and the city Have Done some remarkable work in italy to Raise awareness about sepsis amongst the Scientific community and politicians so Warm welcome to you silvio and i'll Leave the introduction of the panelists In this discussion to you Over to you thank you Thank you very much eureka can you hear Me well yes definitely Excellent um okay my name is silvio Guerrardi unfortunately you know In english geh is g but in italian is gh Is gay so my right name is gerardi Sorry about that No no problem uh when i have been living In the states everybody used to call me Girardi and so i'm i'm acquainted with This I want to thank you esa for inviting me Giving the honor of Sharing this section um this is a very Important point that we have

How we can Involve patients uh how we can inform Patients when it comes to [Music] Sepsis and particularly to covet We have Three speakers tonight elisa perego Christiane hertog and hopefully i can Pronounce the names correctly and the Ulf bodyshell I would like to ask Elisa to start with her presentation Elisa is a honorary research associate At the university college of london And she has been involved in a lot of Research on health disability and Inequality She was as well in lombardia in the North of italy when the big pandemic Strike happened in in italy Um I think uh we have to uh start with uh Christianity Yeah Elisa is not quite here yet so Okay so cristiano she is a physician Sepsis researcher and lecturer at the uh Charity berlin and she's coordinating The esa working group on patients and Family support Thank you christiane You have 10 15 minutes First of all i want to thank the Organizers for this interesting meeting

And the opportunity to speak on behalf Of the european sepsis alliance patient And family support working group It is um [Music] It is a pity that We have not yet listened to elisa's talk But i can tell you it is very moving to Hear From Not only a patient and the sepsis Survivor But of the patient who has kind of Empowered herself And Thought and developed a name for what She was experiencing Now why is this important i am a general Practitioner by training I have been working with sepsis patients And family members for many years And Patients stories are important input Because they remind us That the first and foremost goal of Medicine Is to put And keep patients in the central focus Sepsis and kovid highlight The weaknesses and the deficits of Healthcare systems And these Weaknesses and deficits are appalling Elisa's story

Is That And i hope she can tell you herself that She was Left Alone It is unique but it is also typical for Numerous other sepsis survivors she has Been left alone to understand Her problems of persisting Health problems of ongoing weakness of Fatigue of Failure to breathe properly and so on She has been left alone to make a sense Of what is happening And she has been left alone to put a Name to it and she invented the name Long covered and i must say that Listening to her story i've listened to Her story before I was Very impressed by what she has achieved And i must tell you if you blame Such problems her problems on the Pandemic Only then you are wrong Her problems Are typical they are a structural Problem It's the story of numerous sepsis Survivors And they will tell you Actually it should be the duty of the Medical profession of the doctor of the

Family doctor of the clinician in the Hospital of the nurses To help us cope and understand and name Our problems to become well again but This is very often not happening And i want you to remind you of the Scope of this Problem the number is published We have 700 000 sepsis survivors in Europe per year But listening to adam linder's a talk Just now Where he found that many cases are not Recorded this is probably Grossly underestimated And now we also have 39 million covid Survivors in europe to date New research suggests that the majority Of hospital-treated sepsis survivors and About Half of hospital-treated covid survivors Suffer from ongoing assisting problems And these are called postsepsis Morbidity Sepsis sequela or in the case of covid Which severe covidius viral sepsis Long covered or post Covid syndrome Our research from german data suggests That about 75 of hospitalized sepsis Survivors Suffer from post sepsis morbidity 25 Are newly dependent on nursing care and

Remember sepsis can affect everyone not Only the aged or the very young but also People in their best years 30 40 50 year Old people and they are suddenly thrown Back And They are like instant aging someone has Said feels like 80 years old dependent On nursing care and over 30 percent die In the following year Other problems Are repeated admissions into hospital Often for recurring infections And A new sepsis episode So what must be done I want to cite the parents of rory Staunton you may have heard of rory He was a 12 year old healthy school boy From new york Who died from sepsis because Neither the pediatrician who was called Nor the emergency doctor They went to recognize the warning signs And symptoms of sepsis This boy Could have been saved like many others And his death led to the implementation Of the rory staunton regulations The Mandated Sepsis protocols and 149 new york state Hospitals And you know that this resulted in a

Drastic decrease of hospital mortality And probably an increase of recognized Sepsis cases And the parents of rory have now written An editorial Accompanying an epidemiologic study of Pediatric sepsis In the critical care journal and this is Their message they say We are not waiting for a drug against Sepsis We are waiting for political leadership And this is my message also today we are Asking for political leadership In the european union and which is the Courage to put solutions that are Already out there we have published them Over the years and you can read them and They are stated and they are put into Protocols and everything so these Solutions are there we do not need to Find them these solutions must be put Into practice Politicians must invest in sepsis Education of the public as well as an Education of the medical profession And the time For volunteers is over Progress so far has been mainly achieved By volunteers but patients and family Members Have the right and they demand that this Is now Becoming professionalized political

Leadership and we must foster new Treatment concepts of post-sepsis Problems That are overarching across medical Fields and bridge medical silos to Answer the needs of parents of patients And families So it is inspiring that in our working Group We have patient representatives from Sweden Norway Belgium France the uk Germany and other countries who do not Turn their back on this horrible Experience they underwent But leverage their experience to seek to Improve the condition for future Patients and family members We have drafted a statement which you Can read on the European sepsis alliance website To political leaders and policy makers On the demands of patients and families Now just want to cite the demands that Patients and families have Training of medical personnel Acute care According to best evidence guidelines Improved communication between doctors And patients and families about sepsis And long-term effects of sepsis Structured aftercare according to

Quality indicators Multi-disciplinary rehabilitation Coverage by insurance And Funding for clinical research and Quality improvement So thank you for your Attention Thank you cristiano I think you gave us two very important Messages One is uh very encouraging and that is We do not need new drugs or new Therapeutic tools For treating Sepsis the second one is a little bit Worrying instead Because We need leadership and education You pointed out very well that Leadership should come from politicians And In my country but i believe in europe All over europe We are still lacking This leadership probably We were not able to sensitize the Political class on how important is to Manage Sepsi By the way this is one of the key Activity that we in the Association do Try to do with the italian

Politicians And the second part of this is the Education to doctors patients and i Would say the press as well Uh the journalists because you know Sepsi is considered Sometime as a Strange disease Very far from us on the normal living And everybody believes that sepsis is Not touching us It's not involving us which is Absolutely not true So thank you for the two messages and Hopefully Uh the other two speakers will uh Expand the concept of leadership as well As the concept of education Um i don't know if we now have uh Thank you again elisa or should we move On with uh Uh dr uh Buddhist shell I think i can see eliza here Yeah Okay my apologies for that before i went Into the room i don't know why And thank you very much for this Excellent opportunity to talk about a Long coverage and the rights of people With chronic illnesses and disabilities [Music] The long-term health effects of Psychoscope infections

Are now is now recognized as a major Clinical and social challenge In this pandemic And long covida is a Patient-made term Which emerges Across The first pandemic month Among Patients people affected by First Just a victor of the background Many of you might remember that at the Beginning of the pandemic we were told That People Were supposed to recover from kobe 19 in Two to six weeks of mild to severe cubit But actually this is what This is what It was not happening Many people Stay Ill For many many months We now know that millions of people it Is estimated that millions and millions Of people across the world are suffering From coping 19 Long-term effects And many people like myself Are still after Like one year in the hall

After The initial infection As i mentioned at the beginning of my Talk at the beginning Policymakers and medical professionals Were not recognizing the fact that People were not recovering so fast from Kobe 19 And it was about Patients Taking things into their heads and Connecting To each other through social media such As twitter the press Facebook And so on So the idea of long copy of the fact That people were not going Travel From patients To policy makers in the medical field This was the The Recognition of long gone And so patients have built an International Graceful Movement of people that achieve some Significant success such as formal Recognition from the world health Recognition in august 2020 that is last Year Patients also organized themselves in Collectives

And Groups that are often Working As reserved jobs do you can you hear me I see a message Can you hear me well Sometimes there is some noise in the Background you may want to try to speak A little bit louder Okay my apologies Maybe it's my internet not working well So basically uh after um Almost two years so of um Working in science communication at the Balkasan research on london I would like to share some ideas That Come to mind And really build on What christiane and professor gravity Shared with us For now So what patients need with the long cove With kobe 19 sevilla First of all the creation of appropriate Medical codes And Care pathways For treatment for recognition and these Are To be Linked to the live Experience Of people who had

Probably 19 and are suffering from And the fact that patients have been so Involved in advocacy and research since The beginning of the pandemic It is interesting because it gives us The idea that patients Can be expert on their own medical Condition this is an idea that could be Exported To other Chronic illness communities such as for Example Sepsis of course And many others A second very important point that Christian mentioned and others have Mentioned as well is about Leadership research funding We need research funding to Study long covered Because we have a new virus in the news Disease And funding must be commiserated to the Disease button and we know that Unfortunately This is huge millions of people are Suffering from long coverage Again Patients Should be in my opinion Strongly involved In the creation and design of research Projects This is because

We have a new disease and patients Have been collecting data and sharing Data since the beginning of the pandemic Often we have a clinical data that the Researchers still do not have because we Do exam medically from ourselves and we Share the data across multiple media And again This kind of Research Patient-centered could be Exported let's say to other chronic Illness communities such as The sepsis and post-interaction Chronic illness community It is also important in my opinion that Um And health care pathways are also Informed By Patients and the input of patients I will note that many medical Professionals and care professionals That Do have long coverage because obviously They contacted the kobe 19 In the hospital while working And this is so basically a Medical professionals are often both Patients and doctors and this can Provide People there and their important Input Into

Service design in the provision of Health We are also thinking about long covert Is a disability Where Encounters It's not recognized Is a disability And i want to mention that Is a Disease which is often severe Energy limiting some days you are really Ill you can't really work But well some patients are really really Severe and i think this is the case of Many uh sepsis survival as well So um i think we really need to think About disability services and access Disability services including benefits That are really you know targeted To the needs of patients And this is especially the case in a Pandemic you know you have a risk Infection with suscucu infection etc for Traveling face to face And so on And i would like to conclude Mentioning that pandemics I have you know history altering events Endorphin You know they bring up the Huge disruption social disruption but Sometimes they can also bring a change And this pandemic is brought about more

Like in the case of long-haul with more Awareness of chronic illness The need for accommodation they need for Example for smart working You know online conferences and so on These kind of things we have so so Does an opportunity to build A better society in this time of crisis And this can involve of course Many other chronic illness communities Such as Sepsis my work i hope This opportunity will be taken thank you Very much for your attention Thank you elisa for your speech sometime We had some trouble in hearing you so Hopefully All the messages you have passed through Have been Perceived by The audience I think there are three points very Important among the others number one is Money for research Research is a key element Uh in any disease particularly when it Comes for to A disease like kobe that that is not yet Well known actually it was totally Unknown And that was an issue um i think that There are Monies a lot of money in europe and in The world in research for covid but one

Of the problem is that we do not have a Coordination Among the research centers so the risk Is that the money that army Made available either by the government Or the uh donations Are not all focused to the same target And The latin used to say dvd at impera That may means in this case if you Divide the money you do not get enough Funds for a outstanding research And and then it comes to leadership as Well because leadership is not only in Politics but it is as well in research The second point is the involvement of Patients In the research And i think this is really a key element You said very well that patients knows The disease probably better than Physicians They do not know the terminology they do Not know maybe the diagnosis or The therapy but the way they describe The disease Is For handbook of medicine so we should Listen to them more and more And finally this is a real long-term Issue for kovid maybe covet will Disappear in the near future with a no But what is sure he may not disappear The disability issue

A key question is is this a temporary Disability is this a permanent Disability we don't know yet because for What i know We have information that disability may Last for about 12 months but we do not Know at least i do not know If we have Cases that is lasting longer going into Chronic issue and maybe this may may be A question to rise to you guys to the Speakers uh is do you believe that kovid Uh may became a permanent disability Issue for patients Uh let me move now to ulf podex shell Wolf is a doctor he's a neurologist and Co-director of the uh thank you elisa And co-director of the Interdisciplinary center for intensive Care Long-term treatment and acute Rehabilitation of the croatia germany Hospital They are very much involved in a Comprehensive care structure for Patients in under rehabilitation And since in 2018 they partner in Treating patients with severe sepsis dr Ulf bereshel Please you have 10-15 minutes Yeah thank you very much for the Instruction Uh As you mentioned i am a neurologist i

Work in The Creature Just a moment please I've prepared some slices Um as you can see on the right side this Is germany And here in the very east this is saxony And then the east of saxony this is this The region east saxony it's a very rural Area There live about One and a half million people and over There Half of them live in the area here Around This is the university hospital in basin Which is the biggest hospital in the Region and has already Different networks with different Hospitals in this area For example a cancer network or a stroke Network And [Music] Here in the south of dresden is the Bavaria clinic in kaiser This is the largest rehabilitation Center for Neurological diseases and we have Focused since the last 20 years on Patients with critical illness Polynomial fatigue we are a big weaning Center

And so we have Lots of Experiences with patients With Um secretly of the sepsis Um I started here In 2000 2016 For that time i was At the university hospital in basin And when i came here the idea climbed up To implement also a comprehensive sepsis Center like to other organ diseases And Therefore The first Step was That we Developed the treatment pathway Professional and interdisciplinary Treatment pathway Um with the university hospital in Dresden and With our clinic For example in this treatment pathway We implemented an early warning system As well as a screening instrument for All emergency rooms At the university hospital And we implemented all these The whole pathway in 2019 We also Started to do teaching courses about Step sets with an interdisciplinary

Approach We had teaching courses for nurses for Therapeutic Therapists and for medical doctors and We did it before covert all also all Together At the moment we do it online And we implemented the quality Management so for example We measure continuously different Quality indicators And we discuss Them every Quarterly In in case discussions To learn about the quality of the Treatment within the path Then We We accompany the observational study To evaluate this project This is a single center evaluation of The observational study Um this is funded by the code collision Institute And Within This Study We included also Follow-up questioning At different time points at 3 months and At 12 months At the beginning at 2020

We had implemented all these things and We started To treat patients within this pathway The vision is of course In the future To to Expand this uh pathway to the Pre-clinical treatment and prevention as Well to the follow-up care at the moment We Included only the hospital treatment at The university of hospital and racing And their rehabilitation at my clinic I will give you some results for the Discussions We started in february 2020 And for this session I made an analysis In august and in this time point we Included 386 patients prospectively in this Observational study and as you can see Here we had 177 patients with sepsis after covet And 191 patients with abscess Without covet Um As you can see here the median age was Not different in both groups But there was a significant difference In The severity of the diseases Measured by the septic shock incidence

By admission The patient with covet 19 Associated sepsis Had a higher Bmi And had More diseases Previously Measured by the charleston co-mobility Index On the right side you can see the All-over mortality which was very high 44 Within three months died Um after including into this Observational study and there was a Significant difference between the both Subgroups covet And non-covet And the covet group almost in 60 percent Died under the non-covet group 29 percent At the moment we are evaluating Um Different Uh Findings Uh if we can find um [Music] Other Uh things that can Help us to understand the difference Between those groups And here are uh the short results for

The three-month follow-up Um all Of all patients 260 206 Were discharged from the university Hospital in briston 46 at home Three to a care facility 25 to Our clinic That means These patients got the structured Treatment pathway in our clinic and 13 Patients went to another rehabilitation Facility And in This prylan Preliminary analysis We could see The patients who have passed structured Treatment pathway May have a better treatment outcome in Terms of quality of life After three months the people Who Have passed this pathway had a better Quality of life than the other people They had a higher reintegration into Normal living And they had less Severity of chronic fatigue symptoms The number Of the patients is too small to make a Statistic analysis this is only a trend

But we are going on with this study to Learn more about the con The Effect from the structured treatment Pathway in septic patients So my conclusion is that the treatment Of sepsis patients at a comprehensive Sepsis center as possible And it's also possible to uh to get an Overview of the treatment quality in This center And We think that continuously collected Results help us to understand the Optimal course of the treatment to Measure the quality of the treatment in The center and it will help us to Improve the treatment quality Continuously The first results regarding the Long-term outcome after surviving sepsis Are very encouraging um however These results are not significant due to The low number of cases at this time Point But we are going on to a level evaluate The study Um the plan is To have data from 300 patients after one Year outcome data So thank you very much Um thank you Dr I have one question for you that is do

You have an idea on How important is an early treatment as Early as possible In terms of prevention of a later Development of sepsis in other words if We are able to treat patients at first Symptoms Uh is this a preventing Action activity In order to sepsis or even if we start Treatment as early as possible they may Go into sepsis as well And the second question is um You show us that mortality was about Fifty percent for sorry sixty percent For Uh coveted patients and thirty percent For Other patients Um though you said you are still Analyzing data but What may be the reason for this Um to the first question Um i'm a stroke Neurologist And in stroke neurology We say time is brain The earlier the therapy the better the Outcome And it's the same for me in septic Patients And we saw in our Analysis in our In our

Case discussions The earlier we treat the patients The better is the outcome And i think we have to focus this is one Of the main problems we have Three emergency rooms At the university hospital And the goal is To implement a tool that every septic Patients Can be assessed very early and can get The correct treatment as soon as Possible i'm with you This is the most important thing Now To the second question Um We saw The Statistically significant difference Between those two groups then the covet Patients had significant mere Thrombotic complications such as Pulmonary embolism This may be a cause And the other Things are still under Investigation Thank you thank you Is there any question from the audience For this section Uh yes Yes I'm sorry so no

Continue No no i read uh In the chat any question If there are Any Difference in the outcome of Non-immunized survivors as compared to The breakthrough covert survivors The number we have is too small We cannot say this yet but We are very interested in getting more Uh Results in this topic another question Good question is is the difference Uh Um if the outcome Not only the survival is different in Covet and non-covet but the Outcome of the survivor was also Different i can't answer this yet Thank you Thank you Other question or intervention Well before we conclude Let me Try to point out one issue In europe Uh as far as covid is concerned Uh what i see and i think we all see is That there is No coordinate coordination whatsoever Among the different countries when it Comes to Covet there are countries where

Vaccination is mandatory or very close To being mandatory Other countries where the so-called Green pass or vaccination pass is again Mandatory Um Countries where the quarantine Is requested but maybe five days or ten Days now the key points here is that Once more Europe it is not yet one country What can we do in order to make Europe one country at least when it Comes to healthcare Does anybody have an idea or suggestion About this Um i would like to say something here if I may Please [Music] Going back to The parents of rory staunton I think Political leadership For is To to put solutions into practice I think we must not fall Into the trap Of looking Into Differences and special problems And Maybe unique uh Problems but look at the common

Um The common underlying problems and and Solutions Dr bodeshta Showed us an example of how A multimodal Therapy which includes All Medical Physical and Mental disciplines which is very unusual For a rehabilitation clinic Is put into practice to Help A patient after covida and sepsis To regain Their health again And this is not That this is a unifi this is an Overarching solution which is known for A long time this is what patients need And I think if We Ask The european union To Support These findings and suggestions that we Have Then these would apply to all european Countries In the same manner And they would apply as well to covet as

To sepsis uh survivors from other Sources be it bacterial sepsis or viral Sepsis for instance from influenza Um i think we also ignore The problems the perennial problems we Have with the survivors from Influenza in influenza census So I think we can if we want to move Forward we need to focus On these Overarching and common solutions For as a common denominator For the problem of treating patients After sepsis Sylvia i think we Need to wrap your little panel up if you If you may um we have some final Questions too that we might have to Address uh After this Do you have anything more you'd like to Add In this group No i would say no I think we can consider this completed Almost on time Very good Thank you so much all of you Before we uh wrap this stay up a bit um There's been some questions that i just See can see if we can get some answers For Um

There was a question about uh Amr and and how uh this Problem with the antibiotic uh being the Basically the only treatment for sepsis Uh is there any new uh treatment um how Long will we have to wait before there Might be some new treatment I think maybe adam is this something That the research group have been Talking about If there's if you have any comments on That Is there any new Treatment for sepsis in the pipeline or Should we have to wait for decades to Come before we have anything else than Antibiotic To use when when treating sepsis Are you still with us adam Maybe not okay Anyone else feel free to ask Answer the question No okay let's let's leave that then Um Well thank you all for uh participating Uh we are now uh Heading towards the end of this this day Um Uh and i would like to introduce our Last speaker uh daniela philipesco who Is vice chairman of the esa i will let You daniella give some final remarks and Conclusions uh to the discussions that We've had here today

Yes before The closure i would like to to say a few Uh words first of all thank you for uh You for moderating the session the the Event uh i i'm so happy that we had this Event today and i would like to to thank All the participants the speakers and The colleagues for their engagement in The fourth annual meeting of the European sepsis alliance We at the european sepsis alliance are Proud to see how much progress we are Doing together Towards raising awareness about sepsis And implementation of the 2017 2017 world health assembly resolution on Improving The prevention diagnosis and management Of sepsis The report we launched today on the European sepsis initiatives is a Demonstration of what concrete measures Can be put in place to improve the Management of sepsis Mitigate its harm and eventually save People life We hope It will be helpful for other countries To find inspiration and for european Institutions and stakeholders pledged to Keep track of the Progress Our call

To the european institution is to Support the sharing of knowledge amongst Member states but we also would like to See european guidelines for the Management of sepsis a comprehensive European infection management program And eu funding for uh sepsis research This should go hand in hand with Extended powers of european institutions And the authorities in the area of Health In this sense we are supportive of the Extension of the acdc mandate as we Believe national health authorities and Professionals need guidance and support In tackling the heavy burden of sepsis On our society Today we have talked about the need to Integrate sepsis into national health Systems and programs to make them Stronger and more Resilient we discussed solutions to fill In the knowledge gap we have heard from The patients and how important is to Support them also after hospital Dismissal To mitigate the long-term effects of Sepsis It has been said Many times today and uh i think it's Important to reiterate That this pandemic is contributing to The uh increase Of the global border burden of sepsis

And if we estimate that to date there Are more than 36 Million profit 19 survivors who Potentially could be facing the long Term effects of the disease similarly to Posceptic syndrome the public health Problem is huge Cov19 is not The only Cause of sepsis in europe we are missing Solid data in order to quantify and Better manage sepsis We have heard that sepsis is not Just in the scope of ecbc However we hope that with the extension Of its mandate sepsis could also find a Space in in it Meanwhile The european sepsis alliance is working On a europe-wide survey to assess the Quality of care of sepsis in europe and We have already launched it Recently And We hope to collect as many data as Possible from participating countries All around europe here i invite our Colleagues to participate and contribute To this ambitious project so please Contact us If you like to contribute We would like to continue this Discussions with all of you and Especially we need the engagement of the

Authorities we have heard about the Goals of the slovenian presidency of the Eu council and the measures underway Proposed by the european commission to Answer to this crisis and the future Ones we have also heard Of the great progress undertaken by Countries like france in setting up a National action plan on sepsis and i Hope that the french presidency Of the eu council will continue in the First semester of 2022 on the basis of The work done so far to put sepsis on The agenda of the eu Let me Thank you all one more time for the Participation today to our amazing Speakers and moderators From whom we have all learned a lot to My colleagues uh physicians nurses and Other professionals For the undeniable and daily effort in Managing the pandemic and sepsis and Save people's life to patients and their Families for helping us to reach our Mandate I thank our members and coordinators for The continued work and support Throughout the years to the european Institutions supporting our endeavor Towards europe free of sepsis As dr haskell the director of who europe Said today we know what is needed let's Make it happen what a nice slogan for

The celebration of the sepsis day on September 13 a number of events in different Countries are organized so please find The ones close to your heart and engage Thank you very much for your Participation Thank you daniela And thank you everyone for participating And listening to us today I hope you've had an enlightening Afternoon and i would like to remind you That uh the recording of today's event Will be available on the esa website Soon And um i would also like to remind you That the esa report that we've been Talking about uh that can also be found On the esa websites and don't forget the Upcoming world sepsis day on monday the 13th of september there will be events Going on all around europe so uh try and Find as daniela said a local event close To you And we also would like to encourage you To uh follow and interact with the European sepsis alliance on twitter I hope you all have enjoyed our program Today and i wish you a very pleasant Evening thank you

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