A simple dose of antibiotics: qualitative analysis of sepsis reporting in UK newspapers

Sepsis: the silent killer

Sepsis was presented as a condition that is silent, fast, and common. Frequent references to sepsis as ‘ the silent killer ’ conveyed the often apparently trivial nature of initial symptoms including ‘ simple sniffles ’, ‘ common colds ’, and ‘ tummy upsets ’ that in retrospect were harbingers of the terrible events to follow.

Warnings about the speed with which familiar childhood illnesses can render the sufferer moribund seemed intended to evoke dread; sepsis ‘ can develop rapidly following even the mildest of infections ’ (Daily Mail, 9 Feb 2016), taking hold with ‘ devastating swiftness ’ (Daily Mail, 14 June 2016) and ‘ terrifying speed ’ (Daily Mail, 16 Feb 2018), leading to ‘ rapid death ’ (Express, 9 Feb 2016) in children who had appeared no more than mildly unwell just hours before. One parent, mother of 3-year-old Morrish, described how it took the life of her child in ‘ what felt like an instant ’ (Daily Mail, 14 Sep 2016).

Along with Mead’s story, reporting of the enquiry into Morrish’s death appeared to signal a paradigm shift in how sepsis was represented. According to his parents, his death in 2010 was initially presented to them as unavoidable: ‘We were told that Sam had died of something rare, fast-acting, hard to spot and therefore very hard to treat’ (Guardian, 19 July 2016); however, a subsequent investigation by the Healthcare Ombudsman in 2014 concluded that his death would have been easily prevented with antibiotics and criticised the initial internal enquiry for failing to be open to this conclusion.¹⁶ Prior to this case, sepsis was framed in the media as a tragic but uncommon occurrence, worthy of attention precisely because of its nature as an exceptional event, as illustrated by the following quotes from parents who had lost children:

‘The doctors said this could happen in one in a million cases and unfortunately we were that one.’ (Daily Mail, 23 May 2006)

‘People need to know it's extremely serious but also extremely rare.’ (Express, 1 Jan 2010)

Following the enquiry into Morrish’s death, sepsis was no longer framed as rare and unfortunate but as ‘ the leading cause of avoidable death in the UK ’ (Daily Mail, 23 May 2017), claiming ‘ 35 000 lives a year, including 1000 under-fives ’ (The Sun, January 27 2016).

Victims: needless deaths of little ones

Although many articles acknowledged that sepsis is indiscriminate and can affect anyone, children were identified as a group at increased risk:

‘It can strike previously healthy patients of all ages, but is most common in young children, pregnant women, the elderly and those with underlying illness. ’ (Daily Mail, 3 March 2016)

Framing of children’s deaths from sepsis as largely avoidable was a recurrent theme, declared via alarming and emotive headlines such as, ‘Sepsis and the little ones who should never have died’ (Daily Mail, 15 March 2016).

This focus on avoidable deaths was reinforced by stakeholders within the health sector, notably The Sepsis Trust, whose opinions featured frequently. Bold statements were made about the potential for awareness campaigns to improve outcomes, with a substantial proportion of recent deaths seemingly directly attributed to perceived delays by the UK Government:

’In all, says The UK Sepsis Trust, 55 000 adults and children have died of sepsis (in the past 14 months ) since Mr Hunt pledged to act, of whom at least 16 000 could still be alive today if loved ones had known what to look for.’ (Daily Mail, 15 March 2016)

Healthcare system: shameful blunders

Descriptions of the health service’s management of sepsis were almost universally critical. Morrish’s death was described as the result of a ‘ catalogue of errors ’ (Telegraph, 18 Dec 2017), while the multiple contacts that Mead had with health services preceding his death was referred to as ‘a series of shameful blunders ’ (Daily Mail, 26 Jan 2016). Numerous articles detailed similar instances of children sent home from primary care or Accident and Emergency (A&E) departments with misplaced reassurance. Frequently, these failings were attributed to inadequate knowledge and understanding:

‘… awareness [of sepsis] among medical professionals and the public is worryingly poor, delaying life-saving treatment.’ (Daily Mail, 3 May 2016)

Other articles blamed attitudinal factors; ‘ patronising ’ doctors were described as giving ‘ cursory examinations ’ (Daily Mail, 18 Aug 2017) and concerned parents dismissed as ‘ overprotective ’ (Daily Mail, 27 Jan 2016) or ‘ paranoid ’ (Daily Mail, 7 March 2018). For another child who underwent multiple amputations after developing sepsis as a complication of minor burns, staff were ‘ too arrogant ’ to consider sepsis as a diagnosis, even after his mother raised it as a possibility (Mail on Sunday, 21 Aug 2016).

When adverse outcomes occurred, there were no assurances in the articles that clinical governance would prevail. Criticism of the NHS’s procedure for investigating fatalities ranged from accusations of apathy to blatant attempts to deceive. The most widely reported failing by an identifiable healthcare professional concerned Bawa Garba, convicted of manslaughter following the death of 6-year-old Jack Adcock. Despite subsequent recognition that complex systemic factors contributed to Adcock’s death, the General Medical Council’s description of Bawa Garba’s care as ‘ truly, exceptionally bad ’ was widely reported.¹⁷

Of the 140 articles, just six (4%) contained praise for the health service’s management of sepsis in children. However, even those articles with positive outcomes aimed to caution parents; one mother, who according to the article now works with The Sepsis Trust to raise awareness, warned: ‘It could have turned out so differently. It could have been someone who wasn't confident enough to point out it could be sepsis.’ (Guardian, 22 Jan 2016).

Parents: it’s not too late for you

The devastation that sepsis has wrought on the lives of affected families was apparent within the highly emotive accounts contained in many articles:

‘Our life now is empty, painful and will never be the same again. To say that we miss him does not do justice to our strength of feeling — Jack was an amazing son and one in a million.’ (Daily Mail, 5 Nov 2015)

‘I feel like my heart has stopped beating. When I wake up, I think I can’t go through a whole day. I’m devastated. I just feel empty.’ (Express, 25 Jan 2011)

‘The hardest thing was closing the [coffin] lid and saying my last goodbye. When you lose a child, you lose their future and your future. There’s no tomorrow. You just get through to the end of each day.’ (Daily Mail, 27 Oct 2016)

Alongside powerful descriptions of grief were insights into the regret that parents experienced when faced with the possibility that different actions could have altered outcomes. For Mead’s mother, ‘the worst thing in the world is knowing that his life could have been saved.’ (Daily Mail, 26 Jan 2016).

In every article in the sample, parents reported that they had consulted for medical advice, sometimes repeatedly, but the message from those who have lost children to sepsis was that this may be insufficient. This was reinforced by journalistic framing, as illustrated in the following editorial excerpt:

’… it doesn't matter how diligent or loving you are, you still can't protect your child from institutionalised incompetence […] the death of William Mead should never be forgotten. Not just because it exposes gaping holes in NHS care; because it unites us all as parents.’ (Daily Mail, 27 Jan 2016)

In this way, responsibility shifts to parents, obligating them as advocates for their children, a role sanctioned by both experts and by fellow parents. Ron Daniels, CEO of The Sepsis Trust and a key actor in the drive to improve sepsis awareness, wishes to ‘empower’ parents to recognise symptoms so that they can seek treatment immediately and raise the question of sepsis if doctors do not: ‘ We would urge parents to always trust their instincts and ask a medical professional, " Could it be sepsis?"' (Guardian, 15 Dec 2011). The mother of a baby who died after repeated reassurance that there was nothing seriously wrong warned: ‘ A mother's intuition is key — the doctor is not always right ’ (Daily Mail, 18 Aug 2017).

Several articles described the guilt endured by parents who survive their children. The UK actor Jason Watkins has spoken extensively about the loss of his 2-year-old daughter, Maude Watkins, and urged fellow parents to have a low threshold for action: ‘My message to anyone is, even if there are just one or two symptoms, get straight down to A & E‘ (Express, 9 Feb 2016). His wife, Clara Francis, was described as unable to shake the conviction that she was somehow to blame: ‘You have one job, to stop your child dying, and I couldn’t do that.’ (Daily Mail, 9 Feb 2018).

The need to prevent others falling victim to the same fate imbues warnings to other parents with an imploring quality and sense of urgency, captured in this plea from Mead’s mother: ’I will never hear my sweet child say, “Mummy, I love you.“ I will never know the man that William would have grown to be. So please, it is too late for me to “think sepsis“ but it's not too late for you.’ (Guardian, 15 Dec 2016).

Parental instinct was therefore presented as key to safeguarding children from this fast-moving, terrifying threat. Yet this concept was poorly defined, and even parents who have experienced loss did not necessarily feel better equipped to recognise when to act. Mead's mother is described as 'beset by worries' when her younger son is unwell: 'Until Arthur can talk I'll always assume the worst if he grizzles or has a cough or a temperature. Even though I know so much about sepsis now, there's always the fear I'll miss something. ' (Daily Mail, 27 Oct 2016).

Antibiotics: the simple solution

The relative ease with which terrible outcomes could have been prevented by ‘ a simple dose of antibiotics ’ is alluded to in several articles, and is alluring in its apparent simplicity. The consequences of treatment delays were recounted repeatedly, giving a sense of pivotal moments where treatment decisions meant the difference between life and death:

‘A simple jab of antibiotics would have saved him.’ (Mail on Sunday, 29 Nov 2015)

‘Knowing that a simple course of antibiotics could have saved him is something his parents will have to live with for the rest of their lives.’ (Daily Mail, 27 Oct 2016)

‘Blessing Matia’s death could have been prevented with a simple dose of antibiotics if medical staff had been able to identify the condition.’ (Daily Mail, 3 Dec 2016)

‘Experts said he would “probably” have survived if he had been given a simple dose of antibiotics.’ (Telegraph, 13 Feb 2016)

One article described how Mead’s ‘ fate was sealed ’ by failure to refer him to hospital where he could have received antibiotics that may have saved him (Guardian, 26 Jan 2016). For Maude Watkins, ‘ the window of opportunity to save her life was fast closing ’ as her condition deteriorated following discharge from hospital the previous day (Daily Mail, 9 Feb 2016). On reattending, she was given antibiotics but ‘it was almost certainly too late for [the antibiotics] to have had any impact on the condition. ‘ The suggestion here is that treatment at an earlier stage may have averted her death; however, the absence of a clear indication for antibiotics in the form of confirmed bacterial infection presents a conflict for doctors who were described as under ‘constant pressure ’ not to prescribe (Guardian, 26 Jan 2016). One article described the conflicting priorities that doctors working in primary care face:

‘ [GPs] are in an impossible bind. On one hand […] they are heavily criticised for not prescribing antibiotics in time. While on the other they are constantly criticised by health officials like the Chief Medical Officer Dame Sally Davies — dubbed the nanny-in-chief for her diktats on how we should lead our lives — for prescribing antibiotics .’ (Daily Mail, 27 Jan 2016)

This same article, while giving the semblance of a balanced representation of the dilemma facing GPs, concluded that, given the findings of the enquiry into Mead’s death, ‘surely it is better to err on the side of caution? ’

Notably, no articles that referred to pressure on GPs to reduce antibiotic prescribing connected this with efforts to reduce antibiotic resistance. Instead, it was positioned alongside issues about managing resources, so that withholding antibiotics was placed on a par with avoiding referring patients to crowded emergency departments. This frames antibiotics as a treatment that patients may be denied despite the benefits they might confer rather than because of the harm that unnecessary treatment may cause. The six articles (4%) that did mention growing resistance to antibiotics did so in relation to its potential contribution to the overall burden of sepsis, failing to acknowledge the paradoxical messages sent out about prescribing:

’Numbers [of sepsis cases] have leapt more than 50 per cent in five years, with experts partly blaming GPs ' over-prescription of antibiotics.’ (Daily Mail, 3 March 2016)

This creates a potentially confusing message, with health professionals to blame as individuals for failing to prevent deaths from sepsis by prescribing antibiotic treatment where needed, but also, as a collective, driving resistance through unnecessary prescribing.