The death of seven-year-old Jakelin Amei Rosmery Caal Maquin in December, shortly after she was taken into custody by Customs and Border Patrol has sparked outrage and redirected attention to the detention of immigrant children attempting entry to the United States. Although investigations are ongoing, early reports suggest that she died from sepsis and dehydration.
Yet this is not an isolated tragedy—and it is a preventable one. More can and must be done to understand the urgency of sepsis, the leading cause of preventable death worldwide, including in children. More than7 million die annually from sepsis—averaging one death every 3.5 seconds.
Sepsis occurs when the body’s response to infection is dysregulated, leading to injury of the body’s organs and tissues. A more severe form of sepsis, called septic shock, results when the body cannot maintain adequate blood pressure to support needed blood flow to vital organs, increasing the risk of death from sepsis.
Disparities exist between resource-abundant countries, including the U.S., where mortality ranges from 2 percent to 10 percent and resource-limited countries, where mortality can approach 50 percent. Recent estimates of pediatric deaths from sepsis range from 21 percent in North America to 40 percent in Africa. Vaccinations and access to clean water are important tools for the prevention of sepsis, which are often not available to immigrant children, particularly during transit.
When children, who have no control over being born into resource-limited settings and who do not make independent choices to migrate, enter this country, where resources exist to recognize and promptly respond to their most basic health needs, it is our moral obligation to address these needs without delay.
While guidelines for management of sepsis have evolved with new knowledge from emerging research, key aspects of sepsis management have remained. Time matters. Early recognition of sepsis is critical to initiating well-supported interventions to decrease mortality.
The Centers for Disease Control’s campaign to “Get Ahead of Sepsis,” highlights the importance of knowing the risks and spotting the signs of sepsis, because delayed recognition of sepsis leads to increased risk of death. Time matters.
Once recognized, aggressive and timely resuscitation reduces the risk of death. After an individual presents for medical treatment, initial management requires rapid administration of fluids to restore the body’s ability to circulate blood to its organs and tissues, administration of antibiotics to fight bacterial infection, and continuous reassessment to monitor the individual’s response to treatment, so that treatment can be adjusted to improve chances of survival. For every hour delay in beginning treatment for sepsis, the risk of death from sepsis can increase by up to 50 percent.
Given the time-sensitive nature of recognition and management of sepsis, it seems clear that health care providers alone will be limited in their ability to reduce deaths caused by sepsis. While emergency room and intensive care unit doctors work to reverse the effects of sepsis in the patients they see, early recognition depends on public awareness of sepsis and the ability to identify when an individual needs rapid medical attention to begin aggressive treatment.
Studies have shown that despite the importance of sepsis as a cause of death worldwide, the public has limited knowledge about sepsis. For the non–health care provider, recognizing signs of sepsis in babies and children can be lifesaving.
Sepsis signs can include confusion; shivering or fever; shortness of breath; and mottled, clammy or sweaty skin. For both babies and children, these signs can vary, and organizations have created specific guidance for recognition in different age groups to aid in sepsis identification.
Certainly, even with prompt recognition and treatment, death from sepsis can and does occur even in resource-abundant countries. But, those traveling from resource-limited countries—such as Guatemala, where Jakelin was from—often face conditions within their own countries where access to clean water, ideal nutrition to support healthy immune system development, and vaccination are not available.
During migration, health status may be affected by poor hygiene and deprivation of food and water. Children, who do not make choices to subject themselves to the conditions of migration, are especially vulnerable to illness under these circumstances, and require prompt attention to their health care needs and access to adequate health care as soon as they arrive in a location with the resources to provide them. Living in detention centers, which are quickly reaching overcapacity, further threatens the physical health of children.
Promises to “do more” must be backed by concrete action.
For migrant children, important first steps include immediately ensuring screening and medical attention by individuals trained in pediatrics and knowledgeable about conditions, such as sepsis, for which they are at higher risk in the settings of limited access to health care, unsanitary conditions and poor nutrition and hydration during migration.
Additionally, continued attempts to release children from detention centers into less restrictive environments, where access to health care may be more readily available, is necessary. Lastly, rejecting policies that dissuade immigrant parents from seeking health care for their children is critical.
Pivotal moments in history are marked by defining events that change the course of a crisis. While the full circumstances surrounding the death of Jakelin Amei Rosmery Caal Maquin will not be known until investigations are complete, we know that for her, time mattered.
We cannot know whether earlier intervention would have definitively changed her outcome. But eight hours reportedly passed between the child being taken into custody and recognition of her deterioration. These are lost hours in reducing her chances of dying from sepsis.
Honoring her life, which ultimately ended far too soon, amid circumstances beyond her control, requires action now.