 What I like from this meeting is that there is this particular talking of love, talking of the need to tell the truth, involvement of patients and families, and last but not least, the deep understanding that without not getting policymakers and stakeholders on board we won't be able to make a difference. And Dr. Detros rightly called it a tragedy that most of the annually 11 million of deaths are preventable. And this complies fully with the message of the Patient Safety Moon Foundation and doing zero harm and that's why I'm glad to speak here. It's poorly understood, understood what sepsis really is and what it makes the difference between a so-called uncomplicated infections. Everybody knows what HIV is, everybody knows what cancer is, but the fact that sepsis develops when the host response, the defense mechanisms of our body, is no longer able to contain an infection locally when it spreads to the blood stream, then there's an explosion of the immune system which kills the own tissues and organs. And it was again, you have heard already about Sir William Osler, there who already at this time, and this was in 1900, understood that most likely it's not sepaticen itself, but the host's response to the injury. At this time this did not make much difference. On the other hand now there are therapies and I will shortly allude to them to interfere with the immune system. And what harms is that infectious and inflammation processes go on, especially on the level of semi-gross circulation which caused this organ damage. And what is also not is not known, although it was already in the report by the WHO in 2017 when the WHO sepsis resolution was adopted, that it's not only bacteria, it's antibody gene including viruses who may cause sepsis. And this means that most of the deaths from COVID-19 are deaths from sepsis, viral sepsis due to multiple organ failure and septic shock. And just some recent data which have fostered the FDA for emergency use authorization, which is an antibody against the innate immune system. And this could be demonstrated in 360 patients only in a worldwide study that the mortality could be reduced, 60-day mortality is by 27%, and in the predefined population for European patients which has to do, and this is all ICU treated patients, their reduction was even higher. So there is care but this needs the understanding what the difference is between an infection and you need to know the science both physicians and also patients because if you do it too early you may harm. What Sir William Osler also said in 1889 is that humanity has three great enemies favor war and famine and by far the most terrible is fever. And this was long ago but if you need look at the number the actual numbers from sepsis, COVID-19, HIV, hunger, war and cancer and AMR you understand that this message is still true today and it's hard to understand what and and this is this is a number of costs which you can find on the website of the Department of Health from a recent publication from Tim Buckman who sets out some numbers of people who develop sepsis in the US and and the number of deaths and that it's around 60 million billion US dollars is spent for health care costs and yet also most Americans are not aware on on sepsis and also the fact that the WHO sepsis resolution which urges member states to integrate prevention diagnosis and treatment of sepsis in the national health systems both and address it both in the community and health care settings is poorly followed and the measures the simple low-cost measures are infection prevention by vaccination clean care and the second message is early recognition and treatment of sepsis like stroke like heart attack and of course we need to take care that also there's an F access to the health care system and also in terms of the existence of intensive care facilities the importance of the health care systems of the quality of the health care system can be depicted from this from this publication from in the charmer where you see that simply by introduction of measures we discussed about mandatory measures for all hospital critical care incidents sales here central critical incidents reporting and the rapid response teams were minded made mandatory around his times and simply without using the word sepsis this resulted in this decrease of the hospital mortality in sepsis and in many countries and except for most anglo-american countries still the alarm in the hospital goes at time of cardiac arrest whereas it has demonstrated again and again the earlier you intervene and your earlier you send then a hospital-wide service to all disciplines if there is a patient who is deteriorating so this can save obviously numerous lives and things like what is the case in in the UK said every health care worker and fish isen fish isen needs to be trained in simple things to recognize deteriorating patients otherwise they may not work especially in these settings and then this simple measure also would save millions of lives so liam denaldson liam denaldson who is present pointed out on the occasion of the adoptive adoption of the sepsis resolution double of wjo said some very important clinical issues affecting life and death has been in the backwaters and what he also said the public and the political space is a space to be to change things and this is a key message of my talk and that quality improvement efforts work has been demonstrated for example by the implementation of the so-called rory staunton regulation in the new york states where all 179 hospitals in state new york were mandated to document to which degree they comply with the so-called sepsis bundles which means antimicrobial in the first hour which means fluid therapy which means also taking blood cuts etc etc and this over several years resulted in a decrease of hospital mortality from 32 percent to 22 percent and there's an hourly decrease in the delay and survival rate by by any delay of antimicrobial and also the great work that has been supported also by Jeremy Hunt after a dramatic and use not necessary deaths of a two-year-old girl which was taken up in the media he apologized publicly he and he understood and aired it that the time of sepsis has come and jointly with the UK sepsis trust they did this campaign to empower patients to educate them to ask the physicians what has been done but which is often turned down still unfortunately also in the US and that every family who gets a child in UK gets a booklet in which there is a 227 phone number and also there's education on the early signs of sepsis in babies and elderly children so this is the way to go and also this resulted in UK that between 2016 and 2018 the number of patients who got the antimicrobial within the first hour increased from around 30 percent to 70 80 and 90 percent so due to an improved screening rate so this is the way to go and there's also data and this is also published in the British Medical journals even in in the outpatient setting that urinary tract infections which are severe are treated and with antibiotics immediately or whether they are treated deferred this results in degrees in mortality so if we we talk a lot of about antimicrobial resistance and we must not forget that to understand and to educate people that those who need them need to get them in the first hour and I will say another thing also on the cost effectiveness of quality improvement you have seen this data from Australia just there's public is one publication who initiated a quality improvement campaign under the label of thinking sepsis acting fast in 10 hospitals in Victoria and they were able to reduce the mortality rate from 15 to 8.5 percent and this went along with the savings of 11 million to point million Australian dollars and the investment in this campaign was 1.8 million dollars so this return of his investment was six fold so it was been rightly said this morning but show that quality improvement providing harm in health care saves money millions billions of money in every country and this is another notion I skip this we need also and this is data from Sweden who have a system which can tell you how long it took when patients addressed for the first first time at GB in the health care system and how long it took until these patients arrived in the hospital and this clearly data show that in case that this was longer than 12 hours the risk to die or the odds to die was four times higher so this means how important education also of the public is on the early signs of sepsis and also the former minister of prime minister now former minister of health and now prime minister in Ireland after the unnecessary death of a frequent women also initiated a national campaign which resulted also in a significant decrease of mortality we are very glad that the former EU commissioner also took this up on the level of the European Union and encourage to really roll out these needs to act in the member states several years ago when we founded the European sepsis alliance I was very happy that our lobbying also and and I liked not only active at Rokessie but also activism to convince Carl Lauterbach the current minister of health and he brought it brought the need to educate and to speak about sepsis in the context also of AMR and to look for the synergies and they also G7 were dedicated to care and to support the implementation of the WHO sepsis resolution on a global level this is the way to go also you can make a difference on the hospital level and this depends on individuals this is right right as the CEO of novel health where we founded in 2010 the global sepsis alliance and they decrease their hospital mortality from around 40% of whether 5% at below 20% and this is an example from a German hospital and again things happened only after patients and family members stood up this lady handed over a puppet to Jeremy Hunt and in this puppet she was the ashes of her child so and Jeremy Hunt declared this publicly and I think this is so strong where you see how and so important that also high-ranked policy makers speak about speak about sepsis so this is basically what I wanted to let you know and to encourage you to join this vision because from my perspective given the high numbers of sepsis that we have worldwide which are higher than from cancer the potential to reduce harm is enormous thank you very much for your attention