Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications

Abstract

Background: COVID-19 has directly and indirectly caused high mortality worldwide. Aim: To explore patterns of mortality during the COVID-19 pandemic and implications for palliative care, service planning and research. Design: Descriptive analysis and population-based modelling of routine data. Participants and setting: All deaths registered in England and Wales between 7 March and 15 May 2020. We described the following mortality categories by age, gender and place of death: (1) baseline deaths (deaths that would typically occur in a given period); (2) COVID-19 deaths and (3) additional deaths not directly attributed to COVID-19. We estimated the proportion of people who died from COVID-19 who might have been in their last year of life in the absence of the pandemic using simple modelling with explicit assumptions. Results: During the first 10 weeks of the pandemic, there were 101,614 baseline deaths, 41,105 COVID-19 deaths and 14,520 additional deaths. Deaths in care homes increased by 220%, while home and hospital deaths increased by 77% and 90%, respectively. Hospice deaths fell by 20%. Additional deaths were among older people (86% aged ⩾ 75 years), and most occurred in care homes (56%) and at home (43%). We estimate that 22% (13%–31%) of COVID-19 deaths occurred among people who might have been in their last year of life in the absence of the pandemic. Conclusion: The COVID-19 pandemic has led to a surge in palliative care needs. Health and social care systems must ensure availability of palliative care to support people with severe COVID-19, particularly in care homes.

The Challenges of Caring for People Dying From COVID-19: A Multinational, Observational Study (CovPall)

“…This continued even in the seven days before survey completion, especially in the UK. Many palliative care patients chose not to come to hospital, preferring care at home for fear of contracting COVID-19 and/or wishing to remain close to those important to them, a result supported by research in other pandemics ( 12 , 31 ), and data from the first wave of the COVID-19 pandemic ( 32 ). Taken together these findings are concerning.…”

How many people will need palliative care in Scotland by 2040? A mixed-method study of projected palliative care need and recommendations for service delivery

“…19 Excess deaths relating to, but not directly caused by COVID-19, have also occurred. 20 The long-term consequences of the virus are not yet known though recovery for some is often slow and may result in longer lasting morbidities. This spike in deaths may be followed by changes in age-specific mortality rates in following months and years.…”

The challenges of caring for people dying from COVID-19: a multinational, observational study of palliative and hospice services (CovPall)

“…Many palliative care patients chose not to come to hospital, preferring care at home for fear of contracting COVID-19 and/or wishing to remain close to those important to them, a result supported by research in other pandemics, 13,29 and data from the first wave of the COVID-19 pandemic. 30 Taken together these findings are concerning. If patients are to remain in the community, then the community and care homes, as well as hospitals, need sufficient resources to be able to provide care; this includes protective equipment, syringe drivers to deliver subcutaneous infusions to control symptoms and sufficient staff and medicines.…”