Palliative Care During COVID-19: Data and Visits From Loved Ones

Abstract

Objectives: A vital component of the coronavirus response is care of the dying COVID-19 patient. We document the demographics, symptoms experienced, medications required, effectiveness observed, and challenges to high-quality holistic palliative care in 31 patients. This will aid colleagues in primary and secondary care settings anticipate common symptoms and formulate management plans. Methods: A retrospective survey was conducted of patients referred to the hospital palliative care service in a tertiary hospital, south east of England between March 21 and April 26, 2020. Patients included had a confirmed laboratory diagnosis of COVID-19 via reverse transcription polymerase chain reaction nasopharyngeal swab for SARS-Cov-2 or radiological evidence of COVID-19. Results: The thirty-one patients included were predominantly male (77%), elderly (median [interquartile range]: 84 [76-89]), and had multiple (4 [3-5]) comorbidities. Referral was made in the last 2 [1-3] days of life. Common symptoms were breathlessness (84%) and delirium (77%). Fifty-eight percent of patients received at least 1 “as required” dose of an opioid or midazolam in the 24 hours before death. Sixty percent of patients needed a continuous subcutaneous infusion and the median morphine dose was 10 mg S/C per 24 hours and midazolam 10 mg S/C per 24 hours. Nineteen percent of our cohort had a loved one or relative present when dying. Conclusion: We provide additional data to the internationally reported pool examining death arising from infection with SARS-CoV-19. The majority of patients had symptoms controlled with low doses of morphine and midazolam, and death was rapid. The impact of low visitation during dying needs exploring.

Dying in times of the coronavirus: An online survey among healthcare professionals about end-of-life care for patients dying with and without COVID-19 (the CO-LIVE study)

“…However, all but one of these studies also found that especially breathlessness and agitation were common in patients with COVID-19. 4 – 7 Comparable to our study, a study from Sweden suggested that breathlessness occurred more frequently in patients with COVID-19 than patients without COVID19. This study also found that establishing complete relief for breathlessness and agitation was more difficult in patients with COVID-19 than patients without COVID-19.…”

“…Other studies found varying prevalences of pain (20%–57%), breathlessness (48%–84%) and agitation (23%–77%) among patients with COVID-19 in the last phase of life. 4 – 7 , 17 These prevalences are difficult to compare to the prevalence found in this study, due to differences in methodologies, for example using patient records as data source or a focus on patients for whom a palliative care service was involved. However, all but one of these studies also found that especially breathlessness and agitation were common in patients with COVID-19.…”

“…17 In several other studies, however, it was concluded that the symptoms of COVID-19 patients could be treated well with similar drugs as used in other patients. [4][5][6][7][8]…”

“…Empirical studies about care at the end of life during the COVID-19 pandemic that have been published until now, predominantly focused on symptom burden and management in studies in patients attended by palliative care services in hospitals. [4][5][6][7][8] They show that dyspnoea, agitation and pain are prevalent and can generally be controlled relatively well. However, it is known that many people die in other settings, such as care homes, or without involvement of palliative care services.…”

Epidemiología y características de la infección por SARS-CoV-2

“…La crisis de la COVID-19 ha supuesto un gran impacto para la población general, tanto por la gravedad de la enfermedad y el riesgo de desenlace fatal como por el aislamiento social generado por las medidas de prevención estrictas que se han debido tomar para controlar la transmisión de la infección. En particular, las personas más vulnerables (especialmente personas añosas y/o con diversas comorbilidades) requieren una especial atención, ya sea por el riesgo de una peor evolución como por el posible impacto a nivel emocional y social 50,51 . Teniendo en cuenta la importancia de poder atender las necesidades de los pacientes y sus familias en una situación de crisis sociosanitaria, donde los recursos pueden verse limitados, algunos autores han elaborado propuestas con el fin de ofrecer una adecuada atención paliativa centrada en conseguir el bienestar del paciente y su entorno tanto en un ámbito hospitalario o sociosanitario como domiciliario mediante una atención telemática y/o presencial 37,[52][53][54] .…”