Palliative Care And The Covid-19 Pandemic 

-The Lancet

Palliative care services are under-resourced at the best of times. The 2017 Lancet Commission on Palliative Care and Pain Relief described the widespread lack of access to inexpensive and effective interventions as a travesty of justice. And these are not the best of times. As health systems become strained under COVID-19, providing safe and effective palliative care, including end-of-life care, becomes especially vital and especially difficult.

Some doctors, short of resources, might have to decide who can receive critical care and who cannot. For patients who won’t survive, high-quality palliative care needs to be provided at least. But COVID-19 makes this more difficult. Time is short when patients deteriorate quickly, health professionals are overworked, isolation is mandated, and families are advised not to touch or even be in the same room as loved ones. This scenario will be compounded most in low-income and middle-income countries where shortages of both critical care and palliative care services are greatest.

Continuing community-based palliative care is also harder to do safely. Many patients who need it are at heightened risk from COVID-19, protective equipment is running short, and surging deaths could overwhelm usual service provision.

WHO has issued guidance on how to maintain essential health services during the pandemic, highlighting immunisation, maternal care, emergency care, and chronic diseases among others, but there was no mention of palliative care. This was an oversight. Indeed, palliative care ought to be an explicit part of national and international response plans for COVID-19.

Practical steps can be taken: ensure access to drugs (such as opioids) and protective equipment, consider a greater use of telemedicine and video, discuss advance care plans, provide better training and preparation across the health workforce, and embrace the role of lay carers and the wider community.

A pandemic is a cause and powerful amplifier of suffering, through physical illness and death, through stresses and anxieties, and through financial and social instability. Alleviation of that suffering, in all its forms, needs to be a key part of the response