Although majority of COVID-19 infections are mild, those with severe infection have a higher risk of requiring oxygen therapy and even intensive care admission. Siow et al. (2020) have provided a summary of solutions that may help low and middle-income countries (LMIC) [1].

Reported literature can vary in the death rate from COVID-19 infection (1-7%), and this figure may be different in resource limited settings or in countries where testing capacity does not reflect the true incidence of COVID-19 [2].

Nevertheless, how can the healthcare sector provide supportive care for COVID-19 patients? What is the role for palliation, and are clinicians confident with having end-of-life care discussions during this strange and unpredictable time?

Clinical guidance for severe COVID-19 and Palliative Measures:

Your local guidance and protocols may vary depending on the available resources and level o healthcare staffing support.
Bajwah et al. (2020) have provided a summary on clinical management options that can be considered for the COVID-19 patient [3].

View the full guidance here.

Home Vs Hospital Supportive Care:

The European Society for Medical Oncology (ESMO) have developed care pathways for palliation of patients with COVID-19 [4].
There is a Home-Care option and a Hospital-Inpatient pathway for clinicians to consider in their management.

This may be a useful resource which can be adapted where resources and hospital capacity are limiting factors. View the full documents here.

ESMO recommendations for use of their pathways:

1. Check whether the medications are available

2. Adjust the medication formulary to fit your national setting

   • Remove medication not available

   • Add other relevant agents that are available

3. Add the names and phone numbers of local clinicians with palliative care expertise

Tips for communicating difficult decisions:

VITALtalk have provided a guide on how we can have conduct difficult discussions around all stages of COVID-19 management - From assessment to end-of-life care.
For the latest update on this guide visit the VITALtalk website.

Final Note - Support your Team

Remember to not only check-in with your patients, but also your colleagues on a regular basis.

References:

1. Siow, W.T., Liew, M.F., Shrestha, B.R. et al. Managing COVID-19 in resource-limited settings: critical care considerations. Crit Care 24, 167 (2020). https://doi.org/10.1186/s13054-020-02890-x

2. Phua J et. al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendation. Lancet Respir Med. April 2020. [ePub ahead of print] Available from: https://www.thelancet.com/action/showPdf?pii=S2213-2600%2820%2930161-2

3. Bajwah S, Wilcock A, Towers R, et al. Managing the supportive care needs of those affected by COVID-19. Eur Respir J. 2020;55(4):2000815. Published 2020 Apr 23. doi:10.1183/13993003.00815-2020

4. European Society for Medical Oncology (ESMO), 2020, Website: Introduction to the ESMO COVID-19 Palliative Care Pathways, Accessed 5 June 2020, URL:https://www.esmo.org/covid-19-and-cancer/covid-19-full-coverage/covid-19-useful-resources/covid-19-palliative-care-pathways