Why we need palliative care during Covid-19 pandemic 

As Uganda continues to register more cases of Covid-19 coupled with rising death tolls, the relief of suffering, supporting complex decision making, and managing clinical uncertainty are key attributes of palliative care and essential components of the response to epidemics and pandemics. 

Globally, the Covid-19 pandemic is escalating rapidly.  Those who test positive for the virus experience symptoms such as breathlessness, cough, myalgia, and fever. The mortality risk is especially high among those with existing illness and multimorbidity.

A pandemic can lead to a surge in demand for health care services, including palliative and end-of-life care.  These services must respond rapidly, adopting new ways of working as resources are suddenly stretched beyond their normal bounds.

 Worldwide palliative care is seen as an essential part of universal health coverage. This implies that for hospital teams, this involves putting in place protocols for symptom control and training no specialists in their use.
 
Hospice services may see a shift in need and should be prepared to focus their resources on community provision. 
Although the importance of palliative care in response to pandemics is indispensable, in Uganda, this is not extensively reflected in Covid-19 management plans for many hospitals.  There are still gaps particularly around the role of palliative care teams. 

There is also relatively little data on provision of palliative care in community settings, although the Ministry of Health has shifted its focus on management of Covid-19 patients from in patient care to community/home-based care due to overwhelming numbers of patients amid limited facilities.
 
Community palliative care can facilitate advance care planning and symptom control, and helps prevent hospital admissions among people near the end of life. However, the rapid escalation of breathlessness in patients with Covid-19 who develop acute respiratory distress syndrome may make this challenging. 

Severe breathlessness and respiratory disease are both known to be associated with increased hospital admissions at the end of life.  Therefore, rapid community response may be needed to manage advanced disease in Covid-19 if people are to remain at home.
 It should be observed that providing palliative care in pandemics can be compromised by the hostile environment, infection control mechanisms, and extreme pressure on services. 

In addition, the family unit of care may be disrupted. Even so, provision of palliative care is an ethical imperative for those unlikely to survive and may have the advantage of diverting dying people away from overburdened hospitals as well as providing the care that people want. 
Pandemics introduce complex ethical challenges concerning allocation of scarce resources, and palliative care teams are well placed to help patients and carers discuss preferences and make advance care plans.

It is important for government to  know that hospice and palliative care services can mitigate against this by maintaining the ability to respond rapidly and flexibly, ensuring protocols for symptom management and psychological support are available, among others.

By Denis Opio
The writer is a palliative Care Specialist.
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