The key role of palliative care in response to the COVID-19 tsunami of suffering
Lukas Radbruch
Felicia Marie Knaul
Liliana de Lima
Cornelis de Joncheere
Afsan Bhadelia
Published:April 22, 2020DOI:https://doi.org/10.1016/S0140-6736(20)30964-8
Coronavirus disease 2019 (COVID-19) has brought a tsunami of suffering that is devastating even well resourced countries. The disease has wreaked havoc on health systems and generated immense losses for families, communities, and economies, in addition to the growing death toll. Patients, caregivers, health-care providers, and health systems can benefit from the extensive knowledge of the palliative care community and by taking heed of long-standing admonitions to improve access to essential medicines, particularly opioids for the relief of breathlessness and pain.1, 2, 3
For low-income and middle-income countries (LMICs), the COVID-19 pandemic is likely to be even more severe than in high-income countries. There will probably be a high burden of COVID-19 in settings where there are weak health-care systems, lack of access to clean water and disinfectants, poor outbreak preparedness, severe shortages in personal protective equipment (PPE) and medical technology, challenges in enforcing physical distancing regulations, and reliance on informal employment. In such settings, it is expected that patients with severe COVID-19 who are unable to access the limited supply of intensive care resources or hospital beds will suffer and die at home, where they would be cared for by family members without PPE and access to relevant information, training, or palliative care resources. These caregivers will probably become infected and spread the disease. Additionally, if resources are reallocated to respond to COVID-19, patients with other life-limiting conditions could find themselves pushed out of their health-care settings with reduced access to opioid medication.
