A COVID-19 palliative care pandemic plan: An essential tool

March 31, 2020

OTTAWA - Palliative care physicians have created a coronavirus disease 2019 (COVID-19) palliative care plan as an essential tool to provide care and help manage scare resources during the pandemic. The plan, which focuses on 8 critical elements -- "stuff," "staff," "space," "systems," "sedation," "separation," "communication" and "equity" -- is published in CMAJ (Canadian Medical Association Journal). https://www.cmaj.ca/content/cmaj/early/2020/03/31/cmaj.200465.full.pdf

Palliative care is a human right for patients. "The current COVID-19 pandemic will likely strain our palliative services beyond capacity," says Dr. James Downar, the head of the Division of Palliative Care at the University of Ottawa and a palliative care physician at The Ottawa Hospital and Bruyère Continuing Care. "We advise acting now to stockpile medications and supplies used in palliative care, train staff to meet palliative care needs, optimize our space, refine our systems, alleviate the effects of separation, have critical conversations, and focus on marginalized populations to ensure that all patients who require palliative care receive it."

"Many people already have advance care plans that stipulate that comfort measures are to be used if they become seriously ill," writes Dr. Downar with coauthors. "Other patients who are intubated and receiving mechanical ventilation but are not improving clinically will be extubated. A third group of patients may be denied ventilation because of resource scarcity."

The plan is an expansion of a framework developed by the US Task Force on Mass Casualty Critical Care for events with large numbers of injuries and casualties, with the addition of the last four elements, sedation, separation, communication and equity. "Any triage system that does not integrate palliative care principles is unethical. Patients who are not expected to survive should not be abandoned but must receive palliative care as a human right," the authors conclude.
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