Waiting for the next pandemic: what to learn from COVID-19 pandemic?

Prof. Wim J.A. van den Heuvel, Chairman of the Editorial Board of PALIAŢIA

The last Editorial of Paliatia ended with: “But we may now already repeat a lesson, which health care policy makers refuse to learn: palliative care should be an integrated part of health care services.”

The pandemic was a ‘complete surprise’: numbers of death much higher than expected and the social-emotional consequences of lockdown for human beings – including the restricted visits to (terminal) ill patients – were not considered.

– During the COVID-19 pandemic, nurses and doctors were confronted with death more often than used to, and due to the lock down rules, they were often the last person to spend time with a terminally ill patient. These experiences may have changed the way health care workers deal with death, although we do not know yet in what way.

– To support health care workers guidelines and protocols were discussed in many health care facilities, which had limited experience and expertise in palliative care. As a consequence, the lockdown rules dehumanized the care for dying patients. By many health care workers, the lockdown rules are experienced as against the nature and art of caring for terminal ill patients.

– A problem – warned for in various European countries in the beginning of the pandemic (the first wave) – was the shortage of protective equipment, materials and intensive care beds. In various European countries, palliative care institutions, nursing homes and homes for the aged were ‘forgotten’ – even when shortage was not an issue – which resulted in a ‘excess mortality’ in these institutions.

And now, when the first wave seems to have passed and while fearing for the second one, the discussion is about triage for intensive care (IC). Does palliative care play a role in triage decisions due to COVID-19? It should be looking at the patients who are at risk. Of course, to maximize saved lives, IC triage should give best possibilities to those patients who have the highest probability to benefit from intensive care. Palliative care specialists do not need to add a different set of triage criteria to the already existing ones; it is neither their competence nor their scope. But palliative care could contribute to better patient care in such a triage context. But are they involved?

The experiences and facts – as published in newspapers, tv-reportages and journals – around COVID-19 raise an old question, as indicated above: when will palliative care really become integrated in health care?

Why should it? Just look at the figures and reports and read Jennifer Moore Ballentine’s call: 

The Role of Palliative Care in a COVID-19 Pandemic https://csupalliativecare.org/palliative-care-and-covid-19/

Why should it? A decade ago, palliative care is formulated and accepted as an essential part of quality of care by the Council of Europe and by the World Health Organisation. The question should not be ‘Why?’, but ‘When?’. It is time to act before the next pandemic arrives