Could Covid-19 become a game-changer at last?

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

The Covid-19 pandemic brings a lot of debate, suffering and mourning. Almost everybody has a point of view. This offers opportunities. Maybe the pandemic could be seen as a ‘wake-up call’ for the way we live and behave. But at least, we could try to learn from it. Elsewhere and some time ago I have argued, that we could learn a lot, but I also raised the question: are we willing to learn (1)?
First of all there are the statistics, which raise a lot of questions. How do we die? How do we mourn? But other important questions behind the statistics are: Are we willing to care for each other? Are we willing and able to care for the most vulnerable ones?
If the answers would be ‘yes’, other questions have to be answered too. How is it possible, that there is a shortage of protective equipment even when the second wave arrived? Why is there (again) a shortage of beds, which postpone regular care and therefore will make more victims? Why do some political leaders prefer to ignore the facts or even deny the existence of a pandemic? Why is it so difficult to follow the simplest rules: social distancing, washing hands regularly, and using masks? At least the first two, should be normal healthy behavior.
Healthy behavior would improve the health of the population and improve health outcomes in seriously ill populations (2). Indeed, co-morbidity is a complicating factor in treating and caring for patients. Co-morbidity is often related to life style and social-economic conditions. And co-morbidity also means not only poor outcomes, but also higher health care costs (3). Also in palliative care medical illness interacts with behavioral health issues, which requires additional social services, which are not part of regular, clinical care (4). This is the well-known plea for ‘integrated care’.
The lesson related to the pandemic is that in all care settings medical, psychological and social components should be not only considered, but should be practiced and financed. But the practice is, that we soon have to consider (again) ‘end-of-life planning’, i.e. who is going to die first? Is that what we have learned of the first wave!
The plea for integrated care is often held in palliative care publications and by palliative care professionals. Are we willing to learn? Could Covid-19 be the game-changer at last?


  1. Heuvel WJA van den. Will lessons be learned from the corona pandemic for health care policy after 23 weeks? Paliatia 2020; 13(3):5-10.
  2. Vossel H. Providers Seek to Integrate Behavioral Health with Palliative Care. [Available from:] Accessed 1.10.2020.
  3. Cheung S, Spaeth-Rublee B, Shalev D, Docherty M, Levenson J, Pincus HA, et al. Model to Improve Behavioural Health Integration into Serious Illness Care. Available from:
  4. Cheung S, Pincus HA, Spaethe-Rublee B. The case for better behavioral health integration in serious illness care settings. Center to Advance Palliative Care. Clinical care: 2020.

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