Patients with covid-19 at the end of life

Introduction Management of Covid-19 has been among the biggest challenges in our medical careers. Unfortunately, it has led to a rapid end of life for some. Our aim was to describe symptomatology and medication requirements at the End of Life for patients with COVID-19 and explore the value of education, with Specialist Palliative Medical availability around the clock for all medical staff. Case 1 A male patient with End Stage Kidney Disease (ESKD) and COVID-19 deteriorated rapidly on day 8 of his illness. The main symptoms were dyspnea and agitation. Case 2 A male patient with ESKD and COVID-19 had progressive dyspnea over the first 5 days of his illness and his symptoms later escalated rapidly over a period of hours. Case 3 A female patient with multiple co-morbidities who developed COVID-19 and initially appeared to be recovering well later deteriorated rapidly, over hours, on day 16 of her illness. Her main symptoms were dyspnea and agitation. Outcome Patients with Covid-19 experienced rapidly escalating dyspnoea and agitation in the End of Life phase, with respiratory secretions being less prominent in this cohort. Medication requirements to achieve symptom control varied considerably. Discussion Major obstacles encountered were the need for strict isolation with Personal Protective Equipment (PPE) for staff and family, and restricted visiting to reduce external exposure to Covid-19. Prior End of Life care education delivered to medical staff focusing on symptom management and medications, may have positively influenced early symptom assessment, proactive initiation of appropriate medications and methods of medication delivery. The availability of around the clock Specialist Palliative Medical advice may have helped other Medical staff cope with this new illness for patients in the dying phase.