COVID-19 pandemic and limited palliative care response: "Lack of comfort care".

Dear Editor,

As the number of active cases of COVID-19 (coronavirus disease) is increasing in India, some or many patients who need critical care beds would be denied curative therapy based on a triage system. However, these patients who are denied life-sustaining therapy can still expect to receive palliative care [1]. Unfortunately, there is no minimal strategy for integrating COVID-19 care with palliative care in India. A large number of patients are deprived of comfort care due to a lack of palliative care strategy in the COVID-19 pandemic. If this pandemic continues in India in the next weeks or months, and if an increased number of elderly patients with multiple comorbidities and a decreased expectancy of survival are managed on ventilators, there may be no ventilators left for young patients with good survival expectancy. When physicians believe that aggressive treatment measures are likely to be futile and will not help in the well-being of patients, they should continue to deliver palliative care aiming not for the survival of patients but to provide physical, social, and mental comfort.

Palliative care services can fulfill their ethical obligation to provide quality of care (good symptom control) to all patients. It can be essential to provide maximum comfort care and help to manage scarce resources during the pandemic [2]. Palliative care should be provided to seriously ill patients if potential life-saving therapies denied so that the patients and their families would not feel abandoned by the health care system and remain comfortable. If palliative care principles are not followed, this pandemic would also exacerbate the stress of the health care workers caring for these seriously ill patients. They are seeing many patients dying with uncontrolled symptoms, which are leading to burnout and stress disorders [3].

Palliative care experts from Kerala developed guidelines for the integration of palliative care with COVID-19 care. They described the importance of palliative care in triage including decision-making, symptom control, management of distress, end-of-life care, and also addressed burnout in health care workers [4]. Canadian palliative care physicians made a COVID-19 palliative care plan by adding four important additional elements (sedation, separation, communication, and equity) to the existing four elements (stuff, staff, space, and sedation) of the framework developed by the US Task Force on Mass Casualty Critical Care for events with large numbers of injuries and casualties [5]. These guidelines should be followed in all hospitals managing COVID-19 patients in India too and authorities should make a specific plan to take further steps in this direction.

As India is trying to contain the spread of COVID-19, we must be ready for the possibility that measures to prevent the spread of the virus might fail. Integrating palliative care to COVID-19 care is a step forward to ensure the palliative care needs of the patients and their family members. Palliative care can prevent health care workers from the physical burden and mental health issues that might be aggravated when ethically difficult decisions are needed in the rationing of intensive care.

Disclosure of interest

The authors declare that they have no competing interest.