The coronavirus disease (COVID-19) that originated in Wuhan, China, at the end of 2019 has spread rapidly across the globe, and poses serious consequences to peoples' lives here in the UK. COVID-19 causes acute respiratory distress (World Health Organization (WHO), 2020). There are a range of symptoms to look out for, although some people are asymptomatic: a new, persistent cough, fever, shortness of breath, diarrhoea and fatigue (WHO, 2020). Emergency symptoms include difficulty breathing, persistent painful cough, high fever, confusion, bluish face or lips and any difficulty waking. Since COVID-19 was declared a pandemic, the UK and other countries have seen a rise in the number of infections and, with that, a record number of deaths on a daily basis.
A report by the Intensive Care National Audit Research Centre (ICNARC) (2020) reported a 50% mortality (death) rate for 165 patients admitted to 285 intensive care units in England, Wales and Northern Ireland since February 2020. Although the majority of those who died were over 70 years, nine (11.4%) who also died were aged between 16 and 49 years, thereby discrediting the claim that COVID-19 only affects older adults. Of the 50% who survived, 28 patients were also reported to be in the same age range. Men were reported as being more susceptible to this disease, although no explanation was offered, apart from more men being admitted to intensive care than women at the point of the audit. It was claimed in the report that 70% of those admitted with COVID-19 were clinically obese, leading to the conclusion that overweight was a key risk factor (ICNARC, 2020). Since the report, more daily deaths have been reported, and as I write, another 207 people were reported to have died in the last 24 hours, after testing positive for the virus, making the total of deaths 1235 in the UK to date.
To stop the spread of the virus, the Government has called for various measures (e.g. social distancing from non-family members, staying at home and frequent hand washing).
These are unprecedented times, and the number of deaths so far has a wider impact and implications for care, support for grieving families and facilitating normal funeral rituals to achieve dignity. This is challenging for patients, families and health professionals in many ways:
Health professionals and families are dealing with ‘the white elephant’ not in the room, but in the world, and while caring and professionalism will continue, it is important to acknowledge the need to balance this with protecting themselves from the virus. Palliative care is at its best when empathy and emotional connection with patients are practised. However, the large numbers of patients dying simultaneously challenge these core principles while reducing the ability to re-energise and emotionally cleanse after each death. The Government must play its part to ensure that all health professionals in all settings have the correct personal protective equipment. When health professionals start dying (reportedly, a medical consultant died on Sunday, 29 March 2020, this being the first confirmed hospital frontline worker to die of COVID-19 in the UK), it raises anxieties about human vulnerability.
Social distancing might reverse some of the gains made towards eliminating loneliness (Nyatanga, 2017). These measures, while necessary, are changing the way people live. Social distancing seems to also lead to reduced eye contact. Finally, it is crucial during this lockdown, which could last for months, that we are conscious of potential violent abuse in homes, being conscious that, when families are confined to the same space, relationships may become strained, although other families may enjoy quality time together. Therefore, we need to reach out to at-risk groups to offer support. The message is clear if we are going to overcome this pandemic: stay at home, protect the NHS and save lives.