Palliative care is the answer

17/04/2020

These incidents happened in the past couple of weeks:

A patient, undergoing dialysis twice a week, wanted an opinion regarding the continuation of dialysis. Whether COVID-19 will affect him if he does? An elderly couple, dependent on help, who are living with their son who is working in essential service, were anxious. They said they did not know how to handle it if one of them, or their caregivers tested positive for a COVID-19 infection. What is the next step? Is there any institutional care to look after such patients? The answer is yes. There are hospices or palliative or rehab care centres.

Palliative care is a medical speciality dealing with medical treatment for chronic and advanced diseases and care for elderly people with multiple diseases. The need to create awareness is much more in this group as these patients are people who are suffering from chronic illnesses and advanced diseases and are also severely immunocompromised. In these times they need to avoid unnecessary visitors. We also need to provide them with appropriate infection control measures — personal protective equipment, handwash, sanitisers for the health workers and those taking care of such patients.

The key goal of palliative care is to reduce suffering of patients by early detection, intervention, complete protection, infection control and personal care. Preventing the spread of infection among patients who need palliative care is essential as their immunity is low and super added respiratory issues may increase the risk of the COVID-19 and the treatment may get complicated. We need to handle the community looking at the social, financial issues, and reduce their physical suffering by frequent monitoring of symptoms. We need to look for respiratory symptoms, encourage respiratory hygiene and cough etiquette.

The best method now is to avoid contact with high risk groups. Family members must desist from visiting them and also save themselves from possible exposure. Consultations, whenever necessary, can be through telemedicine. We need to avoid interventions or treatments that may not be urgently needed.

The risk groups include patients with illnesses such as cardiovascular disease, diabetes, respiratory conditions, cancer, patients who have a compromised immune system, smokers, senior citizens, the elderly with multiple chronic conditions.

Emergency situations depend on the treatment and disease phase, especially in cancer, dialysis, other rehabilitation specialisations. Treatment is required only when the concerned primary physician insists on it.