The COVID-19 pandemic has arrived, and we are all in uncharted waters. Whether we are clinicians, researchers, educators, administrators or advocates, we are all experiencing stress, disruptions and new demands at work and at home, and this new normal is changing by the day. Just a week ago, we deliberated over whether mass gatherings were safe. Now, we find ourselves gowned, gloved and masked on the front lines of the outbreak or scrambling to implement emergency measures to delay or manage a surge in critically ill patients. Many of us are under self-quarantine or self-isolation, and we should all be distancing ourselves from physical contact with others as much as possible. I’m keeping my distance and working remotely from home. For her daily visits to her mother living in a long-term care facility, my wife now stands outside in the dirt and waves from the window while talking to her on the phone. Testing is not yet universally available, and we face potential shortages in personal protective equipment (PPE) and medications. Many are ramping up telehealth capabilities as a lower risk alternative to in-person visits. We hope any surge won’t overwhelm our capacity to provide both critical care and palliative care, but many are planning for how to make tough decisions if that happens.
As we batten down the hatches to weather this storm, I think it’s important for us to remember our core mission, to improve the quality of life for people with serious illness and their families, whether suffering from severe COVID-19 or anything else. Palliative care and hospice are not non-essential services; in fact, they have never been more essential. Jennifer Ballantine, Executive Director of the California State University Shiley Institute for Palliative Care, makes a cogent case in her recent blog: “Those who are elderly, frail, and/or with underlying chronic or serious illness are most at risk from the novel coronavirus. These are palliative care’s core patient population. Utilizing the unique skills and strengths found in palliative care must be part of the response.”
To maintain or ramp up our palliative care services in these challenging times, we need access to not only the latest information from scientists and public health authorities but also emerging observations and best practices from our colleagues in the field. I have started following a new Twitter hashtag, #pallicovid, focused on the palliative response to the pandemic. I urge Academy members to engage with their colleagues on the AAHPM Connect Open Forum. We have created an AAHPM COVID-19 web page with links to essential resources and are exploring the development of pertinent just in time education.
The Journal of Pain & Symptom Management is welcoming manuscripts related to COVID-19 in a new fast track that will provide a rapid decision, ideally within one week of submission. Accepted manuscripts will be published online immediately, with open access.
COVID-19 fast track articles can describe any aspect of the involvement of palliative care in COVID-19 preparation and response, with an emphasis on lessons, insights, or recommendations that would be of immediate value to the field. This includes descriptive studies of patient characteristics or the impact of the pandemic on patients or staff, reports of palliative care interventions, or recommendations for practice. Manuscripts submitted to the JPSM COVID-19 fast track should be less than 1,500 words and 12 references and should include an unstructured abstract. COVID-19 fast track manuscripts can be submitted at the JPSM page for authors by selecting “COVID-19 fast track” as the article type in the coming days. If you have questions about the suitability of a manuscript for the fast track, please contact David Casarett, Editor-in-chief (David.email@example.com).
In their special article for JPSM (2010) titled Palliating a Pandemic: “All Patients Must Be Cared For”, James Downar and Dori Seccareccia outline four essentials in pandemic response: stuff, staff, space and systems. Working with our partners and coalitions, AAHPM is advocating for measures to ensure full access to the stuff we need for our staff to care safely for our patients wherever they reside. We joined the National Coalition for Hospice and Palliative Care in a letter to Senate leaders urging immediate passage of the 2nd coronavirus package, including key provisions to eliminate patient co-pays for testing, ramp up manufacturing and distribution of PPE, and provide for the wide deployment of telehealth.
With these measures, we hope we won’t have to make tough decisions about which sick patients receive access to limited critical or palliative care services. Should we face such a challenge, palliative care and hospice teams will be essential in supporting just and ethical decisions. Downar and Seccareccia have outlined a solid ethical framework for triaging limited resources in a pandemic, based on the following principles:
- protection of the public from harm
- duty to provide care
- equity, and
As we ramp up to meet this unprecedented challenge, all of us are feeling stress and working extra hard. Many of us are experiencing grief, fear or moral distress. This is a good time for us to double down on essential self-care practices and extend grace, kindness and compassion to all. AAHPM has a web page dedicated to resources to support clinician well-being and resilience. We are in a crisis, but we still need to take a moment to breathe. I know we can count on each other to do our best for our patients and carry each other through.
Chief Medical Officer