Palliative care - general issues: Scenario: COVID-19 Management

General advice

• When managing a person who is in the palliative or terminal phase of their illness with COVID‑19 like symptoms, take into account:
  • That not all people with these symptoms will have COVID‑19.
  • The person's underlying health conditions, severity of the acute illness, and if they are taking multiple medicines.
  • That older people with comorbidities, such as chronic obstructive pulmonary disease (COPD), asthma, hypertension, cardiovascular disease and diabetes have a higher risk of deteriorating and may need additional monitoring or more intensive management, including hospital admission, if this is appropriate to their phase of illness.
  • That patients with severe symptoms of COVID‑19 may deteriorate rapidly and need further assessment if this is appropriate to their phase of illness.

Symptom control

There are separate CKS topics on Palliative care - cough, Palliative care - dyspnoea and Delirium please see these topics for more information.

• Fever
  • Be aware that, on average, the fever associated with COVID-19 is most common 5 days after exposure to the virus.
  • If you suspect that the person has COVID-19 advise them to drink fluids regularly to avoid dehydration (no more than 2 litres per day).
  • Do not use antipyretics with the sole aim of reducing body temperature.
  • Advise people to take paracetamol if they have fever and other symptoms that antipyretics would help treat. 
  • Tell them to continue only while the fever and the other symptoms are present. 
  • NICE suggests that until there is more evidence, paracetamol is preferred to nonsteroidal anti-inflammatory drugs (NSAIDs) for people with COVID‑19. 

Anticipatory prescribing

• When prescribing and supplying anticipatory medicines at the end of life:
  • Take into account potential waste, medicines shortages and lack of administration equipment by prescribing smaller quantities or by prescribing a different medicine, formulation or route of administration when appropriate.
  • If there are fewer health and care staff you may need to prescribe subcutaneous, rectal or long-acting formulations, and carers or family members may need to administer them.
  • Consider different routes for administering medicines if the patient is unable to take or tolerate oral medicines, such as sublingual or rectal routes, or subcutaneous injections.