- onset of symptoms to death 17·8 days and to hospital discharge 24·7 days
- fatality rate:
- 1·38% in those aged <60 years, 6·4% in those aged ≥60 years, up to 13·4% in > 80 years
- Estimate of proportion of infected individuals needing hospitalization increased with age, up to maximum 18·4% in > 80 years
- 80% mild disease
- 13.8% severe disease (tachypnoea ≥30 breaths per min, oxygen saturation ≤93% at rest)
- 6.1% critical disease (respiratory failure requiring mechanical ventilation, septic shock, organ dysfunction requiring ICU)
- highest risk for severe disease and death: > 60 years, underlying conditions eg hypertension, diabetes, cardiovascular disease, chronic respiratory disease, and cancer.
Reference: COVID-19 data from Verity et al. Lancet March 30, 2020 DOI: https://doi.org/10.1016/S1473-3099(20)30243-7
Symptoms: fever, cough, shortness of breath, muscle aches (confusion, headache, sore throat, diarrhea, chest pain <10%)
Preparing for the palliative needs of patients with COVID-19:
- Article pandemic planning for palliative care: https://doi.org/10.1016/j.jpainsymman.2009.11.241
- Ensure adequate medications to treat shortness of breath, sedation for extreme dyspnea, fever, diarrhea and constipation from opioids. Get medications on site beforehand.
- Have goals of care conversations early: – not when people critically ill. Especially with older adults & multiple comorbidities. Most likely to develop severe disease and die. Early talk prevents difficult decisions when critically ill.
Severe and critical disease can develop Acute Respiratory Distress Syndrome – severe shortness of breath – feels like drowning
Treating severe shortness of breath:
Morphine 2.5-5 mg sc/iv, repeat clinically indicated every 15-20 minutes s.c. or 5-10 minutes I.V. until patient gets adequate relief
Medications for distress from severe shortness of breath or severe delirium:
Midazolam 1-2 mg s.c./iv, repeat clinically indicated every 15-20 minutes s.c. or 5-10 minutes I.V. until calm +/- sedated
Lorazepam 0.5-1mg s.c./I.V., repeat as clinically indicated every 20-30 minutes until calm +/- sedated
Non-medications tips: Position – 45-60 degrees upright, arms away from chest and supported on pillows. Calm presence. Let in fresh air or electric fan providing direct gentle breeze across face.
Communication tip: “name” is very sick and is going to die from this virus. We need to make her/him comfortable with medications so that their last hours/minutes are comfortable and they can die in peace. This medication does not make them die, it makes them comfortable until they die from the virus