Covid-19 pandemic ‘worst medical emergency in 102 years’

The Covid-19 pandemic was “the worst medical emergency in 102 years” and we must acknowledge the “overwhelming darkness of it,” an expert in palliative care medicine has said.

Dr Paul Gregan, GP and consultant in palliative medicine at Our Lady's Hospice and Care Services in Blackrock, Dublin, addressed Forum 2021 – the Irish Hospice Foundation's conference on Dying Death and Bereavement on Tuesday, in which he spoke of the lessons learned from the pandemic.

Speaking on the first day of the two-day online conference, Dr Gregan described the past 18 months, which has claimed more than 5,000 lives in Ireland, as "very numbing" and said it was particularly difficult for palliative care patients who were already very vulnerable.

The loss of day hospice services, respite care and reduced specialist palliative care team in-person visits meant that families were under huge strain caring for dying relatives at home.

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While virtual consultations were introduced, their use was extremely challenging in palliative patients many of who are frail, elderly, living with dementia, deafness or reduced vision he said. Patients would also regularly need a family member to help with the technology which could be “hugely invasive of privacy” Dr Gregan added.

Dr Gregan said that end-of-life care was also disrupted by the loss of personal contact, relatives had limited visits and the need for PPE, masks and goggles throughout the pandemic made communication with elderly, frail, dying people “extraordinarily difficult.”

“It was really a horrendous time, particularly in the first year and many patients died alone especially in hospitals,” he said.

He said patients died alone in Covid wards monitored remotely from outside on the corridor with donated laptops and iPads, all of which was extremely difficult to watch for caregivers and families.

The management of people dying from other diseases at home, many of who were cut off from usual supports as a result of the pandemic was also hugely challenging for family members he added.

The Covid pandemic also affected people after death he said, as remains had to be body bagged, and mortuary and funeral restrictions were in place, all of which impacted on bereavement.

Therefore he said that Covid-19 “affected the journey of people through their illness and into dying.”

In relation to primary palliative care, Dr Gregan said GPs were uniquely placed to provide palliative care. He said GPs wanted to get involved however, they needed to be paid for this work and he was currently looking to develop a contract similar to the current chronic disease management programme, so that GPs would be adequately paid and resourced to deliver palliative care in the community.

Dr Mike Ryan, Executive Director of the WHO Health Emergencies Programme also spoke at the IHF Forum 2021 conference via a pre recorded video address. Dr Ryan paid tribute to the hospice movement and extended his personal gratitude to everyone working in palliative care worldwide for their tireless efforts before and during the pandemic, which he said, deserved "the highest recognition and respect."

“Covid-19 has confronted us all with an unprecedented global scale of death. Today 4.75 million people have died of COVID-19 around the world; behind this number are so many personal stories of grief and grandparents, parents, siblings, children, friends, colleagues and neighbours. It is impossible to capture the totality of loss and bereavement we are facing globally, “ he said.