LAUSR

Abstract The current Covid-19 pandemic has put significant strain on all aspects of healthcare delivery, including palliative care services. Given the high mortality from this disease, particularly in the more vulnerable members of society, it is important to examine how best to deliver a high standard of end of life care during this crisis. This case series collected data from two acute hospitals examining the management of patients diagnosed with Covid-19 who subsequently died (n=36) and compared this to national and local end of life audit data for all other deaths. Our results demonstrated a shorter dying phase (38.25 hours vs 74 hours) and higher rates of syringe driver use (72% vs 33% in local audits), although with similar average mediation doses. Of note was the significant heterogeneity in the phenotype of deterioration in the dying phase, two distinct patterns emerged, with one group demonstrating severe illness with a short interval between symptom onset and death and another group presenting with a more protracted deterioration. This brief report suggests a spectrum of mode of dying. Over all the cohort reflects previously described experiences, with increased frailty (median Clinical Frailty Scale score of 5) and extensive comorbidity burden. This brief report provides clinicians with a contemporaneous overview of our experience, knowledge and pattern recognition when caring for people with Covid-19 and highlights the value of proactive identification of patients and risk of deterioration and palliation.