For COVID-19 patients, there are guidelines to help manage their symptoms as they approach death. However, little attention has been paid to the actual symptom patterns, level of adherence to drug usage recommendations, and participation in palliative care. For a study, researchers sought to determine the progression of COVID-19 symptoms, the medications taken to treat them, and the level of palliative care provided during the last week of life.

From January 1 to December 31, 2020, the retrospective analysis examined all COVID-19 inpatient fatalities at 5 metropolitan hospitals in Australia. Results were measured on the day of death and the days before, on days 1, 2, 5, and 7. These were the utilization of supportive pharmaceutical and non-pharmacological interventions and the severity of COVID-19 symptoms (measured by the Palliative Care Outcome Scale). Also gathered was the referral timepoint for palliative care.

Breathlessness, anxiety, discomfort, and respiratory secretions were the most prevalent symptoms among the 230 patients in the sample. About 79% (n=181) of people had at least one symptom on the day of death, and 30% (n=68) had severe or extremely severe symptoms. Midazolam, glycopyrrolate, and infusions were used later, less often, and at lower dosages than recommended by recommendations and previous research to treat symptoms. Referrals for palliative care were made insufficiently early, at a median of 3 days before death (IQR 1-6 days), and for only half of the COVID-19 fatalities (51%; n=118).

In the final 3 days of life, symptoms peaked. Given the increased chance of passing away in pain, earlier usage of infusional and breakthrough drugs should be considered in anticipation of symptoms. In addition, high-risk patients should be sent to palliative care earlier, which should be considered at hospital admission.