Do you have questions? Do you want to join us for a weekly webinar? Join us for our Global Palliative Care and Covid-19 series being run in conjunction with the IAHPC, WHPCA and PALCHASE.
Details on the topic for discussion each week and the link to join the webinar can be found on the home page of our website.
What is COVID-19?
COVID-19 is a disease caused by a new strain of coronavirus. ‘CO’ stands for corona, ‘VI’ for virus, and ‘D’ for disease. Formerly, this disease was referred to as ‘2019 novel coronavirus’ or ‘2019-nCoV’.
The COVID-19 virus is a new virus linked to the same family of viruses as Severe Acute Respiratory Syndrome (SARS) and some types of common cold.
How is COVID-19 spread?
It mainly spreads from person-to-person between people who are in close contact with one another and through respiratory droplets produced when coughing or sneezing. If these droplets get in the mouths or noses of nearby people or if they are inhaled then this can cause the disease to spread. It is important that you do not touch your face/mouth as it is also possible to get COVID-19 by touching a surface or object that has the virus on it. It is thought that the virus can spread prior to individuals showing symptoms, although it is most contagious when they are sick.
What are the symptoms of COVID-19?
Symptoms can include fever, cough and shortness of breath. In more severe cases, infection can cause pneumonia or breathing difficulties. More rarely, the disease can be fatal. These symptoms are similar to the flu (influenza) or the common cold, which are a lot more common than COVID-19. This is why testing is required to confirm if someone has COVID-19.
Who is most at risk?
Older people, and people with chronic medical conditions, such as diabetes and heart disease, appear to be more at risk of developing severe symptoms. As this is a new virus, we are still learning about how it affects children. We know it is possible for people of any age to be infected with the virus, but so far there are relatively few cases of COVID-19 reported among children. The virus can be fatal in rare cases, so far mainly among older people with pre-existing medical conditions, however we are aware that children receiving palliative care and with chronic life-limiting conditions are extremely vulnerable. This is a new virus and we need to learn more about how it affects children.
What is the treatment for COVID-19?
There is no currently available vaccine for COVID-19. However, many of the symptoms can be treated and getting early care from a healthcare provider can make the disease less dangerous. There are several clinical trials that are being conducted to evaluate potential therapeutics for COVID-19.
How to avoid catching or spreading coronavirus
- Wash your hands with soap and water often – do this for at least 20 seconds
- Always wash your hands when you get home or into work
- Use hand sanitiser gel if soap and water are not available
- Cover your mouth and nose with a tissue or your sleeve (not your hands) when you cough or sneeze
- Put used tissues in the bin immediately and wash your hands afterwards
- Try to avoid close contact with people who are unwell
- Try not to touch your eyes, nose or mouth if your hands are not clean.
Advise re Personal Protective Equipment (PPE).
- Advice on the use of masks
- Questions and answers for health care workers on PPE
- Home care for patients with Covid-19
- Rational use of PPE
COVID-19 and Children with Comorbidities
The evidence for COVID-19 and children is minimal but is growing. Information can be found here which is updated regularly and includes links to all of the main papers on COVID-19 and children. The Royal College of Paediatrics and Child Health (RCPCH) in the UK are also summarising the evidence for COVID-19 in children which can be found here. A paper was published in JAMA Pediatrics looking at the characteristics of children with COVID-19 admitted to US/Canadian Pediatric Intensive Care Units.
The following paper has been published which showed that severe outcomes from COVID-19 are rare among children, but risk is higher for children who are under 1 month old, male or have pre-existing conditions – COVID-19 in Children and Adolescents in Europe: A Multinational, Multicentre Cohort Study
More recently a paper has been published analysing Covid-19 in children in the UK. COVID-19 in children: analysis of the first pandemic peak in England
A useful guide for parents of children with disabilities has been developed by UNESCO, CDMRP and the Social Justice Department and can be downloaded here.
There has been some reports of some children experiencing a ‘toxic shock’ type syndrome. This is very rare but has been noted and the Paediatric Intensive Care Society in the UK have published a statement on this. The RCPCH have also released guidance on an approach to clinical management for this. Some papers published on this area include:
- Multi-System Inflammatory Syndrome in Children in Association with COVID-19
- Understanding SARS-CoV-2-Related Multisystem Inflammatory Syndrome in Children
- COVID-19 Disease in Children: Not as Mild as We Have Been Let to Believe
- Multisystem Inflammatory Syndrome in Children (MIS-C) Related to COVID-19: A New York City Experience
- Multisystem Inflammatory Syndrome in U.S. Children and Adolescents
- Intensive Care Admissions of Children with Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) in the UK: A Multicentre Observational Study.
- Septic shock presentation in adolescents with COVID-19
- Associated Multisystem Inflammatory Syndrome in Children
- Clinical Characteristics of Children and Young People Admitted to Hospital with Covid-19 in United Kingdom: Prospective Multicentre Observational Cohort Study.
- SARS-CoV-2 Antibody Responses in Children with MIS-C and Mild and Severe COVID-19
COVID-19 and Children’s Palliative Care
ICPCN have worked with colleagues around the world, and with the IAHPC, WHPCA and PALCHASE on Briefing Notes on all aspects of Palliative Care and COVID-19. Four Briefing Notes have been developed on children which include:
- Caring for children with underlying serious health conditions during the COVID-19 Pandemic
- Symptom control at the end of life in children with COVID-19 infection
- Psychological and spiritual impact of COVID-19 on children with palliative care needs
- The social impact of COVID-19 on children with palliative care needs and their families
The NHS in the UK have several helpful guides:
- The Association for Paediatric Palliative Medicine in conjunction with the NHS have published clinical guidelines for children and young people with palliative care needs in all care settings during the COVID-19 pandemic which are regularly updated and can be downloaded here.
- The Novel coronavirus (COVID-19) standard operating procedure: Children and young people with palliative and end-of-life care needs who are cared for in a community setting (home and hospice) during the COVID-19 pandemic and can be downloaded here.
- There are general guidelines for the management of paediatric patients during the coronavirus pandemic in the UK that can be downloaded here.
- There are general guidelines for the management of palliative care in hospital that can be downloaded here.
- Community Palliative, End of Life and Bereavement Care in the COVID-19 pandemic that can be downloaded here.
- How to deliver the news of a death by telephone which can be downloaded here.
COVID-19 and Palliative Care resources
The COVID-19 pandemic has highlighted in many places the great need for palliative care. There are papers and resources available and these can be found on the following websites:
- The globalpalliativecare website and also on the WHPCA website
- The African Palliative Care Association
- The Asia Pacific Hospice Palliative Care Network
- The European Association for Palliative Care
- The Asociacion Latinoamericana de Cuidados Paliativos
- The National Hospice and Palliative Care Organization
Some of the following papers may also be helpful:
Prevalence and transmission in children
- COVID-10 in children: the link in the transmission chain.
- Horizontal transmission of severe acute respiratory syndrome coronavirus 2 to a premature infant: multiple organ injury and association with markers of inflammation
- Epidemiological Features and Viral Shedding in Children with SARS-CoV-2 Infection
- Maternal Transmission of SARS‐COV‐2 to the Neonate, and Possible Routes for Such Transmission: A Systematic Review and Critical Analysis
- Culture-Competent SARS-CoV-2 in Nasopharynx of Symptomatic Neonates, Children, and Adolescents
- The Role of Children in Transmission of SARS-CoV-2: A Rapid Review. Journal of Global Health
- Role of Children in Household Transmission of COVID-19
- Prevalence of SARS-CoV-2 Infection in Children Without Symptoms of Coronavirus Disease 2019
- Symptomatic and Asymptomatic Viral Shedding in Pediatric Patients Infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): Under the Surface
- SARS-CoV-2 Infections Among Children in the Biospecimens from Respiratory Virus-Exposed Kids (BRAVE Kids) Study
- Transmission Dynamics of COVID-19 Outbreaks Associated with Child Care Facilities — Salt Lake City, Utah, April–July 2020.
- Impact of Social Distancing and Travel Restrictions on Non-COVID-19 Respiratory Hospital Admissions in Young Children in Rural Alaska
- Pediatric SARS-CoV-2: Clinical Presentation, Infectivity, and Immune Responses.
Papers on Palliative Care and COVID-19:
- Alleviating suffering and upholding dignity in the midst of COVID-19 response: A place for palliative care
- The key role of palliative care in response to the COVID-19 tsunami of suffering
- Pursuing a good death in the time of COVID-19
- Applying palliative care principles to communicate with children about COVID-19
Papers on symptoms in children
- COVID-19 infection in children
- Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review
- Presenting Symptoms of COVID-19 in Children: A Meta-Analysis of Published Studies
- COVID-19 and Children: Adding Another Piece to the Puzzle
- Ocular Manifestations and Clinical Characteristics of Children With Laboratory-Confirmed COVID-19 in Wuhan, China.
- Clinical Characteristics and Viral RNA Detection in Children with Coronavirus Disease 2019 in the Republic of Korea
- Comparison of Clinical Features of COVID-19 vs Seasonal Influenza A and B in US Children
General Papers on Children and COVID-19:
- The implications of COVID-19 for the care of children living in residential institutions
- Mitigating the impacts of the COVID-19 pandemic response on at-risk children
- Atypical presentation of COVID-19 in young infants
- A contingency plan for the management of the 2019 novel coronavirus in neonatal intensive care units.
- A guide to preventing and addressing social stigma
- Ethnicity and COVID-19 in children with comorbidities
- A wake-up call: COVID-19 and its impact on children’s health and wellbeing
- Avoiding indirect effects of COVID-19 on maternal and child health
- Children are being sidelined by COVID -19
- Protecting the Health of Vulnerable Children and Adolescents During COVID-19–Related K-12 School Closures in the US
- The effects of social deprivation on adolescent development and mental health
- Spectrum of COVID-19 in Children
- Addressing Health Inequities Exacerbated by COVID-19 Among Youth With HIV: Expanding Our Toolkit
- The Impact of COVID-19 Infection on Labor and Delivery, Newborn Nursery, and Neonatal Intensive Care Unit: Prospective Observational Data from a Single Hospital System
- Why Children Avoid the Worst Coronavirus Complications Might Lie in Their Arteries
- School Nurses on the Front Lines of Healthcare: The Approach to Maintaining Student Health and Wellness During COVID-19 School Closures
- Children and Adolescents in the CoVid-19 Pandemic: Schools and Daycare Centers Are to Be Opened Again without Restrictions. The Protection of Teachers, Educators, Carers and Parents and the General Hygiene Rules Do Not Conflict with This
- The Rise of Adverse Childhood Experiences during the COVID-19 Pandemic
- The Epidemiology of SARS-CoV-2 in a Pediatric Healthcare Network in the United States
- Public Health Education for Parents during the outbreak of COVID-19: A Rapid Review
- Paediatric COVID-19 Admissions in a Region with Open Schools during the Two First Months of the Pandemic
- Culture- Competent SARS-CoV-2 in Nasopharynx of Symptomatic Neonates, Children and Adolescents
- Neurologic and Radiographic Findings Associated with COVID-19 Infection in Children
- Risk Factors Associated with COVID-19 Infection: A Retrospective Cohort Study Based on Contacts Tracing.
- Covid-19: Delays in Attending Emergency Departments May Have Contributed to Deaths of Nine Children
- Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children
- Covid-19: Delays in Attending Emergency Departments May Have Contributed to Deaths of Nine Children
- Adolescents’ Health Literacy Health Protective Measures and Health-Related Quality of Life during the Covid-19 Pandemic
- Mental Health Implications of COVID-19 on Children with Disabilities
- COVID-19 Crisis Impacts on Parent and Child Psychological Well-Being
- Hospitalization Rates and Characteristics of Children Aged <18 Years Hospitalized with Laboratory-Confirmed COVID-19
- Clarifying the Sweeping Consequences of COVID-19 in Pregnant Women, Newborns, and Children With Existing Cohorts
- Clinical Features of Neonates Born to Mothers with Coronavirus Disease-2019: A Systematic Review of 105 Neonates.
- SARS-CoV-2–Associated Deaths Among Persons Aged <21 Years — United States, February 12–July 31, 2020
- Adolescent Health in the Days of COVID-19: Scoping Review
- Including Children with Developmental Disabilities in the Equation During This COVID-19 Pandemic
Many of the journals, including the Lancet, have dedicated COVID-19 resources pages.
Other resources offering practical tips include:
- COVID-19: Working with and for Young People. Available hereand summary guidance here
- Practical Tips on Engaging Adolescents and Youth in the COVID19 Response can be found here
- COVID19 and Youth Mental Health – Available here
- Toolkit to Spread Awareness and Take Action on COVID-19 – Available here
- COVID-19: GBV Risks to Adolescent Girls and Interventions to Protect and Empower Them – Available here
- Five Actions for Gender Equality in the COVID-19 Response: UNICEF Technical Note – Available here
- COVID-19 and HIV: Questions and Answers for Adolescents Living with HIV in time of COVID-19 – Available here
ICPCN recommends that all those caring for children with palliative care needs read and adhere to WHO guidelines to control the spread of the virus and protect their children. Below we have provided links to guidelines which can be helpful.
- The WHO has a one stop shop for COVID-19 related issues
- The WHO has a webpage with updates on the disease and a short online course: Infection, Prevention and Control (IPC) for novel coronavirus (COVID-19)
- Comprehensive WHO guidance can be found here
- WHO infection control guidance can be found here and we encourage everyone to follow this guidance.
- WHO’s interactive map with updated data or confirmed cases and mortality rates, can be found here.
- The WHO’s guide on integrating palliative care and symptom relief into responses to humanitarian emergencies and crisis is a useful resource and can be found here.
- The WHO’s specific guidelines for healthcare workers can be found here
Different countries and governments are following different policies on dealing with COVID-19 and it is important that individual palliative care providers take note of what their own governments are saying. Some examples from around the world include the following:
- The USA Centres for Disease Control and Prevention Key facts on Coronavirus
- The European Commission risk assessment, prevention and Q&A
- Palliative Care Australia statement on Coronavirus
- Sphere and partners Covid-19 guidance
One of the challenges of COVID-19 is the impact that it is having and will continue to have, on the provision of health care, for example, the provision of home palliative care, respite care etc. As we hear of new developments we will try and keep this resource page up-to-date through signposting to the experts in the field.
Resources for Children
Several great resources have been developed for children about Covid-19 including storybooks, guides on how to talk to children about Covid etc. Some examples can be found here:
- Coronavirus: A book for Children by Elizabeth Jenner, Kate Wilson and Nia Roberts, illustrated by Axel Scheffler
- My Hero is You: How kids can fight COVID-19 by the Inter-Agency Standing Committee
- The story of the Oyster and the Butterfly: The Corona Virus and Me to help children deal with their feelings of worry, fear, and anxiety.
- Q is for Quarantine: The ABCs of Coronavirus – a colouring book
- A Coronavirus colouring book from St Judes Children’s Research Hospital
- My 2020 Covid-19 Time Capsule – a work book to help children document their experience during the Covid-19 pandemic.
- How to best protect yourself from the new coronavirus infection from UNICEF and the Red Cross
- There is also various guidance available to help talk to healthy children about coronavirus and this could be helpful when explaining to siblings etc. For example: from UNICEF, from Child Mind Institute, on YouTube.
Resources for self care
- Looking after ourselves is very important at this time, here is a useful link for a course on psychological well-being in healthcare workers in response to Covid-19.
The recordings of the IAHPC, ICPCN, PALCHASE, WHPCA – Global Palliative Care Series Webinars can be found below:
- Palliative Care and COVID-19 in LMICs
- The Impact of COVID-19 on Palliative Care and Health Systems
- Access to palliative care during the COVID-19 Pandemic: Access to internationally controlled essential medicines, ethical issues, and human rights
- Clinical and Prevention Aspects in COVID-19
- Palliative Care &COVID-19: Holistic Care of Children and Symptom Control
- Suffering alone and Grief and Bereavement
- Palliative Care for Older People in the Context of COVID-19
- How People with Pre-Existing Palliative Care Needs are Affected by the COVID-19 Pandemic
- Palliative Care in Covid-19 for Persons with Disabilities and in Humanitarian Crises
- Inter-Professional Spiritual Care and Self Care
- The Role of Telemedicine in Delivering Palliative Care during the Covid-19
- Valuing and Strengthening Palliative Nursing in the Time of COVID-19
- Advocating for Integration of Palliative Care into National COVID-19 Responses
More information and resources are available at globalpalliativecare.org