Managing the supportive care needs of those affected by COVID-19

Globally, the number of people affected by coronavirus disease 2019 (COVID-19) is rapidly increasing. In most (>80%), the illness is relatively mild and can be self-managed out of hospital. However, for about 20%, the illness causes respiratory compromise severe enough to require hospital admission [1]. Patients with severe and critical disease need full active treatment. This may include oxygen for hypoxaemia and ventilatory support, along with optimal management of complications, e.g. super-imposed bacterial infection, and any underlying comorbidities, e.g. COPD or congestive heart failure. To date, no antiviral agent has shown to be effective in treating the disease [2].

Patients with severe disease not considered suitable for escalation to intensive care, i.e. those who are frail or have multiple comorbidities, are at very high risk of dying, with an estimated death rate of 15–22% [3, 4]. We have a moral obligation to provide good symptom control to prevent avoidable suffering. Thus, comprehensive care of the patient with COVID-19 requires identification of patients at increased risk of dying, who would benefit from a parallel approach to management. This encompasses optimal symptom management for those with severe disease but who will survive, and expert symptom management and end of life care for those that are deteriorating and in their last days or hours of life. The aim of this editorial is to provide a succinct informative overview to guide respiratory healthcare professionals on the frontline.