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Symptom burden and clinical profile of COVID-19 deaths: a rapid systematic review and evidence summary
  1. Paul Keeley1,2,
  2. Deans Buchanan3,
  3. Clare Carolan4,
  4. Lara Pivodic5,
  5. Simon Tavabie6 and
  6. Simon Noble7
  1. 1 Palliative Care Team, Glasgow Royal Infirmary, Glasgow, UK
  2. 2 MVLS, University of Glasgow, Glasgow, UK
  3. 3 Palliative Medicine & Supportive Care, NHS Tayside, Dundee, UK
  4. 4 University of the Highlands and Islands, Inverness, Highland, UK
  5. 5 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
  6. 6 Marie Curie Hospice Hampstead, London, UK
  7. 7 Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
  1. Correspondence to Dr Paul Keeley, Glasgow Royal Infirmary, -, Glasgow GE 0SF, UK; paul.keeley{at}


The spread of pandemic COVID-19 has created unprecedented need for information. The pandemic is the cause of significant mortality and with this the need for rapidly disseminated information for palliative care professionals regarding the prevalence of symptoms, their intensity, their resistance or susceptibility to symptom control and the mode of death for patients.

Methods We undertook a systematic review of published evidence for symptoms in patients with COVID-19 (with a specific emphasis on symptoms at end of life) and on modes of death. Inclusion: prospective or retrospective studies detailing symptom presence and/or cause or mode of death from COVID-19.

Results 12 papers met the inclusion criteria and gave details of symptom burden: four of these specifically in the dying and two detailed the cause or mode of death. Cough, breathlessness, fatigue and myalgia are significant symptoms in people hospitalised with COVID-19. Dyspnoea is the most significant symptom in the dying. The mode of death was described in two papers and is predominantly through respiratory or heart failure.

Conclusions There remains a dearth of information regarding symptom burden and mode of death to inform decisions regarding end-of-life care in patients dying with COVID-19. Rapid data gathering on the mode of death and the profile of symptoms in the dying and their prevalence and severity in areas where COVID-19 is prevalent will provide important intelligence for clinicians. This should be done urgently, within ethical norms and the practicalities of a public health, clinical and logistical emergency.

  • hospital care
  • symptoms and symptom management
  • terminal care

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  • Correction notice The paper has been corrected since it was published online. The fourth author's affiliation has been updated.

  • Contributors PK conceived the study; PK and SN undertook the relevant searches and data extraction; DB, CC, LP and ST had input to the drafting of the text relating to the review.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.