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‘Flattening’ one curve: what about ‘raising the line’ on the other? COVID-19 and palliative care in low-income and middle-income countries
  1. Richard Antony Powell1,2,
  2. Luisa Rodriquez-Campos3,
  3. Edwina Beryl Opare-Lokko4,
  4. Bassey E Ebenso5 and
  5. Matthew John Allsop6
  1. 1 Department of Primary Care & Public Health, Imperial College London, London, UK
  2. 2 Department of Learning and Research, MWAPO Health Development Group, Nairobi, Kenya
  3. 3 Department of Anaesthesia, Pain and Palliative Medicine, Universidad de La Sabana, Chia, Colombia
  4. 4 Greater Accra Regional Hospital, Faculty of Family Medicine, Ghana College of Physicians and Surgeons, Accra, Ghana
  5. 5 Nuffield Centre for International Health and Development, University of Leeds, Leeds, UK
  6. 6 Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
  1. Correspondence to Richard Antony Powell, Department of Primary Care & Public Health, Imperial College London, London SW7 2BU, UK; r.powell{at}

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The death toll from the COVID-19 pandemic has exposed the public to the reality of death and dying, raising awareness of the fragility of one’s mortality. It has revealed to many care professionals and policymakers the need for integrated, comprehensive care provision across public health and medical services, including palliative and end-of-life care. With large disparities in the capacity of health systems globally prior to the pandemic, inequity in the response to COVID-19-related palliative care needs was inevitable across low-income, middle-income and high-income countries (HICs). Importantly, the immediacy of the dialogue around COVID-19 response preparedness has largely muted calls around the need to enhance palliative care service provision in low-income and middle-income countries (LMICs), and the longer term development necessary to inform future disease outbreaks specifically and the needs of the dying generally.

Palliative care (PC) was initially deprioritised in the contagion compared with efforts aimed at curbing the infection, medical management and vaccine development. However, escalating admissions to HICs intensive care units increased awareness of the prevalence of patient symptoms that can be highly distressing, including breathlessness, pain and delirium. They also highlighted the often poor quality of dying and death of those affected by COVID-19, and the grieving needs of bereaved families and friends, colleagues and communities, challenging the feasibility of individualistic Western conceptions of a ‘good death’.1

Recognition of the importance of PC accordingly grew, clinical narratives emphasised the integration of care and relief for those destined not to survive, as well as saving those who could. Subsequent guidance has been provided internationally to governments to ensure continued access to controlled medicines, including opioids, during the pandemic,2 alongside the need to integrate palliative care in response preparedness plans.3 The COVID-19 response in HICs reinforced the vital contribution PC can make in addressing the multidimensional …

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  • Contributors RAP’s independent contribution to this article is supported by the National Institute for Health Research Applied Research Collaboration Northwest London. The views expressed in this publication are those of RAP and not necessarily those of the National Institute for Health Research or the Department of Health and Social Care.

  • 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.

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