Changing patterns of mortality during the COVID-19 pandemic: population-based modelling to understand palliative care implications

BackgroundCOVID-19 has directly and indirectly caused high mortality worldwide. AimTo explore patterns of mortality during the COVID-19 pandemic and implications for palliative care provision, planning, and research. DesignDescriptive analysis and population-based modelling of routine data. Participants and settingAll deaths registered in England and Wales between 7th March and 15th May 2020. We described the following mortality categories by age, gender and place of death: 1) baseline deaths (deaths that would typically occur in a given period) 2) COVID-19 deaths 3) additional deaths not directly attributed to COVID-19. We estimated the proportion of COVID-19 deaths among people who would be in their last year of life in the absence of the pandemic, using simple modelling with explicit assumptions. ResultsDuring the first 10 weeks of the pandemic there were 101,615 baseline deaths, 41,105 COVID-19 deaths and 14,520 additional deaths. Deaths in care homes increased by 220% compared to home and hospital deaths which increased by 77% and 90%. Hospice deaths fell by 20%. Additional deaths were among older people (86% aged [≥]75 years), and most occurred in care homes (56%) and at home (43%). We estimate that 44% (38% to 50%) of COVID-19 deaths occurred among people who would have been in their last year of life in the absence of the pandemic. ConclusionsHealthcare systems must ensure availability of palliative care to support people with severe COVID-19 in community and hospital settings. Integrated models of palliative care in care homes are urgently needed. Key statementsO_ST_ABSWhat is already known about the topic?C_ST_ABSO_LIThe COVID-19 pandemic has directly and indirectly resulted in high mortality in many affected nations. C_LIO_LIInternationally the response has been focused on prevention and curative treatments, with little emphasis on palliative care needs of people dying during the COVID-19 pandemic. C_LIO_LIWe do not know how many of those dying with COVID-19 would have been in their last year of life in the absence of the pandemic, and this group may have distinct care needs. C_LI What this paper addsO_LIThe number of people dying in care homes trebled during the first 10 weeks of the COVID-19 pandemic in England and Wales; many of these deaths were additional deaths, that is associated with the COVID-19 pandemic but not directly as a result of COVID-19. C_LIO_LIWe estimate almost half of all COVID-19 deaths occurred among people who would have been in their last year of life in the absence of the pandemic. C_LI Implications for practice, theory or policyO_LIHealthcare systems must ensure availability of palliative care to support people with severe COVID-19 in community and hospital settings. C_LIO_LIThe need for integrated models of palliative care in care home settings is imperative and research to underpin these models is warranted. C_LI