There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.
Abstract
Background
The SARS-CoV-2 (COVID-19) pandemic is posing major challenges for health care systems.
In Germany, one such challenge has been that adequate palliative care for the severely
ill and dying (with and without COVID-19), as well as their loved ones, has not been
available at all times and in all settings., the pandemic has underlined the significance
of the contribution of general practitioners (GPs) to the care of severely ill and
dying patients.
Objectives
To describe GPs’ experiences, challenges and perspectives with respect to end-of-life
care during the first peak of the pandemic (spring 2020) in Germany.
Materials and methods
In November and December 2020, a link to an Unipark online survey was sent to GPs
registered on nationwide distribution lists.
Results
In total, 410 GPs responded; 61.5% indicated that the quality of their patients’ end-of-life
care was maintained throughout the pandemic, 36.8% reported a decrease in quality
compared to pre-pandemic times. Of the GPs who made home visits to severely ill and
dying patients, 61.4% reported a stable number of visits, 28.5% reported fewer visits.
62.7% of the GPs reported increased telephone contact and reduced personal contact
with patients; 36.1% offered video consultations in lieu of face-to-face contact.
The GPs reported that relatives were restricted (48.5%) or prohibited from visiting
(33.4%) patients in nursing homes. They observed a fear of loneliness among patients
in nursing homes (91.9%), private homes (87.3%) and hospitals (86.1%).
Conclusions
The present work provides insights into the pandemic management of GPs and supports
the development of a national strategy for palliative care during a pandemic.
To effectively address end-of-life care, GPs and palliative care specialists should
be involved in COVID-19 task forces on micro, meso and macro levels of health care.
As countries are affected by coronavirus disease 2019 (COVID-19), the elderly population will soon be told to self-isolate for “a very long time” in the UK, and elsewhere. 1 This attempt to shield the over-70s, and thereby protect over-burdened health systems, comes as worldwide countries enforce lockdowns, curfews, and social isolation to mitigate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, it is well known that social isolation among older adults is a “serious public health concern” because of their heightened risk of cardiovascular, autoimmune, neurocognitive, and mental health problems. 2 Santini and colleagues 3 recently demonstrated that social disconnection puts older adults at greater risk of depression and anxiety. If health ministers instruct elderly people to remain home, have groceries and vital medications delivered, and avoid social contact with family and friends, urgent action is needed to mitigate the mental and physical health consequences. Self-isolation will disproportionately affect elderly individuals whose only social contact is out of the home, such as at daycare venues, community centres, and places of worship. Those who do not have close family or friends, and rely on the support of voluntary services or social care, could be placed at additional risk, along with those who are already lonely, isolated, or secluded. Online technologies could be harnessed to provide social support networks and a sense of belonging, 4 although there might be disparities in access to or literacy in digital resources. Interventions could simply involve more frequent telephone contact with significant others, close family and friends, voluntary organisations, or health-care professionals, or community outreach projects providing peer support throughout the enforced isolation. Beyond this, cognitive behavioural therapies could be delivered online to decrease loneliness and improve mental wellbeing. 5 Isolating the elderly might reduce transmission, which is most important to delay the peak in cases, and minimise the spread to high-risk groups. However, adherence to isolation strategies is likely to decrease over time. Such mitigation measures must be effectively timed to prevent transmission, but avoid increasing the morbidity of COVID-19 associated with affective disorders. This effect will be felt greatest in more disadvantaged and marginalised populations, which should be urgently targeted for the implementation of preventive strategies.
Background Coronavirus disease 2019 (COVID‐19) is a rapidly emerging disease that has been classified a pandemic by the World Health Organization (WHO). To support WHO with their recommendations on quarantine, we conducted a rapid review on the effectiveness of quarantine during severe coronavirus outbreaks. Objectives We conducted a rapid review to assess the effects of quarantine (alone or in combination with other measures) of individuals who had contact with confirmed cases of COVID‐19, who travelled from countries with a declared outbreak, or who live in regions with high transmission of the disease. Search methods An information specialist searched PubMed, Ovid MEDLINE, WHO Global Index Medicus, Embase, and CINAHL on 12 February 2020 and updated the search on 12 March 2020. WHO provided records from daily searches in Chinese databases up to 16 March 2020. Selection criteria Cohort studies, case‐control‐studies, case series, time series, interrupted time series, and mathematical modelling studies that assessed the effect of any type of quarantine to control COVID‐19. We also included studies on SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) as indirect evidence for the current coronavirus outbreak. Data collection and analysis Two review authors independently screened 30% of records; a single review author screened the remaining 70%. Two review authors screened all potentially relevant full‐text publications independently. One review author extracted data and assessed evidence quality with GRADE and a second review author checked the assessment. We rated the certainty of evidence for the four primary outcomes: incidence, onward transmission, mortality, and resource use. Main results We included 29 studies; 10 modelling studies on COVID‐19, four observational studies and 15 modelling studies on SARS and MERS. Because of the diverse methods of measurement and analysis across the outcomes of interest, we could not conduct a meta‐analysis and conducted a narrative synthesis. Due to the type of evidence found for this review, GRADE rates the certainty of the evidence as low to very low. Modeling studies consistently reported a benefit of the simulated quarantine measures, for example, quarantine of people exposed to confirmed or suspected cases averted 44% to 81% incident cases and 31% to 63% of deaths compared to no measures based on different scenarios (incident cases: 4 modelling studies on COVID‐19, SARS; mortality: 2 modelling studies on COVID‐19, SARS, low‐certainty evidence). Very low‐certainty evidence suggests that the earlier quarantine measures are implemented, the greater the cost savings (2 modelling studies on SARS). Very low‐certainty evidence indicated that the effect of quarantine of travellers from a country with a declared outbreak on reducing incidence and deaths was small (2 modelling studies on SARS). When the models combined quarantine with other prevention and control measures, including school closures, travel restrictions and social distancing, the models demonstrated a larger effect on the reduction of new cases, transmissions and deaths than individual measures alone (incident cases: 4 modelling studies on COVID‐19; onward transmission: 2 modelling studies on COVID‐19; mortality: 2 modelling studies on COVID‐19; low‐certainty evidence). Studies on SARS and MERS were consistent with findings from the studies on COVID‐19. Authors' conclusions Current evidence for COVID‐19 is limited to modelling studies that make parameter assumptions based on the current, fragmented knowledge. Findings consistently indicate that quarantine is important in reducing incidence and mortality during the COVID‐19 pandemic. Early implementation of quarantine and combining quarantine with other public health measures is important to ensure effectiveness. In order to maintain the best possible balance of measures, decision makers must constantly monitor the outbreak situation and the impact of the measures implemented. Testing in representative samples in different settings could help assess the true prevalence of infection, and would reduce uncertainty of modelling assumptions. This review was commissioned by WHO and supported by Danube‐University‐Krems. Does quarantine control coronavirus (COVID‐2019) either alone or in combination with other public health measures? Background Coronavirus disease 2019 (COVID‐19) is caused by a new virus that has spread quickly throughout the world. COVID‐19 spreads easily between people who are in close contact, or through coughs and sneezes. Most infected people suffer mild, flu‐like symptoms but some become seriously ill and even die. There is no effective treatment or vaccine (a medicine that stops people catching a specific disease) for COVID‐19, so other ways of slowing (controlling) its spread are needed. One of the World Health Organization’s (WHO) recommendations for controlling the disease is quarantine. This means separating healthy people from other healthy people, in case they have the virus and could spread it. Other similar recommendations include isolation (like quarantine, but for people with COVID‐19 symptoms) and social distancing (where people without symptoms keep a distance from each other physically). What did we want to find out? We wanted to find out whether and how effectively quarantine stops COVID‐19 spreading and if it prevents death. We wanted to know if it was more effective when combined with other measures, such as closing schools. We also wanted to know what it costs. Study characteristics COVID‐19 is spreading rapidly, so we needed to answer this question as quickly as possible. This meant we shortened some steps of the normal Cochrane Review process. Nevertheless, we are confident that these changes do not affect our overall conclusions. We looked for studies that assessed the effect of any type of quarantine, anywhere, on the spread and severity of COVID‐19. We also looked for studies that assessed quarantine alongside other measures, such as isolation, social distancing, school closures and hand hygiene. COVID‐19 is a new disease, so, to find as much evidence as possible, we also looked for studies on similar viruses, such as SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome). Studies measured the number of COVID‐19, SARS or MERS cases, how many people were infected, how quickly the virus spread, how many people died, and the costs of quarantine. Key results We included 29 studies. Ten studies focused on COVID‐19, 15 on SARS, two on SARS plus other viruses, and two on MERS. Most of the studies combined existing data to create a model (a simulation) for predicting how events might occur over time, for people in different situations (called modelling studies). The COVID‐19 studies simulated outbreaks in China, UK, South Korea, and on the cruise ship Diamond Princess. Four studies looked back on the effect of quarantine on 178,122 people involved in SARS and MERS outbreaks (called ‘cohort’ studies). The remaining studies modelled SARS and MERS outbreaks. The modelling studies all found that simulated quarantine measures reduce the number of people with the disease and the number of deaths. With quarantine, estimates showed a minimum reduction in the number of people with the disease of 44%, and a maximum reduction of 81%. Similarly, with quarantine, estimates of the number of deaths showed a minimum reduction of 31%, and a maximum reduction of 63%. Combining quarantine with other measures, such as closing schools or social distancing, is more effective at reducing the spread of COVID‐19 than quarantine alone. The SARS and MERS studies agreed with the studies on COVID‐19. Two SARS modelling studies assessed costs. They found that the costs were lower when quarantine measures started earlier. We cannot be completely certain about the evidence we found for several reasons. The COVID‐19 studies based their models on limited data and made different assumptions about the virus (e.g. how quickly it would spread). The other studies investigated SARS and MERS so we could not assume the results would be the same for COVID‐19. Conclusion Despite limited evidence, all the studies found quarantine to be important in reducing the number of people infected and the number of deaths. Results showed that quarantine was most effective, and cost less, when it was started earlier. Combining quarantine with other prevention and control measures had a greater effect than quarantine alone. This review includes evidence published up to 12 March 2020.
This is an open access article distributed under the terms of the
Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided
the original author and source are credited.
History
Date
received
: 17
April
2021
Date
accepted
: 18
June
2021
Page count
Figures: 0,
Tables: 5,
Pages: 14
Funding
Funded by:
funder-id http://dx.doi.org/10.13039/501100002347, Bundesministerium für Bildung und Forschung;
Award ID: 01KX2021
Award Recipient
:
Nils Schneider
The project PallPan is funded by the German Ministry for Education and Research (Grant
Number: 01KX2021).
https://www.netzwerk-universitaetsmedizin.de/projekte/pallpan The co-author NS received funding. The funders had no role in study design, data
collection and analysis, decision to publish, or preparation of the manuscript.
Categories
Subject:
Research Article
Subject:
Medicine and Health Sciences
Subject:
Health Care
Subject:
Palliative Care
Subject:
Medicine and Health Sciences
Subject:
Epidemiology
Subject:
Pandemics
Subject:
Medicine and Health Sciences
Subject:
Health Care
Subject:
Health Care Facilities
Subject:
Nursing Homes
Subject:
Medicine and Health Sciences
Subject:
Medical Conditions
Subject:
Infectious Diseases
Subject:
Viral Diseases
Subject:
Covid 19
Subject:
Research and Analysis Methods
Subject:
Research Design
Subject:
Survey Research
Subject:
Surveys
Subject:
People and places
Subject:
Geographical locations
Subject:
Europe
Subject:
European Union
Subject:
Germany
Subject:
Medicine and Health Sciences
Subject:
Health Care
Subject:
Health Care Providers
Subject:
Physicians
Subject:
People and Places
Subject:
Population Groupings
Subject:
Professions
Subject:
Medical Personnel
Subject:
Physicians
Subject:
Medicine and Health Sciences
Subject:
Health Care
Subject:
Health Care Providers
Custom metadata
Data Availability The data from this study cannot be shared publicly because of data protection regulations
put in place by the Data Protection Commissioner. Data are available for researchers
who meet the criteria for access to confidential data from the Ethics Committee of
the Hannover Medical School (No. 9232_BO_K_2020) via email (
allgemeinmedizin@
123456mh-hannover.de
).
scite shows how a scientific paper has been cited by providing the context of the citation, a classification describing whether it supports, mentions, or contrasts the cited claim, and a label indicating in which section the citation was made.
Smart Citations