Open almost any daily or weekly publication, and you will read about how to live with Covid-19, but few describe the challenges associated with dying. In an ordinary world, a single person’s death involved many people – friends, family, doctors, attorneys, funeral directors, etc. But in a pandemic-stricken world, many are suddenly grappling with their mortality. Some die suddenly in hospital wards with their loved ones distant and no plan in place once they pass. For those who survive the virus, an alarming number continue to suffer from crippling symptoms that call for long-term medical care.
On December 10th, the United States crossed the threshold of 3,000 COVID-related deaths a day, with a record 106,219 people hospitalized. At the same time, many rural hospitals serving the most vulnerable have closed across the country. Research by the Physicians Foundation in 2020 indicates that as much as 12% or some 16,000 medical practices may be shuttered by the end of this year. With this crushing influx of people, hospitals are approaching – or exceeding – their maximum capacity to treat people. Under this crippling pressure, hospitals resort to immediate medical technology to extend life with defibrillators, ventilators, and feeding tubes without asking about end-of-life preferences.
Before the pandemic, roughly 8 in 10 Americans passed away from conditions such as cancer, heart disease, or diabetes. Since these conditions were chronic, it allowed people to plan for their deaths properly. But in a pandemic-stricken world, these manageable conditions have mixed disastrously with the novel coronavirus, tragically ending lives within days of a Covid-19 diagnosis. By default, those without a plan will leave complex decisions for others. Without end-of-life directives such as a living will, durable power of attorney, or a healthcare proxy, loved ones cannot convey end-of-life choices to medical caregivers.
Separately, we have learned of people who overcame the virus’s acute, short-term symptoms, only to suffer from secondary chronic conditions. The incidence is frequent enough to have earned a diagnosis of “post-acute COVID,” otherwise known as the “long-haulers.”
The amount of care “long-haulers” need is varied. Some have minor aches and pains, while others develop debilitating symptoms that need additional medical care. Hospitals may offer crisis care, but not long-term treatment. Home care is an option, but someone must hire, schedule, and supervise 3-4 caregivers for 21 weekly shifts and a payroll of an estimated $3,000+ per week at minimum wage rates. Fifty-two weeks of home care could be hundreds of thousands of dollars. Anyone who would plan to rely on loved ones for home care should confirm their ability to provide what will become 24-7 attention.
Hospice may be a viable, caring option, but availability varies by ZIP code. Assisted living facilities offer only what the name implies – no medical care or regulated guidance. More often than not, assisted living situations are owned by investors seeking a return.
Most roads eventually lead to nursing home care. The CDC website lists more than 15,500 nursing home facilities currently operating at near 80% occupancy. They are regulated and must have a physician as a medical director for compliance. Still, the physician directors do not provide regular medical care for residents.
Family separation further compounds the problems with long-term medical care. Before coronavirus restrictions, nursing home residents could look forward to visits from loved ones, occasional entertainment, and peer activities outside of the home. Now, these homes are isolated and removed from the rest of society.
If a long-term care facility becomes a hotspot for COVID, the results can be disastrous. While many nursing homes are not reporting 2020 statistics, independent research estimates indicate that 40-45% of all COVID-19 deaths may occur in nursing homes. Some have turned in to temporary morgues.
In conclusion, the Covid-19 pandemic has forced our nation – if not the world – to reevaluate how we approach death and terminal illnesses. Legitimate questions have been avoided for far too long; questions regarding the quality of life of someone’s final days, pain tolerance, and perhaps most importantly, dying with dignity.
Legally, the U.S. Supreme Court long ago granted all informed citizens the right to choose relief from suffering, even if the action shortens life. At last count, nine states and Washington D.C. allow death with dignity measures if the diagnosis is terminal. Palliative sedation with prescribed medication is embraced as a means by all. While it’s not lawful for loved ones to take end-of-life actions, no restrictions support those who choose an early end to a terminal illness.
Extended periods of suffering are painful for patients as well as those who love them. COVID-19 has multiplied the impact and intensity. Those who are honest openly express relief at the time of death and sadness that the suffering could not have ended sooner. In many cases, it could have. End-of-life issues have always been controversial, but our new COVID-19 world is altering the debate’s direction.
______________________________________________________________________________________________________________________
Dr. Don Clardy
Dr. Don Clardy is a tenured professor with 40+ years in higher education.
______________________________________________________________________________________________________________________
