key: cord-0816948-p0tiw2rb
authors: Molokhia, Ashraf; Khaliq, Waqas
title: The reality of dying in an intensive care unit with Covid-19 during the pandemic
date: 2020-06-17
journal: Br J Anaesth
DOI: 10.1016/j.bja.2020.06.018
sha: 465314e7288e16668281fee3890d2dd0a46fb2e7
doc_id: 816948
cord_uid: p0tiw2rb

nan

Patients with COVID-19 are admitted to the Intensive Care Unit (ICU) due to hypoxaemia that fails to respond to standard oxygen therapy. They are treated with noninvasive mechanical ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO). In a study of 138 patients, 53 were presumed to have been infected in hospital, including 17 patients who were already hospitalized for other reasons and 40 healthcare workers, hence, restrictions on hospital visitors have been introduced in most countries [2] .

With ICUs under immense pressure, families have been denied access to visit their loved ones even whilst critically unwell. Information updates to their next of kin are being given using alternative methods such as telephone, internet calling or video link. In some ICUs families have even been denied access to their loved ones during their final hours and are simply informed of their demise over the phone [3] . Religious ceremonies are restricted to a bare minimum number of individuals. It is recommended that touching the body, if it is necessary, should be performed only by those with experience in using PPE. The CDC has reported COVID-19 spread during a funeral that lead to a mortality [7] . Similarly, countries have placed restrictions on the number of individuals who can attend funerals; even at funerals social distancing is advised.

The prohibitions on being with loved ones during their final hours, the inability to kiss the deceased, coupled with restrictions to religious and funeral arrangements places tremendous stress and anxiety amongst families and friends already coping with heightened anxiety and anger due to being quarantined during the pandemic [8] . A patient's death has been identified as a risk factor for the family to develop Post Traumatic Stress Disorder (PTSD) symptoms. Family members may develop psychological distress including generalized anxiety disorder, depression, and panic disorder [9] . 

The authors have no conflicts to declare.

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