Lindsay Farrant and Kerene Payne, School of Public Health and Family Medicine (Palliative Medicine), University of Cape Town
At the beginning of the COVID-19 pandemic it was predicted that cases in Africa would rise exponentially and somewhere between 83 000-19 0000 people would die from the coronavirus1. In South Africa, where roughly 13% of the population are living in poverty with HIV, TB and other non-communicable diseases and the healthcare systems and personnel have limited medical resources to cope with a pandemic of this magnitude,2 there was great concern that many patients would become infected and then not have access to/qualify for intensive care at hospitals/clinics. These patients would therefore end up being cared for at home in the community by family members/caregivers. With the reality of overburdened health systems, health professionals might face difficult decisions around discharging COVID-19 positive patients’ home for palliative or end of life care.
It was felt that there needed to be guidance and support for those on the frontline both in the hospitals/clinics and the communities with regards to palliative care and end of life matters during this time of COVID-19. Therefore, the Guidelines for Palliative Care Homecare in South Africa during the COVID-19 pandemic were initiated by the UCT School of Public Health and Family Medicine in partnership with the ASSET project, Kings College London, and created in collaboration with palliative care providers and educators in a variety of South African contexts . These guidelines were developed using the PALPRAC clinical care guidelines, which were developed by PALPRAC for use in South Africa during the COVID-19 pandemic, and aim to support health professionals when facing difficult ethical decisions, as well as address the practical needs of these COVID-19 positive patients, and their families, should they be discharged home for palliative support or end-of life care.
The guidelines and collection of resources can be accessed at:
PALPRAC guidelines and other resources can be accessed at:
1. World Health Organization. New WHO estimates: Up to 190 000 people could die of COVID-19 in Africa if not controlled. 2020 [cited 2020 May 24]. Available from: http://whotogo-whoafroccmaster.newsweaver.com/
2. Wadvalla, BA. Covid-19: decisive action is the hallmark of South Africa’s early success against coronavirus. BMJ. 2020:1-2. doi: 10.1136/bmj.m1623