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

Bone, A. E.; Finucane, A. M.; Leniz, J.; Higginson, I. J.; Sleeman, K. E.

Background COVID-19 has directly and indirectly caused high mortality worldwide. Aim To explore patterns of mortality during the COVID-19 pandemic and implications for palliative care provision, planning, and research. Design Descriptive analysis and population-based modelling of routine data. Participants and setting All 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. Results During 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. Conclusions Healthcare 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.