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  • InAdvance Consortium

A bird’s eye view of needs through a microscopic virus

Updated: Jun 1, 2023

M Soledad Giménez Campos


Hospital Universitari i Politècnic La Fe

Departament de Salut València La Fe

The COVID-19 pandemic has brought to the forefront human vulnerability at all levels in an unprecedented way.

The consequences of this novel virus on individuals and society in general are related to a combination of high transmissibility, severe health outcomes, and the ability to cause huge societal and economic disruption. The impact of the COVID-19 pandemic has reflected the weakness of governments and institutions in facing this public health crisis. The immediate actions focused mainly on minimizing the spread of coronavirus and on strengthening the response to acute clinical problems. Physical distancing measures and the efforts on the management of severe clinical problems have made it possible to contain the morbidity and mortality related to COVID. However, focusing exclusively on survival mode action could have consequences in many patients directly affected, or not, by the virus.

A recent illustration attributed to @VectorSting suggests the four waves the healthcare systems are going to face. This conceptual and non-empirical approach is an inspiring proposal to insight and reframe vulnerability in the COVID era.

The graph aimed to start conversations about the points that should not be neglected while we continue to leap forward into the pandemic response. Comments shared on this trending tweet are a reflection of the concerns beyond those on the first wave, mainly focused on acute clinical issues and ICU bed availability. One of the most relevant aspects is the care for the end-of-life of patients with life-threatening and life-limiting illnesses. The prevailing survival paradigm, the strict isolation measures and the scarcity of resources - among other reasons - have transformed today’s experience of death, dying and bereavement for all patients.

During the last months, many editorials and articles have echoed this reality (1–3) highlighting the

indisputable role of palliative care in adapting actions aimed to dignify the process of dying.

Measures geared to the discernment of patient goals, the adequacy of therapeutic effort and also the optimal management of symptoms must be implemented in parallel to active treatment approaches. Moreover, actions aimed to

mitigate the loneliness of dying and to support the bereavement process

must also be taken into consideration as the usual rituals have been interrupted.

Being sensitive to the broad spectrum of needs and particularly to the vulnerability of end of life is an ethical requirement in this exceptional condition. COVID confronts us with the known challenge of integrating curative and palliative paradigms.

Let us take the opportunity to have a bird’s eye view of the needs through the consequences of this microscopic virus.

Reference list:

1. Yardley S, Rolph M. Death and dying during the pandemic. BMJ [Internet]. 2020 Apr 15 [cited 2020 May 21];369. Available from:

2. Re: Death and dying during the pandemic. 2020 May 21 [cited 2020 May 21]; Available from:

3. Wakam GK, Montgomery JR, Biesterveld BE, Brown CS. Not Dying Alone — Modern Compassionate Care in the Covid-19 Pandemic. New England Journal of Medicine. 2020 Apr 14;0(0):null.


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