Andreas Laupacis is Editor in Chief of CMAJ.


I have brief phone calls with mom every 3 to 4 days, as visits to her nursing home continue to be forbidden. Thankfully, because of her dementia, she has no idea what COVID is nor that we are not visiting. She is unfailingly cheerful.

If mom died from COVID that would not be the worst thing that could happen. Her dementia is progressing so rapidly that her non-COVID future is bleak, and she was very clear about her wishes when she was lucid.

What would be terrible would be for her to die with inadequately managed shortness of breath. I worry about that a lot. When I was practicing as a palliative care doc, I’d see many people come to the ED from their nursing homes with shortness of breath. They had clearly indicated that they did not want life extending care, but they were in the ED because their nursing home was not adequately resourced to manage even the most straightforward end of life symptoms.

That was pre-COVID. What’s going to happen during a COVID pandemic? How are mom’s symptoms going to be managed if she gets short of breath? The most likely cause of shortness of breath would not be COVID but heart failure (common things are common in a 94 year old lady). Either way, she doesn’t want to go to hospital, nor should she. Does her nursing home have an adequate supply of end-of-life medications and the personnel who know how to use them?

I’ve just emailed the nursing home to find out. I’ll let you know what I hear.

Two images have particularly affected me during the last three days.

The first is this one of Italian health care workers.

Every time I look at these four people, I am humbled. And then angry. Because the photo makes me think of that idiot in Miami who boasted he doesn’t give a shit about social distancing. Macho man intends to party on. Who is going to care for him, and the people he has infected? People like this. And some of them are going to die!

The second image is this one.

Two incredibly gorgeous kids. It was emailed to me by a clinician working in the general medicine ward of a hospital. We hadn’t talked for a while and the email came more or less out of the blue. Its title was “The kids” and the email consisted of one line. “Hope you guys are well and stay safe.” That expresses it all. Anxiety that things may not go well. Worry about our loved ones. And reaching out to those we care about.