Symptom burden and clinical profile of COVID-19 deaths: a rapid systematic review and evidence summary

BMJ Support Palliat Care. 2020 Dec;10(4):381-384. doi: 10.1136/bmjspcare-2020-002368. Epub 2020 May 28.


The spread of pandemic COVID-19 has created unprecedented need for information. The pandemic is the cause of significant mortality and with this the need for rapidly disseminated information for palliative care professionals regarding the prevalence of symptoms, their intensity, their resistance or susceptibility to symptom control and the mode of death for patients.

Methods: We undertook a systematic review of published evidence for symptoms in patients with COVID-19 (with a specific emphasis on symptoms at end of life) and on modes of death. Inclusion: prospective or retrospective studies detailing symptom presence and/or cause or mode of death from COVID-19.

Results: 12 papers met the inclusion criteria and gave details of symptom burden: four of these specifically in the dying and two detailed the cause or mode of death. Cough, breathlessness, fatigue and myalgia are significant symptoms in people hospitalised with COVID-19. Dyspnoea is the most significant symptom in the dying. The mode of death was described in two papers and is predominantly through respiratory or heart failure.

Conclusions: There remains a dearth of information regarding symptom burden and mode of death to inform decisions regarding end-of-life care in patients dying with COVID-19. Rapid data gathering on the mode of death and the profile of symptoms in the dying and their prevalence and severity in areas where COVID-19 is prevalent will provide important intelligence for clinicians. This should be done urgently, within ethical norms and the practicalities of a public health, clinical and logistical emergency.

Keywords: hospital care; symptoms and symptom management; terminal care.

Publication types

  • Systematic Review

MeSH terms

  • COVID-19
  • Cause of Death*
  • Coronavirus Infections* / complications
  • Coronavirus Infections* / mortality
  • Dyspnea* / etiology
  • Dyspnea* / mortality
  • Fatigue* / etiology
  • Fatigue* / mortality
  • Heart Failure* / etiology
  • Heart Failure* / mortality
  • Humans
  • Myalgia* / etiology
  • Myalgia* / mortality
  • Pandemics*
  • Pneumonia, Viral* / complications
  • Pneumonia, Viral* / mortality
  • Respiratory Insufficiency* / etiology
  • Respiratory Insufficiency* / mortality