Excess death rates for Republicans and Democrats during the COVID-19 pandemic

Political affiliation has emerged as a potential risk factor for COVID-19, amid evidence that Republican-leaning counties have had higher COVID-19 death rates than Democrat- leaning counties and evidence of a link between political party affiliation and vaccination views. This study constructs an individual-level dataset with political affiliation and excess death rates during the COVID-19 pandemic via a linkage of 2017 voter registration in Ohio and Florida to mortality data from 2018 to 2021. We estimate substantially higher excess death rates for registered Republicans when compared to registered Democrats, with almost all of the difference concentrated in the period after vaccines were widely available in our study states. Overall, the excess death rate for Republicans was 5.4 percentage points (pp), or 76%, higher than the excess death rate for Democrats. Post- vaccines, the excess death rate gap between Republicans and Democrats widened from 1.6 pp (22% of the Democrat excess death rate) to 10.4 pp (153% of the Democrat excess death rate). The gap in excess death rates between Republicans and Democrats is concentrated in counties with low vaccination rates and only materializes after vaccines became widely available.

HYPERTENSION IN THE TIME OF COVID: PIVOTING TO AN ASYNCHRONOUS QI INTERVENTION FOR HOME BLOOD PRESSURE MONITORING

BACKGROUND: Hypertension (HTN) affects 29% of US adults, however in-office blood pressure (BP) readings are often inaccurate leading to clinical inertia. Repeating BP within 6 weeks leads to quicker control but patients and primary care practices have limited resources for frequent visits. Home blood pressure monitoring (HBPM) is accurate and convenient. In reviewing HTN burden at a suburban Maryland primary care practice, we found 19% of patients had an encounter BP >140/90, and a sample chart review estimated half were advised to self-monitor but lacked standardized follow up. We aimed to implement a quality improvement program to increase HBPM among our patients. METHODS: We engaged stakeholders (practice leadership, frontline staff) and content experts (HTN, patient engagement) to develop educational materials on HBPM and reporting results via the patient portal. We planned in office implementation, identifying patients with elevated BP during encounters and utilizing nurses to provide counseling. However, with COVID-19, we pivoted to asynchronous outreach and home delivery of BP cuffs. We developed messaging, delivered via the patient portal, for patients with uncontrolled HTN, controlled HTN, and elevated BP readings without HTN. Eligible patients, covered by a single insurance that provides reimbursement for BP cuffs, had HTN on their problem list and/or a BP >140/90 during an encounter between Jan-Oct 2020. For interested patients, we placed BP cuff orders and sent the educational materials. RESULTS: We identified 243 eligible patients who received outreach about HBPM;4 did not have patient portal access and received letters with no responses. Of the remaining 239 patients, 77% (N=183) read the electronic message and 43% (N=103) responded. Among responders, 81% (N=83) requested a cuff and 14% (N=14) reported having an up-to-date device. Among patients with a cuff, 18% (N=17) reported a BP reading to their primary care physician, with systolic and diastolic readings on average 11 and 6 mmHg lower, respectively, than the most recent in-office measurement. Initial review found some patients did not receive a cuff after the order resulting from delayed order processing and patients not scheduling delivery. CONCLUSIONS: Patients with elevated BP readings or HTN responded to messaging through the patient portal and were interested in receiving BP cuffs for HBPM. However, many patients did not report BP values after a device was ordered. Next steps include addressing barriers to delivery of the cuffs and incorporating follow up visits, including with our clinical pharmacist, to encourage reporting of HBPM. We will use lessons learned from this pilot to plan outreach and encourage self-monitoring during the COVID-19 era.

Is There an Authoritarian Advantage in Pandemic Response? A Comparative Case Study of China's Responses to SARS-CoV-1 (2003) and SARS-CoV-2 (2019)

Effective pandemic response has become an increasingly important focus for research in the face of the COVID-19 pandemic. While there are a number of variables that may be considered as influencing effective response, this paper focuses on the potential impact of an "authoritarian advantage" in achieving an effective response in the period prior to pharmaceutical interventions being available with China as a case study. In essence, this paper explores whether China enjoys an authoritarian advantage, and if so, how it functions. This study compares China's SARS-CoV-1 (2003) response with its SARS-CoV-2 (2019) response by exploring the impact of the authoritarian advantage on the state's ability to effectively engage three key explanatory variables - centralized decision-making powers, public support and media engagement.

Supplement-Induced Thyrotoxicosis Presenting as New Onset Tachycardia

INTRODUCTION: Dietary and herbal supplements can contain clinically significant amounts of exogenous thyroid stimulants and hormones, including T3 and T4, thus placing consumers at increased risk of thyrotoxicosis and other metabolic-related adverse effects. We present a case of thyrotoxicosis in a young man with no history of thyroid disease, who was found to be consuming an extensive variety of supplements. DESCRIPTION: A 31 year old man with hypertension presented with 1 week of intermittent palpitations. He was in his usual state of health until 1 week prior to admission, when he noticed intermittent, self-resolving episodes of tachycardia as high as the 160s on his smart watch, associated with palpitations, dyspnea, low grade fevers, and intermittent dry cough. He came to the ED for persistence of symptoms. In the ED: T 98.8 F, HR 129, BP 152/77, RR 18, SpO2 98% on RA. CBC, BMP, UA, UTox, blood alcohol content, troponin and COVID tests were unremarkable. TSH was < .007 [0.358-3.740 ulU/mL], with a free thyroxine of 0.54 [0.70-1.48 ng/dL];other thyroid studies later returned with TSI < 0.10 [0.00-0.55 IU/L], free T3 32.50 [1.80-4.60 pg/mL], and an unremarkable thyroid ultrasound. CXR showed no acute infiltrates. EKG revealed sinus tachycardia, no Wolff-Parkinson-White syndrome, and no Brugada waveforms. He was given 2L NS, ceftriaxone 1g IV, aspirin 81mg PO, and tylenol 650mg PO, and admitted to the telemetry unit. Exam revealed an anxious appearing man with tachycardia. On ROS, patient admitted to drinking 6-8 cups of coffee daily, and to taking at least a dozen different supplements. He was started on propranolol 30 mg every 6 hours with improvement in his heart rate, and was counseled to stop the supplements and wean his caffeine intake. He was discharged the following day with plan for endocrinology and primary care follow-up. DISCUSSION: Thyrotoxicosis in this young patient with no history of thyroid disease posed a diagnostic quandary. This prompted further investigation into a more detailed social history, which revealed the extensive variety of supplements he was taking, consistent with thyrotoxicosis factitia. In patients presenting with newonset tachycardia, our case highlights the importance of collecting a thorough social history and maintaining early suspicion for thyroid disease and thyrotoxicosis.

POOR SLEEP QUALITY IS ASSOCIATED WITH BURNOUT IN EMERGENCY MEDICINE HEALTHCARE WORKERS

Introduction: Prolonged exposure to stressful environments is associated with adverse psychological outcomes, including sleep disturbance and burnout. Burnout rates have increased substantially during the unprecedented challenges faced by healthcare workers (HCWs) during the COVID-19 pandemic. Since burnout has been associated with significant health risk and adverse organizational outcomes, it is important to identify factors that inform preventive or therapeutic approaches to mitigate adverse outcomes in HCWs. Methods: Participants were HCWs (physicians, nurses, advanced practice providers, technicians etc.) from 4 emergency departments in New York City who completed a cross-sectional electronic survey (completed at study enrollment between November 2020-October 2021). The Pittsburgh Sleep Quality Index (PSQI) assessed global sleep quality. The Maslach Burnout Inventory (MBI) assessed 3 burnout dimensions: emotional exhaustion (EE;feelings of being emotionally overextended and exhausted by one's work);Feelings of depersonalization (DP;unfeeling and impersonal response towards patients);and reduced personal accomplishment (PA;feelings of competence and successful achievement in one's work). Descriptive statistics were calculated and separate binary logistic regressions were used to predict poor global sleep quality (PSQI >5) from individual MBI subscales (dimensions of burnout), while controlling for age, race, ethnicity, and gender. Results: Ninety-one participants, studied to date, were included in the analysis (51% non-Hispanic/Latino White, 63% female, mean age: 40 [SD: 9.6] y). Poor global sleep quality was reported by 68%. High EE (score >9), DP (score >6) and reduced PA (score <9) were reported by 44%, 27%, and 18% of participants, respectively. Poor global sleep quality was significantly associated with presence of elevated EE (OR: 3.04, 95% CI: 1.07-8.63, p=0.037), but not with elevated DP (OR: 1.35, 95% CI: 0.44-4.10, p=0.603) or reduced PA (OR: 3.29, 95% CI: 0.65-16.44, p=0.146). Conclusion: During the COVID-19 pandemic, poor sleep quality was reported by the majority of participants and associated with increased burnout in HCWs. Poor global sleep appears to have the most influence on the burnout dimension EE, thus suggesting new evidence about associations between sleep and emotional regulation in HCW during the pandemic. Future trials should test whether existing (or novel) interventions can improve sleep and thereby support HCWs in high stress periods.

IDENTIFICATION OF SLEEP FACTORS RELATED TO BLOOD PRESSURE IN EMERGENCY MEDICINE HEALTHCARE WORKERS

Introduction: Emergency Department (ED) healthcare workers (HCWs) may be at elevated risk for the development of cardiovascular disease (CVD), due in part to sleep and/or circadian disturbances. This study aimed to evaluate the relationship of sleep factors with blood pressure, a primary marker of CVD risk, in ED HCWs. Methods: Participants were HCWs (physicians, nurses, advanced practice providers, technicians, etc.) from 4 EDs in New York City who completed study procedures between November 2020-October 2021. Participants completed a 2-week data burst, which included sleep/activity (Fitbit Inspire) and home blood pressure monitoring (Omron 5 Series BP7250;preceding and following their main daily sleep episode). Linear regression models, adjusted for age, gender, and race/ethnicity, were conducted predicting blood pressure from sleep factors. Results: The sample included n=74 ED HCWs (mean [SD] age=38.4 [8.7] years). Most were female (62.2%) and non-Hispanic/ Latino White (55.6%). Mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 116.1 (12.5) mmHg and 75.1 (7.6) mmHg, respectively. Actigraphy-derived sleep factor means for the data burst period were: a) Total sleep time (TST): 6.8 (1.0) hours;b) Sleep efficiency (SE): 94.5 (2.2)%;c) Percentage of main sleep episodes throughout the burst with TST <6 hours: 25.9 (20.8)%;d) Sleep start time: 24:06 (01:24);and e) Within-subject inter-daily bedtime variability (i.e., SD of sleep start times): 2.4 (1.8) hours. Higher TST was associated with lower SBP (B [SE] =-0.50 [0.30] mmHg/10 min, p=.04) and DBP (B [SE] =-0.50 [0.20] mmHg/10 min, p=.01). Greater SE was associated with lower SBP (B [SE] =-1.23 [0.55], mmHg/%, p=.03) and DBP (B [SE] =-1.05 [0.39], mmHg/%, p=.01). A higher proportion of nights with TST <6 hours was associated with higher DBP (B [SE] =1.4 [0.40], mmHg/10%, p<0.01) but not SBP. Sleep start time and bedtime variability were not associated with BP. Conclusion: These findings provide support for the relationship between sleep and blood pressure. Of note, data were collected during the COVID-19 pandemic, which may impact observed relationships. Because this is a cross-sectional analysis, the causal direction of the association may be (at least partially) reversed. Further research should examine psychological and work-related factors in ED HCWs that may modify these relationships, e.g., stress/anxiety, burnout, and job strain, and include assessments of the circadian system.

SAFETY AND CRITERIA FOR PERCUTANEOUS LEFT ATRIAL APPENDAGE OCCLUSION SAME DAY DISCHARGE

Background: Left Atrial Appendage Occlusion (LAAO) with the Watchman device is considered an elective procedure, and thus often deferred during outbreak peaks associated with the COVID-19 pandemic. Patients with bleeding issues on anticoagulation may require additional hospitalization for bleeding episodes or suffering increased risk of stroke by postponing occlusion while anticoagulation is discontinued. We chose to develop a protocol for screening, same day discharge, and follow up of selected LAAO patients and continuing to provide quality clinical outcomes while accounting for decreased bed and staff capacity due to the pandemic. Methods: Utilizing Knowledge to Action (KTA) nursing framework, a protocol was developed and reviewed with key stakeholders. Criteria for Same Day Discharge (SDD) includes: support at home, stable vitals and access site hemostasis prior to DC, agreeable to SDD, tolerant of oral intake, ability to urinate and safely ambulate prior to DC. Exclusion for SDD includes: Liver disease, Plt count <70,000, ESRD or CKD IV or any site or procedure complications. With Perclose usage patients must have 3 hours of bedrest, with manual pressure closure must have bedrest for 6 hours and purse string suture removed. This is followed by a next day phone call to ensure the patient is taking appropriate medicines and have no medical issues. Results: 38 out of 113 patients were screened as SDD candidates from January 2021-October 2021. Average patient age was 76, 31% female, with average CHA2DS2-VASc of 5. One patient required overnight hospitalization due to underlying asthma and need for nebulizer. One patient presented to an outpatient ED on a weekend with chest pain and underwent heart catheterization due to elevated troponin and did not require intervention. There were no access site complications. No patients contracted SARS-Cov-2 within 6 weeks post procedurally, compared with 2 of the overnight stays during the same period (75 patients). Conclusion: SDD in a carefully selected patient population is a feasible and safe strategy for LAAO patients. These patients had a clinically significant, though underpowered decrease in incidence of COVID-19 diagnosis within 6 weeks post implant.

Distributional impacts of retail vaccine availability

As countries transition from facing COVID-19 vaccine supply shortfalls to requiring novel strategies to facilitate vaccination, modern retail chains-often designed and located to target particular demographic groups-are a potential vaccine delivery vehicle. Using geospatial data, we quantify the proximity to vaccines created by a U.S. federal program that distributes vaccines to commercial retail pharmacies. We then quantify the impact of a proposal to provide vaccines at Dollar General, a low-priced general merchandise retailer. We show that adding Dollar General to the federal program would substantially decrease the distance to vaccine sites for low-income and minority U.S. households.

Impact of telemedicine use on blood pressure control during the covid-19 pandemic

Background: Telemedicine use vastly expanded during the Covid-19 pandemic, with uncertain impact on cardiovascular care. quality. Objectives: To examine the association between telemedicine use and blood pressure (BP) control. Methods: This is a retrospective cohort study of 32,727 adult patients with hypertension (HTN) seen in primary care and cardiology clinics at an urban, academic medical center from February to December, 2020. The primary outcome was poor BP control, defined as having no BP recorded OR if the last recorded BP was ≥140/90 mmHg. Multivariable logistic regression was used to assess the association between telemedicine use during the study period (none, 1 telemedicine visit, 2+ telemedicine visits) and poor BP control, adjusting for demographic and clinical characteristics. Results: During the study period, no BP was recorded for 486/20,745 (2.3%) patients with in-person visits only, for 1,863/6,878 (27.1%) patients with 1 telemedicine visit, and for 1,277/5,104 (25.0%) patients with 2+ telemedicine visits. After adjustment, telemedicine use was associated with poor BP control (odds ratio [OR], 2.06, 95% confidence interval [CI] 1.94 to 2.18, p<0.001 for 1 telemedicine visit, and OR 2.49, 95% CI 2.31 to 2.68, p<0.001 for 2+ telemedicine visits;reference, in-person visit only). This effect disappears when analysis was restricted to patients with at least one recorded BP (OR 0.89, 95% CI 0.83 to 0.95, p=0.001 for 1 telemedicine visit, and OR 0.91, 95% CI 0.83 to 0.99, p=0.03 for 2+ telemedicine visits). Conclusions: BP is less likely to be recorded during telemedicine visits, but telemedicine use does not negatively impact BP control when BP is recorded.

Backward-Design Model for an Astronomy Course Using RSpec

The new normal imposed on us by the COVID-19 pandemic restricted the traditional ways we would teach high school students who are eager to participate in introductory astronomy projects on our university campus. This turned out to be a blessing in disguise as we were forced to come up with creative ways to get around this obstacle. The outcome is an outline of a pedagogically sound and even more robust instructional plan for an astronomy course using RSpec in conjunction with freely available databases. In addition to the traditional topics, the new model will allow an instructor to explore emission lines of variable Be stars like Gamma Cas and the classification of supernovae by an interpretation of their spectra. We argue that this new model should be used even if we return to the old normal. © 2021 Author(s).

Experiences, challenges and potential solutions of generalist palliative care in inpatient setting during the SARS-CoV2 pandemic

Background: During the SARS-CoV-2 pandemic all health care systems faced enormous challenges. Due to increased severity of illness, palliative care patients continued to require comprehensive care. In order to provide general palliative care during a pandemic, experiences of staff should be utilized. Aim: Description and analysis of experiences, challenges and potential solutions of multiprofessional hospital staff in general palliative care with regard to care of severely ill and dying patients (with/without SARSCoV- 2) and their relatives. Method: After ethical approval qualitative semi-structured online focus groups were conducted. Individual interviews were also used when necessary. The results were recorded, transcribed, and analysed with the qualitative content analysis by Kuckartz. Results: Five focus groups having four to eight participants and one additional individual interview were conducted. The participants either work in intensive care, isolation wards or with patients being exceedingly burdened (e.g. dementia). Fifteen main categories with two to eight subcategories were formed. Patients, relatives and staff as well as visitation regulations and farewell were elaborated as most important main categories. Subcategories are for example insecurity, strain and reprocessing or with regards to visitation: restraints, guidelines or exceptions. The biggest challenge addressed by all interviewees were visitations as the restrictions caused a lot of suffering for everyone involved. Discussion: Current general precautions and general palliative care are insufficiently meeting the needs of severely ill and dying patients. Their needs are still existing throughout the pandemic and should be addressed accordingly. Interprofessional and -disciplinary cooperation is a precondition for individualised care of seriously ill patients and their relatives. Measures preventing infections (e.g. concepts) should be transparently communicated in hospitals. Funding: BMBF.

Interdisciplinary palliative care during the first SARS-CoV-2 pandemic phase in german hospitals

Background: The SARS-CoV-2 pandemic challenged interdisciplinary cooperation between hospital staff and specialized palliative care (SPC) by facing sudden restrictions, yet dying patients still required comprehensive palliative care. Aim: Examination of interdisciplinary cooperation from the point of generalist palliative care between hospital staff and SPC during the SARS-CoV-2 pandemic in German hospitals as a part of a multicenter project (PallPan). Method: A 43-Items-questionnaire was developed based on literature and semi-structured qualitative interviews concerning the first pandemic phase and was sent to hospital staff via the online platform UniPark (n=10.357). Excluded were inhospital specialized palliative care. Interviewees were able to answer the questions beginning from 01/12/20 until 20/01/21. The data was analyzed via SPSS and descriptive statistics and cross tables were done. Results: In total 550 hospital staff did answer the questionnaire and after exclusion of SPC-respondents 530 questionnaires were analyzed. While 32.4% (n=159) did not have the possibility to include SPC into the care process, 74.1% (n=215) did often incorporate SPC in their daily work. There was a significant discrepancy for SPC-co-management regarding Covid-19 positive (46.6%, n=152) and Covid-19 negative patients (69.9%, n=228, p= < .001). Most hospital staff considered additional support by SPC as helpful (83.1%, n=368). This contains mainly easily accessible information (69.0%, n=254) and training in palliative care (63.9%, n=235). Discussion: Inhospital SPC was present in the pandemic, yet there is space for improvement. The discrepancy concerning SPC-co-management at the patients' bed is one major issue that needs to be addressed. In order for a comprehensive care SPC should provide training and easily accessible information to generalist palliative care during and outside a pandemic.

The association between sleep and psychological distress among New York healthcare workers during the COVID-19 pandemic

Introduction: Healthcare workers (HCWs) treating patients with COVID-19 report high rates of acute stress, depressive and anxiety symptoms. We examined whether sleep disturbances were associated with psychological distress in New York City (NYC) HCWs during the initial peak of COVID-19 in-patient admissions (April 9 - May 11, 2020). Methods: HCWs (physicians, nurses, and advanced practice providers) completed a web-based survey which screened for acute stress (4-item Primary Care PTSD screen), depressive symptoms (Patient Health Questionnaire-2), and anxiety (2-item Generalized Anxiety Disorder scale). Past week insomnia symptoms were assessed with a modified item from the Insomnia Severity Index (5-point Likert Scale: none, mild, moderate, severe, very severe). Insomnia was defined as having “moderate, severe, or very severe” symptoms. Short sleep (SS) was defined as self-reported sleep duration <6 hours per day. Poisson regression analyses predicting psychological distress from SS and, separately insomnia. adjusting for age, gender, race/ethnicity, clinical setting (COVID-focused or not COVID-focused), physician vs. nonphysician status, and redeployment status, were performed. Results: Data included 813 HCWs (80.6% female, 59.0% White, 75.6% worked in a COVID-focused setting). Mean sleep duration was 5.79 ± 1.22 hours/night. The prevalence of SS and insomnia were 38.8% and 72.8%;the prevalence of acute stress, depressive symptoms, and anxiety were 57.9%, 33.8% and 48.2%, respectively. Having SS, vs. not was associated with acute stress (adjusted prevalence ratio [PR]: 1.21, 95% CI: 1.07, 1.31), depressive symptoms (PR: 1.65, 95% CI: 1.35, 2.02), and anxiety (PR: 1.51, 95% CI: 1.30, 1.74). Presence of insomnia symptoms vs. “none or mild” was associated with acute stress (PR: 1.92, 95% CI: 1.57, 2.34), depressive symptoms (PR: 3.13, 95% CI: 2.16, 4.52), and anxiety (PR: 2.40, 95% CI: 1.86, 3.11). Conclusion: Among NYC HCWs, sleep disturbances, including SS and insomnia symptoms during COVID-19 are common. In our study, SS and insomnia were associated with acute stress, depressive symptoms, and anxiety in HCWs, however further research on whether a bidirectional relationship exists between sleep and psychological distress during the COVID19 pandemic are still needed.

COVID-19 and obstructive lung disease: Are COPD and asthma risk factors for severe COVID-19? evaluating the data from the largest health system in New York State

RATIONALE: An analysis of data collected between March 1, 2020 through July 1, 2020 from the largest health system in New York sought to investigate the association between COVID-19 and obstructive lung disease including asthma and chronic obstructive pulmonary disease (COPD). Methods: A total of 21,865 patients were included in the analysis, 2,518 had obstructive lung disease and COVID-19. There were 1,370 [HA1] patients who had asthma and COVID-19, and 847 patients had COPD and COVID-19. There were 301 patients who had overlapping asthma and COPD diagnoses. There were 19,347 patients who had a diagnosis of COVID-19 without asthma or COPD. Logistic regression analysis of the data was performed. Results: Analysis of our data showed COPD patients with COVID-19 were more likely to be intubated as compared to the control group (OR 1.346 95% CI 1.061-1.707 p=0.0095). Additionally, there was no association between COPD and mortality in patients with COVID-19 (OR 0.845, 95% CI: 0.685-1.042 p=0.1436). There was no association between asthma and COVID-19 and intubation (OR 1.175 95% CI 0.936-1.475 p=0.2193). There was no statistical association between asthma and mortality in patients with COVID-19 (OR 0.849 95% CI 0.669-1.079 p=0.2455). However, patients with asthma were at a decreased risk of dying from COVID-19 compared to COPD patients with COVID-19 even after controlling for comorbid conditions (OR 0.718, 95% CI 0.526-0.979 p=0.0329). Patients presenting with asthma exacerbation or COPD exacerbation in the setting of COVID-19 infection were not at increased risk of death as compared to COPD or asthma patients with COVID-19 (Asthma exacerbation OR 1.042, 95% CI 0.62-1.73 p=0.8796), (COPD exacerbation OR 0.95 95% CI 0.67-1.36 p=0.762). Conclusion: Our finding with regards to intubation may be explained by an aggressive approach early on in the pandemic towards intubation especially in patients that may have been perceived as high-risk patients' due to underlying lung disease. Our data also showed no association between COPD and death in COVID-19 and asthma and mortality in COVID-19-meaning COPD and Asthma were not risk factors for death in our patient population. As to why asthma patients were at decreased odds of dying compared to COPD patients may be related to the different pathophysiological mechanisms of asthma as compared to COPD or a small protective effect of inhaled corticosteroids. Lastly, presenting with an asthma exacerbation or COPD exacerbation in the setting of COVID-19 infection did not increase your odds of mortality.

[General palliative care during the pandemic]. / Allgemeine Palliativversorgung in Pandemiezeiten.

BACKGROUND: The German healthcare system is facing unprecedented challenges due to the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic. Palliative care for critically ill patients and their families was also severely compromised, especially during the first wave of the pandemic, in both inpatient and outpatient settings. MATERIALS AND METHODS: The paper is based on our experience in routine inpatient palliative care and partial results of a study conducted as part of the collaborative project "National Strategy for Palliative Care in Pandemic Times (PallPan)". Based on our experience from the inpatient care of patients suffering from severe or life-limiting disease, best-practice examples for improving or maintaining care in the on-going pandemic are described. RESULTS: Restrictive visitor regulations, communication barriers and insufficient possibilities to accompany dying patients or their grieving relatives continue to pose major challenges in general and specialized inpatient palliative care. In order to maintain high-quality palliative care, it is necessary to create structures that enable targeted therapy discussions and end-of-life care in the presence of relatives. Therefore, innovative communication methods like video calls or individualized exceptions from visitor restrictions are needed. CONCLUSIONS: Adequate care for seriously ill and dying patients and their relatives must be guaranteed during the pandemic. Individual arrangements should be arranged and implemented. If available, earlier involvement of specialized palliative care teams can be beneficial.