Mass Suicide of COVID-19 Patient’s Survivors; a Clinical Experience

We had just started our shift at the emergency department that day, when a highly agitated pale middle-aged woman was brought to the emergency department by the emergency medical service (EMS). Behind her were 5 of her family members, 3 were her children and the other 2 were her sister and her brother in law. She was immediately transferred to the cardiopulmonary resuscitation (CPR) room and cardiac and respiratory monitoring were provided, central venous access was established (due to lack of peripheral vascular access because of severe hypotension), and fluid infusion was performed. During the time these services were provided, a history was taken from her relatives. The patient’s children were the ones who provided the history: apparently, their father had died 20 days before due to COVID-19. Dealing with his death was difficult for them, especially for their mother, due to the strong emotional bond with the father. The whole family had decided to commit suicide by consuming rice tablet (aluminum phosphide). On the day we met them, the mother takes an unknown number of aluminum phosphide tablets without the children knowing and then drinks instant coffee on the balcony, after which she develops symptoms and is brought to the emergency department. After a little while, the mother develops cardiorespiratory arrest in CPR, she is intubated and resuscitation is performed and her cardiac rhythm returns for 1 hour, but then develops arrest again and her heart stops beating despite cardiac resuscitation.