No visitors allowed: We need humane hospital policy during COVID-19
Most people in Washington are not big fans of executive authority. When used, it should be targeted to address a specific problem; limited in scope; and focus on an issue that needs resolution quickly. As the COVID-19 crisis wears on, however, I’m starting to think we may need to use such authority when it comes to affording leniency for some hospital visits.
I’m not suggesting that we allow routine visitors to the hospital during this epidemic. No one thinks that. Yet, for those just beginning their life, and for those at the end of life, we might need to rethink current policies, and balance multiple interests.
Yes, there are good, scientific reasons to prohibit visitors to the hospital. We must prevent spread of the COVID-19 infection, especially given that we will likely face a peak in cases and deaths in a few weeks. The lack of a vaccine, no proven treatments, and a shortage of personal protective equipment (PPE) have created significant risk for everyone in the hospital, especially for front-line health care workers. It is unconscionable that people are working without adequate protection, and we need to address it urgently.
Yet, we also need to manage and stratify risk versus benefits. In some circumstances, we need to consider if are we doing more harm than good, and perhaps a more surgical approach, rather than a sledgehammer, may be warranted.
There are benefits to hospital visits. No one would disagree that a child’s birth is a special moment and should be celebrated. Because of coronavirus, many women are forced to deliver their child with no family or friend present — only their doctors and nurses. It’s not just about sharing that special moment but also a recognition that spouses and family members provide much-needed emotional support. Being alone creates more stress and anxiety, which can impact delivery. Given the shortage of nursing staff, family and friends can play an important role in monitoring both mom and baby. Under the right circumstances, can one or two other people be allowed limited admittance? What’s the real risk, if properly controlled?
Some hospitals are allowing one visitor for childbirth but, despite pleas, others are not making any exceptions. This led the governor of New York to issue an executive order that requires hospitals to allow one support person in labor and delivery settings. This order does require that any visitor be asymptomatic for COVID-19 and must not be a suspect or recently confirmed case. Additionally, hospital staff must screen the visitor for symptoms of COVID-19. This truly is a sensible policy. Other states need to follow.
End-of-life is also an issue that needs to be addressed where we may need an exception. I have heard from many colleagues how incredibly painful it is to deny access to family members, preventing them from being with loved ones during the final hours. I know some hospitals are using videoconferencing, but I don’t think that’s the right platform for most people in this circumstance. It is heartbreaking that patients are breathing their last breaths without loved ones present. How can that be good policy?
Remember, this doesn’t only affect patients suffering from COVID-19 but other dying patients as well. One remedy is to increase use of hospice care for non-COVID19 patients/caregivers so they can choose to be at home during their last days. But for those suffering from COVID-19, how can we allow visitors while minimizing risk to everyone?
We need to stop framing it as either protecting health care workers versus allowing visitors. How can we do both, in limited circumstances, while managing risk in a thoughtful way? No one wants to come in this world alone or die alone. If hospital officials can’t create a more rational policy, state or federal authorities might need to step in.
Dr. John Whyte is the chief medical officer at WebMD. He is a practicing physician in the metro DC area, and is a former FDA and CMS official.