Hospitals Consider Opening Their Doors to Visitors Again

Last week, a family won their battle to visit their father who was dying of COVID-19 at a North Dakota hospital, sparking questions about whether hospitals should start opening their doors to visitors once again.

Many hospitals have generally allowed one visitor for labor and delivery, for a pediatric patient, and in some instances, for patients with dementia. But now that coronavirus hospitalizations are going down in many states, and since hospitals have a more robust supply of personal protective equipment (PPE), some clinicians are calling for more flexible visitor policies.

"It is time to rethink what has become national policy of not allowing families into hospitals," Cameron Kyle-Sidell, MD, of Maimonides Medical Center in New York City, said on Twitter. "Patients are missing their #1 advocates and that is not a small thing to miss. We SHOULD be able to protect family members who are in turn protecting our patients."

Several sources confirmed to MedPage Today that in many instances, especially later in the outbreak in New York, family members were indeed able to come into the hospital to see their family members at the end of their lives -- so trends have already been moving in that direction.

On Tuesday, Gov. Andrew Cuomo announced a pilot project at 16 hospitals around the state to begin to allow visitors. Maimonides Medical Center, where Kyle-Sidell works, is one of those sites, along with hospitals in the Northwell Health, NewYork-Presbyterian, NYU Langone, and Mount Sinai health systems.

Visits will be time-limited, and visitors will have to wear PPE and will be subject to temperature and symptom checks, Cuomo said.

"It is terrible to have someone in the hospital and that person is isolated and not able to see family and friends," Cuomo said during a press briefing. "I understand the health reasons for that. We were afraid of the virus spreading. But this is a pilot project to see if we can bring visitors in and do it safely."

As of press time, the Greater New York Hospital Association hadn't returned a request for comment as to what benchmarks will have to be met in order for the pilot project to be continued beyond 2 weeks or expanded.

Cleavon Gilman, MD, an emergency medicine resident at NewYork-Presbyterian, said it's the right time to reconsider visitor policies.

"These patients are dying alone," Gilman told MedPage Today. "And it's put a burden on healthcare providers to be there with them in their last seconds on this earth."

"It's horrible when you have to hold your phone up and FaceTime family members and show them how critically ill their loved one is," he added. "They cry on the phone, they're screaming. It's hard to see parents, or siblings, or a child like that."

Gilman said that with "proper PPE and a mask, they can go in there and be protected."

David Reich, president and chief operating officer of the Mount Sinai Hospital in New York City, said things have shifted since limited-visitor policies were first put in place.

"Staff were feeling very unsafe in the early days of COVID," Reich told MedPage Today. "The combination of staff anxiety, as well as the undeniable risk with such widespread transmission in the community, led to hospitals shutting down relatively tightly."

"One of the most important things for people to recover is the support of the people who love them," Reich added. "To have that wholly electronic was challenging. Now that death rates are down, and new cases have come down to a quarter of what they were from the peak, we've reached a point where we can manage things better."

"It's still a crisis, just less of a crisis," he continued. "We're confident that staff have grown in their ability to manage visitors in these units. We have better techniques for educating visitors about how best to protect themselves."

Many clinicians are still cautious about what bringing in additional visitors will mean in terms of disease control, since the virus remains as transmissible as it was at the beginning of the first wave. Decisions may also be dependent on new case trends and PPE supply in various parts of the country.

Suraj Saggar, DO, chief of infectious diseases at Holy Name Hospital in Teaneck, New Jersey, the site of one of the state's earliest outbreaks, said his hospital will carefully consider when it's safe to re-open their doors to visitors outside of laboring mothers or pediatric patients.

"You have to think about possible breaches in infection prevention security," Saggar said. "We're still limiting the number of visitors coming in and that will probably stay in effect for the short and medium term."

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