Visiting Hours: Time to Re-evaluate Restrictions Caused by COVID

As respiratory virus season nears, this would normally be the time hospitals would work to start planning for flu vaccination distribution and metrics for visitor restrictions. This year though … things are different. Normally visitor restrictions are about limiting the number for each patient, and no children under the age of 12. Visitor restrictions though, in the era of coronavirus disease 2019 (COVID-19) is vastly different.

For many, we have just started to have conversations about relaxing visitor restrictions that were implemented for COVID-19. Most hospitals have implemented stringent visitor restrictions that don’t allow anyone to visit, even during end of life. While an understandable public health and infection prevention measure, it has generated some concern. Hospitals have scrambled to find ways to ensure that families and loved ones are able to stay up to date and help make stressful medical decisions in this remote setting.

From ensuring calls several times a day to providing tablets for video chatting, these are measures that had to be quickly enacted for not only medical care, but also patient and family satisfaction. As Jason Karlawish, MD, noted in his op-ed about this very issuein STAT, “When this pandemic is over, we ought to compare the outcomes of care in hospitals that recognized the role of caregiver and had programs like HELP and those that did not. I’d bet we would find that when caregivers were present, resources and lives were saved. Even more valuable will be the dignity we preserved when faced with a pandemic that threatened humanity. With these insights, we’ll change ‘visitor rules’ to recognize the need for a caregiver for persons with cognitive impairment.”

Now though, as we move to open things a bit in areas with lower community transmission, the question is – how do we relax things safely? Masks for all, but what if a visitor refuses to wear a mask? Many are opting to limit visitors to one per patient in an incremental process. The challenge though, will be doing this slowly as to avoid straining visitor screening measures.

One thing we’ll have to consider is how will this impact the potential for healthcare-onset cases of COVID-19. With universal masking in hospital still, the potential for a visitor to remove their mask or introduce COVID-19 to a patient is much more likely, especially with a disease that is frequently asymptomatic. This piece will be particularly challenging as the asymptomatic aspects of COVID-19 make healthcare-associated cases highly dependent on testing – but how often? Aside from testing on admission, should patients be screened as they are allowed visitors?

Therein lies the challenge of infection prevention in a COVID-19 world – the nuances that make healthcare-associated cases hard to understand and much more complex than just an incubation period. Moreover, this also begs the question if a healthcare-onset definition for COVID-19 will be present in the 2021 Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) chapters that we rely on for surveillance. These critical pieces need to be addressed as we not only navigate the longevity of the COVID-19 pandemic, but also consider the role of visitors.