Hospitals weigh easing virus-patient visit rules

Mental health in balance, experts say

Nurses carry coolers of the Sinopharm covid-19 vaccine Wednesday as they go house to house to vaccinate residents in the Villa Maria del Triunfo neighborhood of Lima, Peru. The country is averaging 743 new infections a day, and slightly more than 45% of its population has been vaccinated.
(AP/Martin Mejia)
Nurses carry coolers of the Sinopharm covid-19 vaccine Wednesday as they go house to house to vaccinate residents in the Villa Maria del Triunfo neighborhood of Lima, Peru. The country is averaging 743 new infections a day, and slightly more than 45% of its population has been vaccinated. (AP/Martin Mejia)

MIAMI -- A year and a half into a pandemic that has killed 700,000 people in the U.S., hospitals in at least a half-dozen states have loosened restrictions governing visits to covid patients. Others, however, are standing firm, backed by studies and industry groups that indicate such policies have been crucial to keeping hospital-acquired infections low.

Some families of covid-19 patients -- and doctors -- are asking hospitals to rethink that strategy, arguing that it denies people the right to be with loved ones at a crucial time.

"We need to get people thinking about that risk-benefit equation," said Dr. Lauren Van Scoy, a pulmonary and critical care physician at Penn State Health who has researched the effects of limited visits on the relatives of covid-19 patients. She said she was referring to "the risk of getting covid versus the risk of what we know these families are going through, the psychological and emotional harm."

Van Scoy said many of the family members she has interviewed have shown signs of post-traumatic stress disorder. In newspaper op-ed pieces, doctors have shared conversations with patients who declined or postponed crucial treatments because of the visiting restrictions.

And studies conducted before the pandemic have shown that older patients in intensive care units that restricted visits developed delirium at higher rates than those in units with more flexibility.

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Van Scoy agrees that it made sense at the beginning of the pandemic to restrict visits because protective equipment and covid-19 tests were in short supply and there weren't any vaccines. But now, testing and vaccinations have vastly expanded, and doctors say screening mechanisms and personal protective equipment can keep the virus at bay.

Nonetheless, the U.S. Centers for Disease Control and Prevention still recommends against in-person visits for infected patients. The nation also has a long way to go in the covid-19 battle, said a leader in that fight Wednesday.

"We've got to do better than that. We need to get the curve to go much further down," Dr. Anthony Fauci said in a briefing of the White House Coronavirus Task Force. "Eighty- or ninety-thousand cases a day is not where you want to be."

The average number of cases has dipped by 12% in a week to about 92,000, said Dr. Rochelle Walensky, director of the CDC. Hospitalizations are down 11% and deaths, which normally lag behind the other indicators, have declined by 5%.

"We do not take lightly the sacrifices we are asking individuals and their loved ones to make. We would not do so unless it was absolutely necessary," Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association, said of the patient restrictions.

Ann Marie Pettis, president of the Association for Professionals in Infection Control and Epidemiology, acknowledged that patients benefit from having visitors but said the group still discourages it in most cases.

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"I don't know of any place that doesn't try very hard because families are incredibly important for the patients' well-being," Pettis said. "These are heartbreaking decisions that have to be made."

Jeremy Starr, a 36-year-old electric utility lineman from Jacksonville, Fla., is familiar with such heartbreak.

Starr, who contracted the virus in the summer, remembers being thirsty, alone and unable to sleep while hospitalized for 14 days in an intensive care unit.

"The non-breathing was bad enough, but not to see your loved ones is the worst," he said. "It felt like you were not a human."

Jayden Arbelaez, who was banned from the Florida hospital room where her mother lay dying of covid-19, pitched an idea to construction employees working nearby.

"Is there any way that I could get there?" Arbelaez asked them, pointing to a small third-story window of the hospital in Jacksonville.

The workers gave the 17-year-old a yellow vest, boots, a helmet and a ladder to climb onto a section of roof so she could look through the window and see her mother, Michelle Arbelaez, alive one last time.

Kirsten Fiest, an associate professor of critical care medicine at the University of Calgary who is studying the effect of isolation on covid-19 patients, said family members are also caregivers who can lighten the burden of stressed-out health care workers in ICUs.

Inspired by the stories of Starr, Arbelaez, and others like them, Darlene Guerra of Jacksonville started an online petition asking Florida Gov. Ron DeSantis to push for more access. DeSantis was an early proponent of reopening nursing homes to visitors, saying he felt that banning them contributed to the suffering of families.

"It's heartbreaking for all these families," Guerra said. "We are going to work, we are going to church, we are going to the store, but we can't go to the hospital and be with our loved ones?"

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Some doctors say health networks are worried about nurse shortages and keep restrictions in place to avoid adding stress to already exhausted health care workers. Others say the process of screening visitors and instructing them how to wear protective equipment also takes time from health care staff.

"I think the position is coming from a place of fatigue and burnout rather than what is good for patients," Van Scoy said.

Some hospitals have allowed people to visit coronavirus patients. The University of Utah Health earlier this year announced that its hospitals would allow up to two adult visitors for the entire hospital stay, provided they remained in the patient's room and wore personal protective equipment at all times, did not have symptoms and were either vaccinated or had recently recovered from covid-19.

Many have made exceptions only for coronavirus patients who are about to die, which was the case at the Jacksonville hospital caring for Arbelaez's mother. The family says the rules were inconsistent: On some days, administrators allowed only one family member to visit; on others, several visitors were permitted. On the last day, only Arbelaez's father, Mitch Arbelaez, was allowed. It happened to be his birthday.

From her perch on the hospital roof, the distraught teen picked up her cellphone, called her dad and sang "Happy Birthday" to him as she peered through the window and gazed at her mother, unconscious on a ventilator.

Hours later, her mom died, alone.

BOOST OR NOT TO BOOST

In developments Wednesday, preliminary data from a federal clinical trial indicated that people who received a Johnson & Johnson coronavirus vaccine may be better off with a booster shot from Moderna or Pfizer-BioNTech.

In a study conducted by the National Institutes of Health, researchers organized nine groups of roughly 50 people each. Each group received one of the three authorized vaccines, followed by a booster. In three groups, volunteers received the same vaccine for a boost. In the other six, they switched to a different brand.

The researchers found that those who got a Johnson & Johnson shot followed by a Moderna booster saw their antibody levels rise 76-fold within 15 days, whereas those who received another dose of Johnson & Johnson saw only a fourfold rise in the same period. A Pfizer-BioNTech booster shot raised antibody levels in Johnson & Johnson recipients 35-fold.

The authors cautioned about the study's small size and noted that they did not follow the volunteers long enough to identify rare side effects.

That finding, along with a mixed review by the Food and Drug Administration of the case made by Johnson & Johnson for an authorization of its booster, could lead to a heated debate about how and when to offer additional shots to the 15 million Americans who have received the single-dose vaccine.

The agency's panel of vaccine advisers will meet today and Friday to vote on whether to recommend that the agency allow Moderna and Johnson & Johnson to offer booster shots.

Despite the questions raised by the new data on the strength of Johnson & Johnson's boosters, some experts anticipated that the agency would clear the shots anyway, since the effectiveness of the one-shot vaccine is lower than that of the two-dose mRNA vaccines made by Moderna and Pfizer-BioNTech. And the broader public may also be expecting the authorizations, given the Biden administration's push for boosters from all brands.

Once the agency authorized a booster from Pfizer-BioNTech last month, "the die was cast," said John Moore, a virus expert at Weill Cornell Medicine.

For those who have received the Johnson & Johnson vaccine, the timing of a booster authorization -- of any brand -- is still uncertain. The FDA panel is set to vote Friday only on whether the agency should permit a second dose of the Johnson & Johnson vaccine, a scenario the CDC's own vaccine advisory committee will discuss next week. If both agencies believe an additional dose should be offered, people could seek them out as early as next week.

Information for this article was contributed by Adriana Gomez Licon of The Associated Press; by Dave Goldiner of New York Daily News (TNS); and by Carl Zimmer and Noah Weiland of The New York Times.

Portrait of Jayden Arbelaez in Jacksonville, Fla., Wednesday, Oct. 13, 2021.  Banned from the Florida hospital room where her mother lay dying of COVID-19, Jayden Arbelaez pitched an idea to construction employees working nearby.  The workers gave the 17-year-old a yellow vest, boots, a helmet and a ladder to climb onto a section of roof so she could look through the window and see her mother, Michelle Arbelaez, alive one last time. (AP Photo/Gary McCullough)
Portrait of Jayden Arbelaez in Jacksonville, Fla., Wednesday, Oct. 13, 2021. Banned from the Florida hospital room where her mother lay dying of COVID-19, Jayden Arbelaez pitched an idea to construction employees working nearby. The workers gave the 17-year-old a yellow vest, boots, a helmet and a ladder to climb onto a section of roof so she could look through the window and see her mother, Michelle Arbelaez, alive one last time. (AP Photo/Gary McCullough)

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