More than a year into the coronavirus pandemic, hospitals are still limiting visitors for patients, especially those sick with COVID-19, even as more than 4.1 million people in Massachusetts are fully vaccinated and society shifts toward normalcy.
Very often, visitors are capped at one or two at a time per patient, a reminder that infection prevention is still a great concern for hospitals that were swarmed with COVID patients for much of the past 15 months and contended with outbreaks among their staff.
Patients who are hospitalized for COVID often cannot have any visitors — unless the patient is dying, so that family members can say goodbye. Nearly 100 people in Massachusetts remain hospitalized for COVID, about one quarter of them in intensive care.
While the visitation restrictions may help prevent the virus from spreading, they are in some cases prolonging one of the most wrenching aspects of the pandemic: patients suffering alone, while family members worry from a distance, unable to hold a hand or offer comfort.
Hospital officials acknowledge the struggle between safety and compassion and say they’re trying to strike the right balance. But even some doctors are wondering whether tight restrictions should remain, with more than 71 percent of adults in the state fully vaccinated and the level of COVID plummeting from its winter peak.
“It feels like we’ve added barriers to delivering smooth, excellent care that are unnecessary at this point,” said Dr. Daniela Lamas, a critical care physician at Brigham and Women’s Hospital.
Now that vaccinated people can roam maskless in stores and restaurants, she said, hospital visitor policies also should evolve.
Lamas said she asks for exceptions so her patients in the ICU can have visitors. But, she said, “if we’re relying on exceptions, maybe the rules should change.”
When Renee Eger contracted COVID last year, she spent six days in a room at the Brigham almost completely alone, struggling to breathe and to walk to the bathroom. Eger tried not to call for help because the nurse entering her room would have to wear protective equipment, which at the time was scarce.
Eger wishes her husband could have been with her, helping her move around and talking to her nurses and doctors when she didn’t have the energy to. But he was not allowed to visit.
“When you’re as sick as I was, it was really hard for me to communicate with anyone. That’s where having a family member would have helped me,” said Eger, 58, who works as an OB-GYN in Rhode Island.
“I was just desperately trying to rest,” she said.
Patients in isolation have been getting by with phone and video calls. For the very sickest people, who are sedated and breathing with the help of a ventilator, nurses sometimes hold an iPad so family members can see them from afar.
A change in state public health guidance this month allowed hospitals to loosen restrictions, but they still must screen visitors for fever, cough, and other COVID symptoms, and record their names in case there’s a need for contact tracing. For patients who are sick with COVID, visits should be reserved for “compassionate care situations,” according to the Department of Public Health.
The rules vary across hospitals. Beth Israel Deaconess Medical Center and UMass Memorial Medical Center, for example, said COVID patients are eligible for visitors only at the end of life.
At Massachusetts General Hospital, visitors are allowed for COVID patients who are dying, and sometimes in other circumstances, such as when a family member may be needed to help make a decision about medical care, said Dr. Kathryn Hibbert, director of the medical ICU at MGH.
Officials at Tufts Medical Center, meanwhile, said they have tried to be more more flexible, allowing families to visit infectious patients on a “case-by-case basis.”
At all these hospitals, teams of doctors and nurses have daily discussions about which patients should get visitors and when.
“There’s a struggle here,” said Dr. Erica Shenoy, associate chief of infection control at MGH. “We know that visitors are so important for the mental well-being of the patient, and also are an important part of the whole care team in the sense that they support the patient’s recovery. At the same time, the guidance we have from public health [officials] is really to limit visitation to these patients.”
Though being vaccinated would significantly lower a visitor’s risk of catching and spreading the virus, Shenoy and other doctors said it’s not practical to ask visitors if they have been vaccinated.
And whether vaccinated or not, anyone who enters the room of a COVID patient must wear personal protective equipment: a mask, face shield, gown, and gloves.
All visitors and staff at hospitals must continue to wear face masks, though vaccinated employees now can unmask in certain areas not open to patients or the public.
The current rules, though less rigid than they were earlier in the pandemic, are a long way from pre-COVID times, when visitors came and went freely, sometimes sleeping overnight on waiting room couches to be close to their loved ones.
Hospital rules could change again, depending on vaccination rates and the level of COVID in the community.
“We would like to be fully open to visitors,” said Dr. Shira Doron, hospital epidemiologist at Tufts Medical Center.
“We long for a day when there aren’t even these additional requirements,” she said. “One day things will change, but it’s hard to predict.”