‘A Heart-Wrenching Thing’: Hospital Bans on Visits Devastate Families

https://www.nytimes.com/2020/03/29/health/coronavirus-hospital-visit-ban.html

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The last time Peter John Dario saw his father alive was on March 14, at the entrance to a hospital in Edison, N.J. An employee took him away in a wheelchair, telling Mr. Dario and his mother gently but unequivocally that they could not go in the building.

In a fog of worry and confusion, as he watched his father’s diminished silhouette disappear through the door, Mr. Dario forgot to say goodbye.

Five days later, his father, Peter Dario, died of respiratory failure from an infection caused by the coronavirus. He was 59. None of the members of his large family — several of them now also sick with Covid-19 — were at his side.

Of all the ways the coronavirus pandemic has undermined the conventions of normal life, perhaps none is as cruel as the separation of seriously ill patients and their loved ones, now mandated at hospitals around the world.

Hospitals in all 50 states and dozens of countries are barring visitors. Lobbies are bare, visitor parking lots empty, flower deliveries stopped. The number of accessible entry points has been reduced, and security guards and staff are posted at those that remain to turn away patients’ relatives and friends.

“It’s a heart-wrenching thing to do,” said Dr. Laura Forese, executive vice president and chief operating officer of NewYork-Presbyterian Hospital in New York. “But it’s for everyone’s protection.”

At most hospitals, exceptions are being made only for patients receiving end of life care, hospitalized children and pregnant women in labor.

Last week, after New York-Presbyterian discovered that multiple pregnant and postpartum patients in its labor and delivery unit had Covid-19 — with minimal or no symptoms — it barred all visitors, including partners. Mt. Sinai Hospital System followed suit. But on Saturday night, following an outcry from expectant parents, Gov. Andrew M. Cuomo signed an executive order requiring all medical facilities licensed by New York State to allow one support person for patients who are in labor.

“This disease has demonstrated to us just how vulnerable the greater community can be when we have a virus circulating that no one has any immunity to,” said Nancy Foster, a vice president of the American Hospital Association. “And that extraordinary reality has forced us to take extraordinary measures.”

While the infection control rationale is clear and sound, the consequences — for patients, their loved ones and the hospital personnel who must enforce the rules — are profound.

Clinicians and hospital staff said keeping families away had been among the darkest experience of their professional lives. The restrictions run contrary to a hospital’s desire to keep patients and families together, not only for the salutary effect of something as simple as a hand held, or a chair pulled close to a bed, but because having a relative present can ease the workload of a medical team. It can also provide crucial information that a confused patient may not be able to offer.

Hospitals are receiving frequent requests for leniency, especially for patients in intensive care units.

“This isn’t easy but we have to deny the vast majority of them,” said Dr. Shereef Elnahal, president and chief executive of University Hospital in Newark, N.J., which is, like other hospitals, managing the requests on a case-by-case basis.

The restrictions raise distressing questions, especially when it comes to end-of-life visits. How close to the end of life must a patient be to merit a visitor? Is near death the right time? Why not earlier, when a patient is healthier, and of sound mind?

As is happening in Italy and elsewhere around the world, people like Peter Dario are dying alone, despite hospital exceptions for end-of-life visitors.

Peter Dario, who had diabetes and was on dialysis, started to look sick at the beginning of March, said his daughter Marsha Dario, 32, a nurse. His 86-year-old mother-in-law, who also lives in the household, was already sick with Covid-like symptoms.

When Marsha Dario picked her father up from dialysis on March 7, he was weak, dizzy and vomiting. She told him he needed to go to the hospital. But he refused.

His condition worsened. Struggling to breathe a few days later, he finally agreed to go to the hospital — but only if his wife, Luzviminda Dario, 63, came too. Although his wife was sick by then as well, she went. “They were inseparable,” said Peter John Dario, his son, who is 23.

The day after he was admitted to John F. Kennedy Medical Center, Peter Dario lay unconscious, intubated and on a ventilator. Three days later, on the night of March 19, the hospital called the family to say his fever had spiked and he was unstable. Finally, a nurse said one family member would be allowed in. The previous day, Luzviminda and Marsha Dario had received positive test results for the coronavirus and were in quarantine at home, so Peter John Dario rushed to the hospital. While he was being screened at the entrance for the symptoms of coronavirus infection, his father died.

Just as difficult is the prohibition of visits with patients who have other grave illnesses or are undergoing risky surgery.

This month, Brittany Sanchez, 32, was at home in Las Vegas getting her two small children ready for bed when she had a seizure and collapsed.

She was taken by ambulance to Valley Hospital Medical Center in Las Vegas. A scan revealed a brain tumor so aggressive that Ms. Sanchez needed immediate surgery.

Her mother, Heather Last, stayed at the hospital with her for two days, then went home to pick up a few things and feed the pets, only to get a call from Ms. Sanchez telling her that the visiting rules had changed and that she could not return.

The next morning, her parents went to the hospital anyway. A security guard refused to let them enter the building.

Updated June 22, 2020

A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

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The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.

So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.

Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.

A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.

Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.

“Heather said they’d have to call the police on her to keep her from going in,” her father, Don Last, said. Eventually both were allowed in.

A few days later, Ms. Sanchez was flown on a medevac jet to the University of California, San Francisco Medical Center for a major neurosurgical procedure. U.C.S.F., too, was in lockdown and Ms. Sanchez’s parents were not allowed in the hospital.

The surgery would be complex and dangerous. “There was a reasonable chance she was going to have a problem,” said Dr. Mitchel Berger, the neurosurgeon who performed the procedure. Dr. Berger tried and failed to persuade his hospital to make an exception to the no-visitor rule.

Ms. Sanchez’s father was beside himself. The night before the surgery, he sent Dr. Berger a text.

“You will have my daughter Brittany’s life in your hands tomorrow,” he wrote. “I expect you to treat her as if she were your own daughter. I will never forgive myself that I was not able to hold her hand through this. Bring her back home to me whole.”

The surgery lasted nearly seven hours. As soon as he was finished, Dr. Berger went to find the Lasts, who were waiting outside the hospital. From six feet away, he told them the surgery had gone well, and apologized again for being unable to allow them in.

“They said they knew it wasn’t my fault, but that I just couldn’t imagine what it would be like to be in that situation,” he said. “And they’re right. I couldn’t imagine it.”

Some hospitals are buying iPads to give to patients for virtual visits. Others are helping patients speak with their family and friends over FaceTime.

Dell Hutchinson, who lives in Oakland, Calif., would gladly have accepted a virtual visit with his wife, but she was too sick to use her cellphone. Mr. Hutchinson’s wife, Sandi Hutchinson, was hospitalized on Feb. 19 with a subarachnoid hemorrhage, bleeding around her brain. On March 15, the hospital stopped allowing visitors.

This left Mr. Hutchinson with one option: calling her room through the main switchboard. But she also could not operate the bedside telephone, Mr. Hutchinson said, which meant he had to hope there was a doctor, nurse or other staff member in the room to pick up when he called.

When Mr. Hutchinson did manage to speak to his wife, he wasn’t able to glean much. Her voice was monotonic. “Without being able to read her body language, how could I know how she was really doing?” he asked. “I couldn’t.”

Just as the Dario family was absorbing the news of Peter Dario’s death, tragedy swept through the household again. On Monday, Cresenciano Victolero, Luzviminda Dario’s 86-year-old father, weak and short of breath, was rushed to the same hospital where his son-in-law had died. No one was allowed to visit.

On Wednesday, a nurse called to say they were unable to maintain his blood pressure. A granddaughter headed to the hospital. Mr. Victolero died while she was en route.

“But they held pronouncing him until she got there,” Marsha Dario said. “The nurse cried with her.”