As the COVID-19 pandemic continues, hospitals should consider whether their visitor policies are too restrictive and potentially adopt more nuanced policies that account for community transmission of the virus, careful use of personal protective equipment and vaccine status, according to a group of doctors in Canada.

Many hospitalized patients lacked support this year and struggled emotionally, particularly in intensive-care units, the group writes in the Canadian Medical Association Journal.

“Despite how busy our ICUs were during the first wave of the pandemic, the absence of family presence was palpable,” said lead author Dr. Laveena Munshi of Mount Sinai Hospital in Toronto.

“Families and designated care partners are essential members of patient-centered care in the ICU and their role extends beyond comfort,” she told Reuters Health by email. “They are patient advocates, they help minimize the impact of delirium, they listen in on our daily ICU rounds and add their insight, and they are substitute decision makers during times when we cannot communicate with patients.”

Dr. Munshi and colleagues discuss the research behind hospital visitor policies, ways to bring family members to the bedside safely and how to communicate with family members if they can’t visit. During the first wave of the pandemic, they found, hospitals across Canada adopted “no visitor” policies that barred nearly all visitors in an effort to prevent the spread of COVID-19 and reserve personal protective gear for healthcare workers.

As scientists and public-health researchers have learned more about COVID-19, though, more flexible policies may be useful, the authors suggest. Previous studies of visitor policies for the flu and other respiratory diseases found that the benefits of allowing visitors outweigh the harms, especially when visitors wear masks.

Studies have shown that family members and caregivers provide emotional support, help with language barriers, play a role in end-of-life decisions and assist with daily activities such as feeding and mobility.

Hospitals could adapt their policies to distinguish between general visitors and immediate family members or designated caregivers, the authors write, and allow certain visitors in ICUs, hospices, surgical recovery wards and labor and delivery units. Face masks, rigorous cleaning procedures and visitor screening with rapid COVID-19 tests could help as well.

Hospitals should also consider the best ways to communicate with family members and caregivers as the pandemic continues, the authors write. In areas with a high rate of COVID-19 transmission or in instances where visitors aren’t allowed, healthcare workers could use video conferencing tools to allow patients to connect with others. When feasible, some hospitals may be able to coordinate visits in outdoor spaces.