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Opinion Isolating Patients During Disease Outbreak: We Can Do Better
Isolating Patients During Disease Outbreak: We Can Do Better
By Caleb Hyde, MD
The pandemic uprooted and brought changes and new challenges to every aspect of our lives. We were faced with a problem that we were not prepared for and did not completely understand. We went into lock down and isolation, not just in our homes, but also in our hospitals. Patients were being admitted for COVID-19 as well as the normal medical issues we see daily. We were scared for ourselves and our patients, and our patients were scared for themselves and their families. Fast forward two years after the beginning, and while as health care providers we became more used to the daily life of COVID-19, our patients were still left isolated, scared, and alone. We need to do better.
During the early portion of the pandemic, hospitals across the nation did the right thing by isolating patients and limiting visitors into the hospitals while we tried to get control of the pandemic. There was also the issue of conserving personal protective equipment (PPE) for our health care
providers while there was an ongoing shortage across the country. However, as it became clearer that COVID-19 was going to become a daily part of our lives, and PPE stores became replenished, we left these isolation protocols and visitation policies in place. At times we had policies in place that allowed no visitors in our hospitals. Patients who were critically ill in our emergency departments and our intensive care units were not allowed the human decency to have their loved ones visit with them while they struggled to live, or while some took their last breaths. We spoke with family members by telephone and explained to them the seriousness of the patient’s illness and were invariably met with the question “Can I come see him?” and we had to tell them “unfortunately at this time we are not allowing visitors.”
All providers have seen the firsthand effects that isolation can have on patients in the hospital and know this as inherently true, but there is also data to back this up. A 2017 study of 1,506 patients in three Canadian hospitals isolated for respiratory illness were studied compared to non-isolated patients which demonstrated that those on isolation precautions for respiratory illnesses stayed 17% longer (95% CI: 9%, 25%), stayed 9% longer than expected (95% CI: 3%, 15%), and had 23% higher cost of care (95% CI: 14%, 32%). Furthermore, a 2018 meta-analysis of 26 papers showed a marked trend for isolated patients to exhibit higher levels of depression, the pooled standardized mean difference being 1.28 (95% CI 0.47 to 2.09) and anxiety 1.45 (95% CI 0.56 to 2.34). These studies help highlight the importance visitors have on the outcomes of patients who are hospitalized.
We all want what is best for our patients, those around them, and the community. There is undoubtedly a fine balance between isolating patients to control disease spread and allowing visitors to see their loved ones to improve patient outcomes. I believe we had the right approach early in the global pandemic but should have adjusted our visitor policies once we had a better idea of how the virus is transmitted and how to limit spread. I believe that to best serve our patients, we need to reflect on this so we can be better prepared in the future to adapt our policies when we have another outbreak such as this. Next time, we need to do better.
ABOUT THE AUTHOR
Dr. Hyde is a Minnesota native and current chief resident at Ascension St. John Hospital Emergency Medicine Program in Detroit, Michigan. His interests include wilderness medicine and the patient care experience.
