Collateral Damage from COVID: Commentary & Research

After more than 2 years of waxing and waning, the COVID pandemic is quieting down. We are all holding our breaths and hoping that another variant does not appear and lead to another surge of hospitalizations. The pandemic has caused global chaos, pain, misery, death, and economic deprivation. Hospitals were stressed to their limits, and face to face events disappeared. During hospitalization peaks, quarantine measures resulted in periods of “no visitors.” Locking out visitors and family increased levels of misery for patients and their significant others. During my inpatient attending rotations at that time, I was witness to a cascade of painful episodes involving critically ill and dying individuals whose only contact with their families was by phone or tablet. These situations were agonizing for patients, nurses, and physicians.

In this issue of The American Journal of Medicine, two reports document hospital collateral damage done to patients and their loved ones by the pandemic. The palliative care team at the Tokyo Medical Center in Tokyo, Japan, reported that during the time of restricted visitation, total doses of narcotics given for pain relief increased significantly compared with a similar period before the COVID-induced limitations. Read: “Do Hospital Visit Restrictions Cause Increase in the Doses of Morphine in Terminal Care? Spiritual Pain and Palliative Care in the COVID-19 Pandemic.”

This study observed that restricted visitation increased patient spiritual pain factors and caused significant patient stress at the end of life. Iness and co-workers at the Virginia Commonwealth University in Richmond, Virginia, report a systematic review of available data concerning the impact of restrictive hospital visitor policies on patient, family and visitor, and healthcare provider well-being during the period of COVID hospital lockdown. Like the findings of the Japanese study, these investigators found that restrictive hospital policies were associated with failure to address the needs of patients, their visitors, and healthcare providers in various clinical environments. Read: “The Effect of Hospital Policies on Patients, Their Visitors, and Health Care Providers During the COVID-19 Pandemic: A Systematic Review.”

These observations were consistent with what I observed on numerous occasions during hospital lockdown. One example was particularly poignant. An 86-year-old woman who only spoke Spanish had a large and supportive family. She was nearing the end of her life secondary to hepatic and renal failure. My ward team and the palliative care consultant were very uncomfortable with the fact that no family member was allowed to be with the patient during her final hours of life. We appealed to our hospital administration asking for an exception to the imposed visitor restriction. The administration granted a compassionate allowance, and the patient’s oldest daughter stayed with the patient during her last 48 hours. Many on our team and the staff caring for this woman were moved to tears by this episode. Unfortunately, many other patients never had this merciful opportunity.

During this period of painful lockdown, I was constantly reminded of Portia’s soliloquy in Shakespeare’s The Merchant of Venice:

As always, I respond to all communications about this or other commentaries at jalpert@email.arizona.edu.