March 2021, a phone call from Caleb Iness: “Hey Audra, my friend’s dad is in the hospital with a stroke and no one can visit him—isn’t that cruel? All because of COVID….I wonder if it even affects viral transmission. You should study it!”
How cool—not only did I, a physician-scientist, have the ability to delve into this question, but my older brother thinks that highly of me!
This call coincided with Dr. Vinay Prasad’s discussion of same topic on the “ZDoggMD” show, where he argued that allowing patients to die alone was both unethical and antithetical to our shared humanity. One quick email to Dr. Prasad, buy-in from my brother (a co-author) and assembling a few colleagues resulted in a passionate grassroots research team. We set to work.
In April 2022, we published “The effect of hospital visitor policies on patients, their visitors, and healthcare providers during the COVID-19 pandemic: a systematic review” in The American Journal of Medicine, which evaluated the evidence surrounding hospital visitor policies during the COVID-19 pandemic. After screening 1,153 abstracts along with reviewing 26 full articles in depth, we were disappointed to find only low-quality evidence.
We could not say with confidence that our visitor policies shielded patients or staff from COVID. We did not know the extent of psychological and moral trauma we caused. In an area this morally charged and broad, the state of the evidence was threadbare and weak.
I led this research effort and was continually surprised by the lack of strong evidence. I wondered how dramatic and rapid policy changes, particularly controversial ones, could occur without rigorous study. Decisions made with evidence are often justified by alternative means, but this invites bias and abuse of power.
Often in science and policy answers may not be immediately available, but there should be checks and balances to ensure they are obtained in a timely manner. Policymakers might be disincentivized to promote research for a variety of reasons, especially under pressure to take action with conviction.
The scientific method starts with a question, and questioning policies may reveal that they are wrong—if you don’t look, you won’t find it. This “research hesitancy” is damaging because it promotes uninformed decision-makers. A good scientist is willing to prove herself wrong and a good policymaker should be too.
Distributing the decision-making power across multiple stakeholders, including autonomous patients and their physicians, may help alleviate some of this pressure. For example, Institutional Review Boards are comprised of representatives from both the lay community and experts in the area of study. This board is charged with appraising proposals for the conduct of ethical and scientifically sound research. This model may serve well for how a similar policy review board may be structured.
With regard to hospital visitors, a committee may include physicians, nurses, former patients, family members, hospital administrators and health department representatives. In our article, we find a patient-centered and thoughtful approach to hospital visitor policies is likely to benefit the stakeholders while minimizing harms. IRB approval did not occur for most hospital policies because these efforts were not considered ‘research,’ but perhaps would have benefited from such review. Ultimately the line between research and implementing an untested policy is faint.
From the side of healthcare providers, we need to be empowered to advocate for our patients and their families. We cannot forget what it means to be human in a time of fear. Having mechanisms in place to safeguard human rights and fundamental ethical principles, such as autonomy, is important, especially against the weight of public health.
We need more community-driven independent research and grassroots efforts like our study. We need more phone calls from older brothers to help us realize we have the means to make a difference.
–By Dr. Audra N. Iness, pediatrics resident, PGY1, at Baylor College of Medicine