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Public health emergencies create challenges for the accommodation of visitors to hospitals and other care facilities. To mitigate the spread of COVID-19 early in the pandemic, health care institutions implemented severe visitor restrictions, many remaining in place more than 2 years, producing serious unintended harms. Visitor restrictions have been associated with social isolation and loneliness, worse physical and mental health outcomes, impaired or delayed decision-making, and dying alone. Patients with disabilities, communication challenges, and cognitive or psychiatric impairments are particularly vulnerable without caregiver presence. This paper critically examines the justifications for, and harms imposed by, visitor restrictions during the COVID-19 pandemic and offers ethical guidance on family caregiving, support, and visitation during public health emergencies. Visitation policies must be guided by ethical principles; incorporate the best available scientific evidence; recognize the invaluable roles of caregivers and loved ones; and involve relevant stakeholders, including physicians, who have an ethical duty to advocate for patients and families during public health crises. Visitor policies should be promptly revised as new evidence emerges regarding benefits and risks in order to prevent avoidable harms. [ABSTRACT FROM AUTHOR]

Background: Food insecurity (FI) often co-exists with other social risk factors, which makes addressing it particularly challenging. The degree of association between FI and other social risk factors across different levels of income and before and during the COVID-19 pandemic is currently unknown, impeding the ability to design effective interventions for addressing these co-existing social risk factors. Objective: To determine the association between FI and other social risk factors overall and across different levels of income-poverty ratios and before (2019) and during (2020–2021) the pandemic. Design: We used nationally representative data from the 2019–2021 National Health Interview Survey for our cross-sectional analysis. Social risk factors available in NHIS included difficulties paying for medical bills, difficulties paying for medications, receiving income assistance, receiving rental assistance, and "not working last week". Subjects: 93,047 adults (≥18 years old). Key Results: Individuals with other social risk factors (except receiving income assistance) were more likely to report FI, even after adjusting for income and education inequalities. While poverty leads to a higher prevalence of FI, associations between FI and other social risk factors were stronger among people with higher incomes, which may be related to their ineligibility for social safety net programs. Associations were similar before and during the pandemic, perhaps due to the extensive provision of social safety net programs during the pandemic. Conclusions: Future research should explore how access to a variety of social safety net programs may impact the association between social risk factors. With the expiration of most pandemic-related social supports, further research and monitoring are also needed to examine FI in the context of increasing food and housing costs. Our findings may also have implications for the expansion of income-based program eligibility criteria and screening for social risk factors across all patients and not only low-income people. [ABSTRACT FROM AUTHOR]

In our estimation, websites of sampled hospitals represented about 1200 hospitals, one-fifth of all US hospitals. Hospitals are often part of multi-hospital systems with web portals for the entire network of hospitals. Complex regulations and limited reimbursement have hindered telehealth.[1] However, increasing experience with telehealth during the COVID-19 crisis represents an opportunity to facilitate its use more generally after this crisis.[2] While telehealth has the potential to expand access to care, disparities in access are an ongoing concern.[3] Many hospitals now offer real-time "virtual visits" for common urgent care through their websites, which offer an opportunity to assess the accessibility of a typical telehealth service.[4] METHODS We assembled a geographically representative sample of 170 hospitals in the USA, according to previously published methodology.[5] In brief, we selected hospitals according to an algorithm that involved gross receipts, geographic diversity, and bed size; at least one hospital in each state was included. [Extracted from the article]