As of today, 115 Bermudians have tested positive for COVID-19. Some remain at home or are isolated in government facilities; 16 are in the hospital. In the absence of a definitive treatment, doctors do what they can. Meanwhile, families of the affected quietly engage in an alternate intervention – one which, you might be surprised to learn, has been tested and published in major scientific journals. It’s called intercessory prayer.
Prayer helps us cope with uncertainty, and when a loved one contracts COVID-19, there’s plenty to be uncertain about. Was it transmitted to other family members? Will their condition suddenly deteriorate? Are there enough ventilators? Intercessory prayer is the act of praying on behalf of someone else.
Of course, for an infectious disease like COVID-19, we turn to 21st century science for answers. And, yes, some things are certain: physical distancing limits spread. So does hand washing. Masks, too. But that’s prevention, not treatment. What can science promise once the virus decides you’re its new home? So far, there’s no approved medicine for COVID-19. Supportive care is the mainstay of treatment. Supportive means if your temperature rises, we lower it. If your blood pressure falls, we raise it. If oxygen drops, we dial in more and roll you on your stomach. If you’re too weak to breathe, we call for a ventilator. If a bacterial pneumonia supervenes, we add antibiotics. Then we wait.
One thing we wait for is more data. Data from local observations, data from the Chinese, data from the Italians, data from any major hospital that has weathered, or is still weathering, the tsunami. What we really want are large-scale studies. But those take time. Until then, the list of medical uncertainties is long:
1. Is there a role for hydroxychloroquine and azithromycin?
2. Should everyone with COVID-19 receive remdesivir, lopinavir, ritonavir, or interferon beta-1a?
3. Should anyone with COVID-19 receive ivermectin?
4. Should we give intravenous zinc to COVID-19 patients?
5. Are standard ventilator settings applicable for COVID-19 patients?
The answers to these questions, at least this week, are: probably not, we’re not sure, no, maybe, and probably not. Amidst widespread uncertainty, one thing science can promise is this: given time, definitive answers will arrive. Already multiple trials are underway to evaluate these and other potential COVID-19 therapies; even this week, a new study suggests remdesivir may reduce symptom duration in the illness. But until we have more data and better therapies, patients, families, and even medical staff are having conversations with some higher powers. Given the times, I thought you might appreciate revisiting two classic scientific studies regarding the power of prayer.
My favorite medical prayer study appeared in 1988. It was my first year of cardiology training, and The Southern Medical Journal published a trial involving 393 patients admitted to San Francisco General Hospital’s coronary care unit. Half the patients were prayed for by intercessors who they never met, but who were provided with patients’ first names, diagnoses, general conditions, and a script to pray from. All patients knew they were involved in the study, but neither patients nor healthcare providers knew who was being prayed for and who wasn’t. For the remainder of their hospitalizations, the prayed-for patients required less ventilatory assistance, less antibiotics, and less diuretics. The study was led by Dr. Randolph Byrd, and the authors concluded that “prayer to the Judeo-Christian God has a beneficial therapeutic effect to patients admitted to a CCU.” As a scientist, I wanted to roll my eyes a little, but I was also a good Catholic boy, and the results fascinated me.
The following year, another prayer study appeared in the Archives of Internal Medicine. This one, by Dr. William Harris and colleagues at the Mid America Heart Institute, evaluated 990 patients admitted to their coronary care unit. The twist here was that no one – neither patients nor medical staff – knew they were part of a study. All patients received standard medical care, but every day for a month, half were prayed for and the other half weren’t. Again, the prayed-for group had fewer adverse outcomes. The study’s conclusion was that “intercessory prayer produced a measurable improvement in the medical outcomes of critically ill patients.”
Are these studies relevant in the age of COVID-19? Let’s hope so. That’s why today I’m not going to be too much of a hard-core scientist. I won’t share the 2006 American Heart Journal study that contradicted these findings or other prayer trials that reported equivocal or negative results. One reason I’m not giving negative prayer studies equal billing today is that right now we need some hope. Another reason is something called confirmation bias. It’s the tendency, when presented with contradictory data, to favor the evidence that supports our beliefs, and reject what doesn’t. Put another way, if you already believe in prayer, Dr. Byrd’s and Harris’ conclusions will reinforce your convictions, and nobody else’s contradictory claims will change your mind. For the same reason, skeptics (assuming they got this far in a newsletter devoted to prayer) will mount valid arguments against the positive results of prayer studies.
Regardless of what science concludes about prayer, I remain optimistic. I have faith that effective treatments and a safe vaccine for COVID-19 are around the corner. Might some intercessory prayer hasten the process? Well, in part, that’s up to us. Until then, Bermuda, stay positive, stay safe, and, as much as possible, stay home.
For more news on the latest developments in cardiology, visit www.ShaneMarshallMD.com, subscribe to the free newsletter The Annals of Cardiology, and follow Dr. Marshall on Twitter @ShaneMarshallMD