Spiritual Care and the Second Spike
Rome, March 27, 2020. Pope Francis prays “for the city and the world” as COVID-19 brings suffering for millions of people across the global.
Pandemic-wise, there is hope. As I write this, the FDA is expected at any time to grant emergency use authorization of the Pfizer-BioNTech COVID-19 vaccine. On Wednesday, Canadian authorities authorized its use. On Tuesday, vaccinations began in the UK. This is all very good news.
And yet, other pandemic-related news is not so good. Yesterday, the US reported more than 221,000 new cases and more than 3,100 deaths, a new record for single-day fatalities. The numbers in Europe are just as grim. On Wednesday, Germany reported 23,679 new cases, a new daily record there. In many places, hospitals are becoming overwhelmed. In many jurisdictions, new restrictions are being put in place. As winter descends on the Northern Hemisphere, we brace ourselves for the long, dark months ahead.
Pandemics are doubly cruel. They bring suffering and death. But they also bring isolation. The need to limit the spread of infection cuts us off from one another. Those who become sick are separated from their loved ones. They can also be separated from their faith communities. For many, this is especially difficult. At a time when many patients most need the strength and hope their faith provides, access to the spiritual support they have always relied on can be suddenly taken away. This can have profound physical, emotional, and spiritual consequences.
Spirituality and health
It is no big surprise to say that there is a strong link between religion/spirituality (R/S) and health outcomes. Data demonstrating this connection abounds. But at a moment like this, it may be useful to recall. Harold Koenig of Duke University conducted a systematic review of the medical literature. Dr. Koenig looked at over 3,300 studies examining various relationships between R/S and health. Here are some highlights:
At least 444 studies have examined the relationship between R/S and depression; 67%reported significant inverse relationships with depression.
Of 32 randomized clinical trials, 69% reported that R/S reduced anxiety more than a standard intervention or control condition.
Of 19 studies examining the relationship of R/S and coronary heart disease, 63% reported a significant inverse relationship.
Of the 27 studies that looked at the relationship between R/S and immune function, 56% found positive relationships or positive effects in response to a R/S intervention.
Of 31 studies that examined R/S and associations with or effects on endocrine functions, 74% reported positive relationships or positive effects.
At least 29 studies have examined relationships between R/S and either the onset or the outcome of cancer (including mortality). Of those, 55% found that patients who are more R/S had either a lower risk of developing cancer or a better prognosis.
At least 121 studies have looked at R/S and mortality, mostly prospective cohort studies where baseline R/S is assessed as a predictor of mortality during the observation period, controlling for confounders. Of these, 68% found that greater R/S corelated with significantly greater longevity.
Various mechanisms may be at play here. R/S predicts better mental health (lower incidence of depression, anxiety, stress, greater sense of well-being). Conversely, an abundance of data show that poor mental health has adverse physiological consequences. Also, R/S is associated with better social support, great marital stability, less crime/delinquency, and greater social capital. These, in turn, are associated with better mental and physical health and greater longevity. Finally, R/S is linked to positive health behaviors, including lower rates of drug and alcohol abuse and cigarette smoking, better diet, more exercise, and safer sexual practices.
R/S and illness
While R/S appears to promote better health outcomes, it also seems to be an important resource for those struggling with illness and loss. The same review article cited strong evidence that R/S helps people cope with illness, pain, bereavement and end-of-life issues. Hope, optimism, self-esteem, and a sense of control all correlate with R/S. Included in Dr. Koenig’s review were 45 studies that looked at the relationship between R/S and a sense of meaning or life purpose. Of these, 93% found a significant positive relationship. These findings are particularly relevant to this moment in the coronavirus pandemic. Millions of people around the world are suffering and grieving. R/S beliefs are a critical source of strength and consolation for many. That is why isolation from spiritual caregivers and networks can be so devastating—and why it is crucial for healthcare providers to do all they can to ensure appropriate spiritual care.
Spiritual care for patients
Perhaps the most important step for healthcare professionals (HCPs) is to take a brief spiritual history of their patients. This can include learning about (1) the patient’s religious background, (2) the role that R/S plays in coping with illness, (3) beliefs that may influence or conflict with decisions about medical care, (4) the patient's level of participation in a spiritual community and whether the community is supportive, and (5) any spiritual needs that might be present. When spiritual needs are present, HCPs should make a referral to pastoral services. Of course, taking a spiritual history should only be done if desired by the patient.
Because of safety protocols necessitated by the coronavirus, access to chaplains, clergy, or other spiritual caregivers may be limited or not possible at all. In these cases, virtual access may be possible. Just as coronavirus has sparked greater innovation in the field of telemedicine, new resources in tele-chaplaincy have also become available. Many helpful resources for chaplains can be accessed online. If professional spiritual care is not available, HCPs themselves can be of assistance by being a compassionate presence and by simply taking time to listen to patients’ hopes and fears.
In the midst of the crisis brought about by the pandemic, HCPs and spiritual care providers must also be vigilant regarding self-care. Compassion-fatigue and burnout are real threats. On-site counseling, support groups for staff, de-briefing sessions, message, bereavement, attention to their own spiritual needs, and self-care plans are important strategies for care providers, especially now.
Spiritual care for a suffering world
The COVID-19 pandemic has imprinted some indelible images on our collective psyche. It has been the year of the face-mask, the Zoom call, the heroic healthcare worker. The image of the virus itself, with its menacing spindles and spikes, has been seared into our brains. But for me, the most unforgettable image came about back on March 27th. On a rainy evening in Rome, Pope Francis spoke to an eerily deserted St. Peter’s Square. In the vastness of that empty space, he appeared as a small, solitary figure. His vulnerability—and hope—in the face of immense suffering seemed to represent the vulnerability and hope of all of us. He said,
“From this colonnade that embraces Rome and the whole world, may God’s blessing come down upon you as a consoling embrace. Lord, may you bless the world, give health to our bodies and comfort our hearts. You ask us not to be afraid. Yet our faith is weak and we are fearful. But you, Lord, will not leave us at the mercy of the storm. Tell us again: “Do not be afraid.”
Whatever your own personal beliefs, Francis’ words and image are a powerful reminder of the deeply human need for hope and consolation in the face of great suffering. It is a reminder we would all do well to reflect on as we face the weeks and months ahead.