Reflections from the Editor

THE HEDGEHOG AND THE FOX: A COVID PARABLE

By Frank Skilling, M.D. In the 1950s, the philosopher Isaiah Berlin wrote an essay entitled, The Hedgehog and The Fox. In it, he postulated that while the Hedgehog knows ONE great thing, the Fox knows MANY things. Following this, he evaluated philosophers and writers throughout history and grouped them into one of these two categories. The question he raised was whether it was better to be a Fox or a Hedgehog. In a way, it was a whimsical query, but it has prompted many erudite discussions over the years. As humans, are we better off to know many things, even if not in detail, or should we strive to know one thing to the exclusion of anything else? (In a way, this mimics the discussion I heard many years ago when I was a young medical student about the difference between generalists and specialists.) This has prompted me to reflect on the state of understanding we have of the COVID-19 pandemic. Who is right? The human foxes who are constantly re-evaluating an approach to the contagion or the COVID-19 hedgehog which only knows how to replicate versions of itself? In a way, we humans are facing a “zombie apocalypse” where the enemy is essentially an unstoppable, untreatable foe that has no other purpose than to reproduce and uses living humans while at the same time destroying their cells to cripple or kill them. While we know many things, we haven’t yet been fully successful in curbing COVID-19 or eradicating it. As I write this, the Delta virus is wreaking havoc throughout our country.

During the 1666 plague year in England, thousands of people died from an unknown condition that was sometimes attributed to the wrath of a vengeful God. Many treatments were tried, all were ineffective, except for quarantine and isolation. Communities that shut themselves off when the plague appeared in the countryside sometimes survived without a significant loss of life. On the other hand, when people stayed in London, they often experienced repetitive waves of death by an unknown cause.

In my estimation, human nature hasn’t changed since then. Despite knowing the cause of the pandemic, we are engaged in debates which cast opposing views as how it should be handled. There is no doubt that handwashing, adequate masks, and social isolation provide a measure of safety. Yet despite having created a plausible vaccine, many people are refusing to get it. A significant portion of the population likewise challenges mask mandates. The deniers tend to link their hesitancy to celebrities, political operatives, or misinformation promulgated on social media. (I think that Russian “bots” are the sources behind some of the misinformation campaigns on social media.) As one medical researcher put it, in the 1950s citizens received the polio vaccine willingly, and there was no one lobbying for the polio virus. Now there is an active lobby supporting this COVID virus, although most anti-vaxxers wouldn’t characterize themselves in such a fashion.

So, we’re back to the question: Who (or what) knows more? The human foxes who have over-thought and over-analyzed their response in the pandemic or the viral hedgehog who only knows how to replicate and mutate enough to keep itself going? (Keep in mind that a virus has no mind to make up.) While the humans are playing the blame game and encouraging each other to do so, the virus keeps plugging along entirely dependent on its hosts’ cells for existence. At some point, the virus will stop re-producing so rapidly and will enter a baseline endemicity in the population. However, our human population will be significantly reduced in a random fashion. In the U.S., there have already been over 667,000 deaths. An estimated three hundred million have already been infected world-wide, and the long-term sequelae still have not been tabulated.

In Cat’s Cradle, the novelist Kurt Vonnegut referred to the fictional Book of Bokonon, which was supposed to contain all the wisdom of mankind. The Fourteenth Book was called, “A short book with a long title.” Thus, Vonnegut expands:

“Title: What Can a Thoughtful Man Hope for Mankind on Earth, Given the Experience of the Past Million Years?

Only Verse: Nothing.”

I have come to think that Vonnegut was right when I contemplate the response of our country to COVID-19.