The science and the art of living with Covid-19

“Ars longa, vita brevis,” is the Latin translation from the original Greek. Part of a quotation by the Greek “Father of Medicine” – Hippocrates, the English translation of the phrase is “Art is long, life is short.” The quotation in full attributed to Hippocrates reads, “Art is long, life is short, opportunity fleeting, experience perilous, and decision difficult.” The ongoing pandemic drives home vividly this ancient wisdom.

While the 19th and 20th centuries witnessed scientific advances at a leisurely pace, the 21st century is witnessing these advances at breakneck speed due to advances in computing, precision medicine, genomics and informatics.

Medicine, which was one of the oldest arts is increasingly becoming the newest science. Hard science is objective and easily understood, its potential often overestimated. Art is subjective and abstract, its subtlety difficult to understand and its potential often underestimated. It encompasses (but not restricted to) the social sciences, ethics, empathy and concern for human dignity both in life and in death.

The pandemic from its genesis to its onward course, reveal brilliant science but deficient art. The brilliance of science unleashed without constraints of ethics and humanism has potential for immense harm like the misuse of nuclear power. Nuclear power went astray during the Second World War with devastating consequences. Is the current pandemic the result of biological power gone astray? As the dust settles, we may get some answers, hopefully.

The dilution of the art of medicine has also influenced epidemiology – the study of disease dynamics in population – a vital tool for control of pandemics. Earlier epidemiologists did field and house to house visits more than even postmen. This helped them to collect data first hand and also study the social and cultural factors (social epidemiology) in a population which are major determinants of disease dynamics.

The art was known as “shoe-leather epidemiology.” The classic example is John Snow’s investigation of the London outbreak of cholera in 1854. Over the years, epidemiologists, particularly those in academics, became less enterprising and “shoe-leather epidemiology” gave way to “arm-chair epidemiology.” Social epidemiology took a back seat.

Presently we are in the era of big data. Data mining and mathematical models contribute to understanding of many epidemiological issues. However, it has spawned a generation of “mouse-click epidemiologists” completely ignorant of social epidemiology. The harsh measures in response to the present pandemic based on sterile mathematical models, illustrates the consequences of neglect of social epidemiology.

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Mouse-click epidemiology predicted large number of deaths as well as generated evidence for drastic measures such as school closures and physical distancing extending to lockdowns. The latter was based on a computer project for influenza control by a high school student. Building on this school project, scientists in the US ran hypothetical data into supercomputers framing policies reminiscent of the Middle Ages!

Lacking insights in social epidemiology, human beings were taken as inert units in the model rather than social beings. Elegant computer outcomes indicated that such drastic measures would break the “chain of transmission.” Both the prediction and NPI models went wide off the mark as evidenced by much low fatalities worldwide than was projected, even as the virus travelled from China to Chandni Chowk.

The art of medicine since the times of Hippocrates held out the cautionary principle, “First do no harm.” The cure should not be worse than the malady. But blind science neglected this axiom. The collateral damages due to this sterile science have been immense.

Loss of livelihoods will lead to severe malnutrition, increase in infectious diseases and deaths from other causes. The harm will exceed the benefit of lives saved from Covid-19. In the blind chase for the coronavirus, we have sacrificed both human dignity and human lives.

The latest scientific miracle has been the development of vaccines against Covid-19 in record time. The euphoria of this has raised the hope of immediate eradication.

In chess, the “hardest thing to win is a won game.” This was stated by an artist of the game, Emmanuel Lasker, a mathematician, philosopher and World Chess Champion for 27 years. In eradicating Covid-19, we have the winning piece, the vaccine in record time. However, as in chess, more important than the winning pieces are the right moves.

Every game of chess has the same pieces but different combination of moves is required in each game depending on the situation. Thanks to brilliant science, we have today a robust surveillance and monitoring system, and treatment protocols have been refined. All these with the vaccine, make for heavy arsenal against the virus.

But if we miss the art at this juncture, we will lose the game. While the science will tend to advocate mass vaccination, the art should see the big picture. Should we go for a win or a draw?

History of medicine does not have any account of eradication of any disease in such a short time. Like in chess, it is very difficult to win a won game. The efficacy of vaccines is also mired in uncertainty.

Given these imponderables, it would be more pragmatic to opt for a draw and learn to live with Covid-19. Once we vaccinate the vulnerable of all ages, and the elderly, Covid-19 should cease to be a public health problem in India.

(The writer is Professor & Head, Community Medicine and Clinical Epidemiologist at Dr DY Patil medical college, Pune. Views are personal)