Professor Yuen Kwok-yung
Henry Fok Professor in Infectious Diseases 
Chair of Infectious Diseases 
Department of Microbiology

Our department started researching emerging infectious diseases in the early 1990s but we only received effective resources and support when the avian influenza A(H5N1) emerged in 1997. Since then, the fear of a pandemic due to H5N1 and later H7N9 has affected the judgement of the public-health and scientific community. We were therefore taken by surprise when SARS-CoV-1 emerged in 2003. Many recommendations were made after that outbreak, many of which contributed to the initial success in controlling COVID-19. Yet, there is still room for improvement to prepare us better for the next pandemic.   

One glaring deficiency is the waning commitment of both government and community to resource allocation and the full implementation of preparedness measures due to jitters about the economy, fading memory of the pandemic and administrative attrition and turnover. While the surveillance has identified hundreds of novel microbes in animals, efforts to further characterize them and their potential to jump the species barrier have flagged. Better support for the research community is warranted to foster this research, and greater cooperation with experts in other regions is needed to facilitate the gathering of soft intelligence and the exchange of information about emerging infections.   

Furthermore, the monitoring of inter-species interfaces targeting animals with unusual tolerance for viral infections, sick healthcare workers, unusual severe illnesses in healthy individuals, and workers at high-biosafety-level laboratories is not being performed to the degree necessary. Surveillance of sick travelers and rapid testing at borders are necessary routines to document the causes of illness and to investigate further for unknown microbes if all standard tests turn out negative. This is especially important when there is an early-warning-system alert of a suspected outbreak due to unknown agents. These samples should be screened by multiplex nucleic acid amplification and subsequent unbiased next-generation sequencing. Novel viruses should be isolated in routine cell cultures, complemented by organoid cultures, and then tested in animal models for interspecies transmission potential. Potential agents are needed for designing rapid diagnostics, therapeutics and vaccines.   

For early detection and control of outbreaks, we must improve our rapid multilayer contact tracing capability through increased information technology (IT) support and manpower. The links and networks for soft intelligence through research and academic exchanges funded at The University of Hong Kong (HKU) were critical in alerting the Hong Kong government on December 31, 2019, that COVID-19 was emerging in Wuhan. This led to early institution of alert response and border screening and control measures. The HKU consensus RT-PCR test for SARS related coronavirus was crucial for case identification before commercial test kits specific for SARS-CoV-2 were available.    

Furthermore, clinical work at the HKU Shenzhen Hospital led to the early detection of person-to-person spread and early institution of the serious-level response. This resulted in good epidemic control during the first two years of the pandemic, which was compromised by too many border-control exemptions granted to certain individuals. While the initial testing capacity in the public healthcare service should have been ramped up early, this shortcoming was eventually remedied by commercial testing operations.   

It was surprising that the computer database of hospitals, public-health services and the private healthcare sector had not been fully integrated over the 20 years since the SARS outbreak of 2003. The surge capacity of hospital services, isolation and quarantine facilities is still limited and almost reached a state of paralysis during the Omicron wave in early 2022. Unsatisfactory space availability, infection control and vaccination at elderly homes was one of the weakest links in our combat against COVID-19.   

It is important to acknowledge that personal protective equipment, diagnostic tests, antiviral drugs and vaccines are strategic assets. We must have the hardware and capability to produce them locally or else they would not be readily available during outbreaks. Finally, the level of trust in the government and scientific experts determines to a large extent the compliance of the public with pandemic control measures and vaccination recommendations, which is pivotal to a successful outcome.