RESEARCH AND INNOVATION THE REVIEW2020 Identifying the New Threat Scholars from the Li Ka Shing Faculty of Medicine (HKUMed) were at the forefront of this new pandemic, producing some of the earliest research findings on the SARS-CoV-2 virus that causes COVID-19 and drawing on deep experience in studying infectious diseases that stretches back to SARS in 2003. The World Health Organization (WHO), governments and other researchers around the world have all worked closely with our scholars trying to understand the virus and how to control it. One of the first questions they grappled with was how to identify the virus and diagnose it in patients. Working with the Faculty of Engineering, HKUMed scholars produced some of the first electron microscope images of SARS-CoV-2, which were released in January, shortly after the pandemic started to threaten. These images have helped researchers and medical professionals around the world identify the virus. HKUMed scholars also quickly developed a protocol for detecting SARS-CoV-2 in humans, and the reagents and methods have been shared with over 70 countries. Over the subsequent months, they refined testing methods and identified new targets. For example, they showed that deep throat saliva samples, especially if taken early in the morning, are highly effective for diagnosis and that the viral load in infected patients is a potential marker for assessing disease severity and prognosis, with loads much higher in severe cases. They also identified two novel virus protein targets, ORF8 and ORF3b, that can facilitate antibody testing for SARS-CoV-2. Symptoms were also investigated. For instance, HKUMed scholars detected auto-antibodies that attack the immune system in more than one in every 10 people who developed severe COVID-19, regardless of age and pre-existing medical conditions, which may explain why some patients suffer a more severe disease than others of the same age. Loss of smell as a symptom was also explored and shown in some cases to be the only symptom. Gastrointestinal effects were shown to be slightly more prevalent in children, especially those under two years old. The fatality rate was also estimated to be about 1.4%, based on patients with symptoms in Wuhan, which is well above the rate for seasonal flu. Diagnosing COVID-19 has not been the domain of only medical scholars, though. Engineers, as mentioned, helped produce the electron microscope images, while scholars in the Department of Statistics and Actuarial Science drew on their years of research into computer imaging to develop a digital online diagnostic system for COVID-19 based on chest CT scans. The system uses AI and integrates radiography and computer vision, and is especially effective for cases with no or minimal symptoms. The scholars are continuing to refine the system and have made it available online free of charge. Tracking Transmission Epidemiologists and microbiologists in HKUMed have been mapping and tracking outbreaks to determine the infectiveness of SARS-CoV-2. Before the end of January, they provided the first evidence of humanto-human transmission of the virus involving a family that was diagnosed at HKU-Shenzhen Hospital. Later, they were the first to show that a patient previously recovered from the virus had been reinfected. A research team led by Professor Guosheng Yin (right) and Dr Bin Liu (left) have integrated radiography and computer vision to develop a digital online diagnostic system for COVID-19 based on chest CT scans. Professor Gabriel Leung (left) and Professor Joseph Wu Tsz-kei (right) warned the general public the domestic and international spread of COVID-19 in late January. Rapid nucleic acid amplification tests developed by HKUMed to detect COVID-19 in patients are being used by public health laboratories in more than 70 countries and territories. Pseudo-colour scanning electron micrograph of SARS-CoV-2 grown in culture from a patient isolate. After 24 hours in culture there are large numbers of viral particles (orange) on the surface of the cell (blue). PATHBREAKERS HKU’s experience in controlling infectious diseases came to the forefront in 2020, when we produced important research across several disciplines that helped deepen understanding of the nature of the COVID-19 virus and how to control it, and identified avenues for treatment and vaccines. The real-time dashboard developed by the School of Public Health, which is accessible for all, provides detailed up-to-date information on daily infection and effective reproduction numbers in Hong Kong. 20 | 21
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