A Microbiologist on the Front Lines

Yuen Kwok-Yung, the head of the microbiology department at the University

of Hong Kong, was invited in mid-February to see a patient who was suffering from a mysterious respiratory disease. The patient had already warned doctors that he had a severe case of pneumonia and feared he was highly contagious. He could only breathe through an artificial respirator and communicate by blinking.

“I had a strange feeling that he was suffering from something new,” said Dr. Yuen, a soft-spoken Hong Kong native with round Harry Potter-like glasses. “He had a severe viral infection, and was not responding to the usual antibiotics.” Tests for known viral diseases all came back negative.

Dr. Yuen gave the patient a combination of new antibiotics and steroids, but the virus had already severely damaged the patient’s lungs. Two weeks later, the patient died.

The patient -- later deemed a SARS “super-spreader” by health experts -- was the now-infamous doctor who stayed at Hong Kong’s Metropole Hotel in mid-February and set off a chain of outbreaks in several countries by spreading SARS to other hotel guests on his floor, who apparently got the disease by sharing the elevator with him or punching the same elevator button that he did.

Within a matter of weeks, the $6.4-million research budget of Dr. Yuen’s department and the focus of its 10 faculty members had been shifted to SARS. Ultimately, Dr. Yuen’s team became the first to trace the disease to a type of virus known as the coronavirus and one of the first to come up with evidence that wild animals consumed as food in southern China might be the source. The Hong Kong researchers also pioneered a drug combination for treating patients that was later adopted by Toronto physicians.

Although the infected doctor from the Metropole Hotel was unintentionally one of the chief sources of an international health crisis, he also inadvertently helped Dr. Yuen’s research. He spread the disease to his brother-in-law, a patient who underwent a lung-tissue biopsy that made it possible for the University of Hong Kong researchers to create cell lines that give the scientists a ready supply of the virus.

Since joining the department in 1988, Dr. Yuen has steered its research to emerging infectious diseases in the region, making it well poised to study SARS. In the past few decades, many infectious diseases that Dr. Yuen believes originated in southern China have been discovered in Hong Kong. Besides heading the microbiology team at the University of Hong Kong, Dr. Yuen was appointed the chairman of Hong Kong’s Advisory Council on Food and Environmental Hygiene, a position that gives him a voice in shaping policies to improve public health.

He believes that southern China is a breeding ground for diseases like SARS because of the high density of humans and animals living in close proximity. “It’s not that Hong Kong is dirty,” he said. “We have better infrastructure; it’s more transparent, and an outspoken media.”

Dr. Yuen first heard about the strange outbreak of an atypical pneumonia from the newspapers in early February. The University of Hong Kong team’s discovery that SARS was caused by a coronavirus was made in late March, a finding that was subsequently published in the British medical journal The Lancet.

The university’s researchers went on to develop a diagnostic test for the virus, whose initial symptoms, a fever and a cough, are similar to the common cold. Subsequently, other researchers, including some at the Chinese University of Hong Kong, have developed other tests, and the race is on to see which one finds commercial favor.

In late May, Dr. Yuen and his team discovered that the SARS virus could be found in the civet, a wild cat that is considered fine cuisine in southern China and is sold in a marketplace just beyond the Hong Kong border. Dr. Yuen and his researchers now have the raw materials to create a vaccine, which he said would take at least two years to develop.

A Wrong Start

Even though he and his team can be credited with several important discoveries, Dr. Yuen spoke humbly about his experiences working on SARS research. “We were so wrong in the beginning,” he said, sitting in a windowless conference room in the maze of buildings where both the Queen Mary Hospital and the University of Hong Kong’s medical school are located. “We thought it was the H5 virus,” he added, referring to the avian flu that struck Hong Kong in 1997 and killed six people. It was only after the lung biopsy of the stricken doctor’s brother-in-law that the researchers began to focus correctly.

The university’s research team has faced a lot of challenges, particularly financial ones. The government donated an additional $130,000 to the department for SARS research, and the university has also accepted private donations, but altogether, it doesn’t amount to much in comparison with universities in the West, said Dr. Yuen. “When Americans and Europeans die, they give their money to a trust fund for research. In Asia, we give our money to our children,” said Dr. Yuen.

While the university researchers made continuous breakthroughs on a limited budget during the height of the SARS epidemic, Dr. Yuen said it has been a sobering time as well. During the height of the epidemic, he slept only a few hours a day, spending most of his time seeing patients and working in the laboratory. He has lost more than 10 pounds in the past few months, accentuating his boyish appearance.

“When people are dying before your eyes every day, there is a huge burden on your shoulders,” he said, speaking with the slight British accent that most Hong Kong residents acquired during the city’s days of British-government rule, which ended in 1997.

“I have a lot of respect for him,” said Joseph J.Y. Sung, a professor of medicine in the Chinese University of Hong Kong’s department of medicine and therapeutics. Although the two have been friends for the past 10 years, Dr. Sung said that he and Dr. Yuen had competed against each other in research, particularly because they are at rival institutions. But during the past few months, Dr. Sung said that the two managed to suppress their competitive streaks to fight SARS. "[Dr. Yuen] told me, ‘Why don’t we put the politics aside and focus on treating patients and saving lives?’” said Dr. Sung.

Dr. Yuen, a lifelong citizen of Hong Kong but also one of its critics, hopes that the outbreak of SARS will force residents to change their approach to the way they live and eat. Dr. Yuen described the former British colony as an “ultradense part of the world” where “capitalism [exists] in its extreme.” It was capitalism that has driven developers to build tall, clustered apartment blocks like Amoy Gardens, where mass SARS infections took place in March, he said. His first goal as the chairman of the Advisory Council on Food and Environmental Hygiene is to pass a law to ban the sale of live poultry at Hong Kong’s open markets -- but the resistance to that change so far has been strong. Dr. Yuen’s also hopes to limit the use of exotic animals.

“Why do we want to eat civet cats?” Dr. Yuen wondered.

Even though the epidemic has subsided, his life remains changed. Every day, he still washes his hands “too many times to count.” His mother-in-law has returned to live with Dr. Yuen and his wife after staying with other relatives during the height of the epidemic. Dr. Yuen had feared that if he were to become infected with SARS and pass it on to his elderly mother-in-law, she could not recover.

Despite the high-risk nature of his job, Dr. Yuen was relaxed in an interview, having lived under the threat of SARS for months. His green surgical mask was pulled down around his chin. “As long as you take precautions, the chances of getting it are very low,” he said, laughing with relief. The only downside of the epidemic ending, said Dr. Yuen, is that with a lack of patients, “we can’t do any more trials.”

http://chronicle.com Section: International Volume 49, Issue 45, Page A35