Podcast: Creative grit, Episode 2

The Global South takes on COVID-19. This is a chat with Dr. Leo Poon who co-directs the Hong Kong University Pasteur Research Pole

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I have been speaking with with researchers across The Global South and came across so much creative grit in the way these scientists dealt and deal with COVID-19.  I wrote a story about them in Nature Methods called  Lessons from the Global South's Fight against COVID-19

This is a podcast series with some of the people I spoke with for the story.  

Episode 1 is with Marycelin Baba of the University of Maidugiri, in Maidugiri, Nigeria. 

And here is episode 2 with Dr. Leo Poon, who co-directs the Hong Kong University Pasteur Research Pole. He and his team have helped colleagues all over the world on COVID-19.  I asked him if he has a fleet of private jets. He does not. But he wishes he did.

He and his team developed a diagnostic assay quite soon after the genome sequence of SARS-CoV-2, the virus that causes COVID-19, became known. His is the lab that detected and identified  SARS, the outbreak in 2003. And many other viruses. 

You can listen to the podcast on streaming services, for example on Apple podcasts, Google podcasts and Spotify. And you can listen to it right here. 

Transcript of podcast

 Note: These podcasts are produced to be heard. If you can, please tune in. Transcripts are generated using speech recognition software and there’s a human editor. But a transcript may contain errors. Please check the corresponding audio before quoting.

That’s Dr. Leo Poon who co-directs the Hong Kong University Pasteur Research Pole. You will hear more about him and his work in this podcast episode. Hi and welcome to Conversations with scientists, I’m Vivien Marx.

 What is nice about interviews these days is that they are mainly video-chats, so I can see people and they can see me. They also see when I don’t understand something. Pre-pandemic I used to do phone calls for interviews. That feels like a century ago. Video-chats feel much more modern to me and they are armchair travel for me and perhaps for you, too. They are not the same as lab visits but still more informative than a phone call and involve more sense, more impressions than a phone call.

 Like most science journalists, I report on COVID-19 and I had been wondering about researchers in the Global South and their COVID-19 related research. I did a piece for Nature Methods, there is a link in the show notes to the story. https://www.nature.com/articles/s41592-022-01439-w And in the show notes, there is also a transcript of this podcast, too.

 As usual in doing that story, so much fell on the cutting room-floor. That is why I do podcasts to share more of what I hear as I do stories.

As I spoke with researchers in different countries, I felt they were all sharing how they were innovating and finding the stamina and creativity to keep going in most difficult circumstances as they dealt with COVID-19. That’s why I felt these episodes should be called Creative grit.

Many of these researchers were called to the front-lines to help their country build capacity and to train others. One previous podcast was based on a conversation with Dr. Marycelin Baba of the University of Maiduguri in Maiduguri, Nigeria. And today I would like you to meet Dr. Leo Poon.

Dr. Leo Poon, along with Dr. Roberto Bruzzone who was traveling when I spoke with Dr. Poon, co-directs the Hong Kong University Pasteur Research Pole. Pasteur is in the name, but it’s not Institut Pasteur, the institute in Paris that focuses on immunology and infectious disease, but there is a partnership that involves Institut Pasteur. The Hong Kong University Pasteur Research Pole is affiliated with Hong Kong University.

Here’s Simon Muller who is communications manager of the HKU Pasteur Research Pole who explains the affiliation.

Simon Muller

It’s affiliated to Hong Kong University with a partnership with Institut Pasteur that started almost 22 years ago. Since 2013 the lab is completely part of the School of Public Health of the University of Hong Kong.

Vivien

So it’s an institute with co-directors Roberto Bruzzone and Leo Poon.

Simon Muller

So as you can see with have Roberto and Leo who are co-directors it shows the partnership. Leo comes from HKU, Roberto comes form In the idea is to have the two directors, it’s a pretty amazing collaboration.

Vivien

What is worth knowing about Dr. Poon and his lab at Hong Kong University is that he is connected to others through a network called Pasteur Network, which connects Institut Pasteur in Paris and partners around the world devoted to infectious disease.

It’s not that the institutes are all dependent on Paris, they are independent institutes. And I have a separate podcast with more information about the Pasteur Network. The members of the Pasteur Network are scientifically connected in many ways. This network turned out to be quite crucial at the height of COVID and continues to be an important link. Here’s Leo Poon.

Leo Poon

We are good partners, we try to exchange information and get to know the situation better so that everyone can be better prepared for COVID. This network did not develop in one day. We have been connecting to one another for many years, Pasteur Network for around 20 years. We know each other quite well, we have regular meetings and each year directors fly to Paris to meet each other. We know each other. We do have connections.      

Vivien

Connections have helped in the battle against COVID-19, they might actually be essential, these connections, this is not a one-country battle.

I should say that Leo Poon’s lab identified the virus that causes Severe Acute Respiratory Syndrome, SARS. In 2003, there was a SARS outbreak of this viral respiratory disease. It started in China and then spread to four other countries. It was not COVID-19 it was SARS in 2003.

 The lab also detected the virus that causes MERS, the Middle East Respiratory Syndrome, the H5N1 avian flu and the causes of other zoonotic diseases.

 When I spoke to Leo Poon, Hong Kong was yet in another wave of COVID-19. When COVID-19 first hit, labs scrambled for supplies, for ways to test samples from people for the virus, to study the virus. But it wasn’t like everyone had stockpiled supplies. And supply chain issues hit labs all around the world. These days, there are still supply chain challenges.

When COVID-19 emerged, Hong Kong University Pasteur Research Pole helped many labs, also those in the Pasteur Network. They helped with supplies and with advice on techniques to detect the virus. Here’s Leo Poon:

 Leo Poon

We do have a warehouse but we are only a small university compared to universities overseas, in US for example. We do have a small warehouse, and we stockpile some things. When we know there is a problem, we contact manufacturers and local suppliers ask for reagents. We did have a hard time in the past. We try to talk to local suppliers because we have known them for a long time and they know we are going something for Hong Kong it’s not only for my own research. They call headquarters. I don’t’ think we had to stop our work even for a single day because of shortness of supply.  

 Vivien

Examples would be consumables, buffer, pipette tips.

Leo Poon

Pipette tips, we do next-generation sequencing, so kits. We are still  ok, we just keep harassing the tech builders . we say we can only tun for another week. We can talk with other colleagues. In Hing Kong. We had a hard time.  But not as bad as some, you heard in the news, they had to stop work.

 We have an in house pipeline and generate results within 48 hours for urgent cases   Then we can  send a big batch of reagents so they can do next gene sequencing for us. The turnaround is longer but they can handle many samples at the same time. Sometimes we have a case and we really want to have the result as soon as possible . We routinely run these local seuqncing pipelines , twice a week, generate baseline and send some to genome center to get a much bigger picture of the viral dynamics in Hong Kong

Vivien

When the SARS-CoV-2 genome sequence was made public in January of 2020, the Poon lab team developed a diagnostic assay and sent it around. By May 2020 it had been sent to 170 labs in 77 countries, including those in the Pasteur Network, which is spread out across Asia, Europe and Africa. I wondered how this sharing was managed and wondered if Leo Poon might have a fleet of private jets.

Leo Poon

I don’t, unfortunately, I wish I had one. Basically. I actually have not left the country because of COVID and Hong Kong has a very strict quarantine policy for incoming travelers. So we communicate by Zoom.

 We are one of the WHO reference labs for COVID, right at the beginning. We developed a diagnostic assay in January were asked to contribute. We have been working on. We are the lab that discover SARS. Then we worked on MERS, H5N1 other anima-human zoonotic diseases. We do have a track record for that. Once COVID turned up we were asked to be involved. Joined working groups WHO, FAO OIE, to facility to improve the standard and try to help others detect COVID-19 at the beginning. We have been helping others by communication and also by Zoom meetings. Right at the beginning we developed a test and we distributed our test.

We have been working with coronavirus for a long time. When we heard about this outbreak the last day of December 2019, there was a press release from Wuhan about pneumonia. At the time we started to worry about this. We tried to do some preparations. When the sequence was available in early January, we used the sequence to design to design a RT-PCR assays. By mid January, we shared the protocol with WHO, we made a big batch of reagents so we can share reagents to other members in Pasteur and others as well. By May 2020 we have sent these reagents to over 150 labs in 70 countries.

 Vivien

After our chat he followed up with me. By May 2020 the reagents had gone to 170 labs in 77 countries. You don’t need a large amount of reagents to do these assays but you need the right reagents.

Leo Poon

The amount if very small. But it helps to have because it takes time to buy reagents, prepare them. But we sent the Primer and probes to them so that they could use that to detect their first COVID patients. 

Vivien

Just as a reminder in early 2020, when Dr. Poon and colleagues were distributing their assays, the US was far from having assays everywhere where they were needed. Hong Kong has a different state of alertness about infectious disease.

Leo Poon

We know about this the last day of December 2019, that was a press release from Wuhan. Because of the history of SARS, everybody here in Hong Kong become very alert. There was news. All the local in Hong Kong was aware of the atypical pneumonia in Wuhan.  

 Vivien

At the time the cluster of atypical pneumonia in Wuhan became known, there was no assay for COVID-19 in the US in the state health departments. On February 4, 2020, the US Secretary of Health and Human Services who was part of the Trump administration declared a public health emergency in the US. And the Food and Drug Administration granted emergency use authorization to the CDC for a RT-PCR Diagnostic test.

In February a number of state public health labs had trouble validating this test. It turns out there was some contamination issue and the test was not working as expected. So the US was struggling to get the assays to work to test for COVID-19.

Of course, developing, validating, troubleshooting assays on a large scale during a pandemic is difficult.

 Leo Poon

To be honest, to be fair to them. That’s why to have multiple groups to have independent opinion, independent reagents. If something goes wrong in one institution there are others which can manage to help. We have to be fair, there is no single institutions that can do all that. If we put all the eggs in a single basket, that will be too bad. It is not what you want to have happen, it’s Murphy’s law something can go wrong, that is why we need multiple engaged in these activities.  

 Vivien

Collaboration and helping others has been quite crucial in the battle against COVID-19. And that might leave its mark on the research community. As I produce this podcast, Leo Poon is facing a COVID-19 lockdown. But there are many diagnostic assays and much is known about the virus, there are vaccines, too, of course. So now it’s about thinking ahead. I wondered what Leo Poon is setting out to do in his research with his team. 

Leo Poon

One of my expertise is molecular diagnostics. That is why I was in the game from the beginning because I have been developing assays for SARS 2003, HN5, 7, 9, MERS, so this is part of my research interest. We have a lab here in Hong Kong, we are close to China , that is why we can help get to know the situation better. I also do basic research, I study basic biology, I study a new approach for studying vaccines.

I am at the School of Public Health, Health is the top of everything, so we are just contributing our expertise on something the public needs. That has priority.

 I can spend all my time developing vaccines. There is a need now, we need to address immediate concerns as soon as possible rather than let somebody else do it. To be honest, Hong Kong is very small city, not many academics. The faculty of School of Public Health has around 20 faculty members. In an American university 100, 200, 400. We are very small so we have to be flexible. We are the experts in Hong Kong so we have to contribute in our own intellectual way to Hong Kong.

 Vivien

20 faculty members at the School of Public Health is indeed pretty small. Now given this latest public health emergency things are changing. And the School is set to grow as is the field more generally. Here’s Leo Poon

 Leo Poon

I will give you a story. When I joined the university the flu group, the group I am working in now, only had 10 staff including the PIs. I was the third PI in this group. We have 10 PIs now and more than 100 people to work on emerging infectious disease. Hong Kong is a good hub for emerging infectious disease so that it can attract more talent. We have great scientists, great students. I look forward to more people join the force to combat emerging infectious disease.

Hong Kong has been affected by H5, SARS, a pandemic and we have been doing a lot of surveillance in animals, birds, pigs We have a long-term track record on these pathogens. When COVID came, we just tried to use the tools that we had established in the past, so we had the foundations from the past two decades.

 Vivien

Looking to the future, it seems likely that another problematic virus will emerge. I wondered how Leo Poon looks to the future as a public health researcher.

Leo Poon

I hope that COVID can give us a good lesson. And to policy makers. We went through SARS and people say I wish we can do better surveillance of animals We, scientists had funding for that, but after a few years, then all the funding for that collapsed. Only a few groups survived. SARS disappeared and they thought was we would not be affected by this anymore.

Other diseases, Ebola, Dengue, Zika, people are talking about this. This is all past tense. They didn’t think there would be another one. We know animals can carry dangerous diseases. But we have HIV, TB, multiple drug resistant diseases, how we can allocate resources for this animal work but cut the funding for these human pathogens.

We have to allocate resources better. Maybe not for HIV, this is in the budget. But just think about how you need to spend to prevent the introduction of animal viruses moving into humans and think about how much you need to spend after this pandemic, COVID-19 has given us a good lesson.

 So maybe you just spend a few percentage of GDP or expenditures, just allocate them for health, health related research that will already help with animal virus introductions. At least we can know better, we can find a better way to control it, reduce the risk. Or maybe we can develop some vaccines, just in case another virus and we have something we are able to use or build proper platforms and use them for vaccines, diagnostics, or anti-viral treatment. 

 My point of view as a public health practitioner, preventive measures, pandemic preparedness is always a way to address the real problem.

Vivien

The pandemic has taught some awful lessons. As I produce this podcast, world-wide there have been over 6 million deaths and 1 million of them in the US.

 Leo Poon

 Humans tend to have a short-term memory. In a few years’ time, when we overcome COVID then people will “maybe will spend more money on the stock market than building up the infrastructure for health.

 Vivien

These days there are many assays and tests for the virus that causes COVID19. Some tests are fast and cheap, perhaps even locally produced. Some are less accurate and others are more elaborate and expensive but terrifically accurate. It’s a difficult balance to strike in a pandemic when many tests are needed. For Leo Poon, having the many approaches is a good development.

Leo Poon

I think we want to run them in parallel, I think we need all of them. For point of care tests, you need a quick result for clinical management.

Vivien

When you have someone who is acutely ill, say in the hospital?

Leo Poon

Yes exactly, you want to have a quick answer. If someone is infected with COVID, you might need to quarantine them, place someone in an isolation ward. If you have antiviral medication, maybe you need to give it right at the beginning. But then we need something that is very accurate, robust and high throughput for public health surveillance. With it we may not be able to know the dynamic of pathogens in the country. So the government might not be able to respond. If we all do rapid antigen tests by ourselves, we would not report it to the government. So the government, the healthcare organizations would not be able to capture these data so they can assess the situation. So I think we need both of them, not only one or the others. Basically we have to be more comprehensive.

Vivien

That can involve wastewater screening.

 Leo Poon

That is an interesting story. We have been collaborating with HKU Pasteur and the school of engineering at Hong Kong U and we worked on testing wastewater for SARS-CoV-2. IN the past we managed to identify some COVI-19 positive buildings After that the government went to the buildings to do mandatory testing of all residents in those buildings. They picked up some asymptomatic COVID patients and that can help to reduce the spread of COVID in a community. 

Vivien

I spoke to Dr. Poon a while ago and he was kind of describing the situation we are in now in which people are mainly doing at-home testing so healthcare workers are not tracking these data because these data are not being recorded.

 Wastewater testing does bring up a certain amount of tension between privacy and public health. But transmission can be tracked this way. Here is how it basically works.

Leo Poon

They collect the samples, extract the RNA and then send to the lab to look for viral DRNA of SARS-Coronavirus 2. Many are doing wastewater testing and it’s used for epidemiological studies and used to see if this region has an upsurge of COVID cases, whether this region is positive for COVID. But we use these data on another level to try to inform public health authorities and to see whether we should try to do mandatory testing for these particular buildings or these particular areas so we can pick up these asymptomatic cases to prevent these people from infecting other people subsequently.

Vivien

Of course not all countries will be able or willing to pursue individual residences and this is about ultimately finding culturally appropriate policies. And then there is the fact that the virus itself doesn’t sit still.

 Leo Poon

We are having an issue now, an introduction of Omicron and we are having a fifth wave. We have been using these strategies but it hasn’t been moving in the right directions as the cases still go up, because Omicron BA.2 is so infectious, so contagious, with several thousand new cases yesterday. So the government will step up more stringent control measures to try to control it better. Maybe the government will like to introduce more frequent testing.

Vivien

I spoke with Leo Poon before the new episodes of spread happened and very stringent measures including lockdown were put in place. The Chinese government has put in place a zero-COVID policy, which is difficult to uphold and may not be sustainable. Hong Kong has been hit by many COVID-19 waves as have many regions of the world.

 Leo Poon

This is the fifth wave in Hong Kong. We were doing well in the past, we didn’t have circulation for months. Omicron, it’s very hard to fight against it. The virus mutates, which makes it more transmissible.  I have trust in the scientists here and the government, we may try to come up with strategies to deal with it.

The good thing is that the majority of Hong Kong citizens has been vaccinated, the death rate is supposed to be low but we are trying to push out to those who have not been vaccinated yet. This may be an opportunity to convince them, this may be the last-minute for them to be vaccinated.

Vivien

I wondered if everyone in his circle had stayed out of harm’s way.

 Leo Poon

None of my friends have been infected. The cases in Hong Kong have been low in the past. We are not so sure now because of Omicron BA.2. I encourage them to stay at home, work from home, wear a mask, stop social mixing. For me, I work alone most of the time. I come to my office, lock my door, do my own work. We still have to work, we are the task force to try to understand COVID in Hong Kong, we can’t stop our activity.

In terms of work, we are in full gear, we see friends much less frequently than before. But this is the new norm in Hong Kong now.  

Vivien

The new normal means different things to different people of course. But for someone in public health these are extraordinary times.

Leo Poon

I am just doing my job, I really think I am just doing my job, I  am on the School of Public Health. I work to combat infectious disease. This is the mandate of our division. We try to control reduce the risk of animal to human zoonotic transmission. We did it 20 years ago and we are still doing it now.

Vivien

That was Conversations with scientists, an episode in the series I’m calling Creative grit. Today’s episode was with Dr. Leo Poon, co-director of the Hong Kong University Pasteur Research Pole and a scientist at the Hong Kong University School of Public Health.

 And I just wanted to say, because there is confusion about these things sometimes, the University of Hong Kong, Institut Pasteur did not pay to be in this podcast. This is independent journalism that I produce in my living room. I’m Vivien Marx thanks for listening.

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This is a transmission electron micrograph of SARS-CoV-2 virus particles that were isolated from a patient. (Image captured and color-enhanced at the NIAID Integrated Research Facility (IRF) in Fort Detrick, Maryland. Credit: National Institute of Allergy and Infectious Diseases, NIH)

 

 

 

 

 

 

 

 

 

Vivien Marx

Journalist , Nature Portfolio