Combatting COVID-19: a round-up of how Hong Kong’s universities are making a difference
Research-based contributions* to understanding and mitigation of different impacts of the pandemic locally and globally from across Hong Kong’s publicly funded universities
World’s fastest portable detection device
Hong Kong University of Science and Technology (HKUST) researchers, led by Professor Wen Weijia, Department of Physics, adapted the latest microfluidic chip technology to devise the world’s fastest portable COVID-19 detection device that reduced the time needed to reliably detect carriers to 40 minutes. Current polymerase chain reaction (PCR) technology takes between 1.5 to three hours. After obtaining the coronavirus’ genetic sequence from Mainland China in mid-January, Wen and his research team worked intensively to create the device in a week. By early February, the device was already in use by Centres for Disease Control and Prevention in Shenzhen and Guangzhou. The device also obtained international CE certification (European Union [EU] standard) and is qualified for export to all EU countries and Hong Kong.
Smart temperature checking system
HKUST researchers also rolled a smart fever screening system, which was deployed at border control points, including Hong Kong International Airport, government facilities and HKUST. Using artificial intelligence, real-time tracking and big data analysis, a multidisciplinary research team led by Professor Richard So, Department of Industrial Engineering and Decision Analytics, developed a novel system that is more accurate in detecting people with fevers, even when the person is wearing a mask and their face is partially occluded. The system achieves this through “visual closure” (the ability to correctly perceive an object even when partly hidden) using deep learning and the science of anthropometry. It also provides greater operational efficiency by combining thermal and colour images on the same screen, enabling immediate identification of those who are unwell. Regular fever monitoring systems use mainly infrared cameras and require operators to watch two screens showing thermal and CCTV images to identify the right person in time.
Protecting frontline medical workers
To boost the effectiveness of personal protective equipment for frontline medical professionals, Hong Kong Polytechnic University (PolyU) collaborated with the city’s Queen Elizabeth Hospital and Hospital Authority respectively to design and produce 3D-printed eye and face shields. Utilising studies by PolyU’s School of Design comparing head sizes between Asians and Westerners also enabled the researchers to make the face shields a better fit for Chinese wearers, said Professor H C Man, Dean of the Faculty of Engineering and Director of the University Research Facility in 3D Printing. After initially mobilising all of the 3D printers in the 3D printing facility and other departments, and operating them 24 hours a day to produce hundreds of eye shields and face shields, PolyU leveraged its strong connections with local manufacturers to increase the production of face shields to 10,000 pieces per day. It was subsequently expected to reach 30,000 pieces per day.
Psycho-behavioural survey findings
The Jockey Club School of Public Health and Primary Care under the Faculty of Medicine at Chinese University of Hong Kong (CUHK) announced the results of an online survey of Hong Kong residents’ risk perception and psycho-behavioural responses, launched within 36 hours of confirmed COVID-19 cases being reported in the city in January.
The survey involving over 1,100 respondents, revealed the majority had difficulty in adopting social distancing. Among the findings, the survey showed 98 per cent were worried about the outbreak. Some 99.5 per cent were alert to the disease’s progression and actively looked for related information, such as number of confirmed cases and treatments (over 80 per cent), while the most trusted sources were doctors (85 per cent) and broadcast media (56 per cent). In addition, around 90 per cent had enhanced personal hygiene practices, including wearing masks and cleaning hands. However, while social distancing measures such as restricting mass gatherings, staying at home, and avoiding public transport were considered useful in preventing COVID-19, only 36 to 86 per cent of respondents actually adopted them. The survey was carried out from 24 January to 5 February 2020. Professor Samuel Yeung Shan Wong, Deputy Director, The Jockey Club School of Public Health and Primary Care, stressed that timely psycho-behavioural community assessment was useful to inform subsequent interventions and risk communication strategies as the epidemic progresses. At the time, Hong Kong had adopted interventions to slow transmission, such as suspension of classes, temporary closure of public facilities such as libraries and arenas, and working from home arrangements. The survey suggested the public should further adopt social distancing to lower the risk of infection, Wong said.
Tackling emotional stress
Lingnan University psychologists and researchers provided advice and a self-assessment test to help the public protect themselves, build up resilience and stay positive in order to battle the epidemic with sufficient psychological capital. Such capital refers to self-efficacy, hope, optimism, and resilience, with resilience the crucial element in times of adversity for both mental well-being and the body’s immune system, according to Professor Siu Oi Ling (Croucher Studentship 1984), Dean of the Faculty of Social Sciences, Chair Professor of Applied Psychology and Director of the Wofoo Joseph Lee Consulting and Counselling Psychology Research Centre. Findings of earlier research in 2009, drawn from survey and face-to-face interviews with over 770 healthcare staff in Hong Kong and Mainland China by Siu and her team, showed those with high scores for resilience in the questionnaire also had higher levels of immunoglobulin A (IgA) in their immune systems, making them less likely to fall sick during epidemic prevention. Ways to improve resilience in the current COVID-19 crisis involved confronting hardships head-on, challenging and expanding existing beliefs while looking for evidence to support hearsay, and having support from family and friends, Siu said. The research team also provided a list of statements reflecting characteristics of resilience that could be used as a psychological self-assessment test.
Traditional Chinese medicine immunity boost
Hong Kong Baptist University (HKBU) distributed a traditional Chinese medicine (TCM)-based immunity enhancement remedy to thousands of senior citizens, patients with chronic illnesses, families receiving Comprehensive Social Security Assistance, and others in need. Working together with various local charities and foundations, HKBU was able to provide the remedy free. In March, the initiative was extended to Hong Kong Hospital Authority frontline medical workers. Professor Bian Zhaoxiang, Associate Vice-President (Chinese Medicine Development) and Tsang Shiu Tim Endowed Chair of Chinese Medicine Clinical Studies, explained that while many questions regarding the virus required further in-depth research, there was a clear consensus among experts globally that personal hygiene, such as frequent hand washing, and strengthening immunity were essential. In addition to a healthy lifestyle, Bian said that the millennia-old Chinese medicine concept of “reinforcing [the] body’s vital essence” could be leveraged, providing “the basis for the prescription, which helps protect the body from viral infection”. The remedy includes Codonopsis Radix (Dangshen 20g), Panacis Quinquefolii Radix (Xiyangshen, 20g), Lonicerae Japonicae Flos (Jinyinhua, 10g), Forsythiae Fructus (Lianqiao, 10g), among other ingredients.
Driverless vehicles help reduce contact
Dozens of autonomous vehicles developed by a HKUST research team, led by Professor Liu Ming, Department of Electronic and Computer Engineering, were deployed in Mainland China to deliver groceries in several cities, including Shenzhen, Shanghai and Suzhou. The 50 vehicles helped minimise human contact and limit human-to-human transmission of COVID-19. They were equipped with all-terrain 3D-mapping and large-scale visual and sensor navigation technologies.
Hand hygiene education and N95 mask fitting
Researchers at Education University of Hong Kong (EduHK) and University of Hong Kong’s School of Public Health found that more than half of 433 survey respondents aged 65 and above were not following widely recommended practices on handwashing, leaving them more susceptible to contracting infectious diseases. Dr Peggy Or Pui Lai, assistant professor in the Department of Health and Physical Education at EduHK and the principal investigator, said those with poorer health literacy – which measures lack of knowledge and competencies connected to healthcare and disease prevention – were more likely to be less observant in frequency and methods of washing hands. The article, published in February 2020 in the American Journal of Infection Control, calls for greater health education targeting this age group. In other hand hygiene research, led by Or and published by the same journal in 2019, pre-school children were found to fare better in sustaining good hand hygiene, following a training programme for 110 pupils on an optimum seven-step handwashing technique. Their practices improved over the four sessions while absenteeism related to flu-like symptoms reduced from 31 per cent in the month before the training to 25 per cent in the month after. Earlier, Or looked at clinical settings, investigating the optimum fitting of N19 respiratory masks for nurses, and the temperature range when they are most comfortable, causing less irritation to the face. Findings from the research, published in 2018 in the Journal of Clinical Nursing, have informed advice shared with hospitals to assist them in increasing the comfort and protection of those fighting COVID-19.
Assisting diagnosis of respiratory diseases
PolyU unveiled the world’s most comprehensive, rapid, automated multiplex diagnostic system to address the challenge faced by hospitals, clinics, and ports in providing frontline diagnosis of infectious diseases that can exhibit similar symptoms or be asymptomatic, including COVID-19. In a single test taking around one hour, the system can identify up to 40 pathogens, including coronaviruses SARS-CoV-2, severe acute respiratory syndrome (SARS-CoV), and Middle East respiratory syndrome (MERS-CoV) as well as seasonal influenza viruses, such as influenza A subtypes H1, H2 and H3, avian influenza viruses H5, H7 and H9, and human respiratory syncytial virus. The system leverages current polymerase chain reaction (PCR) technology, and is fully automated from sample nucleic acid extraction and amplification to signal detection and analysis. Its patent-pending microfluidic and biochemical technologies achieve ultra-sensitive detection (down to five gene copies) and simultaneous differentiation of various pathogens with extremely high specificity. It is also user-friendly, with no manual handling throughout the testing process. Dr Terence Lau, Director of PolyU Innovation and Technology Development, and his research team led development of the system, with support from University of Hong Kong (HKU) Professor Yuen Kwok Yung (Croucher Senior Medical Research Fellowship 2006). Yuen is Chair Professor of Infectious Diseases, Department of Microbiology, at Li Ka Shing Faculty of Medicine. PolyU and HKU jointly established the Respiratory Virus Research Foundation in 2015 to explore innovative technologies to tackle existing and emerging respiratory infectious diseases.
Projected spread of virus in Hong Kong
Concerns over the effectiveness of quarantine measures were raised by a City University of Hong Kong (CityU) expert in mathematical modelling for infectious diseases, who estimated a 3.5-day time gap between patients showing COVID-19 symptoms and being quarantined in Hong Kong. To model the projected spread of COVID-19 in Hong Kong, Dr Sean Hsiang Yu Yuan, Assistant Professor in the Department of Biomedical Sciences, adapted research by Imperial College London, and included different parameters in his projection. Yuan estimated Hong Kong would have around 60 new infections between mid-February and mid-March if patients were quarantined 3.5 days after showing symptoms and did not have any contact with others during their quarantine. If infected patients had a recontact rate of 20 per cent - that is, contact with 20 per cent of the people they are normally in touch with – new cases would leap to 350. If recontact was up to 50 per cent, new cases would rise further to 1,235 in one month. To prevent community outbreaks, early isolation of patients was the key, he said.
Potential vaccine targets identified
A team of HKUST scientists announced they had identified a set of potential vaccine targets which could be helpful for the development of a vaccine against the SARS-CoV-2 coronavirus. The team led by data scientists Professor Matthew McKay, Departments of Electronic and Computer Engineering and Chemical and Biological Engineering, and Dr Ahmed Abdul Quadeer, Research Associate in the Department of Electronic and Computer Engineering, identified a set of B cell and T cell epitopes derived from severe acute respiratory syndrome (SARS) – protein fragments that can trigger an immune response against SARS-CoV – that may similarly trigger an immune response against the novel coronavirus. The team also performed a population coverage analysis and found that the T cell epitopes identified in the study had the capacity to induce an immune response in a large portion of the population, both globally and in Mainland China, during the time of SARS. “Given this epitope set also exists in the COVID-19 virus, a vaccine developed from it has the potential to also be effective for a large portion of the population,” Quadeer said. The findings were published in the scientific journal Viruses.
Hong Kong and Mainland joint medical and applied mathematics research teams modelling different aspects of the coronavirus outbreak had more than 10 reports published or in press from January to March 2020. Examples of studies include a data-driven analysis offering an early estimation of the basic reproduction number of the novel coronavirus, the time-varying serial interval of COVID-19 and its gender-specific differences, and a conceptual model for the outbreak of COVID-19 in Wuhan with individual reaction and government action. Researchers include PhD student Shi Zhao and Assistant Professor Maggie Wang (CUHK), Associate Professor Daihai He and Associate Professor Yijun Lou (PolyU), and PhD student Jinjun Ran (HKU). Reports have already appeared in several different journals, for example, the International Journal of Infectious Diseases, Travel Medicine and Infectious Diseases, Journal of Clinical Medicine, and Annals of Translational Medicine.
Enhancing infection control
HKUST reported the development of an antimicrobial formula that provides lasting protection and surface disinfection from microbial contamination. The multilevel antimicrobial polymer (MAP-1) coating can effectively kills up to 99.99 per cent of bacteria and viruses through contact killing. Among others, the coating is effective against avian influenza, H1N1, measles, and surrogate feline calicivirus (FCV), a super hard-to-kill non-enveloped virus that is even more resistant than coronaviruses, such as SARS-CoV-2. HKUST, in collaboration with Chiaphua Industries Limited (CIL), has applied the smart coating in over 70 day-care centres, elderly homes, kindergartens, primary and secondary schools. Professor King Lun Yeung, Department of Chemical and Biological Engineering and the Division of Environment and Sustainability, led the research. The technology incorporates a special blend of antimicrobial polymers and works by creating surface moieties that actively disrupt the microbial envelope and biomolecules, rendering the microorganisms nonviable upon contact. The coating, effective for 90 days, also prevents microbial adhesion on surfaces, keeping it clear of microbial contaminants. It is proven non-toxic, and safe for the skin and environment, according to the Technical Standard for Disinfection issued by Mainland China’s National Health Commission. Earlier, Chiaphua donated anti-microbial air filters based on air purification technology developed by Yeung’s team in 2017 to hospitals in Mainland China. Recipients included Huoshenshan Hospital, the emergency facility specially constructed to handle the COVID-19 outbreak in Wuhan.
SARS-CoV-2 in children
To address the limited data on epidemiologic characteristics and clinical features of infected children, a team of medical scientists, including Professor Gary W K Wong, Department of Paediatrics and School of Public Health at CUHK, presented data from an evaluation of children infected with SARS-CoV-2 and treated at Wuhan Children’s Hospital in a letter published in the New England Journal of Medicine. Other researchers came from Mainland China and US institutions. The team’s evaluation describes a spectrum of illness from SARS-CoV-2 infection in children. Of 1,391 children assessed and tested from 28 January to 26 February 2020, 171 (12.3 per cent) were confirmed to be infected. A total of 27 patients (15.8 per cent) did not show symptoms of infection or radiological features of pneumonia and 12 had radiological features but no symptoms. As of 8 March 2020, there had been one death, 21 patients were in stable condition in general wards, and 149 had been discharged. Thus, in contrast to infected adults, most infected children appeared to have a milder clinical course. The team further noted that determining the transmission potential of asymptomatic patients would be important for guiding measures to control the on-going pandemic. Wong was also involved in a study published in the Journal of Microbiology, Immunology and Infection, of three paediatric cases in Qingdao, Shandong Province. Findings showed persistent shedding of SARS-CoV-2 in stools of infected children for as long as four weeks after fever had abated, presenting further evidence that COVID-19 can be spread through stool excreta. (See Infectious disease control: the battle to beat coronaviruses).
Signature Home, a smart geo-fencing technology developed by HKUST researchers, was licensed and deployed in mid-March by Compathnion Technology Ltd as a mobile app to provide a resource-efficient and user-friendly way to monitor people under home quarantine. When paired with a Bluetooth wristband worn by the person under quarantine, the Stay Home Safe app can accurately detect whether the person is complying with the quarantine, and alert the relevant authorities if not. The core Signature Home technology, created and designed by researchers and engineers led by Professor Gary Chan, Department of Computer Science and Engineering and Director of the Entrepreneurship Center at HKUST, is based on the concept that environmental signals within a certain location, including cellular, wi-fi, and Bluetooth signals, collectively form a unique “signature”. Should the signal vary from that originally collected for the quarantined person’s accommodation, it is likely the person has left the designated location. Compathnion was founded by Chan in 2015. The company focuses on innovation in the field of indoor positioning.
Calming pet owners
After strong advice from the Hong Kong government’s Agriculture, Fisheries and Conservation Department on a 14-day quarantine and health screening for pets of people infected with COVID-19, a top academic at CityU’s Jockey Club College of Veterinary Medicine and Life Sciences issued advice and produced a video to reassure pet owners. The quarantine for pets was put forward after a dog belonging to a COVID-19 patient in the city tested weak positive for the disease. Professor Vanessa Barrs, Chair Professor of Companion Animal Health and Disease in the Department of Infectious Diseases and Public Health, noted that the test results suggested the dog had a low-level of infection, as had also been found in several pets during the 2003 SARS outbreak. “Previous experience with SARS suggests that cats and dogs will not become sick or transmit the virus to humans,” she said. “At that time, a small number of pets tested positive but none became sick. Importantly, there was no evidence of viral transmission from pet dogs or cats to humans.” The CityU video with advice from Barrs was posted on YouTube.
Fighting COVID-19 – keeping us informed and learning
The University of Hong Kong (HKU) and Chinese University of Hong Kong (CUHK) have developed comprehensive resources on the Covid-19 pandemic, including the latest status of the disease in Hong Kong, news of their research, podcasts, community tips and advice, and links to online courses. HKU offers the Fight COVID-19 site and CUHK the CUMED on COVID-19.
* Compiled from Hong Kong universities’ media releases and journal publications, January 2020 to March 2020