Top Covid-19 Doctor Explains Hong Kong's Low Death Rate

Hong Kong’s top coronavirus pandemic doctor sees a way out of intensive care for thousands of Covid-19 patients: keeping them from entering in the first place. After sobering experiences 17 years ago with the outbreak of severe acute respiratory syndrome (SARS), Yuen Kwok-Yung is advocating early, aggressive hospitalization and treatment to minimize ravaging disease and death. Hong Kong’s 2% Covid-19 fatality rate as of Friday, well below the global average, lends weight to the approach.

Most therapies for SARS-CoV-2 are authorized for use in severely ill patients, in some cases backed by research that’s still in question. Yuen, the Henry Fok professor in infectious diseases at the University of Hong Kong for 15 years, is admitting patients with minimal disease so they can be isolated, monitored and treated if needed.

“In places like the U.K. and U.S., usually if you have mild symptoms, you are not admitted to a hospital at all -- you just wait at home until you feel very bad or you have shortness of breath,” he explained over Zoom from his office. “But we basically admit any patients, even without much symptoms, into the hospital for isolation.”

The strategy reduces transmission in the community, and enables patients to enter a clinical trial and receive experimental treatment soon after developing a fever or showing other signs of worsening illness, Yuen said. That’s critical because the amount of SARS-CoV-2 virus or “viral load” in patients peaks at around the time symptoms appear -- similar to influenza.

Yuen, who graduated from the University of Hong Kong in 1981 and has the rare distinction of being a microbiologist, surgeon and physician, has been at the forefront of the city’s response to infectious outbreaks for decades. In 1998, he and colleagues described the first dozen patients afflicted with the H5N1 strain of avian influenza. Five years later, they reported SARS in a patient visiting Hong Kong from Guangzhou, China.

“All this is an extension of our experience in the year 2003,” Yuen said. “We have nothing to brag about because we learned bitterly from 2003 SARS.”

The appearance of an unknown virus to which no one has immunity created a desperate need for effective treatments. Hong Kong doctors are using several experimental treatments, including infusions of convalescent plasma -- a mix of factors extracted from recovered patients’ blood -- and injections of interferon, an immune-system protein.

They’re also using the antivirals ribavirin and Kaletra, although preliminary results released Thursday from a World Health Organization-led trial involving 11,266 patients in 30 countries found they don’t decrease patients deaths. Yuen said he wasn’t surprised by the results of the WHO’s study because the drugs weren’t administered soon after patients became ill.

“No antiviral will work if given late,” he said. The drugs were also administered singly, rather in combinations that could add to their impact, he said.

“We know that one drug is not good because all of these are very modestly active,” Yuen said. “We need early cocktail therapy to get good results.”

Giving a combination of ribavirin, Kaletra and interferon to patients in the first week of illness reduced the time to clear the virus by six days and shortened hospitalization by a week, when compared with giving Kaletra alone, Yuen and colleagues showed in a study in May.

The trial, published in The Lancet medical journal, recruited 127 patients from Feb. 10 to March 20 -- more than half of the Covid-19 cases reported in Hong Kong during that period. Patients began treatment about five days after developing symptoms.

“With the memory of the 2003 SARS pandemic, most patients with Covid-19 in Hong Kong accepted antiviral treatment, which explained our high recruitment rate,” Yuen and his team wrote.

Hong Kong took rapid and decisive action in response to Covid-19 because of the legacy of SARS, Yuen said. He hopes others will learn from the current crisis about the need to prepare for and mitigate the risks of future pandemics.

“It’s the 2003 experience that allowed us to walk another mile early,” Yuen said. “I hope that everybody in the world will learn this time that emerging infectious disease is something that would happen more and more frequently.”

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