One of the SARS and COVID leaders, Professor Ivan Hung, is on Straight Talk this week. He reflected upon Hong Kong's efforts during SARS and COVID-19 and talked about whether Hong Kong is ready for the next pandemic.

Check out the full transcript of TVB’s Straight Talk host Dr Eugene Chan’s interview with Prof Ivan Hung:

Chan: Good evening! This is Straight Talk with Eugene Chan. Is Hong Kong ready for the next pandemic? What better time to talk about this than the present as we emerge from COVID? And to help us with this tonight we have leading expert in infectious diseases, Prof Ivan Hung. Prof Hung is Chair Professor and head of the Division of Infectious Diseases at the University of Hong Kong. He was on the frontline during both the SARS outbreak and was one of the public faces of our COVID-19 vaccination campaign. He is a world-leading expert in the field of antiviral and vaccinology. And with both his extensive expertise and first-hand experience in this area, he will help us reflect on Hong Kong’s COVID journey. Welcome, Ivan!

Hung: Good evening, Eugene!

Chan: I read that you have received the Anti-SARS Gold Badge Award from the Hospital Authority.

Hung: Yes.

Chan: As a frontline medical officer ... So, I will start by revisiting the SARS pandemic that was in 2003, which was like 21 years ago, which lasted for 3 months, infected about 1,700 people and killed nearly 300 people, and also shut down Hong Kong at that particular time.

Hung: Yes.

Chan: So, quite a significant impact on Hong Kong. How did Hong Kong fare during SARS, when compared with other regions in Asia and the world at that particular time?

Hung: I think for SARS, it is more like an epidemic, so very much a regional thing. Hong Kong was badly affected, the Chinese mainland was also badly affected. And then of course, there were scattered patients or cases in Canada, in Singapore, in Vietnam, in other parts of the world. But I think in Hong Kong, that is a very important experience that we have, in actually preparing for the next epidemic or pandemic that, of course, happened 20 years later, which is the COVID. And again, during that time, we did, I think, pretty well. In fact, at that time we did not have any isolation facilities, we didn't have negative pressure facilities, we didn't have a vaccine or antiviral. So, we were treating the patients and putting them into single room, and supporting them with the ventilator support. But we were actually one of the, probably, first teams in the world to isolate the SARS coronavirus, as the cause of the SARS.

Chan: Right. Professor, when you say that Hong Kong was, I would say particularly, we have done fairly well, do you think it was because we are particularly more vigilant? Or the public awareness or cooperation within the community, what helped to contribute to this sort of not such a bad outcome?

Hung: I think in terms of SARS, it is that we were very vigilant. We were also trying, at the very beginning, to find the cause of SARS. And of course, with several important leaders at their time, including Professor KY Yuen and Professor Peiris, we were able to isolate the virus at the very beginning. Because once we isolate the virus, we were able to have a diagnostic test, that were able to help us to diagnose and confirm the patient with that infection. And hence we were able to isolate the patient and stop them from spreading.

Chan: Yeah, I can still remember with like close to 300 fatalities at that time was very alarming at that particular time.

Hung: Indeed, yes. But when I said relatively a small number, it is when I compare it to the recent COVID-19 that we had.

Chan: So, do you think it was luck that we had? Or you think it was all hard work that help to keep …

Hung: It was all very hard work, I think it was the hard work of all the frontline medical staffs, including doctors and nurses. We were very alert from the beginning, and everyone was very vigilant, we were wearing N-95 masks and protective gown at the time. And I think the government did extremely well in that situation. And hence, we were able to contain the spread of the virus very quickly, isolate the virus, and of course, we did develop some kind of, you know, repurposing antiviral treatment towards the end of the epidemic. And of course, very fortunately, the epidemic come to an end even though at that time, I think, the mortality rate was still about 10 percent, which is very high.

Chan: Right. When you said that our experience in SARS gave us a very good foundation in the fight against COVID, if you want to isolate you’d have to identify a few factors, what will be the main things that we have learnt from dealing with SARS that gave us such a good foundation when we dealt with COVID?

Hung: I think the experience that we had from SARS, most important is there are several aspects. The first will be that we were able to form the Center of Health and Protection. That is one of the most important things that we were able to liaise very closely with the WHO, the USCDC, and the Chinese CDC. Hence we were able to get the first-hand knowledge in terms of these emerging infectious diseases. Second thing, very important, is that in each of the hospital clusters including, of course, the infection center at Princess Margaret Hospital, we are able to have at least 20-30 negative pressure facilities or negative pressure rooms, that we are able to quarantine our patients. And of course, in Princess Margaret Hospital, they have up to, I think, 200 beds of negative pressure facilities, which we were able to control right from the beginning if we have another epidemic or pandemic.

Chan: Right.

Hung: And then of course, other things including we are already developing in our research in terms of antivirals, and also in vaccines. So, these are the things that help us to combat the subsequent epidemic and pandemics.

Chan: Yeah, I can still remember at the beginning of the outbreak, Hong Kong, I would use the term ‘relatively unscathed by it’ because we had quite a flat epidemic curve …

Hung: Indeed.

Chan: … than other places, which was quite remarkable being an international transport hub. And we have like … I mean we are so close to the mainland as you just mentioned, that we had millions of mainland visitors annually, that make us more vulnerable because there are more people coming in and out. So, all that helped us to sort of maintain a very flat curve in the beginning.

Hung: Very much so. I think we actually did very well at the beginning, especially, I think, before the 5th pandemic that happened in early 2022. We have, I think, before that, we have one of the lowest mortality and the lowest number of cases in the world. I think at that time we have around just 200 deaths. And in terms of confirmed cases, we have around maybe just 15,000, which is a very small number compared to other places. I think we did even better than Singapore at that time.

Chan: So, do you think … I mean I can still remember all those scenes of daily lives coming out, running off my eyes, it's like people wearing a lot of, wide adoption of wearing masks and all that. Do you think that was instrumental since you mentioned that?

Hung: Yes, I think that was instrumental. And I think that is because of the experience that we had from SARS, that basically the whole community is very aware. And hence right from the very beginning in January 2000, the entire Hong Kong community as already very vigilant, already wearing masks and already having some diagnostic kits already available. We also started doing nasal swab, which we have a very good, easy way to sample and make the diagnosis. And hence, we were able to pick up the cases very early on, and starting maybe 1-2 days from symptom onset. And hence, we were able to quarantine them very quickly. We actually quarantined every single patient at that time, and hence stopping the virus from spreading among the community.

Chan: Right. Apart from those mask wearing, also we have adopted quarantine measures and tightening screening at border station, I am sure they all helped. I still remember on Jan 25, Hong Kong government declared our outbreak as an emergency.

Hung: Yes.

Chan: We were one of the highest warning tiers that we were quite early compared to other countries. And I remembered all those amusement parks, like Disneyland and public museums and sports centers and schools, were all close. And even government servants were starting to work from home.

Hung: Yes.

Chan: Was all that a wise move at that particular time?

Hung: Yes, I think it was one of the best moves. And I think that actually helped in containing the spread of the virus. And also minimizing the number of patients who had been hospitalized. And hence allowing us to focus on treating these very severe cases. And I think already at that time, we did have some repurposing antiviral treatment with Interferon and Ribavirin, all these kind of antiviral that is effective. And also later on Remdesivir, against the SARS-COVID-2. So, we did have antivirals to treat our patients at that time, right from the beginning. And we had already had a design and clinical trial in January. So, we were probably one of the earliest places to have this kind of treatment, from diagnostic to quarantine, to isolations, to treatment. Basically the whole management plan ready available right from the beginning.

Chan: When you mentioned all those terms, all those names coming back all over my mind is such less we had the Leave Home Safe app as well.

Hung: Yes.

Chan: And also one thing that we must be very grateful is that at SARS, 20 percent of the healthcare workers were infected …

Hung: Yes.

Chan: … I think we had a much better performance with our healthcare workers at COVID, isn’t it?

Hung: Yes, very much so. I think we had very, very few, probably, at the beginning, close to 0 nosocomial, that means hospital infection. Even I think for healthcare workers, most of them had the infection from the community.

Chan: Right. Professor, let us take a break now. but viewers, stay tuned, we will be right back for more discussion on how ready is Hong Kong for the next pandemic.

Chan: Thank you for staying with us on Straight Talk. We have been reflecting on our SARS experience and how that has helped Hong Kong to combat COVID-19 in the initial phases. So, professor, thank you for sharing with us your recollection of what happened and telling us that we have done very well with the SARS experience. I mean it was sort of joint effort by Hong Kong people, the government, healthcare workers, and all of you guys, of course. Thank you very much for keeping things very well controlled right at the beginning. I think everything kind of … when it was a bit of out of control as soon as the Omicron or the fifth wave came. And I think the infection, as you said, was pretty low, and we jumped to like 10,000 cases a day. Our healthcare system was really stretched, and many of our elderly died. And we ended up with over 10,000 deaths by the end of 2022, including my father and some of my close relatives and friends. So, what actually happened that with such a good background of preparation and experience, and reassurance from all of us are we were doing well compared to the rest of the world, what actually happened?

Hung: Well, I think the major pitfall was basically happened towards the end of 2022. It was when … we actually launched the vaccination program in mid-2021, and it actually went pretty well. The only problem, of course, is that there are misinformation about the vaccine, people worried about the side effects of the vaccine, especially the elderly. And the problem, of course, is that we had a very good vaccination rate apart from our elderly, which is probably the most vulnerable. And those elderly, majority of them are in elderly homes. So, if you can imagine if there is a major outbreak happening in the elderly homes, you could see that the virus could spread very quickly because the environment they are living in. and that is probably contribute to the subsequent so-called rapid rise in the number of cases and ending up with a relatively high mortality rate at the end of the so-called 2022. And what happened is that probably one of the single case of Omicron have escaped from the quarantine. And because of the Omicron is very much like airborne transmission, so it could spread very quickly. And just one single case or one single patient, subsequently leading to many, many cases at the end of the day. And the problem, of course, is the elderly people who have not been vaccinated. We understand that actually for those who had not been vaccinated had a much, much higher mortality rate compared to the others who have received two or three doses of the vaccine, regardless of what vaccine you take.

Chan: Right. Professor, since you mentioned the side effects of vaccines, I can still hear stories during casual conversations that “oh, I didn’t take a vaccine, I wasn't infected”, “you look at all those people who had the vaccine subsequently had to deal with all these side effects”. So, are those factual or are they just myths?

Hung: They are all myths. We do have some side effects of the vaccines, but the interesting thing is that when we did the subsequent research or the surveillance, basically the whole population surveillance, by the University of Hong Kong, of course, and we find that basically the side effects, especially among the elderly, are actually fewer compared to young people. Because the young people’s response are much higher compared to the elderly. So, that is why the elderly, in fact, even if they are receiving the mRNA vaccine, they have very few side effects. But the importance is, of course, the benefit of the vaccines is far out-weigh those minor side effects. And if you received, especially 3 doses of the vaccine, you have a very very good protection against severe diseases. And the protection, the efficacy, is above 90 percent.

Chan: Right.

Hung: So, that is so important for the elderly people, they need to get the 3 doses of vaccine. But unfortunately, because of the side effects in all these myths, elderly people, especially in the elderly homes, they refused to get vaccinated, especially during that period of time. And if you look at the vaccination rate, we had a very good vaccination rate, we have above 92-93 percent of the population. But if you look at those about the age of 80, the vaccination rate, even up to now, it is still running around 75 percent, which is not enough. And that probably is the reason why we have such a high mortality in the fifth wave. And again, because we had a very high elderly population, probably one of the highest in the world.

Chan: Right. Professor, since you mentioned all those factors, were you guys anticipating such a widespread infection from the Omicron? Because we know that there have been very contagious infections in other countries.

Hung: Yes.

Chan: Could we have done better in hindsight?

Hung: Yes, I think definitely we could have done better. We are anticipating an outbreak already, end of 2022, for the Omicron, we knew that it was coming. But we underestimated that it could spread so quickly. And I think what we could have done better, already of course, by the end of 2022, we already strongly advising the government to, perhaps, try to increase the vaccination rate among the elderly homes. And I think the government already responded very well, they actually tried their very, very best in trying to vaccinate the elderly at that time. But unfortunately it comes too quickly. And I think in hindsight, what we probably could have done better is by, perhaps, we might need to, to a certain extent, we might need to, not actually forcing them, but to whatever way, that we should be able to convince them.

Chan: Right.

Hung: Especially in the elderly homes to get vaccinated.

Chan: Right. Ivan, you were the co-convener of the expert committee on clinical events assessment following COVID-19 immunizations.

Hung: Yes.

Chan: Any insights that you can share with us?

Hung: Yes, I think we actually did … we work very hard. My other co-convenor, Dr CK Lee. So, both of us have been working very hard from the beginning. I think in the mid-2021, already we were actually, once the vaccination program was launched, we were already spending every week with the media and explaining in detail that both vaccines platforms very safely. And that we do have some kind of so-called mortality after vaccination, but these are actually due to patients who already had very critical disease. And that when you have a mass vaccination, you will have come to so-called mortality. But these mortality are not associated with the vaccination. It is that whatever happen, whatever they have, maybe they have flu illness, they have a flu vaccine, whatever, these individuals are likely to have these complications anyway. So, we were already spending time explaining in details to the population.

Chan: Thank you for a very detailed sharing of what your thoughts are. One thing I think I am sure the viewers are going to like to know is Hong Kong is one of the very few countries that sort of adopted a zero COVID elimination strategy.

Hung: Yes.

Chan: And we had one of the longest hotel quarantine in the world. However, it didn’t really protect us. And we actually had a significant impact on our economy. In hindsight, would you use the same strategy? And also, was it all worth it when you look at it?

Hung: Yes, I think the so-called zero strategy actually worked very well at the beginning because before the time when we had an efficient antiviral or when we had a vaccine available, we needed to have a very close surveillance and so-called quarantine, and try to minimize the spread of the virus in the community. But when you have vaccines and antiviral available, then we need to change, the policy needs to change. So, I think on hindsight, I think when you have a very good vaccination rate, and when you have a very effective antiviral, I think it is the time, the time of changing from the zero policy to gradually opening up will be very important. So, the timing of the change, perhaps, I think we could have done better. That is something that we have learnt.

Chan: We could have done earlier.

Hung: Yes.

Chan: Professor, we are now at the final part of the show. Time has gone very quickly, and I am sure people want to know more. But most importantly, it has been said that it is not a question of whether that we are going to have another pandemic, but when? I am sure you agree to that. So, what factors will trigger that and when would that be?

Hung: It could happen anytime. In fact emerging viral infection could be happening maybe in a few years, and it is happening all the time. But the important thing, of course, is the surveillance. I think very important is that you need to survey for these emerging infectious diseases, and be prepared for the next pandemic. So, I think if you have very good surveillance among both the animals and the humans, and then you prepare in every front, in terms of vaccine, in terms of antiviral, that will be very important.

Chan: One final question – are we ready for the next pandemic? And what can we do to protect ourselves?

Hung: Yes, I think we are very much ready for the next pandemic. And already we are setting up with the HKUD, the global pandemic surveillance alliance and also with Singapore, with US, with the mainland. And also we have another, it is the international vaccine institute.

Chan: Right.

Hung: Developing vaccines and also probably antiviral to tackle these. So, I think we are very much ready for the next pandemic. But we still need to work hard on the research.

Chan: Right. Thank you, Professor Hung, for helping us to reflect on Hong Kong's experience with COVID, and SARS, of course. While there had been success, there are ongoing challenges. We certainly need to learn from our experiences and prioritize collaboration and innovation to be ready for the next pandemic, as Prof Ivan Hung has suggested. Quote for this evening: “Prepare and prevent, don't repair and repent”.

Let’s stay vigilant and united in our efforts to build a healthier future. Have a good evening and see you next week!