This clinician-scientist would rather trade all her accomplishments for a COVID-free 2020.
“There was no way that any one of us anticipated that it could grow to the kind of scale that we saw,” reflects Dr Jenny Low, a then-associate professor with Duke-NUS’ Emerging Infectious Diseases Programme.
As an infectious disease physician, Low had seen a number of outbreaks flare up before being quickly contained. Even the first SARS outbreak in 2003 — although devastating — lasted only a matter of months before life went back to normal.
“But most of us came to the realisation that we will have to live with this for a long time to come.”
While the sheer scale may have surprised some, Low and her colleagues at Duke-NUS and across the road at Singapore General Hospital (SGH), where the clinician-scientist works, were prepared for the outbreak.
“We always knew, that these events are ‘whens’ not ‘ifs’, so mentally we’re prepared,” she says shrugging.
Life in a flash
Low — like most other healthcare workers and infectious diseases scientists — had been working at breakneck speed for the past almost 18 months. Bolstered by the lessons learnt from the 2003 SARS outbreak, the robust screening system ensured that symptomatic patients were quickly identified, isolated and tested.
Just around Chinese New Year with the number of suspected cases snowballing, Low who divides her time between clinical work and research had to take on full-time clinical duties; her colleagues were already away on long-planned trips across the Malaysia-Singapore border and would have to quarantine once they returned.
“I was doing calls 24 hours for four days in a row,” Low recalls. “And at night, my phone was going off every 15 minutes. People wanted to know what to do with all these suspected cases, what risk factors to consider, whether these cases should be isolated.”
Those early days just flew by.
“Comparing this experience with working through SARS, I had a lot more energy back then,” muses Low. “I didn’t have kids either, but now I have four! There was a difference in my energy level, stamina and time,” she adds.
Despite being pressed for time, Low and her collaborators managed to share their early experiences dealing with this novel virus in a slew of publications, which included a report on the first three cases admitted to SGH as well as a larger report about the disease in 18 patients, which was published in the Journal of the American Medical Association.
By April 2020, she was finally able to focus on her research duties, joining the fray by recruiting patients for a range of clinical trials to evaluate potential treatments and other interventions to help people sick with COVID-19 as well as to examine the immune response and disease progression of infected individuals.
“I was having to deal with the speed needed to accelerate the research,” laughs Low, who also heads SingHealth’s early phase clinical trials unit, the Investigational Medicine Unit. “It was crazy. I was really racing against time and racing against everyone else.”
The most demanding leg of that race involved shepherding the Arcturus vaccine candidate, ARCT-021, Singapore’s first locally tested vaccine project against the virus, through early phase clinical testing.
“It was a very exciting time,” says Low of the days leading up to National Day 2020 as she and the team geared up for the first clinical trial.
But unlike other mRNA vaccines, ARCT-021 included a self-replicating component that had not been used in a vaccine. While her long-time collaborator Professor Ooi Eng Eong, who led the preclinical testing, was on tenterhooks as the first doses were administered, Low felt quietly confident.
“By the time we started working on the vaccine with Arcturus, they were recruiting children with a rare inherited disorder in New Zealand for a trial using this platform and had safety data from their early phase study. Since we were using the same platform, I didn’t foresee much of an issue,” says Low.
Still, as the first doses were administered, Low remained on hand, vigilant for signs of an anaphylactic reaction in her participants. She did the same whenever the dosing was increased.
In the end, out of the more than 100 volunteers, all but two adverse events experienced by the participants were mild or moderate. And the vaccine candidate was greenlighted for further testing at the end of 2020.
Bittersweet moment that heralds the slow return to normal
Just as the vaccine entered the next phase of testing, the other frontrunners were shipped to countries across the world for real-world use. While that proved to be a bittersweet moment, Low was glad that the world had access to vaccines — vaccines that could prevent severe disease and help the world emerge from the pandemic.
And she has no regrets.
“The world got lucky. We had a ready platform that had been developed for cancer that could be designed into vaccines,” she says, pointing to the need for continued innovation.
“If we look around us to see what’s happening in the world now, there quite clearly aren’t enough vaccines for the short term,” adds Low, who co-directs the Viral Research and Experimental Medicine Centre at SingHealth Duke-NUS (ViREMiCS).
“So, when there’re more available vaccines on the market, ones that can be administered as a single dose, that’s going to benefit more people.”
And the faster vaccines could be made available, the better, as the long tail of the pandemic was starting to take its toll on people’s wellbeing.
The intermittent tightening and loosening of safe distancing measures had resulted in corresponding changes to work routines and school life. And home itself became an added source of mental stress.
“It was very difficult managing work plus home-based learning,” recalls Low. “I think for all of us, the difficulty lay more in coping with just how long the pandemic was lasting.”
But she knew, too, that after the vaccines were rolled out, there was a good chance that the situation in Singapore could return to some semblance of what it was like pre-COVID.
“With more people vaccinated, we can quickly get our vaccination rates in this country to cross the 60 per cent magic mark,” she muses.
“That number’s not going to get us herd immunity, but it’s going to get us a level good enough that we can handle small outbreaks without having to reimpose restrictions,” she continues.
As it would turn out, the wily virus would require a close-to-perfect vaccination rate to adequately cushion its impact on an exhausted healthcare system and fatigued economy before safety measures would be significantly relaxed.
Like all scars, Low knows that they will heal with time. By the time the pandemic is a peculiar memory of the past, Low wishes that the medical community’s recommendations will guide individual behaviour more.
“We have always strongly advocated masking up, yearly flu vaccination and pneumococcal vaccines and staying away from crowded places to our at-risk patients with damaged and vulnerable lungs,” she says. “Hopefully, people will be convinced.”
As for Low, she continued to pursue new projects profiling immune responses to vaccines and infection to gain a better understanding of the evolving virus. Colleagues, too, tapped her expertise for other research projects including saliva testing and N95 mask re-usage. It was fulfilling, purposeful work and resulted — and would continue to result — in, as Low says, “many publications and fantastic research achievements”.
But she would trade a normal 2020 for all these accomplishments any day.
“It makes me realise that I’ve missed so many things that I can do in normal times. I’ll do more travelling,” she lists for when the pandemic ends. “I obviously wasn’t taking enough breaks. I wasn’t spending enough time with family. Maybe I’ll catch up on all this.”
She laughs with a touch of self-deprecating awareness.
“I guess the whole world thinks the same.”