Getting a buzz out of studying the chikungunya virus

Dr Lisa Ng studies viruses.

It's not a subject you and I are naturally attracted to because of what viruses can do to you.

If we could, we would rather not want to know anything about viruses, ever. But even if we wanted to, it would take a lot of hard work.

To begin with, you wouldn't know how to describe a virus.

It's not a living thing by the usual definition of the word because it can't sustain life on its own.

It comes alive only when it meets a living cell, and then all hell can and often does break loose.

Dr Lisa Ng says with some pride that the work done by Singapore scientists in profiling chikungunya is probably unmatched, and used by researchers elsewhere as a benchmark.
Dr Lisa Ng says with some pride that the work done by Singapore scientists in profiling chikungunya is probably unmatched, and used by researchers elsewhere as a benchmark. ST PHOTO: CAROLINE CHIA

  • The science and why it is important

    When scientists study a virus, they want to know what it is made of, how it interacts and infects living cells, how the body responds to the attack, and what treatment is effective.

    It is a growing field of study and highly competitive because air travel has speeded up the spread of infectious diseases worldwide.

    Singapore has had its share of these outbreaks, starting with Sars in 2003, followed by the avian flu H5N1, dengue, chikungunya and, most recently, Zika. Its research interest in these diseases is part of the Government's multimillion-dollar investment in biomedical sciences.

    But it's not just about the science. Scientists have to work closely with doctors and public health officials to understand how patients react to the infection and how they respond to treatment. When the collaboration succeeds, scientists add to their knowledge and healthcare in the country improves, with doctors finding new ways of managing the disease.

Nor will you know what it looks like because it is so small - a thousand times smaller than a human cell - it can't be seen with an ordinary microscope.

Fascinating subject to study?

Only if, like Dr Ng, you have spent an entire life researching these deadly things, putting them into test tubes, under a fancy scope (it's called flow cytometry) and tracking their every move.

Then you are entitled to say, as she does when I visit her office at the Singapore Immunology Network (SIgN) in Biopolis: "I like the chikungunya virus."

She is telling me how she decided in 2007 when she joined SIgN to make it her research focus.

It was an inspired choice because, a year later in 2008, a chikungunya outbreak occurred in Singapore for the first time, and Dr Ng threw herself into the work of trying to understand and manage the disease.

Like dengue, which is endemic in the region, chikungunya is carried by the Aedes mosquito and causes similar symptoms - rashes, high fever, headache and joint pains.

When Dr Ng studies the virus, she wants to know what it is made up of, how it infects the body, how the body responds to an attack and what treatment might work.

It is both about the science and about public health.

She was trained in the former but her work on both the Sars and chikungunya viruses made her actively involved in the latter and changed her views about the way scientists work and go about solving problems.

"It made me change the way I asked questions. Previously, I was always asking questions about the virus - what does it do, why is it important. Now it is about what the patients are telling me, how they are responding," she says.

That means expanding her knowledge in areas such as immunology, which is the study of the body's immune system.

It also means having to work with doctors and hospitals and being interested in patients and how they are doing. Even total strangers in chance encounters.

Dr Ng recounts a trip to Kuching in Sarawak where she was giving a talk. A woman in the audience approached her to ask about her joint pains that had persisted years after the infection. Even though the pain had subsided, she had "never felt the same again".

Dr Ng didn't have an answer but the problem has troubled her since.

She's still working on finding out what causes the pain which can be debilitating for some patients.

As she explains all this to me, I am beginning to understand the nature of biomedical research in Singapore, on which millions of dollars have been spent. It is all part of the country's multibillion-dollar R&D effort to find new ways to grow the economy. But it's not just about trying to find the latest scientific breakthrough that might lead to a new drug.

That's an expensive gamble with no guarantee of success.

It's also about helping to improve, even if incrementally, the way doctors treat the disease.

That's the public health part which Dr Ng first became involved in when the Sars epidemic hit Singapore in 2003, when she was still a rookie scientist working at the Genome Institute of Singapore.

She had been roped in despite her relative inexperience because her doctoral research had been on avian coronavirus.

When I ask her for examples of how her current work has led to better healthcare, she cites the way Singapore has been able to determine which chikungunya patients are likely to develop mild symptoms compared to those with more complicated reactions, from their blood samples. It helps hospitals better decide who to send home and who to admit for closer observation and treatment.

Singapore is able to do this better than many other countries because it has a well-organised healthcare system able to track patient cohorts accurately. This is unlike in some countries where researchers can't be sure the patients they study have not also been infected with some other disease apart from the one being studied.

She lets on that that was what her counterpart in the Reunion Island had told her when a chikungunya outbreak took place.

Patients there had developed more severe reactions than those being observed in Singapore but researchers could not tell for sure if there were other causes.

They told her: "When Singapore says this is a chikungunya patient, it is a real, clean chikungunya case."

As a result, scientists here are able to carry out their experiments with a high degree of confidence.

She says with some pride that the work they did profiling chikungunya is probably unmatched, and used by researchers elsewhere as a benchmark.

Indeed it came in useful during the recent Zika outbreak in various parts of the world: Because the symptoms were so similar to those of dengue and chikungunya, researchers were able to determine, based on the Singapore reference, that they were in fact dealing with another virus.

It turned out to be Zika.

In fact, Dr Ng had started work on the virus after the number of local chikungunya cases dwindled and there were not enough patients left to study.

It's a tricky virus to research, she says, because the symptoms are often very mild. "So, you and I might have already been infected without us knowing."

When Zika finally appeared here earlier this year, she says, "everything went crazy".

There must be a method to the craziness though because the World Health Organisation later declared that Singapore's handling of the outbreak was a model for other countries to emulate.

An important part of the success has to do with scientists like Dr Ng having close ties with medical colleagues working in the hospitals.

It takes time to develop this and the best partnerships are usually the result of an informal network of close collaborators.

Dr Ng credits her working relationship with Professor Leo Yee Sin, who heads the Institute of Infectious Diseases and Epidemiology at Tan Tock Seng Hospital, for what they have been able to achieve so far.

The result may not be as dramatic as discovering a new drug or vaccine.

But when lives are saved, the returns are no less satisfying.

A version of this article appeared in the print edition of The Sunday Times on October 23, 2016, with the headline 'Getting a buzz out of studying the chikungunya virus'. Print Edition | Subscribe