 Hello and welcome to the OIST podcast, bringing you the latest in science and tech from the Okinawa Institute of Science and Technology Graduate University. My name is Lucy Dickey. This episode is all about COVID-19. 2020 might well become known as the year of the coronavirus. It's been a year of lockdowns, cancelled plans and uncertainty. In this episode, I speak to OIST Provost Professor Mary Collins about OIST response to the outbreak in Okinawa. We talk about the virus, but also about the creativity that OIST scientists have shown during this time and the many projects that have been started to slow the spread in our community. And we discuss why the spread of COVID-19 in Okinawa appears to be so low compared to mainland Japan and many other countries. It was an interesting conversation and I hope you enjoy listening to it. So to start with, could you please say your name and explain your role at OIST? I'm Mary Collins. I'm the Provost at OIST. That's coordinating the university side. I look after the faculty researchers and students who are under the Dean of Faculty Affairs and the Dean of the Graduate School. Looking for research partnerships with the Dean of Research and I also run the Research Support Division and the Health and Safety Service. I've been with OIST for nearly four years now. Cool. So it sounds like you're keeping busy. I have been extremely busy due to the global pandemic, which is not something I signed up for, I have to say. Yeah, I know that must have come as a bit of a shock. So I was having a chat with a colleague yesterday about your research field and we were trying to figure out if you were an epidemiologist or a virologist. So what do you most identify with? I'm very much a virologist and immunologist and I really work mostly with mice in the past. I've looked at immune responses in mice and I've looked at how to use viruses for gene delivery in mice. So that's my home territory. That's what I really understand. The epidemiology about COVID-19 spreading or modeling or whatever. I have in the past worked in a department that included epidemiologists and clinical virologists. So I'm familiar with the technology they use. I'm familiar with the limitations of some of this modeling work or some of the diagnostic tests. But I've never had to actually think about it in anger before until now. I see. Yeah, so just so it's clear. So virology is kind of more the experimental work. Epidemiology is more the modeling. That's right. So epidemiologists are looking at models based on some testing and some questionnaires of people. Virology is very much in the lab, in cell culture, in animal models, sometimes in human vaccines or human testing. So biggest challenge of the interview and I don't think any scientist has managed to do this correctly previously. But in just a few sentences, could you sum up your research career? Absolutely. I started off studying cell biology at my PhD and then I moved into immunology as a postdoc and a second postdoc. And I've been studying mostly immune responses in animals and also how to engineer viruses for vaccine and gene delivery. That's the last 30 years or so. Wow. And then you kind of moved into more of the sort of administrative process. Yeah. So when I've just before I left London, I was dean of a faculty at a big university, plus having a lab. And I felt that my lab wasn't really getting full support. I was too busy. So I thought my next role, I'm going to either run a lab or do leadership. So when I came to OIST, doing leadership was my choice and that I think has been much better for me, actually. It means you're also a bit detached from the lab workers and you can advise them in a kind of mentoring way rather than be their competitor while running a lab. And so when did COVID-19 first appear on your radar? Probably not as early as it should have. It's funny. I went back to the UK in February. It was various birthdays happen in February. And I went to a virology meeting at my old university university college, which was the 80th birthday of one of my mentors. And at that meeting were most of the virologists from the United Kingdom. Okay. And they started to just go on and on about this COVID virus. And I'd obviously seen the news, but I think that put it into perspective for me. They amongst them was some clinicians, some epidemiologists and so on. Everybody was working on it. Everybody was really worried about this virus. Before then I had it a little bit in the SARS bracket that it was very dangerous, but it would burn out very quickly. But people were telling me things about how the virus works that really worried me after that. So when I came back to the beginning of March, I realized we were in for a real problem. Yeah. Yeah. So how does the virus work? How is it different from, say, SARS? That's a good question. I think the main problem with this virus, the COVID SARS Coronavirus 2, which causes COVID-19, is that it transmits very well when people don't have any symptoms. So you can be just fine walking about, not even coughing, but probably talking at people or singing. That's another problem. And during that phase, the virus is transmitting. The SARS COVID-1, the first SARS Coronavirus, that made you very ill quickly. So you were not wondering about transmitting the virus to other people. I had a friend who came from Singapore to London, who was a virologist, and he felt incredibly ill on the plane from the original SARS. And he was quarantined in Germany for three months, which was pretty serious. They took him off the plane and he was quarantined. And he did not transmit it to anybody, which is interesting, I think. He courted in the hospital in Singapore, but he did not transmit it. Whereas this virus, he'd have been on the plane. He'd have landed in London. He'd have met everybody. He would have transmitted it before he felt ill. Yeah. So I guess that shows really clearly how it's spread around the globe so quickly. So I moved here in February. And after a few weeks, I started to get a little bit worried about Okinawa's ability to handle the virus outbreak, considering the resources here. Yes. Was this a concern of yours as well? When we started interacting with the Okinawan prefectural government, we realized that the system here is pretty robust. The system is robust. So the testing has been very efficient. As soon as anybody has something that looks like plausible symptoms to a doctor, they are tested and their contacts are traced. And we know that because we started getting involved in PCR testing, helping the Okinawan government. So that brought it home to me that this very meticulous testing and tracing is actually working in Okinawa. It has been a disaster in the UK, as you probably know, where they gave up on testing and tracing almost at the beginning. So once I realized that, I thought this is not as bad as it might be. And we also had contact with some of the doctors in the hospitals. And we realized that there are some fairly high-tech hospitals in Okinawa. They don't really have the same level of numbers of infectious disease beds and so on. But they have high-tech care that they can quickly turn over to seriously ill people. So I think once I was lucky enough to be in communication with some of the people involved in it, I began to be less worried, actually, because they seemed highly professional, organized. And in some ways, I think, because it's a small place, better able to communicate with all the hospitals, better able to enforce testing and tracing than a bigger and chaotic country. UK is chaotic country number two. Probably the US is chaotic country number one. So I think, actually, being in Okinawa, I felt safer. And just going back to what you were saying about Okinawa being quite small with a population of I think one and a half million. That, as you outlined, obviously helped quite a lot. Do you think that was a big influence in why Okinawa has seen a different rate of spread to, say, mainland Japan? I think that Okinawa can control its borders to some extent because we're an island. I think some of the on running cases in mainland Japan involve drinking in bars, involve nighttime entertainment. The Okinawa governor asked people to stop doing that and people pretty much stopped, I think. So I think probably in Okinawa, we have a governor and a government who are supported in general by the behavior of the people. Tokyo seems to be a bit wild there. As soon as they open a bar, it's full of people. So I think in Okinawa, the response has been very good from the people, basically. And you see everybody wearing masks in the supermarket and so on and so forth, which I think is really responsible and probably a little different from some of the big cities on the mainland where people feel anonymous and they're not part of it somehow. Alright, so you coordinated the setup of the PCR testing at OIST. Do you think this has been quite successful so far? I think it's taught us a lot. And we also knew that in Okinawa, there were only two labs who were set up to do this. So I think the whole system was a little bit fragile and we thought being a third lab was a good idea. I don't think we have done the majority of testing here. The other labs have probably done more than we have, but you've just got to think that if the machine breaks in another place or the people get sick, having some resilience here is really important. So I think my colleagues in the DNA sequencing section were wonderful. They're very professional about how to do these things. And the people in the health and safety section, particularly the biosafety officer, Toshi Tanaka, were very swift in getting this set up. So I think it has actually taught us a lot and it's been useful for Okinawa in the first place. And now for OIST because we can offer people the reassurance of a test if they've traveled somewhere where there's a lot of cases. Yeah, absolutely. So just into the science of this a little bit, how does a PCR test work? So this virus has an RNA strand as its genome and the PCR first of all copies that into DNA and then it amplifies this bit of DNA and it amplifies it through so many cycles at every cycle you double the amount you have. And you quantitate how much there was in the beginning by how many cycles it takes to get a visible signal. The good thing about this PCR test is it's quantitative and if there's no virus there's no signal. So there are never any false positives. So we like it for that. The downside slightly is it takes some time to do. It's a next day result and also it's quite expensive. It's about $30 a test. So in terms of mass testing or in terms of you know you stop at the airport, you need a test. We need to think maybe in future about some things that will be quicker and cheaper. But the PCR test I would say is the gold standard. Right, so just going on about how you're talking about mass testing, obviously some countries are mass testing. Are they using PCR tests for that or is it something else? So in terms of testing the whole population to see who's been infected, people are using antibody tests and this picks up antibodies that your immune system has made against the virus. So we're setting that up. Matthias Wolf here is setting up this antibody test at OIST. Some of the antibody tests are very unreliable. These little strips that look like a pregnancy test kit. These seem to be not really giving sound results. Some false negatives basically, not very sensitive and maybe some false positives. So we're trying to set up a lab based test which is more reliable. It means you can't send the little tests out to everybody in Okinawa and have them mail them back. But we will screen, we think 6,000 patients in Okinawa hospitals. We have a contract with the OPG to do that, prefectural government to do that. And I think that will say how many people in Okinawa have been infected. And that will be a very useful baseline I think because at the moment we don't really know. We're saying we don't think many people were infected but we don't know that. And so this antibody test will be a good way to see how many people have had the virus. So going back to the PCR test obviously and you did touch on the health and safety side of things and obviously the group followed international health and safety regulations. Could you talk a little bit about this? Of course. So we realised early on that because we're not growing the virus the first step here is we take the cap off the sample that has the virus in it and then we immediately inactivate it by extracting the RNA. So we didn't need a category 3 lab to do that. We could do that in a hood in what we call a category 2 lab. So that was good. We could actually for diagnostic testing you don't need the full hazmat suit, high containment laboratory and that's practice around the world. So that was helpful but we set that up basically. So we set up a dedicated lab with the right kind of containment hood for people to do this RNA extraction from the samples and once you've done that the samples are the same as any other old RNA sample and you can run the rest of the reactions wherever you want. So very soon or possibly now we can start travelling within Japan and then the aim is to use the PCR tests to reduce the time you need to spend in quarantine when we return. So could you talk me through what someone would have to do if they're returning to OIS from outside of Okinawa? Absolutely. So we're encouraging people who have been to areas where there are ongoing cases to take a voluntary PCR test. It'll be free, hooray. And on the first day you have to come in, collect a pack from the guardhouse on the gate, take a swab from inside your mouth and deliver that sample. The rest of that day you can work at home and then the next morning you should hear whether the test is positive or we strongly hope negative and if it's negative you just come to work and then you take another test after a couple of days because the virus could be developing and another final test after six days because that will be the end of any incubation period. So I think that is very relatively low effort on part of the traveller. It just means one day at home at the beginning after your return but that's sometimes quite nice to have a rest after you get back. Yeah, I agree. Around how many PCR tests has always performed so far? We've been performing, we performed about 50 clinical tests and at the moment the number's going up. I think we're having 10 to 20 tests a day from travellers at this point because people are flexing their wings a little bit and travelling overseas. So when you first set up PCR testing here there was a shortage of tests globally in Japan and in Okinawa. Do you think we've somewhat moved past the shortage? Yes, the original problem was some particular test kits which were recommended by the WHO and so we had a frenzy of trying to order these from various places but we've since changed our protocol and we don't need those particular kits anymore and clearly the lesson in this is to stockpile a reasonable number of kits of whatever your current test is so we will be doing that in case there's another wave of infection in the winter but I think that obviously all the businesses who make this type of kit are ramping up now. What's bad for the world is quite good for people who make test kits basically so we will be able I think to source those in future. So definitely in Okinawa but do you think you can speak globally? That's an interesting problem because what you really need for PCR is a relatively high tech lab so if you look at Africa for example there are some countries with very high tech research there are some countries with international diagnostic labs that have been set up like the Gambia I know has a very good molecular virology lab that's linked to the UK so it's interesting I think it's country by country there there will be some places where the diagnosis will be just on symptoms and clinical diagnosis I think PCR testing to the whole world is a difficult one ideally we would have a less complex and cheaper test that we could spread and we don't have that at the moment for actual diagnosis. The antibody tests we may be able to spread those but the diagnostic tests for the RNA we don't have a cheap and low-tech version. Alright so moving on from the PCR testing there's been a number of other initiatives that OIST has been involved with such as the gel, face shields, cotton candy machines were you particularly involved with any of these? I really encourage the students to do the hand gel and I was so pleased this project has taken off so we've helped large organizations like the Tuba hospital we had the students had a lovely letter from the head of the Tuba hospital thanking them for keeping his hospital going during the shortage of disinfectant gel and we've also had wonderful postcards and emails from small kindergartens or daycare usually with the children saying thank you so much for our gel and very touching and I think that one actually has been very good for public relations because the students went out to a lot of different places to deliver this so that project I think has been a winner in fact they've all been winners the mask sterilization I think that will be a protocol that is developed in future and we might actually implement that in OIST for mask sterilization because for things like animal research we go through far too many masks so we could reduce our costs quite considerably by using that. I think the face shield production by Amy Shen has been very useful for many medical facilities here and probably a local company will pick up that manufacturer and take it forward so I think every enterprise has been successful basically and I think there's no shortage of creativity amongst the OIST researchers as you might expect. Yeah absolutely um so just going back to the gel so for people who don't know could you talk through exactly what the students did? Yes so they got a gel from the gel recipe from the WHO website and they mixed isopropanol water and glycerol in large containers and then they handed out bottles of gel to the OIST community I still have mine and they also distributed larger amounts of gel to the local hospitals or daycare facilities or nursing homes in Arno village. My favorite story is Fukuoka-san the head of health and safety had to look up how much isopropanol you can transport in a car at one time because they were driving these large amounts of gel to Chubu Hospital and that was great so they managed they I think the answer was they could take 80 litres at one go so that amounts distributed varied from 80 litres down to 500 ml and I think everybody has been really appreciating this. Yeah absolutely um so obviously the gel project came from