Flu fighter

Today is the eighth of March 2020. It has been 17 years since the death of Dr Lim Kok Ann, the former Secretary-General of the World Chess Federation. Right now, the world is undergoing great strain from the pandemic known as Covid-19 which previously was known as the Wuhan coronavirus. I am bringing up Lim Kok Ann's name on the anniversary of his passing so that more people will be aware of his other life's work as a research scientist in Singapore.

In 1957 Singapore and the Malayan peninsula were hit by the A2 strain of the Asian Flu. This virus was thought to have emerged from the province of Kweichow or Guizhou (貴州) in China. First reported in February 1957, this virus spread to Yunnan province and moved rapidly through China. Up to 500,000 Chinese people were infected. In March 1957, Mongolia and Hong Kong were hit, followed by Singapore in April. All of Asia was infected by mid-May. The influenza strain was subsequently called A2 by virologists. [1]

In a front page story in The Sunday Times of 05 April 1957 [2], the newspaper reported that hundreds of Singapore people had been hit by an influenza epidemic believed to have been spread by ships from Hong Kong. "The epidemic is widespread," said the newspaper, adding, "On Pulau Brani, 30 cases were reported in one kampong inhabited by workers of the Marine Department (population 200)." Many other cases were subsequently reported in other parts of the island.

Some other excerpts from the newspaper:

Virologists of the University of Malaya have isolated the virus in some cases at Pulau Brani. Specimens will be sent to the World Health Organisation influenza centre in Britain, which takes strains from all parts of the world, to trace how the epidemic is travelling.

The Professor of Bacteriology, Prof. J.H. Hale, yesterday described it as "true influenza." It was impossible to give figures, as it was not a notifiable disease, he said. He said the Medical Department could think of no special measures to check its spread.

"Let it burn out. We can do nothing about it," he said. The wearing of sterilised masks would not be of any help, he said. "I don't want to give false hopes to anyone by asking them to wear them," he added.

Prof. Hale said that members of his staff had gone to Pulau Brani earlier in the week to get specimens of the virus. They had later heard that there were many cases in other areas. They had sent cables to the World Health Organisation in Geneva and London saying that they had isolated the virus. He said Dr. Lim Kok Ann was working on the specimens.

The disease has struck several Asian countries recently. A report from Japan in January said that 200,000 people were affected. In March came a report that an influenza epidemic was raging in Peking, causing hospitals and clinics to be crowded and schools to suspend classes.

Then in April a record outbreak of influenza gave Hong Kong doctors one of the busiest spells they could remember. Earlier this month reports from Taipei described hospitals as "crowded" as the epidemic spread in Formosa.

For a very brief time, Dr Lim Kok Ann was sort of a chess mentor to me. I first met him in 1974 when I was playing in the Malaysian team at the first Asian team chess championship in Penang, and he was the chief arbiter for the event. I had just suffered a bad loss in one of my games and I must have looked rather down and frustrated. He took me aside and gave me some words of advice. Chess, he said, was not about playing tactics randomly. You must have a strategy when playing the game. Strategy, after all, is the sum of all the tactics you put together. The last time I met him was in Singapore, maybe two or three years before his death on 08 March 2003. Already elderly and frail, he kept mostly to himself during that annual Malaysia-Singapore chess match. But he still wanted to play for the Singapore side, such was his passion for the game.

Born in 1920, Lim Kok Ann was the grandson of the Singapore pioneer, Dr Lim Boon Keng. His father was Walter Lim Kho Leng who was the first manager of Ban Hin Lee Bank Ltd in Penang when the bank opened for business in September 1935. Apart from being well-known in international chess circles, Lim Kok Ann had a long and successful career as a research scientist. Stella Kon, his daughter and author of Emily of Emerald Hill, said that as a young lecturer in Singapore, he conducted the world's first clinical trials of the new Sabin polio vaccine for the World Health Organisation in 1949. As a result of these trials in Singapore, polio was almost eliminated throughout the world. [3]

His other contribution to medical science was in isolating the A2 strain of the Asian Flu in 1957. How it happened was that he was invited by a friend to visit Pulau Bukom to see some patients suspected of having got influenza from a flu outbreak in Hong Kong. It was very likely the patients in Pulau Bukom, where Shell Oil Company had a large installation and where some port workers lived, had caught influenza from passengers off ships they had visited. [See Note 1 below] [4]

"I went over to Pulau Bukom with the Public Health doctor and found typical cases of influenza - the patients had fever, running noses, red eyes, some cough - and were miserable," he wrote in his unpublished auto-biography which his children had since released as a blog, Gong Gong Says, in 2006. He took throat swabs and blood specimens and returned to the laboratory where he innoculated some eight-day-old and some 14 day-old chick embryos with extracts of the throat swabs to which a mixture of penicillin and streptomycin had been added.

To cut a long story short, the laboratory tests made him suspect that he might have isolated an influenza virus. As he could not be sure initially, he prepared sealed glass ampoules of the chick embryo abstract and sealed ampoules of the patient’s serum, and packed them off to various influenza centres in London, Washington and Melbourne for further tests. The Walter & Eliza Hall Institute for Medical Research in Melbourne was the first to respond and subsequent tests proved that his virus isolate which, although belonged to the Influenza A virus group, was sufficiently different from other Influenza A strains.

His auto-biography continued: "On Monday morning the Singapore Straits Times reported my coup with front page headlines: Brilliant Singapore scientist discovers new influenza virus. In following write-ups they called me Flu Fighter. I did not think that they knew my Grand Uncle by marriage, Dr.Wu Lien-Teh, had published his memoirs under the title Plague Fighter. [See Notes 2, 3 and 4 below]

He then concluded in a rather resigned tone: "The aftermath of my discovery of the new Influenza virus, subsequently named Influenza A2 virus was something of an anti-climax. The main aim of the world-wide WHO Influenza Observer network was the early detection of new influenza virus variants. The A2 virus was present in Hong Kong at least two weeks before it came to Singapore where the virus was isolated about a week after cases had been recognised. It then took a further week before the virus was identified as a new type. WHO’s interest in new influenza variants was not purely academic; WHO had hoped that early detection and isolation of new influenza variants could lead to better control measures because vaccines could be prepared against the virus and populations elsewhere protected against the new virus before it arrives.

"This was a vain hope. It took about a month for vaccines to be made against the virus isolates sent to England and to the United States. First the virus had to be adapted for growth in large quantities, then tests for safety and efficacy would have to be made before the vaccine was actually used. By the time the health authorities had a vaccine ready, the new influenza had arrived on their shores and in most cases, second epidemic waves had already begun.

"Modern transportation enables large numbers of infected people, some not even showing signs of illness to be landed among susceptible populations well within 30 days, the minimum lead time for isolating a new virus and preparing a vaccine from it. Flu Fighter was an empty label; I fingered the enemy, but nothing I did affected its progress round the world."

NOTES
[Note 1: His unpublished auto-biography said Pulau Bukom but The Sunday Times newspaper of Singapore, dated 05 May 1957, had instead mentioned Pulau Brani.]
[Note 2: Maybe time had fogged his memory again, but The Straits Times of 24 May 1957 gave, as a sub-heading on the front page, "High Praise for Colony Doctor"] [5]
[Note 3: Wu Lien-Teh's first wife, Ruth Wong Shu-Chiung, was the sister of Lim Boon Keng's wife, Margaret Wong Tuan Keng, which meant that Wu Lien-Teh and Lim Boon Keng had a tang mooi relationship.]
[Note 4: Wu Lien-Teh was a giant icon in his time. He is best remembered as the medical doctor from Penang that fought and beat the plague in China in 1911. My stories on Wu Lien-Teh can be accessed here.]

SOURCES
[1] Paleomicrobiology: Past Human Infections, p206. Editors: Didier Raoult, Michel Drancourt. Publishers: Springer-Verlag Berlin Heidelberg, 2008. ISBN: 978-540-75854-9.
[2] Flu strikes Singapore. The Sunday Times (Singapore), 05 May 1957
[3] The Inspiring Achievements of Lim Kok Ann, by Stella Kon, imbedded in Junior Tay's story called Remembering Prof Lim Kok Ann. Published in the blog known as IM Kevin Goh's Chess Site, 19 January 2013
[4] Flu Fighter. Lim Kok Ann. Published in the auto-biographical blog known as Gong Gong Says, 07 December 2008
[5] Scientists say the flu bug is new type. The Straits Times (Singapore), 24 May 1957.