When Bin Cao was called by the Chinese Ministry of Health in January 2020 to travel from Beijing to Wuhan to assist with patients severely ill with acute respiratory infection, he was not fazed. It was not the first time he had received such a request. He recalls many similar occasions, including going to Jinan and Tibet in 2009 to look after patients infected with influenza A H1N1 and travelling to Shanghai and Nanjing in 2013 to care for patients with avian influenza H7N9. “I cannot remember how many times I was called to other cities to take care of the severely ill patients, not only me, but many doctors from teaching hospitals because we have the training and skills to provide help to local physicians”, says Cao who is Vice President and Director of the Department of Pulmonary and Critical Care Medicine at the China-Japan Friendship Hospital, Beijing, China, and Vice Director of China's National Center for Respiratory Medicine. He is a leading researcher in pneumonia and influenza and has been instrumental in increasing knowledge about COVID-19.
Cao's training and skills were developed at Peking Union Medical College Hospital (PUMCH) during an 8-year medical degree. Yuanjue Zhu, a professor in the Division of Respiratory Medicine at PUMCH, and specialist in respiratory medicine and interstitial lung disease was his mentor. Cao gained an interest in the specialty as a result and did his undergraduate research about the pathogenesis of idiopathic pulmonary fibrosis. After he graduated in 1998, he trained for 5 years at PUMCH as a resident and then as a chief resident. During that time, he gained an interest in respiratory tract infections. He admits that this path was influenced by his wife, Hui Wang, who was a microbiologist working at PUMCH when they met. “I was so lucky that my mentor is a primary physician, and my wife is a well-trained microbiologist. I combined the two areas together, and little by little I got interested in pulmonary infection, actually pneumonia.”
Cao's interest in pneumonia deepened after the SARS pandemic in 2003. At the beginning of the pandemic, Cao had just completed his residency training and began working as a pulmonary and clinical physician at Beijing Youan Hospital. “I worked in the SARS ward to take care of patients, and some of the SARS patients were actually doctors and nurses who got infected taking care of patients”, he recalls. “My training and the career taking care of acute respiratory infection patients helped me to study more about the microbiology, do the diagnosis, and do research in pneumonia”, he says.
His research achievements include the first national epidemiological study of adult viral pneumonia in China, discerning the clinical differences between emerging human adenovirus type 55 and other types of adenovirus, and studies suggesting that low dose corticosteroid might benefit patients hospitalised with influenza viral pneumonia but a high dose is harmful. He was responsible for China's latest guideline on community-acquired pneumonia, which, for the first time, included a chapter on viral pneumonia. The guideline assisted doctors in Wuhan to consider viral pneumonia as the diagnosis for the initial patients they saw with severe respiratory disease at the start of the COVID-19 pandemic. He also reported the clinical features of pandemic H1N1 in China and human infection with avian H7N9 and led a study suggesting that combination antiviral was superior to monotherapy for influenza viral pneumonia.
Chen Wang, President of the Chinese Academy of Medical Sciences, is a past mentor of Cao's. He comments: “After more than 20 years of diligent work, he led his team to implement a series of high-quality clinical studies in the areas of community-acquired pneumonia, viral pneumonia, and emerging respiratory infectious diseases” which “have made crucial contributions to the advancement of research and clinical management of respiratory diseases in China”.
Cao's seminal papers during the COVID-19 pandemic include the first report of the clinical characteristics of COVID-19 patients in Wuhan, the description of the risk factors for mortality for adult inpatients, and the results of trials testing the use of antiviral drugs, including lopinavir-ritonavir, to treat COVID-19 in China. Although administration of lopinavir-ritonavir did not reduce the mortality of patients hospitalised with severe COVID-19, “the data helped doctors all over the world that they should not use the drug again”, notes Cao. He is the lead investigator of a follow-up study of COVID-19 patients discharged from hospital that reported its 6-month findings in January. His group is also working to understand the “antiviral immune response, how long immune protection can persist, and whether there is some kind of immune damage” from SARS-CoV-2, he notes. About the future, Cao adds: “I'm very open to working together with scientists to test potential treatment targets, not only antiviral drugs, but also host-directed therapy”.
Peter Horby, professor of Emerging Infectious Diseases and Global Health, Nuffield Department of Medicine, University of Oxford, UK, has known and collaborated with Cao for several years. He comments that Cao is “an outstanding physician-scientist, a leading figure in China and internationally, and a tireless champion of evidence-based medicine for respiratory infections. He is primarily driven by a deep compassion for his patients, for which I have huge admiration. His actions during the earliest days of the COVID-19 pandemic were heroic, travelling to Wuhan from Beijing, staying there for months and working day and night not only to save individual patients but also to increase the world's understanding of this new disease”.