With lessons from SARS, Hong Kong’s Covid-19 tutorial for the world

The small city state has benefited from lessons learned after it was the epicentre of the SARS epidemic, keeping infections to less than 1,000, writes Rahul Jacob

Half an hour into a virtual UK parliamentary committee meeting on Wednesday, Jeremy Hunt, the former UK foreign secretary, asked a question that sounded like a drowning man seeking a lifeline. Hunt was responding to a summation of Hong Kong’s relative success in dealing with the Covid-19 outbreak by Professor Gabriel Leung, chair of the medicine department at the University of Hong Kong and one of the two international invitees to the committee meeting. Leung had argued that the foundation of Hong Kong’s success in containing the epidemic to less than 1,000 cases of infections and four deaths in the city of more than 7 million was aggressive testing backed up by quarantining and tech-enabled contact tracing since January.

Hunt asked what Leung would say to scientists in the UK, which has lagged well behind its Organisation for Economic Co-operation and Development peers in levels of testing, who argued that the UK’s epidemic was now akin to a “ship (that had) sailed. We are beyond that point.” Leung, a global expert in infectious diseases, said epidemiologists had well-established sampling methods to use tests to determine the transmission patterns of a virus even after an epidemic had spread widely across a country. It was critical to continue testing to prevent second and third waves of outbreaks, which the world is anticipating.

The exchange would not merit headlines, but deserves a chapter in the annals of postcolonial history. Less than 25 years after Britain’s handover of Hong Kong to China in 1997, the city stands as a global role model in combating Covid-19 — and its former sovereign as one of the laggards. (The meeting had begun with the chair wishing the UK prime minister and its health secretary a speedy recovery.) Hong Kong, Singapore, Korea and Taiwan (and outliers such as Germany) have been at the vanguard of the battle with Covid-19, but Hong Kong’s success in many ways is the most remarkable. As an entrepot of trade and finance for China, it is a revolving door for travel to and from the mainland. In 2018, before widespread protests for universal suffrage prompted a tourism downturn, 78 per cent of the 65 million visitors to the city came from China. The city has weathered three waves of transmission from outside — initially from China, then from returnees from the Diamond Princess cruise ship and most recently from Hong Kong residents returning from Europe and the US ahead — and still has succeeded in keeping transmission within the community tiny. Leung reported that the rate of transmission was 0.7 — anything below 1 suggests the epidemic is receding. The US, by contrast, has seen its rate of transmission drop from above 4 to currently above 2.

Social distancing marks at a restaurant in the city

The city-state has achieved this without the de facto police-state curfew that India has resorted to. Restaurants remain open, people continue to go to parks and favourite hiking routes but nearly everyone wears a mask. This is in part because of the legacy of the outbreak of SARS, which started in China but killed 286 and infected more than 1,500 in 2003 in Hong Kong. SARS is still a vivid memory that allows the city’s superb public healthcare system and the population to respond to health crises such as Covid-19. For the past decade and a half, it has been common etiquette in Hong Kong to wear a mask outside the home when a person has a cough or cold. Door handles and elevator buttons are sanitised every couple of hours in office buildings for the past decade and a half. Critically, Hong Kong has one of the world’s best public healthcare systems, experienced at dealing with challenges such as the avian flu in 1997 to the H1N1 in 2009. Two long-time Pakistani residents in the city, who were on holiday in northeastern America as the epidemic unfolded there, are recent beneficiaries.

They had woken up in Cambridge, Massachusetts on March 7 with the same thought: that they needed to cancel the rest of their holiday and return to Hong Kong. Days later, they tested positive for the virus, likely picked up either in Cambridge or on the flight back. Separated into two control groups to determine the efficacy of treatments, the husband’s recovery route involved a hepatitis injection while the wife was given retro-virals usually used in treating HIV+ patients. This week I caught up by phone with the wife, a lawyer and a loyal friend who sent me tubs of haleem when I had bronchitis last year, after she had been discharged from the city’s Ruttonjee hospital. Named after a Parsi businessman from the British era, who founded it after losing his daughter in 1943 to tuberculosis during the Japanese occupation of Hong Kong, the government hospital has isolation wards to treat Covid-19 patients. My friend contrasted the thoroughness with which the city has tackled the epidemic with the US government’s and public’s erratic responses. Returning early from the US “was the best decision of our lives”. An Australian friend in the city, released from two weeks of self-quarantine on Thursday under the watch of a StayHomeSafe app installed on her phone at the airport after she returned from Australia, also praised the government’s efficiency.

Similar technology has been used for geo tracing in recent weeks by many states in India but many experts believe that the Modi government compounded doing too little, too late by imposing the world’s most stringent controls, an emergency licence raj that has seen farmers struggle to get their produce to markets and hire migrant labour to harvest the rabi crop.

In an interview with The Week, Partho Sarothi Ray, a molecular virologist teaching at Kolkata’s Indian Institute of Science Education and Research, said that if India had isolated and tested travellers from overseas early on as the WHO advised, social distancing would have sufficed without the drastic lockdown that looks set to be extended. Ray warns, “Lockdown makes infected people remain at home. As a result, families are infected. In 65 per cent of the cases, the symptom is missing. When the lockdown ends these people would come out and infect old and vulnerable people, leading to resurgence of virus.” In the 1918 Spanish influenza, peak mortality came during a surge of cases in a second wave of infections. In the past fortnight, Hong Kong and Singapore have had to tighten rather than loosen their restrictions after a new increase in infections, warning that a calibrated approach to physical distancing looks set for the long haul.

By contrast to Leung’s experience speaking to a UK parliamentary body this week and playing a prominent role in Hong Kong, however, Ray reports that he has not been consulted by New Delhi or by state governments. All former colonies are not equal; some have governments more pragmatic and more responsive than others.

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Rahul Jacob lived in Hong Kong for more than a decade and covered the SARS epidemic for the Financial Times