Stuart Heaver reports from Hong Kong on the contrasting approach taken on the island to the Coronavirus pandemic – and the lessons the UK should have learned from it.
Viewed from Hong Kong, the UK’s public health response to COVID-19, is looking tragically inept.
Despite being a densely populated city – roughly the same size as London – where the COVID-19 death toll now exceeds 3,500, new cases of the disease in Hong Kong are now in single digits and total deaths have been restricted to four people.
Neither experts nor ordinary citizens here can comprehend the two months of dithering and denial which characterised the UK approach. Locals gasped in astonishment at images of Londoners travelling on the Tube without wearing face masks or attending concerts. As one exasperated doctor here told me in February: “They know it’s contagious, they know there’s no cure and they know it kills people, what more do they need to know?”
The biggest threat to Hong Kong is now imported cases – many of them from the UK – resulting in the border being closed to non-residents. Everyone returning home is tested for the Coronavirus and sent into compulsory quarantine. Tracking bracelets are issued and police carry out follow-ups.
Last Wednesday, a 42-year old British data manager returning from London tested positive for the virus on arrival at Hong Kong airport and became case number 1,106 – one of four recorded that day.
“In London, people won’t do anything unless you can’t breathe or your lips turn blue and they’re not doing any testing,” he told local reporters. He added that, after being advised by the NHS that he and his wife were infected, he was told that their symptoms were not serious enough to warrant hospital treatment, but to stay at home for two weeks until they subsided. A doctor then cleared them to end their isolation. But the man was still infected and possibly contagious.
It is one small example of how the UK is still getting its containment and mitigation policies for COVID-19 badly wrong, while Hong Kong has developed a successful strategy based on border controls, testing, social distancing and quarantine.
“From the perspective of a family doctor residing and working in Hong Kong, the approach taken here has clearly been quite successful and in addition, less costly, socially, emotionally and financially,” said Dr Grant Ross.
Ross says that key to the successful action in Hong Kong was the speed and scale of the response and the implementation of supervised quarantine and testing/tracing procedures, rather than what he calls “an ungovernable lockdown that did not target the risk zone”.
Professor Ben Cowling is an eminent epidemiologist based at the University of Hong Kong’s School of Public Health. On Saturday, he published new research in the Lancet medical journal suggesting that “social distancing and population behavioural changes – that have a social and economic impact that is less disruptive than total lockdown – can meaningfully control COVID-19”. But Cowling says that “it’s too late to do test and trace in the UK, there is no capacity to identify all the mild infections and no capacity to trace and quarantine their contacts”.
‘No One Has a Clue Where We Are’
In Hong Kong, there has been no lockdown. Schools and public buildings have been closed since 25 January but people are still able to travel around the city, albeit cautiously and in much reduced numbers.
It wasn’t the Government but the public that led the response, donning masks en masse, calling for tighter border controls and self-imposing hand-hygiene and social distancing measures. This is all based on bitter experience of SARS in 2003-4, which claimed the lives of 299 people in Hong Kong.
In a society which is widely contemptuous of its own Government and sceptical about any information emanating from Beijing, Hongkongers did not wait for official instructions. A survey carried out as part of Cowling’s research revealed that 85% of respondents reported avoiding crowded places and 99% reported wearing face masks when leaving home.
Cowling says that, compared to the UK, Hong Kong has built up a lot more capacity for laboratory testing and also has hospital facilities for the isolation of more than 1,000 patients in negative-pressure rooms. “We also have the public health infrastructure for contact tracing and quarantine of close contacts in special facilities outside the home,” he added.
This begs the question: why does the UK not have similar facilities in place and why did the UK Government take no basic containment measures and initially consider a ‘herd immunity’ approach to the Coronavirus?
Professor Malik Peiris is an eminent virologist who was credited with playing a key role in identifying SARS in 2003. Peiris is calling for extensive serological testing to establish the true scale of SARS-CoV-2 infection in the community.
“Everyone is talking about herd immunity for which it is estimated that 50-55% of the population must be infected but no one has a clue where we are,” he said. Peiris was not talking specifically about the UK but the implication is clear – when the UK Government was considering a ‘herd immunity’ response to COVID-19, it had no way of knowing what the death toll would be in achieving it.
He also expressed confusion as to the reason for the difficulty in undertaking effective testing for frontline health workers in the UK. “I don’t understand the problem with testing – it’s not a very simple test [the PCR or swab test] but there are many labs in the USA and UK easily capable of undertaking it,” he said. His team published the details of one of the first effective tests on the World Health Organisation website in late January.
Experts seem bemused by the UK response to COVID-19, given the dire warnings emanating from Hong Kong and elsewhere since January and many expatriates are openly critical. One summed it up: “clueless”.