March 19, 2020 — As the coronavirus (COVID-19) continues its spread across the world, the medical community is closely monitoring events, regularly updating policies and protocols, and enacting preparedness plans in response to the ever-changing information and in collaboration with local health agencies.
The effects on physicians and other health care professionals, as well as hospitals and health systems, are deep and broad—from rescheduled elective surgeries and routine appointments to an influx of patients to limited availability of certain medical supplies and drugs. Cardiothoracic surgeons are among those who are navigating the growing impact of COVID-19 and embracing the changes, which are happening by the minute. Live updates and coverage of COVID-19 have been flooding televisions, social media feeds, and news sites for weeks now, keeping the public updated on the latest news.
Dr. Alan D. L. Sihoe offers an international perspective on COVID-19 and shares his personal experience and thoughts on how the coronavirus pandemic has affected Hong Kong and what it means for the rest of the world.
The number of new cases daily in Hong Kong has essentially not exceeded single digits. How is this possible?
The Public Response
The public’s confidence in the government has, for other reasons, diminished in recent years. Even though Hong Kong began closing all but three of its border crossings with mainland China on January 28, when Hong Kong had only eight cases, there was some vocal criticism from the public that this was not fast or thorough enough. This suspicion of government has seen the emergence of a very distinct movement in Hong Kong: that of ordinary citizens acting to protect themselves and their communities instead of just relying on the “authorities.”
Since as early as January, some of the more obvious measures that most ordinary folks in Hong Kong have taken – rightly or wrongly – include:
- Wearing masks at all times when outside home.
- Frequent use of hand sanitizer when outside home (hand washing when at home).
- Avoiding going out and taking public transport as far as possible.
- Keeping distance between each other whilst in queues or on an escalator.
- Avoiding touching anything when outside the home and using a tissue or a pen to push buttons.
- Closing the seat cover on toilets before flushing and ensuring adequate water levels in U-traps of all plumbing.
- Sharing of advice and encouragement through social media networking in lieu of physically meeting.
Some of the negative impacts of the COVID-19 crisis on daily life in Hong Kong have been the massive blow to many local businesses (ranging from tourism to school buses) and the infamous spree of panic buying during late January to mid-February that resulted in not only supplies of masks and hand sanitizer being depleted, but also toilet paper, rice, and pasta.
However, the never-say-die spirit of Hong Kong shone through in many ways. Many badly hit restaurants offered visible measures to reduce cross-infection risks, such as temperature checks, offering paper envelopes to diners in which to store masks when eating, keeping greater separation between tables, and even erecting Perspex (Plexiglas) barriers between guests. During the worst period of panic buying, ordinary people mobilized to donate masks and distribute them to those in greater need. Many doctors and nurses in the private sector volunteered their time to serve in public hospitals or provide public education.
The public response may have begun with an over-reaction driven by the instinct for self-preservation, but the end result of near-universal mask wearing and social distancing was an effective limitation of local spread thus far. Of the last 57 confirmed cases in Hong Kong, 50 were imported rather than from local spread.
A Coming Threat?
Hong Kong may become a victim of its own apparent success in limiting the outbreak thus far. As word quickly spreads that Hong Kong is "safer" than most countries around the world, tens of thousands of its citizens working or studying abroad are realizing quickly that it may be advantageous to return. At the time of this writing, there has been a sudden surge of Hong Kong people abroad anxiously rushing to fly back, and it is uncertain whether returning citizens will bring a second wave of imported infections.
Within Hong Kong, a certain sense of complacency may be creeping in as supplies of masks, hand sanitizer, and – yes – toilet paper are returning to near-normal. This comes alongside a degree of “cabin fever” after self-isolation since January. There is a risk of self-discipline eroding if Hong Kong congratulates itself prematurely.
Lately, the world seems to have learned from Hong Kong’s official and public responses and has started to implement measures to limit cross-border and local spread. If Hong Kong is further ahead than most other regions on the COVID-19 curve, the rest of the world would do well to watch closely how Hong Kong copes with the new challenges in the coming days and weeks.
Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU). Authoritative real-time dashboard on the global situation with Covid-19 outbreak. Available at: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
Hong Kong SAR Dashboard on Latest Situation of Coronavirus Disease (COVID-19) in Hong Kong. Hong Kong’s official real-time dashboard on COVID-19 outbreak. Available at: https://chp-dashboard.geodata.gov.hk/covid-19/en.html
Hong Kong SAR COVID-19 Thematic Website. Official government website offering guidance to the public on COVID-19. Available at: https://www.coronavirus.gov.hk/eng/index.html
Alan D. L. Sihoe, MBBChir, MA, FRCSEd, is an Honorary Consultant in Cardio-Thoracic Surgery at the Gleneagles Hong Kong Hospital. He is an International Director on The Society of Thoracic Surgeons Board of Directors, Council Member of the Asian Society for Cardiovascular & Thoracic Surgery (ASCVTS), and Board Member of the Asian Thoracoscopic Surgery Education Program (ATEP). Dr. Sihoe also is Associate Editor-in-Charge of the Thoracic Surgery for the European Journal of Cardio-Thoracic Surgery (EJCTS).