| By Adam Taylor with Benjamin SolowayThe Washington Post, March 12, 2020  Email |
Hong Kong learned from SARS. Can the United States learn from Hong Kong?
Two women wear masks in Hong Kong on March 25, 2003. (Peter Parks/AFP/Getty Images)
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HONG KONG — The traumas of recent history have informed Hong Kong’s response to the current coronavirus pandemic. An outbreak of severe acute respiratory syndrome, better known by its acronym SARS, tore through the city in 2003, leaving 299 people dead.
Keiji Fukuda, a U.S. expert on infectious diseases and former assistant director-general for health security at the World Health Organization, told Today’s WorldView that SARS and other outbreaks provided lessons for Hong Kong that it is applying today. “Virtually everybody here has been through the drill,” he said. “They know the consequences.”
As cases of covid-19, the disease caused by the novel coronavirus, spread around the world, countries including the United States will need to internalize some of those same approaches, Fukuda said. The United States has marked well over 1,000 cases, despite administering a limited number of tests, while Hong Kong, despite its proximity to and interconnections with mainland China, has confirmed only about 120 cases.
The local government recognized the risk early, raised the alarm Jan. 4. The fears soon proved justified. The city logged its first case on Jan. 23 — the same day that China declared a lockdown in Wuhan, the epicenter of the initial outbreak.
Fukuda, now head of the University of Hong Kong’s School of Public Health, said the city took the novel coronavirus so seriously in part because many people there were already accustomed to worrying about infectious diseases. “In Hong Kong it is pretty common, even without an outbreak, to see people going around in masks because they may be sick and they don’t want to infect other people,” he said. For many in Hong Kong, the habits that can help control an epidemic are quite common.
That intrinsic level of consciousness may be hard for the United States and other countries to import. “I think there are lessons that the U.S. and other countries can pick up from Hong Kong,” Fukuda said, “but applying them may be difficult.”
Hong Kong made investments to improve its health system after SARS, Fukuda said, funding new measures and building a major infectious disease program at the University of Hong Kong, the school at which he teaches.
An official investigation led to the resignation of the city’s top health official in 2004. This time around, the city government launched a response plan well before confirming any cases. Amid pro-democracy protests, it was willing to take firm measures early on, announcing it would cancel school in late January and pushing citizens to socially distance from each other in public spaces.
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The world is adjusting to a new normal. In Asia, some countries are now closing in on two months of severe restrictions on daily life. Beijing has put swaths of China on lockdown. Despite the heavy toll, mainland Chinese officials are now suggesting their tactics should be emulated abroad.
Critics think otherwise, and point to the chaotic Chinese response in the early days of the virus. Fukuda, for his part, sees the lockdown on Wuhan as a crucial move for stopping the virus’ spread, but doubts that similar tactics could work for long in a democracy. “It’s unimaginable for me in the U.S. that you could lock down 50 million people,” he said.
In South Korea, where there are nearly 8,500 confirmed cases, mass testing of more than 10,000 individuals a day has become the norm. One reason South Korea was motivated to test so many so quickly was the memory of Middle East respiratory syndrome (MERS), an outbreak that killed 33 people in 2015, where faulty tests abetted the spread of the virus.
The United States, meanwhile, stumbled in its own efforts to develop a test. Jeremy Konyndyk, who oversaw the international response to Ebola during the Obama administration, told The Post that it reflected a slow overall reaction. “They’ve simply lost time they can’t make up. You can’t get back six weeks of blindness,” he said.
Hong Kong was not the only place to react with relative rigor early on. Taiwan and Singapore have been able to keep their numbers low because of surveillance and contract tracing — in some cases raising privacy concerns. All three countries saw deaths from SARS.
“Singapore has been very open about all of it’s cases and has described in detail and in near-real-time it’s epidemiological investigations,” Jennifer Nuzzo, a professor at Johns Hopkins Bloomberg School of Public Health, said in an email.
There are no quick fixes, and Hong Kong’s response has been far from perfect. Some critics have argued that the Hong Kong government was too slow to impose border restrictions. The full impact of the outbreak remains to be seen, as a second wave of cases in Singapore may show.
Fukuda cautioned that it is hard to compare the actions of a city of about 7 million with a country of more than 300 million. But just as Hong Kong learned from SARS, the United States may have to learn from covid-19.
“The U.S. has probably two of the strongest health institutions in the world,” Fukuda said, referring to the Centers for Disease Control and Prevention and the National Institutes of Health, but their funding goes “up and down.” It was unclear who was leading the response, he said, and who was paying for vital measures including tests — which are covered by the government in Hong Kong.
“The virus is moving a lot quicker than the [United States] is going to move,” he said.
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