People are seen wearing masks in Hong Kong, south China, Feb. 28, 2020. (Xinhua/Wang Shen)

OPINION-Resurgence of Covid-19 Cases in Hong Kong: Implications and Lessons

Since a sudden emergence of 25 infected Covid-19 residents on July 8, Hong Kong has been plunged into a “third wave” of outbreak, raising governmental and public concerns about the penetration of the virus into the community and exposing the crucial weaknesses of insufficient testing and relatively lax control over the imported Covid-19 cases.

On July 7, nine cases of infections were found, including five unknown sources. The most worrying situation on July 7 was that students, parents and teaching staff were among the infected cases, pointing to the ferocity of the virus and its infiltration into the school community.

On July 8, 25 new cases of infections were discovered, including two major groupings of a nursing home and a restaurant, while five cases had unknown sources.

On July 9, an unprecedented 34 cases of infections were reported, the highest number of infected residents in July. The nursing home group witnessed an increase of 23 infections directly related to the Tze Wan Shan Kong Tai Nursing Home, affecting not only the elderly stayers but also some staff members. Another group was composed of seven taxi drivers and their relatives. Clearly, Covid-19 penetrated deep into the community and was spreading fast among the ordinary people.

On July 10, 38 cases of infections were found, including 32 local ones. Among the 32 cases, 11 came from group infections in a public housing estate named Ming Chuen Building in Shatin. Many residents were frightened and moved out of the public housing estate. Most of the cases in Ming Chuen Building had no visible symptoms, but the infected residents were characterized by coughing, sneezing, chest pain and headache. The Environmental Protection Department and the Housing Department inspected the Ming Chuen Building, believing that the virus was not spreading because of any leakage of pipes, which were located outside the housing estate. The government did not have any conclusive findings on the sources of Covid-19, and it has no plan to evacuate the residents from the whole building. 

However, a 66-year-old woman in Ming Chuen Building was found to have CT value of 22, meaning that her virus level was much stronger than others. The government workers started to collect the testing samples from residents, while quarantining those who were infected with the virus.

About 30,000 residents are living in Shui Chuen Ao public housing estate at which Ming Chuen Building is located. Because some residents infected with Covid-19 visited the market and shopping mall, it was feared that some more residents might be infected with the virus. While disinfection work was immediately conducted in the market and the shopping mall, their business declined immediately on July 11 and 12.

Of the 11 infected cases in the Ming Chuen Building, 2 of them are primary school students. The two primary schools involved immediately called off all their classes on July 10, while the community centre located at the Ming Chuen Building terminated all its activities for two weeks.

Some reports in Hong Kong point to four major factors leading to the outbreak of Covid-19 in Shui Chuen Ao public housing estate. First, many residents did not wear masks, including some members of the South Asian community. Second, some residents complained to the media that the cleaning company staff used the same pieces of cloth to wash the facilities, which included the floor, walls, and railings. Third, many lower-class residents in the public housing estate reused their masks for many times rather than buying new ones. Fourth, the lifts in the public housing estate were very congested, accommodating almost 50 people at the peak hours, increasing the possibility of infections. It is not known whether these factors were really contributing to the outbreak of Covid-19; nevertheless, the living environment and public awareness and vigilance appeared to be the main problems shaping the outbreak of Covid-19.

The Kong Tai Nursing Home also revealed how Covid-19 exploited the environmental context to infect 34 people within four days. First, the beds for the elderly were quite congested. Second, the infected persons included not only the elderly stayers but also the nursing staff, because they had frequent interactions and provided a bleeding ground for the spread of the disease.

On the other hand, of the four taxi drivers who were found to be infected with Covid-19 on July 9, they either visited the same fast food restaurant or had interactions with residents who went to this restaurant. 

On July 10, six cases of infections were found to be imported from outside areas, including two infected persons who had already left Hong Kong. Of the two who left Hong Kong, one was a seaman and the other was an American pilot who returned to the United States. The other four cases involved Filipinos who arrived Hong Kong. Hence, there were gaps in dealing with the imported cases, either because their infections were discovered late as the virus was hidden and their symptoms were invisible, or because the testing results were relatively slow compared to their mobility.

Some Hong Kong-based scientists believe that Covid-19 had grown far more virulent through mutations, and that it has spread to the community much easier than ever before. They appeal to the residents of public housing estates to check their toilet and kitchen pipes to see whether there might be any leakage, odours and seeping water, signs that showed the possible spread of the virus. Moreover, they suggest that drivers should keep their taxi windows open to reduce the chances of Covid-19 infections. Some scientists in Hong Kong emphasize the importance of public hygiene in the community efforts at preventing the spread of the disease.

Due to the infections of some students, the Education Department announced on July 10 that all primary and secondary schools and kindergartens will terminate their classes from July 13 onwards until further notice. Furthermore, schools have their autonomy and discretion to arrange their examinations and supplementary examinations. Above, social distancing should be maintained among the students. 

On the other hand, the annual bookfair that is scheduled to be held from July 15 to 21 would likely continue as planned, but its participating publishers will have to institute stricter measures of crowd control and social distancing. Only 60 percent of participants would be accommodated during the bookfair. Health ambassadors would be sent to educate the participants on the need to observe hygiene standards.

On July 11, 29 cases of infections were found, including 12 imported cases and 8 unknown sources. In one case, a resident who went to buy sushi on June 22 at a sushi shop in Ping Shek public housing state felt uncomfortable after a man in the same sushi shop coughed. It looked like the spreading of the disease was relatively easy and fast, pointing to the necessity of ordinary citizens to wear masks to reduce the possibility of being infected from other residents with invisible symptoms of Covid-19.

The resurgence of Covid-19 cases has important implications for the city and other parts of the world. First, public hygiene is extremely important for any country or place to prevent the spread of the disease. Second, members of the public need to maintain a highly vigilant attitude, including the necessity of wearing masks. In places and countries where Covid-19 is serious, many citizens appear to lack the knowledge of the importance of wearing masks to protect themselves and others. Third, the testing of Covid-19 needs to be accelerated and popularized in Hong Kong. In mainland China, the rapidity and large scale of testing of Covid-19 virus among the citizens appeared to be a decisive factor in stemming the spread of the disease in cities, such as Beijing recently. Fourth, strict requirements of testing and quarantine of visitors from outside Hong Kong are necessary. Critics of the Hong Kong authorities have pointed to the existing gaps in not only the relatively limited scope of testing residents on whether they may be infected with Covid-19, but also the lack of strict control on the visitors from other countries. 

If Covid-19 remains a virulent disease that can infiltrate into different corners of the society, the Hong Kong experiences have important implications for other parts of the world, especially those countries where Covid-19 remain very serious and infiltrating into the community extensively.