Hong Kong, one of the world’s most densely populated cities, has proven highly resilient in containing COVID-19. The tragic lessons learned during the SARS epidemic of 2003 gave the city a head start in tackling the new coronavirus. Its whole-of-government-cum-society approach, which has been built on informed policymaking and an acute sense of responsibility among the population, might provide some insights for European and other Western cities that have been hit harder by the pandemic.
Like any global city, Hong Kong is vulnerable to infectious disease. Its location in southern China and several convenient cross-border links with the mainland, where COVID-19 first broke out, have made the city’s population even more exposed. Density in some parts of urban Hong Kong is as high as 48,500 per km2, more than four times the density of New York City. About 210,000 of the 7.5 million population live in some 92,700 sub-divided units (SDUs) and half of these are elderly, children and patients with chronic disease (CSD, 2016). Per capita living space in SUDs is only 5.3 m2 (ibid.) and not all of the units have separate toilets. The city’s high-density built form provides the perfect condition for chimney or stack effect in disease transmission. Yet, Hong Kong has proven to be one of the most resilient cities in containing the new coronavirus. On May 13th, almost four months after the identification of the first COVID-19 patient, the city reported 1,051 confirmed cases and four deaths. By comparison, on the same day, New York City, where the first case only appeared on March 1st 2020, reported 2,193 confirmed cases and 115 deaths. The divergence between how the pandemic has unfolded in the two cities illustrates the inconsistency of the recently popular argument that there is a direct causality between urban density and the impact of COVID-19.
Hong Kong learned many lessons from the SARS outbreak in 2003, which laid bare major health governance issues in the city.
What accounts for Hong Kong’s “success” in fighting the pandemic, especially when 17 years ago the city lost 299 lives to the Severe Acute Respiratory Syndrome (SARS), a more deadly coronavirus than the one currently spreading? Hong Kong learned many lessons from the SARS outbreak in 2003, which laid bare major health governance issues in the city and highlighted the importance of local modes of health governance for containing an epidemic or pandemic (Ng, 2008). Since SARS, the city’s government has developed detailed guidelines to foster a whole-of-government-cum-society approach to prepare for, monitor and combat infectious diseases. Comprehensive guidelines have been developed not only for medical actions, but also for schools and public education, work places, homes for the elderly and disabled, social services, public and private housing, public transport and aviation, tourism and hotels, and restaurants and markets.
SARS, and the little information that was initially available about the atypical pneumonia, also taught Hong Kong the great importance of collaborating with national and provincial-level health authorities in mainland China on disease surveillance. Over the past two decades the government of Hong Kong has been in regular contact with the Chinese Ministry of Health and the health authorities in the province of Guangdong and the region of Macao (both of which played a leading role in tackling the SARS epidemic), and it has been an active member of international health networks for information sharing. Further, as a result of SARS, Hong Kong’s medical community was able to build up expertise in coronaviruses. The city’s doctors and scientists played a critical role in identifying SARS as a coronavirus and Hong Kong’s “anti-SARS hero”, a professor from the University of Hong Kong, later became a member of the Chinese National Sanitation and Health Committee. During the past few weeks, many of the same experts who led the battle against SRAS have formed part of the government’s advisory committee on COVID-19, which has informed the city’s policymaking. To help Hong Kongers make sense of the new virus and combat “infodemics”, the government is holding daily press conferences that are led by a soft-spoken doctor, and it has created a dedicated website that provides live information on the development of COVID-19.
SARS left a lasting imprint on the city’s civil society: people know from experience that they have to practise self-help and support the poor and marginalised.
The government of Hong Kong has done a meticulous job of tracing the source and connections of cases and alerting people early on to the danger of social gatherings. But the government was also helped by people self-disciplining. The “ghost” of SARS and the horrifying unconfirmed stories from the mainland about the “new SARS” led many Hong Kongers to practice self-imposed social distancing almost from day one. In fact, many people already started wearing masks when the WHO and local government were still insisting that this was only necessary for sick people (before the Chinese University of Hong Kong closed for the Chinese New Year on January 24th 2020, half of my students were already wearing masks in class).
The situation changed towards the end of the Chinese New Year holiday in early February, when masks were becoming a rare commodity and the government announced the first emergency measures. To ensure social distancing, schools were closed until further notice and the entire public administration, except essential services, was told to work from home. At the end of March, when the number of COVID-19 cases increased due to incoming travellers, public gatherings of more than four people were prohibited (this number was relaxed to eight before Mother’s Day). Conscious of the large number of Hong Kongers working or studying abroad, the government had already introduced measures to prevent the import of new COVID-19 cases in early March, before the WHO declared the virus a pandemic. The Asia Expo near the city’s international airport was turned into a testing centre and since March 19th all arrivals from foreign countries have been quarantined. The government operates a mobile app that uses geofencing (rather than GPS) technology to ensure that these people stay in the quarantine location while protecting their privacy. On March 25th the measures were tightened further. The border was closed to all non-Hong Kongers and returnees had to go through a 14-day quarantine. Since April, returning Hong Kongers, including those without symptoms, have had to undergo a deep-throat saliva test. Those with symptoms are sent to triage and test centres in hospitals.
With the increase in confirmed cases, the government mobilised substantial funds to adapt the city’s medical infrastructure and to financially support its citizens. In addition to repurposing hostels, resorts and new public housing estates, the government used HK$1.1 billion (US$1.41 million) from the Lottery Fund to build temporary quarantine facilities. Further, it allocated HK$290 billion (US$37.2 billion) to subsidise peoples’ salaries and, similar to the United States federal government, it made direct payments of HK$10,000 (US$1,282) to each citizen. Both of these measures are unprecedented and they indicate how severely Hong Kong’s economy, which privileges exchange over use value, has been hit by the pandemic. Compared to 2019, GDP has dropped 8.9%, service exports have plunged 37.8% and consumption is down by 10.2% (Choi, 2020). To mitigate the impact on small businesses and shops, the government has provided rent reductions to enterprises located in government-owned buildings and some private property owners have followed suit. But there are also emerging efforts to turn the economic crisis into an opportunity for change and innovation. Some of the city's startups are working on innovative and future-oriented solutions to doing business in times of social distancing and lockdown, and some NGOs have joined an international movement to reconsider the merits of “economic growth” and push for a more progressive urban agenda for a sustainable, climate-friendly, ecological and humane future.
More broadly, Hong Kong’s civil society has been very active in filling the gaps in government action to tackle COVID-19 and its socioeconomic consequences. SARS left a lasting imprint on the city’s civil society: people know from experience that they have to practise self-help and support the poor and marginalised. There exists a strong collective belief that the “haves” bear a moral obligation to help the “have-nots”. Some examples of civil society action include NGOs, pop stars, evangelical Christians and other charitable organisations mobilising resources to source face masks for street cleaners, the elderly, people living in SDUs, the homeless and students having to attend public examinations; a private foundation sponsoring the disinfection of 1,000 SDUs with antibacterial and antivirus solutions that can provide protection for up to nine months; private companies offering donations to purchase protective gear for the poor and to subsidise the rents of families living in SDUs; and key government officials and university presidents donating their salaries to combat COVID-19. To soothe peoples’ anxiety and sense of hopelessness, different organisations are offering psychological and in-kind support via web or WhatsApp platforms. Other platforms offer traditional Chinese medicine anti-virus recipes or low-cost yet nutritious meals to the poor or those who have lost their jobs. These are no small feats considering the city has been deeply divided by the months-long urban protests triggered by the introduction of the extradition law in February 2019 (Ng, forthcoming). Yet, in typical Chinese culture, collective interests (in this case public health) matters much more than individual “rights and liberties”.
The tragic lessons learned during the SARS epidemic gave Hong Kong a head start in tackling the new coronavirus. Well-coordinated actions by the government and an acute sense of responsibility among the population have allowed the city to limit the spread of the pandemic and some of its socioeconomic repercussions.
CHOI, W.H. “Analysis of COVID-19’s economic impacts on Hong Kong”. BOC Economic Review Monthly, February, 2020.
NG, M.K. “The making of ‘violent’ Hong Kong: A centennial dream? A fight for democracy? A challenge to humanity?”. Planning Theory and Practice (forthcoming).
NG, M.K. “Globalisation of SARS and health governance in Hong Kong under ‘One Country, Two Systems’”. In H. Ali and R. Keil (Eds.), Networked Disease: Emerging Infectious Disease in the Global City (pp.70-85). Oxford: Wiley-Blackwell, 2008.