A Tale of Two Cities: How Hong Kong Has Controlled its Coronavirus Outbreak, While New York City Scrambles

By Jerri-Lynn Scofield, who has worked as a securities lawyer and a derivatives trader. She is currently writing a book about textile artisans.

I was chatting on Facebook the other day about the topic de jour – protecting friends, family, and myself from coronavirus – with Dr. Sarah Borwein, an old friend and travel buddy from my Oxford days. Sarah’s a Canadian- trained doctor who has practiced family medicine for more than 15 years in Hong Kong. She co-founded the Central Health Group.

I recently attended Sarah’s wedding in Hong Kong in early January – and got out just in time to avoid some of the more draconian travel restrictions that have since been imposed as a result of the outbreak of COVID-19. At least for now. And just before Hong Kong implemented drastic restrictions that have allowed it to weather the coronavirus crisis while recording only three deaths  so far.

She has an extensive professional history of dealing with infectious diseases in Asia. Prior to commencing her practice in Hong Kong, she successfully ran the Infection Control program for the only expatriate hospital in Beijing during the SARS period, also serving as liaison with the World Health Organization. For a fuller account of her career and her thoughts on the current crisis, see this interview in AD MediLink, Exclusive Interview on COVID-19 with SARS Veteran Dr. Sarah Borwein.

I thought readers might be interested in some of the things Hong Kong is doing to combat the virus.

Partial Lockdown

The city has been in partial lockdown from the middle of January, with schools and universities shut, employees encouraged to work from home, sports facilities and museums closed down, and people told to avoid crowds according to the Financial Times, Hong Kong’s coronavirus response leads to sharp drop in flu cases. Hong Kong residents have accepted these restrictions, since:

Hongkongers are particularly compliant with public health measures because the 2002-2003 Sars outbreak, which claimed almost 300 lives in the territory, is still fresh in many people’s minds.

The partial lockdown is neither easy nor cost-free, but it largely seems to have controlled incidence of the disease, without paralysing Hong Kong. The city is close to mainland China and has extensive economic and other ties. But so far, it has recorded only three deaths, according to the South China Morning Post, Coronavirus: Hong Kong records third death as five more cases confirmed, bringing total to 114. And this for a city with population of roughly 7.5 million people.

Testing

There has been extensive testing for the coronavirus in Hong Kong – which is free. This allows public health austhories to track the spread of the disease, and see that victims get treated properly and promptly.

This record stands in contrast to the US, which has not yet managed to distribute tests widely – let alone, as far as I can see, determine who will pay for testing.

The disease seems to have taken hold in In U.S., with cases exceeding 500 and deaths so far recorded of 22, with 19 in Washington state, according to the New York Times, Cases of Coronavirus Cross 500, and Deaths Rise to 22.

New York declared a state of emergency on Saturday. Governor Andrew Cuomo has complained about the lack of testing kits (see Coronavirus in N.Y.: Cuomo Attacks C.D.C. Over Delays in Testing).

The inability to test means that it’s not possible to track the progress of the disease properly, is as to determine from where a patient may have caught it. Nationwide in the US, a fraction of people who are symptomatic or who may  have been exposed to the virus have been tested. Even India, which has so far managed to limit exposure of its population to foreign sources of infection, has tested many more people – and is doing comprehensive screening at its airports.

Which makes a lot of sense, as foreigners – tourists – are principal source of the infection, Others are Indians returning from foreign climes, carrying with them the disease. So far, India has reported 39 cases, a large cluster of which is an Italian tour group that visited Rajasthan. Five other recent cases are non-resident Indians (NRIs), who returned to India from Venice. We can only hope as the temperature slowly rises as we approach the Indian summer, that increase in temperature slows spread of the virus (see Coronavirus cases rise to 39 as 5 found infected in Kerala). Whether this will prove to be the case is as yet unknown, but as Sarah discussed in her MediLink interview:

 It is true that some viruses that are spread by respiratory droplets, as COVID-19 is believed to, spread more easily when the air is cold and dry. In warm, humid conditions, they fall to the ground more easily and that makes transmission harder.

But there is still a lot we don’t know about exactly how COVID-19 is spread and the effects climate may have on it. We do see it spreading in Singapore, which is warm and humid, so who knows?

I should mention that there has been dark musing about the NRIs returning to the state of Kerala from Venice – as they concealed their travel history and exposure. Kerala Health Minister K.K. Shailaja  has said these victims  will be treated, but that this type of behavior — the deception – should be considered to be a crime.

Hong Kong has made it a criminal offence to lie to a health care provider about one’s travel or exposure history, according to Sarah; I wonder whether the US will attempt to do the same?

There have been numerous complaints about the lack screening at US airports, including JFK, for people coming from Italy, which has locked down 16 million people in Lombardy and the north (see ‘Absolutely Chilling’: Reports From Frontlines of Coronavirus Outbreak Reveal Roadblocks to Testing, Lack of Safety Protocols.)

How to Protect Yourself From Infection

Most of us have heard the advice for avoiding infection. I’m going to repeat this advice. Those who know it all already, feel free to skip ahead. Those who’ve not seen such advice, pay attention.

Wash your hands, with soap, properly and frequently. I posted this video last week, but some readers may not have seen it:

WHO handwashing technique. Notice the attention to between the fingers, back of fingers, and nails:

Hand sanitiser can be used as a stopgap until you can wash your hands, but the World Health Organization says that only those that are 60% alcohol killl the virus. And hand washing is an absolute must for hands that are visibly dirty.

Maintain social distance. Avoid crowds.

Cough or sneeze into a tissue, and dispose of it promptly and properly (I’m tossing mine into my toilet, and flushing them away.).

Pay attention to your overall health. Eat well. Including plenty of fruits and vegetables. Stay properly hydrated.

Get a ‘flu shot if you haven’t already. Although this won’t protect you from coronavirus, ‘flu can be a nasty disease in its own right, and catching it can land you in hospital or quarantine. Not to mention getting sick with the ‘flu overburdens health systems when resources are needed elsewhere.

The procedures Hong Kong has put in place to control coronavirus have also led to a drastic decline in ‘flu cases,. In fact, its winter influenza season has ended  more than a month earlier than usual. ‘Flu cases also dropped during the ARS crisis, according to the FT:

Data provided by the government’s Centre for Health Protection show the incidence of infection with influenza had fallen to less than 1 per cent by the end of February, marking an end to the winter flu season, which normally extends to the end of March or into April.

“A similar pattern happened in 2003 during Sars. All respiratory infection diseases were down between March to September compared to 2002,” said David Hui, a respiratory disease expert from the Chinese University of Hong Kong.

“Influenza spread is one of the markers [of the coronavirus containment] as the same principles of avoiding droplets and social contacts apply.”

Ho Pak-leung, a leading microbiologist at the University of Hong Kong, said data showed the flu season had shortened from an average of 98.7 days to 34 days this year.

Use of Masks?

Masks are not very useful, and many places are out of stock anyway, but Sarah says these can prevent you from passing along any infection you might have to others. She says the advice to avoid masks outright is wrong. There is a place for them, they’re just not a panacea, and in any case, if used improperly, they may actually increase your risk.

From her Medilink interview:

The shortage of masks has many people feeling quite anxious and unprotected. But masks are NOT very effective at preventing transmission of viral infections, particularly when worn by healthy people. They are by no means the most important measure you can take to protect your health. In fact, if you wear a mask incorrectly, touch or adjust it frequently, re-use it, or fail to wash your hands before putting it on and after taking it off, you may actually increase your risk.

Who should wear a mask:

– People who are sick, to prevent them spreading their viral droplets when they cough or sneeze.

– People caring for sick people at close quarters.

– In a health-care setting.

– People whose occupation requires them to have close contact with clients.

As it has become socially unacceptable in Hong Kong to NOT wear a mask, there may be situations in which you might choose to wear a mask simply to make other people feel comfortable. But in general, healthy people do not need to wear masks, except when they need to be in crowded places, or with possibly sick people.

Infection Control Protocol?

This to me was the most striking thing I learned from our conversation. I don’t think anything like this infection control protocol is yet in place – certainly not throughout the US, nor even in high-risk areas. And it it should be.

From a text from Sarah:

We have triage at the door. People with high-risk travel history can’t be seen, have to go directly to government hospital if symptomatic; or if just for routine care, wait 14 days after return (all of which must be healthy). Low risk people with symptoms we isolate immediately; they never enter the main clinic. And we wear PPE [i.e., personal protective equipment] to see them.

In Hong Kong, people are being told to get tested if you think you have been exposed, and/or are symptomatic. Anyone with a fever or respiratory symptoms is tested as a matter of course, upon recommendation of a doctor.

To be fair, I should mention that Hong Kong did not initially test so extensively. Sarah texted me:

Testing has been ramped up gradually. Initially they just added testing of all pneumonia patients, regarless of epidemiological link. The testing of all mildly symptomatic patients with no epidemiologic link is relatively new. A few weeks ago they started offering it in the public hospital A&E’s and public outpatient clinics. Then last week they extended that to private sentinel clinics (of which we are one) and this week have extended it to all private clinics

But in the US, even if your doctor wants to test you, no testing kit may be available to conduct the test. This is simply insane, so many weeks after the disease has taken root in so many places, and after the World Health Organization made accurate tests available months ago.

Hong Kong has also made it easier for patients to test themselves, without involving a health care provider. From a message from Sarah:

They also pioneered a test that patients could do themselves – ie they self-collect a “deep throat saliva” sample at home. That reduces risk of exposure to  healthcare workers, as taking nasopharyngeal swabs is “aerosol generating”

So there is considerable scope for United States to learn from Hong Kong’s  experience and ramp up its testing – without appreciably increasing risk to its health care providers.

One thing chatting with Sarah has driven home to me is how poor the comparative US infrastructure for dealing  with such a disease is – although she didn’t say so in so many words. These are my words, but I don’t think she would dispute the conclusion.

Contrast that to Hong Kong. From her MediLink interview:

The situation is much less serious in Hong Kong than in mainland China, especially Wuhan and Hubei. We are quite exposed here, because of our close ties with the mainland, but we have a very strong public health system, good resources, and deep experience in managing epidemics. After SARS, Hong Kong set up the Centre for Health Protection (CHP), which is our version of the CDC in the United States. When COVID-19 emerged, there was already an epidemic management plan in place that just had to be activated. The four best prepared places in Asia are probably Hong Kong, Singapore, Thailand and South Korea.

Her MediLink interview is upbeat in some ways. Perhaps a better description would be measured.  She points out that COVID-19 is less lethal than SARS. But because of that fact, it’s much easier to spread:

COVID-19 and SARS do share some common features: they belong to the same family of viruses,  they both seem to have jumped from animals to humans, they both originated in China and both can cause severe pneumonia.

But there are some important differences. SARS was more lethal than COVID-19, but less easily transmitted. It went straight for the lungs, and caused severe pneumonia which became transmissible only when patients were quite severely ill and usually by then in hospital. About 10% died.

COVID-19, on the other hand, seems to be more likely to replicate in the upper respiratory tract and it seems like individuals might produce a lot of virus when they are only mildly symptomatic. It’s not known how many people with COVID-19 develop pneumonia, but of the ones who do, about 20% get severely ill and fewer than 2% die. Overall death rates are still not known for sure, but are probably less than 1%.

So COVID-19 is a lot less lethal than SARS, but harder to control because it spreads more easily and by people with milder symptoms. That’s why, despite being considerably less likely to kill you than SARS was, COVID-19 has still in total killed more people in 6 weeks than SARS did in eight months.

We should recognise considerable advances in infection control  have been made since that time. Alas, many countries seem not to have absorbed these lessons – including the United States. Or if they did, that knowledge has failed to translate into effective responses. From MediLink:

Another important difference is that medical science has advanced considerably in the 17 years since SARS. In 2003, it took months to identify the virus and develop a test. For COVID-19 that happened within a couple of weeks. That has made identifying patients a great deal easier. In addition, there are newer treatments and some vaccine prospects already in the works.

Epidemic control is something  that has confounded the US political system. The relevant public health officials may know what needs to be done, they’re not doing it. That may simply be, at least in part, because resources are simply not available. It’s also due to the way we divide authority for such problems, with responsibility largely lodged  at the state and local level. And the reflexive reliance on neoliberal, market-based solutions is also at fault. There are some things government is uniquely positioned to provide, but many are no longer capable of recognising that simple fact.

Over to Sarah’s MediLink interview again:

The most important thing we learned from SARS was that infectious diseases do not respect borders or government edicts, and cannot be hidden. It requires international cooperation, transparency and sharing of information to control an epidemic.

We also learned the importance of providing good, balanced, reliable information to the public. In any epidemic, there is the outbreak of disease and then there is the epidemic of panic. And nowadays, there is also what the WHO has termed the Infodemic, the explosion of information about the epidemic. Some of it is good information, but some of it is rumour, myth, speculation and conspiracy theory, and those things feed the anxiety. It can be hard to sort out which information to believe, so it is important to choose trustworthy sources. Panic and misinformation make controlling the outbreak more difficult.

On a day when markets are melting down, and people are succumbing to panic, I can only say, keep calm. And remind everyone: wash your hands!

 

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59 comments

  1. Eustache de Saint Pierre

    The only query I would have with that is in reference to masks, is that people who appear healthy can be asymptomatic so are therefore spreading the disease, which I believe that masks would help prevent.

    Reply
    1. Ignacio

      The problem is that there are no masks for everybody so these should be available for those who need them the most. This is a F*c*n*gly problematic issue and that is why there must be a campaign against massive mask usage. It has to be repeated 100 1000 1000000s times but we f*c**gl* avoid to understand this necessity.

      Reply
      1. Jerri-Lynn Scofield Post author

        I don’t understand why there isn’t more attention to making more masks. I know precious little about manufacturing. Yet I’ve read many stories about 3D printing. Isn’t it possible to ramp up production of masks? I mean, this ain’t rocket science.

        Reply
        1. Ignacio

          To comply with their function these have to be done using materials and methods that are appropriate and most probably 3D printing is not compliant except for a sham of a mask.

          Reply
          1. Jerri-Lynn Scofield Post author

            Thanks for your reply. Okay 3d printing might be a non-starter, but surely we could have mounted a crash program of mask production by now?

            Reply
            1. Ignacio

              Yes. We are somehow like the student that suddenly notices the exam date has been dated sooner than anticipated. Also, lots of masks were sent to China.

              Reply
            2. PlutoniumKun

              I can stand corrected on this, but my understanding is that it was once common practice for every hospital to have several weeks of stocks of items such as masks and other sanitary items.

              Then managers with MBA’s got involved (apologies to the good people here with MBA’s) and introduced just in time delivery concepts. Result – greater ‘efficiency’, but no stocks for emergencies.

              Reply
              1. Pym of Nantucket

                Amen to your point. Every new theory relies on assumptions. Risk management is about stress testing and looking for fat tails.

                Reply
            3. Louis Fyne

              given the specialty of modern assembly lines, I doubt existing production lines of non-mask items (like air filters) could be converted—unlike WWII.

              One might be better off just going the old-fashioned route and reaching for a sewing machine…

              South Korea has a cottage industry of DIY masks using specialty filters and homemade masks. They were tested by professional and are surprisingly effective (for being “McGyvered” on a kitchen table, not the same as N100-level masks but better than nothing)

              (I can’t find the article talking about the lab-tested efficacy of homemade masks….my google-fu is failing me)

              http://koreajoongangdaily.joins.com/news/article/article.aspx?aid=3074579

              from pre-covid https://www.researchgate.net/publication/258525804_Testing_the_Efficacy_of_Homemade_Masks_Would_They_Protect_in_an_Influenza_Pandemic

              Reply
            4. Anon

              It’s important to recognize that many of the face masks that are being sold online are NOT ASTM F2100 certified (like those masks used in an OR by surgeons and nurses). So, many folks are purchasing masks at exorbitant prices and getting little protection.

              The ASTM F2100 specification requires three layers of specific permeability. There are also three levels of medical grades within the ASTM specification. The N95 masks are only used on special conditions in the medical setting.

              Reply
              1. Norbert Senf

                Did you not read the article?
                Masks are ineffective for protection if you are healthy, and can be worse than no mask.

                Reply
              2. Yves Smith

                I don’t mean to seem to come down on you, but this discussion is missing the key point.

                Surgical masks are to protect the patient from the surgical team infecting him. They were NEVER intended to prevent medical professionals from contracting infections from patients. They are ineffective in preventing a user from contracting coronavirus. They don’t seal tightly to the face, among other things.

                n95 masks are the only masks that are adequate to protect the user from viruses. They are used in a medical setting when treating patients with dangerous contagions, and also for workers exposed to toxic fumes, from inhaling Bad Stuff. And that level of filtering makes it so hard to breathe that you can’t wear an n95 mask for more than an hour (your body interprets the difficulty of breathing as asphyixiation), you need breaks.

                Reply
                1. Anon

                  Yes. I understand the issues you so graciously explain. The F2100 masks are to protect patients from contamination by medical staff in the operating room. If you have the CV wear it; to protect others.

                  My point was actually about the online sale of bogus masks (masks that don’t meet the ASTM F2100 standard). People are not only buying masks for the wrong reasons, but they are paying top dollar for non-medical quality masks.

                  The “special conditions” that require the N95 masks are the ones described above.

                  Reply
                2. TD

                  Regarding the n95 masks, it depends on whether you have a valve. My reusable half face respirator with n95 filters has 1 way valves so that when I breath in, air comes through the filters, and when I breath out, it goes out through a valve. I had no breathing difficulties (I have ridden my bike with it on with no problems).

                  Also re comfort – I have tested my mask fit (its not difficult – block the valves and breath in and you can feel the mask tighten around your face in synch with your attempts to breath with no hissing on the seals) and then test worn my mask for a whole day while I was working at home. No issues – YMMV ask my mask has a silicone seal which is quite comfy.

                  That being said you look like a extra out of mad max so I dont plan to wear it in public until we get clusters in my local area.

                  Reply
                  1. Yves Smith

                    That is inconsistent with reports from medical professional who say they can tolerate them for only a half hour, and other experts that say they are can be used for only an hour continuously for an hour.

                    The CDC has a piece up on extended use of n95 respirators and they have tons of issues that raise doubts about the effectiveness of extended use (several hours+). For instance:

                    One study found that nurses averaged 25 touches per shift to their face, eyes, or N95 respirator during extended use. Contact transmission occurs through direct contact with others as well as through indirect contact by touching and contaminating surfaces that are then touched by other people.

                    https://www.cdc.gov/niosh/topics/hcwcontrols/recommendedguidanceextuse.html

                    If you read the document, you can infer the CDC is at best ambivalent, and I suspect it is due to the many complaints made by medical professional attempting extended use in other contexts (you can find them not even looking for them, that is how I became aware of the issue).

                    Reply
                    1. Cuibono

                      Yes well i can tell you no one is going to take care of these patients without them and supplies are dangerously low in many institutions right now. Hopefully US.Gov has sufficent stockpiles somewhere, and/or a plan to RAMP UP PRODUCTION but i am not hopeful at this point

                    2. TD

                      Re: comfort/effectiveness – The CDC guidelines are for disposable respirators (possibly with NO valve as they cannot breath OUT unfiltered air to keep their environment sterile). I am referring to the reusable n95 respirators that tradies/construction workers use which they do wear for long periods. The filtration capability is the same (n95 is a testing standard) but it is much more comfortable.

                      Healthcare workers for the large part do not use reusable respirators because you have to decontaminate them which is tricky. There are white papers (dont have the link on me) written about hospitals looking at using reusable respirators for increased efficiency/effectiveness purposes (filters easier to manufacture en mass, also reusable respirators are multiple sizes with silicone seals that fit different face shapes better). Its just mass decontamination protocols have not been implemented yet.

                      Re touching your face – this is a personal discipline thing that you can train yourself for.

                    3. johnf

                      I expect you could sterilize a half mask, between uses, with formaldehyde gas, using powdered paraformaldehyde as the generator. Sazuki and Nambi (1982) used 60 grams in a sealed bag for 24 hours to sterilize a surgical microscope. Some in an airtight reclosable box should last for weeks or months.

        2. mitelika

          1, The production line of masks is relatively simple but need time to adjust to product masks. 2, Polypropylene is needed to make the masks, which is short of supply themselves. 3, A simple surgery mask will cost 2 weeks to be manufactured due to the sterilization step (if not sterilized by nuclear radiation) . China can make 70 million masks daily now, but still not sufficient for its own people. Chinese here.

          Reply
      2. Eustache de Saint Pierre

        As I understand it the estimate of those being asymptomatic is about 20%, which is why I thought that the Chinese & the South Koreans unlike the Italians for instance through the enforced use of masks & Isolation have to quite a large extent put a lid on it – SK now down to about 0.6% whereas the Italians at about 4 % CFT.

        BTW – the Chinese sent 100,000 masks to Iran.

        Reply
        1. Eustache de Saint Pierre

          Another aspect of this is the fact that the masks do not protect against the virus as the mask mesh size is 0.3 microns, whereas Covid – 19 is smaller at 0.1 so can penetrate, but wearing them does appear to stop the wearer passing it on.

          Strikes me as being a potential way as in the Chinese method to at least alleviate the spread, but perhaps they could manage it as that part of the world since wholesale outsourcing manufacture most of them, & whose fault is that ?

          I guess we are going to find out which Emporer’s now wear no clothes.

          https://www.quora.com/Is-it-true-that-wearing-face-masks-is-useless-in-preventing-the-contraction-of-the-COVID-19-virus-because-the-virus-is-smaller-than-the-filter-in-the-mask?share=1

          Reply
          1. Noel Nospamington

            I thought the N95 and higher rated masks can stop sub 1 micron viruses including COVID-19.

            Reply
            1. Eustache de Saint Pierre

              Perhaps they can as I am only going by information I have received, but all i have been able to find is the spec shown above.

              I would very much like to be proven incorrect.

              Reply
          2. Pym of Nantucket

            The mask stops droplets, not the virus flying naked through the air. From what I have seen in the studies, the instructions to not use them is almost entirely about conserving supplies and not useful for an individual making choices on their own. They do reduce risk to the wearer, undeniably.

            Reply
            1. Eustache de Saint Pierre

              Thank you for that, certainly worth wearing then in that case – if available of course.

              Reply
            2. The Heretic

              Question for all,

              How is it possible to be a asymptomatic and yet be infections? I had thought that like most flu and colds, the aerosols generated during sneezing or coughing is what transmits the virus via micro or macroscopic droplets of mucous/phlegm. Is COViD-19 virus able to exit the respiratory tract via the humid breath that we all naturally expel?

              Reply
          3. TD

            This is a misconception – n95 masks DO filter against small nano particles under 0.3 micron size. 3M has put out technical advice clearly explaining this.

            https://multimedia.3m.com/mws/media/376179O/nanotechnology-and-respirator-use.pdf

            In fact the SMALLER the particle gets away from 0.3 microns, the MORE effective it is at filtering it. This is due to brownian motion (read the pdf above).

            The 0.3 micro figure is actually selected for testing because it is the midway in the band of particle sizes where the WORSE filtration performance occurs.

            The misinformation around masks floating out there is insane. I guess the shortage for medical workers is so bad they have to try everything to stop demand by normal citizens.

            Reply
            1. Yves Smith

              No, it is because n95 masks are not terribly useful for “normal citizens”.

              First, they require special training to wear properly. Merely ordering them is no good.

              Second, they can be worn for AT MOST one hour continuously. Medical personnel say they need breathing breaks every half hour or so, the masks become intolerable. That is because breathing through them is so difficult that users start panicking because they feel they are asphyxiating.

              So pray tell, how much good is a n95 mask if you need every half hour or so, to go to find a “safe” place to breathe normally for five minutes? Medical workers under normal circumstances can do that (not a crisis, but say in an operating theater with a patient with a dangerous pathogen). Workers handling dangerous materials can take breaks. But someone on an airplane? In public transportation? In a waiting room where the wait is getting long?

              Reply
          4. Cuibono

            THis has been clarified before; this disease IS NOT THOUGHT TO BE AIRBORNE but through particle droplets which are many times larger than the virus itself

            Reply
      3. Brooklin Bridge

        Ignacio, I hope you will forgive me for this question, but would it not be true (assuming enough masks were available so that there was no problem for medical staff) that if everyone wore masks correctly, the virus would stop in its tracks since no one (or a vastly reduced number) would give the disease to others? Never mind getting it; just not giving it; that is, nobody giving it, whether or not they had it to give.

        If true, would that not also be true and perhaps more practical for local areas where the incidence was particularly high and otherwise difficult to contain?

        Reply
  2. a different chris

    >We do see it spreading in Singapore, which is warm and humid, so who knows?

    I was going to make a not-well-thought-out remark of “well we then do know.”

    But then I gave it some more thought – Singapore being First-World in a way that most of the US would not even recognize, they no doubt spend a lot of time in air-conditioned public spaces.

    And that may be the problem. Despite its origins, this is looking like a First World disease. Older wealthy people globe-trotting thru air conditioned spaces. Interesting if it turns out to be true. Mother Nature may be getting tired of our BS.

    Reply
      1. Louis Fyne

        There is 0% chance any public space is using hospital-grade+ filters for the HVAC….unless the owner is very caring about theie occupants.

        It’s expensive as-is for one’s house (compared to the bare basic filter that traps visible dust)

        Reply
    1. Charles 2

      First world but unequal : For the vast majority of the population of singapore, people don’t use air-con at home (electricity is not cheap) and open windows to have airflow instead. Aircon main exposure comes from public transportation, offices and Malls.
      Malls are clearly deserted these days. Offices are a source of contamination indeed, but paid sick leave is a public rule, and Quarantine is covered as well. That leaves public transportation, but most train stations are outdoors and ventilated, and air is renewed when doors are opened.
      Riding an exponential is a tricky game : as Long as R0 is lower than 1, one is safe, but a notch above that all hells break loose. For Singapore, so far so good…

      Reply
  3. Ignacio

    Today has been a day of overreaction indeed. I would point as an addition to Sarah remarks on disease spreading that regarding weather, temperature and humidity as important or even more important than virus air transmission or fomites-led transmission is our susceptibility to infection. A healthy mucosal epithelium contains non-specific barriers to virus and other pathogens including our normal microbiota, enzymes and various types of fibers acting as a physico-chemical barrier for virus entry. In winter, these barriers are less efficient. The same virus load will not have the same effect in winter or in summer in the nasopharyngeal tract. In this sense HK and NY are not comparable. Regarding the lessons of SARS epidemics, if one of them is to keep calm that is a goos lesson. If another lessons is to identify the sites that need stronger protection, that is another good lesson. A third good lesson would be awareness on precautions to be taken personally. Anyway given differences between SARS1 and 2 in virulence and epidemiology there are not many more lessons to learn. Again comparing Singapore or HK with NY in terms of potential fatalities is not spot on for weather reasons.

    The main failure in Italy first, or in Spain now, has IMO been on lack of awareness. No overreaction is needed but good reaction would have made things better if the objective is to reduce fatalities and avoid HC services being overwhelmed. Focus on safety in hospitals is a must. Focusing on safety in residences for the elder is a second must (this has been noticed too late for many).

    This evening I will have a discussion with my son that wants to go to a concert next saturday in a closed ambient. I think that the government will come to my rescue and forbid this class of events.

    Reply
  4. Alan

    Travelling today by suburban train into Mumbai, no one coughing. In the cafe, no one coughing. Situation appears normal. Let’s hope it stays that way.

    Reply
  5. Expat2uruguay

    Is this the future for United States?

    This is what the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care suggests in a technical document linked to the coronavirus emergency . “It may be necessary to place an age limit on entry into ICU . It is not a question of making merely valuable choices, but of reserving resources that could be very scarce for those who are primarily likely to surviveand secondly to those who can have more years of life saved, with a view to maximizing the benefits for the greatest number of people “, reads the report entitled” Recommendations of clinical ethics for admission to intensive treatments and for their suspension , in exceptional conditions of imbalance between needs and available resources “.

    https://www.ilfattoquotidiano.it/2020/03/07/coronavirus-i-medici-delle-terapie-intensive-in-lombardia-azioni-tempestive-o-disastrosa-calamita-sanitaria-lipotesi-delle-priorita-daccesso-prima-chi-ha-piu-probabilita-di-sopravvivenza/5729020/

    Reply
    1. Synoia

      But that would expunge the Trump and Biden bases….Whereas a $ based system would enhance the effect of their bases…

      Reply
    2. rtah100

      My colleague’s spouse is a doctor in Bergamo. They are already limiting ICU entry. The cut-off is at 70 years old and dropping.

      Reply
      1. Louis Fyne

        That. In my opinion, healthy adults are unreasonably panicking, whil seniors and those who run senior centers are too complacent.

        The data is clear, seniors and those with compromised immune systems are at most risk

        Reply
  6. Chauncey Gardiner

    Thank you for this post, Jerri-Lynn, and to your physician friend in Hong Kong for her insightful observations. I particularly appreciated the final three paragraphs of the post in which she mentioned the need for international cooperation and good information to the public, which in turn would seem to require accurate and comprehensive testing be administered.

    Given population density, the active resistance by the city’s residents last year to preserve their civil rights, and Hong Kong’s close cultural and economic ties to China, the city’s comparative performance in controlling the spread of this virus to date and the cooperation of its residents is little short of amazing… A Tale of Two Cities indeed.

    Reply
  7. Ignacio

    Eur CDC has raised to high, the risk of contagion in regions in the EU and UK where local contagions have generalised. In Madrid schools colleges and universities close doors next Wednesday and for 15 days.

    Reply
  8. Eustache de Saint Pierre

    Just adding this from Dr. John Campbell based on a study of around 10,000 people & supported by the British Medical journal, on the seemingly proven benefits in particular for those in Northern lands for taking Vitamin D, which boosts the immune system helping it to fight both viral & bacterial infections.

    Apparently the benefit ranges from 12% to 70% for those who are very deficient. He explains how the study works & it seems that those with a dark skin need it more than old whiteys like myself.

    https://www.youtube.com/watch?v=W5yVGmfivAk

    Reply
    1. JBird4049

      Vitamin D deficiency is a perennial problem in the United States especially in the black population. We get most of it from what our skin produces under sunlight. IIRC, 15-20 minutes per day for a white person like me wearing a short sleeve shirt. However, while being dark skinned protects one from skin damage and cancer, which just about everyone in my family gets, it also reduces the ability of the skin to make vitamin D via sunlight. You need more sun. Since the American diet, especially among the poor, has gotten worse, even pale people have gotten an increase in vitamin D deficiency. Add in the short, cold days of winter and there’s a real problem.

      Reply
      1. Eustache de Saint Pierre

        I don’t know but I imagine that Vit D deficiency is likely to be a large problem in the UK, due to our generally bleak winters & often not very sunny other seasons. We have I believe around 4 million people who would have varying levels of darker skin & although I would guess that we are not as bad as the US for food standards, we would likely have many on poor diets at the bottom.

        Am worried about the effect all of this will have on vulnerable groups like the homeless of which in the UK about 200,000 would be children. There are also about 2000 food banks who many depend on, run by volunteers who might be hard to find if things deteriorate further & hunger sure as hell isn’t going to help much with anyone’s immune system.

        Reply
  9. MsExPat

    As a Hong Kong resident, I can add a few things that perhaps it would be impolitic for Dr. Sarah to have mentioned.

    That is, politics. One of the reasons we had a mask shortage in Hong Kong before coronavirus hit is because our government actually used emergency powers to ban mask wearing some months ago, in reaction to the protests. (The legislation is currently being challenged in the courts, and the government has conveniently gone mum on the issue). The mask ban in HK caused many suppliers to halt imports to the city, even in the early weeks of the virus.

    Astonishingly, it took our government more than two weeks to implement border controls with Mainland China, and even now we have a somewhat porous border still (several entry points are still open, and arrivals from the mainland need only “self-quarantine” for 14 days. Originally our government refused to close ANY borders, until frontline health care workers mounted a strike, and then the government reluctantly closed the main gates at Lo Wu and several other crossings.

    I mention this to underline the important issue that Hong Kong’s successful response to coronavirus has been IN SPITE of the Hong Kong government, not because of it. It is the community and the extraordinary and heroic professionals in our health care system taking up the responsibility and initiative here.

    The nearly 100% mask-wearing in Hong Kong can be understood as a united community response to government negligence. We are over-compensating because they are still treating the coronavirus as a political issue (they banned masks because the riot police demanded it, and they didn’t want to “offend” China by completely closing the borders), rather than a public health one.

    The takeaway here is that a truly united and vigilant public can compensate for a disastrous government when it comes to disease. And I do think that the near universal use of surgical masks has been a net positive here–since so many infections are asymptomatic, we are literally all protecting each other.

    But our hygiene vigilance is supported by a public health infrastructure that dates back more than 130 years, to the time the bubonic plague raged through Hong Kong. We have an excellent, if underfunded, public hospital system, and everyone has access for a tiny fee (about $22 USD). Without universal free health care access, we would have been in big trouble.

    Reply
  10. VietnamVet

    Where there is a good public health system and the city/nation healthcare system doesn’t break down, the death rate for the Wuhan coronavirus is about 0.2%. This is similar to the seasonal flu. Except this is a new strain. Humans have no immunity to it. It really hits seniors hard. We are 14.5% of the US population, 52 million. The Coronavirus is so contagious the UK estimates 80% of the population will get it. The real problem is the influx of millions of ill 70-80-year-olds in the next two months swamping ICUs requiring ventilation to stay alive. The healthcare system will collapse. Italy is letting them die in order to treat younger patients but is imposing a nationwide travel ban to try to limited the number of the deaths.

    That is not the case in the USA. The federal government is so incompetent it is unable to provide the directions to build the emergency ICUs to save lives or impose internal travel bans. The government is quite willing to let millions of old Americans die by procrastination and avoiding spending money needed to dampen down and extend the pandemic. All thanks to Donald J Trump and the flushing of the government down the drain in order to get rid of taxation and regulation.

    Reply
  11. Kelvin

    Also a regular reader from Hong Kong.

    Using Hong Kong as an example, there was a lot of public debate on whether the boarders should be closed completely. The fact that more than 60% of land based arrival are local resident is usually ignored by the public when border controls are discussed. (The current 14 days self-quarantine policy does effectively stop most of the visitors from mainland china, but there are still some locals returning from china.) No government can legally stop their citizen returning their place of residence, so the responsible thing to do is to impose designated quarantine for high risk individuals, home-quarantine for lower risk returners and provide comprehensive testing for them. These are actions which the government have done right.

    However, these effectively measure does become controversial when politics are involved. Because of the deep mistrust and normalisation of violent action, we didn’t just have our usual NIMBYism protest against quarantine locations and designated coronavirus clinics. We had arson attack at designated testing clinic and toilet bombing in control points and public hospital.

    I have already read that gun and ammo sales have increased in US. That really is not an encouraging sign.

    Reply
  12. The Rev Kev

    Late to comments here. From what I have heard, Hong Kong, Singapore and South Korea have been doing a heroic job fighting the spread of Coronavirus. Hong Kong has been so well done that even their normal flu has been stomped on but hard. I have a bad feeling when I see countries like Australia, America and others and think of what is happening in Italy.

    I note too that the flu season in Oz, which may be typical for the southern hemisphere, is from June through to September with a peak in August. Well before then Coronavirus will be firmly established. As they say at Peak Prosperity-

    Case, case, case, cluster, cluster – Boom!

    Reply
    1. Cuibono

      Sadto say our Public Health leaders are NOT of a mind to even argue for follwing these nations lead.
      They simply say: it can NOT happen.
      THat political “reality” is going to cost a LOT of lives

      Reply
  13. Cuibono

    Of all the anomalies of this disease ONE STANDS OUT!
    The CFR in the very young.
    THis is so highly unusual that every effort to understand it will likely yield tremendous insights in how to better deal with it.

    Reply

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