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Members of a Chinese lion dance team wear face masks during a performance in Mong Kok, Hong Kong, on February 1, the seventh day of the Lunar New Year. There is no need to panic, but the coronavirus can’t be checked unless ordinary residents do their part to minimise person-to-person contact and observe good hygiene. Photo: AFP
Opinion
Opinion
by Lawrence J. Lau
Opinion
by Lawrence J. Lau

Where closing borders will fail, good hygiene and personal vigilance will help us check the coronavirus outbreak

  • The key is to stop the transmission by as-yet-unidentified infected people to others. And the best way to do that is if all members of the public take the necessary precautions by avoiding close contact with others and practising good hygiene

In 2003, during the severe acute respiratory syndrome crisis, I was still living in the US. In March of that year, based on data on the occurrence of newly reported cases since the first case was identified in Guangdong in December 2002, and taking into account the isolation and quarantine measures then in place, I predicted that the epidemic would end in June, which it actually did. How did I manage to do so?

The key is to focus on the number of newly reported cases. If and when it drops to zero, the epidemic is over. To achieve this goal, two essential things must be done. First, all the identified patients must be isolated and treated. And, second, the potential transmission by the as-yet-unidentified infected patients must be prevented.

When transmission can be effectively stopped, all the remaining unidentified patients will eventually be identified after the incubation period.

Once a new patient is identified and isolated, he or she would no longer be able to transmit the virus. Only the as-yet-unidentified patients could continue to transmit the virus. If transmission can be limited, the number of unidentified patients would decline over time, falling to zero eventually, and the epidemic would be under control.

Preventing transmission by the unidentified patients is extremely important; otherwise, the number of new (and as-yet-unidentified) patients will continue to rise.

The Sars virus is transmitted primarily through close person-to-person contact, via respiratory droplets produced when an infected person coughs or sneezes.

A critical parameter was the number of new patients that a Sars patient would be likely to infect before he or she was identified. Obviously, this depended on the length of time that a Sars patient could remain unidentified, as well as the degree of stringency of the avoidance of contact with others.

Working backwards from the new-patient data and assuming an incubation period, I estimated these numbers, which turned out to be quite low on average, on the order of low single digits, and declining over time. I could therefore predict when this number would fall to zero, which would signal the end of the Sars epidemic.

Controlling the current coronavirus epidemic requires a similar strategy. We need to identify all the infected patients as soon as possible, and isolate and treat them, so they can no longer transmit the virus. Moreover, once a new patient is identified, we can also identify other people with whom he or she has had close contact, and proactively test these potential patients for possible infection, and isolate and treat if necessary.

For us, the public, we also need to take proper precautions by minimising physical contact with other people, both friends and strangers. If we succeed in doing so, we will be able to reduce the transmission of the virus to virtually zero. This is possible if we are willing to adopt and maintain good hygienic behaviour and practices.

Coronavirus forces world’s largest work-from-home experiment

For example, instead of shaking hands to greet others, we could use the traditional Chinese way of greeting, gong shou – that is, holding up your hands and cupping one hand in the other. It does not require physical contact, and can be done in a group as well as between two people.

We should wear masks, use disposable gloves when touching things in public areas, wash our hands with disinfectant or wipe them with alcohol regularly, and refrain from touching our eyes, nose and mouth with our hands.

The transmission of the virus will stop if everyone takes the proper precautions for his or her own protection. By taking measures to protect ourselves, we will also protect others by helping to reduce the probability of secondary transmission to zero.

There is no need to panic. In any case, the mortality rate of the coronavirus is, as of now, not high, about 2 per cent, and so far the deaths caused by the virus were concentrated among high-risk groups such as older people and people with pre-existing health conditions.

Now that the virus has spread beyond China, potential unidentified patients can in principle come from anywhere, not just from the Chinese mainland. Even closing the border completely to the rest of the world will not stop the increase of new coronavirus patients in Hong Kong because of the existence of as-yet-unidentified patients.

Now may be the time to close the border

Working at home will help reduce opportunities for transmission, but it can only be a temporary measure, and in itself will not stop the transmission. The proper way to prevent the spread of the coronavirus is for all of us to take precautionary hygienic measures, to make it impossible for transmission from unidentified patients to occur.

All travellers to Hong Kong, wherever they come from and whether they are permanent residents, should be monitored and required to undergo tests and, if necessary, quarantined. If all of us continue to be cautious, there should be no new infected patients, and we would have stopped the epidemic.

In time, hopefully soon, vaccines will be developed and cures found. However, perhaps we should continue with our new behavioural and hygienic norms so as to avoid other infectious outbreaks in the future. And governments around the world should ban wildlife markets, the source of both the Sars virus and the new coronavirus, permanently.

Lawrence J. Lau is Ralph and Claire Landau Professor of Economics at the Chinese University of Hong Kong, and Kwoh-Ting Li Professor in Economic Development, Emeritus, at Stanford University

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