City Weekend

How hectic Hong Kong is turning into hotbed of infectious diseases

Doctors warn that since 2003 Sars outbreak awareness of diseases has grown, but many Hongkongers are too busy to take the preventative action needed

PUBLISHED : Saturday, 13 January, 2018, 8:01am
UPDATED : Saturday, 13 January, 2018, 9:14am

Busy and hectic lives mean an increasing number of Hongkongers have little time to consider personal hygiene, a phenomenon which has inadvertently turned the city into a hotbed of infectious diseases, a medical expert has cautioned.

The warning comes amid reports that the city recorded 10 flu-associated deaths in the first nine days of 2018.

Every year Hong Kong is hit by seasonal flu outbreaks, most commonly occurring from January to March and July to August. On top of that, the city also has to deal with about 50 infectious diseases including chickenpox and tuberculosis.

Despite these, Hongkongers still fail to fully acknowledge the threat to the community in the city’s war against disease, according to University of Hong Kong microbiologist Dr Ho Pak-leung. He says that since the 2003 outbreak of severe acute respiratory syndrome, public awareness about communicable illnesses has grown, but high infection rates abound due to a lack of action.

“People know about the preventive measures but don’t put them into practice,” Ho says.

Inaction is just as bad as having zero awareness, he says.

People know about the preventive measures but don’t put them into practice
Dr Ho Pak-leung

As the city’s population grows, it brings about a higher likelihood that infectious diseases will spread. “We live in an environment where personal space is limited, such as in the MTR train compartments, where passengers are so squashed into such tiny spaces with poor ventilation that a sneeze or cough can do a lot of damage,” Ho says.

Vigilance and personal hygiene are essential to prevent viruses being easily transmitted.

“It is particularly crucial for members of the public to make hand washing second nature, especially among adults,” Ho says. “It seems as if their lives are so busy they can’t even spare time to wash their hands properly.”

10 deaths in 9 days as Hong Kong enters winter flu season

A survey by health care group Bupa in 2015 found that Hong Kong workers spent approximately a quarter of the year’s total working days sick, but still went to work anyway. This caused a productivity loss to the economy worth over HK$30 billion – approximately 1.3 per cent of Hong Kong’s gross domestic product, according to research by the company. The productivity loss from staff showing up for work unwell was even higher than it would have been from employees taking sick leave, the firm found, as it undermined the well-being and health of staff.

Seasonal flu

Hong Kong has entered its winter flu season. This past summer the flu season kicked in earlier than expected, sending more than 15,000 patients to public hospitals, which had to cope with occupancy rates of 120 per cent amid staff shortages.

Dr Paul Chan Key-sheung, chairman of the Department of Microbiology at the Chinese University of Hong Kong, warned the public to brace themselves for the upcoming flu season from January to March.

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“We stay indoors more in the winter because of the drop in the mercury, and with the windows shut there is little ventilation, so the virus is more likely to be breathed in and transmitted,” he says.

The flu virus is a common respiratory tract infection spread by direct contact or through droplets when infected people cough, sneeze or talk.

“People who have the flu usually suffer from a fever, cough, sore throat, runny nose, muscles or body aches as well as headaches. Some even experience vomiting, diarrhoea or chills,” Chan says.

The virus is a microscopic infectious agent that invades the cells of bodies and causes serious illnesses in high-risk individuals such as children, chronically ill patients and the elderly.

“Because of their weaker-than-normal immune systems, these people are more prone to developing more severe complications once infected,” Chan says.


Tuberculosis, or TB, was once one of the most deadly diseases in Hong Kong and other Asian cities, and still leaves a lingering fear among older generations. Just last year, Hong Kong saw at least 4,209 reported cases. Back in November there was an outbreak at a Sha Tin secondary school, Kiangsu-Chekiang College, which infected eight people.

Ho says the disease is commonly seen in schools, offices and nursing homes because the symptoms are often regarded as a simple cold and so are overlooked. Those who encounter coughing that lasts three weeks or more must consult a doctor and ask about the possibility of a bacterial infection, he warns.

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China is among seven countries responsible for 64 per cent of the world’s 10 million new cases of TB last year – along with the Philippines, Indonesia, India and Pakistan.

The disease is caused by a germ called tubercle bacillus or mycobacterium tuberculosis. It usually affects the lungs, but can also affect other parts of the body, including the lymph nodes, bones, joints, spine, brain and kidneys. The illness can be spread through the air from one person to another, often when a patient coughs or sneezes, which releases small droplets containing the germs.

Prolonged exposure is usually required for the disease to be transmitted, according to Ho.

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But not everyone who is infected develops TB-linked diseases. Ho says 95 per cent usually escape the illness due to good personal immunity. While the infection will remain dormant in the body, it is not likely illness will appear or be transmitted to other people. However, there is still a one in 10 chance of it becoming active, especially when a person’s body resistance is reduced.

Hand, foot and mouth disease

Last year the Department of Health recorded 419 cases of hand, foot and mouth disease. One took place at a primary school in Sheung Shui, affecting 19 pupils aged seven to 11 and one staff member.

According to the Centre for Health Protection, hand, foot and mouth disease is mostly self-limiting and resolves in seven to 10 days. The contagious virus, which often attacks infants and children, usually begins with a fever, poor appetite, tiredness and a sore throat. One to two days after the onset of fever, painful sores develop in the mouth.

“It starts with small red spots with blisters and develops into ulcers, usually on the tongue, gums and inside of the cheeks,” Chan says.

There may also be a skin rash that is non-itchy, and blisters. The rash is usually on the palms of the hands and soles of the feet. Sometimes though, a person with the virus may not have symptoms, or may have only the rash or mouth ulcers.

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Chan says the disease mainly spreads by contact with an infected person’s nose or throat discharge, saliva or stools, or by touching contaminated objects.

“It is most contagious in the first week of infection so toddlers and children should not go to school and should steer clear of body contact with peers,” he says.

The mainstay of prevention is good personal and environmental hygiene.

“Members of the public should maintain good personal hygiene and wash their hands with liquid soap, especially before touching their nose or mouth and eating or handling food,” Chan says.


Hong Kong is seeing a gradual rise in the number of cases of methicillin-resistant staphylococcus aureus, also known as golden staph, since it was first reported in the city in 2001. The bacteria are commonly carried on the skin or around the nasal area without symptoms of infection. But Ho says even healthy individuals with the bacteria may sometimes pass on diseases including infections of the skin or urinary tract, or food poisoning.

“The main mode of transmission of MRSA infections within the community is direct contact with wounds or discharge,” Ho says.

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In 2007, 173 cases of so-called community-associated MRSA were notified to the Centre for Health Protection. That number increased by more than six times, to 1,148, in 2016.

Most of the time MRSA infections occur in people who have been hospitalised. Infections in the community usually manifest as skin infections, which cause problems such as pimples, boils, abscesses or wound infections.

“The infected area will turn red, swollen and painful,” Ho says. “In more serious cases, the bloodstream can become infected, leading to lung infections or necrotising fasciitis, an infection that results in death of the body’s soft tissue.”