With vigilance slipping and a hard-pressed health system, is Hong Kong ready for the next deadly epidemic?
Sars heroes caution that it is always possible for the virus to make a comeback – and that ‘the son of Sars’ had already emerged in the shape of the Middle East respiratory syndrome
Hong Kong is now better equipped in some ways after battling Sars back in 2003, but experts warn of the city losing its vigilance against emerging threats and the dangers of an overwhelmed public health care system.
After the outbreak killed 299 people in the city, the government established the Centre for Health Protection to strengthen surveillance of communicable diseases in communities. Public hospitals also increased the number of designated isolation beds to 1,400, compared with just a handful scattered among various specialties before the epidemic, with 500 available immediately and the rest ready within 72 hours.
Fifteen years ago, cross-border surveillance was basically non-existent but now there is a sophisticated and comprehensive network.
In addition, medical practitioners are more experienced, and there is greater public awareness.
Still, experts cautioned it would always be possible for the Sars virus to make a comeback. This is especially true for a city that is a regional transport interchange and situated at an infectious diseases hotspot.
In fact, experts warned that “the son of Sars” had already emerged in the shape of the Middle East respiratory syndrome (Mers) coronavirus.
A massive outbreak of Mers in South Korea claimed 186 lives in 2015. It sparked a small panic locally when a South Korean traveller who visited Guangdong province via Hong Kong on business was confirmed as China’s first patient with the virus.
“History always repeats itself,” warned top microbiologist Yuen Kwok-yung, a professor at the University of Hong Kong.
Yuen was named one of Time magazine’s “Asian heroes of the year” in 2003 for helping crack the mystery of the Sars epidemic, which had no obvious cause or source, and the identify of the coronavirus behind it.
That provided the first step towards effective diagnosis and later the treatment of Sars. Within a few months, the virus’s source was traced back to the Chinese horseshoe bat, via the civet cat. It infected humans when sick animals were caught and sold as food in the markets of Guangdong.
Wild animal markets in the province were closed following the discovery. But in the past decade, there have been reports of some reopening and operating secretly to serve locals’ cravings for exotic animals.
“People tend to forget and lose vigilance after a while,” Yuen said, noting that Hong Kong was kept spotlessly clean right after its deadly lesson and people were mindful of environmental hygiene. Rubbish was well attended to and few rats were spotted. “But look at the streets now,” he said.
Professor Malik Peiris, HKU’s clinical and public health virologist who gained international recognition for his key role in discovering that a new coronavirus was the cause of Sars, stressed that it was the public that must stay alert for another pandemic threat.
He pointed out that most new diseases that threaten human health today are zoonotic, meaning they originate in animals, mutate and jump to people.
For example, Mers – a deadlier but less infectious cousin of Sars – has been traced back to one-humped camels in Saudi Arabia. Bird flu strains H5N1 and H7N9 both came from wild birds or live poultry. The Ebola virus emerged in Africa and is believed to come from bats and monkeys.
“This is why it is so important that we be proactive in monitoring what is happening in animals,” Peiris said.
Professor Leo Poon Lit-man, of HKU’s school of public health, said that once zoonotic diseases mutate to infect humans, they usually become more deadly.
“We understand too little of nature. We cannot even say we have enough experts to study the complexity of human health. There are even relatively fewer experts looking into animal health.”
Hidden time bombs in Hong Kong’s medical system
Other than infectious diseases, superbugs and seasonal influenza are also a cause for concern, especially for Hong Kong’s overburdened public hospitals, experts warned.
They said hospitals that are stretched to breaking point during peak demand will not be able to handle another massive outbreak.
“There are always conditions that are not as acute as Sars, but of a more chronic situation, for example, global warming and the issue of antimicrobial resistance,” Yuen said. “People tend to regard them as less important.”
Antimicrobial resistance happens when microorganisms such as bacteria and viruses resist previously effective antimicrobials as a result of misuse and overuse of the drugs. The World Health Organisation has in recent years warned of the terrifying prospect of a superbug emerging as an “increasingly serious threat” to global public health.
Hong Kong authorities launched a strategy and action plan on antimicrobial resistance last July. An official survey found that nearly half of 1,255 interviewees said they had taken antibiotics in the past 12 months.
“I would say the situation is extremely shocking and serious, but people aren’t very concerned. By the time antibiotics are no longer able to treat drug-resistant bacteria, it is already too late,” Yuen warned.
“People may die after very simple surgery.”
Yuen also pointed to the threat of seasonal influenza which hits the city twice a year – in summer and winter – and is often dismissed by the public.
“Every year flu is an important infectious disease but people are still reluctant to get flu jabs because the mortality rate is much lower compared with other diseases such as smallpox. People just think it will not happen to them.”
Gastroenterologist Professor Joseph Sung Jao-yiu, former vice chancellor of Chinese University, echoed those views. Also one of Time ’s “Asian heroes” in 2003 , Sung led a squad of medics dubbed the “dirty team” that took care for Sars patients at Prince of Wales Hospital in Sha Tin.
He also expressed worries about hard-pressed public hospitals.
Sung described the current capacity overload as having “gone back to the overcrowding situation in 2003, if not even worse”, with all medical wards crammed with extra beds.
“Not only is there a shortage of beds, there is also low morale among health care workers who have been living in such a stressful environment for a prolonged period,” he said.
“I am concerned that infection control measures in public hospitals may not be working properly under such circumstances. If the situation cannot be rectified, it will weaken our defences against new infection outbreaks.”
Sung said Sars was a wake-up call for the community – if not the world – on the potential dangers of infection.
“It was a moment of truth for the health care profession, to think about the meaning of their job and their calling to serve society. It was a lesson that we hope we don’t need to learn again.”
Looking to the future for talent
The microbiologists also said fewer students were following a path that would take them into medical research, and warned about a brain drain.
“I feel it is getting more difficult to recruit young Hong Kong students who have an interest in research work,” said Poon, who helped decode the first Sars coronavirus sequence in 2003.
“It seems local students are either no longer interested in doing scientific research, or they do not see a bright future in pursuing it as a career in Hong Kong.”
In recent years, his department received only a handful of student inquiries per year about research prospects, compared with more than 20 about a decade ago.
Very few were Hong Kong students, Poon said, with most from mainland China or possessing training overseas. Just one local student enrolled for a doctorate and was admitted to the department in recent years.
“I’m worried that the city will lose its edge in academic research and innovation,” Poon added.
Sung, who stepped down as head of Chinese University in December, shared the concern.
“Infectious disease has never been an attractive specialty in medicine and that is very sad,” he said.
Yuen, known for seeking answers to tough medical puzzles, said it was sad that research in Hong Kong required considerable hard work and was not a job “that could earn big money”.
“It requires curiosity and imagination, and years of hard work and dedication to prove [a theory]. There are a lot of failures too. All the effort will not always prove to be successful. But once you manage to find the answer, there is huge satisfaction.”
The experts said the government’s recent announcement to set aside HK$50 billion (US$6.4 billion) to promote innovation and technology development in the city was a good move.
“I hope with more resources it would really encourage more local talent to see a future in doing research and development, so that young people will have more choice for their career other than in the finance sector,” Poon said.