Covid-19 has become more transmissible in Hong Kong, with one patient likely to infect more than two people on average, a top health adviser to the government warned on Friday, as the number of daily cases surged to a three-month high of 92. In an interview with the Post , Professor Gabriel Leung, dean of the University of Hong Kong’s faculty of medicine, urged the government to reintroduce tougher social-distancing measures to reverse the trend and set its own example by allowing civil servants to work from home. Leung also weighed into a heated ongoing debate by expressing reservations about calls for mandatory testing and partial lockdowns, but backing Chief Executive Carrie Lam Cheng Yuet-ngor’s policy address target of achieving “zero infection”. In addition to a still-expanding cluster of infections spread through dance venues that have formed the biggest outbreak of the pandemic so far, the city was facing a new threat as health authorities said a major private hospital was likely to have been hit by a “small” outbreak. An elderly patient who tested preliminary-positive died at the Hong Kong Sanatorium and Hospital, and two staff members were infected, prompting the authorities to review protective measures at private medical facilities. The city’s hospital chiefs also raised concerns over an alarming spread of the virus in public health care institutions, a sign seen in the third wave back in July. “As in July and August, community cases have once again surrounded hospitals … We are quite worried as it may lead to a spread in hospitals,” said Dr Linda Yu Wai-ling, a chief manager of the Hospital Authority. “We have alerted our colleagues to stay vigilant and they must do anti-infection measures.” Of Friday’s new cases, 72 were linked to previous infections, including 58 tied to the growing dancing club cluster, the city’s largest to date with 367 patients. But no new dancing venues were uncovered and added to a list of 21 premises where recent patrons and staff would be required to take a Covid-19 test. Seventeen patients acquired the virus locally but without a known source, while three cases were imported. Friday’s figures took the city’s infection tally to 6,039, with 108 related deaths. More than 60 people tested preliminary-positive. Health authorities believed a “small outbreak” took place at the sanatorium. A 77-year-old woman, who had been in the hospital since mid August for other illnesses, died after testing preliminary-positive for the virus. Dr Chuang Shuk-kwan, head of the Centre for Health Protection’s communicable disease branch, said the patient had stayed in a single room on the 33rd floor of the hospital, and developed a fever and shortness of breath on Wednesday. Hongkongers face hefty fines for ignoring Covid-19 test note from doctor Some family members and carers had been visiting her but Chuang said further investigations would be needed to determine the route of transmission. Her case would not be added to the city’s Covid-19 death toll until her infection was confirmed after a second test. A nurse, who was involved in resuscitation of the patient, and a support staff member working on the same floor also tested preliminary-positive. Chuang said about 30 doctors and nurses would be sent to a quarantine camp, while 13 patients on the floor would undergo two-week isolation at the hospital as they could not be moved because of pre-existing illnesses. The hospital could not confirm whether the 13 would be housed in isolation wards equipped with standard negative-pressure facilities, but said in a statement that all 3,200 staff would be given virus tests in the next three days. It also asked infectious disease expert and government adviser Professor Yuen Kwok-yung to conduct an on-site investigation. Yuen told the press after his visit that some measures at the hospital could be strengthened, including increasing fresh air flow in wards, and warned more infections among staff could not be ruled out. He said the patient was not in contact with others in the dance cluster, but it was possible visiting family members were linked to them. The hospital would also tighten visiting arrangements, allowing only three preregistered visitors for each patient and requiring them to undergo Covid-19 tests every three days. The number of visitors allowed for each patient will also be cut from two to one at any given time. Professor David Hui Shu-cheong, another government adviser, said all private hospitals should consider screening visitors, and suggested a test that took only 50 minutes to get the result. Dr William Ho Shiu-wei, chairman of the Hong Kong Private Hospitals Association, agreed that extra infection control measures should be reassessed “constantly”, but that a balance needed to be struck. “Many patients loathe the no-visiting policy of public hospitals, hence they seek treatment in private hospitals. There needs to be a balance,” he said. Most importantly, there had to be strict adherence to mask wearing and hand hygiene. “Sometimes, it’s hard to discover patients and visitors who have let their guard down after pulling the curtain surrounding the bed, chatting away and eating fruits and snacks together,” he said. Coronavirus: infection fears among city’s well-heeled as cases emerge in private clubs “It is important to strengthen education and put up prominent signs to remind everybody.” The health authorities also released details of testing for symptomatic patients under previously announced measures. A patient who receives a test advice from a private doctor must get screened within three days and hand in the result to authorities no more than four days after receiving it. They can also choose to hand in a saliva sample for testing. Patients will receive a mandatory test order and a HK$2,000 (US$260) fine if they do not comply. Those who breach the mandatory order face a maximum penalty of six months’ jail and a HK$25,000 (US$3,200) fine. Meanwhile, HKU’s Leung, who tracked the transmissibility of the coronavirus, revealed that with the fourth wave expanding across the city, one individual carrying the virus could on average spread it to 2.3 people, according to the latest data recorded last Thursday. The figure was as low as 0.3 on October 22. He said the mobility trend of adults and students, based on their traffic data, had returned to 90 per cent of pre-pandemic levels in January, and urged the government and the private sector to send their workers home. “Hong Kong has succeeded in getting daily infections down to zero after the first, second and third wave, we can do it again by using those tried and tested methods,” he said. Hong Kong medical workers who joined coronavirus strike to have pay deducted Leung voiced support for the “zero-infection” target announced in the policy address on Wednesday in getting out “a clear message” to residents, but he said the way to do it would be through work-from-home arrangements and closing down high-risk venues such as concert halls and gyms. Veteran Chinese infectious disease expert Zhong Nanshan said Hong Kong should conduct another citywide testing of all residents, echoing a suggestion also floated by Carrie Lam this week. Leung believed public acceptability was key to the success of draconian measures such as localised lockdowns and mandatory universal testing, but stressed old methods should be used first. In the city’s public hospitals, a paediatric ward nurse in Princess Margaret Hospital who recently had contact with a confirmed patient without wearing a mask and a patient admitted to Tuen Mun Hospital’s orthopaedic ward were also among preliminary-positive cases. Four babies treated by the nurse in the ward returned negative test results for the virus, while 20 other infants who did not have contact with her would also be tested. The chairman of i-CABLE Communications, David Chiu Tat-cheong, and his wife also tested positive for Covid-19, after attending a private dinner at a friend’s house last Thursday. Among the 17 untraceable cases was a 14-year-old student from SKH All Saints’ Middle School in Mong Kok, which would close for 14 days. All staff and students were encouraged to get tested. Friday’s daily figure set a new high for the city’s fourth wave after a three-day run of 80 or more confirmed infections. It was also the highest daily count since 95 infections were logged on August 6, during the city’s third wave. Separately, virus testing kits would be available at 121 post offices starting from Saturday, the government said. A HK$5,000 (US$650) cash allowance scheme for people recently infected with Covid-19 opened for applications on Friday.