An elderly Covid-19 patient in a public palliative care ward in Hong Kong became a “super spreader” who infected at least 18 others, prompting officials to pledge to do more to contain the outbreak and strengthen preventive measures in the overtaxed public health care sector. A top infectious disease expert said the spread of the coronavirus at United Christian Hospital in Kwun Tong was helped by a practice of shifting patients to different beds and the failure by a staff member to wear full protective gear. The Hospital Authority pledged to review his suggestions before implementing enhanced measures. The cluster was revealed as health officials confirmed another 59 new cases, of which 26 were untraceable and six imported. Authorities also said a third person who had recently returned from Britain was found to be carrying the mutant strain of the virus that is sweeping across England, while mandatory screening was ordered at a public housing estate hit by a worsening outbreak. About 50 people also tested preliminary-positive, including eight patients and seven staff members from the hospital ward, which also provides acute medical services. Another 83-year-old patient who stayed in the ward last week but was discharged has also tested initially positive, while three patients were confirmed as infected earlier this week, pushing the total number of known and suspected cases tied to the outbreak to 19. The super spreader woman was in a coma when she was admitted to hospital suffering from diabetic ketoacidosis, a serious complication of diabetes, according to Professor Yuen Kwok-yung, an infectious disease expert at the University of Hong Kong who inspected the facility on Saturday. An initial X-ray revealed she also had mild pneumonia but this was a common occurrence in patients in a confused state who often had difficulties managing to keep saliva from entering the lungs. She tested negative for Covid-19 and was admitted to the ward. A later screening found a separate patient was infected and after contact tracing determined the elderly woman was at risk, a second test came back positive for the virus. She had a low cycle threshold value of between 14 and 18, which indicated she had a high viral load, Yuen said. He suspected the coronavirus was spread through to others through the air. Coronavirus in dog, burst travel bubble, nasal vaccines: Hong Kong’s firsts amid 2020 pandemic “This is an unfortunate super spreading event that affected other patients,” he said. “It is a palliative care ward, and most of the patients there are suffering from very severe conditions … their immune system is very poor, and thus they are very easily infected.” Yuen noted the woman was transferred to another cubicle due to a shortage of beds and that had worsened the spread. Among four staff who were reported to have tested preliminary-positive on Saturday afternoon was a nurse who had fed the patient and helped wash her mouth but without wearing a pair of goggles. A review was under way into how the other three workers contracted the virus, he said. But he noted that if many patients were infected in a ward at the same time, it was possible medical staff who were wearing surgical masks could have still contracted the virus. Officials announced late on Saturday night that tests on three more workers came back as preliminary-positive. To avoid another such outbreak, Yuen recommended that any patient with persistent lung problems who tested negative for the virus be screened a second time. He also advised medical workers against transferring patients to other zones, although he acknowledged that might be difficult given wards were full. Staff should wear eye protection when carrying out procedures that required patients to take off their masks and more air purifiers must be added to the affected ward, he said. He believed the pressing pandemic situation in Kowloon East was the overriding factor behind the outbreak as more infected patients were filling up hospitals. While his advice was aimed at United Christian, Yuen told the Post separately that other hospitals should also consider it as well. Dr Lau Ka-hin, a chief manager at the Hospital Authority, said the organisation would consider how to adopt the recommendations. “We will bring [them] to the central committee on infectious diseases and discuss with different experts how to implement the recommendations to protect our patients and staff,” Lau said. Officials also confirmed an 18-year-old woman who arrived from Britain on December 11 was infected with the more infectious strain of the coronavirus mushrooming across the south of the country. She was sent to hospital on Sunday after developing a fever. Dr Albert Au Ka-wing, from the Centre for Health Protection’s communicable disease branch, said the teen had been quarantined in a hotel since her arrival. “She didn’t have any close contacts after coming back. She is currently in hospital and in stable condition,” Au said. Two students were confirmed as having the variant earlier this week. Authorities have ordered residents of Lei Sang House at Lei Yue Mun Estate to undergo mandatory screening after a resident in one flat was confirmed as infected, taking the cluster to six cases, which are spread across four flats. Au said the flats were located on different floors and facing separate directions. One unit involved three infections, which were linked to an existing cluster related to dancing and singing venues. The government also asked those who had been in Ming Lai House at Choi Wan (II) Estate in Wong Tai Sin and Ming Yan Lau at Jat Min Chue in Sha Tin to comply with an earlier mandatory testing order and undergo a second screening given the long incubation period of the virus. Meanwhile, a woman who tested preliminary positive gave birth at Kwong Wah Hospital but the newborn returned a negative result and had been placed in an isolation ward. A male nurse at Caritas Medical Centre also tested initially positive. He was last at work on Wednesday and cared for Covid-19 patients. He previously ate with two colleagues, who will be quarantined. His wife is also a nurse at the hospital. An outsourced staff member of the centre responsible for receiving air travellers at the specimen collection centre in the Hong Kong International Airport was also confirmed to be infected on Saturday evening. He was reported to have worn appropriate protective gear while at work. As Hong Kong is preparing to receive its first batch of vaccines next month, the government gave additional details about a new appointment system and digital immunisation record. Secretary for Innovation and Technology Alfred Sit Wing-hang told a radio programme the platform would allow users to choose their preferred vaccine and book two vaccination slots at the same time. Sit said the government was trying to set up a centralised system to store vaccination records so people could provide their phone numbers and other personal information to get their second jab. Chief Executive Carrie Lam Cheng Yuet-ngor earlier announced the government had procured more than enough Covid-19 vaccines to cover all 7.5 million residents, after striking a deal with three manufacturers, giving a total supply of 22.5 million shots. The city’s tally of confirmed Covid-19 cases stands at 8,540 cases, with 136 related deaths. Sit also revealed the “Leave Home Safe” contact tracing app had been downloaded by about 400,000 people since its launch in November. Users can scan a QR code at 67,000 different locations to keep track of where they have been. The app will notify users if a person confirmed with Covid-19 has recently visited any of them. Sit added that the bureau was studying ways to improve the app, including installing sensors at different places and on public transport so people could automatically log their whereabouts using bluetooth technology instead of through a QR code. Speaking to the media after the programme, Sit dismissed claims that the low number of users reflected public distrust in the government. “The question of whether the people trust the government does not exist. The public can choose different ways to keep track of their whereabouts,” he said. “More importantly, it is the responsibility of the government to give options to the people.” Chinese asked to stay home for the holidays as 20 new infections reported Asked whether it would be mandatory to download the app, Sit said it would depend on the development of the health crisis in Hong Kong. Separately, Macau hosted the opening of the state-run China Media Group’s new Asia-Pacific headquarters in Hong Kong. The gambling hub has successfully managed to contain the pandemic, in part through strict control of its borders. It recently raised its mandatory quarantine period for returnees to 21 days, and Hong Kong subsequently followed suit. The Leisure and Cultural Services Department also said nearly 6,000 verbal warnings and 10 fixed-penalty tickets were issued over social-distancing violations between Thursday and 4pm Saturday. It urged the public to avoid group gatherings. Additional reporting by Danny Lee