“With the needs of social distancing, how we place beds now might not meet such needs and more space would be needed between beds,” Fan added.

Under the two 10-year development plans for the city’s public hospitals, which cover 2016 to 2035, more than 15,000 additional beds will be provided through redevelopment and expansion.

While ward occupancy rates in the city’s public hospitals often exceed 100 per cent during the winter flu season, Fan said familiar images of overcrowded waiting rooms would not be acceptable given the new need for social distancing.

“We cannot go back to the time when [waiting areas of] outpatient clinics were filled with patients,” said Fan, who took the reins at the authority in December.

“In the past, we were good at adding beds during winter flu season … some of the beds were even placed underneath sinks. We can no longer do this.”

The impact of Covid-19 on Hong Kong hospital patients with other conditions

But getting more space dedicated for health care use in the land-starved city could be challenging.

The administration has been criticised for underestimating the amount of land needed for medical facilities in the next three decades, in part by failing to take the city’s ageing population into account.

Fan said a subcommittee set up under the authority’s task force on sustainability was looking into how development plans should be revised under the new situation.

Over the past few months, Fan said, public hospitals had been forced to cope with one crisis after another, from a shortage of personal protective equipment (PPE), to a workers’ strike, to the second wave of infections that came in late March.

The spike in daily reported cases had been especially concerning, he said, with many linked to travellers arriving from overseas. The number of new infections hit its apex with 65 on March 27.

“I was very scared and nervous at that time,” Fan said. “We witnessed a record of 65 new infections and didn’t know whether the figure would go further the next day – 65 could jump to 130, and 130 could surge to 260. We noted in some countries, the number of new cases had increased exponentially.”

Fears of a potential shortage of hospital beds and PPE loomed. “The chain reaction would put a strain on the already stretched manpower,” Fan said.

A shortage of protective gear occurred from the earliest stages of the pandemic in late January, when global supply tightened as the virus spread.

While public hospitals should theoretically have a three-month stock of protective gear on hand at all times, by February, there were only enough surgical masks left for about one month.

“We had placed orders for personal protective equipment with our usual suppliers in mainland China. But some local governments on the mainland stopped the export of protective gear at the time and we couldn’t get the stock we had purchased,” he said, admitting the authority had been caught off guard by the situation.

The problem was finally resolved after the Chief Executive’s Office pleaded with the central government to help release the protective gear the authority had ordered, Fan said, expressing his gratitude to both governments.

“We would be in big trouble if there wasn’t enough protective gear … how could we ask our colleagues to take care of patients?” he said.

Board member Daniel Lam Chun said a shipment of a mere 10,000 N95 respirators from the authority’s usual supplier, 3M, had been vastly complicated.

“They told us we had to pay our deposit right away for goods that would only arrive in June, and worse still, [would be] subject to the American government’s approval for export.”

He said the board took the extraordinary decision to suspend normal procurement rules that required open tendering, opting for direct purchase to secure supplies of the globally sought-after medical equipment.

Review system and cut through red tape, minister urges Hospital Authority

Sufficient numbers of surgical masks and protective gear for use handling patients in isolation were two of the five demands that sparked some 7,000 hospital workers to launch a week-long strike in early February.

That strike, at a time when health care workers were needed the most, was the second crisis addressed by Fan.

“It was unfortunate that the strike happened,” he said, conceding there were communication issues between frontline staff and management trying to solve the problem.

Now, 100 days after Hong Kong’s very first cases, Fan said public hospitals needed to stay prepared and “learn how to live with the virus”, even with the recent easing of the crisis.

“[Public hospitals] are the last lines of defence. We have no room for complacency,” he said.

Additional reporting by Victor Ting

This is the first of a four-part series on the 100th day of Hong Kong’s Covid-19 crisis. Other parts of this series have examined how the pandemic exposed Hong Kong’s inadequate links between public and private hospitals; the deepest fears held by some of the city’s medical heroes; and, the harrowing account of a musician who was part of Hong Kong’s Covid-19 bar cluster.