Updated FAQ about Novel Coronavirus Infection
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Updated FAQ about Novel Coronavirus Infection
Updated March 2, 2020
1. What do we know so far?
2. Global Situation update
3. Hong Kong Situation update
4. What countries have imposed restrictions on travelers from Hong Kong?
5. How many cases ARE there?
6. What are the characteristics of the disease?
7. Who is at risk?
8. How is the disease spread?
9. Can it be spread through drainage pipes?
10. Can it be contracted from food?
11. What about Cruise Ships?
12. What other events have led to transmission?
13. What is the chance of dying from COVID-19?
14. The WHO declared a PHEIC. What does this mean?
15. Is this now an epidemic? A pandemic? What is the difference?
16. What is the role of masks?
17. How does testing work?
18. Are there treatments? What about a vaccine?
19. How do you actually control an epidemic?
20. Why did they close the schools? What is social distancing?
21. How does quarantine work in Hong Kong?
22. Do border closures work?
23. What are the important answered questions?
24. The Seven habits of Highly Protected People
25. Where can I get reliable information? Managing the Infodemic
What do we know so far?
On 31 December 2019, the World Health Organisation was alerted to a cluster of 44 cases of
pneumonia in Wuhan City, Hubei Province of China. Shortly thereafter, Chinese authorities
confirmed that they had identified a new virus, from the coronavirus family, and temporarily
named it 2019-nCoV. The WHO has now named the virus SARS-CoV-2 and the disease it
causes as COVID-19.
Coronaviruses are a large family of viruses, some causing illness in people and others that
circulate among animals, including camels, cats and bats. Human coronaviruses cause
illnesses ranging from the common cold to more severe diseases including pneumonia.
Rarely, animal coronaviruses can evolve and infect people and then spread between people
such as has been seen with MERS (Middle East Respiratory Syndrome, thought to have
spread via camels) and SARS (Severe Acute Respiratory Syndrome, thought to have spread
via civet cats). Both viruses likely originated in bats. It is thought, but not yet confirmed, that
2019-nCoV may also have originated in bats, or possibly snakes, and then amplified in someunknown intermediate animal. An intermediate host is needed because the bat-borne virus
lacks the necessary hardware to attach to human cells.
There is recent, as yet unpublished data suggesting that the stepping stone was via
PANGOLINS. Pangolins are scaly long-snouted ant-eaters that are sold, controversially, for
their meat and scales. Their even greater use is in traditional Chinese medicine, in which
parts of the animal are used to treat ailments such as skin diseases, menstrual disorders and
arthritis.
On January 26, China banned wildlife markets until the coronavirus epidemic is over. There
is increasing pressure to enforce a permanent end to the trade of exotic animals.
In addition, some experts recommend compiling a watch list of all animals that could
potentially transmit viruses to humans.
Global Situation Update
The Chinese have now officially named the disease NCP, or Novel Coronavirus Pneumonia.
The WHO, however, calls it COVID-19 disease, to reflect the fact that not all cases result in
pneumonia. This has become the accepted name.
The numbers have become increasingly hard to interpret, as cases are counted differently in
different places.
The WHO includes only laboratory-confirmed cases
China started reporting clinically-identified cases from Hubei province (without a
positive laboratory confirmation) and then reversed this policy
The new counting method in China resulted in a large spike in cases during the week
of February 10th; however we don’t know if these are new cases, or retrospectively
determined cases
China at least for a while, and in some places, counted only cases with pneumonia. It
is impossible to know how many milder or even asymptomatic cases there may be.
WHO includes Hong Kong, Taipei and Macao in their China numbers, resulting in
different numbers of exported cases
Regardless of how you count the cases, more than 93% of cases continue to be reported from
China; however more new cases are now being reported from other countries than from the
mainland..
On February 7, the death of 34-year-old Wuhan doctor, Li Wenliang, who sounded the alarm
about the virus in December only to be punished, sparked an outpouring of grief and anger
over the government's handling of the crisis, and demands for greater freedom of press. The
Chinese law prohibiting giving out information on an epidemic was also an issue in the 2003
SARS outbreak. There is growing pressure on the Chinese central government to change this
law.
WHO numbers dashboard:
http://who.maps.arcgis.com/apps/opsdashboard/index.html#/c88e37cfc43b4ed3baf977d77e4a
0667
Hong Kong Centre for Health Protection numbers dashboard:https://chp-dashboard.geodata.gov.hk/nia/en.html Johns Hopkins CSSE dashboard: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd402994234 67b48e9ecf6 The Coronavirus App: https://coronavirus.app/ Hong Kong Situation Update As of February 28, 2020, Hong Kong has reported 94 confirmed cases of novel Coronavirus infection and two deaths. Of the cases in Hong Kong, 13 are imported, 2 are close contacts of imported cases, and the rest are locally, or possibly locally acquired, and their close contacts. This does suggest that some limited community transmission is occurring; however the numbers are increasing only slowly. Control mechanisms, so far, seem to be working. By way of comparison, Singapore has reported 96 confirmed cases, including several cases that may have been transmitted locally. Thailand has reported 42 cases and Japan 234 cases. Hong Kong has now effectively closed its borders with China, by imposing a 14 day mandatory quarantine for anyone arriving from the Mainland. It is hoped that this will slow the spread enough to contain any community outbreak. Hong Kong has also enacted strict and very proactive social distancing measures, such as closing the schools and asking civil servants and many others to work from home. These measures, implemented even in the absence of a significant local outbreak, are designed to avert a possible epidemic. Singapore has also closed its borders to all foreign travelers from mainland China, as has Australia, New Zealand, the US, India, the Maldives and others. What countries have imposed restrictions on travelers from Hong Kong? Some countries have also imposed some sort of restriction on travelers from Hong Kong. Currently these include: Taiwan The Philippines Bangladesh Kiribati Kuwait Marshall Islands Mauritius Micronesia Mongolia North Korea (they’ve closed their borders to all tourists) Palau Samoa
The Seychelles
Tonga
Vanuatu
The exact nature of these restrictions varies and the situation is constantly changing. It’s best
to check before planning travel.
How many cases ARE there?
The true number of cases affected by the virus remains a matter of speculation. Modelling by
scientists at Imperial College London suggests that there are many more cases than reported,
As of January 31, they estimated that there were 140,00 or more cases in Wuhan city alone.
The uncertainty over numbers is related to differences in what constitutes a case, and
difficulties in finding and counting milder cases. China counts only pneumonia cases; other
places have detected patients with milder disease. If there are many mild or minimally
symptomatic cases, then the count is likely far higher than reported, but the average severity
is likely lower. Some of the cases detected outside of China have had only minimal
symptoms and have recovered quickly, suggesting that the spectrum of disease can vary from
mild to severe.
Modelling by Imperial College London suggests that about two thirds of COVID-19 cases
exported from mainland China have remained undetected, potentially resulting in multiple
chains of as yet undetected human-to-human transmission in other parts of the world
What are the characteristics of the disease?
2019-nCoV appears to cause mild to severe respiratory illness with symptoms including:
Fever (83%)
Malaise
Dry cough (82%)
Difficulty breathing
Pneumonia in both lungs (75%) or one lung (25%) on chest X-ray
Diarrhea (3-6%)
A preliminary study out of China looking at 1099 patients admitted with Novel Coronavirus
Pneumonia found the following:
1. The median incubation period was 3 days, with a range of 0 to 24 days
2. Only 44% had fever at presentation, although 88% developed it later
3. Cough occurred in 70%
4. Diarrhea (3.7%) and vomiting (5%) were less common
5. The median time from symptom onset to pneumonia was 4 days
6. 5% needed ICU
7. 1.4% died
8. When they included data from Guangdong province (603 cases) where effective
prevention had been undertaken, the death rate dropped to 0.88%These percentages are based on Chinese numbers, which only count cases of pneumonia. The
full clinical picture of 2019-nCoV is still not completely clear. It is thought that about 20% of
pneumonia cases are severe, but again, this is based on incomplete and possibly skewed data.
The incubation period is estimated to be between 1 and 14 days, with an average of 3 days.
The estimated range will likely be narrowed as more data become available.
Who is at risk?
It appears that anyone can get the disease. Cases have been found in all age-groups, from
newborn to very elderly. However, it is increasingly apparent that the risk of developing
severe disease is higher in:
The elderly – those over 60, and especially those over 80
Those with underlying health problems, especially cardiovascular disease or diabetes
Men account for 2/3 of severe cases
A study published on February 17th by the China CDC (CCDC) documented pre-existing
conditions that put patients at higher risk of dying from a COVID-19 infection. Bear in mind,
that these are based on Chinese data that include only cases with pneumonia.
Pre-existing Condition DEATH RATE
Cardiovascular Disease 10.5%
Diabetes 7.3%
Chronic Respiratory Diseases 6.3%
Hypertension 6.0%
Cancer 5.6%
No pre-existing conditions 0.9%
The same study also documented fatality rates by age, again based only on cases with
pneumonia, so likely over-estimates:
AGE DEATH RATE
>80 years old 14.8%
70-79 years old 8.0%
60-69 years old 3.6%
50-59 years old 1.3%
40-49 years old 0.4%
30-39 years old 0.2%
20-29 years old 0.2%
10-19 years old 0.2%
0-9 years old 0
Although case numbers are too small for certainty, it appears that pregnant women and
children (under age 20) are not at high risk for severe disease.How is the disease spread? Transmission is thought to be by respiratory droplets. That means it is spread by sick people coughing or sneezing out the virus in droplets which can be breathed in by another person, or can settle on objects (known as “fomites” in med-speak). It is thought that diseases spread by droplet transmission may also be transmitted by people touching contaminated fomites and then touching their eyes, nose or mouth. This is why hand-washing is so important. It is not known for sure how long the virus can persist on surfaces; currently it’s thought to be a few hours. The disease is thought to be spread mainly be sick, symptomatic patients. Asymptomatic transmission has, however, been reported. It is not clear how common this is; the WHO has stated that it is likely to be rare. A small case study showed no virus in breastmilk. There have been reports from China and Japan that some people have been reinfected or relapsed after being discharged from hospital. Regard these reports with caution for now. Some recovered cases later tested positive again by PCR testing; however this doesn’t prove infectivity, or that the virus is still viable. The test may be detecting the DNA of dead virus. This happens quite often with some other diseases, and is the reason why PCR testing should not be repeated too soon after treatment. Currently the R0, or average number of people infected by a single sick person, is estimated to be between 2 and 4, higher than for seasonal flu and SARS. The massive control measures underway are designed to try to reduce the R0 to less than 1, so that the disease stops spreading. Can it be spread through drainage pipes? There is some preliminary evidence that the virus may also be spread by the fecal-oral route. During the SARS outbreak in 2003, there was a superspreading event at a housing estate in Hong Kong called Amoy Gardens. Over 300 people were infected via defective bathroom drainage pipes that allowed the aerosolization of virus from diarrhea (sorry to be graphic!). So when 4 people from the same block of a housing estate in Tsing Yi were confirmed to have been infected with SARS-CoV-2, there were fears that the same thing was happening in 2020. The affected block was rapidly evacuated , all the residents tested (fortunately negatively), and the drainage system investigated. A blocked ventilation pipe was found in the toilet of one of the cases; it is not at all clear if any transmission occurred as a result, as the other 3 cases in the building might have been infected at a hotpot dinner they all attended. Nonetheless, good maintenance of drainage pipes is recommended. Can it be contracted from food? In general, Coronaviruses are thermolabile, meaning that they can be destroyed by heat. The WHO advises avoiding raw or undercooked animal products, and handling them with care while preparing. You should also avoid eating food from wild/exotic animal markets, now mainly closed anyway. Aside from these precautions, however, they do not believe that the disease is directly spread from food, even though the initial cases may have started when the
virus jumped from an animal to a human. At this point, the disease is not spreading in this
way; it is spreading directly from person-to-person.
Transmission has occurred at a number of food-sharing events, including hotpot meals,
banquets and buffets. Although the mechanism is not fully understood, it is thought that it
may not be the food itself, but rather contamination of and by shared utensils, as well as
people staying in close contact with other people during the meal and in buffet line-ups.
What about Cruise Ships?
There is a large outbreak on a cruise ship called the Diamond Princess, currently docked off
Yokohama, Japan. More than 600 cases out of 3700 passengers have tested positive and 2
have died. Many have now been evacuated to their home countries (including Hong Kong),
where they are subject to another two weeks of quarantine. Those who had tested positive
prior to evacuation are isolated in Japanese hospitals. . The ship was enroute from Singapore
to Yokahama, when an elderly passenger who disembarked in Hong Kong was diagnosed
with COVID-19. If this cruise ship were a country, it would have one of the largest outbreaks
outside of mainland China.
Several other episodes have all turned out to be false alarms:
The MS Westerdam left Hong Kong on Feb 1, 2020 and was meant to disembark in
Shanghai. The ship attempted to change itinerary but was denied docking in Japan,
then Manila, Taiwan, Guam , Malaysia and Thailand before finally being allowed to
dock in Sianhoukville in Cambodia even though no cases were on board.
Subsequently, an 83 year old American woman who disembarked tested positive for
Coronavirus in Malaysia.
World Dream Cruise docked at Kai Tak was quarantined after 3 previous passengers
had tested positive on a previous cruise. The infected cases were on board Jan 19-
24; a a new cruise set sail on Feb 2, and on Feb 4th was denied docking in Kaohsiung,
Taiwan. The ship then came to Hong Kong on Feb 5 and all 3700 passengers were
tested. No cases were found and all the passengers were released
The Royal Caribbean (Anthem of the Seas) was quarantined in New Jersey for several
days because 4 passengers had flu-like symptoms and were feared to have
coronavirus infection. It was eventually released when all passengers tested
negative.
Hong Kong has closed both cruise terminals since Feb 6th, 2020.
Cruise ships may pose a special hazard because of the close mixing of people from many
countries, often including many elderly higher risk people.
What other events have led to transmission?
There have been several “cluster” events leading to the infection of many people. These
include Business networking events and conferences– 20 cases in 6 countries were traced to
a business conference in Singapore. 15 cases in Germany and Spain were linked to a
conference in Bavaria
Family hotpot dinners – Two clusters in Hong Kong
Church services – Two clusters in Singapore have been linked to church services
Cruise ships – as above
A very large outbreak associated with a religious service near Daegu in South Korea.
It has also been speculated that eating at buffets is a risk factor. At al buffet, people may
socialise and talk while taking food, allowing invisible and visible droplets of saliva to travel
onto food and utensils. Buffet food can be also be left out for up to 4 hours so that many
people may have lingered over the food before you. Some risk-management people have
noted that there have NOT been spreading events on airplanes, and wondered if the meal
arrangements may be the reason.
What is the chance of dying of COVID-19?
The case fatality rate of 2019 nCoV is the topic of some debate and uncertainty. Just looking
at the official numbers, the death rate is approximately 2.3%. Many experts feel this is an
overestimate, as it is likely that there are a great many more mild cases than have been
reported. In addition, in cases outside of Hubei province, the death rate appears to be much
lower. There have been only 19deaths outside of China, out of nearly 1900 cases. This would
imply a case fatality rate of around 1%. Preliminary modelling data also puts the death rate
at around 1%, as did a recent case series report from China. Nonetheless, more data is needed
before an accurate assessment can confidently be made. It is always the case that the case
fatality rate cannot be fully understood until the epidemic is over.
Is this now an epidemic? A pandemic? What is the difference?
An epidemic refers to an increase, often sudden, in the number of cases of a disease above
what is normally expected in that population in that area. Outbreak carries the same definition
as epidemic, but is often used for a more limited geographic area. A pandemic refers to an
epidemic that has spread globally, usually affecting a large number of people.
HIV/AIDS is an example of a pandemic, one of the most destructive ones in history. The
Spanish influenza in 1918-1919 is another. The latter is estimated to have killed 50 million
people worldwide. By contrast, the emergence of Ebola Fever Disease in West Africa in 2016
was an outbreak that became an epidemic, but never turned into a pandemic.
2019-nCoV started as an outbreak in Wuhan, but would now qualify as an epidemic. As
global cases are still limited, it does not yet constitute a pandemic. The public health
measures being taken are designed to try to prevent it from becoming one. It is not yet clear
whether that will succeed and we do have to prepare for the possibility of a global pandemic
of COVID-19.
The CDC has developed a Pandemic Severity Index, a bit like the Hurricane grading scale,
that rates pandemics on a scale of 1 to 5:CDC Pandemic Severity Index char
Category CFR Example(s)
1 less than 0.1% Seasonal Influenza, Swine Flu
2 0.1–0.5% Asian Flu, Hong Kong Flu
3 0.5–1% ??COVID-19
4 1.0%–2.0%
5 2.0% or higher Spanish Flu (1918)
This scale was designed for grading Influenza Pandemics, not Coronaviruses. But you can
see from this that COVID-19 would likely be a Level 3, or worst case 4, Pandemic. Worse
than seasonal flu, but not approaching the gravity of Spanish Flu.
The WHO declared a PHEIC. What does this mean?
The WHO declares a PHEIC (pronounced “fake”), or Public Health Emergency of
International Concern when there is an extraordinary event that is determined to constitute a
public health risk globally through the international spread of disease and to potentially
require a coordinated international response. A key consideration in declaring a PHEIC is
whether the disease threat is dire enough to risk countries enacting travel and trade
restrictions, with potentially very serious economic consequences. Since the tool was
developed in 2007, the WHO has only declared a PHEIC 5 times, once for Swine Flu in
2009, once for polio resurgence in 2014, twice for Ebola and once for Zika virus.
Although initially the WHO declined to declare 2019-nCoV a PHEIC, on January 30 they
changed their mind due to increased international transmission and some cases of person-to-
person spread outside of China. This is meant to help mobilize international response, and in
particular to help protect countries with weaker healthcare systems. The WHO may
recommend travel restrictions, but has not done so in this case. Many countries, including the
US, Singapore, Australia and Japan have made their own decision to close their borders with
China.What is the role of masks?
Public health officials in Hong Kong have recommended that people wear a surgical mask
when taking public transport, when in crowded places or when sick themselves. This is
reasonable advice, but masks have become quite difficult to obtain. Should you be worried if
you don’t have access to face masks? How important are they?
The answer is, not very. Most people wear masks incorrectly, often contaminating themselves
when putting them on or taking them off, touching their face due to the discomfort they
cause, taking them off to eat, or by re-using them.
Masks are most important for sick people, to prevent them spreading their viral droplets
around when they cough or sneeze. They also can be important for healthcare professionals
who have close contact with sick people; in this case special virus-filtering masks (N95
masks) may be recommended. For healthy people, their role is less clear. They likely make
sense in highly infected areas such as Wuhan itself, where the chance of coming in contact
with a coronavirus patient is quite high. In Hong Kong, this likelihood is low at present, and
face masks have less of a role.
In all cases, other measures are far more important, in particular hand-washing. Try to avoid
touching your face and practice hand hygiene frequently. If you do wear a mask, make sure
to wash your hands before putting it on and after taking it off, and pay attention to how often
you touch your face.
The following information on correct use of medical masks derives from the practices in
health-care settings:
1. place mask carefully to cover mouth and nose and tie
securely to minimise any gaps between the face and the
mask;
2. while in use, avoid touching the mask;
3. remove the mask by using appropriate technique (i.e. do not touch the front but
remove the lace from behind);
4. after removal or whenever you inadvertently touch a used mask, clean hands by using
an alcohol-based handrub or soap and water if visibly soiled
5. replace masks with a new clean, dry mask as soon as they become damp/humid;
6. do not re-use single-use masks; discard single-use masks after each use and dispose of
them immediately upon removal.
How does testing for Coronavirus work?
Testing for 2019nCoV infection involves taking a swab from the nose or mouth and looking
for the DNA of the virus (PCR testing). In Hong Kong, testing can only be done by the
government virology lab, and, as of this week, by all the government hospital cluster
laboratories. The test takes about 3 hours to run, but usually takes longer as it is run in
batches.
The Hospital Authority has begun an initiative to test people with mild respiratory illness, in
an effort to identify milder cases of COVID-19. Patients are given a home kit to take home
and bring back the following day; the test is done on saliva.Until now, all testing has been done in the government hospitals; however private laboratories will soon be offering this test. We will do thorough risk-assessment before deciding to offer this test through Central Health. In the meantime, we encourage patients with symptoms of fever or respiratory illness to take advantage of the testing through the government hospitals. Point-of-care serology tests done on blood will be available in a few weeks. This will help add to the accuracy of diagnosis. Are there treatments? What about a vaccine? There are no definitive treatments for novel Coronavirus infection. Treatment is largely supportive, involving provision of intravenous fluids, antibiotics, inhalers, oxygen and close monitoring. Severe cases may require mechanical ventilation or ECMO (Extracorporeal Membrane Oxygenation). ECMO is a technique of providing prolonged heart and lung support to persons whose own are unable to provide an adequate amount of gas exchange or perfusion to sustain life. Chinese hospitals have been treating coronavirus patients with HIV drugs -- an oral two-pill combination of antiretroviral drugs called Kaletra. These drugs target an enzyme called protease which is found in coronaviruses as well as in the HIV virus. When protease is disrupted, the virus has difficulty reproducing itself. These treatments do look promising, although not curative. Studies are underway. Tamiflu does not work. Some other medications like Ribavirin, Baloxavir, and Interferon may have limited effect. Another antiviral drug, Remdesivir, is showing promise. This drug was developed initially as a treatment for Ebola virus and Marburg virus disease, but has shown some effect in other coronavirus infections such as MERS-CoV. Trials are underway. China has also recently licensed an antiviral drug called Favilavir. It’s efficacy is not known. During SARS in 2003, high dose steroids were routinely used to try to reduce the inflammatory effects of the virus on the lungs. We now know this does more harm than good, and has left many survivors with complications of the treatment. Several candidate vaccines are in development including one in Hong Kong. However, even if development is expedited, these vaccines are months to a year away at a minimum and are therefore unlikely to be the answer to controlling the epidemic. How do you actually control an epidemic? It’s all about getting the R0 – the number of people infected by a single sick person, down below 1. Once this happens, the disease will die out. To do this, human-to-human transmission must be curbed. The main strategies for doing this are isolation, quarantine, contact tracing and social distancing.
Isolation is used to separate ill persons from those who are healthy. Patients who are sick
with coronavirus infection will be isolated in hospital and separated from other patients.
Hong Kong greatly expanded its isolation capacity after SARS, and currently all confirmed
cases are isolated in special units.
Quarantine is used to separate and restrict the movement of well persons who may have
been exposed to a communicable disease to see if they become ill. These people may have
been exposed to the disease and do not know it, or they may have the disease but do not show
symptoms. Currently, close contacts of novel coronavirus cases are being quarantined in
several holiday centres around Hong Kong.
Contact tracing is defined as the identification and follow-up of persons who may have
come into contact with an infected person. The department of health is diligent in this regard;
contacts of Coronavirus cases are being followed up and quarantined.
Why did they close the schools? What is social distancing?
Social distancing is a public health safety intervention used to reduce the likelihood of
transmitting communicable disease. Social distancing involves minimizing exposure to
infected individuals by avoiding large public gathering venues, and by following proper
personal hygiene practices.
Closing the schools was done pre-emptively, as part of a social distancing strategy. During
the SARS epidemic in 2003, the government was criticized for not closing schools quickly
enough. That critique certainly can’t be levied this time, as the schools were closed even
before there was a local outbreak. Although children don’t appear to get severely ill with
COVID-19, it is still quite possible that they are important in transmission, and until we know
better, it makes sense to close the schools.
Cancelling mass gatherings and closing workplaces are other examples of social distancing.
We have all been affected by event cancellations and many people are now working from
home. It is all not very much fun, but worth it in the end if it averts an epidemic.
What we can say for now is that so far the public health measures being taken seem to have
worked. We have not had a huge number of cases. Time will tell and hindsight will be 20/20.
How does quarantine work in Hong Kong?
Since February 8th, Hong Kong has required anyone entering Hong Kong from mainland
China, regardless of whether they are a Hong Kong resident or not, to be quarantined for 14
days.
Some people ARE exempted, for example:
cross-boundary goods vehicle drivers and necessary accompanying personnel;
cross-boundary coach and shuttle drivers and necessary crew members;
air crew disembarking from planes at Hong Kong International Airport and
entering Hong Kong; crew members of aircrafts of air freight operators who need to commute to and
from the Mainland for performance of necessary duties related to freight
forwarding;
government officials carrying out governmental duties;
government agents and contractors supporting the operation of cross-boundary
functions;
crew members of goods vessels; and
crew members of fishing vessels and fish collectors (including mainland
fishermen deckhands).
They are subject to medical surveillance
How quarantine works
Hong Kong residents are mainly confined to their own homes
Non-residents must stay at booked centres or in government-run centres,
which include Lady MacLehose Holiday Village (full), Lei Yue Mun Holiday
site, Po Leung Kuk Jockey Club, and soon Pak Tam Chung Holiday Camp, as
well as in Sai Kung Outdoor Recreation Centre.
300 mobile units are being built, and other sites are being looked for
There is a fine ($25000) and 6 month prison sentence for non-compliance
Quarantine is also required for asymptomatic close contacts of known cases
Electronic wristbands are being used to monitor some people
Quarantine is monitored by visits from Centre for Health Protection staff,
contact by phone, twice daily temperature checks and daily symptom records
There is also a 24 hour hotline for people under quarantine
Known or Suspected cases of COVID-19 are ISOLATED in hospital
Asymptomatic close contacts of known or suspected cases and asymptomatic visitors or
HK residents returning from mainland China are QUARANTINED – either at home or
in a quarantine centre.
Do border closures work?
Border closures never completely succeed because all borders remain somewhat porous, and
almost inevitably are applied too late. However, border closures and aggressive screening and
quarantine measures may slow the spread of the disease, and buy crucial time to ramp up a
response, understand the nature of the disease, determine who needs special protection, and
develop vaccines and treatments.
What are the important answered questions?
1. The spectrum of clinical disease: proportions of asymptomatic persons; persons who
are symptomatic but apparently (to others) asymptomatic; those with influenza-like
illness, focal pneumonia, or severe respiratory compromise; and fatalities
2. The numerical risk for travelers going to areas with sustained transmission (i.e.,
destinations with cases occurring without known exposure to other cases)
3. The meaning of a positive PCR test in an asymptomatic person.4. Exactly when one becomes infectious in relation to symptoms.
5. The nature and frequency of super-spreading events
6. The role of surfaces and inanimate objects in transmission
7. The reproductive number (R0) on average, how infectious is the typical case?
8. The case fatality rate
9. Differences in clinical manifestations in Chinese (smoking, pollution) versus other
populations
10. Likelihood of mutations within the genome with serial passage through humans
11. How did the species jump from bats to humans occur, what is the intermediate host,
and do animals still pose a threat?
The Seven Habits of Highly Protected People
1. Avoid crowded places and close contact with people who are unwell
2. Frequently wash hands with soap and water for at least 20 seconds (the time taken to
sing “happy birthday” twice). Use alcohol hand-rub when soap and water is not
available.
3. Wear a mask if you have respiratory symptoms or if you need to be in a crowded
place. Make sure to wash your hands before putting a mask on and after taking it off.
4. Cover your mouth and nose with tissue or your flexed elbow when coughing or
sneezing and dispose of the tissue immediately afterwards.
5. Avoid visiting live animal markets and the consumption of raw or undercooked meat.
6. Observe good personal hygiene and learn to avoid touching your face
7. Seek medical attention promptly if you are unwell. Make sure to share your travel
history with your healthcare provider
Simple things prevent infection, if we are consistent and vigilant about applying them.
Good Sources of Information
There is a great deal of information circulating online, not all of it good. The WHO has called
it an Infodemic, and has launched a concerted attempt to counter the false information and
rumours that are circulating, via a number of social media platforms including (including
Weibo, Twitter, Facebook, Instagram, LinkedIn, Pinterest) and their website.
https://www.who.int
https://www.facebook.com/WHO/
https://twitter.com/WHO
https://www.weibo.com/whoinchina?is_hot=1
https://www.instagram.com/WHO/
https://www.linkedin.com/company/world-health-organization/
https://www.pinterest.ch/worldhealthorganization/
Other good sources:
Hong Kong Centre for Health Protectionhttps://www.chp.gov.hk/en/features/102465.html Public Health England https://www.gov.uk/government/publications/wuhan-novel-coronavirus-background- information/wuhan-novel-coronavirus-epidemiology-virology-and-clinical-features CIDRAP – The Center for Infectious Disease Research and Policy http://www.cidrap.umn.edu/ Centers for Disease Control (CDC) US: https://www.cdc.gov/coronavirus/2019-nCoV/index.html The New York Times, The Washington Post and The Boston Globe have deep experience in health reporting
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