My first jet-lagged impression of Hong Kong on Saturday night (Friday morning Philly time) was that for a place that’s been civilized since about 200 BC, it is surreally new. We’re talking an endless vista of skyscrapers, most with utilitarian post-modern design, giving the city a soul-less Blade Runner aesthetic. It’s no coincidence that Hong Kong was an inspiration for the dystopia depicted in that neo-noir cult movie. Of course, Blade Runner came out in 1982. Since then, almost everything in this former British colony has been ripped down and replaced with newer, taller, more high-tech structures. I’m barely exaggerating. The driver who picked me up at the vast, airy airport said it – and the reclaimed land it sits on -- is 10 years old. Likewise the 5.8-mile bridge and tunnels that connect it to the network of islands and peninsulas that make up greater Hong Kong. (The driver also pointed out a "really old" brick building from the early 1900s.)
The thing is, Hong Kong feels more like Utopia than Dystopia. Murder and armed robbery are rare. There are no taxes because the city government has so much money. (The reason, as it was explained to me, is that the government owns all the land and collects staggering sums from developers, who in turn charge staggering sums for a 600-square-foot apartment.)
Even though 7 million people are packed into the human equivalent of beehives, the individuals I’ve encountered have been unfailingly polite and friendly. Women and men alike have held doors open for me. On the crowded subway, a teenager offered me his seat. (Maybe the 18-hour flight has made me look particularly haggard? Maybe they can tell it's my first time in Asia?) Most surprising and best of all as far as I’m concerned, smoking is banned in indoor public places.
But I digress. I’m here with fellow journalists from places including Minneapolis, Seattle, Vietnam, Bangladesh, China and Indonesia because Hong Kong is likely to be ground zero in any explosion of a novel infection that could kill billions of people – or be quickly snuffed. As a hub for global commerce and a gateway to mainland China, Hong Kong is uniquely situated to get hit. This is where SARS (severe acute respiratory syndrome) – the pneumonia-like illness that apparently originated in China -- was first identified in 2003. It went on to affect more than 3,000 people worldwide and kill more than 150 of them. Hong Kong is also where, in 1997, a ferocious new bird influenza first “jumped” to humans, sickening 18 people, of whom six died.
Hong Kong snuffed that bird flu, called H5N1, by killing 1.5 million chickens and by temporarily shutting down the filthy, bloody open-air markets where poultry and other live animals are slaughtered on the spot for shoppers. (Tomorrow, our East-West Center leaders will take us to one of these “wet” markets, so-called because the ground is slimy with animal waste and blood.)
In the past few years, H5N1 has come roaring back among poultry in Asia and beyond. Only rarely does this endlessly-mutating microbe infect humans, but when it does, it is highly lethal – and it gets another chance to mutate in a way that would enable it to infect humans with ruthless efficiency. Maybe even as efficiently as the 1918 flu pandemic that killed at least 20 million people worldwide.
While American media pay only periodic attention to H5N1’s scary potential, it's the kind of threat that keeps Hong Kong authorities awake at night. SARS was their wake-up call, and no one wants to be caught cat-napping when a pandemic strikes – as experts believe it eventually will.
Today, Monday (Sunday in Philly), we journos got to see two big changes wrought by SARS.
The first change was the creation, in a mere two years, of the $125 million Centre for Health Protection -- Hong Kong’s version of the U.S. Centers for Disease Control and Prevention. Not coincidentally, Dr. Thomas Tsang, the new controller of CHP, worked for several years at the CDC.
One component of CHP is an “emergency response centre” that looks only slightly less high-tech than a NASA mission control room. But instead of monitoring a space shuttle, uniformed workers track reports of illness outbreaks in Hong Kong’s healthcare system. Twice a day, the information is sifted and synthesized into a “sitrep” – a situation report.
Most of this data is numbingly mundane, so to keep an edge, the emergency center runs drills, like last month’s “Exercise Cypress.” This involved the pretend landing of a plane carrying two people infected with H5N1 bird flu. They were hypothetically admitted to Princess Margaret Hospital, where they set off a Level 3 response and were put in the new isolation wing to avoid infecting anyone else. Officials in the patients’ imaginary country were immediately notified, as was the Hong Kong airport, the World Health Organization, etc.
The isolation wing is the other big post-SARS change. It is part of a gleaming, state-of-the-art Infectious Disease Centre (there’s that annoying British spelling again) at Princess Margaret Hospital, where SARS demonstrated the strengths – and weaknesses – of Hong Kong’s infection control system. The hospital was overwhelmed by 585 real SARS patients and twice that many suspected cases. Ten percent of the hospital’s staff contracted SAR$, including the head of the intensive care unit; fortunately, these selfless workers survived, unlike 10 percent of the other SARS patients.
Four hospital officials gave us a tour of the new, barely-used facility, with its 8 floors of negative air pressure wards, airtight doors and windows, and bio-safety lab. Each of the 108 isolations rooms is separated from the corridor by a special anteroom about the size of a walk-in closet. The anteroom doors are programmed to open and close sequentially by sensing the presence of, say, a nurse – thus eliminating germy door knobs and preventing contaminated air droplets from escaping into the hallway. Unfortunately, this safety feature was problematic with our group of 15.
“Move closer. More. More,” directed senior hospital administrator Olivia Ma, trying to get us all sufficiently crowded together in the anteroom so one door could close and the other one open.
Editor’s note: The program Marie is traveling with is sponsored by the Honolulu-based East-West Center, founded by Congress in 1960 to promote research and education about issues of common concern to the U.S. and the Asia Pacific region. Nine other health journalists from the U.S. and Asia are participating in the health journalism program. Their first stop was Hong Kong.