COVID-19 pandemic in Hong Kong

The COVID-19 pandemic in Hong Kong is part of the worldwide pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus was first confirmed to have spread to Hong Kong on 23 January 2020.[1] Confirmed cases were generally transferred to Princess Margaret Hospital's Infectious Disease Centre for isolation and centralised treatment. On 5 February, after a five-day strike by front-line medical workers, the Hong Kong government closed all but three border control points – Hong Kong International Airport, Shenzhen Bay Control Point, and Hong Kong-Zhuhai-Macao Bridge Control Point remaining open.

COVID-19 pandemic in Hong Kong
0.00%-0.02% confirmed infected   0.02%-0.04% confirmed infected   0.04%-0.06% confirmed infected   0.06%-0.08% confirmed infected   0.08%+ confirmed infected
Disease	COVID-19
Virus strain	SARS-CoV-2
Location	Hong Kong
First outbreak	Wuhan, Hubei, China
Index case	West Kowloon station, Kowloon
Arrival date	23 January 2020 (5 months, 24 days)
Confirmed cases	4,525
Active cases	857
Recovered	3,599
Deaths	69
Government website
www.coronavirus.gov.hk

As of 17 August 2020, Hong Kong had 4,525 confirmed cases (including 1 probable case), with 3,599 recoveries and 69 deaths.

Hong Kong was relatively unscathed by the first wave of the COVID-19 outbreak and had a flatter epidemic curve than most other places, which observers consider remarkable given its status as an international transport hub. Furthermore, its proximity to China and its millions of mainland visitors annually would make it vulnerable.[2] Some experts now believe the habit of wearing masks in public since the SARS epidemic of 2003 may have helped keep its confirmed infections at 845, with four deaths, by the beginning of April.[2] In a study published in April 2020 in the Lancet, the authors expressed their belief that border restrictions, quarantine and isolation, social distancing, and behavioural changes such as wearing masks likely all played a part in the containment of the disease up to the end of March.[3] Others attributed the success to critical thinking of citizens who have become accustomed to distrusting the competence and political motivations of the government, the World Health Organization, and the Chinese Communist Party.[4] However, Hong Kong saw an uptick in COVID-19 cases in July, with more than a hundred cases being reported several days in a row until early August. Experts attributed the rise to imported cases – sea or aircrew members, and domestic helpers classified as such cases.[5]

Background

Main articles: 2019–20 Hong Kong protests and 2019 Hong Kong local elections

For Hongkongers, the outbreak of the pandemic evoked bitter memories as the city was at the forefront of the SARS epidemic in 2003, when over 1,700 people contracted the virus and almost 300 people died locally.[6] The coronavirus outbreak in Wuhan took place in the backdrop of widespread and intense political conflict and civil unrest fed by anti-government sentiment, since June 2019.[7][8] Carrie Lam, the city's Chief Executive, was reported in May 2020 to have a negative approval rating of 80 percent.[4] The District Council elections in November, widely regarded as a proxy referendum over the protest movement's demands,[9] saw the pro-democracy camp achieve their biggest landslide victory in Hong Kong's history, where they took control of 17 out of 18 districts.[9][10] The economy of the city has been reeling under the effects of the unrest, as the number of mainland visitors fell and business confidence suffered, and the city slipped into recession.[11]

Lam had invoked the Emergency Regulations Ordinance on 4 October to impose a law to ban wearing face masks in public gatherings.[12][13] The law would come to contradict later measures to control the spread of the virus,[14] and has been widely ignored by citizens, who have learnt to be mistrustful of the government.[4]

As the coronavirus crisis escalated in February and March 2020, the scale of the protests dwindled.[15] Protest activities continued regularly in Tseung Kwan O, Yuen Long and Mong Kok every month.[16][17][18] Large-scale protests gave way to the coronavirus pandemic,[19] but smaller scale protests in various districts resumed upon easing of virus restrictions. Through its Prevention and Control of Disease Ordinance, the Hong Kong government imposed a 4-person limit for public gatherings.[20] Many observers believed that the coronavirus pandemic had provided cover for an increase of arrests related to the protests.[21] Following the emergence of three cases of local transmission, the government extended its coronavirus social distancing measures by 14 days, to 4 June, affecting the annual commemoration of the Tiananmen Square massacre in Victoria Park. The government denied suggestions that the extension was aimed at interfering with the commemoration, saying the decision was made in accordance with its extension policy.[22][23]

Timeline

COVID-19 cases in Hong Kong  ()      Deaths        Recoveries        Active cases Jan Jan Feb Feb Mar Mar Apr Apr May May Jun Jun Jul Jul Aug Aug Last 15 days Last 15 days
Date			# of cases	# of deaths
2020-01-23		​	2(n.a.)
⋮		​	2(=)
2020-01-25		​	5(+150%)
2020-01-26		​	8(+60%)
⋮		​	8(=)
2020-01-29		​	10(+25%)
2020-01-30		​	12(+20%)
2020-01-31		​	13(+8.3%)
2020-02-01		​	14(+7.7%)
2020-02-02		​	15(+7.1%)
2020-02-03		​	15(=)
2020-02-04		​ ​	18(+20%)	1(n.a.)
2020-02-05		​ ​	21(+17%)	1(=)
2020-02-06		​ ​	24(+14%)	1(=)
2020-02-07		​ ​	26(+8.3%)	1(=)
2020-02-08		​ ​	26(=)	1(=)
2020-02-09		​ ​	36(+38%)	1(=)
2020-02-10		​ ​	42(+17%)	1(=)
2020-02-11		​ ​	49(+17%)	1(=)
2020-02-12		​ ​ ​	50(+2%)	1(=)
2020-02-13		​ ​ ​	53(+6%)	1(=)
2020-02-14		​ ​ ​	56(+5.7%)	1(=)
2020-02-15		​ ​ ​	56(=)	1(=)
2020-02-16		​ ​ ​	57(+1.8%)	1(=)
2020-02-17		​ ​ ​	60(+5.3%)	1(=)
2020-02-18		​ ​ ​	62(+3.3%)	1(=)
2020-02-19		​ ​ ​	65(+4.8%)	2(+100%)
2020-02-20		​ ​ ​	68(+4.6%)	2(=)
2020-02-21		​ ​ ​	68(=)	2(=)
2020-02-22		​ ​ ​	69(+1.5%)	2(=)
2020-02-23		​ ​ ​	74(+7.2%)	2(=)
2020-02-24		​ ​ ​	81(+9.5%)	2(=)
2020-02-25		​ ​ ​	85(+4.9%)	2(=)
2020-02-26		​ ​ ​	91(+7.1%)	2(=)
2020-02-27		​ ​ ​	93(+2.2%)	2(=)
2020-02-28		​ ​ ​	94(+1.1%)	2(=)
2020-02-29		​ ​ ​	95(+1.1%)	2(=)
2020-03-01		​ ​ ​	100(+5.3%)	2(=)
2020-03-02		​ ​ ​	101(+1%)	2(=)
2020-03-03		​ ​ ​	101(=)	2(=)
2020-03-04		​ ​ ​	105(+4%)	2(=)
2020-03-05		​ ​ ​	105(=)	2(=)
2020-03-06		​ ​ ​	108(+2.9%)	2(=)
2020-03-07		​ ​ ​	110(+1.9%)	2(=)
2020-03-08		​ ​ ​	115(+4.5%)	3(+50%)
2020-03-09		​ ​ ​	116(+0.87%)	3(=)
2020-03-10		​ ​ ​	121(+4.3%)	3(=)
2020-03-11		​ ​ ​	130(+7.4%)	3(=)
2020-03-12		​ ​ ​	132(+1.5%)	3(=)
2020-03-13		​ ​ ​	138(+4.5%)	4(+33%)
2020-03-14		​ ​ ​	142(+2.9%)	4(=)
2020-03-15		​ ​ ​	149(+4.9%)	4(=)
2020-03-16		​ ​ ​	158(+6%)	4(=)
2020-03-17		​ ​ ​	168(+6.3%)	4(=)
2020-03-18		​ ​ ​	193(+15%)	4(=)
2020-03-19		​ ​ ​	209(+8.3%)	4(=)
2020-03-20		​ ​ ​	257(+23%)	4(=)
2020-03-21		​ ​ ​	274(+6.6%)	4(=)
2020-03-22		​ ​ ​	318(+16%)	4(=)
2020-03-23		​ ​ ​	357(+12%)	4(=)
2020-03-24		​ ​ ​	387(+8.4%)	4(=)
2020-03-25		​ ​ ​	411(+6.2%)	4(=)
2020-03-26		​ ​ ​	454(+10%)	4(=)
2020-03-27		​ ​ ​	519(+14%)	4(=)
2020-03-28		​ ​ ​	583(+12%)	4(=)
2020-03-29		​ ​ ​	642(+10%)	4(=)
2020-03-30		​ ​ ​	683(+6.4%)	4(=)
2020-03-31		​ ​ ​	715(+4.7%)	4(=)
2020-04-01		​ ​ ​	766(+7.1%)	4(=)
2020-04-02		​ ​ ​	803(+4.8%)	4(=)
2020-04-03		​ ​ ​	846(+5.4%)	4(=)
2020-04-04		​ ​ ​	863(+2%)	4(=)
2020-04-05		​ ​ ​	891(+3.2%)	4(=)
2020-04-06		​ ​ ​	915(+2.7%)	4(=)
2020-04-07		​ ​ ​	936(+2.3%)	4(=)
2020-04-08		​ ​ ​	961(+2.7%)	4(=)
2020-04-09		​ ​ ​	974(+1.4%)	4(=)
2020-04-10		​ ​ ​	990(+1.6%)	4(=)
2020-04-11		​ ​ ​	1,001(+1.1%)	4(=)
2020-04-12		​ ​ ​	1,005(+0.4%)	4(=)
2020-04-13		​ ​ ​	1,010(+0.5%)	4(=)
2020-04-14		​ ​ ​	1,013(+0.3%)	4(=)
2020-04-15		​ ​ ​	1,017(+0.39%)	4(=)
2020-04-16		​ ​ ​	1,018(+0.1%)	4(=)
2020-04-17		​ ​ ​	1,022(+0.39%)	4(=)
2020-04-18		​ ​ ​	1,024(+0.2%)	4(=)
2020-04-19		​ ​ ​	1,026(+0.2%)	4(=)
2020-04-20		​ ​ ​	1,026(=)	4(=)
2020-04-21		​ ​ ​	1,030(+0.39%)	4(=)
2020-04-22		​ ​ ​	1,034(+0.39%)	4(=)
2020-04-23		​ ​ ​	1,036(+0.19%)	4(=)
2020-04-24		​ ​ ​	1,036(=)	4(=)
2020-04-25		​ ​ ​	1,038(+0.19%)	4(=)
2020-04-26		​ ​ ​	1,038(=)	4(=)
2020-04-27		​ ​ ​	1,038(=)	4(=)
2020-04-28		​ ​ ​	1,038(=)	4(=)
2020-04-29		​ ​ ​	1,038(=)	4(=)
2020-04-30		​ ​ ​	1,038(=)	4(=)
2020-05-01		​ ​ ​	1,040(+0.19%)	4(=)
2020-05-02		​ ​ ​	1,040(=)	4(=)
2020-05-03		​ ​ ​	1,040(=)	4(=)
2020-05-04		​ ​ ​	1,041(+0.1%)	4(=)
2020-05-05		​ ​ ​	1,041(=)	4(=)
2020-05-06		​ ​ ​	1,041(=)	4(=)
2020-05-07		​ ​ ​	1,045(+0.38%)	4(=)
2020-05-08		​ ​ ​	1,045(=)	4(=)
2020-05-09		​ ​ ​	1,045(=)	4(=)
2020-05-10		​ ​ ​	1,048(+0.29%)	4(=)
2020-05-11		​ ​ ​	1,048(=)	4(=)
2020-05-12		​ ​ ​	1,048(=)	4(=)
2020-05-13		​ ​ ​	1,051(+0.29%)	4(=)
2020-05-14		​ ​ ​	1,052(+0.1%)	4(=)
2020-05-15		​ ​ ​	1,053(+0.1%)	4(=)
2020-05-16		​ ​ ​	1,053(=)	4(=)
2020-05-17		​ ​ ​	1,056(+0.28%)	4(=)
2020-05-18		​ ​ ​	1,056(=)	4(=)
2020-05-19		​ ​ ​	1,056(=)	4(=)
2020-05-20		​ ​ ​	1,056(=)	4(=)
2020-05-21		​ ​ ​	1,064(+0.76%)	4(=)
2020-05-22		​ ​ ​	1,066(+0.19%)	4(=)
2020-05-23		​ ​ ​	1,066(=)	4(=)
2020-05-24		​ ​ ​	1,066(=)	4(=)
2020-05-25		​ ​ ​	1,066(=)	4(=)
2020-05-26		​ ​ ​	1,066(=)	4(=)
2020-05-27		​ ​ ​	1,067(+0.09%)	4(=)
2020-05-28		​ ​ ​	1,067(=)	4(=)
2020-05-29		​ ​ ​	1,080(+1.2%)	4(=)
2020-05-30		​ ​ ​	1,083(+0.28%)	4(=)
2020-05-31		​ ​ ​	1,085(+0.18%)	4(=)
2020-06-01		​ ​ ​	1,088(+0.28%)	4(=)
2020-06-02		​ ​ ​	1,094(+0.55%)	4(=)
2020-06-03		​ ​ ​	1,094(=)	4(=)
2020-06-04		​ ​ ​	1,100(+0.55%)	4(=)
2020-06-05		​ ​ ​	1,103(+0.27%)	4(=)
2020-06-06		​ ​ ​	1,106(+0.27%)	4(=)
2020-06-07		​ ​ ​	1,107(+0.09%)	4(=)
2020-06-08		​ ​ ​	1,108(+0.09%)	4(=)
2020-06-09		​ ​ ​	1,108(=)	4(=)
2020-06-10		​ ​ ​	1,108(=)	4(=)
2020-06-11		​ ​ ​	1,108(=)	4(=)
2020-06-12		​ ​ ​	1,109(+0.09%)	4(=)
2020-06-13		​ ​ ​	1,110(+0.09%)	4(=)
2020-06-14		​ ​ ​	1,110(=)	4(=)
2020-06-15		​ ​ ​	1,113(+0.27%)	4(=)
2020-06-16		​ ​ ​	1,113(=)	4(=)
2020-06-17		​ ​ ​	1,121(+0.72%)	4(=)
2020-06-18		​ ​ ​	1,125(+0.36%)	4(=)
2020-06-19		​ ​ ​	1,128(+0.27%)	4(=)
2020-06-20		​ ​ ​	1,129(+0.09%)	5(+25%)
2020-06-21		​ ​ ​	1,132(+0.27%)	5(=)
2020-06-22		​ ​ ​	1,162(+2.7%)	5(=)
2020-06-23		​ ​ ​	1,178(+1.4%)	6(+20%)
2020-06-24		​ ​ ​	1,180(+0.17%)	6(=)
2020-06-25		​ ​ ​	1,194(+1.2%)	7(+17%)
2020-06-26		​ ​ ​	1,197(+0.25%)	7(=)
2020-06-27		​ ​ ​	1,198(+0.08%)	7(=)
2020-06-28		​ ​ ​	1,200(+0.17%)	7(=)
2020-06-29		​ ​ ​	1,204(+0.33%)	7(=)
2020-06-30		​ ​ ​	1,206(+0.17%)	7(=)
2020-07-01		​ ​ ​	1,234(+2.3%)	7(=)
2020-07-02		​ ​ ​	1,243(+0.73%)	7(=)
2020-07-03		​ ​ ​	1,248(+0.4%)	7(=)
2020-07-04		​ ​ ​	1,259(+0.88%)	7(=)
2020-07-05		​ ​ ​	1,269(+0.79%)	7(=)
2020-07-06		​ ​ ​	1,286(+1.3%)	7(=)
2020-07-07		​ ​ ​	1,300(+1.1%)	7(=)
2020-07-08		​ ​ ​	1,324(+1.8%)	7(=)
2020-07-09		​ ​ ​	1,366(+3.2%)	7(=)
2020-07-10		​ ​ ​	1,404(+2.8%)	7(=)
2020-07-11		​ ​ ​	1,432(+2%)	7(=)
2020-07-12		​ ​ ​	1,470(+2.7%)	7(=)
2020-07-13		​ ​ ​	1,522(+3.5%)	8(+14%)
2020-07-14		​ ​ ​	1,570(+3.2%)	8(=)
2020-07-15		​ ​ ​	1,589(+1.2%)	10(+25%)
2020-07-16		​ ​ ​	1,656(+4.2%)	10(=)
2020-07-17		​ ​ ​	1,714(+3.5%)	11(+10%)
2020-07-18		​ ​ ​	1,778(+3.7%)	12(+9.1%)
2020-07-19		​ ​ ​	1,885(+6%)	12(=)
2020-07-20		​ ​ ​	1,958(+3.9%)	12(=)
2020-07-21		​ ​ ​	2,019(+3.1%)	14(+17%)
2020-07-22		​ ​ ​	2,132(+5.6%)	14(=)
2020-07-23		​ ​ ​	2,250(+5.5%)	15(+7.1%)
2020-07-24		​ ​ ​	2,373(+5.5%)	16(+6.7%)
2020-07-25		​ ​ ​	2,506(+5.6%)	18(+12%)
2020-07-26		​ ​ ​	2,634(+5.1%)	18(=)
2020-07-27		​ ​ ​	2,779(+5.5%)	22(+22%)
2020-07-28		​ ​ ​	2,885(+3.8%)	23(+4.5%)
2020-07-29		​ ​ ​	3,003(+4.1%)	24(+4.3%)
2020-07-30		​ ​ ​	3,152(+5%)	25(+4.2%)
2020-07-31		​ ​ ​	3,273(+3.8%)	28(+12%)
2020-08-01		​ ​ ​	3,397(+3.8%)	33(+18%)
2020-08-02		​ ​ ​	3,512(+3.4%)	35(+6.1%)
2020-08-03		​ ​ ​	3,590(+2.2%)	39(+11%)
2020-08-04		​ ​ ​	3,670(+2.2%)	42(+7.7%)
2020-08-05		​ ​ ​	3,755(+2.3%)	43(+2.4%)
2020-08-06		​ ​ ​	3,850(+2.5%)	46(+7%)
2020-08-07		​ ​ ​	3,939(+2.3%)	47(+2.2%)
2020-08-08		​ ​ ​	4,008(+1.8%)	47(=)
2020-08-09		​ ​ ​	4,080(+1.8%)	52(+11%)
2020-08-10		​ ​ ​	4,149(+1.7%)	56(+7.7%)
2020-08-11		​ ​ ​	4,182(+0.8%)	59(+5.4%)
2020-08-12		​ ​ ​	4,244(+1.5%)	63(+6.8%)
2020-08-13		​ ​ ​	4,313(+1.6%)	65(+3.2%)
2020-08-14		​ ​ ​	4,361(+1.1%)	67(+3.1%)
2020-08-15		​ ​ ​	4,407(+1.1%)	69(+3%)
2020-08-16		​ ​ ​	4,481(+1.7%)	69(=)
2020-08-17		​ ​ ​	4,525(+0.98%)	69(=)
2020-08-18		​ ​ ​	4,561(+0.8%)	70(+1.4%)
Sources: Centre for Health Protection of the Department of Health

January

Upon learning of the outbreak, the government required disclosure by those who had been to wet markets in Wuhan. The government widened the criteria for notification on 3 January – anyone who had visited Wuhan within 14 days before the onset of any respiratory symptoms of illness would need to inform health authorities.[24]

The HK government declared a "serious response level" to the virus outbreak centred on Wuhan on 4 January, when Hong Kong announced eight suspected cases; the eight cases turned out negative for the disease from Wuhan. Medical experts in Hong Kong urged mainland authorities to be more forthcoming with Wuhan patient information that could aid epidemiological study.[24] Although Wuhan health authorities said there was "no obvious evidence" of human-to-human transmission of the then-unidentified virus, University of Hong Kong infectious diseases expert Dr Ho Pak-leung suspected such transmission had happened among cases in Wuhan, and urged "the most stringent" precautionary measures.[24] However, press reported that border checks at the West Kowloon high-speed rail terminal were not yet operational.[6] On 8 January, Hong Kong's Centre for Health Protection (CHP) added "Severe respiratory disease associated with a novel infectious agent" to their list of notifiable diseases to expand their authority on quarantine.[25] The Hong Kong government also shortened hospital visits and made it a requirement for visitors to wear face masks. Screening was tightened at airports and train stations with connections to Wuhan.[26] In the first week of 2020, 30 unwell travellers from Wuhan were tested. Most had other respiratory viruses.[27][28]

On 22 January, a 39-year-old man from mainland China who had travelled from Shenzhen and who arrived in Hong Kong by high-speed rail developed symptoms of pneumonia. Resident in Wuhan, he had arrived in Shenzhen by highspeed rail with his family. He tested positive for the virus and was hospitalised in Princess Margaret Hospital, Kowloon. The same day, a 56-year-old man from Ma On Shan, who had visited Wuhan in the previous week, also tested positive. These two cases were listed as "Highly Suspected Cases", they were confirmed positive the following day.[1]

On 23 January, the Hong Kong government designated the Lady MacLehose Holiday Village in Sai Kung as a quarantine centre.[29] The Hong Kong Tourism Board cancelled the Lunar New Year Cup and a four-day Lunar New Year carnival, citing concerns over the virus outbreak.[30][31] In addition, the previous two cases of "Highly Suspected Cases" had been confirmed positive by health and government officials.[32]

On 24 January, health authorities confirmed three more cases, all of the patients had come from Wuhan. The third case was a 62-year-old woman that had arrived to Hong Kong with her husband. They had both moved in with their daughter and son-in-law, who lived locally. Her husband, daughter and son-in-law had not developed symptoms and were both quarantined in the Lady MacLehose Holiday Village. The 4th and 5th cases were a 62-year-old woman and her husband aged 63 who had both arrived in Hong Kong on 22 January and had moved into their daughter's house. The couple attempted to escape from Prince of Wales Hospital after learning that they would have to be quarantined, but failed when the police were called.[33]

On 25 January, the Hong Kong government declared the viral outbreak as an "emergency" – the highest warning tier.[34] The city's largest amusement parks, Hong Kong Disneyland Resort, Ocean Park Hong Kong, and wax museum Madame Tussauds Hong Kong closed from 26 January, until further notice.[35]

On 26 January, three more cases were identified: the 6th consisted of a 47-year-old man who lived in North Point who had been working at a wet market in Wuhan for a few weeks before returning to Hong Kong; the 7th was a 68-year-old Hong Kong woman who lived in neighbouring Shenzhen and had visited Wuhan earlier that month. She was sent to North District Hospital after she presented symptoms while arriving at the Shenzhen-Hong Kong (Luowu) border on 25 January; the 8th case was the 64-year-old husband of the 3rd case in Hong Kong. He had developed a fever on the night of 25 January during quarantine, and was immediately sent to hospital to be tested for the coronavirus. A newly built housing block in Fanling in Hong Kong's New Territories that was earmarked as a quarantine facility for people who may have been exposed to Wuhan coronavirus, was fire-bombed. Dozens of residents and protesters opposed to the idea held rallies outside the complex.[36]

On 28 January, Chief Executive of Hong Kong Carrie Lam announced the suspension of high-speed rail service between Hong Kong and mainland China from 30 January, a halving of all cross-border ferry services[37][38] and flights from mainland China, cross-border bus services would also be reduced. The Hong Kong government was awaiting the for the central government's agreement to suspend issuing individual visitors permits for mainland residents to Hong Kong.[38] All government employees (except those providing essential/emergency services) were instructed to work from home. In a press conference later that day, Lam said that the Man Kam To and Sha Tau Kok border checkpoints would be closed.[39]

On 29 January, two connected cases were confirmed by health officials. The 9th and 10th cases consisted of a couple from Wuhan in their 70s who had arrived in Hong Kong on board Cathay Dragon KA853 on 22 January, and checked into a hotel in West Kowloon on the same day. They had visited multiple restaurants at the hotel, the Elements mall, the Ritz Carlton. During their visit to the Four Seasons Hotel on 28 January, the staff who noticed that the couple had a persistent cough and appeared unwell called an ambulance, and both were transferred to Hospital, where they tested positive for coronavirus. The Leisure and Cultural Services Department (LCSD) announced that all facilities overseen by the department including all public museums, public libraries and sports centres and venues would be closed until further notice as a precaution.[40] On 14 February, the LCSD announced that the closure of its facilities would be extended until 2 March 2020.[41] On 28 April, Hong Kong Public Libraries announced a partial reopening of some of its locations from 6 May.[42]

On 30 January, two new cases of coronavirus were confirmed. The 11th case was a 39-year-old woman who lived and worked in Hong Kong – the daughter of the 9th and 10th (couple from Wuhan) cases. She had previously also stayed with them at the W Hotel in West Kowloon, and also visited the Hong Kong with them. She developed symptoms on 28 January after sending her parents to hospital. She was the first case of local transmission in Hong Kong. The 12th patient was a 75-year-old man who lived in Tsing Yi who had visited Guangdong province in China from late December till early January, and Macau for several days in mid-January. He developed coughing symptoms on 22 January and was hospitalised in a regular hospital room at the Queen Margaret Hospital. Not having declared his travel history, he was initially not tested for the coronavirus. On 30 January, his conditions worsened and he tested positive for the coronavirus.

On 31 January, the 13th case of COVID-19 was confirmed – a 39-year-old Hong Kong man with diabetes who lived in Whampoa, Kowloon. He had come back from Wuhan in the previous week, developed muscle pain on 29 January and a cough and fever on 31 January. After he was confirmed to have the coronavirus, his family were transferred to a quarantine camp.

February

On 4 February, the CHP reported Hong Kong's first death, that of a 39-year-old patient, the 13th case.[43] Three cases were confirmed on 5 February,[44] three on 6 February,[45] and another two on 7 February.[46]

On 9 February, Hong Kong confirmed three more cases with two from the same family, bringing the total number to 29.[47] It was also announced on the same day that the passengers and crew of the World Dream cruise ship were allowed to leave after a check revealed that they were negative for the coronavirus and had no history of being in close contact with eight disembarked passengers who were tested positive for the virus.[48] On 19 February, a 70-year-old man with pre-existing illnesses became the second person to die of COVID-19 in Hong Kong.[49] On 24 February, seven new cases were identified that included two evacuees from Diamond Princess, a cruise ship quarantined in Japan, bringing the total number of cases to 81.[50]

March

Street in Hong Kong during the COVID-19 pandemic

As of 2 March, Hong Kong had reached 100 confirmed cases. Two new cases were confirmed that day which include a brother of a COVID-19 patient and a woman from the Diamond Princess cruise ship. An 88-year-old man living at a care home in Shau Kei Wan had tested "weak positive" for the virus the same day, further tests would be done to test whether he was infected.[51]

On 20 March, Hong Kong recorded 48 new coronavirus infections, the biggest daily tally since testing began, bringing the total to 256 confirmed cases. Of these cases, 36 had a travel history. Gabriel Leung, member of an expert panel on the viral outbreak, warned the public about letting down their vigilance prematurely as Hong Kong was at the "highest risk" since the start of the pandemic.[52] An article published on 25 March by the office of Chief Executive Carrie Lam warned that an increase in confirmed cases would "inevitably" occur as long as Hong Kong citizens continued to return from abroad.[53]

On 22 March, the Hong Kong University of Science and Technology published an article on Multilevel Antimicrobial Polymer (MAP-1), a surface coating spray that inactivates viruses, bacteria and spores and that was successfully used in the combat of COVID-19 in public places like schools, shopping malls and school buses.[54]

On 25 March, Hong Kong closed its border to all incoming nonresidents arriving from overseas. Transiting through Hong Kong was no longer allowed either. All returning residents, regardless of point of departure, were subject to the Compulsory Quarantine Order, which required all to stay at a reported quarantine premise (either home or hotel) for 14 days. Tracking devices were employed to enforce the order. All returning residents from the United States, the UK, and continental Europe were required to go through enhanced screening and submit saliva sample for COVID-19 testing.[55]

On 27 March, Hong Kong Chief Executive Carrie Lam banned indoor and outdoor public gatherings of more than four people, for 14 days starting from 29 March. Other regulations enacted, which took effect at the same time, included requiring restaurants to operate at half their capacity and to set tables at least 1.5 meters apart.[56]

April

On 1 April, the Hong Kong government announced the temporary closure of karaoke lounges, nightclubs and mah-jong premises. Confusion over the government's listing of venues to be temporarily closed led the public to believe that other venues such as beauty parlors, massage parlors and clubhouses would have to be closed as well. However the government clarified that such establishments would be allowed to remain open subject to businesses providing hand sanitiser to customers, as well as requiring customers to wear a mask and have their temperature taken while inside the business venue.[57]

On 3 April at 18:00, all pubs and bars across the territory were ordered to close for 14 days.[58]

At a press briefing on 21 April, Chief Executive Carrie Lam announced that the social distancing rules, which already been extended previously,[59] would be extended beyond 23 April by 14 days.[60] Shortly after the press briefing, the Food and Health Bureau said that the cap on the number of customers at 50 per cent capacity would be relaxed.[60]

In late April, researchers at the Hong Kong University of Science and Technology said that a newly developed antiviral coating may provide up to 90 days of "significant" protection against COVID-19. The disinfectant is encapsulated in heat-sensitive polymers and released when there is human contact with a surface such as a handrail or elevator button.[61]

May

On 1 May, no major Labour Day demonstrations were authorised as the gathering limit of four persons was upheld. Police handed out 18 penalty tickets for breach of social-distancing rules at street booths and at a singalong event in a mall.[62]

On 5 May, Chief Executive Carrie Lam announced that the cap on public gatherings would be raised from four to eight people, and that a number of businesses including beauty salons and gyms would be allowed to reopen subject to precautions. The number of people allowed to use a single table in restaurants and catering facilities was likewise increased from four to eight. Schools will resume classes in stages from 27 May, starting with secondary schools and moving progressively to younger ages.[63]

By 30 May, a total of sixteen passengers arriving in Hong Kong from Pakistan on Qatar Airways flight QR818 on 28 May had tested positive.[64][65] Also on 30 May, a 34-year-old woman with no recent travel history tested preliminary positive.[65]

June

The Hong Kong Government extended the social distancing measures for two more weeks, until 18 June, after six people were confirmed infected, including a female employee at Kerry Logistics warehouse in Kwai Chung, her husband, two colleagues and the paramedic.[66] The Hong Kong Government later decided to evacuate some residents in Luk Chuen House at Lek Yuen Estate in Sha Tin, where the confirmed cases were found.[67]

On 8 June, the government announced that Ocean Park is set to reopen on 13 June while Hong Kong Disneyland will reopen "soon". Both theme parks suffered from financial difficulties during the pandemic. Trade fairs and conventions, which were suspended since the beginning of the year, will be hosted again in Hong Kong starting with the Hong Kong Book Fair on 15 and 21 July.[68]

July

There was an increase in confirmed COVID-19 cases in July, following a 21-day period of no confirmed local cases. A cook in a restaurant confirmed positive on 5 July;[5] a person from Ping Shek Estate and a nurse from a nearby clinic were diagnosed with the coronavirus the following day.[69] However, on 7 July 16 people were locally infected from multiple districts, the highest local increase in cases since the start of the pandemic in Hong Kong. On 9 July 34 locally infected cases were reported, with new social gathering restrictions enforced from the following midnight. However, with the addition of 41 locally infected cases reported on 13 July the Hong Kong government further reduced the limit on public gatherings from 50 to 4.[69] A notable cluster of 44 patients linked to a home for the elderly emerged; Tsz Wan Shan district also recorded more than 150 cases.[5]

A total of 108 new cases were confirmed on 19 July – the highest since March: 83 cases were local in origin, while 25 were imported.[70] The majority of the locally transmitted cases cannot be traced back to a single group gathering or event.[71] That day, the government announced a raft of measures hoping to slow the spread: civil servants are to work from home and only emergency and essential public services will remain open; eat-in restaurants will be banned from 6pm to 5am, and mask-wearing in indoor public places is henceforth mandatory.[70]

The growth in the number of patients during the week to 25 July put pressure on isolation facilities in public hospitals, which were reported to be running close to maximum capacity. Carrie Lam announced that she had requested help from mainland health authorities, and that testing capacity would be increased with their help; areas of AsiaWorld-Expo would be upgraded to serve as a “mobile cabin hospital”.[72] While pro-Beijing political groups have requested medical personnel from officials from the liaison office, members of the medical profession expressed reservations that those sent are not licensed to practise medicine locally; furthermore there were concerns that cooperation would be straightforward because of language political and cultural issues. The liaison office criticised their "arrogance and prejudice" in resist the offer of support, and effectively putting political consideration above people's safety.[73]

On 28 July, Secretary for Food and Health Sophia Chan admitted that there was "empirial evidence" that quarantine exemption policies for over 30 groups of inbound travellers – including cross-boundary goods vehicle drivers, aircraft crew members, government officials on duty, and numerous company executives – had contributed to the recent increase in coronavirus cases.[74] Experts had been pointing to such loopholes as a likely cause already a week earlier, mentioning in addition returning domestic workers.[5] The 118 new cases announced that day heralded the eighth consecutive day of three-digit infections per day. Social-distancing rules were further toughened by limiting public gatherings to two people; banning eating-in at restaurants; and making the wearing of face masks compulsory in all public places.[75] However, the ban on eating-in was highly unpopular with the public amid viral images of workers eating their lunchboxes on roadsides in the heat and rain. It ended in a government U-turn after 48 hours.[76]

August

A team of mainland health officials charged with carrying out COVID-19 testing arrived in Hong Kong at the beginning of the month, ostensibly to step up the testing capacity. [77][78] Although details have not yet been finalised by the time of the team's arrival, the free voluntary universal testing programme aims to test all residents within two weeks, to quickly detect silent transmissions in light of the rapid rise in cases, according to the government.[77][78]

On August 17th, Hong Kong banned Air India from flying to the city for two weeks over imported Covid-19 cases, the Hong Kong Government invoked emergency public health powers after linking 11 imported coronavirus infections to New Delhi flight. “The fact 11 passengers tested positive on the same flight shows the lab tests back in India are not very reliable,” a government source said. “The airline has to do deep cleaning [on its planes] and make sure it won’t happen again on future flights before they can be resumed.” [79]

Shortages

Aerial view in Kowloon Bay, 5 February 2020, showing long queues to buy masks going around a block

Since the outbreak, the availability of a significant number of products including toilet paper, face masks and disinfectant products (such as alcohol and bleach) came under pressure across the city.[80] An ongoing period of panic buying has also caused many stores to be cleared of non-medical products such as bottled water, vegetables, and rice.[81]

On the professional level, the Hospital Authority reported at the end of January that stock of surgical masks for public hospitals had fallen below three-months' supply, but said it hoped to secure replenishment lasting until June. Chief Executive Carrie Lam said she had written to the State Council hoping to obtain supplies from mainland China.[82] The Government of Hong Kong had its imports of face masks cancelled as global face mask stockpiles decline.[83] As 80 per cent of surgical masks sold in Hong Kong were mainland-sourced, the considerable internal demand for masks rendered Hong Kong a lower priority.[80]

At the retail level, masks and hand sanitiser were in short supply by the end of January. Desperate citizens took to chasing supplies across town, rushing to any store where they may be available, and many pharmacies had long queues forming outside; some would queue overnight despite advice from stores.[80][82] Unsuccessful customers took out their frustrations on store staff, and disputes were widely reported; police were called on one occasion by pharmacy staff in Tin Shui Wai. Most stores had limited supplies, and customers would often face rationing.[82] In addition to toilet paper, flour became oversold as citizens took up home baking.[84]

Amidst shortages due to hoarding, the Mong Kok branch of Wellcome supermarket was robbed by armed gangs who made off with 50 packets (600 rolls) of toilet paper.[85]

In early February, after CSI masks appeared in the local marketplace, the government was called to account for the supplies of masks manufactured by inmates in local prisons under the aegis of the Correctional Services Industries. In 2019, masks were produced at a rate of 4 million in each quarter by the Correctional Services Department, and were distributed among various government departments. Media reported that the stocks within different departments were freely available to staff before the lunar new year. Due to the onset of the epidemic, they suddenly became a precious commodity in Hong Kong, and the abuse was highlighted.[86]

Following an admission that the city had failed to procure adequate supplies of PPE, the government announced support for local private mask production by subsidising each production line with grants, help in identifying suitable premises, as well as placing orders to sustain their operations.[87] An increase in mask production by Correctional Services Industries from 1.8 million to 2.5 million units a month is planned.[87]

The government announced that its procurement had fallen victim to a scam involving 6 million counterfeit masks bearing the Medicom trademark valued at HK$15 million ($1.9 million).[88]

Impact

In view of the coronavirus outbreak, the Education Bureau closed all kindergartens, primary schools, secondary schools, and special schools until 20 April.[89] The disruption raised concerns over the situation of students due to take examinations at the end of the year, especially in light of the protest-related disruption that happened in 2019.[90] The Hong Kong Diploma of Secondary Education examination was postponed for four weeks from late March to late April, with HKEAA announcing that the oral component of both Chinese Language and English Language would be cancelled.[91]

On 5 February, flag carrier Cathay Pacific requested its 27,000 employees to voluntarily take three weeks of unpaid leave by the end of June. The airline had previously reduced flights to mainland China by 90% and overall flights by 30%.[92]

The arrest of dozens of pro-democracy activists and opposition politicians for protests organised and carried out during 2019 in the course of the 2019–20 Hong Kong protests, which included the arrest of 15 high-profile pro-democracy figures on 18 April,[93][94] was seen widely as having been expediated by the local restrictions on demonstrations, besides the decreased international attention due to the pandemic.[95] Police have used coronavirus laws banning groups of more than four, for example, to disperse protesters outside Prince Edward station on 31 March,[96] and a 300-person singing protest in Cityplaza on 26 April.[97]

Success factors at early stages

In a study published in April 2020 in the Lancet, the authors expressed their belief that border restrictions, quarantine and isolation, social distancing, and behavioural changes such as wearing masks likely all played a part in the containment of the disease up to the end of March.[3][98]

Another important success factor is the critical thinking of citizens, who now distrust the government through lessons learned from the pro-democracy protests. The Atlantic credits the swift, collective and efficient grassroots movement. Already familiar with tides of misinformation during months of protests, obsessive fact-checking is practised; after the 2003 SARS epidemic, claims about the non-transmissibility of the disease advanced by the government, the Communist Party and the WHO were also ignored by citizens, who took to wearing masks despite the anti-mask law in place.[4]

Criticism

Policy comparisons with Macau

See also: COVID-19 pandemic in Macau

The government actions with regards the epidemic in Hong Kong were inevitably compared with the "calm, organised handling" in neighbouring Macau, notwithstanding the relative sizes of the population.[99][100] From the outset, Macau demonstrated a faster and better coordinated response, introduced firm measures to limit the flow of people from mainland China, and implemented comprehensive collection and effective usage of big data.[100] In particular, in contrast to long queues of desperate citizens chasing masks often at inflated prices in Hong Kong, Macau was lauded for providing their citizens with a measure of peace of mind by taking control of mask distribution, ensuring affordable masks were available for each Macau resident at the start of the epidemic.[99][100]

Immediately upon the detection of its first cross-border case, Macau closed its border with neighbouring Zhuhai.[99] Macau's entry bans on Hubei residents, and those who had visited the province 14 days before their arrival in Macau, was similar to Hong Kong's ban on the surface, but the Macau authorities' demanding official medical certification of infection-free status brought down visitor numbers more sharply because such certificates are hard to obtain.[99][100]

The media reported that Macau police searched 86 hotels and deported about 150 visitors from Hubei and put 4 into voluntary quarantine, whereas immigration officers in Hong Kong checked 110 hotels, and only took down details of the 15 travellers identified as being from Hubei because none showed symptoms of Covid.[100]

While Macau Chief Executive Ho Iat-seng announced the measure, his Hong Kong counterpart was attending the World Economic Forum summit in Davos.[99]

Border closure controversy

The Hong Kong Government refused to close all the borders with the mainland to reduce the risk of the virus entering Hong Kong, opting instead for progressive partial closures in response to increasing public pressure. There were calls for tightening up controls and checks for visitors, especially those coming from Wuhan, the point of origin of the epidemic.[101] Medical experts had demanded mandatory health declarations at all borders and ports but they were initially rejected. Chief Executive of Hong Kong Carrie Lam rejected proposals to close borders as "inappropriate and impractical", but said that mandatory declarations would be implemented.[101]

On 28 January, Lam announced that the high-speed rail link with mainland China, and all cross-border ferry services, would be suspended starting two days later.[37] Additionally, the number of flights from mainland China and cross-border bus services were reduced. Hong Kong government employees (except those providing essential/emergency services) were asked to work from home. Later on that day, the government closed two border checkpoints.[39] Government clarification that treatment for Coronavirus patients would be free for allcomers further inflamed Hong Kong residents as the policy ignited fears of infected mainland Chinese deliberately travelling to Hong Kong to seek medical care, thus risk spreading the disease as well as further overwhelming medical facilities. Following public uproar, the government re-imposed fees for non-Hong Kong residents.[102]

As the major border checkpoints such as Lo Wu, Lok Ma Chau and Huanggang remained open, public sector health workers, as represented by Hospital Authority Employees’ Alliance – a newly formed union – decried the government measures as "too little, too late".[103] Over 400 public hospital doctors and nurses also wrote to the government, demanding border closure and also threatening strike action.[104] The union warned the government its members may go on strike in early February if the government failed to implement tighter controls on immigration.[103]

Many flights from Hong Kong International Airport were cancelled in late March due to COVID-19

Strike call

Facing continued pressure from strikers and from all parties across the political divide, Lam announced a raft of measures including six further border closures on 30 January. Lam explained her government's insistence on keeping major border crossings open conformed with the WHO's position that draconian travel and trade restrictions were unnecessary, and it was opposed to any "discriminatory move" to close borders with China or restrict access to Chinese travellers.[105] On 3 February, the government closed all but four border crossings – the Hong Kong–Zhuhai–Macau Bridge, Shenzhen Bay Port, the international airport, and the Kai Tak Cruise Terminal – and introduced further quarantine measures, but still refused closing the border with China.[106] After a union vote, a public hospital strikes ensued.[106] The strike involved 6,000 medical workers, lasted five days – from 3 to 7 February – culminating in an occupation of two floors in the Hospital Authority complex in Kowloon City. According to the authority, the industrial action had led to "severe disruption" to operations, particularly at accident and emergency, neonatal intensive care, cancer and cardiac units. A second strike call was not successful.[107] Pundits noted that after the turmoil caused by her bungled handling of the extradition bill enactment, Carrie Lam lacked the political capital to make the demand for full border closure – something the Chinese government was not inclined to accede to.[106]

Quarantine loophole

Neglected categories of arrivals in Hong Kong were said by experts to be responsible for imported COVID-19 infections between 8 and 21 July – 34 cases (30 per cent) were sea or aircrew members, and 28 (25 percent) were domestic helpers.[5] In late June, the loophole was highlighted after nine ship workers who arrived with their vessel in Ningbo tested positive. The ship had made a three-day port call in Hong Kong on its way to Ningbo. Official figures show that more than 11,700 sea crew members have been exempted from quarantine since February, while Hong Kong still allows unrestricted sea crew change for vessels since 8 June. Prior to 8 July, sea and aircrew members were exempt from testing and quarantine. Since then, the authorities require sea and aircrew members to produce negative COVID-19 test results before coming to the city. However, a community outbreak is already under way.[5] On 26 July, as the number of daily confirmed cases reached 128 – the second highest level since the start of the pandemic and the fifth consecutive day when cases numbered in excess of 100 and a death toll of 18 – the government announced that ships without any cargo trade sailing via Hong Kong would no longer be allowed to change their crew in the city from 29 July. Disembarking crew members would have to remain on the ship and wait to be transported to the airport to avoid community infections. Medical experts said that the government measures were "too little, too late", and further questioned why the measures were only applicable three days afterwards.[108]

According to experts, the acceleration of the community outbreak is due to the government's slow reactions and complacency of the public.[5] Many Hongkongers believe the increase in cases is due to people who have entered the city from abroad without having been subjected to quarantine, and have appealed to the government to end the exemptions.[109] The government defended the loopholes for certain workers, such as cross-boundary truck drivers, sea and aircrew, as "essential to maintain the necessary operation of society and the economy".[5] As the daily number of cases has hit three figures, government adviser Professor David Hui urged the government to suspend allowing the sea port for crew change; Dr Ho Pak-leung, microbiologist at the University of Hong Kong, said quarantine exemptions for sea crew members could be likened to a "doorless chicken coop".[110]

Mass testing controversy

Absence of public tender

The government embarked on a programme of mass testing, citing the need to limit the number of asymptomatic transmission.[78] Questions were raised about the absence of tendering procedures, and that the contractors' credentials which critics deemed suspect.[78][111] Lam said that there were only three companies that were capable of carrying out mass testing in the scale required;[111] they were given exemptions under Hong Kong law by virtue of their being qualified in China.[78] Arisina Ma, president of the Public Doctors' Association, decried the lack of transparency in inviting Chinese specialists and appointing Chinese companies to provide testing, saying that even senior health department officials were unable to give clear terms of reference of the interventions.[112] Many local health experts question why the government chose a strategy of wasteful universal testing, instead of focussing testing on more people who are deemed to be in higher risk groups; others question why local laboratories were not solicited although they have spare capacity.[112] Carrie Lam said that the Chinese government would absorb part of the cost.[78]

Privacy concerns

Citizens were concerned about the privacy implications if the tests involved the subject's DNA.[112][113] The fact the Hong Kong police have been weaponising pandemic control by collecting DNA samples while arresting activists during the previous few months of protests, without justification nor explanation, has contributed to the fears of abuse.[114][115][116] Since the first week of August, prior to the arrival of the mainland testing team, the city has been rife with rumours that the team was being sent to obtain DNA from residents through the tests and used for surveillance purposes.[77][78][112] There is considerable public mistrust in the Hong Kong government which continues to fuel conspiracy theories.[114][115] China's building of DNA database and its use and biometric surveillance are of great concern to human rights activists,[112][114] and the fact that one of the contractors is on a US government blacklist for taking DNA for surveillance purposes.[78] The government attempted to reassure the public that testing would be optional, that tests carried "would meet all legal requirements and that no samples would be sent back to the mainland".[113][114]

Credibility of contractors

According to some press reports, the main business of China Inspection Company (中國檢驗有限公司), one of three contractors, was vehicle and electronic inspections, and had no track record whatsoever in medical testing. The board of its local subsidiary consisted of three people, none of whom was a qualified laboratory clinician and was thus not compliant with Supplementary Medical Professions Ordinance (Cap 359).[111] A second contractor, BGI Group (華大基因), one of the biggest companies conducting coronavirus testing in China,[112] has been blacklisted by the US government as a BGI subsidiary had allegedly been engaged in taking DNA from Uyghurs in Xinjiang for surveillance purposes.[78][113] The only Medical laboratory scientist on the BGI board was the laboratory clinician in a beauty clinic involved in a scandal eight years previously in which one customer died from unsupervised medical procedures involving botulinum toxin (botox), and another lost a limb through amputation.[117]

Statistics

(Source: Hospital Authority )

Up to 17 August 2020:

• Discharged cases: 3668 (including 69 deaths)
• Length of stay in hospitals: 2 to 128 days (median 13 days)*

As at 9:00am of 16 August 2020:

• Hospitalised cases: 831
  • Cases in critical condition: 36
  • Cases in serious condition: 59
  • Cases in stable condition: 958
• Occupancy of Airborne Infection Isolation Rooms: 70%
  • Occupancy of Airborne Infection Isolation Beds: 65%

Asymptomatic cases: 1015 (~22% of confirmed cases)
Average days from onset to confirm: ~5.5 days

Cases by age groups and gender

No. of cases up to 17 August

Ages	Hospitalised		Discharged		Deceased		Calculated		Case fatality rate
	Male	Female	Male	Female	Male	Female	Total	Percentage
0 to 20	37	28	277	230			573	12.7%	N/A
21 to 30	63	45	326	299			742	16.4%	N/A
31 to 40	52	57	278	333	1		730	16.1%	0.14%
41 to 50	44	47	240	320			653	14.4%	N/A
51 to 60	82	64	277	329	2		755	16.7%	0.27%
61 to 70	115	60	241	239	3		662	14.6%	0.46%
above 70	65	72	104	106	37	26	410	9.1%	15.59%

Graphs

Daily number of new cases:

Number of active cases:

Number of cases by condition:

  Cases in hospital (Active): 814 (17.9% of confirmed cases)

  Discharged cases: 3677 (80.6% of confirmed cases)

  Deceased cases: 70 (1.5% of confirmed cases)

Number of cases by infection source:

  Imported cases: 1110 (24.5% of confirmed cases)

  Local cases: 1239 (27.4% of confirmed cases)

  Possibly local cases: 103 (2.3% of confirmed cases)

  Close contact of confirmed cases: 2073 (45.8% of confirmed cases)

See also

• Severe acute respiratory syndrome (SARS)

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External links

• Together, We Fight the Virus!
• The Centre for Health Protection
• Latest Situation of Novel Coronavirus Infection