Everybody is freaking out about the recent novel coronavirus—and with good reason. Most modern Hongkongers live with some degree of PTSD after their experience with SARS back in 2003 (more on that later). Aside from being obsessive with hygiene, it’s also important to remember to keep the hope alive and believe that we can come out of this crisis stronger.
With this in mind, we have compiled a list of the most serious pandemics that have swept the city in the past. If we’ve struggled through these health crises and came out better the other side, then we can tide out the coronavirus outbreak of 2020 too.
Referred to as the third pandemic because it was the third major bubonic plague outbreak to affect European society, this particular plague pandemic began in Yunnan, China, in 1855. It spread to all inhabited continents on the globe and was actually considered active by the World Health Organisation up until 1960.
This plague reached Hong Kong in May of 1894. This largely happened because people had returned to their ancestral homes in the mainland to tend to family graves for Ching Ming Festival; unfortunately, this festival coincided with the outbreak of the epidemic in Guangzhou, and many had, therefore, brought it back into Hong Kong.
At the time, the area of Tai Ping Shan in Sheung Wan was the city’s most densely populated area, and naturally became the area hardest hit. The British had designated Tai Ping Shan as a settlement for Chinese workers, and the inhabitants effectively lived in squalor. The hilly neighbourhood was packed with Chinese-style tenement housing with no sewage system or running water, and abysmal draining channels.
As the situation worsened, the health authorities conducted house searches, isolated the infected, and rapidly disposed of corpses—so many had died so quickly that the streets were clogged with dead bodies. Eventually, Tai Ping Shan’s residents had to be forcibly evicted and the buildings were razed to the ground.
The most common form of the plague is bubonic, which affects the lymph nodes and enlarges them, forming “buboes.” If left untreated, they cause symptoms that include seizures, cramps, cough, fever, delirium, as well as gangrene in the extremities. Needless to say, patients died in excruciating pain. Within three months, the plague had killed more than 2,000 people and a third of Hong Kong’s population had fled.
It was Alexandre Yersin of the Institut Pasteur who was sent to Hong Kong and eventually isolated the plague bacillus bacteria—through desperate means such as stealing infected corpses and draining pus from the cadavers’ buboes. This medical discovery contributed hugely to the study of the plague. Meanwhile, in the following 30 years after the third pandemic, the plague occurred in Hong Kong almost annually, killing more than 20,000 people before eventually dying out.
In mid-1968, a global outbreak of influenza broke out in China, commonly referred to as the Hong Kong flu pandemic. For the couple years during which it was around, the flu caused an estimated one to four million deaths.
The H3N2 virus which initiated the outbreak was suspected to have evolved from influenza A subtype H2N2, which was responsible for the previous influenza pandemic of the 20th century—the 1957 Asian flu. This highly contagious virus quickly spread around the globe; within two weeks of its emergence in Hong Kong, some 500,000 cases had been reported. In other words, 15 percent of the population then was infected.
Within several months, it had badly affected Southeast Asia, spread throughout the United States and reached western Europe and multiple countries in Africa. Because of how dense Hong Kong’s population is, the outbreak reached maximum intensity in merely two weeks and lasted six months in total. Worldwide death numbers peaked much later.
Symptoms were those typical of upper respiratory infections and included chills, fever, muscle pain, and weakness. The highest mortality rates came from groups that were most susceptible, namely the young and the elderly. A vaccine was eventually developed, but by the time it became available, the pandemic had already peaked in many countries.
In Hong Kong, you’ll often see signs in public spaces warning people against feeding birds. The reason for this city-wide eschewing of wild birds is rooted in the avian flu, also commonly known as bird flu.
Despite previously only infecting birds, in 1997 there were 18 people who were infected with the H5N1 strain of influenza A, of which six ended up dying. Two others were later documented in 2003. Initial symptoms of avian flu sufferers prove to be similar to other flu viruses, and can include fever, headache, muscle pain, runny nose, cough, and sore throat. Left untreated, these can quickly worsen into high fever, chest infection, respiratory failure, then multi-organ failure, and eventually death.
The H5N1 avian influenza is transmitted from infected live birds to humans, instead of from human to human. The virus does not commonly infect humans, which is precisely why there is little to no immunity against it in people. In addition, even though it’s mainly those in close prolonged contact with birds that are likely to contract the bird flu, what makes it dangerous is that the virus is highly deadly to those who are unlucky enough to contract it. Over the last 15 years, the avian flu has had a mortality rate of over 50 percent—much more deadly than SARS (a 10 percent mortality rate; see below entry) or the recent novel coronavirus (2 percent mortality thus far).
The outbreak of the avian flu in Hong Kong was behind some significant changes in the ways locals conduct everyday life. Apart from not interacting with birds and avoiding contact with bird droppings, wet markets also largely stopped stocking live chickens. This caused some consternation in the community as the Chinese much prefer their poultry live and fresh to chilled or frozen. Still, a sense of self-preservation prevailed, and to this day you would be hard-pressed to find a market stall selling live chicken.
Funnily, during this transition period of poultry selling, the general public were urged not to blow on chicken bottoms when purchasing live birds. No, that is not a mistranslation! Apparently this is a practice common among the elder Chinese generation; by blowing a chicken’s bum feathers out of the way, you’d be able to tell if it has laid eggs before, and therefore if it’s a young, juicy chicken, or a tough old bird. This culturally interesting scene was even featured in a scene of Rush Hour 2.
Roughly 1.3 million chickens were killed by the Hong Kong government in December 1997 alone. Importing poultry from mainland China was also suspended, as the precursor to the human-infecting H5N1 virus was first detected in Guangdong.
Unfortunately, even as China is scrambling to tackle the recent novel coronavirus, there has been an outbreak of avian flu reported in Hunan province, south of the coronavirus epicentre of Hubei. Almost 18,000 chickens have been culled since the discovery, though no human cases of the H5N1 avian influenza have been reported yet.
An acronym for severe acute respiratory syndrome, the SARS coronavirus is a viral respiratory disease that caused 774 deaths across 17 countries, the majority of which were in mainland China and Hong Kong.
The outbreak occurred in Guangdong, China, in late 2002, but the Chinese government tried to cover it up by discouraging press coverage, delaying reporting of the outbreak to the World Health Organisation (WHO), and reporting false numbers—all of which resulted in international criticism. As a result, neighbouring nations did not get sufficient warning to prepare for a possible health crisis.
At the end of January, a fishmonger checked into the Sun Yat-Sen Memorial Hospital in Guangdong, where he infected 30 medical staff. From there, the virus spread to nearby hospitals. A doctor named Liu from the hospital in Guangdong then travelled to Hong Kong in February; he proved to be the super-spreader who would go on to infect much of the city. Apart from seeing various family members, he also stayed in the Metropol Hotel. 23 other guests of the hotel developed SARS, while Liu’s brother-in-law eventually died of the disease. Liu checked himself into the Kwong Wah Hospital and later died in the Intensive Care Unit.
A large proportion of those infected were either medical staff or family members of those who were ill. Reportedly, at least 99 medical staff were infected while treating a single patient who had visited a guest at the Metropole Hotel. A global health alert was issued by WHO about the new infectious disease in March 2003.
The following months were a dark period for Hongkongers. Schools were all cancelled indefinitely, the streets were largely empty, and people could only watch as infected numbers increased daily. Among the residential estates, Amoy Gardens was hit particularly heavily: in just Block E of the estate there was an outbreak of over 200 cases. Residents were transferred to quarantine camps, and it was later found that the virus spread through droplets from the drainage pipes because the apartments shared a sewage system.
The symptoms of SARS are similar to flu and may include fever, muscle pain, lethargy, cough, and sore throat. The only common symptom that all patients had was running a fever above 38 degrees Celsius. Its average incubation period is four to six days, and patients are most infectious during the second week of illness, so if detection was early and the carrier was quarantined by day five of their illness they rarely infected others.
It wasn’t until June that Hong Kong was removed from WHO’s list of affected areas. There is still no vaccine for SARS; clinical isolation and maintaining personal hygiene remains the most effective means to stop it spreading.
The swine influenza pandemic of 2009 was the second of the two pandemics involving the H1N1 influenza strain. It was estimated that 11 to 21 percent of the global population then—or roughly 700 to 1,400 million people—contracted the disease. Overall, this was more than the Spanish flu pandemic of 1918, but also had a much lower case fatality rate.
Widespread infection of swine flu was first recognised in Veracruz, Mexico. When the Mexican government failed to control the virus and it spread globally, and the WHO declared a ‘public health emergency of international concern’. Although it’s called the swine flu, the virus cannot be transmitted by eating pork; instead, it is contracted from infected people via respiratory droplets, much like other influenza viruses.
It stands to reason that H1N1 symptoms are therefore also similar to other influenzas, and may include fever, dry cough, headache, muscle or joint pain, sore throat, chills, and runny nose. In some cases, diarrhea, vomiting, and neurological problems were also reported. In severe cases, patients mostly generally begin to deteriorate around the three- to five-day mark, then rapidly progressing to respiratory failure within 24 hours. Surprisingly, the H1N1 virus does not disproportionately infect adults older than 60 years, as is the case with most other diseases.
The virus spread to Hong Kong in May 2009, when a Mexican national travelled to the city—Asia’s first confirmed case. 12 students at St. Paul’s Convent School were later confirmed to have contracted the virus, which lead to the closure of all schools for half a month. By November that year, there were 32,301 confirmed cases of swine flu. 282 of the patients in the city had severe complications, and 80 of these died.
Worrying, in June 2010, Hong Kong scientists discovered a new swine flu virus, which turned out to be a hybrid of the pandemic H1N1 and viruses previously found solely in pigs. It was discovered that pigs could be infected by the avian flu virus and also by human viruses. When these animals are simultaneously infected with more than one virus, the strains can swap genes resulting in mutations and new variants which could then spread to humans. We’ll just have to wait and see!