AT THE EPICENTRE HONG KON G AN D TH E

SARS OUTBREA K

Edited b y Christin e Lo h and Civi c Exchang e

# m * 3 * m is. f± HONG KON G UNIVERSIT Y PRES S

Hong Kong University Press

14/F Hin g Wai Centr e

7 Tin Wa n Pray a Roa d Aberdeen Hong Kon g

© Hon g Kon g Universit y Pres s 200 4

ISBN 96 2 20 9 68 3 2 (Hardback ) ISBN 962 20 9 68 4 0 (Paperback )

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CONTENTS

Preface vi i Christine Loh

Calendar o f Event s x v William Chiu and Veronica Galbraith

Chapter 1 Unmasking SARS : Voices from th e Epicentr e 1 Alexandra A Seno and Alejandro Reyes

Chapter 2 At th e Frontline : Th e Medica l Challeng e 1 7 Moira Chan-Yeung

Chapter 3 Healing Myself : Diar y o f a SAR S Patient an d Docto r 3 3 Gregory Cheng

Chapter 4 The Ne w Coronavirus : I n Searc h o f th e Culpri t 4 3 Moira Chan-Yeung and Christine Loh

vi Contents

Chapter 5 T h e Publi c Healt h Viewpoin t 5 5 Gabriel M Leung, Anthony J Hedley, Edith MC Lau and Tai-Hing Lam

Chapter 6 The Number s Trail : Wha t th e Dat a Tell s U s 8 1 Alexis Lau

Chapter 7 T h e Myster y o f Amo y Garden s 9 5 Stephen Ng

Chapter 8 How th e Stunnin g Outbrea k o f Diseas e Le d t o a Stunnin g 11 7 Outbreak o f Dissen t Michael E DeGolyer

Chapter 9 The Politic s o f SARS : Th e WHO , Hon g Kon g an d Mainlan d Chin a 13 9 Christine Loh

Chapter 1 0 SARS an d China : Ol d v s New Politic s 16 3 Christine Loh and YIP Yan Yan

Chapter 1 1 T h e Economi c Impac t o f SAR S 17 9 Stephen Brown

Chapter 1 2 T h e Medi a an d SAR S 19 5 Christine Loh, Veronica Galbraith and William Chiu

Chapter 1 3 SARS an d th e H o n g Kon g Communit y 21 5 Christine Loh and Jennifer Welker

Chapter 1 4 Lessons Learne d 23 5 Christine Loh

Notes 25 1

Contr ibutors 281

PREFACE

Christine Loh

...SARS ca n an d mus t b e containe d — pushe d bac k ou t o f it s ne w

human host . One b y one, the many puzzlin g features of this new diseas e

are bein g unmasked . On e b y one , th e mos t sever e outbreak s i n th e

initial waves of infectio n are being brought unde r control . Recommende d

measures — cas e detection, isolatio n an d infectio n control , and contac t

tracing and follow-up surveillanc e — ar e working. With thi s reassurance ,

the imag e o f population s unmaske d becaus e o f fear , th e publi c fac e o f

SARS, ca n no w begi n t o fade .

— Th e World Healt h Organisatio n (WHO )

20 Ma y 200 3

SARS' plac e i n histor y i s assured . I t wa s th e firs t sever e ne w diseas e to e m e r g e i n th e twenty-firs t century . A s such , i t p rov ide d a warning o f wha t coul d happe n i n a globall y in terconnecte d worl d

where infectiou s disease s hav e th e capacit y t o sprea d rapidl y a lon g international ai r trave l routes . Within a period o f days , SARS spread fro m mainland Chin a vi a H o n g Kon g t o man y citie s a roun d th e world . I n th e initial stage s o f th e outbreak , doctor s di d no t eve n kno w wha t t o cal l the disease , muc h les s ho w i t shoul d b e treated . Th e symptom s wer e like thos e o f c o m m o n p n e u m o n i a bu t th e diseas e wa s clearl y m o r e virulent. Fo r wan t o f a bette r term , doctor s bega n referrin g t o i t a s a form o f "atypica l pneumonia . "

Fortunately, SAR S was no t th e globa l pandemi c tha t communicabl e disease expert s ha d feare d i t woul d be . Despit e it s abilit y t o sprea d vi a

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air travel , th e diseas e wa s relativel y inefficien t i n human-to-huma n transmission. Ha d i t been mor e efficient , th e world would hav e been i n much bigge r trouble . Bu t SARS gave us a sense o f what "th e rea l thing " — a full globa l pandemi c — could b e like . Many experts fear tha t SARS could re-emerg e a s earl y a s th e winte r o f 2003 , albei t o n a les s sever e scale. However, new and mor e deadl y diseases could als o be lurking an d the world needs to prepare for a worst-case scenario — for the emergenc e of an unknown diseas e tha t is efficient i n human-to-human transmission . Dr. Hen k Bekeda m o f th e Worl d Healt h Organisatio n (WHO ) ha s warned tha t i t i s no t enoug h t o b e 100 % read y fo r infectiou s diseases , the authoritie s "nee d t o b e 300 % ready. " A sobering though t indeed . So far , wit h th e exceptio n o f HIV/AIDS , fe w o f th e ne w disease s tha t have emerge d durin g th e pas t severa l decade s hav e presente d a majo r threat in terms of global public health , which may be why the authoritie s in develope d countrie s hav e becom e somewha t complacen t abou t communicable diseases . Avian flu, Nipa h virus , West Nile feve r an d th e Ebola viru s ar e worryin g bu t t o date , th e impac t o f thes e disease s ha s been regiona l rathe r tha n international . However , healt h expert s wer e alarmed b y certai n characteristic s o f SAR S as a disease , particularl y it s common an d non-specifi c symptom s an d it s ten-da y incubatio n perio d — a period lon g enough t o allow carriers who seemed health y to sprea d SARS locally an d internationall y vi a ai r travel .

In th e future , th e outbreak s o f greates t concer n wil l b e thos e tha t occur i n transportatio n hubs , suc h a s Hon g Kong , o r i n densel y populated areas , suc h a s sout h China , becaus e suc h outbreak s coul d affect a larg e numbe r o f people , whic h woul d i n tur n mak e treatmen t and contro l muc h mor e challenging . Hence , th e WH O regard s ever y country with an internationa l airport , o r bordering a n are a where ther e is an outbreak , a s a high-risk area in term s of transmissible diseases . Fo r those o f us who liv e in th e sout h Chin a neighbourhood , SAR S brough t home t o u s th e fac t tha t ou r regio n ha s a histor y o f bein g th e world' s incubator fo r ne w diseases . I n a globa l world , thi s present s specia l responsibilities fo r regiona l authoritie s a s wel l a s citizen s i n term s o f disease preventio n an d control .

The worldwide response t o SARS was also atypical. Events happene d quickly. Healthcar e professional s ha d t o fac e enormou s persona l risk s in fightin g th e diseas e o n th e frontline . Scientist s aroun d th e worl d collaborated t o a n unprecedente d degre e t o fin d ou t wha t the y coul d about SAR S as th e first ste p i n discoverin g a cure . Nee d ha s bee n th e

Preface i x

mo the r o f a n u m b e r o f usefu l inventions , suc h a s th e contac t tracin g system develope d i n Hon g Kong . SAR S also touche d almos t ever y o the r aspect o f persona l an d communit y lif e i n affecte d areas . Minister s an d officials los t thei r jobs. Man y businesse s suffered . Ordinar y peopl e wer e forced t o reasses s thei r priorities . Communit ie s ha d t o find usefu l way s of copin g wit h pani c whil e continuin g t o fight th e disease .

rf: ̂ f c 5} c

This boo k open s wit h a Calenda r o f Event s compile d b y Willia m Chi u and Veronic a Galbraith , tw o researcher s a t Civi c Exchange , whic h show s key loca l a n d i n t e r n a t i o n a l event s be twee n N o v e m b e r 200 2 a n d Sep t embe r 2003 . A s thi s t imelin e illustrates , th e pac e o f th e SAR S o u t b r e a k wa s b r e a t h t a k i n g a n d o v e r w h e l m i n g , p a r t i c u l a r l y fo r communit ies dealin g wit h th e disease . Th e Calenda r provide s a usefu l reference fo r reader s an d set s th e stag e fo r Chapte r 1 , Unmasking SARS :

Voices fro m th e Epicentre, written b y seasoned reporter s Alexandr a Sen o and Alejandr o Reyes . Thi s chapte r describe s th e loomin g SAR S crisi s b y piecing togethe r differen t narrative s t o giv e a sense o f how SAR S affecte d the live s o f individual s i n Hon g Kong .

I a m gratefu l t o Dr . Moir a Chan , a well-respected respirator y healt h specialist, fo r contr ibut in g Chapte r 2 . A t th e Frontline : Th e Medica l

Challenge trace s th e progressio n o f th e diseas e fro m it s emergenc e i n mid-November 200 2 i n Guangdon g Province , China , t o it s transmissio n to Hon g Kon g i n Februar y 2003 , fro m wher e i t was exported vi a ai r trave l to Singapore , Vietnam , Toront o an d othe r internationa l cities . I n eac h of th e affecte d areas , th e pat ter n o f infectio n wa s th e same . Th e diseas e first too k r o o t i n hospi ta l sett ing s whe n hea l thca r e worker s wer e unknowingly expose d t o th e infectiou s agent . Hospita l staf f the n sprea d the diseas e t o th e community . Chapte r 3 i s th e persona l stor y o f a dis t inguished doc to r wh o himsel f becam e a SAR S pat ient . Gregor y Cheng's Healin g Myself : Diary o f a SAR S Patien t an d Docto r recount s his persona l experienc e o f SAR S o n a day-by-da y basis . Hi s insight s a s both a docto r an d a pat ien t contr ibut e t o ou r unders tandin g o f th e disease an d it s impac t o n huma n lives . Dr. Cha n an d I co-wrote Chapte r 4, Th e Ne w Coronavirus : I n Searc h o f th e Culprit , whic h describe s th e role o f scientist s fro m H o n g Kon g an d a roun d th e worl d i n learnin g more abou t th e ne w diseas e an d summarise s wha t w e kno w abou t th e virus t o date .

In additio n t o th e immediat e medica l challenge , SAR S also presente d

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a majo r publi c healt h challeng e fo r H o n g Kong . Publi c healt h scholar s Gabriel Leung , Anthon y Hedley , Edit h La u an d Tai-Hin g La m co-wrot e Chapter 5 , The Publi c Healt h Viewpoint , whic h highlight s th e respons e of loca l official s an d institution s t o th e outbreak . Th e author s discus s the nee d fo r additiona l informatio n abou t th e diseas e fo r effectiv e diseas e control i n th e futur e an d mak e a ple a fo r improvemen t i n th e interna l communicat ion an d cultur e o f H o n g Kong' s publi c healt h institution s in o r d e r t o achiev e d e e p e r a n d b r o a d e r col labora t io n a m o n g th e stakeholders involve d i n healt h management .

Dur ing th e SAR S outbreak , a l thoug h medica l professional s an d virologists playe d a vita l rol e i n carin g fo r th e sic k an d identifyin g th e coronavirus , exper t s i n o the r discipline s coul d als o hav e m a d e a n impor tant contr ibutio n ha d the y bee n mor e extensivel y involve d i n th e fight agains t th e disease . Fo r example , aeroso l scientist s coul d hav e he lped publi c heal t h authori t ie s t o bet te r unders tan d th e sprea d o f infectious diseases . Statistician s coul d hav e helpe d t o analys e t rend s i n the outbreak . I was, therefore , particularl y kee n t o hav e Alexi s La u an d Stephen N g contr ibut e t o thi s book . Dr . La u i s a n aeroso l scientis t an d a mathematician . Hi s Chapte r 6 , The Number s Trail : What the Data Tell s

Us, show s ho w non-medic s coul d hav e helpe d t o unrave l som e o f th e questions an d controvers y surroundin g infectio n an d deat h rate s fo r th e disease. D r Ng , a n epidemiologist , contribute s a fascinatin g Chapte r 7 titled, Th e Myster y o f Amo y Gardens , Amo y Garden s wa s th e housin g estate wher e betwee n 2 1 Marc h an d 1 April 2003 , 18 7 resident s an d 14 2 households wer e affecte d b y SARS. Dr. Ng help s u s t o understan d variou s theories a s t o wh y thi s housin g estat e wa s s o susceptibl e t o SAR S a n d why, despit e studie s b y th e Hon g Kon g Governmen t an d th e WHO , thi s mystery ha s ye t t o b e full y resolved .

In addit io n t o th e obviou s impac t o f SAR S o n medicine , publi c heal th an d science , th e impac t o f SAR S o n H o n g Kon g politic s als o deserves seriou s consideration . Michae l DeGolye r discusse s th e effec t o f SARS o n loca l politic s an d th e man y challenge s i t pose d fo r official s i n Chapter 8 , Ho w th e Stunnin g Outbrea k o f Diseas e Le d t o a Sturinin g

Outbreak o f Dissent . Hi s chapte r als o look s a t th e relationshi p betwee n SARS, Articl e 2 3 legislatio n an d Governmen t accountabil i t y fro m a political perspective , particularl y i n term s o f th e massiv e 1 July 200 3 demonstrat ions. I hav e contr ibute d a chapte r focusin g o n th e politic s of H o n g Kon g an d mainlan d China , includin g th e rol e playe d b y th e

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W H O . Chapte r 9 , Th e Politic s o f SARS : Th e WHO , Hon g Kon g an d

Mainland China , explore s th e relationship s betwee n H o n g Kon g an d G u a n g d o n g , G u a n g d o n g an d Beijin g an d H o n g Kon g an d Beijing . Chinese effort s i n term s o f diseas e contro l an d preventio n wer e critica l in th e fight agains t SAR S worldwide. China' s initia l denia l o f th e severit y of th e diseas e contr ibute d directl y t o th e exten t o f th e globa l outbreak . In Chapte r 10 , SAR S an d China : Ol d v s Ne w Politics , YIP Yan Ya n an d I highlight wha t we believe ar e th e inheren t contradiction s i n th e Chines e political system , which continue s t o favour secrec y ove r transparenc y eve n as nationa l leader s see k modernit y an d globa l recognitio n o f Chin a a s a responsible worl d power .

The nex t thre e chapter s hel p t o provid e a mor e complet e pictur e of H o n g Kong' s SAR S experience . Economis t Stephe n Brow n offer s a useful discussio n o f H o n g Kong' s politica l econom y i n Chapte r 11 , The

Economic Impac t o f SARS . He show s tha t SAR S actually ha d littl e impac t on th e overal l e c o n o m i c p ic tu re , a l t h o u g h individua l businesses , especially thos e i n th e trave l an d hospitalit y sectors , obviousl y suffered . Indeed, Hon g Kong' s amazingl y successfu l externa l sector , which include s trade an d globa l manufacturing , appear s no t t o hav e bee n affecte d a t all. Willia m Chiu , Veronic a Galbrait h an d I tak e a loo k a t ho w H o n g Kong wa s affecte d b y internationa l medi a report in g o n SAR S a s wel l a s the controversia l rol e playe d b y th e H o n g Kon g medi a i n Chapte r 12 , The Medi a an d SARS . T h e loca l medi a fel t conflicte d b y it s rol e a s objective bystande r an d it s desir e t o us e medi a channel s t o participat e directly i n fighting SARS .

Finally, Jennifer Welke r an d I examin e th e communit y respons e t o the outbrea k i n Chapte r 13 , SARS and th e Community . Th e diseas e ha d the effec t o f forcin g individual s t o reasses s thei r persona l prioritie s an d companies t o conside r thei r socia l responsibility . Th e sens e o f communit y solidarity wa s on e o f th e mos t endur in g aspect s o f th e SAR S experienc e and ma y prove t o b e on e o f th e mos t significan t i n term s o f Hon g Kong' s future.

I provide d th e concludin g Chapte r 1 4 o n Lesson s Learned . Thi s chapter summarise s som e o f th e ke y point s note d b y o the r author s a s well a s providin g additiona l insight s o n th e impac t an d legac y o f SARS , particularly i n ligh t o f th e findings o f th e SAR S Exper t Commit te e Report , release d o n 2 Octobe r 2003 , an d th e Hospita l Authorit y Revie w Panel Repor t o n th e SAR S Outbreak , release d o n 1 6 Octobe r 2003 .

xii Preface

Like man y organisation s i n Hon g Kong , Civi c Exchang e sough t t o contribute t o th e fight agains t SAR S i n som e way . Ho w coul d w e participate mos t usefully a s a public polic y think tank ? In April 2003 , we drew on ou r networ k o f researchers t o provide SAR S data t o th e publi c as and whe n i t became available . Later , w e helpe d t o foun d Fearbusters, a community campaign t o develop short- and long-ter m project s relate d to disease prevention an d improvin g public hygiene. We closely followed SARS-related event s a s they took place , both locall y and globally . Whe n Hong Kon g Universit y Pres s suggeste d tha t w e consolidat e thi s information an d writ e abou t th e lesson s learne d fro m SARS , we wer e delighted t o d o so . This boo k i s the outcom e o f tha t suggestion .

Having th e opportunit y t o hel p writ e an d pu t thi s boo k togethe r also represent s th e culminatio n o f a very specia l persona l experience . As the devastatin g impac t o f SAR S on th e communit y becam e evident , I found mysel f at a loss as to what I could do for Hong Kong. My feeling was tha t we neede d t o dea l wit h ou r fea r first an d foremos t s o tha t we could asses s the risk of catching the disease objectively and tak e effectiv e preventative action , both o n a personal and o n a societal level. I believed strongly tha t providin g th e publi c with timel y information a t th e outse t would have helped t o ease panic. Since I manage a research organisation , my focus i s on informin g peopl e abou t issue s and event s from a s broa d a perspectiv e a s possible . Thi s i s ho w I though t I coul d contribute . I learned wha t I could abou t SAR S and trie d t o provide informatio n an d analysis to others throug h Civi c Exchange an d th e Fearbusters campaign. This became a personal journey throug h whic h I met man y carin g an d energetic peopl e wh o al l wante d t o hel p Hon g Kong . Today , m y mos t vivid an d meaningfu l memorie s fro m th e outbrea k ar e o f workin g together wit h peopl e fro m al l walks o f lif e an d bein g abl e t o shar e m y fears an d hope s fo r th e futur e wit h others . I am als o awar e o f th e pai n and grie f tha t SAR S has lef t behin d i n th e community . Eac h illnes s an d death affecte d man y lives. In recognising th e positive aspects of SARS as a learnin g experience , w e mus t no t forge t tha t ther e wer e irreparabl e losses.

Acknowledgements

We ar e gratefu l t o al l o f th e author s fo r thei r willingnes s t o participat e in thi s projec t an d fo r writin g s o enthusiasticall y an d speedily . Eac h

Preface xii i

played a n importan t role , whether directl y o r indirectly , i n fighting SARS . We als o wish t o than k Elizabet h Hut ton , Veronic a Galbrait h an d J o a n n e Bunker fo r thei r editoria l advic e an d assistance , an d Coli n Da y fo r hi s wise counse l an d constan t encouragemen t i n helpin g u s ge t thi s boo k out o n time .

As a whole , w e hop e thi s boo k wil l tel l th e stor y o f H o n g Kong' s SARS experience fro m a variety o f perspectives . Civi c Exchang e believe s that b y considerin g thi s experienc e widel y from th e viewpoin t o f expert s as wel l a s generalists , th e boo k provide s a n hones t accoun t o f wha t lif e was lik e a t th e epicentr e o f th e SAR S outbreak . I t look s a t th e questio n of ho w th e peopl e o f Hon g Kon g perceive d wha t was happening t o the m and whethe r thi s ha s altere d thei r sens e o f identit y an d community . Hopefully, th e experienc e o f SAR S an d th e lesson s tha t ca n b e learne d from i t wil l hel p Hon g Kon g an d o the r citie s t o b e mor e prepare d fo r dealing wit h simila r emergencie s i n th e future .

Shortly befor e thi s boo k wen t t o print , th e government-appointe d SARS Exper t Commi t t e e release d it s r e p o r t o n th e publ i c sector ' s handl ing o f SARS . That repor t was followed b y the releas e o f th e Hospita l Authority Revie w Pane l repor t o n th e SAR S outbrea k tw o week s later . Both repor t s po in t t o a lac k o f leadership , absenc e o f strateg y an d contingency plannin g an d poo r communicat io n an d crisi s managemen t skills a s majo r weaknesse s o f Hon g Kong' s healthcar e system . However , the finding b y the Exper t Committe e tha t n o on e wit h th e powe r t o mak e decisions wa s responsible fo r erro r doe s littl e t o addres s publi c demand s for i nc rease d accountabi l i t y a n d t r anspa renc y o n th e p a r t o f th e authorities. Whil e th e Revie w Pane l repor t wa s highl y critica l o f man y aspects o f Hon g Kong' s handl in g o f SARS , i t als o avoide d th e issu e o f accountability. Ha d tim e permit ted , I woul d hav e like d t o includ e a n addit ional chapte r t o thi s boo k tha t compare d th e findings o f th e tw o reports .

T h e Tun g Chee-hw a administratio n need s t o unders tan d tha t it s unpopularity, a s demonstrate d b y th e massiv e publi c protes t o n 1 July 2003, i s du e t o it s governanc e styl e an d p o o r decis ion-making . It s abhor rence o f faul t finding i s characteristi c o f it s approac h t o runn in g H o n g Kong . I n politics , thos e wh o hol d powe r mus t t o b e abl e t o mov e on fro m mistake s s o tha t ne w opportunit ie s fo r th e renewa l o f publi c trust ar e created . Findin g individual s t o b e a t faul t i s never a n eas y task . Indeed, i t i s unpleasant an d difficult . Bu t t o tr y and explai n Governmen t errors b y saving tha t official s trie d thei r best , tha t SAR S was a ne w threa t

xiv Preface

or tha t i t i s better fo r official s t o sta y in powe r becaus e the y hav e learne d from pas t mistake s ring s hollo w t o th e publi c — particularl y give n th e high h u m a n an d economi c cos t o f SAR S fo r H o n g Kong . Moreover , l ingering doubt s abou t th e competenc y an d transparenc y o f official s wil l continue t o feste r an d sa p th e credibilit y o f th e administratio n a s a whole . It woul d b e equall y painfu l fo r th e individual s concerne d t o remai n i n power an d b e force d t o continu e t o defen d thei r action s an d decisions . A mor e effectiv e approac h woul d b e t o remov e individual s responsibl e for er ro r fro m offic e an d signa l a ne w beginnin g b y introducin g fres h faces.

Undoubtedly, ther e ar e importan t lesson s t o b e learne d fro m SARS . The questio n remain s whethe r Hon g Kon g authoritie s ar e read y t o lear n them an d chang e accordingly .

Christine Lo h Chief Executiv e Office r Civic Exchang e October 200 3

CHAPTER I T1

Lessons Learne d

Christine Loh

SARS provide d a dramati c demonstratio n o f th e globa l havo c tha t can ensu e followin g th e emergenc e o f a ne w infectiou s disease . Public healt h authorities , doctors , nurses , othe r hospita l workers ,

scientists an d laborator y researc h staf f aroun d th e worl d struggle d t o cope with SARS. Public panic was widespread in many parts of the world that wer e affected . Som e governmen t official s los t thei r jobs du e t o mishandling of the situation. The short-term economic impact was severe and painful . Hospitals , school s an d man y place s o f entertainmen t ha d to b e closed , an d trave l advisorie s wer e impose d tha t greatl y limite d international travel .

Now that the outbrea k ha s subsided, what are th e lesson s tha t nee d to b e learned ? Ther e ar e fou r ke y aspect s o f th e 200 3 SAR S outbrea k that stan d out , upo n whic h al l othe r issue s hang . First , SAR S was th e first severe and readily transmissible new disease to emerge in the twenty -first century . As such, i t was a reminde r tha t while moder n scienc e ha s done muc h t o improv e publi c healt h i t ha s no t conquere d disease . Second, i n controllin g th e sprea d o f a n infectiou s disease , ever y hou r counts. Timely and effective communicatio n amon g key decision-makers is critica l i n crisi s management ; communicatio n wit h th e publi c i s also essential i n keepin g th e communit y informed . Implement in g preventative an d contro l measure s require s decisio n action , amon g th e most importan t measure s being basic, low-technology initiatives such a s

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isolation an d quarantin e arrangements . Third , althoug h SAR S appears to hav e originate d i n Guangdon g Provinc e a s early a s November 2002 , because mainland Chin a refused t o acknowledge th e exten t and severit y of th e disease , Hon g Kon g becam e th e d e fact o epicentr e o f th e outbreak. I n othe r words , th e lea d acto r i n th e SAR S stor y wa s reall y mainland Chin a bu t Hon g Kon g played th e ke y role becaus e i t was in a tiny corne r o f th e countr y tha t ha d a fre e medi a an d a n independen t medical profession , bot h factor s tha t prove d critica l i n providin g information abou t th e ne w disease t o the natio n an d t o the world. Last , the outbrea k gav e th e peopl e o f Hong Kon g a chance t o se e how thei r society operated unde r intens e stress . The experienc e contribute d t o a sense o f gratitude an d communit y pride tha t resulted i n an unexpecte d show o f unit y o n 1 July 2003 .

The fac e o f th e ne w diseas e

SARS' place i n histor y is assured. I t was this century' s first majo r publi c health scare . The outbrea k ma y have give n th e worl d a tast e o f what i s yet t o come , a s virologist s continu e t o worr y abou t th e possibl e emergence o f a highly infectious diseas e that has the capacity to transmi t efficiently fro m perso n t o person. Due to modern ai r travel, new diseases can sprea d ver y quickl y aroun d th e globe , a s SAR S has shown . I n th e case o f SARS , th e worl d wa s luck y tha t th e infectivit y o f th e viru s wa s relatively low.

SARS reminded th e worl d tha t moder n medicin e ha s yet t o defea t infectious diseases , despite significant advances . Rising standards of living in many parts of the world mean tha t increasing numbers o f people ca n afford bette r foo d an d accommodation , leadin g t o highe r diseas e resistance an d improve d publi c hygiene . There hav e been man y publi c health successe s ove r th e pas t hundre d years . For example , smal l pox , once a majo r killer , ca n no w b e avoide d throug h vaccination . Othe r diseases like diphtheria can be cured using antitoxins, while plagues ca n be brough t unde r contro l b y preventativ e measure s suc h a s isolation , quarantine an d pes t control . I n man y part s o f th e world , th e sprea d o f cholera has been containe d by improving water supplies. Antibiotics ca n now b e use d t o trea t typhoid , enteri c fevers , syphili s an d pneumonia . The resul t ha s bee n a significan t dro p i n th e world' s deat h rate , du e largely t o bette r managemen t o f infectiou s diseases . Ye t SAR S wa s

Lessons Learned

worrying becaus e i t was a ne w diseas e tha t cam e fro m a virus tha t ha d the capacit y t o mutate , raisin g importan t question s abou t th e futur e evolution o f outbreak s an d th e developmen t o f cures .

It i s eas y t o focu s o n th e mechanica l aspec t o f diseas e preventio n and contro l i n term s o f developin g bette r diagnosti c test s an d findin g the righ t vaccin e an d ignor e th e mor e comple x underlyin g concerns . Though exceptiona l i n term s o f it s impac t an d eas e o f internationa l spread, SAR S i s onl y on e o f aroun d fift y internationall y importan t outbreaks in any given year, according to the World Health Organisatio n (WHO).1

Twenty year s ago , expert s warne d tha t th e intensiv e farmin g o f animals an d th e clos e proximit y betwee n human s an d animal s tha t i s prevalent i n sout h Chin a provide s "a n ecosyste m fo r th e interactio n o f viruses" (se e Chapte r 5) . Furthermore , th e way s i n whic h animal s ar e caught o r reare d an d slaughtere d i n thi s regio n ar e fa r fro m human e or healthy . Animal protection law s are often openl y flouted. Coope d u p in cage s o r tigh t spaces , animal s farme d fo r foo d ofte n develo p man y types of illnesses. In sout h China , th e wild animal trad e provide s exoti c dishes i n ever-large r quantitie s a s income level s increase . Wild animal s are reservoir s for al l types of viruses. The discover y of a possible linkag e between th e SARS-coronaviru s an d th e cive t cat and othe r wild animal s slowed consumptio n o f these specie s and le d t o a Chinese Governmen t ban o n th e trad e an d transportatio n o f wil d animal s i n Ma y 2003 . However, by July 2003, the ban was lifted. I t seems that the SARS outbreak slowed th e consumptio n o f exoti c animal s onl y temporarily .

Beyond intensive farming an d huntin g o f wild animals for food an d other uses , the degradatio n o f the natura l environmen t i n south China , as a resul t o f rapi d development , ha s resulte d i n widesprea d pollutio n of th e air , wate r an d soil . Pollutio n cause s ecologica l imbalance s tha t have a negative impact on public health. Living in polluted environment s weakens th e immun e syste m o f both human s an d animals , resultin g i n a highe r incidenc e o f sickness . Moreover , whe n huma n disease s ar e treated wit h stron g drug s suc h a s antibiotics , no t onl y d o viruse s buil d up resistanc e t o th e drug s ove r time, bu t als o th e body' s ow n defenc e mechanisms ma y become weakened .

Thus, SAR S represente d mor e tha n a medica l challenge . Publi c health i s intimatel y linke d wit h th e stat e o f th e natura l environment , which goe s beyon d improvin g hygiene . N o amoun t o f superficia l cleaning o f street s an d building s i s sufficien t t o revers e th e kin d o f

Christine Loh

ecological disturbance brough t on by massive development project s tha t clear forests , diver t rivers , chang e th e climat e o r poiso n th e lan d an d waters. T o ensur e a health y future , societ y ha s t o tak e a muc h mor e holistic approach tha t includes reassessing whether it s development pat h is sustainable o n a long-term basis . This is unfortunately somethin g tha t authorities in Hong Kong and Guangdong have yet to consider seriously .

Every hou r count s

In a n infectiou s diseas e outbreak , ever y hour counts , "a s the window of opportunity fo r preventin g death s an d furthe r sprea d close s quickly." 2

Once th e disease has affected healthcar e workers in significant number s and i s presen t i n th e genera l community , i t become s muc h harde r t o control. Government s an d healthcar e professional s therefor e nee d t o move quickl y t o contai n th e sprea d o f th e disease . SARS demonstrate d that respondin g t o a n outbrea k requires goo d communicatio n amon g key decision-makers s o tha t informatio n ca n b e amassed , analyse d an d acted upon . A n effectiv e respons e extend s beyon d providin g medica l care t o patient s an d ma y continu e lon g afte r th e diseas e itsel f ha s subsided. SAR S not onl y had a significant impac t o n medica l treatmen t and practice , it also created a substantial political challenge and possibl y even a lega l challeng e fo r th e authorities .

In th e cas e o f Hon g Kong , question s continu e t o b e raise d abou t the timin g and effectivenes s o f the government' s respons e t o SARS. For example, di d Hon g Kong' s healt h officials pa y attentio n t o a pres s statement issue d b y Guangdon g authoritie s o n 1 0 Februar y 2003 , acknowledging tha t there was an outbrea k o f atypical pneumonia acros s the borde r tha t ha d infecte d 30 5 peopl e an d cause d five deaths ? Th e report o f th e government-appointe d SAR S Expert Committe e release d on 2 Octobe r 200 3 note d tha t Hon g Kong' s Departmen t o f Healt h sought information abou t th e outbreak from Guangdon g authoritie s o n 10 February but that this request was ignored. Hong Kong then contacte d the Ministr y of Health i n Beijing. 3 I t is unclear what information Hon g Kong received from Beijin g but i t is clear that Hong Kong officials wer e not provide d wit h th e exper t repor t o n atypica l pneumoni a i n Guangdong (mentione d i n Chapter 9) give n to the mainland authoritie s on 2 3 January 2003 . Ha d Hon g Kon g receive d informatio n i n earl y February, man y lives could hav e been spared . While th e failure t o shar e

Lessons Learned

information openl y is a legacy of the mainland culture of official secrecy , it als o reflect s th e fac t tha t Hon g Kon g appear s t o hav e bee n totall y helpless when dealin g with mainlan d authorities .

Nevertheless, on 1 1 February, Hong Kong's Hospital Authority (HA ) and Departmen t o f Healt h di d tak e th e ste p o f settin g u p a joint tas k force, calle d th e Workin g Grou p o n Sever e Community-acquire d Pneumonia, t o identify pneumoni a case s in Hong Kong similar to thos e reported i n Guangdong. The H A is a statutory body that manages Hon g Kong's 4 3 publi c hospital s an d work s closel y wit h th e Departmen t o f Health. Thus, as early as February, health professionals were anticipatin g that th e diseas e coul d easil y ente r Hon g Kong , despit e Guangdong' s claim tha t th e situatio n acros s th e borde r wa s "unde r control. " Th e number o f dail y passenge r crossing s betwee n Hon g Kon g an d Guangdong i s i n th e regio n o f 250,00 0 t o 300,00 0 people . Describin g the work o f the Working Group , Directo r o f Health Dr . Margaret Cha n noted that : "...together with the Hospita l Authority [th e Department o f Health] examine d al l community-acquire d pneumoni a admitte d int o hospitals. We had t o find ou t about the origins of the infection, whethe r they were cause d b y germs, virus or flu... . A t that tim e what concerne d us mos t wa s influenza . I t wa s th e winte r pea k fo r flu." 4 Doctor s participating in the task force surveillanc e exercis e reported n o unusua l cases of flu o r pneumonia. 5 However , betwee n 1 2 and 2 1 February, th e pre-existing influenz a infectio n guideline s an d a speciall y prepare d information packag e entitled "Frequently Asked Questions" about Severe Community-acquired Pneumoni a wer e circulated t o al l public hospital s in Hon g Kong .

On 2 1 Februrary, Dr . Liu Jianlun, Hon g Kong' s index cas e patient , arrived i n Hon g Kon g fro m Guangdong . Piecin g togethe r th e data , researchers hav e conclude d tha t Dr . Liu , "patien t zero, " infecte d 1 2 people, who then infecte d man y more aroun d th e world within a matte r of days. Hong Kong's Metropole Hote l also became infamous a s the poin t of contact betwee n Li u and othe r hote l guest s who would subsequentl y become infected. By mid-May 2003, the WHO estimated that of the 8,000 -plus SARS cases worldwide at that time, more tha n 4,000 could be trace d back t o Liu' s two-da y stay at th e Metropol e Hotel .

When Li u was admitted t o the Kwong Wah Hospital on 2 2 February, he wa s already very sick. He tol d doctor s an d nurse s tha t h e ha d com e in contac t wit h patient s i n Guangdon g suspecte d t o hav e atypica l pneumonia, bu t though t tha t h e ha d recovered . A s hi s conditio n wa s

Christine Loh

poor, h e wa s put int o intensiv e car e i n a n isolatio n roo m immediately . His case was also promptly reported t o the HA as well as the Departmen t of Health . O n 2 8 February , Liu' s brother-in-la w wa s als o admitte d t o Kwong Wah Hospita l with th e sam e symptoms . While th e Repor t o f th e Hospital Authority Review Panel on th e SAR S Outbreak, release d o n 1 6 October 2003 , noted tha t the HA and the Department o f Health Working Group di d issu e information o n infectio n contro l t o al l hospitals, i t was critical of the limited effort s b y health authoritie s to alert other hospital s of the potentia l risk s of the disease . For example , while information o n infection contro l wa s provided t o infection contro l officer s i n th e for m of "Frequentl y Aske d Questions " an d poste d o n th e H A website , th e Review Panel found tha t the conten t o f informational material s and th e way in whic h the y wer e circulate d "faile d t o ge t th e attentio n of , an d thus warn , staf f abou t th e ris k o f infection." 6 Th e Pane l als o note d th e failure t o assembl e al l availabl e dat a "hel d b y a rang e o f peopl e insid e and outsid e th e H A int o a singl e picture," 7 an d recommende d tha t i n the even t o f an emergin g unknow n infectiou s disease , "an y indication s that i t i s infectiv e t o heathcar e worker s shoul d b e communicate d t o frontline staf f immediately." 8

According t o th e Revie w Panel, th e passivit y of health an d hospita l authorities was due t o the fact tha t "there was no strategy or contingenc y plan suitabl e fo r dealin g wit h a majo r diseas e outbreak," 9 an d n o "comprehensive, multi-agency strategy for disease prevention and contro l that put s th e healt h o f th e publi c first." 10 Th e lac k o f a clea r overal l leadership structur e als o raise d problems. 11

In th e rus h t o put th e ne w Principal Official s Accountabilit y Syste m (POAS) i n plac e b y 1 July 2002 , the Chie f Executive di d no t allo w tim e to clearl y demarcat e th e responsibilitie s o f a numbe r o f officia l posts . This resulte d i n som e overla p betwee n th e responsibilitie s o f th e Secretary fo r Health , Welfar e an d Foo d an d th e Directo r o f Health , leaving Hong Kong without the equivalen t o f a surgeon genera l o r chie f medical officer.12 I n its October 2003 report, the SARS Expert Committe e noted tha t there was an "imbalance between responsibility , authority an d accountability i n th e healt h system . Fo r example , [th e Secretary ] ha s accountability fo r th e healt h syste m a s a whole...bu t statutor y publi c health power s ar e veste d i n th e Directo r o f Health." 13 Mor e astut e members o f th e Legislativ e Counci l (LegCo ) ha d foresee n thi s typ e o f problem i n 200 2 whe n th e POA S wa s implemented , bu t th e Tun g administration chos e t o prioritis e spee d ove r clarit y o f th e leadershi p

Lessons Learned 24 1

structure. The confusion inheren t in the way the POAS was implemented was evident following th e "penn y stocks" incident i n 2002 . At that time , a review panel note d tha t th e specifi c responsibilitie s an d power s of th e relevant ministeria l post s were unclear. 14

Jurisdictional confusio n withi n th e syste m was compounded b y th e failure o f administrator s t o anticipat e th e publi c healt h implication s o f the initial outbreak at the Prince of Wales Hospital (PWH) . On 1 0 March, after 1 1 PWH staf f working in Ward 8 A became ill , doctors immediatel y closed th e war d t o admission s an d visitors . O n 1 1 March , hospita l administrators uphel d th e decisio n t o sto p patien t admission s t o War d 8A but began re-admittin g visitors wearing protective gea r because the y did not want to cause anxiety among patients. Between 1 1 and 1 9 March, PWH managemen t increase d protectiv e measure s incrementally , first cordoning of f th e floo r wher e War d 8 A wa s situate d an d eventuall y closing its accident an d emergenc y departmen t completely . During thi s ten-day period, the WHO issued two global alerts about the new disease. Despite th e finding o f th e SAR S Exper t Committe e tha t th e variou s decisions o n th e managemen t o f th e diseas e were mad e "collectivel y a t meetings" attende d b y bot h administrativ e an d senio r healthcar e professionals, controversy over the series of decisions that led to a gradua l approach i n closing PWH never subsided becaus e o f the numerou s an d continued objection s from frontlin e healthcar e workers and th e medica l faculty a t th e Chines e Universit y o f Hon g Kon g (CUHK) , whic h use s PWH a s it s teachin g facility. 15

The H A Review Panel was much mor e critica l o f decision-making a t PWH than the SARS Expert Committee. In its report, the Panel describe d the reopenin g o f Ward 8 A to visitor s o n 1 1 Marc h a s " a ste p dow n i n the stric t infectio n contro l measures " introduce d o n th e previou s day . Despite th e fac t tha t PW H administrator s pu t stricte r precaution s fo r visitors i n place , th e decisio n t o reope n th e war d "potentiall y expose d [visitors], an d henc e th e wide r communit y t o infection." 16 Th e Pane l also note d tha t CUH K bega n callin g fo r th e closur e o f PW H o n 1 2 March, "bu t because there was no effective mechanis m fo r ensurin g tha t the ke y stakeholder s coul d properl y conside r th e benefit s an d consequences o f such a complex decision , the n b y default th e hospita l was neve r closed." 17 B y contrast , th e SAR S Exper t Committe e merel y stated tha t "ther e wa s a lack o f clarit y in th e rol e o f university staf f i n a hospital outbreak situation an d failures o f communication betwee n HA , DH [Departmen t o f Health ] an d th e university." 18 Th e pric e pai d fo r

242 Christine Loh

this "lac k o f clarity " was substantial: a tota l o f 23 9 people wer e infecte d during th e PW H outbreak .

It should als o be noted tha t by the en d o f February, virologists suc h as Professo r Mali k Peiri s an d hi s colleague s a t th e Universit y o f Hon g Kong (HKU) , ha d alread y begu n t o believ e tha t the y might b e dealin g with a ne w virus. 19 Indeed , o n 7 March, th e HA' s own Working Grou p reported t o its board (whic h included to p government officials ) tha t th e atypical pneumoni a case s migh t hav e bee n cause d b y a n "unusua l virus."20 Thus , senio r managemen t a t th e H A an d th e Departmen t o f Health kne w tha t ther e wa s a strong possibilit y tha t th e diseas e was no t just a variant o f winte r flu an d tha t whateve r it s identity , it s impac t o n patients wa s serious .

The HA Review Panel made an interesting observation o n thi s point :

Looking back , informatio n abou t th e viru s an d th e potentia l havo c i t

could cause was scant prior to early February . Those privy to informatio n

were reluctan t t o shar e it , an d wha t wa s share d ofte n onl y ha d th e

status o f rumour . I t stil l remain s unclea r wha t wa s known , b y who m

and when . I t wa s clea r however , tha t somethin g unusua l wa s

happening.21

By 15 March, the day the WHO named th e new disease "severe acute respiratory syndrome " o r "SARS, " i t wa s impossibl e fo r Hon g Kon g authorities t o ignore th e exten t o f the outbreak , which ha d no w sprea d to man y countrie s aroun d th e worl d an d resulte d i n th e infectio n o f more tha n 15 0 people. Despite thes e facts, health authoritie s continue d to deny the severity of the outbreak, prompting Professor Sydne y Chung, Dean o f the Faculty of Medicine a t CUHK, to go public o n 1 7 March t o contradict statements by the Secretary of Health, Welfare an d Food an d the Directo r o f Healt h tha t th e diseas e ha d no t sprea d t o th e genera l community i n Hon g Kong . Th e SAR S Exper t Committe e partiall y exonerated th e Secretar y for thi s lapse b y saying tha t hi s statement was technically correct at the time it was made but noting that he could hav e used " a more pruden t phrase " — which sound s mor e lik e an apology. 22

By 21 March , virologist s i n Hon g Kon g kne w tha t th e causativ e agen t for th e diseas e wa s a coronavirus . Yet it was only o n 2 4 March tha t th e authorities finall y create d a specia l inter-departmenta l tas k forc e t o coordinate th e fight against SARS; only on 27 March tha t the governmen t advised peopl e t o quarantin e themselve s fo r te n day s if the y had com e

Lessons Learned

into contact with SARS patients; and i t was 31 March when the y decide d to isolat e Bloc k E o f Amo y Gardens , te n day s afte r larg e number s o f residents ha d begu n t o fal l ill . Th e SAR S Exper t Commit te e acknowledged "ther e wer e significan t shortcoming s o f syste m performance durin g the early days of the epidemic" but was not prepare d to find anyon e a t fault. 23

From th e community' s poin t o f view , governmen t prevaricatio n resulted i n th e los s of valuable opportunitie s t o minimise th e sprea d o f SARS. The government even mishandled th e setting up of a SARS Expert Committee t o revie w th e governmen t managemen t o f th e SAR S crisis . The Committe e receive d ba d pres s from th e start , after Chie f Executiv e Tung Chee-hw a appointe d th e Secretar y fo r Health , Welfar e an d Foo d Dr. E K Yeo h a s it s head . Hi s reason s fo r doin g s o seeme d incomprehensible becaus e Dr. Yeoh's own decisions and conduc t durin g the outbrea k ha d t o b e include d i n th e review . Althoug h th e Chie f Executive finally replaced Dr . Yeoh as head o f the Committee o n 1 7 July, the damage t o the government' s credibilit y had already been done . This is wh y th e publi c continue s t o questio n th e Committee' s refusa l t o apportion blam e t o ke y decision-makers . It s explanatio n tha t i t sough t to avoid the "hazard s o f retrospective judgement"24 i s suspect because i t would the n mak e i t har d t o hol d official s accountabl e fo r an y issue o r event the y d o no t foresee .

In a further displa y of public dissatisfaction, mor e tha n hal f a million Hong Kon g peopl e too k t o th e street s o n 1 July 2003 . Whil e th e immediate caus e o f th e protes t wa s th e Articl e 2 3 nationa l securit y legislation, i t wa s als o clea r tha t Hon g Kon g peopl e ha d a litan y o f complaints regarding the performance o f the Tung administration sinc e 1997. His insistence on appointing an implicated party to head an inquir y is only on e illustratio n o f hi s governin g style , and raise d doubt s abou t the sincerit y an d valu e o f th e evaluatio n process . I n thi s light , on e o f the loca l member s o f th e SAR S Exper t Committee , Dr . Rosi e Young , made a n extraordinar y statemen t o n televisio n o n 4 October when sh e referred t o th e handlin g o f SAR S victims: "Th e governmen t wa s ver y indifferent an d di d no t hav e enoug h car e fo r th e people . I gues s th e whole governmen t shoul d learn." 25

On 2 9 Octobe r 2003 , LegC o vote d t o us e th e power s grante d t o i t under th e Powe r an d Privilege s Ordinanc e t o conduc t a n inquir y int o how the Hong Kong authorities handled SARS . Both th e LegCo proces s and th e H A Revie w Pane l repor t ma y hel p t o addres s publi c

Christine Loh

dissatisfaction wit h th e SAR S Expert Committe e report , bu t clearl y th e preferable situatio n woul d hav e bee n fo r th e Chie f Executiv e t o appointment an independent public inquiry team whose credentials were beyond disput e a t the outset . Furthermore, the SARS crisis may give rise to man y privat e la w questions i n th e month s t o come . Ther e ar e lega l issues t o b e addresse d concernin g would-b e plaintiff s an d potentia l defendants.26 The government has committed itsel f to a range of ex gratia payments t o certai n relative s o f healthcar e worker s wh o die d o f SARS. For example , i n thre e cases , th e familie s o f th e decease d wil l receiv e HK$3 millio n i n assistanc e payments. 27 Nevertheless , frontlin e medica l staff, familie s o f those who died from SARS , those who contracted SAR S in hospital s an d th e resident s o f Amoy Garden s ma y stil l bring lawsuit s against th e government .

In term s o f timeliness, what was truly impressive was the work of th e WHO's Global Outbreak Alert Response Network (GOARN) , as discussed in Chapte r 9 , and th e networ k o f 1 3 research laboratorie s studyin g th e SARS virus tha t was convened b y Dr. Klaus Stohr a t the WHO's Genev a headquar te r s (se e Chapte r 4) . Wit h th e hel p o f moder n telecommunications an d i n a spiri t o f collaboratio n tha t enable d professional rivalrie s to be put aside in the interests of the greate r good , experts were abl e t o mak e impressiv e stride s in understandin g th e ne w virus i n a relativel y shor t perio d o f time . Whil e muc h mor e researc h remains t o b e done , th e effor t b y internationa l institution s t o wor k together demonstrate d th e spee d wit h whic h informatio n ca n b e transmitted worldwide , contributin g t o globa l knowledge . I t was also a reminder tha t expertis e an d technolog y ar e availabl e i f th e decision -makers responsible for public health understand ho w to use them. When it is possible t o coordinate s o many parties in so many parts of the world to wor k t o thei r highes t efficiency , i t i s harde r t o excus e poo r communication an d decision-makin g withi n on e hospital , suc h a s th e PWH, or between two government bodies, such as the HA and th e Heath , Welfare an d Foo d Bureau .

A furthe r aspec t o f timelines s i s th e importanc e o f informatio n management an d disseminatio n i n a highl y wire d world . Moder n information technolog y enable s th e rapi d disseminatio n o f legitimat e information, bu t i t als o offer s a wa y t o publicis e rumour s an d misinformation tha t ca n lea d t o widesprea d panic . Despit e clinica l uncertainty about the nature an d identify o f the new disease at the initia l stage o f th e outbrea k i n Hon g Kong , a n importan t lesso n fo r

Lessons Learned

governments an d publi c institution s i s tha t i t i s thei r responsibilit y t o put out timely information o n matters of public concern, otherwise the y may los e th e opportunit y t o addres s publi c confusio n an d fears . Thi s became apparen t o n Apri l Fool' s Da y when a teenage r i n Hon g Kon g used th e Interne t t o mak e a false announcemen t tha t Hon g Kon g ha d been declare d a n "infecte d port " (se e Chapter 13) . Again, failure b y the authorities t o releas e informatio n abou t th e sprea d o f SARS within th e community le d fou r informatio n technolog y engineer s t o tak e matter s into thei r own hands by setting up th e website www.sosick.org to provide information t o th e publi c o n affecte d area s an d buildings . Th e lesso n for th e authoritie s i s tha t failur e t o tak e th e initiativ e ca n resul t i n a "lose-lose" situation where other s pu t ou t incorrect o r false informatio n or citizen s en d u p doin g thei r jobs fo r them . Eithe r scenari o create s perceptions o f officia l ineptitude . Furthermore , Chapte r 6 provide s a reminder tha t there i s still much usefu l informatio n abou t the outbrea k that th e H A an d th e Departmen t o f Healt h hav e no t release d t o th e public. The message i s clear: in fostering a true knowledge-based society , the authoritie s pla y a critica l rol e i n ho w the y promot e acces s t o information.

Mainland Chin a

The initia l response o f mainland authoritie s t o the emergenc e o f a new infectious diseas e i n Guangdon g wa s t o downpla y th e situatio n an d attempt t o contro l information . Th e lesso n fo r Chines e leader s i s tha t stonewalling no longer works well in a wired world. Indeed, in th e even t of a future outbreak , th e bes t strategy is to be transparen t abou t what is happening, especiall y in suc h a vast country. National leaders in Beijin g need t o hav e timel y informatio n abou t loca l event s i n orde r t o mak e the right decisions . At th e tim e o f th e outbreak , nationa l leader s wer e so preoccupied wit h the politics of the transitio n i n leadership tha t the y did no t se e the stor m o n th e horizo n eve n though , a s Chapter 9 point s out, i t seem s inconceivabl e tha t to p leve l official s wer e unawar e tha t something unusual was occurring. The Chines e Governmen t should no t lose sigh t o f th e fac t tha t i t los t a valuabl e opportunit y t o infor m th e nation abou t SARS at the National People's Congress meetings in Marc h 2003, an occasio n tha t coul d hav e been use d t o provide informatio n t o the entir e countr y o n preventativ e an d contro l measures . Th e pric e

Christine Loh

China ha d t o pa y fo r it s oversigh t wa s substantia l — man y death s an d loss o f credibilit y worldwide .

Mainland Chin a shoul d hav e bee n th e epicentr e o f th e SAR S outbreak a s th e diseas e originate d an d affecte d th e larges t numbe r o f people there , no t i n Hon g Kong . As a resul t o f th e mainland' s refusa l to acknowledge th e exten t o f th e outbrea k i n Chin a u p unti l mid-Apri l 2003, Hong Kong , which ha s a free flo w o f information, becam e th e d e facto epicentre .

As a Specia l Administrative Regio n (SAR ) o f the People' s Republi c of China , Hon g Kon g operate s unde r th e "on e country , tw o systems " principle. Ther e ar e man y aspect s o f lif e i n Hon g Kon g tha t ar e fundamentally differen t fro m practice s o n th e Mainland . Hon g Kon g residents enjoy freedom o f expression and a free media , neither o f which is available t o Chines e citizen s on th e mainland . Whe n SAR S hit Hon g Kong in February, th e loca l media pursued th e stor y relentlessly once i t realised tha t SAR S was an importan t issue . In fact , report s comin g ou t of Hong Kon g about th e situation i n south Chin a enabled th e WHO t o press mainlan d Chin a fo r mor e informatio n o n wha t wa s happenin g there. N o doubt , additiona l pressur e wa s supplie d i n th e for m o f diplomatic message s relayed t o Beijing from othe r nation s — who were also operatin g o n th e basi s of information reporte d b y the Hon g Kon g media. Had i t not been fo r Hon g Kong's separate "system, " it might well have take n Chin a eve n longe r t o addres s SARS . At leas t i n th e cas e o f SARS, th e "on e country , tw o systems " principl e ma y b e viewe d a s a blessing in disguise for both mainland Chin a and th e global community .

Another differenc e betwee n Hon g Kon g an d mainlan d Chin a concerns th e rol e o f th e Chines e Communis t Party , whic h dominate s the mainlan d government . O n th e mainland , th e Part y an d therefor e the governmen t pla y a ke y leadershi p rol e i n numerou s aspect s o f Chinese life , includin g th e conduc t o f healthcar e professionals . Contrasting the role of Dr. Jiang Yanyong in Beijing and Professor Sydne y Chung in Hon g Kong , it is clear while both me n fel t tha t they must pu t evidence and professionalism ahea d o f official objectives , Dr. Jiang face d greater obstacle s in finding a way to ge t out th e messag e tha t mainlan d officials wer e no t admittin g t o th e hundred s o f SARS cases in Beijing' s military hospitals. Although Jiang became a folk hero for telling the truth , he wa s eventuall y silence d b y th e authorities . B y contrast , medica l professionals i n Hon g Kong , lik e Professo r Chung , d o no t regar d th e government a s a superior . The y operat e independentl y fro m th e

Lessons Learned

authorities i n th e exercis e o f thei r professiona l judgment . Professo r Chung always chose his words carefully when speaking in public, as would be expecte d fro m a perso n o f hi s standing .

The SAR S crisi s showe d ho w importan t i t i s t o ensur e tha t professionals operat e independentl y o f governmen t an d ca n spea k ou t to maintai n standard s an d ensur e tha t officia l statement s ar e base d o n actual evidence. On th e mainland, th e Community Party has yet to allow truly independent groups to function. Ther e is no shortage of competent , dedicated an d courageou s professional s o n th e mainland , bu t the y lack the politica l environmen t tha t permit s tru e independenc e — a basi c requirement fo r tru e professionalism . I t remains unclea r ho w the Part y and th e Chines e Governmen t view Dr. Jiang today. It is to be hoped tha t the fac t tha t Jiang an d othe r mainlan d physician s di d spea k ou t abou t the officia l cover-u p durin g th e outbrea k i s a sign tha t thing s coul d b e changing for th e better . Ther e i s no doub t abou t ho w Professor Chun g is regarded — fo r Hon g Kon g peopl e h e i s a hero .

The cultur e o f officia l secrec y die s har d eve n a t a momen t whe n Hong Kong, Guangdong and Macau have agreed to be more transparen t in sharin g information . Whil e th e respectiv e authoritie s hav e agreed t o cross-border reportin g o n eigh t disease s and informatio n exchang e o n all notifiabl e disease s i n thei r ow n jurisdictions, thi s information i s stil l treated a s confidentia l an d ha s no t bee n mad e availabl e t o th e public . One importan t concessio n i s that medical professionals ca n hav e acces s to th e informatio n fo r researc h purposes , althoug h i t remain s unclea r how th e issu e wil l be handle d i n publishin g researc h findings.

Official abhorrenc e o f openness rubs in other ways as well. The first example i s with regar d t o scientifi c research . A s th e Communis t Part y and mainlan d governmen t denie d th e tru e exten t o f th e outbrea k u p until 1 7 April, when the Politburo changed its tune by calling for accurat e reporting, mainlan d scientist s were denied th e opportunit y t o carry ou t scientific studie s o f th e ne w virus a t th e firs t opportunity . Th e officia l cover-up therefore als o prevented mainlan d scientist s from participatin g in groundbreakin g research . Again , scientist s i n on e tin y corner o f th e country — Hong Kon g — came t o th e forefron t i n th e investigatio n o f the diseas e and eventuall y won internationa l recognitio n fo r thei r work in identifyin g th e SARS-coronavirus .

The secon d exampl e i s th e lac k o f trus t i n officia l information . Chapter 9 notes tha t Shangha i wisely took earl y precautions t o preven t the sprea d o f SARS ; this, couple d wit h som e goo d luck , wa s critica l i n

Christine Loh

preventing a n outbrea k o n th e scal e o f tha t experienced b y other citie s in China and around th e world. Yet doubts about the accuracy of Chinese information persist . Lastly, even though governmen t health ministers an d the mayo r o f Beijin g wer e fired a s a sig n tha t Chines e leader s wante d accountability, i t is doubtful tha t any internal review reports will be mad e public. I t seem s likel y tha t th e enquirie s o n Hon g Kong' s handlin g o f SARS will be th e onl y report s mad e publicl y availabl e i n China .

A renewed sens e o f dignit y

Hong Kong people appeared t o have lost their self-confidence sinc e 199 7 as th e econom y softened . Perhap s eve n mor e significan t i n th e mind s of Hong Kong people has been thei r adjustment fro m subject s o f a small British colon y t o citizen s o f a larg e countr y experiencin g rapi d modernisation. I t ha s undoubtedl y bee n difficul t fo r Hon g Kon g t o redefine itsel f withi n th e contex t o f a n evolvin g People' s Republi c o f China. As the mainland continues to advance economically, Hong Kong' s traditional rol e a s a gateway t o Chin a seem s t o hav e becom e obsolete .

Chapter 1 1 provides a usefu l perspectiv e o n Hon g Kong' s curren t economic situation . Hon g Kon g remain s highl y competitive , no t necessarily i n term s o f cos t (althoug h cost s ar e no w mor e competitiv e than before), but certainly in terms of its social "software," which include s its managemen t capacity , professionalism , opennes s an d transparency , free media , persona l libertie s an d rul e o f law . Th e SAR S outbrea k brought ou t man y o f thes e strengths , includin g th e abilit y o f th e community t o wor k togethe r i n th e fac e o f toug h times . Hon g Kon g people sa w how well many aspects of their society worked. Even in term s of the government , th e publi c saw that despit e poo r crisi s managemen t at the earl y stages of the outbreak , onc e th e severity of the situation was fully understoo d an d acknowledged , soli d advance s were quickl y mad e in many areas. For example, Hong Kong developed an impressive contac t tracing system for people who had come into contact with SARS patients. Hospitals an d healthcar e worker s revise d infectio n contro l procedures . These innovations will prove very useful i n case of future outbreaks , bot h in Hon g Kon g and elsewhere . The calibr e o f Hong Kong' s respons e t o SARS allowed th e peopl e o f Hong Kon g t o fee l goo d abou t themselve s and abou t thei r community .

Between Marc h an d Ma y 2003 , Hon g Kon g droppe d almos t

Lessons Learned

everything else to focus on fighting SARS. As the outbreak waned, peopl e began t o pick up thei r live s again where the y had lef t off . On e pressin g issue was th e nationa l securit y legislation propose d b y the governmen t in complianc e wit h Article 2 3 of the Basi c Law, Hong Kong' s post-199 7 constitution. Th e articl e require s Hon g Kong on it s own t o pass laws to prohibit treason , secession, subversion, sedition, theft o f state secrets an d links betwee n loca l an d oversea s politica l bodies . Th e Tun g administration hope d t o pas s th e legislatio n o n 9 July 2003 . As soon a s public attention was transferred awa y from SAR S to Article 23, objections to th e conten t o f th e draf t legislatio n mounte d da y b y day . Non -governmental group s joined force s t o organise a demonstration agains t the draf t bil l o n 1 July 200 3 — a publi c holida y t o commemorat e th e return o f Hon g Kon g t o Chines e rul e i n 1997 . In th e wee k leadin g u p to the holiday , it became clea r that a large number o f people were likely to join th e demonstrations . Medi a report s suggeste d tha t ther e woul d be ove r 100,00 0 protesters .

On th e day, over 500,000 people showed up to participate in a march that was entirely peaceful an d yet was a powerful expressio n o f the dee p discontent o f th e communit y wit h th e Tun g administration. 28 Amon g the protester s wer e healthcar e worker s wh o wante d t o ven t thei r frustrations regardin g the government handling of SARS. As noted above , the Chie f Executive's subsequent decision t o remove Dr. EKYeoh a s the head o f th e SAR S Exper t Committe e wa s a respons e t o publi c dissatisfaction. Fur thermore , i n th e sam e wa y tha t heal thcar e professionals becam e loca l heroe s durin g th e SAR S outbreak , Hon g Kong's lega l professional s playe d a pivotal rol e i n takin g a vocal stanc e against Article 23 and helping the public to understand th e complexitie s of the legislation. This was another confirmation o f the strength o f Hong Kong's social software an d th e importance o f independent commentar y by professionals fo r th e community as a whole. Post-1 July, Hong Kong' s interest in politics seems to have been awakened . The call for democrati c reform i s unambiguous .

SARS presented a n unprecedented challeng e for Hong Kong. Facing and overcomin g thi s challeng e allowe d Hon g Kon g peopl e t o fee l a s though the y had regaine d thei r dignity . The event s of 1 July also force d leaders i n Beijin g t o reasses s Hon g Kon g an d conside r th e possibilit y that ther e wer e man y aspect s o f it s developmen t tha t the y di d no t adequately understand. The res t of the world, which was close to writing off Hon g Kon g a s a has-bee n becaus e o f SAR S and Hon g Kong' s sof t

250 Christine Loh

economic performanc e agains t rapid advance s on th e mainland , bega n to reasses s Hong Kong' s importance a s well. While th e stake s for Hon g Kong ar e high , i t i s clea r tha t i t ha s th e capacit y t o pus h fo r change s that wil l hav e reverberation s o n th e mainland . Thi s proces s o f chang e could yiel d positiv e result s i f the protagonist s kee p a coo l head .

NOTES

CHAPTER 2

1. K.W . Tsang , P.L . Ho , G . Ooi , e t al. , A cluste r o f case s o f sever e acut e respiratory syndrom e i n Hon g Kong , New England Journal of Medicine 2003; 345: 1977-85 ; S.M . Poutanen , D.E . Low , B. Henry, e t al. , Identificatio n o f severe acute respiratory syndrome in Canada, New England Journal of Medicine 2003; 348: 1953-66; N. Lee, D. Hui, A.Wu, et al., A major outbrea k o f severe acute respirator y syndrom e i n Hon g Kong , New England Journal of Medicine 2003; 248: 1986-94; and CM . Booth , L.M. Matukas, G.A. Tomlinson, e t al. , Clinical features an d short-ter m outcome s o f 14 4 patients with SARS in th e Greater Toronto Area, Journal of the American Medical Association 7 May 2003, http://jama.ama-assn.org/cgi/content/fulI/289.21.lOC30885vI.

2. Th e repor t of the Hong Kong Hospital Authority Review Panel on th e SARS outbreak, release d t o th e publi c o n 1 6 October 2003 , als o provide s a very useful summar y of events and facts . See Section IV: A chronological overvie w of the outbrea k o f SARS in Hon g Kong , and Sectio n V: The detaile d facts . Report of the Hospital Authority Review Panel on the SARS Outbreak, Hospita l Authority, Hon g Kong , Septembe r 2003 .

3. C.C . Luk, Chief Executive, Kwong Wah Hospital, "Index patient," South China Morning Post 29 May 2003 , Lette r t o th e Editor .

4. N . Lee, D. Hui, A. Wu, e t al. , A major outbrea k o f severe acut e respirator y syndrome i n Hon g Kong , New England Journal of Medicine 2003; 348: 1986-94.

5. SAR S Exper t Committee , SARS in Hong Kong: From Experience to Action, 2 October 2003 , pp . 23-35 .

6. Ell a Lee, "Waging war on a n unknown enemy, " South China Morning Post 26 March 2003 , p . A l l .

7. Se e endnot e 5 . 8. Se e endnot e 5 .

251

Notes to pages 23-2 7

9. Worl d Healt h Organisation , Firs t dat a o n stabilit y an d resistanc e o f SAR S coronavirus compiled by members o f WHP laboratory network, 4 May 2003, www.who.int/csr/sars/survival_2003_05_04/en/index/html.

10. Depar tmen t o f Health , HKSA R Government , Mai n finding s o f a n investigation int o th e outbrea k o f Sever e Acut e Respirator y Syndrom e a t Amoy Gardens , 1 7 April 2003 , www . i nfo.gov. hk/dh.

11. Se e endnot e 1 . 12. K.T . Wong , G.E.A . Frazer , D.S.C . Hui , e t al. , Sever e acut e respirator y

syndrome: Radiographi c appearance s an d patter n o f progressio n i n 13 8 patients, Radiology August 2003 , 228(2) : 401-6 an d N . L. Muller , G. C Ooi , P.L. Khong, N. Sawas, Severe acute respiratory syndrome: Radiographic an d CT findings , American Journal of Roentgenology 2003 (i n press) .

13. K.W . Tsang , P.L . Ho , G . Ooi , e t al. , A cluste r o f case s o f sever e acut e respiratory syndrom e i n Hon g Kong , New England Journal of Medicine 2003; 345: 1977-85 .

14. Hospita l Authorit y (Hon g Kong) , Informatio n o n managemen t o f SARS : Case definition , 3 0 April 2003 , www.ha.org.hk/sars/sars_index_e.html .

15. Worl d Health Organisation , Cas e definition fo r surveillanc e o f severe acut e respiratory syndrom e (SARS) , 5 Ma y 2003 , www.who.int/csr/sars / casedefinition/en.

16. J.S.M . Peiris , CM. Chu , V.C.C. Cheng, e t al. , Clinical progressio n an d vira l load i n a community outbrea k o f coronavirus-associated SAR S pneumonia : A prospectiv e study , Lancet 2003 ; 361 : 1767-72 ; an d Worl d Healt h Organisation, Us e o f laborator y method s fo r SAR S diagnosis, 5 May 2003 , www.who.int.csr.sars.labmethods/en.

17. Worl d Health Organisation , Use of laboratory methods for SAR S diagnosis, 5 Ma y 2003 , www.who.int.csr.sars.Iabmethods/en/ ; an d Worl d Healt h Organisation, Recommendation s fo r laboratorie s testin g b y PC R fo r presence o f SAR S coronavirus-RNA , 1 3 Ma y 2003 , www.who/int/csr / coronarecommendations/en.

18. J.S.M . Peiris , CM. Chu , V.C.C Cheng , e t al. , Clinical progressio n an d vira l load i n a community outbrea k o f coronavirus-associated SAR S pneumonia : A prospectiv e study , Lancet 2003 ; 361 : 1767-72 ; an d Worl d Healt h Organisation, Recommendation s fo r laboratorie s testin g b y PC R fo r presence o f SAR S coronavirus-RNA , 1 3 Ma y 2003 , www.who/int/csr / coronarecommendations/en.

19. W . Ho , Guidelin e o n managemen t o f sever e acut e respirator y syndrom e (SARS), Lancet 2003; 361: 1313-5.

20. L.K.Y . So , A.C.W . La u , L.Y. C Yam , e t al. , Developmen t o f a standar d treatment protoco l for sever e acute respiratory syndrome, Lancet 2003; 361: 1615.

21. J . Gerberding , Lac k o f i n vitr o activitie s o f Ribaviri n agains t coronavirus , Centres fo r Diseas e Contro l an d Prevention , Pres s briefing , 2 2 April 2003 .

Notes to pages 28-46

22. W.K . Lam , K.W . Tsang , C Ooi , M . Ip , M . Chan-Yeung , Sever e acut e respiratory syndrome , i n Respiratory Disease: An Asian Perspective, edite d b y M.S. Ip , M . Chan-Yeung, N.S . Zhong, W.K . Lam . Hon g Kong : Hon g Kon g University Pres s 2004 .

23. J.S.M . Peiris , CM. Chu , V.C.C. Cheng, e t al. , Clinical progression an d vira l load i n a community outbrea k o f coronavirus-associated SAR S pneumonia : A prospective study , Lancet 2003; 361 : 1767-72.

24. K.L.E . Hon , CW . Leung , W.T.F . Cheng , e t al. , Clinica l presentation s an d outcome o f severe acute respiratory syndrome in children, Lancet 2003; 361: 1701-3.

25. CA . Donnelly, A.C. Ghani, CM. Leung , et al., Epidemiological determinant s of sprea d o f causa l agen t o f sever e acut e respirator y syndrom e i n Hon g Kong, Lancet 2003; 361: 1773-8.

26. Departmen t o f Health . Health , Welfare 8c Food Bureau , SAR S Bulletin, 3 0 May 2003 , www.info.gov.hk/info/infection-c.htm .

27. Ibid . 28. Se e endnot e 5 .

CHAPTER 4

1. Mat t Pottinger , Elen a Cherney , Gauta m Nai l an d Michae l Waldholz , "Ho w a globa l effor t identifie d SAR S virus i n a matte r o f weeks, " The Wall Street Journal 1 6 April 2003 .

2. Davi d Heymann, Executive Director, Communicable Diseases , World Healt h Organisation, from a transcript of a conference cal l on 8 April 2003 in CLSA Speaker Series , SARS — Hype from Reality, published b y CLS A Emergin g Markets. Se e als o Chri s Taylor , "I n China , i t seem s th e 'bi g one ' i s yet t o come," South China Morning Post 11 May 2003, p . 4 .

3. Worl d Healt h Organisation , Sever e acut e respirator y syndrom e (SARS) : Status of th e outbrea k an d lesson s for th e immediat e future , 2 0 May 2003 .

4. Se e endnote 2 . The father, a 33-year-old man, and his nine-year-old son were admitted t o hospita l o n 1 1 and 1 2 February respectively . Th e mothe r wa s admitted on 1 3 February. The father die d but the son and mother recovered . The famil y als o ha d a secon d daughte r wh o remaine d asymptomati c throughout.

5. Se e endnote s 3 and 4 . 6. Se e endnot e 1 . 7. Se e endnot e 3 . 8. Se e endnot e 1 . 9. D . Normile , U p clos e an d persona l wit h SARS , Science 2003 ; 300 : 886-7 ,

www.sciencemag.org. 10. Worl d Health Organisatio n Multipl e Collaborative Network for Severe Acute

Respiratory Syndrom e (SARS ) Diagnosis , A multipl e collaboratio n t o

Notes to pages 47-51

investigate th e caus e o f sever e acut e respirator y syndrome , Lancet 2003; 361 : 1730-3.

11. J.S.M . Peiris , S.T . Lai , L.L.M . Poon , e t al. , Coronaviru s a s a possibl e caus e of sever e acut e respirator y syndrome , Lancet 2003 ; 361 : 1319-25 .

12. Mar y Ann Benitez , T h e struggl e t o profil e a killer , South China Morning Post 25 J u ne 2003 , p . A14 .

13. T.G . Ksiazek , D . E r d m a n , C S . Goldsmi th , e t al. , A nove l coronavi ru s associated wit h sever e acut e respirator y syndrome , New England Journal of Medicine 2003 ; 348 : 1953-66 ; an d C Drosten , S . Gun the r S , W . Preiser , e t al., Identif icat io n o f a nove l coronaviru s i n pa t ient s wit h sever e acu t e respiratory syndrome , New England Journal of Medicine 2003 ; 348 : 1967-76 .

14. Se e e n d n o t e 1 . 15. Lawrenc e K Altman , "Experiment s o n monkey s zer o i n o n SAR S cause, "

New York Times 1 6 Apri l 2003 . 16. Koch' s Postulate s are :

(a) Th e organis m ha s t o b e isolate d fro m disease d tissue s o f th e patient.

(b) Th e organis m ca n induce th e sam e disease in another individua l or a clos e species .

(c) Th e sam e organis m ca n b e isolate d agai n fro m th e infecte d individual o r a clos e species .

17. K.V . Holmes , SARS-associate d coronavirus , New England Journal of Medicine 2003; 348 : 1848-1951 .

18. Se e endno t e 1 . 19. Mar y Ann Benitez , "SAR S study puts cive t cat s back i n th e dock, " South China

Morning Post 5 Septembe r 2003 , fron t page . 20. Ibid . 21 . E.G . Brow n an d J.A . Tetro , Comparativ e analysi s o f th e SARS-coronaviru s

genome: A goo d star t t o a lon g journey, Lancet 2003 ; 361 : 1756-7 . 22. M . E n s e r i m k , C a l l i n g al l c o r o n a v i r o l o g i s t s , Science 2 0 0 3 ; 300 : 4 1 3 ,

www.sciencemag.org.

23. Center s fo r Diseas e Contro l an d Prevention , CD C La b sequence s g e n o m e of ne w coronavirus , 2003 , www.cdc.gov/od/oc/media/pressrel/r030414.htm ;

P.A. Rota , M.S . Oberste , S.S . Monroe , e t al. , Characterizatio n o f a nove l coronavirus associate d wit h sever e acut e respirator y syndrome , Science 2003; 300: 1394-9 ; M.A . Marra , S.J.M . Jones , C.R . Astell , e t al. , T h e g e n o m e sequence o f th e SARS-associate d coronavirus , Science 2003 ; 300 : 1399-404 ; a n d YJ . Ruan , C L . Wei , A.I . Ee , e t al. , Comparativ e full-lengt h g e n o m e sequence analysi s o f 1 4 SAR S coronaviru s isolate s an d c o m m o n mutat ion s associated wit h putativ e origin s o f infection , Lancet 2 4 Ma y 2003 ; 36 1 (9371): 1779-85.

Notes to pages 51-66

24. Se e endnot e 12 . 25. Se e endnot e 21 . 26. Se e endnot e 12 . 27. M . Enserimk, Clue s t o th e anima l origin s o f SARS, Science 2003; 300 : 1351,

www.sciencemag.org. 28. Rober t J. Saiget , SARS antibodies found i n wild animal traders in Souther n

China, Agenc e France-Press , 2 5 May 2003 . 29. Ro b Stein , "Tes t result s revea l a toug h virus, " The Standard 5 May 2003 , p .

B6. 30. Worl d Healt h Organisation , Firs t dat a o n stabilit y an d resistanc e o f SARS-

coronavirus compile d b y member s o f WH O laborator y network , www.who.int/csr/sars/survival_2003_05_04/en/index.htmi, 4 May 2003 .

31. Agencies , Josephine M a and Mar y Ann Benitez , "SARS probe wil l focus o n laboratories," South China Morning Post 10 September 2003 , fron t page .

32. Staf f reporters , "SAR S labs tighten up afte r Lio n Cit y case," The Standard 11 September 2003 , p . B4.

33. Worl d Healt h Organisatio n Update , Wha t happen s i f SAR S returns ? www.who.int/csr/sars/survival_2003_06_26/en/index.html, 2 6 June 2003 .

CHAPTER 5

1. V u TH, Caba u JF, Nguyen NT , Lenoir M , SARS in Norther n Vietnam , New England Journal of Medicine 2003; 348 : 2035.

2. Poutane n SM , Lo w DE , Henr y B , e t al. , Identificatio n o f sever e acut e respiratory syndrome i n Canada , New England Journal of Medicine 2003; 348: 1995-2005.

3. Tsan g KW, Ho PL, Ooi GC, et al., A cluster of cases of severe acute respirator y syndrome i n Hon g Kong , New England Journal ofMedicine 2003; 348:1 977 -85.

4. Le e N , Hu i D , Wu A, e t al. , A majo r outbrea k o f sever e acut e respirator y syndrome i n Hon g Kong , New England Journal of Medicine 2003; 348: 1986 -94.

5. Shortridg e KF , Stuart-Harri s CH , A n influenz a epicentre ? Lancet 1982 ; 2 : 812-3.

6. Wickramasingh e C , Wainwright M, Narlikar J, SARS — A clue to its origins? Lancet 2003; 361 : 1832.

7. Hospita l Authority , Sectio n II : Prologu e an d summar y o f ou r analysis , Response to the report of the Hospital Authority Review Panel on the SARS outbreak, 16 October 2003 , p . 54 , paragraph 2.18 .

8. Donnell y CA , Ghani AC , Leung GM , et al. , Epidemiological determinant s of sprea d o f causa l agen t o f sever e acut e respirator y syndrom e i n Hon g Kong, Lancet 2003; 361 : 1761-6.

256 Notes to pages 68-81

9. Rile y S , Frase r C , Donnell y CA , e t al. , Transmissio n dynamic s o f th e etiological agen t o f SAR S i n Hon g Kong : Impac t o f publi c healt h interventions, Science 20]un 2003 : 300(5627) : 1961-66 .

10. Ibid . 11. Lipsitc h M , Cohen T , Cooper B , et al. , Transmission dynamic s an d contro l

of severe acute respiratory syndrome, Science 20]un 2003 : 300(55627): 1966-70.

12. Anderso n RM , Ma y RM , Infectious Diseases of Humans. Oxford : Oxfor d University Pres s 1991 , p. 70 .

13. Ferguso n NM , Galvan i AP , Bus h RM , Ecologica l an d immunologica l determinants o f influenz a evolution , Nature 2003; 422 : 428-33.

14. Se e endnot e 9 . 15. Se e endnot e 9 . 16. Se e endnot e 9 . 17. Gallowa y G, Scope o f SARS outbreak understated , critic s say, The Globe and

Mail 2 9 Ma y 2003 , p . Al . 18. Leun g GM, Hedley AJ, Ghani AC, et al., Case fatality rat e in 152 9 inpatient s

with severe acute respiratory syndrome (SARS ) in Hong Kong, 2003 (unde r review).

19. S o LKY, Lau ACW , Yam LYC , et al. , Development o f a standar d treatmen t protocol fo r sever e acut e respirator y syndrome , Lancet 2003; 361 : 1615-7.

20. Boot h CM , Matukas LM, Tomlinson GA , et al. , Clinical features an d short -term outcome s o f 14 4 patient s wit h SAR S i n th e Greate r Toront o Area , Journal of the American Medical Association 4Ju n 2003 : 289(21) : 2801-9 .

21. Persona l communication , Dr . Allison McGeer , 3 0 May 2003 . 22. Th e Harvar d Team , Improving Hong Kongs Health Care System: Why and For

Whom'? Hong Kong : Governmen t Printe r 1999 . 23. W D Scot t and Co , The Delivery of Medical Services in Hospitals: A Report for the

Hong Kong Government. Hon g Kong : Governmen t Printe r 1985 . 24. Hutzle r C , Beijin g missteps on virus show research failings , Asian Wall Street

Journal 4 June 2003 , p . Al . 25. Horto n R , The ne w publi c healt h o f ris k an d radica l management , Lancet

1998; 352 : 251-2 . 26. Horto n R , The ne w publi c health , Lancet 1998; 352: 904. 27. Reaso n J, Huma n errors : Model s an d management , British Medical Journal

2000; 320 : 768-70 .

CHAPTER 6

1. Gr o Harle m Brundtland , Da y On e Conclusio n — Th e respons e s o far , Speech b y th e Directo r Genera l a t th e Worl d Healt h Organisatio n globa l

Notes to pages 82-93

meeting o n SARS , Kual a Lumpur , 1 7 June 2003 , www.who.int/csr/SARS / conference/june_2003/materials/presentations/brundtland/en.

2. Worl d Healt h Organisation , SAR S — Status of the outbreak an d lesson s fo r the immediat e future , Ma y 2003 , www.who.int/csr/media/SARS_wha.pdf .

3. Peoples Daily, WHO officials stud y SARS situation in S. China province, 5 April 2003, www.english.peopledaily.com.cn/200304/05/eng20030405_l 14618.shtml .

4. Worl d Healt h Organization , SAR S epidemiolog y t o date , 1 1 Apri l 2003 , www.who.int/csr/SARS/epi2003_04_11 /en.

5. Worl d Health Organisation , Update 49 — SARS case fatality ratio, incubation period, 7 May 2003 , www.who.int/csr/SARSarchive/2003_05_07a/en .

6. Kare n Richardso n an d Bets y McKay, WHO's methodolog y ma y understat e SARS death rate , som e official s say , The Wall Street Journal, 2 2 April 2003 , www.aegis.com/news/wsj/2003/Wl030410.html.

7. Hon g Kon g SA R Governmen t Pres s Release , www.info.gov.hk/gia/general / 200304/26/0426132.htm.

8. Hon g Kon g SA R Governmen t Pres s Release , www.info.gov.hk/gia/general / 200304/19/0419180.htm.

9. Olive r Razum , Heik o Becher , Annett e Kapaun , Thoma s Junghanss, SARS , lay epidemiology, an d fear , Lancet 17 May 2003 .

10. I n contrast , the change in the ICU/hospital rati o at the end is less significan t as th e numbe r o f patient s i n hospita l i s a lo t lower .

11. S . Riley , C Fraser , CA . Donnelly , e t al. , Transmissio n dynamic s o f th e etiological agen t o f SAR S i n Hon g Kong : Impac t o f publi c healt h interventions, Science 23 Ma y 2003 , www.sciencemag.org/cgi/rapidpdf / 1086478v1.pdf.

12. C . Dy e an d N . Gay , Modelin g th e SAR S epidemic , Science 2 0 June 2003 , www.sciencemag.org/cgi/reprint/300/5627/1884.pdf.

13. Worl d Health Organisation , Cumulativ e number o f reported probabl e case s of SARS , www.who.int/csr/SARS/country/2003_07_11/en ; Dat a fro m th e United States is not included, since only eight of the reported 7 5 SARS cases have bee n confirme d t o b e SAR S b y serolog y tests . Se e U S Center s fo r Disease Control , Reporte d Suspec t an d Probabl e SAR S Cases , b y SARS -Associated Coronaviru s (SARS-CoV ) Serology , Unite d States , 1 5 July 2003 . Available a t www.cdc.gov/ncidod/SARS/casecount.htm .

14. Ministr y of Health, People' s Republi c of China, www.moh.gov.cn/zhgI/yqfb / index.htm.

15. Lorett a Yam, Lectur e o n SARS-relate d issue s give n a t Hon g Kon g Scienc e Museum on 7Jun e 2003 , t.hk/~avwork/MyDir/Archive/Archive/OUDPA/SARS / SARS01_070603.ram.

16. Ibid . 17. Se e Chapte r 7 .

Notes to pages 95-111

CHAPTER 7

1. Certai n sections of this chapter ar e reprinted with permission from Elsevie r from th e articl e entitle d "Possibl e rol e o f a n anima l vecto r i n th e SAR S outbreak a t Amoy Gardens " b y Dr. Stephen N g {Lancet 2003; 362 : 570-2) .

2. Al l chronology i s based o n dat a obtaine d fro m th e Departmen t o f Healt h on 4 April 2003 . Subsequen t mor e up-to-dat e dat a ar e no t availabl e a t th e time o f th e writin g o f thi s chapter .

3. Departmen t o f Health , Hon g Kon g Government , Outbreak of Severe Acute Respiratory Syndrome (SARS) at Amoy Gardens, Kowloon Bay, Hong Kong, Main Findings of the Investigation, 2003.

4. Ming Pao (Hong Kong) , 2 7 March 2003 . 5. Ming Pao (Hong Kong) , 1 1 April 2003 . 6. Ming Pao (Hong Kong) , 5 May 2003 . 7. Ibid . 8. Se e endnot e 3 . 9. Worl d Healt h Organisatio n Laborator y Network , Firs t data o n stabilit y an d

resistance o f SARS coronavirus, www.who.int/csr/sars/survival_2003_05-04 / en/.

10. Lipsitc h M , Cohen T , Cooper B , et al. , Transmission dynamic s and contro l of severe acute respiratory syndrome, Science 20 June 2003 ; 300(5627) 1966 -70.

11. Ibid . 12. Du e t o incomplet e data , th e epidemi c curve s ar e constructe d usin g 18 7

confirmed SAR S case s instea d o f th e 26 7 case s tha t wer e reporte d a t th e time.

13. Jacob y RO , Rat coronavirus , i n Viral and Mycoplasmal Infections of Laboratory Rodents: Effects on Biomedical Research, edited b y Bhatt PN, Jacoby RO, Morse AC II I an d Ne w AE. Orlando : Academic Pres s 1986 , pp . 625-38 .

14. Th e Universit y o f Arizon a Cooperativ e Extension , www.cals.arizona.edu / pubs/insects/az1280.pdf.

15. Professiona l Pes t Management Association, www.pestworld.org/homeowners / spotlight/roof_black_ship_rat.asp.

16. New York Times (New York), 2 4 May 2003 . 17. Peiri s JSM, Chu CM , Cheng VCC, et al. , Clinical progression an d vira l loa d

in a communit y outbrea k o f coronavirus-associate d SAR S pneumonia : A prospective study , Lancet 2003; 361: 1767-72.

18. Ming Pao (Hong Kong) , 8 May 2003 . 19. South China Morning Post (Hong Kong) , 2 8 May 2003 . 20. Rot a PA , Oberst e MS , Monro e SS , e t al. , Characterizatio n o f a nove l

coronavirus associated with severe acute respiratory syndrome, Science 2003; 300: 1394-9 .

Notes to pages 111-118

21. Marr a MA, Jones SJM, Astell CR, et al., The genom e sequence o f the SARS-associated coronavirus , Science 2003; 300 : 1399-404 .

22. Haijem a BJ , Volder s H , an d Rottie r PJM , Switchin g specie s tropism : A n effective wa y to manipulate th e feline coronaviru s genome, Journal of Virology April 2003 ; 77 : 4528-38.

23. Researcher s from th e US National Institute of Allergy and Infectious Diseas e have just reported tha t they had successfully inoculate d mice with the SARS coronavirus (Science vol. 302 , 10 October 2003) . Mice showed n o symptom s of diseas e despit e activ e replicatio n o f virus i n thei r bodies .

CHAPTER 8

1. Yas h Ghai , Hong Kongs New Constitutional Order (Hon g Kong : Hon g Kon g University Pres s 1997) , pp . 113-18 4 discusse s extensivel y th e lega l an d constitutional theor y of autonomy in Chinese law. However, in practice , th e Central People s Governmen t kep t Hon g Kon g practicall y seale d of f fro m access by the res t of the country , allowing limited tourism , and the n onl y in authorised, vette d groups . Busines s trip s ha d t o b e approve d b y centra l authorities, with th e Hon g Kon g and Maca u Affairs Offic e an d th e Centra l People's Governmen t Liaiso n Offic e jealousl y guardin g thei r respectiv e authorising powers over Hong Kong-mainland exchanges . Contacts betwee n Hong Kon g an d Shenzhe n an d Guangdon g authoritie s wer e largel y ceremonial, highl y bureaucrati c o r unofficial , excep t fo r thos e focuse d mainly o n cross-boundar y policin g issues . Contour s o f th e Hon g Kong -mainland relation s between mid-1997 and mid-2003 are best discerned fro m the initiative s registere d i n th e "On e Country , Tw o System s Researc h Inst i tute" (se e th e lis t o f researc h project s a t www.octs.org.hk / e_page_research.htm), whic h urge d variou s change s i n th e relationship . Compare to the Hong Kong government website under the listing "mainland of Chin a an d Hon g Kong " (se e fo r exampl e "infrastructur e coordinatio n with th e mainland " a t info.gov.hk/topic_f.htm) . Th e rigi d line s o f officia l communication an d th e negotiate d date s an d agend a o f forma l meeting s highly restrained cooperatio n an d coordinatio n i n the case of emergencie s such a s SARS. See endnot e 5 .

2. Keit h Bradsher , "Hon g Kon g doctor' s ordea l a s SAR S patient, " New York Times, 25 April 2003; and Mar y Ann Benitez' s interview of Dr. Tom Buckley , acting directo r o f th e PW H intensiv e car e uni t fro m 1 2 t o 2 2 Marc h wh o alerted physician s worldwid e t o th e severit y o f th e atypica l pneumoni a outbreak while Hong Kong officials were denying its seriousness, in "Docto r overwhelmed afte r launchin g e-mai l campaign, " South China Morning Post 31 March 2003 .

3. Se e Chapter 4 ; and Canni x Yau, "Too little, too late in battle t o stop killer, " The Standard 15 April 2003 .

Notes to pages 118-123

4. Pats y Moy and Marca l Joanitho, "Pneumoni a prompt s WH O healt h alert, " Sunday Morning Post 16 March 2003 , lea d story . Also se e nex t endnot e fo r repeated call s fo r calm .

5. Mar y Ann Benite z and Le u Siew Ying, in "WHO accused of spreading pani c as pneumonia number s hi t 83, " South China Morning Post 18 March 2003 , p. 1, quote Guangdon g Healt h Burea u officia l Fen g Shaomin g a s saying "We will monitor the situation in Hong Kong very closely but as for any exchange or cooperation , w e nee d t o ge t approva l (fro m th e centra l government). "

6. Se e belo w for detail s o f th e Articl e 2 3 controversy . 7. Th e 2003-04 Budget Address, see especially pages 75-93, "Raising Revenue,"

available at the Hong Kong Government website: www.budget.gov.hk/2003 / eng/index.htm.

8. Se e statemen t o f th e Financia l Secretar y t o th e pres s o n hi s reprimand . Available o n th e Hon g Kon g Governmen t websit e at : www.info.gov.hk/gia / generai/200303/15/0315217.htm. Se e als o Margare t Ng , "Th e cas e agains t Antony Leung, " South China Morning Post 28 March 2003 .

9. Se e China Daily 17 July 2003 where Ip is highly praised while Leung receive s very different treatment . Available at: wwwl .chinadaily.com.cn/en/doc/2003-07/17/content_245828.htm. Contras t thi s dr y recita l wit h th e A P repor t at : www.twincities.com/mId/twincities/news/world/6313397.htm an d especiall y the Shenzhen Daily's accoun t at : www.szed.com/szdaily/20030718 / ca437983.htm.

10. Joh n Pomfret , "Chines e authorities ordered doctor s in Beijing to hide SARS patients," Washington Post 20 April 2003. Warnings by mainland official s no t to asses s th e mainlan d government' s handlin g o f SAR S were reporte d i n July, o n th e da y followin g th e giganti c protes t ove r Articl e 2 3 legislation , which included propose d ne w restraints on media reportage o f state secrets in Hong Kong. "Media and academics 'gagge d by officials' ove r SARS," South China Morning Post 2 July 2003 .

11. Bate s Gil l an d Andre w Thompson , "Wh y China' s healt h matter s t o th e world," South China Morning Post 16 April 2003 .

12. Charge s that the Hong Kong Government also tried to hide aspects of SARS or kept information awa y from th e public appeared throughou t th e period . See, for example , Chow Chung-yan, "Police told not to cause panic by using masks," South China Morning Post 31 Marc h 2003 ; Matthe w Lee , "Official s 'played down ' kille r virus," The Standard 14 April 2003 ; and Phili p Bowring , "What th e outbrea k reveals : Hong Kon g a t it s worst," South China Morning Post 7 May 2003. Bowring complained abou t th e Hon g Kong Government' s secrecy with basi c data , an d attribute d it, i n part , t o th e politica l structur e that empowere d clique s with informatio n denie d t o th e rest .

13. Th e first cal l for a 100,000 person turnou t was reported 2 0 June i n the South China Morning Post (jimmy Cheung , "Rall y agains t securit y la w promote d

Notes to pages 123-126 26 1

via postcards") . B y 2 5 June, 100,00 0 wer e expecte d t o atten d (Ambros e Leung and Stell a Lee, "Democrats prepare t o begin 100-hou r hunger strike, " South China Morning Post) . The nex t day , afte r Tsan g Yok-sing , Executiv e Councillor an d hea d o f the DAB , stated tha t "eve n i f 200,000 attended th e rally th e governmen t woul d no t withdra w th e bill. " Thi s prompte d Le e Cheuk-yan t o cal l fo r 300,00 0 t o 400,00 0 t o attend , bu t n o on e predicte d such a turnout . Se e "Cannix Yau, Massive protes t urged o n Articl e 23, " The Standard 26 June 2003 . The highes t forecast numbe r appeare d i n Christin e Loh, "Welcom e t o a n unhapp y Hon g Kong , Premie r Wen, " South China Morning Post 30 June 2003 . Loh noted tha t "Estimates (fo r the turnout) rang e from 100,00 0 to even 250,00 0 people." The titl e of Loh's op-ed piece refer s to th e TBW A report , Marketing Premium Brands in Asia, tha t foun d Hon g Kong people t o be "th e unhappies t i n th e regio n b y a wide margi n — an d that was before th e added depression brought on by SARS." Victoria Button , "Hong Kon g peopl e saddes t i n region, " South China Morning Post 29 June 2003.

14. Fo r accounts of the unrest in the 1920 s see Chan Lau Kit-ching, From Nothing to Nothing, The Chinese Communist Movement and Hong Kong 1921-1936 (Hon g Kong: Hong Kon g University Press 1999 ) pp . 53-77 . Compare t o Norma n Miners, Hong Kong Under Imperial Rule, 1912-1941 (Hon g Kong : Oxfor d University Press , 1987) , pp . 12-20 . Se e Ia n Scott , Political Change and the Crisis of Legitimacy in Hong Kong (Hong Kong: Oxford Universit y Press, 1989), pp. 81-126 , for a n accoun t an d analysi s o f th e 1966-6 7 disturbances .

15. Elain e Wu , "N o arrest s throughou t orderl y protest, " South China Morning Post 2 July 2003 .

16. "Over-focu s o n politics to harm HK' s interests," China Daily, Hong Kong ed. 1 6 July 2003 , www. 1 .chinadaily.com.cn/en/doc/2003-07/16/content_245665.htm. Also, "Miscalculatio n o f publi c opinion, " China Daily, Hong Kong ed. 1 0 July 2003, wwwl xhinadaily.com.cn/en/doc/2003-07/10/content_244251 .htm.

17. Poll y Hui, Linda Yeung and Gar y Cheung, "100 schools decide t o shut thei r doors, bu t th e educatio n ministe r remain s adaman t tha t ther e i s no nee d for blanke t closures, " South China Morning Post 27 March 2003 .

18. Th e connectio n betwee n th e A w case an d Leun g wa s made repeatedl y i n the press . Fo r example , Stell a Le e an d Ravin a Shamdasani , "Whethe r t o prosecute i s my business, says Elsie Leung," South China Morning Post 17 July 2003; the lea d editoria l i n th e South China Morning Post 19 July 2003 , "Th e prosecution tes t tha t mus t b e passed" ; an d a n op-e d piec e i n th e sam e newspaper by Christine Loh, "A crisis we could have avoided," 1 8 July 2003. For an account of the Aw case, see Albert H.Y Chen, "Continuity and chang e in th e lega l system, " i n The Other Hong Kong Report 1998, edite d b y Larr y Chuen-ho Cho w an d Yiu-kwan Fan , Hon g Kong : Chines e Universit y Pres s 1998, pp . 46-47 .

Notes to pages 126-130

19. Se e th e Hon g Kon g Fearbuster s websit e fo r age s o f everyon e wh o die d i n Hong Kon g at www.fearbuster.org.hk. Onl y one perso n unde r th e age of 30 died: a 28-year-old .

20. Th e bes t accoun t o f thes e event s wa s writte n b y John Pomfre t o f th e Washington Post from Beijing . Se e "Chin a order s en d t o SAR S coverup , officials begi n belate d campaig n agains t disease" (1 9 April 2003); "Coverup spurs shakeup in Beijing" (2 1 April 2003); "China's crisis has a political edge" (27 Apri l 2003) ; "Outbrea k gav e China' s H u a n opening , presiden t responded t o pressure inside and outside country on SARS" (13 May 2003).

21. Th e Healt h Ministe r Zhan g Wenkan g an d Beijin g mayo r Men g Xuehon g were sacke d o n 2 0 April . B y 2 6 April , Rober t Chung' s PO P poll s wer e reporting tha t trus t in th e Hong Kong government had droppe d whil e tha t for th e mainland ha d soared. See "Beijing firings win our trust," The Standard 26 April 2003 . Fon g Tak-ho , "Leader s ge t toug h wit h loca l officials, " South China Morning Post 9 Ma y 2003, reporte d 12 0 mainland official s ha d bee n sacked fo r ba d performanc e durin g th e SAR S emergency .

22. Indication s tha t th e Article 2 3 legislation wa s in troubl e i n LegC o could b e seen o n 4 July 2003 on th e fron t pag e o f the South China Morning Post. The Post, runnin g a headlin e "O n Tuesday , 500,00 0 peopl e marche d agains t Article 23 . Today , w e as k ou r 6 0 legislator s ho w the y wil l vot e . . . an d whether event s o f th e pas t wee k hav e affecte d thei r decision. " Th e articl e took u p th e whol e fron t pag e wit h colou r photo s o f eac h LegC o membe r and indication s o f ho w the y stoo d o n th e vot e slate d t o tak e plac e 9 July. On 6 July 2003 the Sunday Morning Post front pag e announced "Tun g makes Article 2 3 concessions" bu t thi s was not enoug h t o sto p criticism , an d no t enough t o satisfy Tien, who resigned late that night. See Fanny Fung, "Tun g shelves bill, " The Standard 7 July 2003 .

23. Under-employmen t i s an economi c ter m use d t o indicat e tha t workers ar e working part-tim e bu t desir e ful l tim e employment .

24. A study by the Universit y o f Hong Kong' s Centr e fo r Suicid e Research an d Prevention, reporte d b y Patsy Moy, "Depression fears as suicides soar," South China Morning Post 8 September 2003 .

25. Tung' s characte r trait s an d th e troubl e the y cause d fo r governanc e coul d be clearl y see n withi n th e firs t yea r o f hi s regime . Se e Michae l DeGolyer , "Civil Service" in The Other Hong Kong Report 1998, edited b y Larry Chuen -ho Cho w an d Yiu-kwa n Fan , Hon g Kong : Chines e Universit y Pres s 1998 , pp. 73-114 . These troubles were comprehensively analysed in the joint Civic Exchange-National Democrati c Institut e publicatio n reviewin g th e accountability system , "Accountabilit y withou t Democracy, " (Septembe r 2002) availabl e at www.civic-exchange.org/n_pub_cont_j02.htm#january2002 . See als o th e author' s "Th e Firs t Fiv e Years " (Jun e 2002 ) a Hon g Kon g Transition Projec t report , an d "Accountabilit y an d Articl e 23 " (Decembe r 2002) a t www.hkbu.edu.hk/~hktp/ .

Notes to pages 131-140

26. Se e endnote above . See also Michael DeGolyer, "Broken rules, " The Standard 4 Septembe r 2003 , an d th e Hon g Kon g Governmen t "organisatio n chart " (which break s al l the rules ) a t www.info.gov.hk/govcht_e.htm (se e note s o n this website especially) .

27. Michae l DeGolyer , "Legitimac y an d leadership : Publi c attitude s i n post -British Hon g Kong, " in Hong Kong in Transition, edited b y Robert Ash e t al , London: RoutiedgeCurzon 2003 , pp. 125-146; Lo Shiu-hing, Governing Hong Kong, Ne w York : Nov a Scienc e Publisher s 2001 ; la n Scott , "Th e disarticulation o f Hong Kong's post-handover politicial system," in Hong Kong Government and Politics, edited by Sing Ming, Hong Kong: Oxford Universit y Press 2003 , pp . 663-94 .

28. Thi s self-observatio n ha s bee n reporte d i n th e pres s numerou s time s an d also by interviewees of the author who prefer anonymity . These interviewee s have interacte d wit h th e Chie f Executive , som e man y times , durin g bot h formal an d informa l exchanges .

29. Th e Government' s Departmen t o f Healt h an d th e quasi-independen t Hospital Authorit y hav e tw o separat e inquirie s underway .

30. Thi s strategy is described b y Lau Siu-kai , now head o f Tung's Centra l Polic y Unit, i n "Governmen t an d politica l chang e i n th e Hon g Kon g Specia l Administrative Region, " i n Hong Kong the Super Paradox, edite d b y James C . Hsiung, Ne w York: St . Martin' s Pres s 2000 , pp . 35-57 .

31. A s evidence d b y th e mor e tha n 3 0 intervention s i n th e propert y market , including Michae l Suen' s famous nin e step s actions i n lat e 2002 . Tung ha s also indicate d man y time s h e consider s hig h wag e level s par t o f wh y h e considers Hon g Kon g "uncompetitive. " See , fo r example , hi s remark s i n December 200 2 at the Hon g Kong General Chambe r o f Commerce annua l business summit , a t www.info.gov.hk/ce/speech/cesp.htm. Als o see the Chie f Executive Offic e websit e i n genera l fo r copiou s example s o f thes e views .

32. Josep h Lo and Jimmy Cheung, "Li Ka-shing proud of protesters," South China Morning Post 22 August 2003 .

33. Chri s Patten' s memoir , East and West (London : Macmilla n 1998 ) discusse s these events in passing, but Jonathan Dimbleby , The Last Governor (London: Little, Brown , an d Co . 1997 ) give s a blow by blow account .

CHAPTER 9

1. Davi d Heymann , Executiv e Director , Communicabl e Diseases , WHO, fro m transcript of a conference cal l on 8 April 2003, CLSA Speaker Series , "SARS - Hyp e fro m reality, " publishe d b y CLSA Emerging Markets. See als o Chri s Taylor, "In China, it seems the 'bi g one' i s yet to come," South China Morning Post 11 May 2003 , p . 4 .

2. Hen k Bekedam , WHO' s Chin a Representativ e i n Beijing , fro m transcrip t

Notes to pages 140-144

of a conference cal l on 29 April 2003, CLSA Speaker Series, "SARS in Chin a — Where t o fro m here? " published b y CLSA Emerging Markets.

3. Carri e Chan and Mary Ann Benitez, "Midjune hin t on trave l advisory," South China Morning Post 22 May 2003 , p . Al .

4. HKSA R Government Pres s Release, www.info.gov.hk/gia/general/200304/02 / 0402260.htm.

5. A n "affecte d area " i s define d b y th e WH O a s a regio n a t th e firs t administrative leve l wher e th e countr y i s reportin g loca l transmissio n o f SARS, www.who.int/csr/sars/areas/2003_03_16/en .

6. Th e criterio n fo r 2 0 continuou s day s o f n o ne w case s bein g detecte d automatically determine s when a place i s SARS-free. Th e criterio n i s based on tw o incubation period s o f te n day s each .

7. HKSA R Government Pres s Release, www.info.gov.hk/gia/general/200305/03 / 0503138.htm

8. SAR S Bulletin , Heal th , Welfar e & Foo d Bureau , 7 Ma y 2003 , www.info.gov.hk/dh/diseases/ap/eng/bulletin0507.pdf. Th e criterio n fo r th e number o f activ e case s no t t o excee d 6 0 was derived fro m th e experienc e in Hanoi, where the number o f cases topped a t 63, according to the WHO's David Heyman n a t a pres s conferenc e i n Hon g Kon g a t th e Foreig n Correspondents' Clu b o n 1 9 June 2003 .

9. HKSA R Government Pres s Release, www.info.gov.hk/gia/general/200305/20 / 0520250.htm.

10. Th e father , a 33-year-ol d man , an d hi s nine-year-ol d so n wer e admitte d t o hospital on 1 1 and 1 2 February respectively. The father die d on 1 7 February while the son recovered . The mothe r o f the family was admitted t o hospita l on 1 3 February and als o recovered. The family had a second daughte r wh o remained asymptomati c throughout .

11. A doctor from th e Hanoi French Hospital , which received the SARS patient, contacted th e WHO' s Dr . Carl o Urban i t o loo k a t th e cas e becaus e i t appeared highl y unusual . Urban i doubte d i t wa s a cas e o f influenz a an d was alarmed by the case. Together with other WHO officials , the y persuaded the Vietnam Government to take action to prevent the spread o f the strang e disease.

12. WHO' s globa l aler t abou t SARS, www.who.int/csr/sars/archive/2003_03_12 / en.

13. Mat t Pottinger , Elen a Cherney , Gauta m Nai l an d Michae l Waldholz , "Ho w a globa l effor t identifie d SAR S virus i n a matte r o f weeks, " The Wall Street Journal 1 7 April 2003 .

14. WHO' s emergency travel advisory, www.who.int/csr/sars/archive/2003_03_1 5/ en.

15. Chri s Taylor , "I n China , i t seems th e 'bi g one ' i s yet t o come, " South China Morning Post 11 May 2003 , p . 4 .

Notes to pages 144-150 26 5

16. Ro b Stein , "O n th e pulse : SAR S has reveale d th e skill s an d limitation s o f the WH O diseas e hunters, " The Standard 3 June 2003 , p . A19.

17. Hu i Li , "Atypica l pneumonia : SAR S i n China, " CLSA Emerging Markets 17 April 2003 , p . 7 .

18. WH O SAR S Update: www.who.int/csr/sars/archives/2003_04_02/en/ . 19. Davi d Heymann , WHO , se e endnot e 1 for ful l reference . 20. Michae l Backman, "SARS: A WHO-induced panic? " Commentary, Far Eastern

Economic Review, 2 2 May 2003. Backman was in fac t mistake n i n stating tha t the WH O ha d issue d a trave l advisor y fo r Vietna m an d Hanoi , althoug h the WH O di d includ e Hano i o n it s SARS "affected area " lis t o n 1 6 Marc h 2003.

21. Th e WHO , The World Health Report 2000, 2 1 June 2000 . The ranking s ha d been se t asid e afte r vigorou s objection s fro m a numbe r o f U N membe r states.

22. Yeo h Sie w Hoon, "Wh o di d th e righ t thin g b y SARS and travel" , intervie w with Dr . Max Hardiman , TravelWeekly, 2 3 May 2003, p . 16 .

23. WH O SAR S Update: www.who.int/csr/sars/archive/2003_04_29/en/ . 24. WH O SAR S Update: www.who.int/csr/sars/archive/2003_05_14/en/ . 25. Thoma s Crampton, "WHO assails China for faltering on SARS," International

Herald Tribune, 3 June 2003 . 26. WH O SARS Update: www.who.int/csr/don/2003_05_23/en/ an d www.who.int /

csr.don/2003_05_24/en/. 27. WH O SAR S Update: www.who.int/csr/don/2003_05_26/en/ . 28. WH O SAR S Update: www.who.int/csr/don/2003_06_04/en/ . 29. WH O SAR S Update: www.who.int/csr/don/2003_06_13/en/ . 30. Healt h Canada , Learning from SARS: Renewal of Public Health in Canada,

October 2003 , p . 40 . 31. Jonatha n Mirsky , "Containing SARS: The scandal over Taiwan," International

Herald Tribune, 12 May 2003 . 32. Ibid . 33. "Wh o will stand up for Taiwan?" Taipei Times, 1 7 May 2003, p. 9. Taiwan was

invited t o atten d a technica l briefin g o n SAR S however an d wa s allocate d time t o mak e a shor t repor t o n th e developmen t o f SAR S in Taiwan , se e Melody Che n an d Wan g Ping-yu , Taiwa n make s progres s a t WHO , Taipei Times 19 May 2003 , p . 1 .

34. Li n Chieh-yu , "WH O campaig n stay s on track, " Taipei Times, 19 May 2003 , P-2.

35. Melod y Chen, "Invitation from WHO reeks of politics," Taipei Times, 1 4 June 2003, p . 1 .

36. Editorial , Asian Wall Street Journal, 31 March 2003 . Long's statement was made on 2 7 March 2003 .

37. Hen k Bekedam , WHO , se e endnot e 2 for ful l reference .

266 Notes to pages 150-157

38. Statemen t from th e Standin g Committee o f the Politburo rea d o n Chines e TV on 1 7 April 2003 .

39. Men g Xuenon g wa s appointed a s the Deput y Directo r o f th e North-Sout h Water Diversio n Offic e o n 1 October 2003 .

40. Joh n Aglionby , 'Chin a open s doo r t o world hel p with it s SARS crisis," The Guardian, www.guardian.co.uk/sars/story/0,13036,946201,00.html , 3 0 Apri l 2003.

41. Staf f reporter , "Deadl y 'cover-up', " The Standard 19 June 2003 , p . B20. 42. Joh n Pomfret , "China' s slo w reactio n t o fast-movin g illnes s fearin g los s o f

control, Beijin g stonewalled, " Washington Post Foreign Service 3 April 2003 . 43. Peoples Daily, english.peopledaily.com.cn/200304/05/print20030405_114618.html.

What is unclear from availabl e reports is whether the Guangdong Departmen t of Health sen t Xiao's report or merely some information base d on the report . Further, ther e ar e als o discrepancies fro m publishe d informatio n a s to when Guangdong issue d th e guidelines t o hospitals informing the m abou t th e ne w disease. The Peoples Daily reported th e 2 3 January, whils t accordin g t o John Pomfret's repor t (endnot e 42) , i t could onl y have been afte r th e 2 7 January since Xiao' s repor t wa s no t suppose d t o hav e been rea d til l then . Th e exac t dates ar e perhap s unimportan t sinc e th e fac t i s systemic secrec y within th e Chinese syste m cause d informatio n t o no t b e acte d upo n t o China' s ow n detriment.

44. Ibid . 45. Josephin e M a and Staf f Reporters , "Guangdong 'reporte d o n th e outbrea k

in February', " South China Morning Post 21 May 2003, p . A3. 46. Hen k Bekedam , WHO , se e endnot e 2 for ful l reference , p . 3 . 47. WH O SAR S Update: www.who.int/csr/sars/archive/2003_04_09/en/ . 48. People's Daily, english.peopledaiiy.com.cn/200304/05/print20030405_114618.html 49. Bekedam , WHO , se e endnot e 2 for ful l reference . 50. Jonatha n Mirsky , "Ho w th e Chines e sprea d SARS, " The New York Review of

Books 29 May 2003 , p . 42 . 51. Matthe w Lee, "Only Beijing t o blame: Yeoh," The Standard 14 June 2003 , p .

B5. 52. SAR S Expert Committee report , SARS in Hong Kong: From Experience to Action,

2 Octobe r 2003 , availabl e onlin e a t www.sars-expertcom.gov.hk . 53. Whil e protectiv e gea r wa s sent , n o medica l worker s wer e dispatched . Se e

HKSAR Government's Press Release, www.info.gov.hk/gia/general/200305/08 / 0508110.htm

54. Christin e Loh , "Lov e th y neighbour, " Hon g Kon g Strategy , CLSA Emerging Markets, March 2003 , www.civic-exchange.or g unde r publication s 2003 .

55. Bekedam , WHO , se e endnot e 2 for ful l reference . 56. Th e autho r i s grateful t o S u Liu o f Wirthlin Worldwid e fo r th e us e o f he r

research o n Shanghai .

Notes to pages 158-167

57. Bekedam , WHO , se e endnot e 2 for ful l reference . 58. Jonatha n Mirsk y note d i n "Ho w th e Chines e sprea d SARS, " The New York

Review of Books 29 May 2003, page 42, that there was a 1996 law that classifie d "highest leve l infectiou s diseases " a s "highl y secret " wit h th e secrec y extending fro m th e firs t occurrenc e o f th e diseas e unti l th e da y i t i s announced. However , i n checkin g th e statu s o f tha t law , Jerry L i o f th e United Nation s Developmen t Project' s (UNDP ) offic e i n Beijin g advise d that th e Ministr y of Health' s Lega l Sectio n tol d th e UND P tha t ther e was a Regulation o n th e Specifi c Scop e o f Secrec y o f it s Classificatio n i n Publi c Health Work but i t had been invalidate d in 2001 , personal communication , 15 July 2003 .

59. Nanfang Rzbao 20 February 2003 . 60. Joh n Pomfret , "China' s crisi s ha s a politica l edge, " Washington Post Foreign

Service 27 April 2003 , p . A33. 61. Ibid . 62. Matthe w Forney, "China stops the presses, again," Time, Asia Edition 3 0 June

2003. 63. HKSA R Government Pres s Release, www.info.gov.hk/gia/general/200307/07 /

0707200.htm, 7 July 2003 .

CHAPTER 1 0

1. "China' s Chernobyl, " The Economist, 2 6 April 2003 , pp . 9-10 . 2. Jame s C F Wang, Contemporary Chinese Politics: An Introduction, 7th Edition ,

Upper Saddl e River , N . J.: Prentic e Hall , 2002 , p . 70 . 3. Th e Centra l Secretaria t ha s seve n majo r departments : propaganda ,

organization, united front work , liaison office wit h overseas Chinese bodies , publication offic e o f the Peoples Daily, policy research, and th e offic e o f th e party school .

4. Kennet h Liberthal , Governing China: From Revolution Through Reform, New York: WW. Norto n 8c Compan y Inc , 1995 , pp. 169-170 .

5. Ibid , pp . 170-171 . 6. Elle n Lee , "Officials fro m H K to Visit Hospitals in Guangdong," South China

Morning Post 1 April 2003 , p . A2. 7. "Whos e security ? — "Stat e security " i n China' s ne w crimina l code , Human

Rights in China and Human Rights Watch/Asia, Vol. 9, No. 4 , April 1997 , pp. 21-25.

8. "Chin a wake s up, " The Economist 26 April 2003 , p . 19 . 9. Se e Chapte r 9 for mor e details . 10. WH O Updates , www.who.int/csr/sars/archives/2003_03_26a/en/ , 2 6 Marc h

2003. For thi s chapter , we have used th e WHO figures rathe r tha n thos e o f China's Ministr y o f Healt h o r thos e reporte d b y th e medi a a s ther e ar e discrepancies.

Notes to pages 167-170

11. WH O Updates , www.who.int/csr/sars/archives/2003_03_27b/en/ , 2 7 Marc h 2003.

12. WH O Updates , www.who.int/csr/sars/archives/2003_03_28/en/ , 2 8 Marc h 2003; and Hugo Restall, "Examining Asian: Keep Up the Pressure on China, " Asian Wall Street Journal 4 April 2003 .

13. WH O Updates , www.who.int/csr/sars/archives/2003_03_31/en/ , 3 1 Marc h 2003.

14. WH O Updates, www.who.int/csr/sars/archives/2003_02_02b/en/, 2 April 2003. 15. WH O Updates , www.who.int/csr/sars/archives/2003_04_03/en/, 3 April 2003 . 16. WH O Updates , www.who.int/csr/sars/archives/2003_04_04/en/, 4 April 2003 . 17. WH O Updates , www.who.int/csr/sars/archives/2003_04_07/en/, 7 April 2003 . 18. Fo r detail s se e Chapter s 9 and 14 . 19. Hen k Bekedam , "SAR S i n China : Wher e t o fro m here?, " Transcrip t o f a

conference cal l fro m Beijing , CLS A Speake r Series , 2 9 Apri l 2003 , CLSA Emerging Markets.

20. Siew-yin g Leu an d Bil l Savadove , "Wh o say s mainland official s continu e t o hinder investigation," South China Morning Post 1 April 2003, p. Al; and Pete r Wonacott an d Susa n V Lawrenc e an d Mat t Pottinger , "Healt h official s express doubt about China' s SARS figures," Wall Street Journal 17 April 2003 .

21. "Worldwid e criticism of outbreak cover-up," South China Morning Post 18 April 2003, p . A3.

22. "Taiwanes e urge d t o avoi d mainlan d a s 13t h cas e i s revealed," South China Morning Post 31 March , 2003 , p . A5.

23. WH O Updates, www.who.int/crs/sars/archives/2003_04_18/en/, 1 8 April 2003. 24. Variou s new s report s indicate d tha t 100-20 0 official s hav e bee n fire d

throughout th e country . Privat e communicatio n indicate d tha t a s many as 500 hav e bee n dismissed .

25. WH O Updates, www.who.int/crs/sars/archives/2003_04_21/en/, 2 1 April 2003. 26. "Th e fund wil l be used t o finance th e treatmen t o f farmers an d poo r urba n

residents infecte d b y SAR S an d t o upgrad e country-leve l hospital s an d purchase SARS-relate d medica l facilities i n Centra l and Western Chin a an d for researc h programme s o n th e virus, " Chin a Create s SAR S Task Force , Special Fund, Ministry of Foreign Affairs o f the People's Republic of China , 24 Apri l 2003 , www.frnprc.gov.en/eng/47496.htmI . New s report s indicate d that some areas did not follow the central authorities' order tha t poor peopl e would be given free medica l care ; see John Pomfret , "SAR S Spread in Rura l China Raise s Concerns, " Washington Post Foreign Service 7 May 2003 .

27. Ibid . 28. "Ju n Yi Jin Zh u Xiaotangshan" (Militar y surgeons stationed in Xiaotangsha n

Hospital), Ming Pao 1 May 2003, p . A18. 29. Fre d Hu , "Wil l SAR S derai l China' s economy?, " China Insight, Goldma n

Sachs, 2 5 Anril 2003 .

Notes to pages 170-176 26 9

30. Nationa l Burea u o f Statistic s o f China , www.stats.gov.cn/tjfx/jdfx / 1200307170031.htm, 1 7 July 2003 .

31. "WH O expert s praise SARS hospital on Beijing' s outskirt, " Xinhuanet 4 June 2003.

32. Bra d Adams , "China' s othe r healt h cover-up, " Asian Wall Street Journal 1 2 June 200 3

33. "Ji e Zhon g Gu o Yin Ma n y i Qing Yi Sheng Jiang Yan Yong Za o Jian Kong " (Dr. Jiang Yanyong, wh o reveale d SAR S cover-up wa s under surveillance) , Asia Times Online, http://asiatimes-chinese.com/514chsars.htm 1 4 May 2003 .

34. Eri c Sautede, "The snares of modernity: Internet, information an d th e SARS crisis i n China, " China Perspectives, No . 47 , May-June 2003 , p . 25.

35. Xi a Liping, "China: A responsible great power," Journal of Contemporary China 2001, p . 17 .

36. Join t Stat e of the Specia l ASEAN-China Leaders Meeting on SARS , Ministry of Foreig n Affair s o f th e People' s Republi c o f China , 2 9 Apri l 2003 . I n respect o f th e pledge , i t wa s interestin g tha t non e o f th e ASEA N natio n pledged mone y t o the fund . I t indicated tha t ASEAN di d no t thin k mone y was the issue .

37. CNN.com/World , "Chin a promise s opennes s o n SARS, " www.edition.cnn.com/2003/WOOLD/asiapcf/06/28/sars.apec/reut/index.html, 28 June 2003 .

38. Judit h Banister , "Population , publi c health an d th e environmen t i n China, " in Managing The Chinese Environment, edite d b y Richar d Loui s Edmonds , Oxford: Oxfor d Universit y Press , 1998 , pp. 262-91 .

39. "China : 'On e i n 3 Chinese kid s suffers fro m lea d poisoning', " Straits Times, 8 Apri l 2003 .

40. Dexte r Roberts , "Breakdown : Ho w China' s decentralize d healt h car e i s failing," Business Week 28 April 2003 , pp . 22-23 .

41. Ibid . 42. Chri s Taylor, "I n China , I t seems the 'Bi g One' i s yet to come," South China

Morning Post 11 May 2003, p . A4. 43. Christophe r Bodeen , "China bans wildlife cuisin e on SAR S fears," Associated

Press 31 May 2003 . 44. Dexte r Roberts , "Breakdown : Ho w China' s decentralize d healt h car e i s

failing," Business Week 28 April 2003 , p . 22 . 45. Ibid . 46. "Foreig n direc t investment increased steadily. In 2002, the contracted foreig n

capitals throug h foreig n direc t ivestmen t stoo d a t 82. 8 billio n U S dollars , up 19. 6 percent, an d th e foreign capital s actually utilized were 52. 7 billio n US dollars , u p 12. 5 percent, " "Statistica l Communiqu e 2002, " Nationa l Bureau o f Statistics , People' s Republi c o f China , www.stat.gov.cn/english / newrelease/stafisticaIreports/1200303120088.htm,28 Februar y 2003 .

Notes to pages 176-187

47. Minxi n Pei , "China's governance crisis, " Foreign Affairs, September/Octobe r 2002, p . 97.

48. Josep h Kahn , "Beijing effectively beat s SARS: WHO declares, " New York Times 26 June 2003 .

49. "N o watchdog, " Asian Wall Street Journal 9 August 2001 , p. 6 . 50. W u Zhong and agencies, "70 dead in China's 'firs t sub accident'," South China

Morning Post, p. Al .

CHAPTER 1 1

1. Trad e Shippin g Industrie s Fisherie s Agricultur e Land , Hon g Kon g Administrative Repor t 1910 .

2. Hon g Kon g Administrative Repor t 1934 . 3. Hansard : Th e Financia l Secretary , Th e Appropriatio n Bill , 1 March 1972 . 4. Ibid . 5. Ibid . 6. Worl d Trad e Organizatio n Agreemen t 1994 . 7. Th e Federatio n o f Hon g Kon g Industrie s an d Th e Hon g Kon g Centr e fo r

Economic Research , Made in PRD, June 2003 . 8. Ibid . 9. Ibid .

10. Gros s Domesti c Produc t 2002 , HKSAR Government . 11. Corporatio n o f th e Cit y of London, The London/New York Study, June 2000 . 12. Corporatio n o f th e Cit y of London, The London/New York Study, June 2000 ;

US Censu s Bureau , 2000 ; and Censu s 2000 ; and HKSA R Government . 13. Annua l Diges t o f Statistic s 1990 , HKSAR Government . 14. Gros s Domesti c Produc t 2002 , HKSA R Government . 15. Corporatio n o f Cit y of London , The London/New York Study, June 2002 . 16. Gros s Domesti c Produc t 2002 , HKSAR Government . 17. Greate r London Authority Housing in London, 2003 ; Rating and Valuation

Department Report , Hong Kong 2003; New York City Rent Guidelines Board 2003 report ; an d Ne w York Housing Suppl y Repor t 2003 .

18. Grub b an d Ellis , New York Special Report 2001; and Corporatio n o f Cit y o f London, London/New York Study, June 2000 .

19. AC I Traffi c Data : World airport s rankin g b y tota l carg o - 2002 . Memphis , the major U S domestic hub, is the world's busiest cargo airport having lifte d almost 3.4 million metric tonnes of freight i n 2002. Hong Kong is the world's second larges t ai r carg o hub , carryin g 2.5 millio n metri c tonne s i n 2002 . Hong Kong , however , onl y carries freigh t internationally .

20. Th e Mayor' s o f Londo n Repor t 2003 , Visit London; and NY C & Co. , th e official bod y promoting touris m i n New York City information availabl e at : www.nycvisit.com/home/index.cfm

Notes to pages 187-198

21. NY C 8c Co; and London Touris t Board and Convention Bureau , informatio n available at : www.londontouristboard.co.uk .

22. Ibid . 23. Ibid . 24. Worl d Trave l an d Touris m Council , SARS has a Massive Impact on Travel &

Tourism in Affected Destinations, 15 March 2003 . 25. Th e Hon g Kon g Governmen t relie s fo r approximatel y 40 % o f it s incom e

from variou s real estate-related sources, principally from sellin g developmen t rights a s i t continue s t o ow n al l th e lan d i n Hon g Kong . Th e declin e i n property price s dramaticall y reduce d revenu e a t th e sam e tim e tha t i t was appropriate t o run expansionary fiscal policies . This has resulted in a budget deficit tha t i s about 5 % in th e year 2003/04 . However , the tota l reserve s o f the HKSA R is probably o f the orde r o f US$100 billion (HK$776. 8 billion) , excluding reserve s dedicate d t o supportin g th e linke d exchang e rat e mechanism, whic h tota l US$8 0 billio n (HK$621. 4 billion) .

26. Pag e 2 , of the Prefac e t o th e Annual Genera l Repor t fo r 192 5 prepared b y the Governor .

CHAPTER 1 2

1. Th e Hospita l Authority' s "probabl e SAR S case " definitio n require s a n X -ray wit h evidenc e o f pneumonia , a feve r an d tw o o f th e followin g fou r symptoms: chills , cough, myalgi a and/o r exposur e t o a SARS patient. Th e WHO's "probable SARS case" definition require s a fever, cough o r breathin g difficulty an d contac t with SARS patient, or travel to or residence in a SARS-affected area .

2. WH O SAR S Update, www.who.int.csr/sars/archives/2003_05_12/en/, 1 2 May 2003.

3. Danyl o Hawaleshka , "I s thi s your bes t defense? " Maclean's 14 April 2003 . 4. WH O Pres s Release , Malari a i s alive an d wel l an d killin g mor e tha n 3,00 0

African children , www.who.int/mediacentre/releases/2003/pr33/en/ , 2 5 April 2003.

5. Carolin a Urib e an d Victo r Rodriguez , "Pue s Yo Me Vuelvo a Hon g Kong " [Well, I'm returnin g t o Hong Kong], " ElMundo Cronica, www.el-mundo.es / cronica/2003/393/1051447606.html, 2 7 April 2003 .

6. Warre n Kinsella , "The racis t face o f SARS," Macleans 14 April 2003; see also Jan Wong , "Ho w SAR S has becom e th e lates t yello w peril, " The Globe and Mail, www.globeandmaiI.com/servlet/story/RTGAM.2003041 1 .cowong0411 / BNStory, 1 1 April 2003 .

7. Davi d Baltimore , "Tak e a balance d approac h t o SARS, " Asian Wall Street Journal, 2 9 April 2003 .

8. WH O SAR S Updates , www.who.int/csr/sars/archive/2003_03_24/en/ , 2 4

Notes to pages 198-200

March 200 3 an d www.who.int/csr/sars/archive/2003_03_25/en/ , 2 5 Marc h 2004.

9. Th e man y stories of business los t by Hong Kon g companies , particularly i n the trave l an d touris m sectors , le d t o accusation s tha t th e WH O wa s insensitive t o th e economi c consequence s o f it s trave l recommendations . To show tha t th e WHO ha d overreacted , busines s peopl e pointe d t o othe r illnesses, including th e commo n flu , tha t ever y year kil l more peopl e tha n SARS. Publi c healt h professional s aroun d th e world , o n th e othe r hand , stressed th e necessit y o f trave l advisorie s from a public healt h perspective , especially give n th e novelt y o f th e SAR S virus, it s unknow n potentia l an d the fac t tha t i t wa s spreadin g quickl y vi a ai r travel . Th e trave l advisories , although designe d t o warn people travellin g to Hong Kong or Guangdong , also affecte d Hon g Kon g busines s oversea s becaus e peopl e fro m SARS -affected area s wer e see n a s potentia l carrier s o f th e virus . Tw o majo r U S and Swiss luxury goods trade fairs banned Hon g Kong business people fro m participating fo r thi s reason . Immediatel y prio r t o th e commencemen t o f the Base l World Watc h an d Jewellery Show, Swiss officials tol d Hon g Kon g representatives tha t the y could no t participat e i n th e Fai r as exhibitors bu t could stil l be admitte d a s visitors. HKSAR Government official s intervene d without success . A similar even t occurred involvin g a jewellery sho w in La s Vegas, but interventio n ther e di d hel p t o revers e th e decision .

10. Lesli e Chang , "China' s petr i dis h t o th e world, " Asian Wall Street Journal 2 April 2003 .

11. Sara h Schafe r an d Fre d Guterl , "Ho w t o mak e a virus," Newsweek 21 Apri l 2003.

12. Elisabet h Rosenthal , "SAR S force s Beijin g t o figh t a n ol d bu t unsanitar y habit," New York Times 28 May 2003 .

13. On e direc t consequence o f the outbreak was the massive clean-ups in Hon g Kong an d i n mainlan d Chines e cities .

14. Arnau d Bedat , "Dans la Cite de Tous les Dangers [I n the city of all danger]," Lillustre, www.illustre.ch/2003/18/pro_1.html , 3 0 April 2003 .

15. Ala n Fung , "Ho w Singapor e outmanage d th e others, " Asia Times, www.atimes.com/atimes/China/ED09Ad03.html, 9 April 2003 .

16. Keit h Bradsher of the New York Times raised the point at the Panel Discussion: "Rebuilding Asia's World City" at the Hong Kong Foreign Correspondents ' Club, 2 0 June 2003 .

17. "Pro-governmen t cam p criticise s th e Government' s P R handling o f SARS," Ming Pao 5 May 2003 .

18. HKSA R Government Pres s Release, www.info.gov.hk/gia/general/200304/13 / 0413193.htm, 1 2 April 2003 .

19. Maggi e Fox, "HK health-care system on the verge of collapse," Indian Express, www.expressindia.com/fuIIsfory.php?newsid=2-471#compstory, 1 1 April 2003 .

Notes to pages 201-203

20. Jame s Kong of the Hospita l Authority's Health Informatic s an d Informatio n Technology tea m develope d "eSARS, " Persona l Communication , 2 1 July 2003. See also WHO SARS Update, www.who.int/csr/sarsarchive/2003_05_06 / en/, 6 May 2003 .

21. "Fearles s an d professiona l reporter s i n quarantin e camp s an d SAR S hotspots," Ta Rung Pao 14 June 2003 , p . A09.

22. "SAR S and th e media, " Sing Tao Daily 15 May 2003 , p . E06 . 23. Media Digest, "Conclusions o f the Hong Kong media's handling of the SARS

crisis," Radi o Televisio n Hon g Kong , www.rthk.org.hk/mediadigest / 20030515_76_79208.html, Ma y 2003 .

24. Sensationa l reportin g prevaile d i n th e earl y day s o f th e crisis . Se e fo r example, "Kille r pneumoni a se t pani c i n Hon g Kong, " Oriental Daily news headline 1 1 Februar y 2003 ; an d "Fata l pneumoni a i s spreadin g an d i s airborne," Apple Daily 11 Februar y 200 3 (fron t pag e headline) . Se e als o "Mutant fl u outbrea k - Trut h behin d fata l pneumonia, " Next Magazine 13 February 2003, which portrayed the disease as one that affected les s educated mainlanders.

25. Man y Hong Kong newspapers and magazines frequently sho w nude picture s as well a s enlarged image s o f victims who hav e die d gor y deaths . Detaile d narratives in sex-related news stories are also quite common. The Hong Kong media i s ofte n unde r attac k fo r th e deterioratio n o f socia l conduc t an d values. For more criticis m o f specific newspaper s an d magazines , see Yu Fu Kwok, "Th e 21s t centur y networ k o f sinners : A study o f case s o f violation s committed b y th e loca l press, " The Candle Network, Th e Societ y fo r Trut h and Light , Issu e 3 1 Vol. 6 No. 4 , July 2003 . Fo r mor e o n th e loca l media' s effect o n Hon g Kon g society, see Yu Wing On, "Th e anti-intellectualis m o f the Hong Kong Media," Media Digest, RTHK, www.rthk.org.hk/mediadigest / 20020315_76_17701.html, Marc h 2002 .

26. "Socia l responsibility, " Hong Kong Economic Times 1 April 2003 , p . CI3 . 27. Th e discussio n too k plac e o n 2 6 April 200 3 a t th e Fearbuster s Workshop ,

see meetin g recor d a t www.fearbuster.org.hk . 28. "Schoo l o f medicin e dean : Abou t 1 0 SAR S infection s i n th e communit y

untold b y officials ; th e Governmen t wa s hidin g infections , th e Chines e University Shows, " Sing Tao Daily 18 March 2003 , p . A02.

29. "Wha t hav e we learned fro m SARS? " Ta Rung Pao 26 June 2003 , p . A26. 30. "Singapor e close s al l schools , bu t Hon g Kon g Governmen t insist s i t i s no t

for HK, " Apple Daily 27 March 2003 , headline . 31. Cheun g Kwai-yeung , "Th e medi a ha s becom e th e protecto r i n th e figh t

against SARS, " Wen Wei Pao 28 May 2003, p . Al l. Th e mainland-controlle d media i n Hon g Kon g adopte d a mor e rigorou s monitorin g rol e afte r 1 7 April when fighting SAR S and truthfu l reportin g were identified a s explici t priorities of China's national policy on SARS . Tai Rung Pao quoted Chines e

Notes to pages 204-208

president H u Jintao, premier Wen Jiabao and state councillor Tang Jiaxuan in sayin g tha t th e media' s monitorin g rol e an d pus h fo r transparenc y improved man y government policie s on man y occasions . See "Fearless an d professional reporter s i n quarantin e camp s an d SAR S hotspots," Ta Rung Pao 1 4 June 2003 , p . A09.

32. Richar d Cullen , "Th e medi a an d societ y i n Hon g Kong, " i n Building Democracy: Creating Good Governance for Hong Rong, edited b y Christine Lo h and Civi c Exchange ; Hon g Kong : Hong Kon g Universit y Pres s 2003 .

33. Se e "SAR S and th e media, " Sing Tao Daily 15 May 2003 , p . E06. 34. Media Digest, se e endnot e 2 3 for ful l reference . 35. Alber t Chen g too k leav e fro m 1 6 t o 2 7 June 200 3 afte r th e Broadcastin g

Authority warne d hi m fo r callin g a governmen t officia l "doglike " an d criticising a Hospita l Authorit y officia l withou t givin g him enoug h tim e t o defend himsel f o n air . For further discussio n o n th e influenc e o f radio tal k shows in Hon g Kon g politics , see Hanna h Beech , "Makin g waves," Time 14 July 2003 .

36. Th e sho w was highly acclaimed fo r it s role i n protectin g pregnan t medica l workers, a grou p whic h wa s particularly vulnerabl e t o SARS.

37. Critic s focuse d o n th e Exper t Committee' s refusa l t o identif y an y maladministration, lac k of diligence or negligence on the par t of individual officials i n handlin g th e SAR S epidemic . Th e SAR S Exper t Committe e report, entitle d SARS in Hong Rong: From Experience to Action, i s availabl e online a t www.sars-expertcom.gov.hk .

38. Brya n Walsh , "Syste m failure, " Time Asia 28 April 2003 . 39. Timeline , www.sosick.org/timeIine.html , las t update 1 6 June 2003 . 40. "Fearles s an d professiona l reporter s i n quarantin e camp s an d SAR S

hotspots," Ta Rung Pao 14 June 2003 , p. A09. See also "Sydney Chung praises the medi a fo r effectivel y monitorin g th e Governmen t an d encouragin g medical workers, " Ming Pao 15 May 2003 , p . A08.

41. Mar y Le e Win g Ming , "Th e rol e an d influenc e o f th e medi a i n th e SAR S crisis," Hong Rong Economic Journal 1 2 June 2003 , p . 25 .

42. Chri s Sorensen , "Toront o saf e t o visit : Lastma n assure s CN N audience, " Toronto Star 25 April 2003 .

43. O n 2 9 April , afte r heav y lobbyin g b y Canadian politica l heavyweights , th e WHO lifted th e trave l advisory for Toronto, after which loca l media interes t in SAR S waned somewha t unti l th e numbe r o f infections ros e agai n an d a second advisor y had t o be impose d o n 2 6 May. Chapter 9 provides a fulle r account o f th e politic s involve d i n th e WHO's unfortunat e fli p flo p polic y in th e cas e o f Toronto .

44. Ja n Won g o f th e Globe and Mail, persona l communication , 1 8 July 2003 . 45. Anecdota l evidenc e indicate d tha t Westerners livin g i n Hon g Kon g ha d a

lower incidenc e o f wearing facemask s tha n thei r Chines e counterparts .

Notes to pages 209-211

46. B y contrast, Toronto' s populatio n densit y i s 800 per squar e kilometre . Se e Population Densit y b y Area , www.info.gov.hk/censtat/hkinf/popuIation / pop5_index.html, Censu s 8c Statistics Department , 2003 ; and Populatio n o f 30 Metropolitan Area s in Canada , www.canadainfolink.ca/cities.htm, Marc h 2003.

47. "Centra l Governmen t fully supports SAR S control effort s i n HK : Hu Jintao," Peoples Daily, english.peopledaily.com.en/200304/14/eng20030414_115104.shtml, 14 April 2003 .

48. "HK' s ne w SAR S patients numbe r unde r on e digi t pe r day, " Peoples Daily, english.peopledaily.com.cn/200305/13/eng20030513_116587.shtml, 1 3 Ma y 2003. However , a s mainlan d control s o n wha t th e domesti c medi a coul d report wer e relaxe d slightly , ther e wer e man y storie s abou t th e Amo y Gardens outbrea k an d th e experienc e o f residents . Th e sufferin g o f th e residents was recognised nationall y when Premie r Wen Jiabao too k tim e t o visit Amoy Gardens durin g a trip to Hong Kong on 3 0 June 2003 . Wen als o paid a visi t t o Kwo k Sin-hun g an d hi s tw o youn g childre n a t th e neighbouring Lower Ngau Tau Kok Estate. Kwok lost his wife to SARS. Elaine Wu and Ambrose Leung , "For a devastated family , words of comfort," South China Morning Post 1 July 2003 , fron t page .

49. Th e informatio n wa s originall y foun d a t www.chinacdc.net.cn/feiyan / default.asp bu t th e author s hav e no t bee n abl e t o acces s th e informatio n again subsequently .

50. "Transparenc y widespread , Chin a openin g wider, " People's Daily, english.peopledaily.com.cn/200306/28/eng20030628_119023.shtmi, 2 8 Jun e 2003.

51. Joh n Pomfret , "Docto r say s Health Ministr y lied abou t disease, " Washington Post Foreign Service 10 April 2003; and Eric Sautede, "The snares of modernity: Internet, informatio n an d th e SAR S crisi s i n China, " China Perspectives, Number 47 , May-June 2003 , p . 26.

52. Benjami n Ran g Lim, "Chinese doctor gagge d ove r SARS cover-up," Yahoo! News UK & Ireland, uk.news.yahoo.com/030522/80/e0lbm.html, 2 2 May 2003.

53. Staf f Reporter, "Media and academics 'gagge d by officials' ove r SARS," South China Morning Post 2 July, 2003 .

54. Se e fo r example , Andre w Brown , Riller Pneumonia, CNN, aire d 2 7 Marc h 2003.

55. Indir a Lakshmanan , "Explorin g China' s silenc e o n SARS : Ne w detail s surfaces o n initia l cover-up, " Boston Globe 25 May 2003 .

56. I n Ma y 2002, 10.3 million peopl e crosse d th e Hon g Kong-China borde r — an averag e o f 343,000 peopl e pe r day . I n Ma y 2003, th e numbe r droppe d to 7. 5 millio n people , a n averag e o f 250,00 0 pe r day .

57. "Chines e universit y professor : Pneumoni a outbrea k i n Guangzho u di d no t cease," Ming Pao 24 March 2003 .

Notes to pages 211-218

58. Jess e Wong , "SAR S show s danger s pose d b y Articl e 23, " Asian Wall Street Journal 1 1 June 2003 .

59. Josep h Ma n Chan , "Extendin g new s monitoring t o th e mainland : Startin g with SAR S coverage, " Media Digest, Radi o Televisio n Hon g Kong , www.rthk.org.hk/mediadigest/20030616_76_84871 .html , June 2003 .

60. Michae l Yahuda, Hong Rong: China's Challenge, London : Routledg e 1996 , p. 130.

61. Chri s Yeung, "Separatio n an d integration : Hon g Kong-mainlan d relation s in a flux," i n The First Tung Chee-hwa Administration — The First Five Years of the Hong Rong Administrative Region, edited b y La u Kiu-kai . Hon g Kong : Chinese Universit y Pres s 2002 , pp. 249-251 .

62. Carri e Chan , "Encephaliti s expose s system flaws, " South China Morning Post 19 June 2003 , p . A4.

63. Media Watch, Radi o Televisio n Hon g Kong , aire d 3 1 May 2003. The surve y found tha t 88.8 % o f respondent s though t the y receive d sufficien t information; 67.9 % di d no t thin k the y receive d to o muc h information ; 63.9% though t th e coverag e o r informatio n wa s accurate ; 37.4 % though t the coverag e tende d t o b e o n th e positiv e sid e while 30.5 % thought i t was on th e negativ e side ; and 63.8 % though t th e medi a ha d don e a goo d jo b monitoring th e government .

64. Ibid . Also se e "Th e atypica l militar y reporter, " Hong Rong Economic Journal 28 March 2003 , p . 13.

65. Th e HKSA R Governmen t announce d o n 7 July tha t i t woul d defe r th e legislation afte r th e Libera l Part y chairma n resigne d fro m th e Executiv e Council th e day before, which mean t tha t the government would no t carr y the vot e i n th e Legislativ e Counci l i f i t pushed ahea d o n th e 9 July.

66. Chri s Yeung, "The media and politics : A balancing act," Sunday Morning Post 13 July 2003 , p . 10 .

CHAPTER 1 3

1. SAR S Expert Committee , SARS in Hong Rong: From Experience to Action, pp. 71-74, availabl e onlin e a t www.sars-expertcom.gov.hk .

2. Keit h Bradsher , " A deadly viru s o n it s mind , Hon g Kon g cover s it s face, " New York Times 31 March 2003 .

3. Jo e Havely , Mystery Bug Sets Tongues Wagging, CNN , aire d 1 April 2003 . 4. Throughou t Apri l an d th e firs t wee k o f Ma y 2003 , th e U S Business Trave l

Coalition conducte d fou r survey s o f majo r buyer s o f commercia l ai r transportation, Fortune 50 0 Corporations and other companies . On 1 April, 27% o f those surveyed barre d corporat e trave l to Asia; by the tim e o f the 7 April survey , i t had increase d t o 58%, on 1 6 April t o 61% and o n 6 May to 59%. As of 6 May, the largest restrictions were 96% to mainland China , 93%

Notes to pages 218-223

to Hon g Kong , 81 % t o Singapor e an d 33 % t o Toronto . 96 % o f th e respondents feared catchin g SARS; 59% said employees returning from Asi a had t o g o throug h lon g perio d o f quarantine ; an d 100 % sai d the y woul d only trave l t o Asia again afte r th e WH O lifte d th e trave l advisory .

5. Davi d Pang of the Hong Kong Airport Authority, Personal Communication , 12 June 2003 .

6. Josep h Tun g o f th e Trave l Industr y Council , Persona l Communication , 2 4 May 2003 .

7. Aliso n Langley , "Fea r o f respirator y diseas e stymie s Swis s jewelry fair, " a s printed i n th e International Herald Tribune 10 April 2003 , p . 15 .

8. Pupil s Sent Into Quarantine, BBC News, www.news.bbc.co.uk/1 /hi/education/ 2957951.stm, 1 8 April 2003 .

9. Ell a Lee , Michae l Gib b an d Agencies , "WH O rebuke s U S universitie s fo r SARS ban," South China Morning Post 10 May 2003, p . Al .

10. Harr y Doran and Tim Maitland, "Athletes Face Special Olympics Ban," South China Morning Post, 17 May 2003, p . A3.

11. Jame s L u o f the Hon g Kon g Hotels Association, Persona l Communication , 24 May 2003 .

12. Stev e Friess, "In Hong Kong, SARS fears infect hearts and minds," USA Today 15 April 2003 , p . D06.

13. Ell a Lee, "Waging war on a n unknown enemy, " South China Morning Post 26 March 2003 , p . Al l .

14. Th e Chines e Universit y o f Hon g Kong , Fighting SARS: We Care, We Serve, www.cuhk.edu.hk/sars/, June 2003 .

15. Dr . York Chow , "What' s goin g on , an d wha t shal l w e do? " Interna l Mem o for Medica l Colleagues , 1 3 April 2003 .

16. Th e Chines e Universit y o f Hon g Kong , Fighting SARS: We Care, We Serve, www.cuhk.edu,hk/sars/, June 2003 .

17. Se e endnot e 15 . 18. Mar y Ann Benitez , "SARS heroes denied to p honour, " South China Morning

Post 1 July 2003 , pag e C I 6. 19. Shaon i Bhattachary a an d Debor a MacKenzie , "Exoti c animals likel y sourc e

of SARS, " New Scientist, www.newscientist.com/hottopics/sars / article.jsp?id=99993763&sub=News%20update, 2 3 May 2003 .

20. Hon g Kong Government Press Release, www.info.gov.hk/gia/general/200307 / 19/0719079/htm, 1 9 July 2003 .

21. www.register.scmp.com/projectshield/acknowledgements.htm i 22. Indir a A R Lakshmanan, "Explorin g China' s silenc e o n SARS : New detail s

surface o n initia l cover-up, " Boston Globe 25 May 2003 . 23. Ann a Heal y Fenton , "M y husban d shoul d no t hav e die d lik e this, " South

China Morning Post 10 June 2003 , p . A16.

Notes to pages 223-232

24. Tedd y Ng , "SAR S job complaint s swam p watchdog, " The Standard 29 July 2003, p . B3.

25. Pats y Moy, "SARS stigma puts control o f disease at risk," South China Morning Pos* 29 July 2003 , p . CI .

26. Nik i Law , "Generou s spiri t thrive s i n a time o f grea t need, " South China Morning Post 19 May 2003 .

27. Hon g Kong Government Pres s Release, www.info.gov.hk/gia/general/200307 / 19/0719079/htm, 1 9 July 2003 .

28. Se e www.alumni.cuhk.edu.hk/eng/wecare . 29. Se e www.sosick.org . 30. www.hku.hk.gened/withu/Frame3_contents.htm . 31. Th e lunc h wa s attende d b y th e tw o author s fo r thi s chapte r an d anothe r

person i n th e hote l sector . 32. www.hongkongunmasked.co m i s a collaboration betwee n Civi c Exchange an d

Lemon, bot h member s o f Fearbusters . Anothe r sit e create d a s a respons e to SAR S was BrightenH K www.brightenhk.org.hk , whic h a s a collaboratio n between The Outstanding Young Persons' Association, Internet Professiona l Association, Bette r Hon g Kon g Foundatio n an d Worl d Trad e Centre s Association.

33. Th e variou s Fearbuster s campaign s ar e describe d i n thei r Newsletters , www.fearbuster.org.hk. Thi s boo k i s also a direc t resul t o f th e campaign .

34. Se e www.operateunife.hkcss.org.hk . 35. Se e www.teamclean.gov.hk . 36. Se e www.info.gov.hk/gia/general/200305/29/0529228.htm . 37. Se e www.vision2047.org.hk. The Vision 2047 group's mission is to strengthe n

understanding of Hong Kong international role . They wrote a letter in April 2003 which was sent to all the members' contacts all around th e world. Othe r business group s als o poste d th e lette r o n thei r websites .

38. Se e www.hkgcc.org.hk/hkcomesback . 39. Se e www.britcham.co m an d www.amcham.org.hk . 40. Jonatha n Sharp , "SAR S wars : Catha y figh t back, " Hong Rong Business July

2003, pp . 64-66 . 41. Jame s Hughes-Hallett , Chairma n o f Catha y Pacifi c Airways , Flying Through

Turbulent Skies, speech t o the Aerospace Forum Asia Industry Luncehon, 2 1 May 2003 .

42. Hon g Kon g 2003 , exhibitio n catalogue , Fon g 8c Yeung Studio , 2003 . 43. Se e www.sarsart.org . 44. To m Hiditch , "Th e mas k o f sorrow, " Pos t Magazine , South China Morning

Post 8 June 2003 , p . 1 0 8c p . 12 . 45. Ibid , p.12 . 46. Ibid .

Notes to pages 233-242

47. Katherin e Forestier , "Academics in a spin to contain th e SARS fallout," South China Morning Post 24 May 2003 , p . W3.

48. Ell a Lee , Michae l Gib b an d Agencies , "WH O rebuke s U S universitie s fo r SARS ban," South China Morning Post 10 May 2003, fron t page .

CHAPTER 1 4

1. Worl d Healt h Organizatio n (WHO) , Severe acute respiratory syndrome (SARS): Status of the outbreak and lessons for the immediate future, 2 0 May 2003 .

2. Ibid . 3. SAR S Exper t Committee , SARS in Hong Rong: From Experience to Action, 2

October 2003 , pp . 68-70 , availabl e onlin e a t www.sars-expertcom.gov.hk . 4. Mar y Anne Benitez , "Taskforce was on aler t pre-SARS," South China Morning

Pos* 6 June 2003 , p . C6 . 5. Se e endnot e 3 , p . 17 , Figure 3.3 . 6. Repor t o f th e Hospita l Authorit y Revie w Pane l o n th e SAR S Outbreak ,

released b y th e Hospita l Authorit y o n 1 6 Octobe r 2003 , pp . 17-18 , paragraph 2.13 .

7. Ibid , p . 17 , paragraph 2.12 . 8. Ibid , pp . 145-147 , paragraph s 6.96 , 6.9 7 an d 6.102 . 9. Ibid , p . 16 , paragraph 2.8 . 10. Ibid , p . 30 , paragrap h 3.8 . 11. Se e endnot e 3 , pp. 87-90 . 12. Ibid , pp . 87-88 . 13. Ibid , p . 88. 14. Civi c Exchang e an d th e Nationa l Democrati c Institut e fo r Internationa l

Affairs (NDI) , Accountability Without Democracy, Septembe r 2002 , p . 2 9 paragraph 7.6 .

15. Ell a Lee, "Hospita l vetoed SAR S ward closure, " South China Morning Post 31 July 2003 , p . 1 . The SAR S Expert Committe e note d tha t "th e absenc e o f a pre-determined hospita l outbrea k contro l pla n an d th e inadequat e involvement o f [Departmen t o f Health ] staf f i n critica l decision s abou t outbreak contro l measures a t PWH were not conducive t o the managemen t of th e outbreak, " se e SARS in Hong Rong: From Experience to Action, p . 71.

16. Se e endnot e 6 , p . 18 , paragraphs 2.15-2.16 . 17. Ibid , p.19 , paragrap h 2.20 . 18. Se e endnot e 3 , p. 72 . 19. Mar y Ann Benitez , "Th e struggl e t o profil e a killer, " South China Morning

Post 25 June 2003 , p . A14. 20. Ibi d 21. Se e endnot e 6 , p . 16 , paragraph 2.9 . 22. Se e endnot e 3 , p . 74 .

280 Notes to pages 243-249

23. Ibid , p . 67 . 24. Ibid . 25. Pats y Moy , "Leader s showe d indifferenc e toward s outbreak , say s panelist, "

South China Morning Post 5 October 2003 , fron t page . 26. Fo r a usefu l discussio n o f th e possibl e lega l issues , see D K Srivastava an d

Richard Cullen , "SAR S in the HKSAR: Some Important Lega l Issues," Hong Rong Lawyer July 2003 , pp . 71-83 .

27. Ravin a Shamdasani, "Payout to 3 more medics' families," South China Morning Post 30 June 2003 , p . C14 .

28. Th e University of Hong Kong's Public Opinion Programme conducte d man y surveys before an d afte r 1 July 2003 that provide useful informatio n o n ho w members of the Hong Kong public felt about how they were being governed . See http://hkupop.hku.hk .

CONTRIBUTORS

Stephen Brown has lived in Hon g Kon g for twent y years. He i s marrie d with tw o teenag e children . H e i s head o f regiona l researc h a t Ki m En g Securities, a leadin g Asia n securitie s firm . H e i s particularly intereste d in the economics of public policy decisions and has become increasingl y interested i n th e histor y o f publi c polic y developmen t i n Hon g Kong . He i s a regula r columnis t wit h The Standard newspaper i n Hon g Kong , appears regularl y on bot h televisio n an d radi o an d i s a director o f Civic Exchange, Hon g Kong' s independen t publi c polic y thin k tank .

Moira Chan-Yeung is on leave as a Professor o f Medicine at the Universit y of Britis h Columbi a (UBC ) an d i s currentl y Chai r Professo r o f Respiratory Medicin e a t th e Universit y o f Hon g Kong . Sh e ha s heade d the Occupationa l an d Environmenta l Lun g Diseases Unit a t UBC sinc e 1989. Sh e ha s als o serve d a s th e Chairperso n o f th e Assembl y o f Environmental an d Occupationa l Healt h fo r th e America n Thoraci c Society; a s a membe r o f th e Pulmonar y Diseas e Advisor y Committee , National Heart , Lung , an d Bloo d Institute , par t o f th e U S Nationa l Institutes o f Health ; an d a s Chairperso n o f th e Respirator y Disease s Section fo r th e Internationa l Unio n Agains t Tuberculosi s an d Lun g Disease. Professor Chan-Yeung' s research interest s include occupationa l asthma an d lun g disease , environmenta l an d geneti c ris k factor s i n asthma an d lun g cancer , an d th e epidemiolog y an d contro l o f tuberculosis.

281

Contributors

Gregory Chen g was born i n Hon g Kon g an d complete d secondar y schoo l at St . Joseph 's College . I n 197 1 h e studie d i n Canad a an d obtaine d M D a n d P h D d e g r e e s a t t h e Univers i t y o f T o r o n t o , spec i a l i s i n g i n Haematology, Transfusio n Medicin e an d Oncology . Dr . Chen g re tu rne d to wor k i n H o n g Kon g i n 1992 , firs t a t th e Quee n Mar y Hospita l an d then a t th e Princ e o f Wales Hospital , wher e h e ha s bee n sinc e 1997 . H e is no w a fello w o f th e H o n g Kon g Academ y o f Medicine , an d Professo r at th e Facult y o f Medicine , Chines e Universit y o f H o n g Kong .

William Chi u receive d hi s Bachelo r o f Scienc e i n Busines s fro m th e University o f Minnesota , USA , in 1997 . Upon returnin g t o hi s hometow n of H o n g Kong , h e too k u p busines s p lannin g an d suppor t role s o n th e t r ad ing floor s o f J P Morga n an d Cit iban k an d als o assiste d i n th e founding o f a n in terne t start-u p business . Chi u ha s bee n a Researche r for Civi c Exchang e sinc e Apri l 200 3 an d i s currently a n MB A studen t a t the H o n g Kon g Universit y o f Scienc e an d Technology .

Michael E DeGolye r ha s bee n Directo r o f th e H o n g Kon g Transitio n Project sinc e 1993 . H e ob ta ine d hi s Ph D i n 198 5 fro m C l a r e m o n t G r a d u a t e University , USA , i n compara t iv e a n d his tor ica l pol i t ica l economy an d i s Associat e Professo r o f Governmen t an d Internat iona l Studies a t H o n g Kon g Baptis t University . H e ha s co-authore d tw o book s and i s th e au tho r o f mor e tha n 7 0 researc h papers / repor t s an d ove r 6 0 published researc h article s an d boo k chapters . DeGolye r ha s als o bee n a weekly columnis t fo r The Standard ( a China-regio n busines s daily ) sinc e May 200 0 an d a n invite d columnis t fo r th e South China Morning Post, Apple Daily, Hong Rong Economic Times, an d th e Asian Wall Street Journal H e i s a contr ibuto r t o th e Economis t Intelligenc e Uni t quarterl y Country Reports on Hong Rong (1995-1998 , 2000-present) . Sinc e 1989 , he ha s mad e over 2,50 0 briefing s t o loca l a n d in t e rna t iona l med ia , businesses , consulates an d othe r official s o f mor e tha n 5 0 countries , H o n g Kon g Government depar tments , an d academic s o n H o n g Kon g an d Chin a affairs.

Veronica Galbraith obtained he r B A in Psycholog y from Huro n Universit y College a t th e Universit y o f Wester n Ontario , Canada . Fro m 1998-200 1 she manage d tutor s an d student s wit h Frontie r College , a Canadia n literacy organisation , a s part o f it s London (Ontario ) executive . Sh e als o worked a t th e Canadia n Consulat e i n H o n g Kon g betwee n 199 9 an d

Contributors

2003. Galbrait h joined Civi c Exchange i n Marc h 200 3 as a Researcher . As such, sh e ha s worked o n a wide rang e o f projects includin g a repor t on corporat e socia l responsibility , th e Fearbuster s campaign , an d th e publication Building Democracy: Creating Good Government for Hong Rong.

Anthony J Hedley has been Chai r Professor o f Community Medicin e i n the Universit y o f Hon g Kon g sinc e 1988 . He wa s formerly professo r o f public health i n the University of Glasgow. His main research and publi c health advocac y interest s i n recen t year s hav e bee n i n th e fiel d o f environmental health , includin g outdoo r an d indoo r ai r pollution, an d the preventio n o f diseas e cause d b y tobacco . An importan t goa l o f th e University o f Hon g Kong' s Departmen t o f Communit y Medicin e i s t o translate epidemiologica l researc h finding s int o publi c healt h policy .

Tai-Hing Lam graduated fro m th e Faculty of Medicine o f the Universit y of Hon g Kon g i n 197 5 and obtaine d hi s MD degree ther e i n 1988 . H e has bee n Chai r Professo r an d Hea d o f th e Departmen t o f Communit y Medicine o f the University of Hong Kong since 2000. His research span s the area s o f epidemiology , occupationa l an d environmenta l health , tobacco control , lifestyl e factors , sexua l an d adolescen t health , an d molecular epidemiology .

Alexis La u i s a n environmenta l scientis t an d Associat e Directo r o f th e Center fo r Coasta l an d Atmospheri c Researc h o f th e Hon g Kon g University o f Scienc e an d Technology . A native o f Hon g Kong , Alexi s graduated fro m th e Chines e Universit y o f Hong Kon g i n 1984 , go t hi s PhD i n Atmospheri c an d Oceani c Science s fro m Princeto n Universit y in 1991 , and returne d t o Hon g Kon g just befor e 1997 . His specialt y i s in modellin g an d statistica l dat a analysi s fo r environmenta l an d atmospheric sciences , wit h particula r focu s o n ai r qualit y issue s ove r Hong Kong and th e Pearl River Delta. A true believer in the importanc e of explainin g scienc e t o th e public , h e als o work s activel y t o promot e science educatio n i n primar y schools .

Edith MC Lau is a Professor in the Department of Community and Family Medicine in the Chinese University of Hong Kong. She is also the Deput y Director o f th e Schoo l o f Publi c Health an d th e Directo r o f th e Jockey Club Center for Osteoporosi s Care and Control in the Chinese Universit y of Hong Kong. She is currently the President of the Hong Kong Colleg e

Contributors

of Community Medicine . Sh e i s an exper t i n th e fiel d o f epidemiology , and ha s conducted muc h researc h i n women's health , osteoporosi s an d other chroni c diseases . Sh e ha s contribute d t o origina l epidemiolog y research and th e development of public health policy in the recent SARS outbreak. Sh e ha s publishe d mor e tha n 10 0 paper s i n internationa l medical journals.

Gabriel M Leun g i s currentl y Clinica l Assistan t Professo r a t th e Department o f Communit y Medicin e o f th e Universit y o f Hon g Kong . He i s a ke y membe r o f th e SAR S Epidemiolog y an d Publi c Healt h Research Group , a collaboration betwee n th e Universit y of Hong Kon g and Imperia l College , London . Hi s researc h span s th e area s o f epidemiology, health services research, and health policy and economics . As a Fulbright Scholar , he graduate d fro m Harvar d Universit y School o f Public Health an d received his undergraduate an d postgraduate medica l education a t th e Universitie s o f Western Ontari o an d Toronto .

Christine Lo h i s Chie f Executiv e Office r o f Civi c Exchange , a n independent publi c polic y think-tank . Sh e hold s a la w degre e fro m England an d a Master s Degre e i n Chines e an d Comparativ e La w fro m City University , Hon g Kong . Sh e als o ha s bee n awarde d th e degre e o f Doctor of Law, honoris causa, from he r alma mater, the University of Hull, England. In 1992 , she was appointed t o the Legislative Council . She gave up he r busines s caree r i n 199 4 to become a full-time legislato r an d ra n successfully i n th e 199 5 and 199 8 elections . Sh e chos e no t t o stan d fo r re-election i n 200 0 t o star t Civi c Exchange . He r wor k i n publi c polic y and promotin g environmenta l protectio n an d equa l opportunit y i s well known. Lo h write s extensivel y fo r loca l an d internationa l publications .

Stephen K.C. Ng graduated fro m th e Facult y of Medicine, University o f Hong Kon g i n 1972 . H e subsequentl y wen t t o th e Unite d State s an d became a board-certified paediatricia n i n 1979 . He obtaine d hi s Docto r of Publi c Healt h (Epidemiology ) fro m th e Schoo l o f Publi c Health , Columbia Universit y i n 1986 . Dr . N g wa s a lecture r o f Communit y Medicine a t th e Universit y o f Hon g Kon g betwee n 1974-76 . H e wa s Professor o f Paediatric s an d Epidemiolog y a t Columbi a Universit y between 1986-9 3 doing researc h i n perinata l an d cance r epidemiolog y before returnin g t o Hon g Kon g i n 1993 . He i s now Adjunct Associat e Professor o f Communit y Medicin e a t th e Chines e Universit y o f Hon g Kong as well as Special Lecturer in Epidemiology at Columbia University .

Contributors

Alexandra A Sen o i s a freelanc e journalis t an d th e Hon g Kon g correspondent fo r Newsweek magazine. As the granddaughter , daughte r and siste r o f medica l doctors , th e SAR S outbreak wa s a stor y tha t wa s personally importan t t o her . Alexandr a ha s covere d Asia n economics , politics, health an d po p cultur e fo r ove r a decade, including seve n an d a hal f years a t Asiaweek Magazine ( a Time Inc . weekly publication base d in Hong Kong) . After receivin g her Bachelo r o f Science undergraduat e business la w degre e fro m th e Atene o d e Manil a Universit y i n th e Philippines, sh e attende d Xiame n Universit y i n Fujia n fo r a year o n a Chinese Educatio n Ministr y scholarship . Alexandra' s wor k ha s als o appeared i n th e Washington Post and th e International Herald Tribune, Sh e has live d i n Hon g Kon g sinc e 1994 .

Jennifer Welker is editor o f TravelWeekly China, a trave l trad e magazin e published b y a divisio n o f Ree d Elsevie r PLC . Sh e als o contribute s t o TravelWeekly's sister publications for the Asia-Pacific regio n based in Hon g Kong. Bor n i n E l Paso, Texas, she move d o n soo n after , an d travellin g became a very natura l par t o f he r life . A t th e ag e o f 11 , she move d t o Hong Kon g fo r tw o years an d witnesse d Chin a just a s i t opened t o th e outside worl d i n th e earl y 1980s . Sh e the n realize d Asi a i s where sh e wanted to spend the rest of her life. Upon graduation from th e University of Missouri-Columbia' s Schoo l o f Journalism i n 1993 , she fle w directl y to Beijin g wher e sh e spen t thre e year s i n intensiv e Mandarin-languag e courses a t the Beijin g Capita l Teacher's University . She has remained i n Asia eve r since .

YIP Yan-yan is a Researcher a t Civic Exchange. Sh e has assisted i n Civi c Exchange's variou s project s suc h a s the Clea n Environmen t Campaig n and researc h o n th e Principa l Official s Accountabilit y System . Sh e als o took par t in researc h fo r th e HKSAR Government's Centra l Polic y Uni t on th e Third Secto r developmen t in Hong Kong in 2002 . She is now co-ordinating th e Enhancin g Democrati c Participatio n Projec t a t Civi c Exchange an d a project o n ho w to sustain a cleaner environment a t th e Lower Nga u Ta u Ko k Estat e post-SARS . Yi p receive d he r MS c i n International Relation s fro m th e Londo n Schoo l o f Economics , UK .