A Lesson in History – SARS in Hong Kong

Go Lean Commentary

Sadly, we report – though it is only a reminder – that there is no cure for the common cold; nor its more debilitating “Big Brother”, influenza or “the flu”.

Sometimes the flu is just the flu. Symptoms may include cough, sore throat, fever, myalgia (muscle pain), and lethargy (fatigue or drowsiness, or prolonged sleep patterns). Unfortunately this normal start for influenza may morph into more serious concerns. For example, consider the SARS epidemic of 2003; see Appendix A.  The same symptoms, above, were the applicable descriptors at the start of the SARS outbreak.

Why would anyone think of anything more than the common/annual flu? How can a community – the Caribbean region in this case – manage such an epidemiological crisis?

For this, we have a well-documented lesson from Hong Kong in 2003. There is much for us to learn from this lesson in history.

The people, institutions and governance of the Caribbean need to pay more than the usual attention to the lessons of SARS in Hong Kong, not just from the medical perspective (see Appendix B), but also from an economic viewpoint.

During the “heyday” of the SARS crisis, travel and transport to Hong Kong virtually came to a grinding halt! Hong Kong had previously enjoyed up to 14 million visitors annually; they were a gateway to the world. The SARS epidemic became a pandemic because of this status. Within weeks of the outbreak, SARS had spread from Hong Kong to infect individuals in 37 countries in early 2003.[3]

Can we afford this disposition in any Caribbean community? Consider this VIDEO:

VIDEO: SARS on Hong Kong’s Economy – BiA Fall 2013 – https://youtu.be/l0rSJhUaCU8

Published on Dec 5, 2013 – Documentary of the impact of the 2003 SARS period in Hong Kong and on its economy. (Business in Asia presentation clip)

Consider how this history may impact the Caribbean region. SARS in Hong Kong was 12 years ago. But last year the world was rocked with an Ebola crisis originating from West Africa. An additional example local to the Caribbean is the Chikungunya virus that emerged in Spring 2014. The presentation of these facts evinces that we cannot allow mis-management of any public health crisis; this disposition would not extend the welcoming hospitality that the tourism product depends on. Our domestic engines cannot sustain an outbreak of a virus like SARS (nor Ebola nor Chikungunya). Less than an outbreak, our tourism economic engines, on the other hand, cannot even withstand a rumor. We must act fast, with inter-state efficiency, against any virus.

This is the goal as detailed in the book Go Lean … Caribbean as it serves as a roadmap for the introduction of the technocratic Caribbean Union Trade Federation (CU). The vision of the CU is to ensure that the Caribbean is a protégé of communities like the US and EU states, not a parasite. This roadmap is an anti-parasite campaign. A virus, like SARS, is a parasite! This commentary is the factual lesson:

Medically, there are effective remedies for SARS; (thank you Hong Kong for teaching this lesson); see Appendix B.

Antibiotics are ineffective, as SARS is a viral disease. Treatment of SARS is largely supportive with antipyretics (fever reducers), supplemental oxygen and mechanical ventilation as needed.

Suspected cases of SARS must be isolated, preferably in negative pressure rooms, with complete “barrier nursing” precautions taken for any necessary contact with these patients; (protective gear: masks, gloves, etc).

The full details of the Hong Kong experience is provided here:

Title: SARS legacy still felt in Hong Kong, 10 years on
By Katie Hunt, BBC News; posted 20 March 2013

Hong Kong – Bathed in low evening light, Amoy Gardens is a hive of activity. People duck in and out of noodle joints, fast food chains and convenience stores before heading home to the warren of apartments nestled in the estate’s nineteen tower blocks.

But 10 years ago, this densely populated Hong Kong apartment complex, home to 19,000 people, was an eerie ghost town.

Two hundred residents had contracted a deadly respiratory disease, now known as SARS, within a week and no-one knew how it was spreading.

Rats and cockroaches were touted by the press as possible culprits.

“Taxi drivers refused to come here,” Yip Hing Kwok, a long-time resident and now a local councillor, recalls of the deadly 2003 outbreak.

Alarm turned to panic on March 31 when residents of block E, which experienced the densest concentration of cases, woke up to find that they were unable to leave their building as police and medical staff clad in protective suits enforced an emergency quarantine order.

Police were ordered to chase down those who had already left and residents were later moved to two holiday camps.

“We tried to improve the cleaning of the estate but the number of cases kept increasing,” says Mr Yip, who did not live in the blighted block. “The situation was uncontrollable.”

Starring role
Amoy Gardens played an unwanted starring role in the 2003 SARS epidemic that infected 8,096 worldwide, and killed 744. The disease, from the same family of viruses as the common cold, emerged in southern China at the end of 2002. CU Blog - A Lesson in History - SARS in Hong Kong - Photo 2

It was carried to Hong Kong by a doctor, whose one-night stay in the Metropole Hotel resulted in seven other guests being infected. These guests then jumped on planes, spreading SARS around the world.

While the disease appeared to spread fast, the number of people killed by the virus was relatively small, especially compared with the half a million people who died of influenza in the same year.

But these facts were not known until the disease had come under control in the summer. In March and early April of 2003, as the epidemic seemed to spiral out of control, Hong Kong was a city gripped by fear.

CU Blog - A Lesson in History - SARS in Hong Kong - Photo 1Surgical masks became hot commodities and the city’s usually crowded shopping malls, restaurants and mass transport emptied. Expats fled, schools closed and those who could worked from home.

Back then, working as a reporter in the city, I recall being urged by a contact to head straight for the airport as Hong Kong was to be declared an infectious port and sealed from the outside world. A teenager was later arrested in what turned out to be an April Fool’s Day stunt.

On the same day, a hugely popular singer and actor, Leslie Cheung, committed suicide by jumping from the 24th floor of the Mandarin Oriental hotel in the middle of the financial district, plunging an already anxious Hong Kong into mourning.

Of course, Hong Kong was not the only place to suffer during the epidemic.

Singapore, Taipei, Beijing and Toronto were hard hit and China’s citizens were kept in the dark about the outbreak as the country’s leaders initially refused to acknowledge the extent and severity of the disease.

But it is perhaps in Hong Kong, the city that suffered the greatest number of casualties, that its legacy is felt most keenly.

Praise and criticism
Hong Kong earned praise for its transparency in reporting the spread of the disease, in sharp contrast to the cover-up in China.

Like the rest of the city, I was glued to the daily 4.30pm televised press conference during the outbreak that detailed the latest death toll and new cases.

However, the government was criticised for its early handling of the outbreak, particularly at Amoy Gardens, where 42 died and 329 were infected.

Hong Kong has taken the lessons to heart, both in its approach to managing new diseases and maintaining hygiene.

Ten years after the outbreak, apartment and office blocks still boast of how many times daily they sanitise lift buttons, hand rails, door knobs and almost all public surfaces. Masks are de rigueur if you have a cold, and a sneezing or coughing fit on public transport meets with disapproving glances.

Kindergartens, like the one my daughter attends, require parents to record their child’s body temperature in a special notebook each morning. If we forget, a note comes back admonishing us.

The threat of a new outbreak is taken extremely seriously and measures are taken that might seem excessive elsewhere. In 2009, the city quarantined 286 guests staying at a downtown hotel for seven days after a Mexican traveller was confirmed as contracting swine flu.

And the city is closely monitoring the emergence of a new SARS-like illness after rumours, later proved unfounded, of a case in Hong Kong in February. The disease has infected 12 and killed six people worldwide.

Bounced back?
Amoy Gardens, like the rest of Hong Kong, has recovered from the SARS outbreak and the economic downturn it triggered with the panache typical of this fast-paced city.

The apartment complex and shopping plaza has since had a HK$60 million (5.1m; $7.7m) facelift, including changes to the drainage and sewage system that was ultimately found to have played a role in the quick spread of the disease at the estate.

Two-bedroom apartments that once struggled to find buyers in the outbreak’s aftermath now fetch HK$3.9m (0.33m; $0.5m) – beneficiaries of a recent property boom.

On a tour of the infamous block E, Mr Yip proudly points out the air purifiers in the marbled lobby, where a cleaning lady stands with detergent and a grey cloth poised to wipe away any germs left by visitors.

But the memories are harder to erase.

Mr Yip said many residents, fed up with the stigma attached to their address, left after the outbreak, and those that remained have asked him to deflect the media attention the 10-year anniversary has attracted.

In the residents’ committee office, Mr Yip flips through a binder of old newspaper clippings and stops on a picture of a young quarantined boy peering from a window at the armed policemen encircling the entrance to his home – a photograph he says made a particular impression on him at the time.

“l felt so helpless,” he tells me. “We want to forget our unhappy image.”
BBC News Website (Posted 20 March 2013; Retrieved 24 March 2015) –

Prior to this SARS outbreak, the WHO had developed a Pandemic War Plan, reserved for the worst situations; see Appendix C. This features strategies and tasks to identify, isolate and eradicate a major virus outbreak … at the start. But the War Plan presents a cautionary warning: should the disease ever escape the isolation attempts, the result could be socio-economic disaster, with millions dead.

The possibility of this warning is the motivation of this commentary and the Go Lean movement.

In general, the CU will employ its own “War Plan”; its strategies, tactics and implementations to impact its prime directives. These prime directives are defined with the following 3 statements:

  • Optimization of the economic engines in order to grow the regional economy to $800 Billion & create 2.2 million new jobs.
  • Establishment of a security apparatus to protect the resultant economic engines and mitigate internal and external threats.
  • Improve Caribbean governance to support these engines.

The issue in this commentary relates to economics, security and economic security; in effect this is a governance issue. This is an issue of business continuity for the region. Early in the Go Lean book, this need for careful technocratic stewardship of the regional Caribbean economy was pronounced (Declaration of Interdependence; Page 12 – 13) with these acknowledgements and statements:

xi.   Whereas all men are entitled to the benefits of good governance in a free society, “new guards” must be enacted to dissuade the emergence of incompetence, corruption, nepotism and cronyism at the peril of the people’s best interest. The Federation must guarantee the executions of a social contract between government and the governed.

xii.   Whereas the legacy in recent times in individual states may be that of ineffectual governance with no redress to higher authority, the accedence of this Federation will ensure accountability and escalation of the human and civil rights of the people for good governance, justice assurances, due process and the rule of law. As such, any threats of a “failed state” status for any member state must enact emergency measures on behalf of the Federation to protect the human, civil and property rights of the citizens, residents, allies, trading partners, and visitors of the affected member state and the Federation as a whole.

xvi.  Whereas security of our homeland is inextricably linked to prosperity of the homeland, the economic and security interest of the region needs to be aligned under the same governance. Since economic crimes, including piracy and other forms of terrorism, can imperil the functioning of the wheels of commerce for all the citizenry, the accedence of this Federation must equip the security apparatus with the tools and techniques for predictive and proactive interdictions.

xxiv.  Whereas the legacy of international democracies had been imperiled due to a global financial crisis, the structure of the Federation must allow for financial stability and assurance of the Federation’s institutions. To mandate the economic vibrancy of the region, monetary and fiscal controls and policies must be incorporated as proactive and reactive measures. These measures must address threats against the financial integrity of the Federation and of the member-states.

The Go Lean book, and previous blog/commentaries, stressed the key community ethos, strategies, tactics, implementations and advocacies necessary to regulate and manage regional threats and emergencies. These points are detailed in the book as follows:

Community Ethos – Privacy versus Public Protection Page 23
Community Ethos – “Crap” Happens Page 23
Community Ethos – Lean Operations Page 24
Community Ethos – Cooperatives Page 24
Community Ethos – Non-Government Organizations Page 25
Community Ethos – Ways to Improve Sharing Page 35
Community Ethos – Impact the Greater Good Page 37
Strategy – Vision – Non-Sovereign “Unified” Proxy Entity Page 45
Strategy – Customers – Residents & Visitors Page 47
Strategy – Agents of Change – Globalization Page 57
Tactical – Confederating a Permanent Union Page 63
Tactical – Fostering a Technocracy Page 64
Separation of Powers – Emergency Management Page 76
Separation of Powers – Disease Control & Management Page 86
Implementation – Ways to Pay for Change Page 101
Implementation – Security Initiatives at Start-up Page 103
Implementation – Ways to Deliver Page 109
Implementation – Ways to Foster International Aid Page 115
Implementation – Ways to Benefit from Globalization Page 119
Planning – Ways to Improve Failed-State Indices Page 134
Planning – Ways to Measure Progress Page 148
Advocacy – Ways to Grow the Economy Page 151
Advocacy – Ways to Improve Healthcare Page 156
Advocacy – Ways to Improve Governance Page 168
Advocacy – Ways to Better Manage the Social Contract Page 170
Advocacy – Ways to Foster Cooperatives Page 176
Advocacy – Ways to Impact Justice Page 177
Advocacy – Ways to Improve Homeland Security Page 180
Advocacy – Ways to Mitigate Terrorism Page 181
Advocacy – Ways to Improve for Natural Disasters Page 184
Advocacy – Ways to Improve Emergency Management Page 196

The Go Lean movement posits that wisdom, prudence and best practices can be adopted by careful study of complex matters. This is defined in the Go Lean book and subsequent blogs as a hallmark of a technocracy. The points of effective, technocratic stewardship gleaned from facts in history were further elaborated upon in these previous blog/commentaries:

http://www.goleancaribbean.com/blog/?p=4166 A Lesson in History: Panamanian Balboa
http://www.goleancaribbean.com/blog/?p=2809 A Lesson in History: Economics of East    Berlin
http://www.goleancaribbean.com/blog/?p=2670 A Lesson in History: Rockefeller’s Pipeline
http://www.goleancaribbean.com/blog/?p=2585 A Lesson in History: Concorde SST
http://www.goleancaribbean.com/blog/?p=2480 A Lesson in History: Community Ethos of WW II
http://www.goleancaribbean.com/blog/?p=2297 A Lesson in History: Booker T versus Du Bois
http://www.goleancaribbean.com/blog/?p=1531 A Lesson in History: 100 Years Ago – World War I
http://www.goleancaribbean.com/blog/?p=798 Lessons Learned from the American Airlines merger

The Go Lean book reports that previous Caribbean administrations have failed miserably in managing regional crises. There is no structure for cooperation, collaboration and coordination across borders. This is the charge of the Go Lean/CU roadmap. To effectuate change in the region by convening all 30 Caribbean member-states, despite their historical legacies or governmental hierarchy.

The CU is not designed to just be in some advisory role when it comes to pandemic crises, but rather to possess the authority to act as a Security Apparatus for the region’s Greater Good. This is the mandate as pronounced in the opening Declaration of Interdependence (Page 11) related to climate change, but it applies equally to pandemics, to …

“protect the entire region it is necessary to prepare to insure the safety and security of life, property and systems of commerce in our geographical region. As nature recognizes no borders in the target of its destruction, we also must set aside border considerations in the preparation and response to these … challenges”.

Legally, each Caribbean member-state would ratify a Status of Forces Agreement that would authorize this role for the CU agencies (Emergency Management and Disease Control & Management) to serve as a proxy and deputy of the Public Health administrations for each member-state. This would thusly empower these CU agencies to quarantine and detain citizens with probable cause of an infectious disease. The transparency, accountability and chain-of-command would be intact with the appropriate checks-and-balances of the CU’s legislative and judicial oversight. This is a lesson learned from Hong Kong 2003 with China’s belligerence.

SARS was eradicated by January 2004 and no cases have been reported since. [4] We must have this “happy-ending”, but from the beginning. This is the lesson we can learn and apply in the Caribbean. This exercise makes our Caribbean elevation quest conceivable, believable and achievable.

Yes, we can make our homeland a better place to live, work and play.  🙂

Download the free e-Book of Go Lean … Caribbean – now!


Appendix A – SARS Definition / Timeline

CU Blog - A Lesson in History - SARS in Hong Kong - Photo 3What is SARS? SARS stands for Severe Acute Respiratory Syndrome and was the name given to the respiratory disease by the World Health Organization on March 15, 2003. Like the common cold, it belongs to the coronavirus family.

Scientists think the disease jumped from civet cats, a delicacy in southern China, to humans. It has also been linked to bats.

Timeline – SARS Outbreak 2003:

  • January 23 – Health authorities in China’s Guangdong province produce a report on cases of atypical pneumonia occurring in the province. The report is not shared with the WHO or Hong Kong government
  • Feb 21 – A medical professor from Guangzhou checks into the Metropole Hotel in Hong Kong for one night, bringing the virus to Hong Kong. He infects other guests, who spread the virus to Vietnam, Singapore and Toronto
  • March 12 – Hong Kong reports 23 cases of the disease at one hospital.
  • March 15 – WHO names the new disease as Severe Acute Respiratory Syndrome (SARS) and says cases have been found in China, Hong Kong, Indonesia, Philippines, Singapore, Thailand, and Vietnam
  • March 31 – Amoy Gardens Block E isolated and residents quarantined
  • April 5 – China apologises for its slow response to the SARS outbreak amid allegations that officials have covered up the true extent of the spread of the disease
  • April 16 – WHO announces that a new pathogen, a member of the coronavirus family never before seen in humans, is the cause of SARS
  • May 23 – Research teams in Hong Kong and Shenzhen, China detect several coronaviruses closely related to SARS in masked palm civet and raccoon-dog at a market in southern China selling wild animals for human consumption
  • June 4- WHO says the outbreak is in decline
  • June 11 – Hong Kong’s last SARS case reported


Appendix B – Referenced Citation

The SARS epidemic in Hong Kong: what lessons have we learned [medically]? Journal of the Royal Society of Medicine; August 2003; retrieved March 24, 2015 from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC539564/


Appendix C – VIDEO: Additional homework – BBC Horizon: SARS, The True Story (2003)

Link: https://youtu.be/MXPaee0uEQM

(This VIDEO length is 45 minutes)

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