Juxtaposing Pandemic Years: A Review on SARS After Two Decades

As Hongkongers recently began to shed their masks and walk out of COVID-19’s shroud, 2023 also marks 20 years after the locals persevered from another epidemic battle, the severe acute respiratory syndrome (SARS) back in 2003. The outbreak of SARS parallels COVID-19 in a number of ways. Both being a form of coronavirus disease, they were similarly sparked by cross-species transmission of unbeknownst viruses from infectious wild animals sold as game meat.

Those who survived the 2003 pandemic will find recent combating measures such as quarantine, health declaration and mandatory mask-wearing familiar. Yet, they were carried out on an unprecedented scale and degree as opposed to its four-month precursor.

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Hongkongers riding the metro with masks during the SARS outbreak in 2003. Photo credit: Getty Images

Even after the city has survived possibly one of the deadliest vicissitudes of the century, SARS does not cease to evoke scarring collective memories and trauma of the millennium’s early years when the outbreak attacked rapidly and unexpectedly like a panther.

“Those were really arduous times. None of us can go home without overtime every single night because we lack the manpower, to begin with. SARS gravely aggravated the situation,” said Chris Lam, a carer who worked at Ci Hao Elderly Home at Ngau Tau Kok.

The elderly have a lower chance of survival due to their weaker immune system. We needed to monitor them more closely on a daily basis and had to take them to the hospital when we weren’t sure, as the symptoms of flu and SARS were similar and difficult to identify during the early stages.

– Chris Lam, a carer at Ci Hao Elderly Home

In fact, among the 295 deaths as of 16 June 2003, a staggering 186 were elders, making up 63% of the cumulative death toll. There were 323 SARS cases recorded among the elders, and more than half of them could not make it.

Left with the long-lasting repercussions of SARS, some of the survivors still suffer from the aftereffects of the contagious disease today.

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Wildlife civet cats were sold as game meat in Guangzhou in 2002. Its importation was later prohibited in Hong Kong on 24 May, 2003. Photo credit: Getty Images

The SARS virus could be traced back to Guangdong in November 2002 when infected civet cats were found in a wildlife wholesale market in Guangzhou, according to the World Health Organization (WHO) in 2003.

The index patient that sparked the first case of the outbreak was a 33-year-old man who lived in Shenzhen. He frequented his brother’s apartment in the Amoy Gardens. The excreta he disposed of allegedly spread the virus to his brother, sister-in-law and the two medical staff from the Prince of Wales Hospital who looked after the infected couple. The coronavirus disseminated through the estate’s Sewage Drainage System and via human contact, resulting in the concentrated outbreak at the Amoy Gardens.

The Public Health Group discussing with the Department of Health officials outside of the highly infected Block E Amoy Gardens during an inspection on July 9, 2003. Photo credit: Public Health Group of SARS Expert Committee

Up till 15 April 2003, Block E had accounted for 41% of the cumulative total, becoming the estate with the largest concentration of cases in the territory back then. Ironically, this building held a record of zero COVID-19 contamination cases for about eight months after the coronavirus broke out locally in 2020.

By early March 2003, the mysterious virus caught the medical sector off guard, resulting in widespread outbreaks across the city.

“It was heartbreaking to see them being taken away to the hospital night after night. I kept thinking to myself whether it would be the last time seeing them,” Lam recalls. She worked in the same district as the Amoy Gardens back then.

SARS reached its peak in Hong Kong on 31 March 2003, with a total of 80 cases. According to WHO’s 2003 end-of-year report, there were 8,096 probable cases of SARS and 774 deaths globally, with mainland China and Hong Kong taking the biggest toll, accumulating over 87% of the global infection number.

The number of local cases declined steadily afterwards and the last recorded case in Hong Kong was on 11 June.

On 23 June 2003, WHO officially removed Hong Kong from the list of areas with recent local transmission of SARS, marking the end of the epidemic.

A bar chart shows the number of confirmed SARS cases in Hong Kong between March and June 2003. Credit: Hazel Ho

After almost four months, SARS ended with 299 deaths and 1,755 infected cases in Hong Kong. Among them, almost 22% were healthcare or medical workers, and over 18% were Amoy Garden residents.

The red flags raised by the outbreak of SARS prompted former Chief Executive Donald Tsang Yam-kuen to raise public hygiene awareness. He announced the increase of littering and spitting fines from HKD 600 to HKD 1,500 in the Interim Report on Measures to Improve Environmental Hygiene in Hong Kong, published in May 2003.

The Public Health Group of the SARS Expert Committee meeting for the comprehensive review of the SARS outbreaks in Hong Kong on July 7, 2003. Photo credit: Public Health Group of SARS Expert Committee

Hong Kong’s first Chief Executive Tung Chee-hwa announced on 28 May 2003 the setting up of a Severe Acute Respiratory Syndrome (SARS) Expert Committee to review the management and control of SARS outbreak in Hong Kong.

In remembrance of the medical staff members who passed away during the SARS epidemic:

Dr Tse Yuen-man
Dr Cheng Ha-yan, Kate
Dr Cheung Shek-hin
Mr Lau Wing-kai
Ms Lau Kam-yung
Ms Tang Heung-may
Ms Wong Kang-tai

Dr Tse Yuen-man has been awarded the Medal for Bravery (Gold) and the other five medical staff the Medal for Bravery (Silver) for their commitment to their duties, with the exception of private doctor Cheung Shek-hin. Most of them were buried at Gallant Garden, an honorary burial ground for civil servants.

Featured image credit: Hazel Ho

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