Dispatch from Hong Kong: Life amid COVID-19

Expatriate veterinarian shares lessons from an epidemic

Churgin night 288 Photo by Suzanne Gendron Originally from Arizona, Dr. Sarah Churgin moved to Hong Kong in 2014. "I thought I'd stay here for three years, but now I've been here more than five," said Churgin, pictured on Hong Kong Island. Originally from Arizona, Dr. Sarah Churgin moved to Hong Kong in 2014. "I thought I'd stay here for three years, but now I've been here more than five," said Churgin, pictured on Hong Kong Island.

Dr. Sarah Churgin is a 36-year-old zoo medicine specialist at Ocean Park, an aquarium, zoo and theme park in Hong Kong. A U.S. native, Churgin has been working in Hong Kong since 2014. In a Q&A by email, Churgin shared her experiences and insights on life near mainland China, where COVID-19, a respiratory disease caused by a new coronavirus, first surfaced late last year, in the city of Wuhan.

Hong Kong had 115 confirmed cases of COVID-19 and three deaths as of noon EST today. Worldwide, the case count stood at 113,579, with 3,995 people dead and 62,496 recovered, according to real-time tracking by the Johns Hopkins University Center for Systems Science and Engineering.

Here is how it looks from Churgin's vantage point.

Tell us about Hong Kong and where you live.

Hong Kong is an incredible dichotomy. Of course, everyone knows the side that you see in movies, the sprawling metropolis with literally thousands of skyscrapers. But few people realize that Hong Kong is actually about 75% undeveloped countryside. That includes mountains, beaches and country parks. The coastal areas look more like Hawaii or Thailand; you'd never know it's Hong Kong if all you've ever seen are the images of the famous downtown skyline.

Within Hong Kong, there are many different regions and neighborhoods, each with a different vibe. I live and work on Hong Kong Island, which is the heart of the business world here and is the most well-known area in Hong Kong. I tend to spend most of my time on the Island, as do most expats (although certainly not all). The densest areas of Hong Kong are actually across Victoria Harbor on the Kowloon side of Hong Kong, where rent is typically slightly less expensive. In 2019, Hong Kong once again earned the distinction of the most expensive housing in the world. Local families often share a 300- to 400-square-foot apartment with up to three generations.

I live alone with my three pets: a dog and two cats. They all moved to Hong Kong with me. (They're all geriatric — the pup is 13, the cats are 15 and 16!) I am really fortunate to live in quite a large apartment by Hong Kong standards, about 800 square feet, and I also have a private outdoor terrace where my dog can go outside. It's an older building and is not in the trendy expat part of town, which makes it a bit more affordable. It's still in a high-rise building, around 30 floors.

When did you first learn about the disease that would become known as COVID-19?

I began to hear rumblings about it very early on, probably in December or very early January. Local Hong Kongers tend to hear things in the Chinese-speaking media or social networks long before the expats do. Our veterinary nurses, all of whom are Hong Kong natives, began making us aware of it in those early days. At that time, there was very little global coverage, and the Chinese government was still saying it was a minor issue, it was well-contained and there was no evidence of human-to-human transmission.

At what point did you suspect that the disease would affect your daily life? How did events unfold?

As media reports began to change about the situation in Wuhan, we slowly began to get the idea that this might be a big deal. The first positive cases (imported from Wuhan) were discovered in Hong Kong on Jan. 22. By the time we were preparing for our Chinese New Year holidays in late January, it was dominating the news cycle. The day after the first positive case in Hong Kong, the government had announced the cancellation of two major upcoming public events. On Jan. 25, they declared an emergency.

While I was on my way to the airport to fly to Bali for the holiday, it was announced that Ocean Park would be closed to the public, along with Hong Kong Disneyland, until further notice. I was traveling that week with fellow expat friends who are teachers. During our trip, we learned that schools would not resume the following week as planned, and might be closed for two more weeks. We knew by then that this was going to seriously impact our lives.

As more cases cropped up over the ensuing weeks, travel from mainland China was restricted further and further until it ultimately became restricted to very few entry points and a mandatory 14-day quarantine. School closures were eventually extended until April 20 (at the earliest). Most government-run parks and leisure facilities have been closed since the beginning of the outbreak.

As in other places, the government has rigorously followed up each coronavirus case and their close contacts. There are multiple quarantine centers throughout the city where close contacts are sent. I believe, at this point, all positive coronavirus cases are hospitalized, regardless of severity. Those who enter Hong Kong from the mainland or other restricted sites can undergo self-quarantine at home, but they are monitored.

How did people react?

The public reaction is a much more complicated story. Discussions of both the government and the public response should be prefaced with the reminder that this city went through SARS [severe acute respiratory syndrome] in 2003, a novel disease that carried a 10% mortality rate. Hong Kong was really the epicenter of that outbreak. It psychologically scarred Hong Kongers forever.

Therefore, as soon as the first whispers of a new coronavirus in Wuhan began to hit the airwaves in Hong Kong, residents began buying masks and hand sanitizer. We ran into shortages of these items very quickly. The public has shown relatively few objections to the mandatory school closures and other drastic measures. I suspect this is because of the history with SARS.

In fact, the public has heavily criticized the government for not doing enough. There was a huge objection to the government's decision not to completely close the border with China. The protests that rocked Hong Kong in 2019 are very much still alive, and without going into detail on that, I'll say that while the physical protests have decreased in frequency and size, the underlying anti-government sentiment has remained very strong.

When did you begin to experience direct effects, and what were they?

We were already discussing contingency plans at work before Chinese New Year. By the time I left for my trip, it was impossible to ride public transit without a face mask; you invite uneasy glances and cause discomfort to others when you don't wear one. I had a blissful week of peace in Bali in the last week of January, but when I returned, I was very much affected right away, since Ocean Park was now closed to the public. That also meant a major reduction of personnel working at any given moment. My schedule was reduced in February, also.

Do you know anyone who is ill from or tested positive for the virus?

I do not. At this point there are only around 100 cases in Hong Kong out of 8 million people — a 0.00125% attack rate. [At publication time, the case figure was 115.]

What do you think is your personal susceptibility to the disease? Are you fearful, unworried, something in between? What measures do you take to protect yourself?

I am definitely not fearful, and probably one step short of unworried. Although we currently believe COVID-19 carries a roughly 2-3% mortality rate, which is highly significant, we also know that it is most lethal to the elderly and those with preexisting conditions. I am fortunate to be relatively young and healthy (other than a benign heart murmur), and my chances of severe illness or death are relatively low.

However, I worry significantly about the impact on my life if I become a close contact or even a mildly affected coronavirus patient, simply because of the quarantine implications. Obviously, I would be unable to work if quarantined or hospitalized, and my pets would have to be cared for by others or even quarantined if I tested positive.

As far as measures to protect myself, I am extremely conscious of hand hygiene — I try not to touch surfaces in public (i.e. on our subway system, the MTR) and work very hard not to touch my face, eyes or mouth until I've washed or sanitized my hands. I have hand sanitizer in my purse at all times. I occasionally wear a surgical mask, especially on the highly crowded public transit, though even then, it's mostly for the comfort of others rather than my own protection. I am required to wear one at the entry gates at work and at various other businesses. My temperature is taken multiple times each day at work, too, and at some businesses (for instance, the gym and movie theaters).

I will say, though, that I have not really changed my social habits. My friends and colleagues and I still go out for meals together on a regular basis. We hike, we meet for drinks. The expat community has been generally more resistant to the calls for social isolation. That could change if the outbreak becomes significantly worse here.

Are you still reporting to work to look after the animals? During the park's prolonged public closure, is your income affected?

Churgin ocean park Photo by Steven Ma A board-certified diplomate of the American College of Zoological Medicine, Dr. Sarah Churgin works at Ocean Park Hong Kong, where her patients include cetaceans such as dolphins. A board-certified diplomate of the American College of Zoological Medicine, Dr. Sarah Churgin works at Ocean Park Hong Kong, where her patients include cetaceans such as dolphins.

Yes, my income is affected. It was unaffected in February, as the company tried very hard to continue compensating us all fully despite the challenges, but starting in March we are all being asked to take a certain amount of unpaid leave per month. For me, it is eight days, equating to 27% of my salary. This will continue until further notice, and it will be a significant financial impact on my life.

I do not have to report to work on my unpaid leave days, but I work full-time as usual on my other scheduled days. Because there are only four veterinarians working at Ocean Park, our manpower is significantly impacted, as well. There's no way for us each to take eight extra days of leave in a month without overlapping, so there are now many days when only one or two of us are working. So the workdays are busy!

How will you cope with the loss of income?

If the mandatory unpaid leave lasts only one or two months, I should be able to cope without much adjustment. I'm definitely watching my purchases more carefully. However, if it is a prolonged period, I will have to significantly cut nonessential expenses like dining out, travel, etc. Travel is an important part of life abroad in Hong Kong, and it's a big reason many of us expats live here. If the income cuts are really prolonged, I may have to consider moving to a different apartment because of my high rent, or even returning to North America if it becomes untenable to stay.

How has the epidemic affected other aspects of your daily life, and of life for Hong Kong residents in general?

For me personally, although there are many ways it has changed my routines and daily experience, most of the effects are small. There was a hysterical hoarding craze in February after online rumors suggested that there would be a disruption of goods from China (there was not). It became impossible to find staples like toilet paper, paper towels and even rice. Those items have finally returned to shelves now, although it remains next to impossible to buy masks.

Many social events I had planned to attend have been canceled, from concerts and seminars to the world-famous Hong Kong Rugby Sevens. There are many small things, too, like the constant temperature checks, mandatory masks and drastically reduced patronage of many businesses, that just make it impossible to forget what's going on for even a moment.

For those with children or those who work in the education system, the daily impact is much more profound. Both students and teachers have been out of school since Jan. 25. Most schools are conducting lessons online to avoid students falling behind. This means my friends who teach are working from home and trying to conduct online classes and virtual meetings all day.

While this might sound nice, they often feel socially isolated and have experienced frustration in not being able to work as efficiently. It's even worse for the parents, who have to provide child care for at least three unanticipated months away from school while also supervising their children as they complete online lessons all day. At least one friend with children has left Hong Kong and moved back to the U.S. because of this.

One unique aspect of living in Asia is the prevalence of domestic helpers, aka live-in nannies and maids. I've read a statistic that one-third of families with children have a helper. Therefore, the impact is not quite so high as it would be in a society like the U.S., where in-home child care is cost-prohibitive for most families.

Many other friends who work in banking, law or other industries have been on mandatory work-from-home orders since the beginning of the outbreak. While they find some aspects enjoyable, they have all described some degree of social isolation when we talk about it.

All of us have been impacted by travel restrictions. Many have been told they're not allowed to travel because their employers fear they won't be able to get back to Hong Kong if new restrictions are placed. Additionally, air travel to and from Hong Kong has been severely cut. There is no longer any domestic American airline operating direct flights to or from Hong Kong. This is due to dramatically reduced demand (rather than a travel ban directly because of the virus). Some countries, however, consider Hong Kong to be part of China and have actually banned travel to or from Hong Kong. In turn, Hong Kong has restricted or banned travel to heavily-hit locations like mainland China, Italy and South Korea.

By far the hardest-hit industry in Hong Kong has been tourism. With the back-to-back challenges of the protests followed by the virus, tourism arrivals at the Hong Kong International Airport were reported to be down 98.5% in February 2020 compared with February 2019. Hotels have single-digit occupancy rates. Anyone working in the tourism industry (including those at Ocean Park and similar destinations) has felt effects of this. Some workers have been given mandatory unpaid leave; others have been laid off.

Are private veterinary clinics open? If yes, do you know whether routine visits have declined?

Yes, private vet clinics are still open. I polled several of my colleagues and found somewhat mixed reviews as to the effects on their business. Interestingly, some of them report that business has actually picked up because so many people have been working from home and spending more time with their pets. Some of them have even had whole families show up for appointments because it's something interesting to do with the kids!

However, others have seen up to a 30% reduction in business. Some clients have postponed elective procedures or wellness visits because they don't want to leave the house unnecessarily. Others may need to tighten the belt financially so they're canceling expensive procedures. Then, of course, there's the issue of the dog testing positive for COVID-19. That's caused a lot of questions and concerns among clients. The private clinic that normally cares for that dog has seen some fallout from the media coverage, because the infected owner visited the clinic and that information was reported in the news.

It's also worth mentioning that pretty much all of our continuing education events have been canceled or postponed in the veterinary community. I serve on the executive board of the Hong Kong Veterinary Association, and we had many CE seminars planned this winter and spring. All of the speakers canceled their travels to Hong Kong, so all the events had to be canceled. Plus, congregating in large groups is discouraged. So that was an unanticipated issue.

Speaking of the dog who appears to have been infected by its owner, how are Hong Kong residents reacting to that development?

I know local small animal vets have been fielding a lot of questions about it. Even before that news broke, some of my fellow veterinary friends had told me stories of owners washing their dogs' coat with disinfectants every time they came in from a walk, which resulted in dermatitis. So there's definitely already a lot of concern about it, and I'm sure it will only get worse with [last week's] announcement. It's been widely reported that thousands of pets have been abandoned in mainland China because of the outbreak, in some cases because of fear of transmission, and in other cases, because the owners were quarantined or were prevented from returning home due to travel restrictions. It sounds horrific.

Thankfully, we have not seen that in Hong Kong. The Hong Kong Veterinary Association and the AFCD (Agriculture, Fisheries, and Conservation Department) have sent bulletins to all Hong Kong veterinarians with the latest facts and recommendations as the situation unfolds, which helps vets be able to keep their clients informed and calm.

How are pets belonging to people who have the illness being cared for?

At the moment, dogs, cats and other mammalian pets are placed into AFCD quarantine under two circumstances: if their owners are confirmed COVID-19 patients, or if their owners have been placed into quarantine centers because of known exposure. Other species are not required to be quarantined but can be cared for at the AFCD quarantine center if needed. The pets are being tested for [the virus that causes] COVID-19 while at the government quarantine facility. As long as they're negative, they can be released to the care of others after 14 days.

Animals belonging to someone in home quarantine can stay in the home.

For your veterinary colleagues and other individuals in countries in earlier stages of the epidemic, how do you recommend they be prepared?

I think the financial impacts to individuals and to businesses are the most serious secondary effect that people don't anticipate. The other major one is child care. There's lots of good advice out there already about stocking up on nonperishable food in case you're asked to stay at home for a few weeks (although this has not been done even in Hong Kong — so it's somewhat unlikely). But I think what people really need to stock up on is money.

If I'd known that I was going to take a 27% salary cut a few months ago, I would have changed my spending and given myself more of a cushion for the months to come. If I can recommend anything, it's to save some money now in case a personal financial crisis (or a large-scale financial crisis) is coming. And make real, feasible contingency plans for child care if you can. Maybe that also means trying to save extra money in case one caretaker has to stay home from work.

For vets, I think it's important to have contingency plans for staffing crises. Some of your techs or associates may be unable to come to work if schools are closed, or they'll have to bring kids to work. Of course, preparing for a financial downturn in business is also wise.

I also think vets are important sources of knowledge during this outbreak, and it's our duty to stay informed on the situation as much as possible.

Lastly, one of the things that has driven some businesses here to make decisions about whether to operate as usual or change their practices is consideration of the public relations fallout if there were to be an outbreak associated with that place of business. That's also something to consider when you're making decisions about your own clinic, if your town or city ends up having an outbreak. Even if there's not mandatory isolation orders, you may have to decide whether it's worth the PR risk (in addition to the actual health risks) to stay open.

Do you believe the government's ongoing response is effective? In your opinion, what are pros and cons of the response?

Schools remain closed and will be closed until at least April 20. A lot of the restrictions on work were actually just eased up, so government employees are returning to work and other big businesses will follow their lead. So far, the travel restrictions from mainland China have not eased up at all, and in fact, new countries have been added to the restrictions, such as Italy and Iran, where they're having major outbreaks now.

I must say, as much as the Hong Kong government has misstepped over the last year (to put it very mildly and without being political), so far, their response has been very successful. As of March 6, we [had] 107 cases in a city of 8 million. That's very low spread compared with other locations.

On the other hand, their response in tightening border controls was slower than it should have been, so perhaps we could've had even fewer infections. I don't think we'll really know how to evaluate the government's response until this epidemic is understood much more completely. Have the reactions been too aggressive? Not aggressive enough? I don't think we can say for several more months, when we see the outcome.

The world response and fears have led to significant social disruption, as you've described. As a medical professional, do you believe the disruptions are a necessary consequence of needed steps to contain a novel, easily transmissible infectious disease? Or, given its apparent relatively low potential to cause critical to life-threatening illness, do you believe the response is an overreaction?

First of all, I think we have to be careful not to undersell the virulence of this virus. Yes, it's less deadly than SARS and much less deadly than MERS [Middle East respiratory syndrome] or Ebola. However, if the current mortality statistics of 2-4% end up holding true, those are very significant numbers. You're still much more likely to survive than you are to die, but if there's a 3% mortality rate, that means in a restaurant of 30 people, one is likely to die. Those aren't the kinds of odds we want for a virus that's easily transmissible.

We also know that your chances of dying of COVID-19 are much higher if you are elderly or have comorbidities. Just because I'm young and healthy doesn't mean that I don't have very important loved ones in my life who are older and/or have health problems. The mortality rate among those populations is going to be much higher. So I think we have to give this infection its due respect and treat it with necessary vigilance.

I think China did buy the world time, as the World Health Organization has said, by going into full lockdown mode and restricting travel so strictly out of Hubei province. There are few countries in the world that could enforce that like China did (for obvious reasons — again, I won't get political). I think that probably prevented it from reaching the scale of Wuhan in many other cities and countries around the world.

However, as understanding of the disease evolves and we really start to understand the true morbidity and mortality rates, only then can we really decide whether all this disruption was worth it. If it turns out to have a mortality rate similar to seasonal influenza (usually reported at around 0.1%), then this was all really a massive overreaction. If it really has a mortality rate of 2-4%, then I think the social disruptions are justified.

I just hope the efforts to contain it turn out to be successful. Otherwise, if we are left permanently with a disease that circulates widely in the human population with a 2-4% mortality rate, it's going to change life as we know it. Masks and hand sanitizer and social distancing may become a way of life.

Any silver linings to this emergency situation?

Yes! The absolute biggest silver lining is the suspension of China's massive and devastating wildlife trade, and potentially the permanent end of the wildlife trade as we know it. Because COVID-19 is suspected to have originated in a Wuhan wildlife market, this issue has finally come front and center and can no longer be ignored. China has taken a very hard-line stance on the wildlife trade for now, and they're saying it may be permanent. But this also happened during SARS, and it didn't stick. As a zoo veterinarian, wildlife conservation is my biggest passion. I have seen and heard horrific things related to the wildlife trade while living in Asia. If anything good can come of this outbreak, it's the demise of the Chinese wildlife trade, or at least a dramatic reduction in its magnitude.

This story has been changed from the original to correct a typographical error on the date school closures might end.