Hong Kong Chief Executive Carrie Lam Cheng Yuet-ngor has compared decisions on COVID-19 policies to a “three-sided tug of war”. After six months of “war”, it is time to do a comprehensive review of the “tripod” (advisers, administrators and the public), upon which a scientific data-driven consensus could be used to launch strategies for the “new norm”. There should be cross-bureau/department coordination, private-public collaboration and clear public policy communication.
On July 31, the Office of the Government of the Hong Kong Special Administrative Region in Beijing issued a weekly newsletter with 26 items. It contained 11 which could well be applied to the special administrative region as well: Work on ensuring employment and livelihood in the next six months; COVID-19 prevention and control co-operative: guideline for meat processing industry; COVID-19 prevention and control co-operative: notice for enhancement of group isolation, medical surveillance and RTPCR testing for incoming personnel; intensified Medical and Health System Reform: 3Q and 4Q essential assignments; industry and informatics: notice for rectification actions for infringement of clients’ rights by apps; notice on promulgation and promotion of the integrated pilot for expansion of service industry in Beijing; support for multi-prong approach for flexible employment measures; notice on addressing the shortcomings for reconstruction of “smart city”; advice on strengthening the system for the support of SME development; notice on orderly recovery of activities for entertainment, performances and internet services in Beijing; 2020-22 plan for strengthening estate management and standards in Beijing.
On the same day, academician Zhang Boli, former director of the Chinese Academy of Chinese Medical Sciences, reported that three months into the pandemic, the mainland government has developed mechanisms, prepared hardware and trained personnel in preparation for the next surge. It involves five major systems: public health, health services, prevention and control, response contingency, and traditional Chinese medicine services.
We should urgently review our problems. We should formulate a strategic plan, with a timetable, to address the current crisis, the winter surge, and the subsequent “new norm” from the perspectives of the advisers, administrators and the public
The preparedness and stringent measures in Beijing saw the resolution of its recent outbreak in 40 days. In contrast, Hong Kong’s outbreak is larger and will last longer. With generous help from Wuhan to build emergency facilities and from Guangdong province to provide mass screening capabilities, we should urgently review our problems. We should formulate a strategic plan, with a timetable, to address the current crisis, the winter surge, and the subsequent “new norm” from the perspectives of the advisers, administrators and the public — covering essential domains of the economy, employment, smart city, SMEs, entertainment and service industries; in addition to the five major systems related to COVID-19.
First, the advisers should include more experts, such as clinicians in key specialties, sociologists, psychologists, engineers, information technology professionals, economists, and public health gurus. They should be given a clear target of “clearing zero” within the shortest period of time, with the least burden on the healthcare system and society, and the least morbidity and death.
Systematic reviews of publications can tell us: The different modes of transmission including oral-fecal route; the physical, medical, digital and behavior means of prevention; the multi-organ pathology and corresponding treatment modalities.
Together, they should work out a timetable to rectify our current deficiencies by taking the following steps:
Replace all border-entry exemptions with testing, and isolation in hotels modified and staffed to meet infection-control standards. Technical and administrative monitoring, violation detection and punishment should be strict and transparent.
Test all high-risk groups once every five to seven days, starting with all front-line healthcare personnel, patients, front-line staff in close contact with high-risk environment or individuals (elderly homes, restaurants, transport, markets, cleaners, receptionists, tellers, etc.).
Improve old-age homes with mandatory virus-killing ventilation and surface coating; with additional staffing for personal and environmental hygiene; and with a plan to reduce overcrowding by funding community programs for caring at home.
Expedite the use of electronic healthcare system eHRSS+, by turning the Hospital Authority’s private-public partnership system into a universal platform to share information and care with primary-care workers — from family physicians, TCM practitioners to therapists, nurses, pharmacists and clinical psychologists — bridging the gap among the four bureaus of health, welfare, education and environment.
Recruit and train public-health staff for transmission investigation, contact tracing and law enforcement monitoring, setting evidence-based standards and supervising local environmental improvements.
Set standards for hardware and software improvements with operational procedures for all work/leisure space, from hotels, schools, markets, malls, restaurants, theaters, halls and stadiums to offices, gyms, and karaoke and mahjong rooms.
Review prevention and treatment modalities with a view to implementing the best medical practice at the earliest possible time. The use of TCM and vaccines should be assessed as soon as possible, to develop a plan of action.
Study the social psychological factors influencing the success or otherwise of containment measures and the effect of such measures on different social groups by age, education, profession and living environment, to fine-tune containment policies.
Study the financial impact of each restriction, under the Prevention and Control of Disease Ordinance, on all walks of life, covering different social and commercial sectors and their interaction effects.
Second, the administrators should assess the proposals in conjunction with the research results, showing the effect on disease, economy and society, under different scenarios of severity of the pandemic with corresponding levels of containment measures (mild, moderate and severe), with a built-in contingency plan for near-, intermediate- and long-term scenarios.
For assessment and comparison of different public-health interventions, we need health economists to calculate the “cost-benefit analysis”. The funding allocated over the past few months should be studied to compare the benefits achieved by modeling the transmission dynamics, the response from citizens and businesses with different levels of loss of income and additional expenditures.
It is essential to have direct funding to support training and salaries for the unemployed to fit into new jobs for the “new norm” with home office, smart city, telemedicine and community-based health activities. Community and home care for the elderly top the list.
According to calculations by the US Centers for Disease Control and Prevention and by Johns Hopkins University, the city needs 3,000 public-health workers as tracers or trackers. We also need additional staff from public-health specialists downward, covering health education, standards setting, prevention and control, emergency response, outbreak investigation and law enforcement.
For environmental safety, a team of engineers and technicians should go through every building to check or advise on improvements in ventilation and drainpipes with a view to complying with indoor air quality and other standards. For public transport, we need evidence to show what a “safe” distance is between passengers, under a defined volume of airflow per hour. The government should assess the air filters, virus-killing mechanisms and coatings for their effectiveness under different conditions, for public information.
For food and environmental hygiene, action teams should be formed under the health and environment bureaus so that problems of rubbish, rats and insects, which are potential vectors for infection, can be dealt with at the level of buildings and estates.
Third, the public is the key to success. Information, education and communication should be done in “real time”, using social media in addition to traditional ones.
Before implementation of any policy, surveys and/or focus group discussions should be held to provide feedback to the advisers and administrators for fine-tuning policies or formulating remedial measures. The recent closure and reopening of restaurants is a good example of an absence of consultation. We must thank the media for providing real-time feedback.
For messages to be effective, they should be simple, clear and consistent. They must be delivered by someone who is trustworthy. The government has to seek advice from professionals in the choice of spokesperson.
In this way, the advisers, administrators, and the public will be ready to launch our plans for the “new norm”.
The author is a former public-health specialist for the World Bank and chief executive of the Hong Kong Hospital Authority. She coordinated the response to SARS as the HA’s director for professional services in 2003.
The views do not necessarily reflect those of China Daily.