Primary school students wait to be picked up from school on March 13
Entering the emergency ward at Tuen Mun Hospital in Hong Kong these days feels a little like getting clearance into a correctional facility. A woman cloaked in head-to-toe blue protective gear stands watch at the sliding glass doors, checking visitors' foreheads to ensure that no one running too high a fever gets through. Those who pass muster are given a blue surgical mask and entry to the fluorescent-lit waiting room. Those who don't are ushered to a clutch of plastic chairs outside, under a blue tent — a makeshift isolation and triage area — near a sign that says, in English and Chinese, "Fever Area."
Flu season is hitting Hong Kong especially hard this year. Outbreaks of common influenza have blossomed all over this dense city, with some 800 cases reported in schools in the last eight days. Doctors have confirmed that two children with flu have died since February, sending parents into a panic that culminated Wednesday when the government abruptly closed all primary schools, kindergartens and day-care centers for two weeks, leaving hundreds of thousands of young children with a lot of unscheduled time and adults at a loss to figure out what to do with it.
The government's extreme response probably says more about Hong Kong's medical history than its current diagnosis. Five years ago, the SARS epidemic crippled the city, killing nearly 300 people and grinding public life to an eerie halt. At the time, the government came under fire for not doing enough to curb the spread of the disease, leading to the eventual resignation of the acting health chief Yeoh Eng-kiong. "This is not as bad as SARS," says Lam Tin Lung, an ambulance driver who worked through that health crisis. "But we take more caution now. We've learned to be more aware of diseases."
Over the last two weeks, the government says Hong Kong's medical workers have put in 15,000 hours of overtime to meet demand at the city's overcrowded hospitals. The Hospital Authority has earmarked nearly $2.6 million in extra funds through the end of April to bulk up services and help pay for overtime at hospitals like Tuen Mun, where emergency ward admissions have spiked about 20% in recent weeks. A specially appointed panel of doctors has examined the cases of the children who died in order to ascertain whether it the flu was the cause — and whether the flu strains circulating in Hong Kong were particularly deadly or showed any signs of the H5N1 bird flu virus. The panel found no evidence of H5N1; both children who died with confirmed cases of the flu had a common flu strain, and both are thought to have died from complicating factors — not the flu itself. (A third child's death has not yet been linked to flu, and is still under investigation.) "I think this year we probably have a little bit more seasonal flu, perhaps more widespread," says Dr. Yuen Kwok-yung, a professor at Hong Kong University and head of the panel. "But it's not more virulent."
Public health experts are still worried, however, that the current flu outbreak will lead to even greater use of the antiflu drug Tamiflu. The powerful treatment has been proven particularly effective against H5N1 and has become widely prescribed in Hong Kong — it is increasingly available illegally, without prescription, in pharmacies — so resistance to the drug is growing fast here. Doctors say the overuse of Tamiflu is creating a manifold risk, not only of weakening a weapon against a potential bird flu outbreak, but also of helping to spread a virulent strain of drug-resistant common flu in the wider population. "It's not a good thing to abuse," says Yuen.
But it's hard to keep a community still scarred by recent medical history from doing whatever it can to protect itself. Samuel Ho, a professor of psychology at Hong Kong University, says that during the SARS epidemic, Hong Kong residents were exceedingly concerned about infecting their families and loved ones with the virus. "People were worried about whether they would get the flu," says Ho, "But they worried more about their relations. ... How can I protect my wife? My kids?" He says that to help alleviate the kind of mass insecurity that recurs in Hong Kong during bad flu seasons like this one, doctors need to inform people not only of the true risks they face, but also what they can do to control them.
In the meantime, health officials hope that closing schools will help curb the high infection rate. On Friday morning, a train that would normally be shuttling office workers is instead abuzz with families. Mega-strollers clog the aisles. A mom wipes the nose of her round little boy, while a young girl in pigtails and a flu mask collapses on her father's shoulder, laughing. This is, after all, a day off, and this particular train is headed to Hong Kong Disneyland. It's not a bad way to spend a sick day.