Chan Sung-ming says the coughs and sneezes echoing through the plywood walls of his windowless, 60-square foot Hong Kong apartment get him thinking: is there a bug going around and could it be deadly?
A decade after SARS began a lethal odyssey via Hong Kong, which has the world’s most-densely populated urban areas, Chan says his apartment -- one of eight in a space about the size of a squash court -- makes him feel more prone to airborne germs.
Even as the city spends HK$1.6 billion ($206 million) a year on a disease-tracking center to prepare for future contagions, a tripling in the price of homes in the past decade has forced its 7.2 million residents closer together. That’s stoking the potential for a rapid rise of bugs like the severe acute respiratory virus that exploded there in early 2003.
“In Hong Kong, we live vertically, not horizontally,” said Sian Griffiths, director of the Chinese University of Hong Kong’s school of public health. “It’s as if we’ve turned a village street on its end. People are so close together here, the risk of transmission is greater.”
Chan’s apartment is smaller than some of the city’s prison cells. The 36-year-old electrician says the cramped living arrangements mean he hears his neighbors’ every cough and bowel movement, and sometimes shares their pathogens too.
“What can I do?” Chan says, seated on a blue plastic children’s chair squeezed between his bed and a table on which he perches a second-hand laptop. “I can’t afford to move.”
When a fast-spreading germ takes hold in Hong Kong, the consequences for the city -- and the world -- can be devastating.
Griffiths was part of a group that investigated the city’s most devastating cluster of SARS cases. More than 40 residents of Amoy Gardens, a middle-class, high-rise private housing estate, died and 329 were infected. The investigators found severe watery diarrhea from infected people carried the virus into other people’s apartments in the form of tiny aerosols that were probably drawn by exhaust fans into the air from the building’s sewage system.
The coronavirus began spreading in a Hong Kong hotel after it was introduced by an infected doctor visiting from Guangdong. From there, it passed to other hotel guests, who took it with them on airplanes to Canada, Ireland, the U.S., Vietnam and Singapore, illustrating the city’s potential to cultivate and disseminate pathogens internationally.
SARS infected 1,755 people in Hong Kong, killing 300, and caused economic losses totaling HK$3.8 billion ($490 million) in two months alone as tourist arrivals dwindled and businesses from restaurants to taxi cabs slumped.
Last year, 56.5 million people transited the city’s airport -- 65 percent more than in 2002. By the time SARS petered out in August 2003, the virus had spread to more than two dozen countries and three regions, causing 8,096 cases and 774 deaths.
“Hong Kong acts as a transit point from China to Hong Kong, and Hong Kong to the world,” said Guan Yi, professor of virology at the University of Hong Kong, who studies the ecology of SARS and influenza viruses, particularly the deadly H5N1 bird flu strain. That virus was discovered in a goose in Guangdong in 1996, seven years before it infected members of a Hong Kong family who had traveled to mainland China. The bird flu strain then spread across Asia and into Europe and Africa.
Since SARS, Hong Kong established a Centre for Health Protection in June 2004 with a HK$500 million donation from the Hong Kong Jockey Club. The center now has an annual budget of about HK$1.6 billion.
The government has also established a HK$500 million research fund for the control of infectious diseases after the SARS outbreak in 2003. That’s strengthened the city’s ability to detect and respond to emerging infectious disease threats, Guan said in an interview.
“We paid too high a price during SARS,” he said. “Now we are ready.”
While newer laboratory testing tools have made surveillance more efficient, the city’s growing population and status as an international hub have increased the challenge of detecting potential threats.
“Cities are where some infectious diseases love to move between people nice and efficiently,” said Richard Coker, professor of public health at the London School of Hygiene and Tropical Medicine.
Hong Kong has a long history of explosive disease outbreaks. Thousands died from bubonic plague, which took hold in the former British colony in 1894 and persisted for decades. In 1968, a novel influenza virus was discovered there that became known as the Hong Kong flu pandemic.
When bird flu was seen as a health threat in 1997, Margaret Chan, the World Health Organization’s director general, serving as Hong Kong’s director of health at the time, ordered the culling of the city’s entire poultry flock to stem the spread.
Concern that an infectious respiratory disease could once again emerge is ingrained in the local psyche, said Joseph Sung, vice-chancellor of the Chinese University of Hong Kong, who led a medical team to combat SARS in 2003. Labels on elevators proclaim hourly disinfection. On trains and in offices, people routinely wear surgical masks in public to prevent spreading germs.
The SARS coronavirus is thought to be transmitted most readily by respiratory droplets produced by the coughs and sneezes of an infected person, according to the Atlanta-based Centers for Disease Control and Prevention. Droplets may travel as far as 3 feet (1 meter) in the air, causing a new infection when they come in contact with the mucus membranes of the mouth, nose or eyes, or when the mouth, nose or eyes are touched after contact with a contaminated surface.
Population density increases that risk.
Hong Kong has added more than 400,000 people the past decade. Many newcomers are like Chan: traveling frequently to the Mainland and willing to sacrifice personal space for higher earning potential in the world’s 10th-largest banking center and third-busiest container port.
“It’s a combination of lots of transient people plus the living conditions of many people here,” said Griffiths at the Chinese University of Hong Kong.
Hong Kong electrician Chan, who shares a mold-stained toilet with his neighbors, says he’d move out if it weren’t for the rising cost of accommodation. Last year, residents were forced to bathe using a shared kitchen sink for six months when a plastic shower hose in the communal bathroom broke, Chan said.
Homes in the city cost an average of 13.5 times the gross median household income, up from 12.6 times a year ago, making it the most expensive housing market in an annual affordability survey by Belleville, Illinois-based consulting company Demographia released in January. The survey examined housing prices in Australia, Canada, Hong Kong, Ireland, New Zealand, the U.K. and the U.S.
Chan’s one-room dwelling is smaller than some single-person cells in the city’s correctional centers, which are typically 62 square feet at Stanley prison and 77 square feet at the Lai Chi Kok Reception Centre, according to the Correctional Services Department.
“Cramped living space in ‘cage homes,’ cubicle apartments and sub-divided flats has become the reluctant choice for tens of thousands of Hong Kong people,” the city’s chief executive Leung Chun-ying said in his Jan. 16 maiden policy address. “Their plight has cast a dark shadow on our thriving city.”
Even as officials pledge to improve the affordability of housing, a scarcity of land, long waiting lists for public housing and the constant influx of people mean prices will stay high in the short term, according to L.H. Li, deputy head of the University of Hong Kong’s department of real estate and construction.
Chan barely survives on a monthly wage of HK$11,000 ($1,418) -- close to the HK$12,000 median income in Hong Kong -- after paying his bills and sending money to his family in mainland China, he says.
“Life is hard,” he says, as a small fan above his door whirs overhead, his room’s only source of air movement. “I hope that more can be done to level the playing field in this city.”