On the evening of Nov 19, a couple in Shanghai were diagnosed with COVID-19. The local health authority there kicked off a series of public health measures. Within 48 hours, by 8 pm of Nov 21, 86 close contacts were isolated and tested negative. Of 8,120 contacts, 7,921 samples were collected with 4,468 tested. Environmental sampling were collected including food and fomite. Out of 336 samples, the four collected from their home were found positive. Their work places: an international logistics hub, a local hospital and their daughter’s school were closed for sterilization.

Hong Kong has gone into the fourth wave of infection with a large cluster from dancing activities. We are still struggling with primary contact tracing and mandatory testing of these high risk groups. We have failed in speedy, focused contact tracing, follow up testing, quarantine and environmental sampling more than a week after the first case appeared. Why?

The Centre for Health Protection (CHP) is understaffed. They are not working around the clock 24/7 to supply the list of names for testing within 48 hours BEFORE the second and third generations of transmission.

The diagnosed cases would not give lists of clients or students to avoid loss of good will and business. Hence the Hong Kong government should exercise the 599 legislation to outlaw those who withhold information and to give permission to check mobile phones for places visited over the preceding 14 days.

The Leave Home Safe App is useless unless the bar codes are mandated for ALL places, at ALL entrances with posters highly noticeable from afar, bearing a specific logo/mascot. Mascots should be walking around every building to invite and help citizens to use it.

The fourth wave was spread by incoming cases from South Asia. After 10 months, we have not perfected the “close loop management” with dedicated testing, monitor, transport and hotels, with NO exception. Hong Kong must separate quarantine hotels from those used by normal travelers. The Department of Health (DH) should take over the public health management of these hotels to educate and supervise the staff.

The SAR government reacted too slowly to super spreading events such as bar-singers, staycations and dancing groups. There are many more private parties in private premises (including homes) which should be ruled by equivalent restrictions in the number of occupants. The UK makes it mandatory and USA is strongly advising not to have Thanksgiving dinner gatherings.

The RT PCR testing is too slow and too inconvenient. We must have one official collection center in each of the 18 districts run by the DH, such that they could make sure outbreak contacts would be served immediately, and that the target high risk groups (taxi drivers, market vendors, old age home staff, etc) are given priority appointments at a place of their choice because they should be tested at least once weekly. Contracting out the laboratory service does not include the public health service.

The health authority in the Chinese mainland has identified cold chain for frozen food as a high risk channel for importation of viruses. Why is Hong Kong NOT doing anything to verify it and take necessary measures?

It is well known that once the gut is infected, it is a route for excretion of viruses. While we teach everyone to cover toilet bowls before flushing, we have not emphasized “toilet hygiene”. Even if they cover before flushing, the aerosols generated can escape from the sides and eventually fall on the counter tops, walls, handles etc. Should they be cleaned after each user? How many outbreaks were associated with shared changing rooms and toilets?

Where is our Sherlock Holmes? The public health detectives should be the first on the “crime scene” to take samples and give a diagnosis of the route of transmission of every case. We do not have such reports from the CHP for our cases, not even large clusters. Is this the reason why we have not learnt from past mistakes? 

In one Guangzhou restaurant, they found the spread among clients around three adjacent tables from one individual with infection was due to inadequate ventilation. Prof Li Yuguo of HKU advised the use of CO2 check for simple monitor of adequacy of ventilation. This is an objective and scientific way to assess the safety or risk in each room. The number of occupants for each restaurant or public place should be based on a unique number. At 10 square feet per person, individuals should be about one meter apart on average. If they all face one direction while the mask is off, the risks would be further reduced. A low CO2 level would be the third factor in reassurance of safety.

In Shanghai, 110 healthcare organizations use official WeChat to form a new media mega platform. Thirty eight district hospitals produced a total of 1,200 health education programs. In Hong Kong, where misinformation abounds, we should use a professional marketing team, not only for education, advocacy and correction of misunderstanding via different communities and media, but to spearhead campaigns of critical importance. The logo/mascot for Leave Home Safe App should be the most urgent one.

The author was a public health specialist for the World Bank, consultant for World Health Organization, chief executive of Queen Mary Hospital and Hospital Authority. She is a regular columnist, radio and TV host on public health education.

The views do not necessarily reflect those of China Daily.