How does the United Kingdom and Hong Kong’s Healthcare System Play their Roles?
Cherry Wong got a taste of how horrible the coronavirus was with symptoms of infections, fever, malaise, dry cough, and shortness of breath when she had to go back to her hometown from the UK as an exchange student in the middle of a pandemic.
Cherry, 21, studying at the Hong Kong Baptist University who majors in communication. She participated in a school exchange program before the deadly outbreak, "In the beginning, I considered that this terrible infectious disease only spread in Asia, so I did not pay too much attention to what would happen in Britain before studying abroad," she traveled to the UK as an international student in the second semester from January 2020, "I thought I had escaped to a safer place, but this is not the case."
Photo: Cherry Wong
"Even until late March, there were still not many people wearing masks," Cherry recalled that local people around did not have much awareness or measures for epidemic prevention. While walking on the street with masks put on, Cherry and her friend were being pointed and scolded by the "Coronavirus" or "Asian" by local people. Some people pretended to cough and sneeze in front of them.
But the campus closures have created a much greater calamity in the lives of international students like Cherry. As shopping malls and most public facilities were shuttered at that time, most of the other students had stopped the exchange program. Cherry finally decided to come back. Wearing protection clothes, goggles, and masks that were brought from Amazon, Cherry and her friends traveled back to Hong Kong from Scotland, transferred by Doha.
The United Kingdom and Hong Kong have comparable medical systems to a certain extent, David Nicholson, chief executive of NHS England, said when he was attending the Hong Kong Hospital Authority's annual conference.
“The health care systems of Hong Kong have loosely mirrored the traditional National Health Service (NHS) system in the UK because of the extended duration of British colonial rule.”
While there are similar systems in both places, Cherry claimed to have returned to the so-called familiar hometown where there was a medical system that had protected her for 21 years. But this time, can she still get protection safely?
The UK confirmed its first COVID-19 infection case on 31 January 2020, following the first case in Europe was confirmed in France on 24 January 2020, and has since then witnessed an increase in the coronavirus cases.
Thirty-one people were tested six days before the virus arrived, and the result was negative in Britain, the government was trying to track down 2,000 people who came from Wuhan in weeks. As of 9 am on 5 May, there have been 1,383,842 tests, with 84,806 tests on 4 May, according to the Department of Health and Social Care.
Hong Kong was among the first regions outside of mainland China to recognize the COVID-19 outbreak as a public emergency - doing so on 25 January, two days after the city confirmed its first two cases. But the government had begun preparation for incoming infection as early as 31 December.
That day, Hong Kong implemented temperature screenings at border points and began warning the medical staff of the new SARS-like virus. On 7 January, Hong Kong's Legislative Council moved to introduce new laws that would qualify the unidentified virus as a "notifiable" disease, giving the government the right to quarantine suspected cases.
Hong Kong was the world's first airport to introduce mandatory COVID-19 testing. As of 24 April, there have been 154,989 tests, according to the Hong Kong Centre for Health Protection.
In Hong Kong, 20.67 out of every 1,000 people have been tested by COVID-19, compared with 13.93 out of 1,000 people in the UK, based on the data on 4 May. A higher percentage of people are tested in Hong Kong, as well earlier the people started to participate in it.
Hong Kong commenced implementing testing 23 days earlier - the same day as China first reported the novel coronavirus to the World Health Organization (WHO) - the first case was confirmed in Hong Kong while the UK started a month later, six days before the first case tested in the country.
All inbound travelers from Hubei Province to Hong Kong are required to participate in testing, and anyone with symptoms can voluntarily go to the nearest test centre to test. In the UK, a higher priority of testing is set for medical workers, elderly, and anyone with work cannot be done from home.
After being tested positive, people are required to be admitted to a hospital in Hong Kong while self-isolation is preferred in the UK.
When Cherry entered Hong Kong, she was neither taken temperature (random inspection) nor nucleic acid test. Instead, she just filled out the health declaration form given out on the airplane, wore a wristband, and got a home anti-epidemic file bag.
"The screening does not have much effect," she added, "several people were coughing on the plane, but no one was reported nor being required to test."
According to the Compulsory Quarantine of Persons Arriving at Hong Kong from Foreign Places Regulation, all persons arriving in Hong Kong are required to commit compulsory quarantine orders and quarantined at a specific place stated by the person for 14 days.
A similar situation of loose screening happened to passengers traveling from Europe but transferred in non-Europe countries. Vanessa is one of them.
Vanessa Fong, a year-3 film student at Hong Kong Baptist University, did the test for COVID-19 infection after returning from Aberystwyth, Wales as an exchange student. Transferred by Dubai from Wales, she arrived in Hong Kong and left the airport by handing in a health declaration form and starting her quarantine. On the last day of her quarantine period, she felt a headache and sore throat and called an ambulance to the temporary test centre at AsiaWord-Expo.
"The time when I was waiting for the result is tough," said Vanessa. During the 9-hour waiting in AsiaWorld-Expo, she wore all protection gear she could have as she believed it was a high-risk infection place. "About three hundred people were waiting for results at the same place. I felt annoyed when some of the others kept walking around intentionally, and some even didn't wear a mask."
According to the testing centre regulations, people can take off the mask only when eating, and masks cannot be removed at other times, including sleeping. People cannot go around at any time except for necessary needs like going to the washroom. But there were no specific penalties or monitoring stated.
"I traveled back to the hotel I stayed at by public transportations while I was still quarantining at that time." After being tested negative to the virus, Vanessa wasn't instructed on anyways of leaving AsiaWorld-Expo that public transportations were the only way she could take. A similar situation happened when she arrived in Hong Kong. There is no tracking on the way from the airport to the quarantine address, which could be a hotel or home.
There were cases where residents discovered people who wore wristbands walking around on the streets. Chuang Shuk-Kwan, head of the Communicable Disease Branch of the Centre for Health Protection, stated on 24 March that 408 warning letters were issued to people who violated the quarantine order. People criticized the deterrent effect of quarantine.
Though I still had coughing symptoms and hadn't finished the last course of medication,” Cherry was told to move to the second-tier isolation ward.
After a 20-hour journey on the airplane without any food and drinks, Cherry stepped back to the zone of worries by ambulance to the hospital from home.
"I felt a bit unwell before I returned, not really sick but slightly uncomfortable," Cherry traveled to Hong Kong successfully and went through compulsory quarantine measures in the airport. She was given a wristband and went home for a 14-day quarantine.
On 28 March night, the next day after she arrived in Hong Kong, Cherry felt sick with fever, cough, headache, and sore throat. She immediately called 999 and was sent to the United Christian Hospital, Kwun Tong.
Blood taking, chest x-ray, deep throat saliva test, etc., after numerous testing in the hospitals, Cherry was confirmed to have suffered from coronavirus disease the next day.
Photo: Cherry Wong
At that time, there were 92 coronavirus disease patients in the hospital where Cherry was staying.
On 22 March, Dr. Linda Yu, Chief Manager of the Hospital Authority, admitted to a press conference that the capacity of isolation beds in public hospitals was close to saturation. She worried about the ability to cope with rising cases in the future.
"Patients whose condition was stable started to move to second-tier isolation beds in early April to relieve the medical pressure of hospital beds," she added.
According to the Hong Kong Hospital Authority, the total number of hospital beds in Hong Kong has increased somewhat over the past 16 years by 453. Although the bottom fell out in 09-10, the name has climbed every year since then.
Dr. Arisina Ma Chung-yee, president of the Hong Kong Public Doctors' Association, said that the workforce of the Dirty Team in public hospitals was tight. Sufficient staff was needed to enable all second-tier isolation beds.
"Patients could stay in the second-tier isolation bed for five days to three weeks until they showed no symptoms and were tested negative twice in 24 hours apart," Arisina worried, even the second-tier isolation wards would be full in one to two weeks if there were dozens of newly confirmed cases every day.
Such an experience happened to Cherry, who was told to move to the second-tier isolation wards if she had no fever symptoms, as well as her lung x-rays no longer showed white shadows.
"Though I still had coughing symptoms and hadn't finished the last course of medication," Cherry added.
Hong Kong was suffering from an Insufficient number of hospital beds. Still, some other countries like the UK also suffered from a similar situation due to the continuous rising numbers of cases.
"Hospitals in England will run short of critical care beds for COVID-19 patients within the next two weeks if the numbers becoming severely ill escalate on the scale experienced in Italy, said doctors," quoted from a news article published in The Guardian.
Research from the University of Cambridge stated that in five of the seven NHS commissioning regions, the number of beds commonly available in hospital intensive care units (ICUs) would not be enough within a fortnight.
Between 1987-88 and 2019-20, the total number of hospital beds fell by 53 percent – from 299,4000 to 141,000. Within this overall number, there are different categories of beds across which the scale of change has varied considerably, according to NHS England.
Over this period, the number of overnight generals and acute beds has fallen by 44 percent. However, within this category, beds for older people's long-term care fell more substantially, falling 61 percent.
While hospital beds in the NHS continued decreasing in these years, hospital beds in Hong Kong slightly increased by 1.5 percent in the past 16 years. Yet, limited beds are still always a hot topic in Hong Kong these years, with more apparent situations reflected in the coronavirus pandemic.
Last year, almost 301 thousand doctors were registered in the United Kingdom, as the doctor to patient ratio is 2.9 doctors for every 1000 people. In Hong Kong, by comparison, the rate is supposedly two doctors per 1000 people, according to the Food and Health Bureau. Doctor-patient ratio of both places is higher than the 1:1000 prescribed by WHO.
The medical workforce in Hong Kong and the UK is facing challenges when dealing with the coronavirus. Staff in Hong Kong's public medical service system has long been insufficient. The Hospital Authority Employees Alliance issued an open letter on 14 January to strongly condemn the recent statement by Hospital Authority that "there is enough manpower to cope with it", criticizing the authority for ignoring the human resources problem and saying that the previous workload was already overloaded for a long time, while the peak season of medical services had yet to come.
The shortage of workforce was reflected in the days when Cherry was staying in the hospitals. Doctors contacted her through phone calls every morning. "I never reached the doctor in person during the period, even the doctor I chatted to on the phone daily was not the same person ... sometimes I feel worried about not being able to describe my condition accurately," Cherry recalls, "Although each call was only about a minute long, they did their best to console me and try to ease me a bit."
Cherry comprehends that doctors are short-staffed, or in case they get infected. Besides, she received tremendous encouragement from the nurses, "From time to time, and they would chat with us to relax us and even show us' cheer up' messages on their cell phones through the window outside the isolation room."
Photo: Cherry Wong
Matt Hancock, the Health Secretary in the UK, issued a request urging retired NHS staff and final-year medical students to return or join the work in healthcare services to ease the burden of the insufficient workforce on 19 March. Besides, the NHS took over the private health services at a cost price and brought about 20,000 more staff into the national services to fight against coronavirus together. However, this is still far from enough.
As a vaccine has yet to be created for the novel coronavirus, some have argued that nations should forgo lockdowns entirely and try to achieve herd immunity by keeping the vulnerable indoors while allowing others to live out of their normal lives-and get infected.
UK's Prime Minister Boris Johnson seemed to support a similar belief in March when he held off on banning large gatherings and closing schools.
Just 70 days after the first COVID-19 case emerged in the UK, the country has gone from "low risk" to an unprecedented national lockdown, with 55,949 confirmed cases including 6,171 deaths.
Still, Carrie Lam, the Chief Executive of Hong Kong, has done a strict job on coronavirus relief, banned public gatherings of more than four people since late March, while bars, fitness centres, cinemas, pubs, and other leisure venues have been ordered to close for two weeks. Restaurants also have to keep tables 1.5 meters apart.
Having gone through the SARS, the HK Government seems sensitive to the deadly outbreak of coronavirus. Schools extended the Lunar New Year Holiday to 16 February when there were only five cumulative local cases. Since then, EDB had changed decisions many times about the date of the resumption of schools.
Latterly, given that the epidemic situation has shown easing, EDB announced class resumption arrangements in phases for all schools. However, to minimize the risk of infection and facilitate schools' cleaning of their premises, all schools should only provide half-days.
The HM Treasury spent about 19.24 percent of the expenditure on health care in The 2020-21 Budget, while that in Hong Kong is approximately 13.36 percent.
In The 2020-21 Budget, Hong Kong Financial Secretary Paul Chan Mo-po's blueprint for the financial year ahead was the bolstering of the city's overall health budget, the third-largest public expenditure after education and social welfare, to a total of HK$97.7 billion, representing a 9.3 percent year-on-year increase from last year's HK$88.6 billion.
The Hong Kong government has pledged an extra HK$3.6 billion a year for the city's public hospitals to improve staff retention, services, and research in late April, and given health authorities coping with the coronavirus epidemic a HK$970 million cash injection.
"Due to the negligent testing process, I'm still afraid that I'll spread the infection to my relatives and fellows, and there may be people who are in the same situation as me." Cherry expects that the government can do better next time a similar outbreak occurs in terms of virus testing, the number of beds, and the arrangement of medical workers...
As the novel coronavirus has become a pandemic globally, responses and measures of different countries show how they used to treat disease and effort and focus spent on the medical sector before.
The global disease brought fear and worry to people and reflected the government's responsiveness and performance. It might be a time for everyone to review themselves and raise awareness on health issues.
When the coronavirus pandemic is still developing, some patients like Cherry were recovered and discharged from hospitals, yet the world was still combating with the virus.