SrasV1, Istex, Corpus, bibRecord, 000243

At the Epicentre: Hong Kong and the SARS Outbreak

Identifieur interne : 000243 ( Istex/Corpus ); précédent : 000242; suivant : 000244

At the Epicentre: Hong Kong and the SARS Outbreak

Auteurs : Pamela Michael

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Social History of Medicine [ 0951-631X ] ; 2005.

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DOI: 10.1093/shm/hki056

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      <p>Christine Loh and Civic Exchange (eds), Hong Kong: Hong Kong University Press, 2004. Pp. 296. $39.50 (hbk). ISBN 9622096832.</p>

      <p><italic>At the Epicentre: Hong Kong and the SARS Outbreak</italic>
 was written during the aftermath of the SARS epidemic and conveys an appropriate sense of immediacy. It contains 14 chapters written by specialists from many areas. The book commences with a timeline of events in Hong Kong that includes key dates in the story from China and elsewhere. Chapter One, written and compiled by two journalists, provides an impressionistic account of the disease outbreak and conveys the incremental way in which knowledge of the disease reached the scientific community and the public. The journalists situate the news bulletins within the context of a growth of a general sense of anxiety generated by various factors; Hong Kong's transition from a British colony to a special administrative region (SAR) of China, the collapse of the property market in Hong Kong, the downturn in the international economy and the war in Iraq. Events unfolded alongside other news that heightened sensitivities; a famous pop star leapt to his death on 1 April 2005 with a green surgical mask in his pocket; the same day a schoolboy caused panic-buying by hacking into a newspaper website and posting news that Hong Kong was to be closed down to contain the disease.</p>

      <p>Chapter Two, written by a respiratory health specialist, outlines the measures taken to counter the disease and the distinctive methods adopted in each of the major hospitals. Medical staff had to deal with the outbreak on a daily basis whilst laboratory research was conducted to identify the disease. A rapid diagnostic test was not available so much depended upon sound clinical judgement. The dangers of hospital infection were great. This chapter ends with a plea for better training of hospital staff in the management of infectious diseases, greater public health education and improved communication amongst health specialists. Chapter Three provides an unusual turn on the patient narrative as it is written by a doctor who contracted the disease and discovered that compliance with medical advice is a very personal matter. Chan and Loh then describe the search for a causal agent and the intense collaboration between international research centres, led by the WHO and linked by a secure website and daily teleconference calls. The ‘search for the culprit’ involved virologists, bio-chemists, bio-physicists, zoologists, geneticists, and many other specialists. Finally, a new coronavirus was identified with the help of a powerful electron microscope employed at Hong Kong University (HKU). Following Koch's postulates (a series of conditions for establishing that a microbe is the cause of a disease, devised by the father of modern bacteriology in 1892) researchers at Erasmus infected monkeys with a SARS-associated virus from cell cultures and found that the animals developed the disease. Virologists were working along the lines that SARS may have crossed the species barrier and moved from birds or animals to humans. In the end, the pathogen was defeated by basic strategies already well-known to historians of public health, including isolation, quarantine, and scrupulous hygiene, from hand-washing to the wearing of masks. A chapter written from the public health viewpoint will provide more familiar reading to historians of medicine, and includes an interesting analysis of the epidemiological parameters of the epidemic. Quantitative techniques are employed in the following chapter, written by a statistician, who draws the conclusion that good predictive as well as retrospective work can be carried out. However, much depends upon the quality of the data available. Alexis Law therefore argues, as do many of the contributors, for the vital importance of transparency of information and the employment of good monitoring techniques.</p>

      <p>Public concern about the authorities' failure to tackle the problem effectively during the first critical weeks led to an outbreak of popular protest and dissent. The political dimensions of the epidemic form the subject of a chapter that considers the issues that were raised in terms of governance and political accountability. The SARS epidemic posed inter-governmental and sub-national questions about the relationship between the WHO, Hong Kong, and Mainland China, and historians of international public health will find the chapter by Christine Loh fascinating reading. The SARS epidemic laid bare the fundamental contradictions between the old systems of bureaucratic management of a centralized command system in China and the demands of a market-oriented economy in Hong Kong. The weaknesses that the SARS epidemic exposed are further explored in a chapter written jointly by Loh and Yip Yan Yan. They call for greater transparency and democratic accountability to ensure better public health protection in the future. Stephen Brown then assesses the impact of the epidemic upon the Hong Kong economy. Whilst the immediate quantifiable impact appears to have been temporary, he speculates upon whether the epidemic may not lead to a further realignment in terms of the relationship of the Hong Kong economy to the Chinese mainland. The issue of the geo-political aspects of the SARS epidemic is one that underscores this volume of essays. Loh and collaborators then scrutinize the intense media coverage in Hong Kong of the SARS epidemic and assess the experiences of the community. They consider the suffering and loss but also note the growth in social cohesion and increased respect for health professionals resulting from the epidemic; they speculate upon the emergence of a sense of new priorities, where human welfare may now rank before private profits or public spending restraints. Finally, in summing up, Loh ends on a similarly positive note, arguing that residents of Hong Kong have achieved a new feeling of dignity and self-respect. Whilst this argument may be contentious, it certainly illustrates the wide-ranging nature of the discussions contained within this timely and well-produced book. In its entirety, this edited volume provides a valuable contemporary history of the SARS epidemic and in particular its impact in Hong Kong. In time the book will doubtless become a key historical document.</p>

      <p>The collection is valuable for other reasons too. It provides insights into a region that is often predicted to be the source of future epidemic challenges; a new global influenza epidemic/pandemic linked to avian flu emerging from the same heavily populated area of south China is a now familiar scenario and Hong Kong may once again find itself at the epicentre. It also reminds historians in the subject area of the fruits of collaborative endeavour. In the same way that the SARS virus rapidly crossed international borders, so the study of SARS is speedily crossing academic boundaries. The chapters in this book are indicative of the epidemic's interest to political scientists, economists, epidemiologists, international relations experts, health policy analysts, sociologists, cultural critics, and so on. For readers of this journal the history of the SARS virus should provide further affirmation of the importance of interdisciplinary and international perspectives on the social history of medicine.</p>

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At the Epicentre: Hong Kong and the SARS Outbreak

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