A Hong Kong citizen who grew up in the midst of the 2003 S.A.R.S. epidemic wants to share the “collective trauma” of that experience, and the valuable public health lessons that live on today.

Tiffany Chan is a volunteer in Samoa and was around six-years-old when the Severe Acute Respiratory Syndrome (S.A.R.S.) swept mainland China and Hong Kong, causing 774 deaths in 17 countries.

In Hong Kong alone, 299 people died. Ms. Chan said the memories of that time, and the names of the frontline health workers who died, are burned into her memory.

Even Ward 8A of the Prince of Wales Hospital is a name she cannot forget, the ward of the Government hospital where the outbreak began with 11 healthcare workers showing symptoms, and quickly became 143 people who had been in contact with patient zero, medical workers and students, other patients, their families and relatives. 

But out of the grief of the epidemic, which lasted nine months, the citizens of Hong Kong have an unwavering dedication to public health practices, she said. 

“It’s pretty extreme. If you start coughing intensely on a crowded train and you don’t have anything on, people will at you or just get up and leave. Or more direct people might say can you please put on a mask. 

Going to work with cold or flu symptoms and no mask is not socially acceptable anymore, Ms. Chan added. But people have learned not to take it personally.

“It’s not personal, it’s for the collective good, you know.”

She said in an era of mass globalisation and frequent international travel, more people should have such heightened awareness of infectious diseases. 

Wearing masks, washing hands carefully and being more cautious around mild illnesses was sparked by the S.A.R.S. epidemic.

“For people who don’t understand the public health concern they might think why? But you just need to care about your neighbours when you are sick, when you are sick you don’t go to crowded places. It is so easily spread.”

So far this year Hong Kong has had 273 cases of COVID-19. Ms. Chan said all the same public messaging around health and hygiene is back, and people are quick to respond.

“It just hit me. It’s been 17 years and no one really forgot about it. It’s as if SARS happened yesterday and we are still in this heightened mode.”

Frequently touched public surfaces like doors and door handles are cleaned often. Elevator buttons will have notices reporting when the panel was last disinfected.

“That makes people feel safe,” Ms. Chan said. 

In other countries that have not experienced recent mass epidemics, the attitude to these issues is completely different. Ms. Chan describes the stark contrast she felt when a clearly sick person was on the same crowded train carriage as her in London, and she was the only person trying to move to the next car. 

“Maybe people in Hong Kong are a little bit extreme, but that is understandable […] It was a very collective trauma for all of us. I was a very young kid but I still remember a lot of details.”

Ms. Chan said she wanted to talk to the Samoa Observer to share what she knows about how to protect yourself from infectious disease based on her lived experiences in Hong Kong. 

She said nothing about it is “common sense” but needs practice and careful attention to detail.

The first thing is how to properly wear a personal protection mask, if you are going to wear one at all. In light of equipment shortages globally and in Samoa, she recommended considering skipping the masks if you are not already sick or going to be in crowded places, which are now banned for two weeks.

“If you wear a mask and you don’t wear it properly then what is the point? You are wasting a mask that could be saved for people on the frontlines.”

A mask needs to be worn the right way up, and the right way around too, she said. The coloured side is typically the outside, and a wire is the top side.

The wire needs to be bent carefully to match the bridge of your nose and to fit the top of the mask closely to the face. Then the bottom of the mask needs to be pulled taught to fit under your chin, getting as close to the throat as possible.

Ideally, a mask should not be removed and replaced several times. But if necessary, Ms. Chan said not to pull it down under your chin, as it could spread any gathered bacteria on the front to the face.

Instead, remove it from your ears by the elastic and fold it outwards, and hold it while drinking water. Then replace it again by holding only the elastic bands.

If it has to be touched, you should wash your hands thoroughly for 20 seconds immediately. 

To put it in the bin, the mask should be removed by the elastic, folded with the inside layer in, and tied tightly with the elastic. Ideally it would be thrown into a closed and lined rubbish bin.

“A mask that can prevent viruses from spreading to you or from you to others has to be three layers,” Ms. Chan explained.

“The outer layer is the one that prevents droplets from coming in. The middle is the filter that blocks micro dust and bacteria, and the inner layer absorbs the moisture that you the wearer emit.

“So if the mask you are wearing is not up to that standard, please do not feel safe wearing it.”

Masks made from fabric are not functional for disease prevention, Ms. Chan said. 

The World Health Organisation advice on wearing masks states they are only effective when used in combination in frequent hand washing with soap and water for at least 20 seconds, or using an alcohol based hand rub.

Healthy people should only need masks if they are taking care of someone with a suspected COVID-19 infection or other disease.

People with flu-like symptoms should wear a mask. 

The Lancet has published a comparison of recommendations on face mask use and is calling for Governments and public health agencies to make “rational recommendations on appropriate face mask use.”

“Perhaps it would […] be rational to recommend that people in quarantine wear face masks if they need to leave home for any reason, to prevent potential asymptomatic or presymptomatic transmission,” the six authours write.

“In addition, vulnerable populations, such as older adults and those with underlying medical conditions, should wear face masks if available. Universal use of face masks could be considered if supplies permit.”