Ten years on, a SARS legacy in the everyday details

HONG KONG -- The sign inside numerous Hong Kong elevators, taped near the floor buttons, seems benign enough: “Sterilized regularly.” It is questionable whether it is even true that the buttons get wiped down often, or if it is just a comforting message leftover from more anxious times.

In 2003, those signs often read “Sterilized every hour.” It looked like a mistake, or something lost in translation. But it was no exaggeration. At the time, the height of the severe acute respiratory syndrome (SARS for short) outbreak, vigilance with disinfectant was at extreme levels.

Of the 774 SARS deaths around the world, 299 were in Hong Kong. In the aftermath of the public health crisis, the government set up its Center for Health Protection, which created more rigorous infrastructure to help prevent and control diseases.

The SARS experience has given the city a better handle on dealing with infectious diseases, with more advanced technology and more knowledge, said Thomas Tsang, a former controller of the Center for Health Protection, at a conference in March. "Most importantly, we have put in place better disease combating structures," he said.

But the shaken public changed their everyday behavior, too, and businesses altered how they operated. And a certain portion of those habits still survive now, 10 years on — while a deadly strain of bird flu looms across the border in mainland China, with a case confirmed in Taiwan.

The sight of people wearing face masks in everyday life did not exist before 2003. But during the outbreak, nearly every person on the street had one on, and it became a symbol of the fear and uncertainty surrounding the virus. The habit lives on today, with sick people expected to don one in public to prevent the spread of germs.

“Now when people are sniffling or coughing, you really think they should be wearing a face mask,” said Jennifer Cheng, a Hong Kong resident who was in high school during the outbreak.

Cheng recalls the government’s instructions to spend a full 30 seconds washing hands, which she obediently followed at the time. Fewer signs are now posted in public restrooms teaching the method of thorough hand washing, but the many hand-disinfectant sprays and gels that were attached to the walls in office building lobbies and fast-food restaurants are still here and used frequently.

At eateries ranging from neighborhood diners to formal dining rooms, disposable wipes started to appear at each place setting, and many restaurants still keep up the practice. “Those wet tissues you get at the restaurants, there wasn’t such a thing before SARS,” said Yam Yim Lan, a magazine writer.

Yam remembers some less obvious directions from the government, too. Residents were encouraged to change their clothes after getting home and wash them after each wear. Some companies that normally required suits told their employees they could dress casually to make it easier to wash each day’s clothes.

Even if some of these habits disappeared after SARS, the “swine flu” pandemic in 2009 proved that they are quickly remembered and readily re-adopted. A survey that year by the Chinese University of Hong Kong found that 73% of respondents said they began washing their hands more after the first swine flu case was reported in Hong Kong, and 89% said they would most likely wear face masks in public places if they had flu symptoms.

“This preparedness might have been built upon the experience of the SARS epidemic, during and after which the awareness and practice of public health measures against respiratory infectious diseases as well as government infrastructures have been much improved,” the report read.

Germaphobes may see the constant opportunity to disinfect their hands as a positive outcome. But broader lifestyle changes have also happened and seem to be here to stay.

During the outbreak, the public was told not to stay cooped up indoors. A government survey of the number of people visiting Hong Kong's hilly country parks each year indicated a sharp increase of outings following SARS, and it stayed at that level -- until the swine flu outbreak, when it jumped again to an even higher number.

It could just be a coincidence, but Andy Cornish, a Hong Kong-based ecologist, connects the population's increased interest in outdoor activities starting in 2003 to SARS.

“People who hadn’t necessarily visited country parks and wanted to get away from crowded places, out of cinemas and malls, they went to country parks,” he said. "I think what it means mostly is they are looking for recreation and better quality of life."

Photo: Flickr/David Bailey MBE

This post was originally published on Smartplanet.com