Mar 25, 2020 - Health

SARS made Hong Kong and Singapore ready for coronavirus

Image of a teacher in Hong Kong addressing a class of masked children on hand hygiene for COVID-19.
A teacher in Hong Kong shows students hand hygiene during the SARS outbreak in 2003. Photo: Tommy Cheng/AFP via Getty Images

Despite their proximity to China, Hong Kong and Singapore have managed to keep COVID-19 infections and death extraordinarily low.

Why it matters: As coronavirus cases surge in parts of the U.S., it's natural to look at the examples of cities that have handled the disease better. But the single most important factor may be something the U.S. can't replicate: the experience of the SARS outbreak in 2003.

There's no shortage of reasons Hong Kong and Singapore have had such success in containing COVID-19. Both cities are rich, with strong public health care systems and a deep bench of infectious disease experts. Both cities were quick to restrict travel from China, to check and quarantine visitors with symptoms and to rapidly trace contacts of any confirmed COVID-19 cases.

  • But the deeper reason lays not in today's success, but in past failure that remains very real for the roughly 13 million citizens of these two globally-connected cities.

Flashback: In 2003, Hong Kong was the epicenter of the SARS outbreak, suffering 298 deaths from the disease, second only to mainland China. Singapore experienced the fifth-most cases of the disease, with 32 deaths.

Those numbers, though, only tell part of the story. I lived and worked as a journalist in Hong Kong during SARS, and what the city experienced during the spring of 2003 was every bit as terrifying and paralyzing as what is happening now.

  • In the early days of the outbreak, SARS burned through Hong Kong's hospitals, infecting dozens of health care workers and ultimately killing nine of them. Hong Kong was also the only city that experienced a widespread public outbreak of the disease, when 329 residents in the Amoy Gardens apartment complex contracted SARS.
  • During the worst period of the outbreak, Hong Kong experienced a shutdown nearly as total as those caused by COVID-19, with people shunning restaurants and public spaces, schools closed for weeks and the city's usually bustling airport all but stilled. Unemployment hit an all-time high of 8.5% in the waning days of the outbreak.
  • Singapore weathered the outbreak better than Hong Kong, but still experienced a GDP drop of 0.47%.

The memory of SARS is burned in the minds of ordinary Hong Kongers and Singaporeans, as well as the city's doctors and leaders.

  • When reports began surfacing in January of a mysterious respiratory disease in China, Hong Kongers began taking steps of their own, wearing masks in public and increasing hand-washing and disinfection.
  • Many Americans are already bristling under the restrictions put in place to slow the spread of COVID-19 — or even doubt the danger of the pandemic altogether — but the experience of SARS has made Hong Kongers and Singaporeans more willing to sacrifice convenience and the economy for public health.
  • “While in many places, the general public tends to regard outbreaks, more or less, like a television fantasy or brief news item, in Hong Kong, the public take outbreaks, and recommendations about what to do, seriously," Keiji Fukuda, the director of the University of Hong Kong's School of Public Health, told the Atlantic this month.

The bottom line: There is plenty for the U.S. to learn from Hong Kong and Singapore's response to COVID-19. But if the most important point is that experience is the best teacher, we may be in for painful lessons.

Go deeper