Visitors to Hong Kong's Museum of Art this week will see a great Andy Warhol exhibit, but they might also notice a sign on the front door that declares how often the handle is sanitized.
Those who take a walk through Hong Kong Park will pass by a memorial garden that honours the health care workers who died. At the airport, officials stand ready to test passengers for fever. "No spitting" signs adorn park benches.
It's been 10 years since the Severe Acute Respiratory Syndrome (SARS) virus arrived in this city, and in some ways, it never left.
Memories of how fear gripped Hong Kong a decade ago as the normally bustling streets grew quiet and the economy ground to a halt are vivid among those who were on the frontlines of the health care system.
"Looking back now, I don't know how I survived," Dr. Lui Siu-Fai says. "We were in the centre of the storm … we were going into a battle unknown."
He was a doctor at Prince of Wales hospital where there was a major outbreak of SARS in the now infamous 8A ward. More than 300 patients were cared for there, 33 of them died. Lui and other doctors lived at the hospital for weeks on end, they were afraid to go home and potentially infect their loved ones.
"We all did our best to not quit, none of us ran away," the retired doctor said in an interview. Sadness and pride are two of the feelings in the mixed bag of emotions that doctors here, some of whom became patients, are experiencing as they reflect on Hong Kong's "dark ages," as one called it.
"I think all of us have changed — it has left an indelible mark on all of us involved," said Eng-Kiong Yeoh, who was Hong Kong's secretary of health when SARS hit. He was speaking at a conference on Tuesday that drew together experts from Hong Kong and around the world, including Canada.
The tables turned on Dr. Henry Chan in March of 2003. One day he was a doctor fighting on the SARS battleground, the next he was a casualty.
When he became infected with the SARS virus at Prince of Wales hospital in Hong Kong, Chan was so sick that turning over in bed took the energy of running 10 kilometres. He couldn't breathe well, he could barely talk, and he was bored.
"In bed, you have nothing to do, except think," he says. "Inevitably you think about your life."
Chan, 43, considers it a privilege that he had the opportunity to really reflect on his life and what he was doing with it. He decided to change it. Up until then he had been so focused on working hard in school, getting scholarships, being at the top of his class in medical school and getting promoted in the hospital ranks.
"When you get closer to death, you suddenly feel … these actually are not the most valuable things anymore. I asked myself, if I get a second chance, if I get out of this hospital, what should be the new direction of my life?" says Chan.
His daughter was a year old when SARS threatened his life. He changed his attitude and approach to life and the doctor now ranks personal relationships ahead of promotions and published papers.
"No matter what you are doing, you should not step on others," he says. Enjoy with friends and family, enjoy the path."
Many recalled the dedication of the doctors and nurses and there was another common theme: Hong Kong, and the global health system generally, is far better equipped to manage a pandemic since SARS, but the preparation and prevention work should never end.
"Hong Kong is definitely more prepared than it was 10 years ago," said Sian Griffiths, the doctor who chaired Hong Kong's post-SARS inquiry. "The question is, prepared for what? And I think that is always the constant issue. I think complacency would be a mistake … things are better, but don't let that lull you into a sense of false security."
It was March 12, 2003, when the World Health Organization issued its global alert about SARS, an illness that eventually spread from China to 30 other countries, infecting more than 8,000 people along the way. There were 774 deaths linked to it, nearly a quarter of those were health care workers.
Hong Kong 'not well-prepared'
Hong Kong bore the brunt of SARS in many ways. There were 299 deaths, hospitals were stretched far beyond their capacity, the economy, which was already struggling, took a huge hit as people stayed home and tourists stayed away.
It was a doctor from mainland China who brought the virus to Hong Kong. He stayed at the Metropole hotel, coincidentally in room 911, checked into a nearby hospital when he fell ill, and he died a few days later. Sixteen other hotel guests picked up the virus, and from them, SARS spread around the world — including to Canada, when a family who attended a wedding at the hotel landed in Toronto.
"I would say at that particular time Hong Kong was certainly not well-prepared," Dr. Wing-man Ko, the current secretary of health, acknowledged in an interview. But a lot changed in the wake of SARS to both prevent a pandemic and respond to one should it ever happen again on the scale of SARS.
Hospitals got an overhaul and now have better surge capacity and infection control measures. The number of beds available to treat highly infectious patients has doubled to 1,400 and there are negative pressure isolation rooms. In 2003, patients were crammed together in open wards, separated by curtains.
A rapid clinical test to identify viruses within hours is available — a major advance from 10 years ago, when it took days for test results to come back. Staff get better protection training now, and there are adequate supplies. In 2003, some health care workers didn’t know how to wear a mask properly, and protective equipment quickly ran out and had to be rationed.
Communication, between government and health officials, and with the public has come a long way. Health officials in Hong Kong first heard about a mysterious pneumonia type illness on the mainland because of media reports about a rush on vinegar. People were using it as a natural remedy to ward off the sickness. Now there are clearer lines of communication with Beijing and government is much more transparent with the public.
The Centre for Public Health Protection was created and border controls with infrared technology were enhanced. Ko talked at length about these and other steps taken to prevent another public health crisis. But he's worried about people relaxing their vigilance, especially when it comes to one area in particular — the consumption of wild animals in mainland China.
It is believed that the SARS virus originated in a bat and spread to a civet cat that ended up for sale in a market. The virus made the leap from the cat to humans and in the wake of SARS the Chinese government imposed a ban on eating civet cat and other wild animals.
"But after 10 years, people have probably relaxed a bit on this awareness," said Ko. "There are reports now and then about selling wild animals for cuisine."
Along with his frequent reminders about hand hygiene, Ko said he often issues warnings about eating wild animals.
The legacy of SARS in Hong Kong can be seen through the memorial garden and other visible symbols, but it's also clearly on the minds of the doctors who were on the frontlines and who are determined to never see another SARS.
"Today, the battle is over, the guns are silent," Dr. Joseph Sung told Tuesday's anniversary conference. "But our mission has not been completed yet."