Press Releases

Transcript of press conference on implementation of home confinement

Following is the transcript of remarks by the Secretary for Health, Welfare and Food, Dr Yeoh Eng-kiong; the Director of Health, Dr. Margaret Chan; and the Acting Director of Home Affairs, Miss Janet Wong; at the press conference on the implementation of home confinement today (April 10):

Secretary for Health, Welfare and Food: Today we have made an important policy decision to implement a new measure to control the spread of severe acute respiratory syndrome in Hong Kong. After a detailed and careful consideration of the developments and all the facts before us, we have decided that all household contacts of patients confirmed with severe acute respiratory syndrome will be confined at home for a period of up to 10 days with immediate effect. Regulation 11 of the Prevention of Infectious Disease Regulation will apply.

The purpose is to facilitate early detection and treatment of all the household contacts of severe acute respiratory syndrome patients and to reduce to the absolute minimum the risk of the disease further spreading in the community. Just to put it into context, from the data that we have so far, the rate of household contacts of acquiring the infection is estimated to be below 5 per cent. So if there is one person who is affected by this virus, the household contacts' risk of getting infection is approximately 5 per cent if they don't take precautions. This is based on the experience at the Prince of Wales Hospital, where many of the households of healthcare personnel were infected by their family members. So they didn't take any precautions and the infection rate is about 5 per cent. But we are implementing this measure as this precaution is to reduce the risk of the disease spreading, and we should give affected households a choice - either confine themselves at home or they wish to move to one of the holiday camps.

Under this measure, the household contacts will not be allowed to receive visits into their flats. Permission to leave their flats will be given only on exceptional grounds. The Department of Health will conduct medical checks on these individuals and observe closely their health conditions. This means that, in effect, they will be required by law to remain at home up to these 10 days.

Some of the household contacts may have already approached the end of their incubation period. As their health conditions are already under close monitoring at our designated medical clinics, we feel that it would not be meaningful for us to require them to stay home for the remaining two or three days. As you know we already have an order for individuals who are close family contacts. At the moment they are required to follow up at the medical clinics of the Department of Health. So for those individuals where there are remaining two or three days, we feel that it is not meaningful to require them to stay at home. We have therefore decided that the new measure should cover all patients' household contacts whose surveillance period ends on or after April 14, as there would still be a three-day period remaining of the incubation period during which the health conditions of the household contacts would be monitored at their homes.

As and when the situation is developing, we need to implement new measures and strategies as necessary to cope with the rapidly changing circumstances.

Furthermore, the community must understand that there has never been a need for us in the past to invoke such powers to confine people in their homes. We must therefore exercise this power very most carefully, sensibly and responsibly. We must also be reasonably sure that the community as a whole is behind us in implementing this measure. Events in the past few days have indicated that the community accepts isolation arrangements despite the inconvenience it caused to affected individuals. We believe that, with the community's support, the time is ripe for us to go one step further to help contain the spread of the disease.

I would also like to take this opportunity to call on the community to support these families and not to stay away from them or discriminate against them. The risk of infecting household contacts based on evidence to date is not very high. This is only an extra precautionary measure that we make. The family members of patients do not pose a clear and present danger to their neighbouring community.

Over the past few days, there have also been concerns about the disclosure of buildings in which there have been confirmed cases of patients with severe acute respiratory syndrome. And I think we completely understand the anxiety over this matter. I think I would also like to appeal to the community not to discriminate against the household contacts of these individuals because in fact these individuals generally do not pose a risk to them. The risk to the individuals in fact is when the patients get sick and by the time the patient has been identified and admitted to hospital, the greatest danger has already passed. So really dealing with the contacts, the family contacts of the individuals. However, to tie in with the new measure of home confinement and to avoid any further speculation on this matter, we have decided to disclose the names of the buildings in which there have been confirmed cases of severe acute respiratory syndrome. And this will be available in the Department of Health's website.

This is a difficult time for everyone. And indeed it is time that we should co-operate to make this measure work. I do believe that crises will always bring out the best and worst of humankind. For this particular one, I only hope that it will bring out the best of the true qualities of the people of Hong Kong. The qualities and values that we the people of Hong Kong have always believed and treasured. We have been moved by the scenes of celebration when the residents of Block E of Amoy Gardens, returned to their homes last night. I think it is now time that we showed the world that we stand not as a divided, angry and irrational community, but as brothers and sisters in arms to fight this very, very alarming disease.

What these families need most will be assistance in purchasing food and daily necessities and delivering these to their doors. However, the assistance can also be given more importantly by relatives, friends and neighbours without much difficulty. It is in terms of gesture of moral support to these families. Most of all, they need the community's understanding that they are not and must not be treated as if they are contagious, and the lepers of yesteryear. These people are ordinary people like yourself and myself. And, some of them may be your friends and relatives. They are unfortunately the victims of circumstance and they must be given the dignity they rightly deserve in getting through this very difficult period.

Director of Health: Thank you, Dr Yeoh. Good afternoon, ladies and gentlemen. This new measure to confine household contacts of affected atypical pneumonia patients for home treatment, under Section 11 of the Prevention of the Spread of Infectious Diseases Regulations Cap. 141, is not a foolproof system. But key to effective implementation is based on self-regulation to be complemented by a proper mechanism to check on compliance.

And, during this period, Department of Health's Health Visiting Team will visit household contacts to provide them with the necessary medical service to ensure that during the 10-day confinement. They would be checked on their body temperature and other signs and symptoms to make sure they are well. And, should any of them develop earlier signs and symptoms, we would like to provide treatment, appropriate treatment, to these people. It is a well-established principle in public health that early identification of cases and treatment is paramount to the control of a further spread of this disease.

And, as I said, our Department of Health colleagues will stand ready to provide the medical home treatment scheme to these people but we would enlist the help of the police to do the compliance check on an ad hoc basis, unannounced basis. We want to make sure that the people, the household contacts, would as far as possible stay at home and be compliant with this programme.

And, we do realise that there are perhaps some people who do not wish to stay at home for whatever reason. Perhaps they are elders and children who are not able to look after themselves. We will provide alternative accommodation to these people at the Lady MacLehose Holiday Village or the Lei Yue Mun Park Holiday Village for the period as stated in the permit to be issued by the Director of Health.

As for the other necessities, meals and daily necessities, the Government is ready to provide assistance and the Director of Home Affairs will shortly brief you on the helpdesk that is to be established under her department to provide support services to these households. I will leave this to the Director of Home Affairs. She will come in, perhaps, in a few seconds.

What about students whose schooling and studies are disrupted during this confinement period? The Government would work with the schools and the university authorities to make sure these students could be given special care and attention when they resume their normal academic studies after the expiry of the prescribed period.

I would like to emphasize one point. It would be wrong for us to draw a comparison between these families with the case of relocating the residence of Block E of Amoy Gardens. The latter is a very special case in which investigation has to be done in the building itself. So I would like you to be clear on this point. In the case of the household contacts of patients in general, the likelihood of them developing infection is very low, as Dr Yeoh has mentioned earlier. It's in the range of four to five per cent.

Nonetheless, having concluded our earlier experience with the different schemes of early identification and detection of cases, we feel that at this stage of the development, this is an appropriate scheme that we could introduce and would have the support of the community and the understanding of the household contacts of patients. And I would like to appeal to the community through you to be sympathetic and supportive of household members of patients of atypical pneumonia. It is important that you care and provide support for them, and not to discriminate them in order to allow this scheme to ripe its maximum benefit. Perhaps I'll stop at this point and ask Director of Home Affairs to continue to give you some more details.

(Chinese version by Acting Director of Home Affairs)

Reporter: (Why did you make the decision on household contacts only now but you ....weeks ago? )

Secretary for Health, Welfare and Food: As I said that earlier, when we made the decision in terms of households, it is not a house arrest, we are really talking about home isolation. In terms of this Quarantine and Prevention of Diseases Ordinance, it enables the Director of Health to give specific instructions to individuals, to limit their activities, for the prevention of disease, of course included the severe acute respiratory syndrome among the infectious diseases that will be governed by this ordinance.

When we made the decision, we had a long discussion on the pros and cons. We had considered using home isolation right at the start. We had long discussion, and that I was explaining that this is something new in modern Hong Kong history. It is not very easy for the public to accept these decisions, not least of which in fact you will be very concerned about the fact that it would have on individual seeking help. I think that was our main consideration, not so much in terms of the privacy and rights of individuals but on the impact that would have on the control of the disease.

So after a long discussion within the Government, there was consensus that it would probably, that because it was something new to Hong Kong to restrict individual's movements for the public good. We were of the consensus that the best way to implement would be to limit their activities but to require them to go to the Department of Health. Of course, since then, we had also the isolation order for the Amoy Gardens in Block E. And there has been quite good compliance with our orders and there seems acceptance that the Government should be doing this. So we take it one step further to protect the public health. So we are now imposing this isolation order.

Reporter: Before I go to my major question, you haven't mentioned how many people would be quarantined and what are the penalties for breaking the order; and my main question is, the outbreak at Princess Margaret Hospital, is there any link between the outbreak in the Princes of Wales Hospital and outbreak of Amoy Gardens?

Secretary for Health, Welfare and Food: OK. In fact, I don't have the information herewith.... the information we prepared for you. To look at the number of cases we have, in fact, the large number of cases that we had related to the two outbreaks, one is the Prince of Wales Hospital outbreak that was initially either unidentified and large numbers of people infected. The second very large outbreak was the Amoy Gardens outbreak, and the effect is seen in Ngau Tau Kok and the adjacent estates spill over from the very large outbreak in the Amoy Gardens and the figures are now coming down. So, when we look at the admission from Amoy Gardens, we now have a few confirmed cases. So, the confirmed cases now, we can see some secondary effects, because as you know, some of the households sadden to have households' members being infected. So, you'll expect some of the households' members to be secondarily infected. So, we now seize some of those secondarily infection in households' contacts. But the numbers are now coming down from Amoy Gardens and from the adjacent complexes in Ngau Tau Kok and the other private estate --- Lee Kee Building. So, these are all related to the Amoy Gardens outbreak. The effect on United Christian and on Princess Margaret simply caused the hospital swamp with large number of patients where there was a great deal of pressure on the medical staff. Of course, there were also individual patients who came from the Amoy Gardens outbreak, but did not give their addresses as from the Amoy Gardens, some did not present the typical features. So, there were infection control breakdowns, because the infection control procedures, there were breakdowns in some of these procedures because patients were not identified. Initially, a patient was nursed for other types of illnesses. So there were inadequate infection control procedures because patients were not identified. And, some of the infections in the healthcare staff, and in intensive care, were because of the demands for the high level of hospital of infection control that proceeds intensive care, which the hospital is now investigating. So, I believe that all these were very much due to large numbers, and the great pressure and demands on healthcare staff in nursing and taking care of patients, where they themselves then got infected.

Reporter: How about the penalties?

Secretary for Health, Welfare and Food: The penalties.... Dr Chan will take the answer.

Director of Health: I'll take that question, thank you. Our arrangement is, any household contacts who do not comply with this home confinement arrangement, we would remove them to designated places for isolation. And, of course, the ordinance does prescribe, you know, imprisonment and fine. But to me, to control the spread of the communicable diseases is more important. If they do not follow the scheme and stay home, we would remove them to designated places for isolation.

Reporter: Could you give us an idea of how many people are affected by this? I know you don't have a specific number, but is it 10, 100, 1,000, 10,000? Secondly, why did you decide on a 10-day period? The Guangdong Government says this disease has an incubation period of 15 days and New England Journal of Medicine says the incubation period can last up to 16 days. And third, if you could just comment on your ability to trace the contacts.

Director of Health: The reason why we pick on 10 days is based on the cases we have in Hong Kong - each and every case - we would find out what the incubation period was. And our studies have demonstrated that it ranges from two to seven days and in some cases it can be as long as 10 days. And as you can see the World Health Organization supports this as a reasonable duration. Having said that, of course I would issue the permit for a 10-day period, but depending on special circumstances, we may need to extend that period. And as for the number of people involved, I have briefly mentioned that any person who has a medical surveillance period, the balance of about four days and above would be incorporated under the scheme. Our estimation, including the new cases today, would be in the range of involving 70 to 80 households. And in terms of a headcount, it would be about 150. And that doesn't include people with a surveillance period of less than four days, who still need to attend our designated medical centres. So all in all, the two schemes collectively, we're talking about a few hundred people.

Reporter: (Questions from reporter of a Singapore newspaper)

Secretary for Health, Welfare and Food: As to the same question Marianne asked why are we doing it now? As I said that the risk of infection on the family contact members if you are in close contacts with the individuals, it is five per cent or thereabouts, let alone the risk to the communities. So these individuals' family contacts if they walk about in the community even if you didn't restrict them, the risk would be less than five per cent or much less than five per cent because even within family settings it is five per cent. This is the average of the individuals who are in working very close office environment etc. But we already said in the first instant that these people are not supposed to go to work.

In our decision to enact the quarantine prevention ordinance, there were lots of anxieties that we would deter people from seeking treatment. Of course if one person doesn't seek treatment and that person gets very sick before that person is admitted, we know that the risk of infection to other individuals are very high because you know the sicker the person, the more infectious the person. And people in the incubation, disease may be infectious but their infectivity is certainly much less and much lower. Of course, when they are sick, we really want to make sure that we get people early, when they are sick, for two reasons. One is to provide early treatment and the other is when they are sick, they are more likely to infect others.

I think it is really a balance of the factors. I think there is no evidence either way. But in terms of public health, when you look at modern day public health practices, very few countries in the world have ever enacted these quarantine ordinances simply because of the concern about deterring people from seeking treatments. I think if you look at HIV AIDS, I think it's the same issue. You could extrapolate that the HIV AIDS, you could extrapolate to other infectious diseases and you see very few countries have enacted these quarantine ordinances.

Reporter: If you could tell us about how many people you actually have conducting the contact tracing work, which department involved? The 150 people who will receive letters tonight for home confinement, seems a rather small number considering it's almost a thousand cases of severe acute respiratory syndrome. You had also talked about the stress on the health care system...?

Director of Health: It is important to understand the medical surveillance period of 10 days and the hundreds, about one thousand cases, started on March 10 with the first outbreak in the Prince of Wales Hospital. As you can see, every 10 days, a group of people would come off the contact tracing list. You see my point. So, it is a rolling list, depending as Dr Yeoh put it, at the early phases with the Prince of Wales outbreak followed by the Amoy Gardens outbreak, in the last five to six days, the cases stabilized at about 30, 40 cases per day. In another words, a big trunk of the two big outbreaks, many of those contacts, which we provided contact tracing, come off the 10 day list. The 150 people, or roughly 72 to 80 households, that I referred to earlier, is counting the ones that have a balance or above, another four days and above for surveillance plus the new cases that will be announced today. So, basically that is the reason.

Reporter: How many people are actually conducting the work?

Director of Health: In terms of contact tracing, we run into 3 000 to 4 000 over the entire period.

Secretary for Health, Welfare and Food: I think the other thing we need to realize. The cases that we reported are confirmed, they are not the cases we admitted yesterday because the confirmation takes some time. You are able to confirm some cases very quickly within a day or two. Some cases need some time to work out. The time when these cases are reported are not the time of the cases that were actually admitted. Obviously the incubation period will be the time when the individual being admitted and left their homes. In the last couple of days, the numbers of admission have dropped but of course there is still a lag phase. That is why the number today is not large. In the last few days, the numbers still reached the forties. But in fact our admission had been reduced - that is, the lag between the time the cases are confirmed and the admission figures. It meant that you see so many cases but the incubation period of many of individuals had really lapsed. But I think the 10 day period, as Dr Chan said, from our own experience, it (the incubation period) is about two to seven days. The WHO sees that in some cases may be slightly longer. So we are just having an extra three days as precaution. As the disease evolves, we might find more and more information. When you looked at infectious diseases, usually individuals have long incubation period, usually have less exposure, the virus tends to be, the infection number tends to be, smaller. When people are exposed to large virus load, the incubation period tends to be shorter and the disease tends to be more severe. There is general high risk in the early periods. In the later period there may be some outliers but you would have got the majority in the individual during the 10-day period. Obviously, these are nothing foolproof as we learn more about the disease then we may have outlines. But we need to assess the impact of these outlines and how much they would pose risk to the society in these outlines. Because we really have a good system once we have put them under surveillance. We would have a good system that they are continuing to be reported and of course we will continue to follow them up.

Reporter: Dr Yeoh, can you tell us how are you going to classify the death on the American teacher? Are you going to update him into Hong Kong's official death toll? Or is he going to be listed under China?

Secretary for Health, Welfare and Food: He was dead on arrival in our hospital. So he is not included into our figure. But we are looking at the figures to see how we should be classifying this individual so the figure would not appear in our death toll because he was not treated in Hong Kong. When he arrived in the North District Hospital, he was dead on arrival. So the Certification of Death is in Hong Kong, so we would include that, but in a different category in our statistics. So he would not appear in the statistics of the mortality of the people that we treated because we never treated this individual. But because he died in Hong Kong and his medical certificate was to be issued in Hong Kong, obviously the death toll would have to appear in Hong Kong's figures.

(Please also refer to the Chinese portion of the transcript.)

End/Thursday, April 10, 2003
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