Query: Hong Kong covid-19

title: Community responses during the early phase of the COVID 19 epidemic in Hong Kong: risk perception, information exposure and preventive measures
abstract: Community responses are important for outbreak management during the early phase when non pharmaceutical interventions are the major preventive options. Therefore, this study aims to examine the psychological and behavioral responses of the community during the early phase of the COVID 19 epidemic in Hong Kong.  A cross sectional online survey was launched within 36 hours after confirmed COVID 19 cases were first reported. Councilors of all 452 district council constituency areas were approached for survey dissemination. Respondent demographics, anxiety level, risk perception, sources to retrieve COVID 19 information, actual adoption and perceived efficacy of precautionary measures were collected.  Analysis from 1715 complete responses indicated high perceived susceptibility (89% and high perceived severity (97% Most respondents were worried about COVID 19 (97% and had their daily routines disrupted (slightly/greatly: 98% The anxiety level, measured by the Hospital Anxiety and Depression Scale, was borderline abnormal (9.01) Nearly all respondents were alert to the disease progression (99.5% The most trusted information sources were doctors (84% followed by broadcast (57% and newspaper (54% but they were not common information sources (doctor: 5% broadcast: 34% newspaper: 40% Only 16% respondents found official websites reliable. Enhanced personal hygiene practices and travel avoidance to China were frequently adopted >77% and considered effective >90% The adoption of social distancing measures was lower (39% 88% and their drivers for greater adoption include: being female (adjusted odds ratio [aOR]:1.27) living in the New Territories (aOR:1.32 1.55) perceived as having good understanding of COVID 19 (aOR:1.84) and being more anxious (aOR:1.07)  Risk perception towards COVID 19 in the community was high. Most respondents are alert to the disease progression, and adopt self protective measures. This study contributes by examining the psycho behavioral responses of hosts, in addition to the largely studied mechanistic aspects, during the early phase of the current COVID 19 epidemic. The timely psychological and behavioral assessment of the community is useful to inform subsequent interventions and risk communication strategies as the epidemic progresses.

title: Impact of Coronavirus Disease 2019 (COVID 19) Outbreak on ST Segment Elevation Myocardial Infarction Care in Hong Kong, China
abstract: ST segment elevation myocardial infarction (STEMI) is a disease of high mortality and morbidity, and primary percutaneous coronary intervention (PPCI) is the typical recommended therapy.1,2 Systems of care have been established to expedite PPCI workflow to minimize ischemic time from symptom onset to definitive treatment in the catheterization laboratory. Little is known about the impact of public health emergencies like a community outbreak of infectious disease on STEMI systems of care. Since December 2019, the emergence of Coronavirus disease 2019 (COVID 19) in Wuhan, China, has evolved into a regional epidemic, including in Hong Kong, a city in Southern China. We describe the impact of the COVID 19 outbreak on STEMI care in Hong Kong through a handful of recent cases of patients with STEMI who underwent PPCI at a single center. We included patients with STEMI admitted via the Accident and Emergency Department and in whom PPCI was performed. We focus on the time period since January 25, 2020, when hospitals in the city started to institute emergency infection protocols to contain COVID 19. This required hospitals to suspend all nonessential visits and adjust clinical in patient and out patient services. Indications for PPCI were according to the international guidelines.1,2 Study exclusion criteria included inpatient STEMI (n=1) STEMI with unknown symptom onset time (n=3) and cardiac arrest patients (n=2) Our hospital has offered 24/7 PPCI service to all eligible patients presenting with acute STEMI since 2010 per standard Accident and Emergency Department protocol. When STEMI is diagnosed, a PPCI team is activated after cardiology evaluation. Data on key time points in STEMI care are recorded in a clinical registry. Symptom onset to first medicalcontact time is defined as the time from patient reported chest discomfort onset time to the time of first medical contact. Door to device time is defined as the time from Accident and Emergency Department arrival to successful wire crossing time during PPCI. Catheterization laboratory arrival to device time is defined as the time from patient arrival in the catheterization laboratory to successful wire crossing time. From January 25, 2020, to February 10, 2020, we observed changes in time components of STEMI care among the aggregate group of 7 consecutive patients who underwent PPCI. We compared these with data from 108 patients with STEMI treated with PPCI in the prior year from February 1, 2018, to January 31, 2019 (N=108) These 7 patients did not suffer from COVID 19 infection, and 6 out of 7 presented to our hospital during regular work hours (8 am 8 pm weekdays, excluding public holidays) The Table shows numerically longer median times in all components when compared with historical data from the prior year. The largest time difference was in the time from symptom onset to first medical contact.  Cardiovascular Quality and Outcomes

title: Escalating infection control response to the rapidly evolving epidemiology of the coronavirus disease 2019 (COVID 19) due to SARS CoV 2 in Hong Kong
abstract: To describe the infection control preparedness measures undertaken for coronavirus disease (COVID 19) due to SARS CoV 2 (previously known as 2019 novel coronavirus) in the first 42 days after announcement of a cluster of pneumonia in China, on December 31, 2019 (day 1) in Hong Kong.  A bundled approach of active and enhanced laboratory surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and contact tracing for healthcare workers (HCWs) with unprotected exposure in the hospitals was implemented. Epidemiological characteristics of confirmed cases, environmental samples, and air samples were collected and analyzed.  From day 1 to day 42, 42 of 1,275 patients (3.3% fulfilling active (n 29) and enhanced laboratory surveillance (n 13) were confirmed to have the SARS CoV 2 infection. The number of locally acquired case significantly increased from 1 of 13 confirmed cases (7.7% day 22 to day 32) to 27 of 29 confirmed cases (93.1% day 33 to day 42; P .001) Among them, 28 patients (66.6% came from 8 family clusters. Of 413 HCWs caring for these confirmed cases, 11 (2.7% had unprotected exposure requiring quarantine for 14 days. None of these was infected, and nosocomial transmission of SARS CoV 2 was not observed. Environmental surveillance was performed in the room of a patient with viral load of 3.3 x 106 copies/mL (pooled nasopharyngeal and throat swabs) and 5.9 x 106 copies/mL (saliva) respectively. SARS CoV 2 was identified in 1 of 13 environmental samples (7.7% but not in 8 air samples collected at a distance of 10 cm from the patient's chin with or without wearing a surgical mask.  Appropriate hospital infection control measures was able to prevent nosocomial transmission of SARS CoV 2.

title: Depression and Anxiety in Hong Kong during COVID 19
abstract: It has been three months since the first confirmed case of coronavirus disease 2019 (COVID 19) in Hong Kong, and people now have a more complete picture of the extent of the pandemic. Therefore, it is time to evaluate the impacts of COVID 19 on mental health. The current population based study aimed to evaluate the depression and anxiety of people in Hong Kong during the COVID 19 pandemic. Respondents were randomly recruited and asked to complete a structured questionnaire, including the patient health questionnaire 9 (PHQ 9) the generalized anxiety disorder 7 (GAD 7) the global rating of change scale and items related to COVID 19. Of the 500 respondents included in the study, 19% had depression (PHQ 9 score 10) and 14% had anxiety (GAD score 10) In addition, 25.4% reported that their mental health had deteriorated since the pandemic. Multiple logistic regression analysis found that not experiencing the SARS outbreak in 2003, being worried about being infected by COVID 19, being bothered by having not enough surgical masks and being bothered by not being able to work from home were associated with a poorer mental health status. Psychological support, such as brief, home based psychological interventions, should be provided to citizens during the pandemic.

title: Estimating the serial interval of the novel coronavirus disease (COVID 19) A statistical analysis using the public data in Hong Kong from January 16 to February 15, 2020
abstract: The emerging virus, severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) has caused a large outbreak of novel coronavirus disease (COVID 19) in Wuhan, China since December 2019. Based on the publicly available surveillance data, we identified 21 transmission chains in Hong Kong and estimated the serial interval (SI) of COVID 19.  Index cases were identified and reported after symptoms onset, and contact tracing was conducted to collect the data of the associated secondary cases. An interval censored likelihood framework is adopted to fit a Gamma distribution function to govern the SI of COVID 19.  Assuming a Gamma distributed model, we estimated the mean of SI at 4.4 days (95%CI: 2.9 6.7) and SD of SI at 3.0 days (95%CI: 1.8 5.8) by using the information of all 21 transmission chains in Hong Kong.  The SI of COVID 19 may be shorter than the preliminary estimates in previous works. Given the likelihood that SI could be shorter than the incubation period, pre symptomatic transmission may occur, and extra efforts on timely contact tracing and quarantine are recommended in combating the COVID 19 outbreak.

title: Distancing, Testing Isolation Stalled Hong Kong COVID 19 Outbreak

title: Staff safety during emergency airway management for COVID 19 in Hong Kong

title: Impact assessment of non pharmaceutical interventions against COVID 19 and influenza in Hong Kong: an observational study
abstract: A range of public health measures have been implemented to delay and reduce local transmission of COVID 19 in Hong Kong, and there have been major changes in behaviours of the general public. We examined the effect of these interventions and behavioral changes on the incidence of COVID 19 as well as on influenza virus infections which may share some aspects of transmission dynamics with COVID 19.  We reviewed policy interventions and measured changes in population behaviours through two telephone surveys, on January 20 23 and February 11 14. We analysed data on laboratory confirmed COVID 19 cases, influenza surveillance data in outpatients of all ages, and influenza hospitalisations in children. We estimated the daily effective reproduction number (R_t) for COVID 19 and influenza A(H1N1)  COVID 19 transmissibility has remained at or below 1, indicating successful containment to date. Influenza transmission declined substantially after the implementation of social distancing measures and changes in population behaviours in late January, with a 44% (95% confidence interval, CI: 34% to 53% reduction in transmissibility in the community, and a 33% (95% CI: 24% to 43% reduction in transmissibility based on paediatric hospitalization rates. In the two surveys we estimated that 74.5% and 97.5% of the general adult population wore masks when going out, and 61.3% and 90.2% avoided going to crowded places, respectively.  Containment measures, social distancing measures and changes in population behaviour have successfully prevented spread of COVID 19. The social distancing measures and behavioural changes led to a substantial reduction in influenza transmission in early February 2020. However, it may be challenging to avoid fatigue and sustain these measures and population behaviours as COVID 19 continues to spread globally.

title: Estimating the Serial Interval of the Novel Coronavirus Disease (COVID 19) A Statistical Analysis Using the Public Data in Hong Kong From January 16 to February 15, 2020
abstract: The emerging virus, severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) has caused a large outbreak of novel coronavirus disease (COVID 19) since the end of 2019. As of February 15, there were 56 COVID 19 cases confirmed in Hong Kong since the first case with symptom onset on January 23, 2020.  Based on the publicly available surveillance data in Hong Kong, we identified 21 transmission events as of February 15, 2020. An interval censored likelihood framework is adopted to fit three different distributions including Gamma, Weibull, and lognormal, that govern the serial interval (SI) of COVID 19. We selected the distribution according to the Akaike information criterion corrected for small sample size (AICc)  We found the lognormal distribution performed slightly better than the other two distributions in terms of the AICc. Assuming a lognormal distribution model, we estimated the mean of SI at 4.9 days (95% CI: 3.6 6.2) and SD of SI at 4.4 days (95% CI: 2.9 8.3) by using the information of all 21 transmission events.  The SI of COVID 19 may be shorter than the preliminary estimates in previous works. Given the likelihood that SI could be shorter than the incubation period, pre symptomatic transmission may occur, and extra efforts on timely contact tracing and quarantine are crucially needed in combating the COVID 19 outbreak.

title: Community Responses during Early Phase of COVID 19 Epidemic, Hong Kong
abstract: During the early phase of the coronavirus disease epidemic in Hong Kong, 1,715 survey respondents reported high levels of perceived risk, mild anxiety, and adoption of personal hygiene, travel avoidance, and social distancing measures. Widely adopted individual precautionary measures, coupled with early government actions, might slow transmission early in the outbreak.