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Stringent containment measures without complete city lockdown to achieve low incidence and mortality across two waves of COVID-19 in Hong Kong.
BMJ Glob Health. 2020 10; 5(10)BG

Abstract

INTRODUCTION

An international city, Hong Kong, in proximity to the first epicentre of COVID- 19, experienced two epidemic waves with different importation pressure. We compared the epidemiological features of patients with COVID-19 in the context of containment policies between the first and second waves.

METHODS

We retrieved information on the first 1038 cases detected in Hong Kong (23 January to 25 April 2020) to analyse the epidemiological characteristics including age/gender-specific incidence, clustering, reproduction number (Rt) and containment delay; in relation to the containment measures implemented. Factors associated with containment delay were evaluated by multiple linear regression analysis with age, gender, epidemic wave and infection source as covariates. A time series of 5-day moving average was plotted to examine the changes across the two epidemic waves.

RESULTS

The incidence and mortality (135.5 and 0.5 per 1 000 000 population) was among the lowest in the world. Aggressive escalation of border control correlated with reductions in Rt from 1.35 to 0.57 and 0.92 to 0.18, and aversions of 450 and 1650 local infections during the first and second waves, respectively. Implementing COVID-19 tests for overseas returners correlated with an upsurge of asymptomatic case detection, and shortened containment delay in the second wave. Medium-sized cluster events in the first wave were family gatherings, whereas those in the second wave were leisure activities among youngsters. Containment delay was associated with older age (adjusted OR (AOR)=1.01, 95% CI 1.00 to 1.02, p=0.040), male gender (AOR=1.41, 95% CI 1.02 to 1.96, p=0.039) and local cases (AOR=11.18, 95% CI 7.43 to 16.83, p<0.001), and with significant improvement in the second wave compared with the first wave (average: 6.8 vs 3.7 days). A higher incidence rate was observed for males, raising possibility of gender predilection in susceptibility of developing symptoms.

CONCLUSION

Prompt and stringent all-round containment strategies represent successful measures in pandemic control. These findings could inform formulation and implementation of pandemic mitigation strategies.

Authors+Show Affiliations

JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China. Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China.Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China paulkschan@cuhk.edu.hk.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33028700

Citation

Wong, Martin C S., et al. "Stringent Containment Measures Without Complete City Lockdown to Achieve Low Incidence and Mortality Across Two Waves of COVID-19 in Hong Kong." BMJ Global Health, vol. 5, no. 10, 2020.
Wong MCS, Ng RWY, Chong KC, et al. Stringent containment measures without complete city lockdown to achieve low incidence and mortality across two waves of COVID-19 in Hong Kong. BMJ Glob Health. 2020;5(10).
Wong, M. C. S., Ng, R. W. Y., Chong, K. C., Lai, C. K. C., Huang, J., Chen, Z., Boon, S. S., & Chan, P. K. S. (2020). Stringent containment measures without complete city lockdown to achieve low incidence and mortality across two waves of COVID-19 in Hong Kong. BMJ Global Health, 5(10). https://doi.org/10.1136/bmjgh-2020-003573
Wong MCS, et al. Stringent Containment Measures Without Complete City Lockdown to Achieve Low Incidence and Mortality Across Two Waves of COVID-19 in Hong Kong. BMJ Glob Health. 2020;5(10) PubMed PMID: 33028700.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stringent containment measures without complete city lockdown to achieve low incidence and mortality across two waves of COVID-19 in Hong Kong. AU - Wong,Martin C S, AU - Ng,Rita W Y, AU - Chong,Ka Chun, AU - Lai,Christopher K C, AU - Huang,Junjie, AU - Chen,Zigui, AU - Boon,Siaw S, AU - Chan,Paul K S, PY - 2020/07/29/received PY - 2020/09/01/revised PY - 2020/09/07/accepted PY - 2020/10/8/entrez PY - 2020/10/9/pubmed PY - 2020/10/27/medline KW - SARS KW - epidemiology KW - public health KW - respiratory infections JF - BMJ global health JO - BMJ Glob Health VL - 5 IS - 10 N2 - INTRODUCTION: An international city, Hong Kong, in proximity to the first epicentre of COVID- 19, experienced two epidemic waves with different importation pressure. We compared the epidemiological features of patients with COVID-19 in the context of containment policies between the first and second waves. METHODS: We retrieved information on the first 1038 cases detected in Hong Kong (23 January to 25 April 2020) to analyse the epidemiological characteristics including age/gender-specific incidence, clustering, reproduction number (Rt) and containment delay; in relation to the containment measures implemented. Factors associated with containment delay were evaluated by multiple linear regression analysis with age, gender, epidemic wave and infection source as covariates. A time series of 5-day moving average was plotted to examine the changes across the two epidemic waves. RESULTS: The incidence and mortality (135.5 and 0.5 per 1 000 000 population) was among the lowest in the world. Aggressive escalation of border control correlated with reductions in Rt from 1.35 to 0.57 and 0.92 to 0.18, and aversions of 450 and 1650 local infections during the first and second waves, respectively. Implementing COVID-19 tests for overseas returners correlated with an upsurge of asymptomatic case detection, and shortened containment delay in the second wave. Medium-sized cluster events in the first wave were family gatherings, whereas those in the second wave were leisure activities among youngsters. Containment delay was associated with older age (adjusted OR (AOR)=1.01, 95% CI 1.00 to 1.02, p=0.040), male gender (AOR=1.41, 95% CI 1.02 to 1.96, p=0.039) and local cases (AOR=11.18, 95% CI 7.43 to 16.83, p<0.001), and with significant improvement in the second wave compared with the first wave (average: 6.8 vs 3.7 days). A higher incidence rate was observed for males, raising possibility of gender predilection in susceptibility of developing symptoms. CONCLUSION: Prompt and stringent all-round containment strategies represent successful measures in pandemic control. These findings could inform formulation and implementation of pandemic mitigation strategies. SN - 2059-7908 UR - https://www.unboundmedicine.com/medline/citation/33028700/Stringent_containment_measures_without_complete_city_lockdown_to_achieve_low_incidence_and_mortality_across_two_waves_of_COVID_19_in_Hong_Kong_ DB - PRIME DP - Unbound Medicine ER -