Imparting wisdom via a wet sponge

March 3, 2006

If bird flu broke out, would face-to-face teaching be viable? Timothy Hamlett recalls sticky times in a Sars-ridden city

Are you wondering what an epidemic of bird flu in a major city might look like? The Sars epidemic in Hong Kong, which terrified residents for five months in 2003, may provide some idea. Sars, or severe acute respiratory syndrome, is a disease not unlike pneumonia that is caused by its own specific virus. It is highly contagious in some stages, fatal if untreated and a serious matter even if you are in a decent hospital. At the beginning of 2003 it had been lurking for some time in Guangdong, the province of China adjacent to Hong Kong. It probably jumped the species barrier from civet cats. The Chinese Government, as is its habit, promised that the situation was under control. The Hong Kong Government, for political reasons, pretended to believe this. So the public was not really prepared for what followed.

The first Sars outbreak was traced to a doctor in Guangdong who had been treating patients with the disease. After spending the night of February 21 in a local hotel, he realised he had Sars himself and checked into a local hospital. He warned medical staff what was going on and full precautions shielded the hospital from a medical outbreak, but unfortunately the doctor had already infected several fellow hotel guests. Sars was now on the global network as guests carried it away on their travels.

Outbreaks followed in Canada and Vietnam. Hong Kong's share of this came from a local resident who was treated at the Prince of Wales Hospital. Nobody had any idea that he was carrying the virus, and it was spread liberally around his ward before the number of staff taking sick leave rang alarm bells. The number of Sars cases discovered daily swiftly rose to more than 100 before the precautions took full effect. Thereafter, the disease declined steadily. The last new case was reported on June 11 and Hong Kong was declared Sars-free on June 23.

Altogether there were 1,755 recorded victims, of whom 300 died. This is not a lot for a city of 7 million people. Many of the fatal cases were people who were already fragile - or difficult to diagnose - because of existing ailments or their age. The only recorded educational victims were students at the Prince of Wales, which is the teaching hospital for the Chinese University of Hong Kong. For most Hong Kong residents, it was not so much the disease that was the problem as the resulting fear. There were constant reminders of the danger of mysterious infection. Building managements abandoned hot-air hand dryers for paper towels. At building entrances, little dispensers offered you a squirt of disinfectant jelly to clean your hands. Lift buttons were covered with plastic sheeting so that they could be disinfected hourly. Most of the population took to wearing surgical face masks in public places and in many private ones.

Scientific doubts about the benefits of the masks - and the undisputed fact that effectiveness drops rapidly after the first 20 minutes of use - did nothing to diminish enthusiasm. Wearing a mask became, as talk show host Albert Cheng put it, "a sign of good citizenship". It might not have been practical but it gave you the feeling that you were contributing something.

It was also a broad hint about the danger of public places, and a lot of people avoided them. In a city where shopping and eating out are the two most popular leisure activities, this had serious economic consequences.

Towards the end of March, with the disease apparently still raging unchecked, and the Government explicitly telling possible sufferers not to go to work or school, it occurred to many parents that their children would be safer at home. Many schools were reporting severely reduced attendances when education chiefs bowed to the inevitable, and on March 29 all classes were suspended. Universities promptly followed suit. All places of education remained closed until April 22, when older students resumed their studies. Because of the Easter break, universities lost only about two weeks. Primary schools had a longer time off, and when students went back some precautions continued to be taken; for instance, all school students had to have daily temperature checks, both from their parents and at school. This did not lead to the discovery of any new cases. But it did disclose the existence of a surprising number of young people whose bodies operated permanently at a temperature over the Education Department's warning threshold.

It was difficult to explain the resumption of classes in terms of a reduced risk of infection. At secondary and university level it seemed that a two-week hiatus was the maximum that could be tolerated without postponing examinations, and all the calendar confusion that that would bring. The empty weeks were, we were often assured, not to be confused with a holiday.

There was much talk of the amount of teaching that could be done over the internet, but you needed advance arrangements for this. It was not the sort of thing that could be improvised in a hurry. Many university staff devoted themselves to working from home. Students were entertained by several rumours of outbreaks in the halls of residence, all of them unfounded. Few people moved out. Some exchange students travelled. A hardy group from Leeds University thought it a good time to visit Guangdong province. They did not catch anything.

When teaching resumed, we all made one discovery. It is really not possible to teach in a surgical mask. After a few minutes of loud speech the moisture that accumulates in the mask turns it into a wet sponge that slithers down your face. So we spoke with naked lips to carefully masked audiences. An interesting diversity had crept into the mask scene by this time. They came in a variety of models and colours. Some people decorated their masks with designs or smiles. Normal life resumed in the summer, though there is still a certain residual nervousness, indicated by occasional bursts of mask wearing in shops and restaurants after reports of bird flu cases. From a teaching point of view, I suppose the lesson for the future is to prepare web-based teaching arrangements now, if that is the way you want to go. Make sure your school has one of those quick thermometers that you can stick in a person's ear. And lay in some face masks - for them, not for you.

Timothy Hamlett is associate professor, department of journalism, Hong Kong Baptist University.

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