Coronavirus FAQ: Cases Are Spiking Again In Hong Kong. What Are They Doing About It?

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New rules in Hong Kong require everyone to wear a mask in all outdoor places or face a $650 fine. Above: A masked woman stretches out a public park. Also: The maximum number of people allowed at a public gathering is ... 2. Miguel Candela/SOPA Images/LightRocket via Gett hide caption

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Miguel Candela/SOPA Images/LightRocket via Gett

Each week, we answer "frequently asked questions" about life during the coronavirus crisis. If you have a question you'd like us to consider for a future post, email us at goatsandsoda@npr.org with the subject line: "Weekly Coronavirus Questions."

Hong Kong is seeing its biggest surge in coronavirus cases since the outbreak began.

After periods when the city had gotten the number of domestic cases — infections not linked to people arriving from abroad — down to zero, Hong Kong is now reporting more than 100 new cases a day.

So what is Hong Kong doing about it?

A lot. And the goal is to get the reported coronavirus case numbers back down to just a handful if not none at all.

Interestingly, Hong Kong isn't ordering a blanket "shelter in place" or universal "stay at home" order as some places have. Hong Kong actually has never implemented a full lockdown since the pandemic began.

Instead, city officials have tightened social distancing rules, shut non-essential businesses and required everyone to wear a mask in all outdoor places and on the subway. Violators can be fined $5,000 Hong Kong Dollars ($650 US).

On Wednesday of this week new rules went into effect that closed all bars, nightclubs, karaoke halls and mahjong parlors. Gyms, hair salons and swimming pools were shut as well.

The rules also shuttered food courts, bathhouses, movie theaters, party halls and sports facilities. And restaurants which had been allowed to offer sit-down service were ordered to switch to takeout only (more on that later).

Business owners who violate the restrictions face fines of $50,000 HKD or roughly $6,500 USD and six months in jail.

And while some places in the world have been capping the size of public gatherings at 50 or 20 or 10 people, Hong Kong set their new limit for public gatherings at 2. Yes, you read that right. You can't really get a smaller party.

At a time when there have been mass street demonstrations about the influence of Beijing over the semi-autonomous territory, people who gather in groups larger than 2 can face up to a half a year in prison and a fine of $25,000 HKD ($3,250 USD).

As the new rules were announced, Carrie Lam, chief executive of Hong Kong, told Hong Kongers in a video message that the city is on the verge of an even larger outbreak that could overwhelm its hospitals.

"The government has put in place the most stringent measures ever in enforcing social distancing," Lam said from behind a white mask. "Our frontline staff are battling with the surge and the central government is helping us to enhance testing capability and set up a community treatment facility. What we need now is your co-operation."

You may wonder how the new restrictions are playing out.

On Wednesday, the first day restaurants were forced to only offer takeout, sidewalks were jammed with people trying to eat lunch outside.

"What we saw on the streets of Hong Kong was a lot of office workers buying their lunch takeaway and then eating it on the street, crouching down, kneeling down, sitting on park benches with umbrellas because it's raining," says Ben Cowling, an infectious disease epidemiologist at the University of Hong Kong.

"It made Hong Kong seem like it was a different country to what we're used to. We don't normally see people crouching down eating their lunch outside. So it's kind of strange to see that."

The takeaway-only rule caused so much chaos that city officials reversed it the next day. On Thursday, they put in place new rules allowing restaurants to serve sitdown lunch at 50% capacity and with at least 1.5 meters between tables – just shy of 5 feet.

Despite Hong Kong having contained the coronavirus incredibly efficiently for months, Cowling says he's not that surprised there's now a surge in cases.

"We knew that we'd get a resurgence sooner or later because we had relaxed all of the public health measures," Cowling says. "By opening up again, we were vulnerable to a resurgence in cases. And that's what's happened in the past month."

Even before this recent wave of cases, Hong Kong had a strict system for isolating people who are infected and people who'd had close contact with any known case.

Anyone who tests positive is admitted to a hospital for treatment even if they've got no symptoms whatsoever. And they're not allowed to leave until they're confirmed negative on two consecutive tests – ideally two days in a row. Close contacts of confirmed cases and people who arrive from abroad are also required to quarantine up to 14 days, even if they test negative.

The quarantine rules are so burdensome that an association representing FedEx pilots this week called on the international shipping giant to suspend operations in Hong Kong. The Air Line Pilots Association said three asymptomatic FedEx pilots who tested positive were "forced" to stay in hospitals for nearly 2 weeks. And other crew members who'd been in contact with them were placed in government camps.

But those strict quarantine requirements have been part of how Hong Kong kept its COVID-19 numbers so low for so long.

Cowling says the new rules that went into effect this week are a way for health officials to put additional pressure on the virus and drive down transmission.

"Hopefully we're going to get the numbers coming down and down over the course of the next month, back to zero again," he says. Slowly restaurants will fill back up. Karaoke will return. Hair salons and swimming pools will reopen.

"And then the whole thing starts again. We try and keep infections out for as long as possible, but sooner or later, they're going to be back and then we'll be facing another wave."

And Hong Kong will have to tighten up measures to push down transmission once again.