Intended for healthcare professionals


China coronavirus: Hong Kong health staff strike to demand border closure as city records first death

BMJ 2020; 368 doi: (Published 04 February 2020) Cite this as: BMJ 2020;368:m454

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  1. Jane Parry
  1. Hamilton, Ontario

Hong Kong has reported its first death related to the novel coronavirus 2019-nCoV, only the second fatality reported outside mainland China, as healthcare workers in the city started unprecedented industrial action to put pressure on the government to close the border and avert an escalation in the number of infections.

The 39 year old man, who had an underlying health condition, had travelled to Wuhan on 21 January. In late January, after his return to Hong Kong, he developed fever and myalgia. The Hong Kong Hospital Authority announced that he had died on 3 February. The news coincided with the second day of industrial action by members of the Hospital Authority Employees’ Alliance, a new labour union representing around 9000 of the 67 000 staff employed by the Hospital Authority, the statutory body that manages all of Hong Kong’s government hospitals.

After a strike by 2700 non-essential staff on 2 February, the union pledged to escalate the strike if the government did not close the border or if the authority management didn’t issue a statement demanding that the government do so. The union expected that 9000 staff would join the strike. On Tuesday the Hospital Authority announced that emergency services had been severely affected by the strike and urged patients with mild illnesses to go to private hospitals or clinics instead of public hospitals.1

All of the 15 patients with confirmed cases of 2019-nCoV and the 76 people in isolation under observation in Hong Kong as at 3 February have a history of recent travel to China or close contact with such a case. Only preventing everyone who wasn’t a Hong Kong citizen from entering the city from China and quarantining returning residents could effectively stop the import of the virus, thus preventing a major outbreak, said Winnie Yu, chairperson of the Hospital Authority Employees’ Alliance. “This is why we have decided to strike now, because there is still a chance to save Hong Kong from the destiny of turning into another Wuhan, being cut off from the world, patients turned away from fully occupied hospitals, and healthcare staff crumbling under the severe pressure,” she said.

As at 3 February more than 30 countries had imposed immigration restrictions relating to the outbreak, ranging from reducing or suspending arrivals from China by air to complete entry bans on foreign passport holders and mandatory quarantine for citizens who have been in China in the past 14 days.2 On 28 January the Hong Kong government closed some of the ports of entry, but chief executive Carrie Lam’s refusal to close the border drew widespread criticism from across the political spectrum and from public health and infectious disease experts in the city, who said that Hong Kong’s proximity to mainland China put it in a uniquely vulnerable position.345

On the day the strike started, the government announced further closures of border crossings, leaving only Hong Kong International Airport, the Shenzhen Bay joint checkpoint, and the Hong Kong-Zhuhai-Macau bridge open for passengers arriving by land or sea. By funnelling all traffic through two points as well as the airport, the inconvenience would deter many travellers, Lam said at a press conference. “We can also concentrate the staff [and] release about 1000 civil servants from the other control points . . . so they can do much better medical surveillance,” she said.6

However, Immigration Department data show that more than 60% of the 11 715 visitors who came to Hong Kong from mainland China on Sunday 2 February entered through the three border points that are to remain open, local media reported. Moreover, not all cases are symptomatic during the incubation period and are undetectable with surveillance measures such as temperature checks.

“A semi-blockage is just as good as none,” Yu said. “In fact, the last time Carrie Lam closed a few of the control points, the passenger flow from mainland China to Hong Kong only slightly decreased. Her measures are not going to stop the disease from being introduced to Hong Kong.”

A survey conducted by the Public Opinion Research Institute released on 31 January found that 61% of respondents backed the healthcare workers’ strike.7

“Also, the amount of support shown on our Facebook page and email is tremendous,” said Yu. “We even received messages from patients who told us that their medical care could be affected by our strike, yet they are still in full support of our actions. So yes, I do believe we have the support of Hong Kong citizens.”


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