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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
  1. Martin C S Wong1,
  2. Rita W Y Ng2,
  3. Ka Chun Chong1,3,
  4. Christopher K C Lai2,
  5. Junjie Huang1,
  6. Zigui Chen2,
  7. Siaw S Boon2,
  8. Paul K S Chan2
  1. 1JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
  2. 2Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
  3. 3Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
  1. Correspondence to Professor Paul K S Chan; paulkschan{at}


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.

  • epidemiology
  • public health
  • respiratory infections
  • SARS

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  • MCSW and RWYN are joint first authors.

  • Handling editor Seye Abimbola

  • Contributors PKSC and MCSW participated in the conception of the research ideas, study design, interpretation of the findings, writing of the first draft of the manuscript, and provided intellectual input to the translational aspects of the study. RWYN, KCC, CKCL, JH, ZC and SSB retrieved information from the relevant databases and performed statistical analysis. All authors made critical revisions on the manuscripts and provided expert opinions on implications of the study findings.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The Survey and Behavioural Research Ethics Committee of the Chinese University of Hong Kong has granted approval for this study (Reference No SBRE-20-006)

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. The data underlying this article are available in the Centre for Health Protection of the Department of Health of the Hong Kong government at The data sets were derived from sources in the public domain:

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