In a stretch of time that has been all too literally plagued with troubles, the world has witnessed varying degrees of public health success and shortcoming. For much of the Western hemisphere — particularly in the US — COVID-19 has wreaked havoc, with cases piling on daily for much of the last year.
Of the 10 million people living in Los Angeles county, there have been over 23,000 deaths. And yet, Hong Kong, which more than doubles Los Angeles in population density, has had just over 200 deaths, despite its population of over 7 million.
Unequivocally, the East has outshined the West in pandemic response effectiveness. According to John Hopkins University, there is not a single East Asian country within the top ten countries ranked by incidence of infection, despite COVID-19 originating in Wuhan, China.
The data are no accident. The 2003 severe acute respiratory syndrome (SARS) outbreak in Hong Kong, while tragic at the time, seemed to provide Hong Kong and surrounding East Asia countries with exactly the crisis preparation that Western nations sorely needed in 2020.
While there are political reasons for this chasm in response, the crux may lie in the shared (and unshared) values of each hemisphere. The pandemic imposed not only a public health crisis but, in a sidelong way, provided a stage to juxtapose East-West principles.
Public health measures pervaded in the years that I lived in Hong Kong, well before the pandemic. Signs in the metro stations and on billboards provided constant reminders to wash your hands, cover your mouth to cough and stay home when sick. At work, it was difficult to sneeze or sniffle without a colleague offering me a surgical mask (and surgical masks were sold in every convenience store on every street corner and building block).
The coronavirus pandemic acted as a catalyst for the Western world to mimic many of the habits that had already been normalized in Hong Kong and other East Asian nations.
“The U.S. culture is very individualistic,” said Dr. Kristen Emory, a professor of public health at San Diego State University. “In the US we’re seeing people who don’t want to wear masks, who are not willing to follow public health recommendations because it’s their ‘right’ not to as Americans.”
Rare are the individuals in Hong Kong who hold the government’s public health response in contempt. Rather, many Hong Kongers have applauded it.
“The effectiveness of the local authority in tackling the virus has been very successful,” said Marco Chong, a Hong Kong resident.“Hong Kongers have a mentality that reflects the valuing of the group over the individual. There’s a natural consensus from citizens that public health takes priority above all else, politics aside.”
Chong’s sentiment hints at a far more united reaction compared to the anti-mask protests that erupted in the UK and US through much of 2020. To suggest that the rights of an individual are anything but paramount remains a sacrilege in most Western nations, for better or worse. From here factions arise, claiming that their individual rights are being curtailed by public health implementations that have been accepted elsewhere.
“A lot of people have refused to do certain small things simply because someone else was telling them to do so,” said Emory. “It’s a strong part of American ideology, but now presents a public health concern.”
Acute to Hong Kong is the lack of space. Tiny apartments are standard, and each one is packed into the heart of a skyscraper in the middle of a metropolis. Fantastic public transport notwithstanding, vehicle traffic and foot traffic are dense. In a public space, it is difficult not to brush shoulders with strangers.
On top of this, Hong Kong’s culture is distinctly communal. Meals are typically served in traditional family-style dishes for all to share from, and multi-generational households are common.
Given these parameters, Hong Kong seemed primed for an outbreak.
But instead the opposite happened. Cases of coronavirus were handled in stride and Hong Kong became one of the global leaders in pandemic response, in large part due to readiness of its citizens.
“When we began hearing about a virus in early January, people immediately took it seriously,” said Hong Kong resident and American expatriate Lily Wu. “Everyone wore a mask, people willingly stayed home and avoided social outings. We didn’t have to learn how to social distance, we did it automatically because we remember SARS.”
After 2003, Hong Kongers took up health measures with renewed enthusiasm. If someone let slip even a tight-lipped cough, a surgical mask was de rigueur and they were expected to stay home. Now, when walking around the city, one is more likely to see sanitation schedules posted on walls than litter on the floors.
“The challenges we faced during SARS showed us how bad things could get,” said Hong Kong resident Jeffrey Tang. “And we know not to make the same mistakes. The Western world didn’t have that experience, and it shows.”
The US, UK, and many European countries have implemented strict lockdowns throughout waves of COVID-19 with mixed results.
Negative economic repercussions have stirred controversy over the efficacy of shutting down businesses, and it became a contested topic during the 2020 US presidential election.
In Hong Kong, while limitations have been put in place — such as two-person socializing limits and take-out only restaurants — there has yet to be an explicit closure of the city and economy. “We are different from the rest of the world,” said Hong Kong resident and British expatriate Kai Kan. “Hong Kong is a special place. We wear masks of course, but we officially have not had a lockdown.”
“Hong Kongers fully understand that masks are not only for ill people,” said Kan. “We see in the Western culture people only wear masks once they are already sick. Here, we understand that masks are a barricade for germs for everyone.”
Hong Kong’s pandemic experience from SARS revealed itself immediately when the virus first emerged. “The city went into voluntary lockdown,” said Alex McMillan, a Hong Kong-based freelance reporter.
“I lived through SARS and so did many Hong Kongers, who recall 2003 only too well. These voluntary steps prevented an initial onslaught of cases, even though many stores and restaurants stayed open all along.”
Similar to Korea, Taiwan and Singapore, Hong Kong residents took precautions willingly and on their own accord. Seemingly small actions brought about lasting results — the very same lasting results that seem to have evaded many Western countries.
In walking around Los Angeles one sees people with masks as commonly as those without. There is a resistance here on an individual basis that, when put in contrast with Hong Kong, cannot seem anything but petty. While hand sanitizer stations abound, so do groups of Americans, socializing without masks.
“It seems ridiculous to people in Hong Kong that masks [in the US] can become a political issue,” said McMillan. “If anything, there’s great peer pressure to wear masks here.”
What is more impressive about the pandemic response of Hong Kong (and its surrounding countries) is the timing: the virus made headlines during the opening weeks of the Lunar New Year, one of the busiest travel holidays in Hong Kong and China.
The Chinese culture is one that prides itself on work ethic and professional output, and the Lunar holiday provides what is usually a much needed respite. So each year Hong Kong residents travel north into China, and millions of mainland Chinese residents travel south into Hong Kong for a holiday.
There were a considerable number of vectors to spread the disease right from the start. But because containment began immediately on an individual basis and from the bottom-up, the spread was slowed.
The US, UK, and Europe, comparatively, were forced to take a top-down approach, with state and local governments implementing pandemic mandates for people to follow. Because Westerners are particularly outspoken regarding top-down parameters, stay-at-home orders have been met with some defiance.
Therein lies the difference between the East and West: even during one of the biggest travel holidays of the year, Hong Kongers did not need to be told to social distance, wear masks, or stay home when COVID-19 landed. Despite the festivities, Hong Kongers were able to do the right thing — get-togethers and celebrations were quickly muted or cancelled. Overwhelmingly people returned home and stayed inside.
On the other hand, many Westerners, to speak broadly, refuse to take action for public health concerns because of the political implications that have seemingly undermined social responsibility.
Staunch individualism, warped politics, and a widespread mistrust for government intervention has set those in the West apart from those in the East during this pandemic.
How many more deaths until the West begins taking note of what has transpired in the East?
Hong Kongers are going out and returning to work, resuming life once again, albeit in masks. Moderate restrictions remain in place but they are met with neither bravado nor disobedience. The traffic on the street and sardine-packed subway cars show that, in Hong Kong, things are business as usual.
“In the West, people may think that mask wearing is an ‘Asian thing,’” said McMillan. “Here it’s perfectly normal. Hong Kong has been spared the worst, because people prepared for the worst.”
Time will tell when the same can be said about the West.