Since March, the several hundred people who arrive on the scarce flights that land at Hong Kong International Airport shuffle through a gauntlet of digital apps, paper forms, tracking bracelets, temperature-gun readouts, shuttle-bus caravans, and line upon line until they step into tiny cubicles at the cavernous AsiaWorld-Expo. There, they hover over plastic vials, clear their throats, and spit — under penalty of imprisonment.
With saliva hocked, their coronavirus testing proceeds and a new adventure begins. Depending on the arrival time of their flights, some people wait more than eight hours at the temporary specimen-collection center for the results of their deep-throat saliva test as they nap (if they came prepared) on yoga mats or in camping tents. Others are ferried to a budget hotel or government quarantine centers, comforted by free carb-dense food deliveries and limited internet. If they receive a positive test, they are sent directly to the hospital. If they test negative, then it’s off to mandatory quarantine for a two-week waiting period.
Persistent, consistent testing, along with adherence to mask wearing and sanitizer slathering, contained the virus’ spread in this corner of China, researchers say. As of August 18, in a city of 7.4 million residents — about a million less than New York City — Hong Kong logged 4,525 COVID-19 cases since January, resulting in 71 deaths. Compare that with the 227,158 cases tallied in New York City since March and a death toll of 19,000 souls, according to the New York City Department of Health. The screening policy at its airport is a crucial component of Hong Kong’s strategy to suppress the pandemic.
With many flights canceled and visitors barred from entering Hong Kong, just 1,210 people were tested at the airport by June, a fraction of the passengers that normally move under the terminals’ vaulted, curved ceilings. This is boutique health care, and skeptics wonder if the city can reopen this year to handle thousands, let alone millions, of arrivals. The city allowed some passengers to transit through the airport starting on June 15 and planned a phased reopening, but a recent surge in cases imperils that progress. Nonresidents are still barred from entering Hong Kong unless they have work or student visas.
“If we lift the screening measures at the border, then the infected cases may spill over to the community,” said Vincent C.C. Cheng, an infection-control officer at Queen Mary Hospital who helped to establish the airport testing site. “In the government they are trying to discuss how we can increase the capacity of the testing every day to cope with this new challenge.”
The on-site-testing process works, travelers say, because results come quickly, and travelers are steered through a mandatory and streamlined process. “Hong Kong has the ability to get test results within 12 to 16 hours. I don’t know if Canada or the U.S. are that far along,” said Janine Waines, a newly arrived teacher from Canada. “This process would be very difficult in a Western country where you had to wait three or four days for a test result … I don’t know, in the West, that people would be as open to something like this.”
Hong Kong’s bright and airy airport is normally one of the world’s busiest, with more than 71 million passengers last year, even amid incessant, sometimes dangerous democracy protests. The city’s respected tribe of epidemiologists — several of whom were seasoned by the 2003 SARS epidemic — worried that the city’s hospitals this year could not safely host arriving travelers without risking a mass outbreak. Hong Kong, they told officials, needed a laboratory near the airport when these people arrived. The exposition center, where Lady Gaga once sang, was conveniently close. By month’s end, about 30 people a day were being tested there. That total climbed to 1,210 by June, said Cheng.
The disease-screening process begins right after wheels touch the tarmac. “As soon as you get off the plane, they are taking your temperature,” said Peter Burton, a London engineer and start-up entrepreneur who arrived in the city in July. Volunteers snapped on coded wristbands that linked to a proprietary app that passengers were instructed to download onto their phones. Taking Burton’s phone, the volunteer typed in some codes and linked the band to the app, ensuring that the phone worked.
After he and his teenage son surrendered their saliva, they waited 13 and a half hours for the results, sleeping on self-inflating camping mats they laid on the expo-center floor. With their fluids clear of COVID-19, it was on to the hotel they had booked for two weeks and the start of their shut-in period.
There, with their wristbands secure, Burton and his son walked the perimeter of their room as instructed, creating what he called a virtual fence for the GPS and Bluetooth chips he assumed were inside the band. Periodically, his phone pinged when it couldn’t sync with the wristwear. On those occasions, Burton manually scanned the QR codes with the band. According to SagaDigits, the Hong Kong company that created it, this system, called Stay Home Safe, picks up signals — including Wi-Fi, Bluetooth, and GPS — and identifies that pattern as the wearer’s location. If the signals alter sharply, the system assumes the wearer left the location and alerts health authorities and police.
Personal data is collected in the process, but for how long is unclear. Alfred Sit Wing-hang, secretary for innovation and technology, told the city’s legislature that the Department of Health keeps the contact phone number of wristband wearers but does not keep any other information. A spokeswoman for the government’s chief information officer said information gathered through the contact-tracing process will be destroyed within three months after the 14-day quarantine ends. The city’s health-department protocols are more vague; the department will “ensure that personal data is not kept longer than is necessary for the fulfillment of the purpose for which the data is or is to be used,” it said in response to a query from New York.
Such requirements have struck some travelers as invasive. After anti-government protesters battled the government for nearly a year, Beijing imposed a stringent national-security law in June that sharply limits free speech and creates a state security realm there. For those who don’t comply with the pandemic measures, fines can climb to $5,000 with a prison term of six months.
Travelers who arrived from nations deemed at special risk — among those India, Pakistan, South Africa, and, recently, the United States — were whisked to government quarantine centers immediately after their spit test. South African Andrew Evans, a pilot for Cathay Pacific, was assigned to the Junior Police Call Permanent Activity Centre and Integrated Youth Training Camp, a boot camp near the border with Mainland China. There, he and his daughter were assigned separate small rooms, similar to many old college dorms. He got three meals, with lots of rice, and often fruit and snacks on request. He and his daughter joined each other for meals, and sometimes they’d step to their doorway and talk with the other lodgers. Other than that, they had to take their temperature daily and report the results. “What I got was not like being thrown into a prison cell. It was like being confined to a B&B for two weeks,” Evans said. Then again, he said, “I did military training back in the day.”
Funerals taught Hong Kong to be cautious of disease. In 2003, more than 1,750 people were stricken with severe acute respiratory syndrome, a zoonotic outbreak carried into the city by a doctor from mainland China. The disease felled 386 health-care workers and killed eight. Today, residents are astounded by reports that Americans protest against laws that require masks and orders to close schools and businesses. In Hong Kong, “Many people test not for themselves but … to protect their family members,” said Kelvin To, a microbiologist at the University of Hong Kong who was not involved in the airport setup. “This culture change would not have happened if there was no SARS in 2003.” In fact, many Hong Kong residents have sharply criticized the government for exempting too many people from mandatory quarantines, such as cross-border drivers, aircrew, and sailors, 10,000 of whom entered without screening. With a recent spike in new cases, the government tightened those exclusions.
Early in the airport process, Hong Kong officials screened narrowly, testing only arrivals from countries where outbreaks had been severe. Because of this, the government missed places where cases were multiplying, To said. Hong Kong is, after all, one of the world’s great financial centers, where Chinese capital leaves to flow west. It’s also a major transit hub and cultural gateway to Asia. To allow more people in, the city will need to expand testing and is contracting with companies in mainland China, to the concern of many local residents already fearful of Beijing’s invasive policing. Testing several thousands of people each day will require the government to find companies that can automate hundreds of tests each hour, To said. The government has not disclosed how much this will cost.
“I think it can be difficult if it returns to the normal number of passengers per day,” To said. If many passengers wait, there would be a risk that some will walk out. “Right now,” he said, “it’s difficult to see reopening the airport to normal practice.”
