Dear Editor,

Hong Kong possesses valuable lessons for pandemic control and management. As one of the few metropolises that were at the forefront of both the severe acute respiratory syndrome (SARS) and coronavirus diseases 2019 (COVID-19), two of the most devastating global infectious disease outbreaks in recent decades, Hong Kong has a relatively rich reservoir of hard-earned hands-on experience and know-how in fighting pandemics. Furthermore, Hong Kong’s drastic change of fate in its coping with the COVID-19 pandemic—from its early successes in keeping infection and hospitalization rates extraordinarily low to its latter failures that have resulted in one of the worst global records of virus spread and deathsReference Yang, Lin and Xiong¹—also elevate its significance as a much-needed case study in shedding light on the do’s and don’ts in pandemic control and management. Hong Kong’s stratospheric level of residential density also adds relevance to its pandemic lessons, not least because most, if not all, first-tier cities across the world may soon face similar high population density issues, if not already, due to factors such as globalization and urbanization.

One key lesson from Hong Kong is the importance of respecting “common sense” pandemic control measures. Best practices in curbing infectious disease spread, especially when resources are limited and the virus evolves fast, are oftentimes the “textbook guidelines” that are well-discussed in the literature and classroom. A critical factor that contributed to Hong Kong’s early success—a period when vaccines had yet to become available—in maintaining infection and death numbers exceptionally low centers on its vigilance in applying known non-pharmaceutical strategies (e.g., masking, stay-at-home orders, social distancing recommendations).Reference Su, Cheshmehzangi and McDonnell² Yet though Hong Kong has won itself a rare break amid the pandemic—a period when the health system is relatively not burdened with treating COVID-19 patients—it failed to leverage it to its advantage, such as utilizing the window to inoculate people against the dangers of vaccine hesitancy and establish the importance of vaccination in protecting personal and public health in the long run.Reference Su, Wen and Abbas^3, Reference Yuan, Xu and Wong⁴ This leads to the second lesson from Hong Kong, which centers on the importance of staying sensitive to virus evolvements and proactive in iterating best pandemic practices that are in sync with the changing reality on the ground. In other words, rather than becoming complacent in their early successes, public health officials should abandon a one-size-fits-all approach for an adaptive and flexible approach in prioritizing various repertoire of pandemic control measures based on the most updated empirical insights. Albeit effective, pandemic prevention tools often have their own, if not unique, shortcomings, like the holes in Swiss cheese.Reference Su, Bentley and McDonnell⁵ It is public health officials’ duty and responsibility to organize and orchestrate an integrated pandemic strategy that can best capitalize on the strengths of individual prevention measures despite their shortcomings.Reference Su, Bentley and McDonnell⁵ Subsequently, the third lesson is the imperative for health officials to develop a long-term pandemic preparation mindset. It takes substantial time for a health system to have strategically layered pandemic preparations resembling the above-mentioned “Swiss Cheese Model”,Reference Su, Bentley and McDonnell⁵ especially considering the chronic shortage of funding and resources faced by most health organizations across the world. Thanks to human activities’ compounding impacts on the climate and the environment, such as deforestation that removes barriers to zoonotic disease spillover from animals to humans, it is highly likely that infectious disease outbreaks may become more severe in frequency and fatality in the future. It is then imperative for health officials to properly shoulder their duty to the people in cultivating a long-term pandemic preparation mindset,Reference Su, McDonnell and Ahmad⁶ and in turn, building a more competent and comprehensive pandemic system for existing or looming pandemics. Time and pandemics wait for no one. We need to act faster and smarter.