The Hong Kong government may be about to face one of their biggest epidemiological nightmares to date. On April 20 it was announced that the Asia World Expo (AWE) Temporary Testing Centre, previously functional 24 hours a day since April 5, would close from midday onwards from April 22.

Morning arrivals into HKIA would be allowed to wait at the airport for their test results, but afternoon arrivals, regardless of their port of origin, would now to be transported by bus and held overnight at the Regal Oriental Hotel in Kowloon City to await their test results.

Regal Oriental Hotel. File photo: User N509FZ, via Wikimedia Commons.

This decision made by the Health Authority marked an extraordinary departure from the process of testing of all arrivals for Covid-19 and maintaining them near the airport at AWE.

Hong Kong was one of the first countries to mandate universal testing for all arrivals, and one of the key factors that supported this was the utilization of AWE, with its unique size, structure, and proximity to the airport.

The facility also allowed for appropriate social distancing, is highly ventilated, and easy to disinfect fully as the key surfaces – plastic and cement – are non-porous.

In contrast, hotels are not suitable for use as quarantine centres. It is highly disturbing that the Government has made this choice, apparently having forgotten the frightening lessons learned during the 2003 SARS-CoV-2 epidemic, when a SARS-infected individual staying in a room of the Metropole Hotel in Kowloon infected seven other people on the same floor of the hotel.

This is not the time to repeat these mistakes, especially when we are trying to keep the numbers of community transmission low.

Hotels are designed similarly to cruise ships, with central ventilation, central food facilities, quick turnover of guests using the same rooms and toilet facilities, generally poor cleaning of common areas including carpets, pillows and bedding, and a high incidence of guests crossing paths in close proximity in hallways and elevators.

Family lands Hong Kong with kids wearing goggles and face masks. Photo: Rachel Wong/HKFP.

There are a multitude of parallels between the new set-up at the Regal Oriental Hotel, to the Grand, Diamond and Ruby Princess Covid disasters, wherein just a handful of positive cases of Covid-19 spread like wild-fire through these ships.

Based simply on the millions of Covid-19 cases in the UK, Europe and the USA, it is an absolute certainty that infected passengers will land in Hong Kong, move into the Regal Oriental, and be in close contact with uninfected passengers.

Currently there is little discrimination between high-risk arrivals and low-risk arrivals who have been in safer countries and under lockdown or isolation, nor useful attempts to safely separate them. Healthy individuals could contract Covid-19 because of their hotel stay, and the Regal Oriental may become Hong Kong’s own epidemiological disaster.

Already, accounts abound of flawed transport, hotel disorganisation, examples of room allocation mismanagement, ongoing cross-contamination incidents in and around constantly crowded elevators, poor room condition and cleanliness, and a lack of PPE being worn by all (masks are neither mandatory nor provided). There is also a severe lack of security and surveillance, with hungry guests found leaving their rooms and stealing food from trays outside other guests’ doorways.

Guest turnover is extremely high, and cleaning staff are not trained to clean rooms with the speed required between guests, nor in the methods of disinfection needed to properly inactivate the virus.

Covid-19 under an electron microscope. File photo: NIAID-RML.

Dirty high traffic areas like carpets cannot be properly and professionally disinfected multiple times a day. All hard surfaces including toilets, drains, taps, light switches, kettles, and door handles need hospital grade disinfection with no less than appropriately diluted sodium hypochlorite, chloroxylenol and benzalkonium chloride between each guest.

Potentially infected items such as sheets and bedding, and in particular, hotel pillows, are a huge source of cross-infection for other guests, and should be removed from each room between guests, and professionally disposed of as biohazardous waste. There is no room for error.

This all raises the question why the Government would make such an ill-advised choice to depart from using the AWETTC system, and instead congregate large groups of potentially infected people in a city hotel, so loaded with confounding factors.

HKIA is a 24-hour airport, and the pathology testing laboratories are likely working 24 hours a day. It is a relative luxury to have a unique facility like AWE adjacent to the airport, where the Government could continue to safely and efficiently manage new arrivals.

Surely it would be possible to maintain a skeleton team of security and health staff at AWE to manage the wait of the afternoon arrivals – certainly much safer for passengers, and ultimately for Hong Kong people.

Photo: Rachel Wong/HKFP.

Anyone currently considering flying to Hong Kong is well aware of the lengthy wait, and ongoing discussion on Hong Kong Quarantine Forums have shown that people are adverse to staying at a quarantine hotel, especially when the risks are highlighted.

Even those who, like me, travel with babies and small children would much prefer to be “safely inconvenienced” at AWE for another 6-8 hours, and perhaps be given a cheap disposable bed, as was implemented in Japan’s Narita Airport, rather than be taken to the Regal Hotel, for what could become the most dangerous night of their lives.

Dr Ariane M. Davison

Dr Ariane M. Davison is a virologist and immunologist with experience in the global healthcare and biotechnology industries. She earned her doctorate from The University of Sydney Medical School, has presented by invitation at international conferences, and her original work has been published in international scientific journals.