Since March 2022, an MSF – Hong Kong team with doctors, nurses, psychologists, and engineers, has conducted multi-disciplinary assessments in 16 elderly homes and residential care homes for persons with disabilities to cope with potential future outbreaks. The team has provided key recommendations on ventilation and air quality, infection and prevention control, as well as mental health and emotional well-being of the residents and staff.

Many residents have different chronic diseases and need assistance with daily activities. They are particularly vulnerable to the highly infectious Omicron variant, the dominant mutant strain of the fifth wave of COVID-19 outbreak in Hong Kong. Despite the homes’ effort to respond to the outbreak, government data shows that the residents accounted for a disproportionately large number of deaths during the fifth wave. Over 50 per cent of the fatal cases were from elderly homes and residential care homes for persons with disabilities.

In early March, Hong Kong recorded tens of thousands of new infections daily during the peak causing the medical system got overwhelmed. Due to the shortage of hospital inpatient capacity and quarantine facilities, infected residents were confined to the homes with non-infected residents and staff.

Albert Lee, an engineer and MSF staff, has taken part in the assessment. He expressed that one of the important elements to curb the rapid transmission of COVID-19 was ventilation system. However, the design of the homes was not ideal for such airborne disease outbreaks.

Since Hong Kong has one of the world’s highest population density, good ventilation and air quality management in the built environment are critical for preventing virus transmission. We need to raise the concern, especially on the premises of the vulnerable groups. Our approach is not just to assess the performance of the ventilation system but also to educate the staff with basic ventilation and air quality knowledge. Therefore, they can be better prepared for any potential future outbreaks.

 - Albert Lee, engineer and MSF staff

Albert Lee (right), an engineer and MSF staff, shared basic concepts of indoor ventilation with a frontline staff member of elderly home (centre). ©MSF


MSF team provided recommendations and in-person training on improving ventilation system, such as how to create negative air pressure environment in the temporary isolation area to enhance air balance by retrofitting exhaust fans.

Even though the frontline caregivers and staff had been performing proper infection and prevention control measures, the COVID-19 virus spread like wildfire in the homes earlier this year. They were under tremendous pressure while taking care of the residents.

The Evangelical Lutheran Church of Hong Kong Shan King Care and Attention Home for the Elderly, one of the elderly homes assessed by the MSF team, had 95 per cent of residents and 40 per cent of staff infected with COVID-19 in the fifth wave.

Time hung heavy at the beginning of the fifth wave. We felt so helpless because there was a surge in coronavirus infections amongst residents. But our staff—care workers, nurses, and social workers—were still united to come up with different solutions and working hard to comfort the residents despite the enormous pressure and risks of infection they faced.

 - Fonia So, the Superintendent of The Evangelical Lutheran Church of Hong Kong Shan King Care and Attention Home for the Elderly

Thirteen of 135 residents of the elderly home infected with COVID-19 passed away during the fifth wave.

 “Our frontline staff felt sorrow for the loss of the resident whom they had performed first aid trying to save his life. They felt guilty because they thought they could have done more,” So recalled the death of a resident. “Despite experiencing negative emotions, we still would console each other and keep looking after other residents,” she said.

Fonia So (left), the Superintendent of The Evangelical Lutheran Church of Hong Kong Shan King Care and Attention Home for the Elderly, believed they could do better to respond to the potential outbreak after MSF’s assessment. ©MSF


MSF team is offering mental health workshops to staff amongst the homes as a crucial step to support them address the trauma, grief, and anxiety due to the severe outbreak.

The situation in Hong Kong, especially in residential care homes, during the peak of the fifth wave of COVID-19 was a painful experience. Public health response must be strengthened to include the vulnerable groups right from the outset of an outbreak to prevent deaths and severity of situation. This unfortunate incident should not happen again.

 - Dr Nason Tan, Regional Director of Operations Support Unit of MSF Hong Kong



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