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H ong Kong was relatively successful in mitigating transmission early in the outbreak of coronavirus disease . Confirmed cases were first reported in the city of Wuhan, China, in December 2019 (1). Situated at the southern tip of China, Hong Kong was at risk for importing COVID-19, given its shared border and high infrastructural and social connectivity with China. In 2019, >236 million passengers crossed the border between China and Hong Kong by land (2). Hong Kong is also vulnerable to virus transmission owing to its high population density and heavy reliance on public transportation. Despite these risks, as of March 20, 2020, transmission control efforts in Hong Kong, as reflected in the numbers of confirmed cases and deaths (256 cases, 4 deaths) (3), had been relatively successful compared with nearby countries and regions, including mainland China (80,967 cases, 3,248 deaths), South Korea (8,652 cases, 94 deaths), and Japan (950 cases, 33 deaths, in addition to the 712 cases from a cruise ship) (4).Health officials in Hong Kong have enacted multipronged interventions to slow disease spread (5). Adopted strategies include border screening (measuring body temperature, imposing a health declaration form system, imposing a 14-day mandatory quarantine period on persons entering Hong Kong from mainland China; parts of Korea, Japan, France, Germany, and Spain; and all of Italy and Iran), social distancing (shutting down the border, reducing cross-border commuting services, delaying the resumption of classes in schools, arranging telework for civil servants, and suspending of public services), and extending the Enhanced Laboratory Surveillance Program to adult patients with fever and mild respiratory symptoms at emergency departments or general outpatient clinics in the public sector.The behaviors of the public are important for outbreak management, particularly during the early phase when no treatment or vaccination is available and nonpharmaceutical interventions are the only options. The efficacy of nonpharmaceutical interventions depends on persons' degree of engagement and compliance in precautionary behaviors, such as facemask wearing, hand hygiene, and self-isolation. Willingness to engage in precautionary behaviors voluntarily depends on risk perception toward the current health threat. In fact, risk perception is a main theme in common health behavior theories (6,7). In addition, with advanced information technology in recent years comes the uncertainty of how risk perception is shaped by various information sources. Hong Kong's experience with outbreaks of novel pathogens (e.g., 2003 severe acute respiratory syndrome [SARS] and 2009 pandemic influenza) also provides a reference point to evaluate the risk perceptions of COVID-19. In comparison, Hong Kong was more affected by SARS than COVID-19 thus far. In 2003, a total of 1,755 persons in Hong Kong contracted SARS, resulting in 299 deaths (8).

BackgroundThe COVID-19 pandemic has impacted the psychological health and health service utilisation of older adults with multimorbidity, who are particularly vulnerable.AimTo describe changes in loneliness, mental health problems, and attendance to scheduled medical care before and after the onset of the COVID-19 pandemic.Design and settingTelephone survey on a pre-existing cohort of older adults with multimorbidity in primary care.MethodMental health and health service utilisation outcomes were compared with the outcomes before the onset of the COVID-19 outbreak in Hong Kong using paired t-tests, Wilcoxon’s signed-rank test, and McNemar’s test. Loneliness was measured by the De Jong Gierveld Loneliness Scale. The secondary outcomes (anxiety, depression, and insomnia) were measured by the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder tool, and the Insomnia Severity Index. Appointments attendance data were extracted from a computerised medical record system. Sociodemographic factors associated with outcome changes were examined by linear regression and generalised estimating equations.ResultsData were collected from 583 older (≥60 years) adults. There were significant increases in loneliness, anxiety, and insomnia, after the onset of the COVID-19 outbreak. Missed medical appointments over a 3-month period increased from 16.5% 1 year ago to 22.0% after the onset of the outbreak. In adjusted analysis, being female, living alone, and having >4 chronic conditions were independently associated with increased loneliness. Females were more likely to have increased anxiety and insomnia.ConclusionPsychosocial health of older patients with multimorbidity markedly deteriorated and missed medical appointments substantially increased after the COVID-19 outbreak.

Highlights Non-pharmaceutical interventions was effective in reducing COVID-19 transmission. Social distancing is more effective than the other NPIs in containing COVID-19. Two or more synchronous NPIs are more effective than a single type of NPIs.

17 18 Background: Community responses are important for outbreak management during the early phase 19 when non-pharmaceutical interventions are the major preventive options. Therefore, this study aims to 20 examine the psychological and behavioral responses of the community during the early phase of the 21 COVID-19 epidemic in Hong Kong.22 23 Method: A cross-sectional online survey was launched within 36 hours after confirmed COVID-19 24 cases were first reported. Councilors of all 452 district council constituency areas were approached for 25 survey dissemination. Respondent demographics, anxiety level, risk perception, sources to retrieve 26 .CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10. 1101 /2020 COVID-19 information, actual adoption and perceived efficacy of precautionary measures were 27 collected. 29Result: Analysis from 1715 complete responses indicated high perceived susceptibility (89%) and high 30 perceived severity (97%). Most respondents were worried about COVID-19 (97%), and had their daily 31 routines disrupted (slightly/greatly: 98%). The anxiety level, measured by the Hospital Anxiety and 32 Depression Scale, was borderline abnormal (9.01). Nearly all respondents were alert to the disease 33 progression (99.5%). The most trusted information sources were doctors (84%), followed by broadcast 34 (57%) and newspaper (54%), but they were not common information sources (doctor: 5%; broadcast: 35 34%; newspaper: 40%). Only 16% respondents found official websites reliable. Enhanced personal 36 hygiene practices and travel avoidance to China were frequently adopted (>77%) and considered 37 effective (>90%). The adoption of social-distancing measures was lower (39%-88%), and their drivers 38 for greater adoption include: being female (adjusted odds ratio [aOR]:1.27), living in the New 39 Territories (aOR:1.32-1.55), perceived as having good understanding of COVID-19 (aOR:1.84) and 40 being more anxious (aOR:1.07). 41 42 Discussion: Risk perception towards COVID-19 in the community was high. Most respondents are alert 43 to the disease progression, and adopt self-protective measures. This study contributes by examining the 44 psycho-behavioral responses of hosts, in addition to the largely studied mechanistic aspects, during the 45 early phase of the current COVID-19 epidemic. The timely psychological and behavioral assessment of 46 the community is useful to inform subsequent interventions and risk communication strategies as the 47 epidemic progresses.48 49

A dense population, global connectivity and frequent human–animal interaction give southern China an important role in the spread and emergence of infectious disease. However, patterns of person-to-person contact relevant to the spread of directly transmitted infections such as influenza remain poorly quantified in the region. We conducted a household-based survey of travel and contact patterns among urban and rural populations of Guangdong, China. We measured the character and distance from home of social encounters made by 1821 individuals. Most individuals reported 5–10 h of contact with around 10 individuals each day; however, both distributions have long tails. The distribution of distance from home at which contacts were made is similar: most were within a kilometre of the participant's home, while some occurred further than 500 km away. Compared with younger individuals, older individuals made fewer contacts which tended to be closer to home. There was strong assortativity in age-based contact rates. We found no difference between the total number or duration of contacts between urban and rural participants, but urban participants tended to make contacts closer to home. These results can improve mathematical models of infectious disease emergence, spread and control in southern China and throughout the region.

Steven Riley and colleagues analyze a community cohort study from the 2009 (H1N1) influenza pandemic in Hong Kong, and found that more children than adults were infected with H1N1, but children were less likely to progress to severe disease than adults.