key: cord-0898757-ygnp343x authors: Abu-Odah, Hammoda; Ramazanu, Sheena; Saleh, Eslam; Bayuo, Jonathan; Abed, Yehia; Salah, Motasem Said title: COVID-19 Pandemic in Hong Kong and Gaza Strip: Lessons Learned from Two Densely Populated Locations in the World date: 2021-02-03 journal: Osong Public Health Res Perspect DOI: 10.24171/j.phrp.2021.12.1.07 sha: 395c67e736ac8077932a2f329c52df4e01bd7bd3 doc_id: 898757 cord_uid: ygnp343x The emergence of the coronavirus pandemic led to the implementation of several precautionary measures across the globe. For densely populated regions in the world, this may have been challenging given the proximity of people to one other. Thus, this brief report sought to compare the measures across 2 densely populated locations, Hong Kong and Gaza. Epidemiological data was obtained from governmental online repositories and was compared with the data presented by the Johns Hopkins coronavirus map to ensure consistency. Descriptive statistics were used to interpret the data obtained over the period of the study. The data suggested that although Hong Kong and Gaza implemented similar strategies, Gaza recorded marginally higher cases compared with Hong Kong in the same timeframe. The strategies implemented in both settings included border closures, social distancing, proper hand hygiene, and mask usage. Cultural and socio-demographic differences may have played a part in this variation in case numbers, in addition to lessons Hong Kong had previously learned from a similar outbreak. As the pandemic is ongoing it is essential that public sensitization to adherence to precautionary measures at the personal/family level does not occur. Following the emergence of the first case of coronavirus disease 2019 (COVID-19) on 29 th December, 2019, in Wuhan, China [1] [2] [3] , all countries around the world have adopted several precautionary measures to limit the spread of the virus. Most countries closed their borders, stopped flights, and imposed a curfew. Despite all these precautions, the virus has spread rapidly around the globe [4] and brought significant challenges to all aspects of life [5] . In response to the high incidence rates of infection, the World Health Organization declared the disease as a global pandemic in March 2020 [6, 7] . Despite the rapid spread of COVID-19, some settings such as mainland China, Hong Kong, and Japan have successfully controlled the pandemic by relying on their previous experience in dealing with infectious diseases, robust healthcare systems, and precautionary measures [8] [9] [10] . However, other countries such as USA, Italy, and Spain seem to be battling the pandemic despite their existing well-organized healthcare systems [11, 12] . The precautionary measures undertaken by some governments seem not to have had a significant impact on minimizing the spread of the virus [13] , particularly in regions with a high-density population [14] . To this end, the current report focused on comparing the precautionary measures that were implemented by the governments of 2 of the world's most densely populated settings, that is, Hong Kong and Gaza in responding to a pandemic. This study also estimates the incidence rates of COVID-19 cases in Hong Kong, the Gaza Strip, and worldwide. It also summarizes key lessons that would help in combating the spread of COVID-19. Understanding the processes of precautionary measures from 2 of the most densely populated settings in the world with different economic levels (i.e., Hong Kong with a high level of resources and the Gaza Strip with a low level of resources) would help countries to manage their situations based on the availability of their resources. Epidemiological data regarding COVID-19 were obtained from the respective governmental online repositories (Hong Kong and Gaza) during the period 24 th August to 14 th September, 2020. These data were reviewed and downloaded into separate Microsoft Excel worksheets. The incidence and mortality rates published on the government websites were monitored daily to update the worksheets and to ascertain the variations. At the end of each day, the reported data was compared with the John Hopkins COVID-19 map to ensure consistency. Following several days of tracking the incoming data daily, descriptive statistics were employed to display the data and draw comparisons across the data set. Hong Kong is a special administrative region located in the southern part of the People's Republic of China, with a population of 7.50 million [15] . This population density, in addition to its proximity to mainland China, made it more vulnerable to the spread of COVID-19 [18] . A total of 4,972 confirmed cases were recorded between 22 nd January, 2020 and 14 th September, 2020 (Table 1) head of population was 1.34 [20] . The Gaza Strip is a part of Palestine located on the eastern coast of the Mediterranean Sea, with a population of 1.99 million [16] . The population density makes it more at risk for COVID-19. On the 21 st March, 2020, Gaza Strip announced its first confirmed imported COVID-19 case. While the first local confirmed case was recorded on the 24 th August, 2020, since that time, the number of confirmed cases increased sharply to 1,927 cases by the 14th September, 2020 [21] . Fifteen people out of the total confirmed cases died; the case fatality rate was 0.01, and the mortality rate per 100,00 was 0.75 (Table 1 ). Prosecution or a wanted warrant was issued to people who violated the rules of compulsory quarantine in Hong Kong [25] . In the Gaza Strip, all arriving citizens were detained in governmental buildings for a 21-day quarantine period, irrespective of the results of the reverse transcriptionpolymerase chain reaction (RT-PCR) COVID-19 test [21, 26] . Positive COVID-19 cases were treated at hospitals while negative cases were detained in schools, hotels, or health centers. Recently, 3 quarantine buildings with a bed capacity of 2,500 have been built. All people under quarantine were tested prior to discharge to confirm that they were free from the virus. The confirmed cases at this point were referred to the hospital for treatment and follow-up, while negative cases were permitted to go home. For community confirmed cases, there was a 21-day governmental quarantine. People who were in close contact with COVID-19 infected cases were also tested, and positive cases were sent to the hospital [21, 26] . From the 25 th March, 2020, all non-Hong Kong residents travelling from overseas countries were denied entry [24] . However, residents of Hong Kong were permitted to enter the city. As for ferry terminals, passenger clearance services In February 2020, reusable face shields were available to those who were in need in the community [28] . The University also provided 1 free reusable face shield for students upon request. The availability of different types of face masks and hand sanitizers with a reasonable price in the stores enabled the citizens to adhere to the government rules and regulations. In the Gaza Strip, at the start of the epidemic, there was a severe shortage of PPE in Gaza health facilities and consequently access to PPE to the public was scarce. By April, Gaza started to produce high-quality devices and export this equipment. Now masks are available to the public at a low price (50 masks for 2.5 US dollars). Although Hong Kong has experienced a third wave of COVID-19, it has reported a low incidence of COVID-19 cases during the period 24 th August to 14 th September, 2020 (Figure 1) , and this is likely to be attributable to its citizens' discipline at adopting stringent levels of personal infection control measures [18] . A recent survey revealed that the majority of Hong Kong citizens practiced safe self-care measures (95% of participants washed their hands thoroughly, and 99% began wearing a mask when the first few cases of COVID-19 were reported [29] . Hong Kong citizens have cultivated the norm to don a surgical mask in public places, thereby preventing a surge of infections in the community. Adherence and awareness of social distancing measures were emphasized in Hong Kong communities. The Hong Kong government adopted the "suppress and lift" approach [30] . Citizens were advised to keep 1-meter distance away from others. Group gatherings were minimized and crowded places were avoided. Under the Prevention and Control of Disease Ordinance regulation (Cap. 599), group gathering of more than 2 people was strictly prohibited (4 th September, 2020 to 10 th September, 2020) [31] . Although the Palestinian government ran educational programs about the importance of wearing a mask and hand washing to minimize the risk of spread of COVID-19, only a minority of citizens adopted a high level of personal infectioncontrol measures [32] . A lack of awareness of Gazan people and ignorance of the risks and potential fatalities which the virus may cause, led to an increase in the incidence rate of COVID-19 ( Figure 2 ). Since the public have a false sense of safety and a feeling that the virus is not in the community and is contained in quarantine departments, they did not respond to governmental instructions. Arabic social habits and behaviors such as shaking hands and kissing also played a key role in increasing the spread of the virus. In addition, water was unavailable for washing due to challenges with water refill during the period of the 24 th August to 14 th September, 2020 which may have led to poor hygiene, and the supply of electricity in the home being cut off for more than 20 hours per day which will have led to citizens not following the curfew as requested. In the last 2 weeks of the study period (24 th August to 14 th September, 2020), there was a marked improvement in the responsibility of the public. The governments of Hong Kong and Gaza Strip, adopted similar approaches to reduce community transmissions of COVID-19 (Table 2 ). For instance, both locations had compulsory quarantine for its residents, screening, and surveillance to detect COVID-19, and the governments convened an online dashboard, and daily press conferences The study sought to highlight lessons learned from 2 densely populated areas in the world regarding the management of the COVID-19 pandemic. The findings suggest that despite the similarities in precautionary measures across the 2 locations, Gaza appeared to be experiencing marginal increases in case rates compared with Hong Kong. Although several factors may explain this occurrence, including the socio-demographic, and cultural context of the 2 settings which seems to have played significant roles. As it stands now, the COVID-19 pandemic has set out a new, normal way of life, for an unspecified period. Thus, precautionary measures such as hand hygiene, use of masks, and quarantine amongst others measures need to be strengthened. 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