‘I feel like I have Ebola’: Hong Kong mpox patient warns fear of enforced isolation may stop people reporting infections

When Covid-19 was at its worst in Hong Kong, a palpable fear pervaded the city: people were afraid not only of the virus, but of being forced into isolation. For some, the threat of quarantine outweighed that posed by the disease, and they chose to keep their infection to themselves rather than report it to the authorities. 

Now, with isolation centres like Penny’s Bay little more than a fast-forgotten meme for many, one patient has warned that Hong Kong’s stringent confinement measures for those infected with mpox risk putting people off alerting health professionals to their condition. 

“The extremely harsh quarantine procedures here, they do so much harm to those who are responsible like me,” Daniel, who asked to use a pseudonym, told HKFP by email from an isolation ward at Princess Margaret Hospital. He added that it felt to him “like we learned nothing” from living though, and ultimately with, Covid-19.

“The quarantine and measures used to stop the spread discourage people from being decent human beings and put additional risk on themselves and potentially others,” said.

‘Extremely low’ transmission risk

In May 2022, the World Health Organization (WHO) raised warnings about outbreaks of mpox – at the time referred to as monkeypox – in countries where the disease was not endemic.

The virus is generally transmitted through intimate, physical contact with someone with the viral illness. Anyone can be infected, although the global outbreak primarily affected men who have sex with men, the WHO said. Symptoms include a rash – often near the genitals – fever, and swollen lymph nodes, with the illness generally lasting for two to four weeks.

“According to latest scientific evidence, the transmission risk through casual social contact, including close family contact is extremely low,” a Centre for Health Protection (CHP) spokesperson said in July.

Despite this, people infected with mpox in Hong Kong are being issued with lengthy isolation orders and placed in quarantine in public hospitals.

“The key control strategies for mpox at this stage in Hong Kong include early detection, prompt isolation as well as identification and quarantine of close contacts… For confirmed mpox patients, isolation will be continued until all lesions have been resolved and become non-infectious,” a Department of Health spokesperson told HKFP in an emailed response to enquiries.

Once a case has been confirmed, the CHP and the health department “will conduct epidemiological investigations and collaborate with the police as appropriate, to conduct contact tracing promptly in a bid to prevent further spread of the virus.” 

The spokesperson added that epidemiological investigations showed “many recent cases in Hong Kong had high-risk exposures, e.g. engaging in sexual practices with strangers, posing a continuous risk of mpox virus transmission in the local population and increased difficulties over contact tracing.”

‘Usually a self-limited disease’

Since reporting its first mpox infection last September, Hong Kong has recorded 28 cases to date. Twenty of those have been confirmed since July, with the Centre for Health Protection (CHP) announcing on July 26 the opening of a designated mpox vaccination centre in Mong Kok amid an “upsurge of confirmed mpox cases,” to bolster its existing inoculation programme which began last October.

A CHP hotline, set up in May to provide information and advice to those who think they may be infected, had received more than 150 inquiries as of Wednesday, the Department of Health said.

“Vaccination is an effective way to prevent mpox infection,” the department’s spokesperson said. “Many of these [recent] cases did not receive or received incomplete mpox vaccination,” they added.

On Wednesday, the Chinese Center for Disease Control and Prevention (CCDCP) reported that mainland China, too, had recorded a recent rise in mpox cases. Authorities confirmed 491 cases in July – 116 of which were in Guangdong province – an almost five-fold increase on June’s 106.

Three of Hong Kong’s recently confirmed cases had been to mainland China within the incubation period, according to the CHP, but only one had a history of “high-risk exposure” across the border.

According to the CCDCP’s Chinese-language guidelines, issued in July, patients with mpox should be sent to medical institutions for isolation and treatment. However, once a patient’s symptoms have visibly improved, or their lesions have scabbed, they could complete their recovery in home isolation.

Additionally, home isolation could be considered for mild cases after evaluation by medical institutions and disease control agencies, the guidelines said.

‘No one ever came’

Daniel first experienced a fever and noticed small spots around his genitals last Wednesday, visiting a private sexual health clinic two days later. “I didn’t associate it with monkeypox to be honest… but thought I would go to the doctor to be safe rather than sorry.”

Daniel’s doctor told him it was likely to be mpox, and said he should go home, pack a bag, and prepare for quarantine. In Hong Kong, medics who encounter a suspected infection must report it to the authorities.

After five hours, Daniel was told to make his own way to Queen Mary Hospital, where he was placed in isolation. Three days later, he was transferred to Princess Margaret Hospital – where he remains, in a shared ward with two other patients, waiting for his symptoms to disappear so he can be discharged. A Queen Mary medic told Daniel he could expect to stay for around three weeks.

Physically, Daniel – who completed the two-dose mpox vaccine regime last November – said he felt fine. “There is some discomfort but I would not say painful.”

However, he said he was struggling psychologically. “I am a happy positive person but here it has created so many issues for me,” he said. “It’s also hard knowing if I was dealing with monkeypox anywhere else in the world I would be treated better and less worried. I would be able to recover in my own space and comfort.”

Last Saturday afternoon, he requested to speak with a mental health professional. “No one ever came.”

Responding to an enquiry from HKFP, a spokesperson for the Hospital Authority said it as was “committed to providing comprehensive and effective treatment for Mpox patients… In addition, if necessary, public hospitals will also facilitate psychological assessments and management for Mpox patients.”

A WHO infographic titled “Recovering from monkeypox at home” suggests that patients should treat their rash by taking warm baths, keeping it clean, and not indulging the urge to scratch. It also recommends exercising “if you feel well enough and can do so while isolating,” doing things that are relaxing and enjoyable, staying connected, and asking for support to maintain mental health.

The WHO suggests using a separate toilet if isolating at home, which is not possible on Daniel’s shared ward. “I am worried about the transmission as we share one bathroom,” he said.

As most infections pass without requiring treatment, the WHO’s recovery guidelines are simple: “Keep hydrated, eat well and get enough sleep. Use medication for pain and fever if needed.”

Indeed, in an outbreak response plan put together by the CHP last June, mpox is described as “usually a self-limited disease,” meaning that it rarely calls for medical intervention.

“I could safely rest at home under much better conditions of sleep, food, medicine, mental health, but these are the procedures still existing today in Hong Kong and that the government has not learned from the previous covid situation… They will round you up and not let you leave,” Daniel said.

“Although Monkeypox has been around for several years now they are unprepared to deal with it and also don’t take into consideration how it spreads,” Daniel added. “I feel like I have Ebola instead.”

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