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This story is one in a three-part series on how Greater China regions—Taiwan, Hong Kong, and Macau—have responded to the coronavirus outbreak.

In China, where the novel coronavirus now known as Covid-19 began, contagion spread at an exponential rate, rocketing from a handful of cases in Wuhan at the end of December to over 80,000 cases nationwide as of mid-March.

In other countries, such as South Korea, Italy and Iran, the virus has transmitted readily, infecting thousands in a matter of days. Yet in Hong Kong, the number of cases so far has crept to 141 since the virus was identified on Dec. 31.

Hong Kong’s low infection rate comes despite it sharing a 19-mile-long border with mainland China, as well as a connecting bridge, an airport, and several seaports. Over 300,000 people percolate between Hong Kong and the mainland every day and—thanks to a new high speed train line—tourists can race the 25 miles from Shenzhen in mainland China to Hong Kong in a little over 15 minutes.

While new cases continue to be reported and Hong Kong remains vigilant, the small region of 7.4 million people seems so far to have kept a large outbreak of Covid-19 at bay.

Hong Kong’s early response

Hong Kong was among the first regions outside of mainland China to recognize the Covid-19 outbreak as a public emergency—doing so on Jan. 25, two days after the city confirmed its first two cases. But the government had begun preparation for incoming infection as early as Dec. 31, when China first reported the novel coronavirus to the World Health Organization.

That day, Hong Kong implemented temperature screenings at border points and began warning medical staff of the new SARS-like virus. On Jan. 7, Hong Kong’s Legislative Council moved to introduce new laws that would qualify the unidentified virus as a “notifiable” disease, giving the government the right to quarantine suspected cases.

HONG KONG-HEALTH-VIRUS — Passengers wear face masks, as a precautionary measure against the COVID-19 coronavirus, as they commute on a tram in Hong Kong on March 12, 2020. The city has largely been spared from a major outbreak.

Since January, the government has opened three sites for quarantining likely coronavirus patients, including the 244 Hong Kong residents recently repatriated from Hubei and the more than 300 returning from the Diamond Princess cruise ship in Japan.

“Most people in the epidemiologist world point to Hong Kong as the gold standard for epidemic control,” Hong Kong University dean of medicine Gabriel Leung said, listing the city’s “open and transparent communication” and “vigorous application of public health principles” as reasons why.

Hong Kong’s SARS legacy

Hong Kong appears to have developed all those positive approaches since it was struck by the severe acute respiratory syndrome or SARS epidemic in 2003—another novel coronavirus outbreak that infected 1,755 people and killed 299 locally. At the time, the government came under criticism for its poor management of the crisis, including lax communication and a failure to ensure patients were properly isolated.

Of the 1,755 SARS patients in Hong Kong, 386 were health care workers, indicating that the safety of hospital staff had been jeopardized. The disease spread easily between patients at hospitals, too. The facilities lacked proper isolation wards, leaving SARS-carrying patients lying beside the uninfected.

Since then, Hong Kong public hospitals have added around 1,400 isolation beds and the city’s Princess Margaret Hospital opened a special infectious disease center in 2007.

However, even now, the public has an unfavorable view of the government’s response to the Covid-19 epidemic.

Open border debate

Hong Kong’s first coronavirus case arrived from Wuhan, crossing into Hong Kong at its border with the mainland city of Shenzhen sometime in January. In response, the government implemented temperature screenings on all arrivals from China and, on Jan. 25, announced flights and trains to Wuhan were cancelled.

However, this was a bit of political showmanship: Wuhan was already on lockdown, authorities had closed its airport and train station two days earlier. For many in Hong Kong, the government action seemed too little too late.

HONG KONG-CHINA-POLITICS-HEALTH-VIRUS — Hong Kong pro-democracy district councillor Eason Chan pushes a cart of face masks and cleaning products in Lam Tin in Hong Kong on March 14, 2020. Hong Kong’s rival political camps have embraced free face masks as a tactic to woo potential voters as protest-era politics color the city’s response.

On Feb. 3, a new union of public sector health care workers, called the Hospital Authority Employees Alliance, organized a series of strikes to demand that Chief Executive Carrie Lam close the border with China entirely. Lam had suspended operations at six border points already, beginning Jan. 30.

After the second day of the strike, Lam conceded and shut four more border points, leaving just three open: the airport, the Hong-Kong-Zhuhai-Macau bridge, and the Shenzhen Bay ferry port. Lam said it would be discriminatory to block all mainland China visitors from entering Hong Kong, but critics were quick to point out the hypocrisy when Lam’s administration unilaterally blocked arrivals from South Korea on Feb. 24 as Covid-19 cases on the Korean peninsula skyrocketed.

“Closing the border earlier is something the government could have done,” Leung said. This week, Hong Kong reported nine new cases in patients who had returned to Hong Kong from other cities experiencing Covid-19 outbreaks. Once again, the public and even members of government are calling for stricter border controls.

Masking public sentiment

The government’s approval rating was driven to an all-time low last year by months of protests and that underlying discontent continues to politicize the public’s perception of the Covid-19 outbreak. For instance, Lam was slow to encourage people to wear surgical masks in public, a move some viewed as her administration trying to uphold a controversial mask ban it enacted amid the protests last year. (Courts had deemed the rule unconstitutional.)

Donning a face mask to protect public health was normalized in Hong Kong during the SARS outbreak. The city’s residents, like many across East Asia, often wear face masks when suffering from any illness—even the common cold. So, despite no official instruction to do so, Hong Kongers began stockpiling and wearing surgical masks in late January.

Unlike governments in Singapore and Macau, which ordered new shipments of masks and rationed their distribution, the Hong Kong government failed to secure mask supplies, and the shortage ignited public panic. On Feb. 5, a line of an estimated 10,000 people appeared over night to purchase two boxes of masks each from an importer that had made a special shipment.

In Hong Kong, the public has adopted some elements of social distancing, too—leaving seats on subway trains empty and holing up at home on weekends. Public schools have also been suspended by government edict since the Lunar New Year break, which began Jan. 25, and students won’t return until late April.

It’s hard to determine what the key factor has been in keeping Hong Kong’s infection rate so low, Leung said, but the “whole package” of open communication, social distancing, good hygiene procedures and effective hospital treatment is having an effect.

“Policy makers need to look and see what…other places with effective control have done and ask, ‘Which of those approaches would be feasible in my own region and accepted by [my]society,'” Leung said. “But that is not a trivial task, and it’s something we’re all working towards at the moment.”