Prince of Wales Hospital and the 2003 SARS Outbreak: A Clinical History of CUHK's Teaching Hospital

This article is a factual archive for the Reference Section (11 Medicine) and carries no credibility badge. Content concerning the 2003 SARS outbreak is strictly based on academic and official sources, recording clinical, epidemiological and control facts — no embellishment, no dramatisation, no invasion of personal privacy. For an overview of the Faculty of Medicine's structure and clinical departments, see faculty-of-medicine.md; for the founding history and founding deans, see faculty-of-medicine-founding.md; for the Faculty's in-depth archive, see 01-academics/deepdive-medicine.md.

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# I. A Hospital Built for the New Territories East

To understand why the Prince of Wales Hospital (PWH) found itself at the epicentre of the storm in 2003, you first need to understand what kind of hospital it was — from the outset, it was designed as a regional acute hospital built to absorb large numbers of patients, not a small specialist clinic.

According to English Wikipedia^※ and the South China Morning Post's retrospective on its opening^※, this public hospital in Sha Tin, sitting next to the CUHK campus, had its works commence on 1 December 1979, originally scheduled for completion in September 1982 and operation by May 1983 — a timetable ultimately delayed by roughly a year due to construction overruns:

• 1 November 1982 — the official opening ceremony, presided over by Katharine, Duchess of Kent;
• Main works completed in November 1983;
• 1 May 1984 — full operation begins, with the first patients admitted seven years after groundbreaking.

It carried two frequently cited "Hong Kong firsts" and scale markers. First, according to sources, PWH was Hong Kong's first fully air-conditioned public hospital — in the 1980s, central air-conditioning across the whole building was itself a badge of modernity. Second, it opened as a large hospital from day one: reportedly around 1,400 beds at launch, serving a population of nearly 700,000 in the New Territories East.

Over the following decades the hospital expanded steadily, growing into the hub of the New Territories East healthcare network. According to the Hospital Authority's PWH "History" page^※:

• November 1994 — the Sir Yue-Kong Pao Centre for Cancer opens;
• October 2010 — the Main Clinical Block and Trauma Centre comes into operation, providing intensive care, operating theatres and day services across roughly 71,500 square metres of floor area on 14 storeys;
• According to the hospital's own materials, it covers the geographically largest of the Hospital Authority's seven clusters — the New Territories East Cluster — serving residents of Sha Tin, Tai Po, the North District, Sai Kung and the outlying islands to the east.

According to English Wikipedia^※, PWH today provides around 1,807 beds and a 24-hour accident and emergency service, employs about 5,500 staff, and serves as the regional acute hospital of the New Territories East Cluster. Neurosurgery is another of its regionally significant strengths — according to an academic article reviewing the development of neurosurgery at PWH^※, its neurosurgery department was granted autonomous status with 40 acute beds and a dedicated intensive care unit, forming a major surgical specialty in its own right across the New Territories East.

Above all, it is CUHK's teaching hospital: according to the CUHK Faculty of Medicine's official page^※, as the Faculty's largest teaching hospital, PWH has helped train over 5,000 healthcare professionals over the decades and underpinned a substantial volume of medical research. In other words, it is not merely a place where people go to be treated — it is the "heart" of CUHK's medical education and clinical research. Under the teaching-hospital model, the clinical floor is the medical school's classroom and laboratory — a configuration that placed it at the very front of the storm in the 2003 public health crisis.

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# II. 4 March 2003: A Pneumonia Patient on Ward 8A

In the 2003 severe acute respiratory syndrome (SARS) epidemic, PWH was one of the earliest sites of a hospital outbreak in Hong Kong. Its outbreak can be traced precisely to one patient, one ward, one clinical decision. The following facts are set out strictly according to the paper authored by the PWH team published in The Lancet (full text via PMC)^※, the New England Journal of Medicine (NEJM) paper on this outbreak^※, the US CDC's Emerging Infectious Diseases (EID) article on the "index patient"^※ and Chapter 6 of the Hong Kong Legislative Council Select Committee report^※, among other public sources:

According to these academic sources, a 26-year-old man was admitted to Ward 8A of PWH on 4 March 2003 with community-acquired pneumonia; he had experienced fever, chills and rigors since 24 February, and responded poorly to antibiotics in the early days of admission. According to the EID article, he had previously visited a hotel in Kowloon where a 64-year-old physician from Zhongshan in southern China had stayed — a chain of contact later identified as the route by which the virus entered PWH (that hotel being the Metropole Hotel, as recorded in the historical record).

According to the timeline compiled by English Wikipedia^※, the patient had in fact sought medical attention before 4 March: he first presented at the PWH accident and emergency department on 28 February, was diagnosed with a "respiratory tract infection" and discharged home with medication. Only when his condition failed to improve did he return to A&E on 4 March and was admitted to Ward 8A. This detail matters: there was a gap of nearly a week between his first presentation and his eventual admission, by which time the virus had begun spreading within the ward. At no point in the triage process was a patient with "recurrent respiratory infection" connected to an unwell physician from Guangzhou who had stayed at the same hotel days earlier. This is the predicament repeatedly invoked in retrospectives on the early SARS response: in a phase where diagnostic tools and knowledge of the pathogen were absent, "reasonable diagnoses" at the individual level could still generate large-scale transmission at the systemic level.

This patient was subsequently confirmed as the index patient of the PWH outbreak. According to the LegCo report, when he was admitted to Ward 8A, no infection control measures including droplet precautions were triggered, nor were case investigation and contact tracing initiated — at the time, nobody knew this was a novel, highly transmissible respiratory disease.

One clinical detail changed the scale of transmission: according to the academic sources above, the index patient received nebulised bronchodilator therapy — specifically, albuterol 0.5 mg delivered via a jet nebulizer driven by oxygen at 6 litres per minute, four times daily for approximately seven days, discontinued on day 8. Multiple studies have suggested that nebulisation may have enhanced the dispersal of the virus in the ward air; after this episode, nebulisation was ceased for patients with suspected SARS. This change was one of the infection-control lessons learned from bitter experience.

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# III. Within Ten Days: The Ward 8A Nosocomial Outbreak

The speed of transmission in Ward 8A — and beyond — was unprecedented at the time. According to the academic and official sources cited above, the key timeline is as follows (all figures per the public sources; numbers as stated in the originals):

According to these studies, those affected in Ward 8A included not only healthcare workers but also medical students on placement and visitors — which is precisely the teaching hospital's point of vulnerability in an epidemic: patients, staff, students and relatives all present in the same ward, dense and fluid in their movement. Infected staff and students were subsequently mostly isolated and treated; some staff themselves became severely ill.

According to the data compiled by English Wikipedia^※, widening the statistical lens: 143 people in total who had direct contact with the index patient within Ward 8A were infected; counting subsequent spread across the hospital more broadly, 239 people were affected in total. These figures correspond to three different measures — "direct ward contacts," "cumulative hospital-wide total" and "bed occupancy at a single time point" (the Lancet paper's "156 admitted by 25 March") — and are not mutually contradictory. The same paper and the Lancet report both note that the scale of nosocomial spread was closely linked to two environmental factors: first, Ward 8A itself was overcrowded, with patients' beds too close together; second, the building's outdated ventilation system was considered "likely" to have amplified the airborne range of the virus — which, together with the nebulisation noted above, became the direct basis for subsequent reviews of ward design and air-conditioning systems across Hong Kong's hospitals.

This chain of in-hospital transmission made PWH one of the earliest and most important field sites for studying SARS transmission patterns and control measures. It answered a question the whole world was asking at the time: how — and how fast — did this new disease spread inside a hospital?

A note on this archive's approach: SARS was a major public health event that caused loss of life. This article records only the objective clinical and epidemiological facts (admission chronology, infection numbers, control research) per academic and official sources — no embellishment, no dramatisation, no personal privacy, no naming of frontline individuals. This archive pays due respect, in restrained prose, to the sacrifice and risk borne by frontline healthcare workers during the epidemic.

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# IV. The Dirty Team and the Clean Team: PWH's Emergency Response

Faced with a new disease whose pathogen had not even been identified, PWH organised a full emergency response within days. According to the account compiled by English Wikipedia^※ and the LegCo Select Committee report cited earlier, the measures taken by the hospital's management included:

• Sealing off the eighth floor of the main block: restricting access to the floor housing Ward 8A to reduce cross-exposure;
• Suspending part of its non-emergency services to free up resources for the outbreak;
• Team segregation: splitting the medical teams in two — a "dirty team" dedicated to caring for SARS patients, and a "clean team" completely isolated from the SARS wards, so that a corps of unexposed staff could be preserved to keep the hospital's other day-to-day operations running. According to this source, the dirty team was led by Joseph Sung (沈祖尧), then a professor in CUHK's Department of Medicine and Therapeutics (and later Vice-Chancellor of CUHK) — he himself contracted the infection through close patient care, and returned to the fight after recovering.

According to UBEAT^※, the student publication of CUHK's School of Journalism and Communication, interviews with frontline staff from that period describe severe shortages of personnel and protective equipment in the early phase of the outbreak: one radiographer recalled that management distributed just one N95 mask per week, in a paper bag, with strict instructions not to lose or damage it because there were no replacements; to accommodate infected staff, the hospital temporarily converted some surgical wards into isolation facilities, and staff on duty worked nearly eight-hour shifts in full protective gear, frequently drenched in sweat. These details corroborate the structural problems identified in the academic papers — "overcrowded beds, old ventilation" — and capture PWH's situation in 2003 as both a medical nosocomial outbreak and a stress test of a system underprepared in resources and institutions.

After the epidemic, Ward 8A was repeatedly cited as the origin point of the outbreak; the hospital subsequently renumbered it Ward 8H, to avoid confusion with the ward numbering of the later inpatient main block — one of the rare instances in PWH's history where a single event led to a ward designation change.

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# V. From Ward to Paper: The Academic Contribution of the CUHK Team

PWH and the CUHK Faculty of Medicine were not merely "the side that took the hit" in this epidemic — they rapidly converted the clinical frontline into scientific knowledge that the world could draw on. This is the positive face of the Faculty's "teaching-research-clinical integration" model under crisis.

First, international publication of clinical experience. The papers cited above, published in The Lancet, the NEJM and Emerging Infectious Diseases, draw heavily on first-hand data from PWH. They gave the international medical community the earliest first-hand clinical record of nosocomial SARS transmission — admission chronology, the healthcare-worker infection curve, the transmission effects of nebulisation, the gains and losses of protective measures. In the early phase of a novel disease, reliable data from the outbreak site of this kind are irreplaceable.

Second, contributions at the viral genome level. According to a review paper summarising CUHK's molecular epidemiological data on the SARS coronavirus (PMC)^※, CUHK's microbiology team was the third group worldwide to publish the complete genome sequence of the SARS coronavirus (naming its isolate CUHK-W1), and went on to sequence multiple full and partial genomes (including CUHK-AG01 and others) to investigate whether different strains circulated during the epidemic. In other words, CUHK not only documented "how the disease spread" but also helped answer "what this virus is." The broader narrative of this research effort appears in 01-academics/deepdive-medicine.md and 04-research/state-key-laboratories.md.

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# VI. The Long-Term Significance of a Clinical History

PWH's experience of SARS left a lasting mark on both the CUHK Faculty of Medicine and Hong Kong's public health system:

• Institutionalising infection control: the bitter lessons of the Ward 8A outbreak directly drove the subsequent comprehensive strengthening of infection control, isolation wards, negative-pressure facilities, personal protective equipment and nebulisation protocols across Hong Kong's hospital system;
• A durable academic contribution: the CUHK team converted clinical and laboratory experience into international publications in top journals, bringing Hong Kong's SARS response experience into the global medical knowledge base and providing a reference point for future responses to emerging respiratory infections;
• The teaching hospital's dual role: in the crisis, PWH simultaneously shouldered the roles of "treating patients" and "producing knowledge" — the extreme expression, in both value and cost, of the teaching-hospital model: vulnerable because of its density of people, yet able to convert the frontline into scholarship quickly because teaching and research are embedded in the same institution.

The human cost of the epidemic for Hong Kong as a whole was heavy: according to public reporting, the 2003 SARS outbreak in Hong Kong caused approximately 299 deaths, including several healthcare workers who died in the line of duty. Among all infected healthcare workers in the territory, PWH was one of the earliest — and among the largest — sites of nosocomial infection. In the years that followed, the hospital system responded in both hardware and institutions: beyond PWH's own reviews of ward design, ventilation and isolation facilities, the Hospital Authority established a dedicated Infection Control Centre at Princess Margaret Hospital outside the New Territories East Cluster, centralising admission of statutorily notifiable infectious disease cases and becoming one of the core facilities for Hong Kong's subsequent responses to avian influenza, H1N1 and other emerging infections; the PWH accident and emergency department was also required to install resuscitation rooms with negative-pressure isolation for handling patients with suspected infectious diseases.

Yet, according to UBEAT's interviews with frontline staff who lived through both SARS and COVID-19^※, these institutional catch-up measures were not without gaps. One frontline physician in internal medicine, reflecting on the intervening years, conceded that "many things should have been improved over the seventeen years, but chronic understaffing and shortages of protective equipment persisted" — and that when COVID-19 emerged in early 2020, the system's isolation capacity and supply-chain resilience again showed strains similar to 2003. The comparison is itself instructive: it demonstrates that "each crisis triggers a round of reform" is not a linear, once-and-for-all process. The resilience of a teaching hospital and a public health system requires sustained investment, not merely short-term patching in the wake of a single event.

The story of PWH is thus more than one hospital's institutional history. It is a severe test of CUHK's "teaching-research-clinical integration" model of medical education in a real public health crisis, and a mirror held up to the resilience-building of Hong Kong's public health system. From the fully air-conditioned new hospital serving the New Territories East in 1984, to the outbreak scene of Ward 8A and the dirty-team/clean-team split in 2003, to first-hand papers in top journals and more than a decade of institutional catch-up since — this thread ties together the heaviest and most critical mission of a teaching hospital.

Related reading: Faculty of Medicine structure and clinical departments, Founding of the Faculty and its founding deans, Medical Faculty in-depth archive (five schools · clinical departments), School of Chinese Medicine, State Key Laboratories, CUHK Medical Centre: A Self-Financing Private Teaching Hospital.

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