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

This article is a factual reference file for Area 11 (Medicine), not assigned a reliability badge. Content relating to the 2003 SARS epidemic is based strictly on academic and official sources, recording clinical, epidemiological, and infection-control facts. It does not dramatise, sensationalise, or disclose any personal private information. For an overview of the Faculty's structure and clinical departments, see faculty-of-medicine.md; for the Faculty's founding history and founding dean, see faculty-of-medicine-founding.md; for an in-depth profile, see 01-academics/deepdive-medicine.md.

# 1. A Hospital Built for the New Territories East

To understand why the Prince of Wales Hospital (PWH) found itself on the front line in 2003, one must first understand what kind of hospital it is. From the outset, it was designed as a regional acute hospital built for high patient volumes, not a small specialist clinic.

According to English Wikipedia^※ and a South China Morning Post retrospective on its opening^※, construction of this public hospital, located in Sha Tin adjacent to the CUHK campus, began on 1 December 1979. The original timeline targeted completion by September 1982 and operation by May 1983, but delays pushed the schedule back by roughly a year:

• 1 November 1982: Official opening ceremony presided over by Katharine, Duchess of Kent.
• Main construction works were completed in November 1983.
• The hospital formally began receiving patients on 1 May 1984, seven years after construction began.

The hospital carries two frequently cited "first in Hong Kong" labels and a label of sheer scale: first, according to sources, PWH was Hong Kong's first fully air-conditioned public hospital—a hallmark of modernisation in the 1980s. Second, it was massive from day one, reportedly opening with approximately 1,400 beds to serve a New Territories East population of nearly 700,000.

Over subsequent decades, the hospital expanded continuously, becoming the hub of the New Territories East medical system. According to the Hospital Authority's "History" page for PWH^※:

• November 1994: The Sir Yue-Kong Pao Centre for Cancer was opened.
• October 2010: The Main Clinical Block and Trauma Centre came into service, providing intensive care, operating theatres, and day services, with a gross floor area of approximately 71,500 m² spread over 14 storeys.
• According to hospital data, it serves the geographically largest of the Hospital Authority's seven hospital clusters—the New Territories East Cluster—covering residents of Sha Tin, Tai Po, North District, Sai Kung, and the eastern outlying islands.

According to English Wikipedia^※, PWH today provides approximately 1,807 beds and 24-hour accident and emergency services, with a staff of around 5,500. It is the regional acute hospital for the New Territories East Cluster. Neurosurgery is another area of regional strength: according to an academic article reviewing the development of neurosurgery at PWH^※, its neurosurgery department achieved autonomous unit status, equipped with 40 acute beds and its own dedicated intensive care unit, forming a significant surgical specialty unit in the New Territories East.

It is, first and foremost, CUHK's teaching hospital: According to the CUHK Faculty of Medicine's official page^※, as the Faculty's largest teaching hospital, PWH has helped CUHK train over 5,000 healthcare professionals over the decades and underpins a vast body of medical research. In other words, it is not just a place for treating illness—it is the "heart" of CUHK's medical education and clinical research. Under the teaching-hospital model, the clinical floor is simultaneously the medical school's classroom and laboratory. It was this very setup that placed it at the epicentre of the 2003 public health crisis.

# 2. 4 March 2003: A Pneumonia Patient in Ward 8A

During the 2003 Severe Acute Respiratory Syndrome (SARS) epidemic, the Prince of Wales Hospital was the site of one of the earliest nosocomial (in-hospital) outbreaks in Hong Kong. Its outbreak can be traced precisely to a single patient, a single ward, and a single clinical decision. The following facts are based strictly on accounts published in open sources, including a paper by the PWH team in The Lancet (PMC full text)^※, a New England Journal of Medicine (NEJM) paper on this outbreak^※, an article in the US CDC's Emerging Infectious Diseases (EID) journal on the 'index patient'^※, and Chapter 6 of the Hong Kong Legislative Council Select Committee's report^※.

According to these academic sources, a 26-year-old man was admitted to Ward 8A of the Prince of Wales Hospital on 4 March 2003 with community-acquired pneumonia. He had experienced fever, chills, and rigors since 24 February and initially responded poorly to antibiotics. According to the EID article, he had previously visited a hotel in Kowloon where a 64-year-old doctor from Zhongshan in southern China had also stayed—a chain of contact later considered the source of the virus's entry into PWH. (This hotel is the Metropole Hotel in the historical record.)

This patient was subsequently identified as the index patient for the PWH outbreak. According to the LegCo report, upon admission to Ward 8A, no infection-control measures, including droplet precautions, were triggered, nor were case investigation or contact tracing initiated. At the time, no one knew this was a novel, highly contagious respiratory illness.

One clinical detail changed the scale of transmission: According to the academic sources cited above, this index patient received nebulised bronchodilator therapy—specifically salbutamol (albuterol) 0.5 mg, delivered via a jet nebuliser driven by oxygen at 6 litres per minute, four times daily for approximately seven days, discontinued on day 8. Multiple studies suggest that the nebulisation procedure may have enhanced the dispersal of the virus in the ward air. Following this incident, the use of nebulised inhalation for suspected SARS patients was immediately halted. This change remains one of the hard-learned infection-control lessons from this experience.

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

The speed of viral transmission within Ward 8A and beyond was, at the time, unprecedented. According to the academic and official sources cited above, the critical timeline is as follows (all figures per the original sources):

According to these studies, those affected in Ward 8A included not just healthcare workers, but also medical students on clinical placement and visitors to the ward. This exposed the vulnerability of a teaching hospital in an epidemic: the ward contained patients, staff, students, and family members simultaneously—a dense and mobile population. Infected staff and students were subsequently isolated and treated; some healthcare workers themselves became severely ill patients.

This chain of nosocomial transmission made the Prince of Wales Hospital one of the earliest and most important field sites for studying the patterns of in-hospital SARS transmission and the effectiveness of control measures. It answered the questions the world was urgently asking at the time: how does this new disease spread in a hospital, and how fast?

A note on the principles of this archive: SARS was a major public health event causing loss of life. This text records only objective clinical and epidemiological facts—admission timelines, infection numbers, infection-control research—based on academic and official sources. It does not dramatise, sensationalise, or disclose any personal private information, nor does it name individual frontline staff. The risks borne and efforts made by frontline healthcare workers during the epidemic are acknowledged with restrained respect.

# 4. From the Ward to the Paper: The CUHK Team's Academic Contribution

During this epidemic, the Prince of Wales Hospital and the CUHK Faculty of Medicine were not merely on the receiving end of the outbreak—they rapidly transformed the clinical frontline into scientific knowledge made available for the world to use. This is a positive manifestation of CUHK Medicine's "teaching, research, and clinical care as one" model during a crisis.

First, the international publication of clinical experience. The aforementioned papers in top-tier journals like The Lancet, NEJM, and EID relied heavily on primary data from PWH. They provided the international medical community with the earliest first-hand clinical records of SARS nosocomial transmission: admission timelines, the infection curve among healthcare workers, the transmission effects of nebulised therapy, and the successes and failures of protective measures. In the early days of an entirely new disease, such reliable field data from an outbreak site were irreplaceable.

Second, contributions at the viral genomic level. According to a paper reviewing molecular epidemiology data on the SARS coronavirus from CUHK (PMC)^※, CUHK's microbiology team was the third research group globally to publish a complete genome sequence of the SARS coronavirus (naming its isolate CUHK-W1). The team subsequently sequenced multiple complete and partial genomes (such as CUHK-AG01 and others) to investigate whether different viral strains were circulating during the outbreak. In short, CUHK not only documented "how the disease spread" but also helped answer the question "what is this virus?" The broader narrative of this research is covered in 01-academics/deepdive-medicine.md and 04-research/state-key-laboratories.md.

# 5. The Long-Term Significance of the Clinical History

The Prince of Wales Hospital's experience with SARS had a lasting impact on both the CUHK Faculty of Medicine and Hong Kong's public health system:

• Institutionalised infection control: The painful lesson of nosocomial transmission in Ward 8A directly drove a comprehensive strengthening of infection-control protocols, isolation facilities, negative-pressure rooms, personal protective equipment use, and nebulisation procedures across Hong Kong's hospital system.
• The sedimentation of academic contributions: By translating their clinical and laboratory experience into top-tier journal publications, the CUHK team entered Hong Kong's SARS response into the global medical knowledge base, providing a reference point for future novel respiratory infectious disease outbreaks.
• The dual role of the teaching hospital: During the crisis, PWH simultaneously bore the weight of "treating patients" and "producing knowledge." This is an extreme embodiment of the value and cost of the teaching-hospital model: densely staffed and thus vulnerable, yet also capable of rapidly turning the clinic into a site of scholarship precisely because of the integration of teaching, research, and care.

The story of the Prince of Wales Hospital, therefore, is not just the construction history of a hospital. It is a severe test of CUHK's model of integrated teaching, research, and clinical medicine during a real public health crisis. From the fully air-conditioned new hospital in the New Territories East in 1984, to the outbreak ground of Ward 8A in 2003, and then to first-hand papers in the world's best medical journals—this thread traces the heaviest and most critical mission of a teaching hospital.

Related reading: Faculty of Medicine: Structure & Clinical Departments, Founding of the Faculty & Founding Dean, CUHK Medicine In-Depth Profile (Five Schools & Clinical Departments), School of Chinese Medicine, State Key Laboratories.