HKUMed researchers found a reduction in hospitalisations and a concurrent increase in deaths during the COVID-19 pandemic in 2020 in Hong Kong: implications for healthcare planning during public health emergencies


HKUMed researchers at the WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine at The University of Hong Kong (HKUMed) found a significant reduction in public hospital admissions and an increase in mortality, particularly from cardiovascular diseases, during the first year of the COVID-19 pandemic in Hong Kong in 2020. The findings, which may reflect avoidable deaths caused by changes in healthcare seeking during the early pandemic, are now published in The Lancet Regional Health - Western Pacific. [link to the publication]

In addition to the respiratory morbidity and mortality caused by SARS-CoV-2 infection, there exists a broad range of direct (e.g. SARS-CoV-2 infection of the heart or brain) and indirect (e.g. increase in cancer mortality due to reduced cancer screening or delayed treatment) public health impacts of the COVID-19 pandemic and related policy responses. To describe these impacts across many medical outcomes, the research team used comprehensive long-term hospitalisation and mortality data collected from the Hospital Authority and the Census and Statistics Department of the Government of the Hong Kong Special Administration Region (HKSAR), to quantify the health impacts of the COVID-19 pandemic. 

They found an absolute reduction of 359,790 hospitalisations in public hospitals largely from respiratory and cardiovascular diseases, and 1,873 additional deaths particularly from cardiovascular diseases in 2020, above what would have been expected in the absence of the pandemic. Children under 5 years of age and older adults aged over 65 years were most affected. Reductions in the number of deaths occurring inside public hospitals were accompanied by increases in deaths occurring outside of public hospitals, which may suggest a reluctance to seek care even when gravely ill.

The results of this study suggested important, indirect impacts of the COVID-19 pandemic on public health in Hong Kong, likely resulting from worry about SARS-CoV-2 exposure in hospitals or other barriers reducing timely access to medical services. These impacts may outweigh even the direct consequences of SARS-CoV-2 infection in some jurisdictions and high-risk population groups. With the possible emergence of more virulent or transmissible strains of SARS-CoV-2 or other epidemics, medical institutions and policymakers should prepare adequate resources, including risk communication, to ensure maintained access to healthcare for non-infected patients during public health emergencies.

About the research team

The researchers from the School of Public Health, HKUMed are: Mr Hualei Xin, PhD candidate; Dr Peng Wu, Assistant Professor; Dr Jessica Wong Yuen-ting, Research Officer; Mr Justin Cheung Kai-him, Research Assistant; Dr Eric Lau Ho-yin, Scientific Officer; Dr Joshua Nealon, Research Assistant Professor; Professor Gabriel Leung, Honorary Clinical Professor; Professor Benjamin Cowling, Chair Professor of Epidemiology, Head of Division of Epidemiology and Biostatistics, and Co-Director of the WHO Collaborating Centre for Infectious Disease Epidemiology and Control.

This project was supported by the Health and Medical Research Fund (grant no. CID-HKU2), the Collaborative Research Scheme (project no. C7123-20G) of the Research Grants Council, and AIR@InnoHK administered by Innovation and Technology Commission of the Hong Kong SAR Government.

About the WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, HKUMed 
The School of Public Health, LKS Faculty of Medicine of The University of Hong Kong (HKUSPH) has a long and distinguished history in public health education and high impact research. With world leading research in infectious diseases as well as on non-communicable diseases of both local and global importance, the School has made significant contributions through its research and advocacy to improve the health of populations and individuals, both locally and globally. The School is a leading research and teaching hub in public health on influenza and other emerging viruses, control of non-communicable and infectious diseases, tobacco control, air pollution, psycho-oncology, behavioural sciences, exercise science, life-course epidemiology, population mental health, and health economics, health services planning and management. Work done by HKUSPH researchers has informed international (e.g. the US Food and Drug Administration, Health Canada, the World Health Organization), national and local public health policies.

The School of Public Health hosts the WHO Collaborating Centre (WHO CC) for Infectious Disease Epidemiology and Control. With a view to protecting the public's health in Hong Kong and across the region, the WHO CC aims to coordinating research on the control and prevention of infectious diseases and providing local and regional education and training in infectious disease epidemiology and control. Members of the WHO CC are involved in the response to COVID-19 and conducted a range of scientific research projects. The team has created a website to share the latest scientific findings and the implications for evidence-based public health policies on the ongoing COVID-19 outbreak [link to website:].