Professor Samuel Yeung-shan Wong says he loves Canada, and wants it to learn from Hong Kong’s successes in the battle with Covid-19.

Wong, director of the Chinese University of Hong Kong’s school of public health, earned his medical degree at the University of Toronto in the 1990s and did his residency in Halifax, Nova Scotia.

When he chats with his Canadian cousins they tell him that “they aren’t going out”, he said. Hong Kong, meanwhile, has avoided a Canadian-style lockdown, and on Friday plans to reopen bars and other businesses.

Wong and CUHK colleagues were authors of a recent paper published in the Canadian Medical Association Journal that suggests how the rest of the world can find guidance from Hong Kong, which has suffered just four deaths from Covid-19 and 1,040 confirmed cases.

Hong Kong has had 17 straight days without a local infection, encouraging this week’s reopening.

“I thought Hong Kong would be OK, but I didn’t know it would be one of the best in the world,” said Wong.

By comparison, Canada has recorded 63,895 infections, as of Thursday, and 4,280 deaths. Its Covid-19 death rate, on a population basis, is thus about 200 times higher than Hong Kong’s.

Wong’s paper, not yet peer reviewed but published on April 24 as an early release by the CMAJ, highlights practices including border controls and social distancing – that have also been employed in Canada to varying degrees – as keys to Hong Kong’s successes. But it also says Hong Kong’s “aggressive contact tracing and quarantine centres, likely contributed substantially to the control”.

And then there are masks.

“The practice of personal protective behaviours, including use of face masks, by most people in Hong Kong may also have played an important role in controlling the spread of SARS-CoV-2 in the region,” says the paper.

It provides a caveat that there is a lack of “good evidence for the effects of using face masks in public to reduce the risk of respiratory illnesses”, noting that “it is difficult to conduct randomised controlled trials on this topic”.

In an interview, though, Wong is less reticent – he has little doubt that masks have worked in Hong Kong to curtail Covid-19, although the lack of historical benchmarks for a new disease makes solid proof elusive. But the recent collapse of Hong Kong’s influenza rate, compared to previous years, provides evidence, Wong said.

“The fact that Hong Kong has done so well [with Covid-19], and 98 per cent of people are wearing masks, there’s some relationship to that,” said Wong, recommending that Canadian authorities support the use of masks.

In contrast to Hong Kong’s official guidance to wear masks in crowded places – and planned distribution of free cloth masks to the public – Canada’s health authorities have made no such recommendation, instead saying they are only “permissive” of the general public wearing non-medical masks.

Wong said he doubted the oft-raised concern in Canada that mask-wearing might encourage a lax approach to other infection controls, such as handwashing. “I don’t see the evidence. People wash their hands in a similar way, if not higher, if they are wearing masks,” he said. “It’s additional. Just raise awareness about being careful … it can be taught, easily.”

Although Hong Kong’s approach could be instructive to many nations, Wong said he wanted the paper published in a Canadian journal because “Canada needs to make important decisions regarding the approach for managing COVID-19 … such [as] whether to recommend mask wearing, etc”.

Although Canada’s pandemic outcomes are generally viewed favourably in the West compared to places including US and Europe, the view is different from Hong Kong, particularly for people with Canadian connections like Wong. There are about 300,000 Canadians living in Hong Kong.

“Canada is much more severely affected than Hong Kong,” said Wong, a difference particularly striking given Hong Kong’s land border with mainland China and relative proximity to Wuhan, the city that was the original epicentre of the pandemic.

Are lockdowns sustainable?

Canada has embarked on a protracted quasi-lockdown to enforce social distancing. Hong Kong has also embraced distancing – it halted school classes in January – but by nearly every measure, Hongkongers have remained far more active outside their homes than Canadians.

On Friday, Hong Kong is allowing restaurants to increase dining groups from four to eight. Bars, gyms, beauty parlours and cinemas are also reopening, with various restrictions – for instance, cinemas must limit audiences to 50 per theatre.

Mobility reports by Google show that visits to retail and recreation destinations including restaurants and shopping centres are down 20 per cent in Hong Kong compared to normal, but in Canada they are down 47 per cent. Hong Kong’s transit usage is down 33 per cent, while Canada’s is down 65 per cent.

Wong also said Canada needed to ramp up Covid-19 testing, pointing to Hong Kong’s policy of testing every person arriving at the city’s airport as something Canada should consider. He also noted Hong Kong’s stricter approach to quarantining travellers, who must wear electronic tracking wristbands to ensure they stay at home or in quarantine centres for 14 days.

There are important contextual differences between Canada and Hong Kong, Wong noted – particularly the high population density in the latter.

Nevertheless, he said he worried about the sustainability of Canada’s lockdown policies, as the public wearies of restrictions.

Governments across the country are planning how to ease their lockdowns, even as the provinces of Ontario and Quebec record hundreds of new infections each day. British Columbia has been a stand-out performer in Canada, reducing new confirmed cases to single digits on Tuesday, for the first time since its lockdown began more than seven weeks ago.

“That’s the thing. That’s always the balance. You do lockdown, or you do more testing, with some masks … there are different degrees of control measure. You can pick and choose, but you need data and evidence,” said Wong.

Wong said Canadians tended to have higher trust than Hongkongers in government officials, making it particularly important for Canadian authorities to get their guidance right.

Public health authorities have been widely celebrated in Canada – BC’s public health officer Dr Bonnie Henry is the province’s most trusted official with a 79 per cent approval rating, according to Insights West polling. Political leaders have also enjoyed popularity boosts.

Hongkongers, on the other hand, have been dismissive of official guidance: CUHK polling cited by Wong found only 16 per cent of Hongkongers thought Covid-19 information on official government websites was reliable.

Instead, many Hongkongers believed government measures did not go far enough; for instance, nurses went on strike in early February to demand the closure of the border with mainland China.

“They don’t feel like the government can protect them. So they do personal measures to protect themselves … some of the credit [for Hong Kong’s covid-19 outcomes] must go to the people of Hong Kong themselves,” said Wong.

Could Canadians be expected to be similarly proactive?

Wong, who said he visits Toronto every couple years, said most Canadians are “quite well behaved, quite sensible” and tended to follow government directives.

“Hong Kong people, though, are not particularly obedient,” said Wong with a laugh.