Stress, anxiety, trauma: how Hong Kong Covid-19 travel curbs affect the mental health of expat families, for whom there are few upsides to isolation

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An ambulance pulls up outside one of the austere blocks at Penny’s Bay, Hong Kong’s quarantine camp, where arrivals to the city and close contacts of Covid-19 cases are confined and monitored.

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Long-time Hong Kong resident Brooke Babington, still jet-lagged from a flight from the United States, peeks out of the window of the small room she is sharing with her daughter, Bayley. The 11-year-old is huddled on the bed and when she sees the ambulance’s flashing lights she begins sobbing, terrified of being taken to hospital or separated from her mother.

Several weeks on – after 17 days in a quarantine hotel – the pair are now sleeping in their own beds at home in Hong Kong, but Babington says her daughter is traumatised by the experience at Penny’s Bay.

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“When the ambulance pulled up in front of our door, we thought they were coming for us. They don’t tell you when they are coming to get you. I liken it to when you hear about people in prison cells not knowing if they are coming to torture you next,” says Babington.

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People arrive to start their quarantine at the Penny’s Bay Quarantine Centre in Hong Kong. Photo: Martin Chan

Babington’s quarantine experience and her concerns about how extended home schooling is affecting her daughter – “she can’t be with her friends, she’s on a computer all day” – are typical of many expats’, says Dr Judith Blaine, a research associate with Rhodes University in South Africa whose study, the first to address the psychological impact of the pandemic on expats in Hong Kong, was published in Psychology and Behavioural Sciences last month.

“One of the things that came up a lot was concern for youth – development of social and developmental skills, missing out on face-to-face teaching, high levels of anxiety in children. They are worried about being taken to Penny Bay’s or put in hospital,” says Blaine, a long-time Hong Kong resident. “People aren’t scared of the virus, they are scared of being put in Penny’s Bay and separated from their kids.”

The study focuses on expatriates as a unique population because, for the most part, they have come to work in Hong Kong on the premise that they will have home leave and ease of movement – factors which Hong Kong’s stringent travel regulations have taken away.

“With expats, their home country is not Hong Kong, so they don’t have the support network of extended family here. They are missing milestones, 80th birthdays, the birth of children, nieces and nephews. There is a disruption of the extended family that causes a lot of stress and distress,” says Blaine.

Her research, based on in-depth, semi-structured interviews, was conducted in March 2021. Almost a year later, and the situation in Hong Kong has only worsened, she says.

People aren’t scared of the virus, they are scared of being put in Penny’s Bay and separated from their kids

Dr Judith Blaine, a research associate, Rhodes University in South Africa

“Last year, we still had flights. Now flights from America, the UK, India, most of Africa, all these countries are banned, and people are feeling trapped,” says Blaine. At the time of writing bans on flights from the UK, France, India, Pakistan, the United States, Canada, Australia and the Philippines were in force.

To get an overall understanding of the psychosocial consequences of the coronavirus pandemic, word clouds were generated from the survey responses, with the most frequently used words depicted as bolder and bigger. The word clouds suggested two overarching themes – black clouds and silver linings.

Perhaps the darkest of the black clouds relates to concerns around separation from family. One of the study participants, a young mother, told Blaine: “Not being able to travel or have family come here means I haven’t seen my family since my younger brother passed away last April. I had my first baby in July and none of my family can meet her. I had no family support becoming a new mum.”

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Isolation units at the Penny’s Bay Quarantine Centre on Lantau Island. Photo: Dickson Lee

A man who has since left Hong Kong said: “My biggest concern is, when am I going to be able to come home? When will I be able to hold my children? When am I going to be able to hug my wife? When am I going to be able to have any sort of sense of connection with family?”

Participants said the cumulative effect of the stress and uncertainty had badly damaged their mental health and that of their children. Many talked about anxiety and a sense of hopelessness, of the pain of missing key milestones – graduations, weddings and funerals – and expressed frustration at the seeming randomness of some of the rules and regulations.

“The restrictions would be easier to stomach if they made sense and the science and reasoning behind what is open and closed, allowed and not allowed, were transparent,” one woman said.

21 days in a quarantine hotel, Facebook, Twitter, Instagram, here

Study author Judith Blaine, at her home in Stanley, Hong Kong. Photo: Jonathan Wong

For some, financial concerns were an additional stressor, with salary cuts and the constant threat of redundancy.

“People spoke about the expense of [returning to Hong Kong] via a third low-risk country for 21 or 22 days and then paying for 21 days in a quarantine hotel. Many people can’t work from quarantine; it’s a huge financial implication,” says Blaine, who paid more for her three-week hotel quarantine in November than a year of her daughter’s boarding school fees cost.

The response from participants was overwhelming when it came to black clouds, but there were some silver linings. Blaine believes it’s important to focus on those “or we’d collapse in a heap”.

Finding new ways to connect and slowing down and gaining time were the brightest of the silver linings. For expats whose job involved extensive travel, the restrictions meant more time at home with their children.

One woman shared how the restrictions meant her husband had connected more closely with their children and another enjoyed the less frantic pace of life.

“I look back on how I used to rush from event to event and it was crazy. I’ve saved so many hours from not needing to plan holidays. I’ve spent more time with my family and on my hobbies due to less commuting and fewer events,” she said.

Some participants expressed an appreciation for what they had and gratitude for the simple things in life, such as good friends and an appreciation of the beauty of Hong Kong and its fantastic hiking trails. Some exercised more and other others learned a new skill or picked up a new hobby.

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Some respondents said they had gained an appreciation of Hong Kong’s hiking trails. Photo: Yvonne Teh

“Spiritually I feel like we are coming together more as humans in the bigger picture and practically I just feel like there are more important things in life than work and Covid has given me perspective,” one participant said.

Blaine differentiates between resilience – “bouncing back” and post-traumatic growth – “bouncing forward”, where people take stock and think deeply about how to improve aspects of their life.

“It gave a lot of people time to contemplate what they want in their future, reassess their priorities. For many, this means reassessing where they are in terms of being in Hong Kong and whether they want to leave as a priority to be with family. What we are finding is that a lot of people are doing just that,” says Blaine.

21 days in a quarantine hotel, Facebook, Twitter, Instagram, here

Arrivals at Hong Kong International Airport face a long quarantine. Photo: Felix Wong

She expects that the post-traumatic growth that will come in the wake of this pandemic will see people reassess whether the previous model of expat life and travel – “getting on a plane as if it were a bus” – is viable.

“We know that’s not sustainable. In the 1970s, when flights weren’t as frequent, people went home once a year for a month or two. The lifestyle that we had isn’t [sustainable],” says Blaine.

Babington is in Hong Kong for the time being and recovering from her traumatic quarantine experience. “When I was at Penny’s Bay, I talked to the US Embassy and they basically can’t help you, you’re on your own. You don’t have any help. All my family is overseas, so I’m all alone here,” she says.

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