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Virtual Technologies of Care in a Time of Viral Crisis: An Ethnographic View from Hong Kong

As the coronavirus crisis enforces social distancing in Hong Kong, virtual technologies of care are supplanting tactile expressions of care between teachers and students, among family members, and across neighborhoods. In this essay, we draw on our experiences as U.S.-trained academics currently working in Hong Kong. Joseph is an A&E (accident and emergency) doctor and Priscilla is a medical anthropologist; we have both conducted research in the Sinophone world for the past two decades. Our postgraduate studies were interrupted nearly twenty years ago by the SARS epidemic, when travel restrictions limited our access to research sites in mainland China. The COVID-19 outbreak is now upending our professional and personal lives in novel ways.

The coronavirus crisis hit the city of Hong Kong in late January on the eve of the lunar new year, ordinarily a festive time when far-flung family members travel home to feast together and exchange red laisee packets. Joseph was called into the hospital to help cover a staffing shortage in the A&E on the day the city of Wuhan was locked down. One of his colleagues was suddenly quarantined at a co-opted “holiday camp” after a patient he had treated a few days earlier tested positive for the new coronavirus (Cheung 2020). Priscilla started noticing disapproving glares when she went out without a mask, but discovered that masks were no longer available for purchase – even on Amazon.com or at her parents’ local Walmart in the midwestern U.S.

For others in Hong Kong, the coronavirus crisis prevented families from enjoying meals together (particularly after an infamous hotpot family banquet resulted in over a dozen people becoming infected [Siu 2020 and Leung 2020]), stopped mundane social niceties such as opening doors for others, and eliminated business handshakes and socialite air kisses. As the viral panic extended into February, friends and lovers flooded social media circles with memes featuring “mask bouquets” and toilet paper gift baskets to celebrate Valentine’s Day. Now into March, with public health experts predicting that the virus will not peak until April or May (Cyranoski 2020), people in Hong Kong are settling into an uneasy grind of daily life under quasi-quarantine, oscillating between tentative hope and unmitigated panic.

Valentine’s Day “mask bouquet.” Source: https://hk.appledaily.com/local/20200214/I2MOUAJ2WPL3VBARLIYFYADEFA/

Valentine’s Day toilet paper gift basket. Source: WhatsApp

The proliferation of information circulating online about the coronavirus outbreak has goaded the World Health Organization to warn against a “dangerous social media ‘infodemic’ fueled by false information” (UN News 2020). However, in this essay, we go beyond critiquing the “diffusion of misinformation” (Allcott, Gentzkow, and Yu 2019) to examine how social media apps, online videoconferencing, and real-time surveillance trackers are functioning as “technologies of care” in a time of viral crisis. These virtual technologies of care have become especially important now that people are afraid to meet face to face and mistrust of expert knowledge from traditional sources remains high after the widespread anti-ELAB (extradition law amendment bill) protests that began in the summer of 2019.

Since the SARS epidemic in 2003, social media and digital communication companies (including Facebook, WhatsApp, Viber, Instagram, WeChat, LINE, and Telegram, among others) have exploded on the scene and embedded themselves into everyday lives in Hong Kong. Take, for example, the cloud-based, highly encrypted instant messaging service Telegram. For many in Hong Kong, this app has become one of the most frequently consulted sources for up-to-the-minute news. During the recent protests, Telegram emerged as a key platform for exchanging information about riot police movements, protest schedule updates, and mobilization efforts. Concerns about the coronavirus outbreak have transformed such technologies of protest into technologies of care. Although preserving an anti-government bent, the Telegram app nevertheless has become the go-to platform in the city for quickly communicating the latest updates about the spread of the virus, organizing strikes among medical professionals to demand safer working conditions, and promulgating other efforts to push back against unpopular government policies perceived as exacerbating the current crisis (including controversies over border control management between Hong Kong and mainland China, inconsistent quarantine regulations, and problems in the government’s procurement of protective equipment). Telegram groups have also organized mask distribution lotteries to raise funds.

Telegram image of Hospital Authority Employees Alliance strike plan posted on Telegram on February 3, 2020. Source: t.me/ha_employalliance

Writing about the biosocial production and management of panics, medical historian Robert Peckham has documented the infective properties of panic during epidemics in colonial Asia (Peckham 2015) and more recently in the current COVID-19 outbreak (Peckham 2020). As the brilliant parody by Hong Kong performer Kathy Mak highlights, basic staples are increasingly in short supply:

“I can’t find bok choy no more

There’s just white people things

Like pasta, cheese and corn

Where the hell’s the rice?

Why’s it three times the price?” (Mak 2020)

As the city’s residents scramble to get their hands on household essentials, Telegram and other social media apps such as WeChat (used primarily by mainland Chinese citizens living in Hong Kong), Viber (popular among foreign domestic helpers working in Hong Kong), and WhatsApp (the most widespread platform used by locals and expats alike) have become virtual lifelines for up-to-the-minute updates about conditions outside one’s apartment/quarantine cell. Through the waves of panic-buying and hoarding, social media apps have been the go-to place to find out if your neighborhood supermarket has toilet paper, how long the queue is for disinfectants at the corner pharmacy, or advice on where to procure masks.

 

WhatsApp group discussion on toilet paper availability. Source: WhatsApp HKU faculty group (permission to share screenshot granted by participants)

As parents of young children enrolled in primary school in Hong Kong, we have also been dismayed by the rolling extension of school suspensions (April 20, at latest count (HKSAR Education Bureau 2020)). This has been no vacation for beleaguered students and their parents. In a recent online class session for third graders, two-thirds of students reported they had not left their apartments in over a week. Schools, libraries, museums, public pools, sports facilities, and Disneyland are all shuttered – so there are few options beyond screen time even if parents weren’t panicked about disease transmission.

Schools in Hong Kong – from kindergartens through universities – have engaged online technologies to “care” for their students and staff in unprecedented ways. During the 2003 SARS epidemic, schools simply shut down for several weeks. But in 2020, schools have continued to operate despite the official suspension of on-campus teaching by using online communication technologies to maintain their educational mission and short-circuit awkward questions about tuition refunds.

Although many Hong Kong teachers and school administrators are experimenting with creative workarounds to simulate classroom learning, this flourishing of innovation can be overwhelming for everyone involved. Just locating each day’s lesson materials and downloading the various worksheets can take over an hour before any learning even begins for the child. Parents may need to access up to a dozen different online platforms just to supervise a primary school literacy lesson: the teacher’s classroom blog for a “morning check-in” video greeting, followed by a Google doc listing the day’s assignments, then a YouTube video lesson, then one of the animated online libraries to check out some examples – interrupted by a visit to the school’s password-protected website listing passwords and access codes to various online resources, followed by a word processing program on the computer to print out the worksheet, then a camera app to take a photo of the completed work, then the Seesaw app to upload the evidence online, ending with an online meeting scheduler such as doodle.com or appoint.ly to set up a call with the teacher for feedback. All the while, the computer(s) theoretically being used by the parent “working from home” have become the technologies of pastoral (child)care.

Author’s daughter participating in a third-grade social studies class via Zoom.

As university educators, we are also using technology to care for our former classroom students. The ability to hold virtual classes has advanced dramatically since the SARS epidemic. Universities across the city now subscribe to videoconferencing platforms such as Zoom for online lecture delivery, tutorial discussions, and “office hour” consultations. While MOOCs have challenged the value of in-person teaching, the outbreak has given new impetus to push everything possible online to maintain the façade that school is still in session.

Online teaching undeniably has its benefits. Time spent commuting, transporting materials, or even getting dressed can now be done away with as classes take place online from the comfort of your home. Staff subjected to mandatory quarantine and students stranded by travel restrictions can continue teaching and learning activities “like normal.” On the negative side, these technologies of care simultaneously operate as technologies of control and surveillance. A current controversy at both of our universities is whether our students should be required to turn on their video cameras or microphones. If they are off, is the student still present for class? As the nine-tiled screens of Zoom shift into view, some cells remain dark. Professors previously worried about distracted students in class surfing the internet; now the question becomes: are they even present? Zoom has targeted these concerns with a “cool feature alert” (Caballero 2018) enabling educators to track the “attentiveness score” of participants, as calculated by the amount of time that Zoom is the primary app in focus on a student’s computer. Perhaps Jeremy Bentham and Michel Foucault would find it no coincidence that the most popular lecture capturing software is named Panopto.

Zoom attentiveness score.
Source: https://blog.zoom.us/wordpress/2018/01/26/zoom-tips-for-educators-attendee-attention-tracking/

The limits of online teaching have been felt most acutely in medicine. Last November when political protests shut down Hong Kong’s university campuses, the city’s hospitals and medical schools remained open for business with clinical education activities continuing despite the abrupt suspension of the academic term. This semester has seen a reversal. Medical education is at a standstill as universities, afraid of potential infection, disallow medical students from ward rounds or other “non-essential” clinical activities. Unfortunately, the crux of medical education remains the intimate seminar and patient-based bedside round. What virtual technologies of care will supplant the visceral art of medicine? Our current graduating medical students have had their educational journeys interrupted during their lifetimes by a succession of biopolitical disruptions, ranging from the SARS shutdown in kindergarten to the umbrella movement in high school to the current anti-ELAB protests and COVID-19 outbreak. What future awaits this next generation of physicians?

Acknowledgments:

Many thanks to Joseph Bosco, Julia Bowes, Kevin Hung, Colin Graham, Loretta Kim, Christos Lynteris, Laura Meek, Robert Peckham, Carolyn Sargent, Ria Sinha, Corinna Treitel, and Jessica Valdez for sharing their experiences with viral panic, insights on the history of protests, and offering feedback on these ideas.

Works Cited

Allcott, Hunt, Matthew Gentzkow, and Chuan Yu. 2019. “Trends in the diffusion of misinformation on social media.” Research & Politics. https://doi.org/10.1177/2053168019848554

Caballero, M. (2020) “Zoom Tips for Educators: Attendee Attention Tracking”, Zoom Video Communications, 2020. (January 26, 2018). Accessed February 22, 2020. https://blog.zoom.us/wordpress/2018/01/26/zoom-tips-for-educators-attendee-attention-tracking/

Cheung, Elizabeth. “Coronavirus quarantine came as a shock to Hong Kong emergency doctor.” South China Morning Post (February 16, 2020). Accessed February 27, 2020. https://www.scmp.com/news/hong-kong/health-environment/article/3050834/coronavirus-quarantine-came-shock-hong-kong

Cyranoski, David. “When will the coronavirus outbreak peak?” Nature (February 18, 2020). Accessed February 28, 2020. https://www.nature.com/articles/d41586-020-00361-5

HKSAR Education Bureau. “SED [Secretary of Education] opening remarks at press conference.” The Government of the Hong Kong Special Administrative Region, February 25, 2020 press release. Accessed February 28, 2020. https://www.info.gov.hk/gia/general/202002/25/P2020022500760.htm

Leung, Kanis. “Coronavirus: Restaurant group temporarily closes hotpot chains as Hongkongers grow wary of communal dining experience.” South China Morning Post (February 14, 2020). Accessed February 26, 2020. https://www.scmp.com/news/hong-kong/hong-kong-economy/article/3050551/coronavirus-restaurant-group-temporarily-closes

Mak, Kathy. “Torn – Natalie Imbruglia (#Coronavirus Parody).” YouTube. Accessed February 10, 2020. https://www.youtube.com/watch?v=i_QXvh8fVPI

Peckham, Robert, ed. 2015. Empires of Panic: Epidemics and Colonial Anxieties. University of Hong Kong Press.

Peckham, Robert. “The covid-19 outbreak has shown we need strategies to manage panic during epidemics.” (February 23, 2020). Accessed February 26, 2020. The BMJ. https://blogs.bmj.com/bmj/2020/02/21/robert-peckham-covid-19-outbreak-need-strategies-manage-panic-epidemics/

Siu, Phila and Alvin Lum. “Coronavirus: nine members of same family confirmed with disease in Hong Kong after sharing hotpot and barbecue meal.” South China Morning Post (February 9, 2020). Accessed February 21, 2020. https://www.scmp.com/news/hong-kong/health-environment/article/3049749/coronavirus-nine-members-same-family-test

UN News. “‘This is a time for facts, not fear,’ says WHO chief as COVID-19 virus spreads.” (February 15, 2020). Accessed February 27, 2020. https://news.un.org/en/story/2020/02/1057481


Priscilla Song, PhD is Assistant Professor in the Centre for the Humanities and Medicine at the University of Hong Kong. She is the author of Biomedical Odysseys: Fetal Cell Experiments from Cyberspace to China (Princeton 2017), which received the 2018 Francis L.K. Hsu Book Prize from the Society for East Asian Anthropology

Joseph Walline, MD is Assistant Professor in the Accident and Emergency Medicine Academic Unit at the Chinese University of Hong Kong. He is a former U.S. Fulbright Scholar with fifteen years of research and clinical experience in the USA, mainland China and Hong Kong. He has published over thirty peer-reviewed research articles on resuscitation, bedside ultrasound training, and the development of emergency medicine in China among other topics.


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