By Reginald Tsang, M.D.
Guest columnist

A city full of masks. An office full of masks. A city under siege. A city now a pariah in the world. A city whose caricature is now "the mask".

It did not have to be so. As the SARS virus began to hit Hong Kong from China, mass panic began. Step by step. "Fear"-"hear"-"peer"-"fear" is the classic vicious cycle that builds into a ferocious hurricane, that in this instance has forced the proud, sophisticated Hong Kong to its knees.

Fear of the unknown, fed by new mass communications system, makes one "hear" the worst in any form of communication. And communications are king in this technologically avant-garde Asian metropolis. The world's highest rate of cell-phone usage, every few hours brings messages of alarm ("Apartment block xyz now infected," "number of new cases today xxx"); e-mails that come from self-styled experts, or a casual acquaintance, are turned into another "fact"; a radio comment from anyone, a media interview with a resident from the infamous "E block" (where SARS infection was rampant) or a casual comment by any health professional; all became fodder for this growing mass of data that grows increasingly mysterious, sinister and life threatening directly to the "hearer."

And then "peer" pressure starts. Imagine yourself unmasked in a room full of masks. It takes a lot of courage to be there with 30 eyes focused on you, above that indecipherable masked face. "Inscrutable" is hardly the word to use; "menacing" might be more appropriate. Even though the CDC has never recommended general mask use, and stated clearly that they are of no value except in select cases for the short-term, the "pressure is on," fueled by image upon image. Images of thousands of masked individuals in the streets, in the airport (now a ghost town), in the shops (now deserted also) create an eerily spooky version of Hong Kong to the world. A land of the spooked, the nervous, and the fearful. And who in their right mind would want to go there? So fear reigns, and starts the next vicious cycle again.

As I traveled through a minimal SARS scare area like Malaysia (no masks) to Hong Kong (fully masked) and to SARS-free Macau (take off masks immediately), the lesson that comes to me is that mass "masked" hysteria is a 21st-century phenomenon that could very well be here to stay. Unless we learn from history and don't allow it to happen again.

People have to base their fear (or more appropriately, "realistic concern") on scientific knowledge and recommendations of reputable solid organizations, such as the Centers for Disease Control and Prevention, and resist the urge to believe everything they hear. Then the "peer" pressure will be to do the principled and scientifically right thing, and not just react to the "rumor of the day."

Fear generates fear, whereas, truth results in a reasoned willingness to face the issues calmly without hysteria. Maybe Hong Kong, or any other city, under attack by another SARS or other "threat" will not succumb the next time around to mass or masked hysteria.

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Dr. Reginald Tsang is a professor emeritus of pediatrics at Children's Hospital Medical Center. He recently returned from a six-week medical mission tour of Malaysia, Hong Kong, the Guandong Province of China and Macau.