More than 300 residents of a private high-rise housing estate were infected with severe acute respiratory syndrome within a short period during the 2003 epidemic in Hong Kong. The outbreak occurred after the identified index patient visited a flat on a middle floor in Block E of the Amoy Gardens estate on two nights. Approximately 45% of the subsequently infected people resided in Block E, while the other 55% of infected cases mainly resided in six other blocks close to Block E. The distribution of the infected flats in Block E conformed to a non-uniform spatial pattern. Probable environmental causes for airborne transmission associated with the air movements between flats in Block E are identified. The well-established multi-zone airflow modeling method was used to analyze the virus-laden bio-aerosol dispersion between flats through door and window leakage areas in Block E under six different scenarios. The distribution of infection risk in Block E matched with the virus concentrations in flats predicted with the use of multi-zone modeling. Our study shows the importance of ventilation design in high-rise residential apartments.
Practical implications: The present study on the Amoy Gardens outbreak presented a scenario in which crowded living spaces might lead to infection disasters. There is a need to improve the current sanitary drainage design and maintenance standards to avoid any leakage of foul gas into the indoor environments. Our study revealed the need for a review of indoor air quality and ventilation design in buildings including offices, homes and hotels. The study has implications to public health in, for example, the control of other airborne respiratory infectious diseases such as influenza, and in bio-terror safety in buildings.