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The MacLehose Trail Is Hong Kong's Great Escape

Adventure
High-rises, power lines and cell towers punctuate the view along the Maclehose Trail. Tse Hon Ning

By Mike Ives

Gauzy lights flicker in the fog, outlining a summit. Otherwise, darkness. The only sounds I can hear are my breathing and the rustling of my windbreaker. A rocky chasm yawns below me, just steps from the trail. For a moment, I imagine that I'm watching a search party traverse a remote wilderness.


But no, I'm solo hiking in Hong Kong, and the lights are the head-lamp beams of three other travelers on the MacLehose Trail. Beyond them, through occasional breaks in the fog, I can just barely see some of the blinking lights on the apartment towers—the edge of a global financial center where 7.4 million humans squeeze into an urban area roughly the size of Boston. Soon I'll be pitching a bright-orange tent on a seaside bluff, as far from that madding crowd as possible.

Hong Kong, a former British colony and now a semiautonomous Chinese territory, has some of the world's densest urban districts. But less than a quarter of its total land is inhabited. Another 40 percent—a noncontiguous area twice the size of Seattle—is divided into 24 country parks that receive more than 11 million visitors a year. The parks' peaks and ridges are known for their panoramic views of skyscrapers, but that's only part of their appeal: They also ease the stress of living in a crowded city wracked by soaring inequality.

It's hard to survive here without a generous corporate salary. Every month, my wife and I, both of us journalists, stretch our budget to rent a tiny walk-up apartment. The price of food and basic services always makes us cringe, and we never manage to save money. Our standard of living could be far worse: One in five Hong Kongers lives below the poverty line, and the affordable-housing crisis is so severe that some locals live in stacked cubicles called "cage homes" or "coffin cubicles." Hong Kong's extreme wealth disparities get under our skin. In our neighborhood, Ferraris and Lamborghinis whiz by a welfare office as the poor queue around the block.

Which explains why I often feel like escaping the grid for a few hours, to a place where trees outnumber people, the cellular signal can be hit or miss, and the Darwinian struggle is mainly waged by other species.

Map by Steve Stankiewicz

The future of the country parks is uncertain, however. The British established many of them in the 1970s, often on lands that bordered streams or reservoirs. Now, as Hong Kong's property market soars, a few local politicians are beginning to talk of carving up some of the parks to make room for housing. The initial cuts, if they ever occur, would likely be modest. But the mere suggestion has rattled conservation groups. Cutting into the parks would set a dangerous urban-development precedent, they warn, and the authorities should focus instead on developing idle sites near existing skyscrapers.

A key feature of the country parks is a nearly 200-mile network of four hiking trails. The longest is the MacLehose Trail, which runs for 62 miles and is named for the British official who governed Hong Kong in the 1970s. I like it because it takes me furthest afield.

The trail begins by edging along the South China Sea, darting through scrubby forests and along sandy bluffs. The air here is heavy with humidity and sea salt, and the location—the far corner of a vast country park—is free of condominiums. One summer afternoon, the only human presence I see from a bluff is an oil tanker cutting through whitecaps. Otherwise it's just me, the breeze, and a sea the color of my wife's engagement ring.

Farther on, the MacLehose passes through a village with surfboard rentals and open-air restaurants that smell of seafood and garlic. Nearby lies a white-sand beach that's tucked into a rocky cove and partially sheltered from the wind. Some local surfers say that the best break in the territory is here, though only in the winter typhoon season, when the swell picks up and the crowds of fair-weather weekenders thin out.

After its seaside leg, the MacLehose hooks west, brushing past the 2,303-foot summit of Ma On Shan (Horse Saddle Mountain) and across a miles-long ridge dotted with graffiti-spattered concrete pillboxes. British soldiers built this so-called Gin Drinkers Line of fortifications in the 1930s to protect nearby Hong Kong Island from invasion. Japanese forces seized the territory anyway, in 1941. Britain regained control after World War II, and the pillboxes still bear London-inspired names like Charing Cross and Shaftesbury Avenue.

"Artillery observation post," a sign on one of them says. "No playing war game."

The artillery is long gone. Today, high-rises, power lines, and cellular towers hover in the not-too-distant background along nearly the entire sweep of the trail. An "unspoiled" wilderness this is not; I'm never more than about 90 minutes from a bus stop or train station. Yet the juxtapositions of urban life and natural scenery are beautiful in their own right: A mountain view framed by a halo of smog, say, or packs of elderly joggers who blare Cantonese opera on handheld radios. Who am I to ask them to turn down the volume? Sometimes, and in some places, it's easier to appreciate wildness if you are reminded of its limits at practically every turn.

Where: MacLehose Trail, Hong Kong

Getting there: The trail traverses a total of eight country parks, mainly in the New Territories, a vast area north of Kowloon and Hong Kong Island. Most trailheads can be reached by a mix of bus, train, or ferry. A taxi or private car will often, though not always, get you there faster.

When to visit: The best time to hike Hong Kong's country parks is late fall through early spring. From late spring through early fall, bring lots of water if you hike on especially hot or humid days.

Camping: There are 41 campsites in the country parks, and a few are scattered along the MacLehose Trail. The campsite at Ham Tin Wan, on the second of the trail's 10 sections, is especially popular because it sits steps from a pretty beach.

Pro tip: Consider a varied range of hikes. The MacLehose, Wilson, Lantau, and Hong Kong Trails are all spectacular in different ways, with offshoots connecting back to the city.

Further reading: The Serious Hiker's Guide to Hong Kong by Pete Spurrier (FormAsia Books, 2007)

More: bit.ly/hongkonghikes

This article appeared in the May/June 2018 edition with the headline "Hong Kong's Great Escapes."

Reposted with permission from our media associate SIERRA Magazine.

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The patient in the case report (let's call him Tom) was 54 and in good health. For two days in May, he felt unwell and was too weak to get out of bed. When his family finally brought him to the hospital, doctors found that he had a fever and signs of a severe infection, or sepsis. He tested positive for SARS-CoV-2, the virus that causes COVID-19 infection. In addition to symptoms of COVID-19, he was also too weak to move his legs.

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We are neurologists specializing in intensive care and leading studies related to neurological complications from COVID-19. Given the occurrence of Guillain-Barre Syndrome in prior pandemics with other corona viruses like SARS and MERS, we are investigating a possible link between Guillain-Barre Syndrome and COVID-19 and tracking published reports to see if there is any link between Guillain-Barre Syndrome and COVID-19.

Some patients may not seek timely medical care for neurological symptoms like prolonged headache, vision loss and new muscle weakness due to fear of getting exposed to virus in the emergency setting. People need to know that medical facilities have taken full precautions to protect patients. Seeking timely medical evaluation for neurological symptoms can help treat many of these diseases.

What Is Guillain-Barre Syndrome?

Guillain-Barre syndrome occurs when the body's own immune system attacks and injures the nerves outside of the spinal cord or brain – the peripheral nervous system. Most commonly, the injury involves the protective sheath, or myelin, that wraps nerves and is essential to nerve function.

Without the myelin sheath, signals that go through a nerve are slowed or lost, which causes the nerve to malfunction.

To diagnose Guillain-Barre Syndrome, neurologists perform a detailed neurological exam. Due to the nerve injury, patients often may have loss of reflexes on examination. Doctors often need to perform a lumbar puncture, otherwise known as spinal tap, to sample spinal fluid and look for signs of inflammation and abnormal antibodies.

Studies have shown that giving patients an infusion of antibodies derived from donated blood or plasma exchange – a process that cleans patients' blood of harmful antibodies - can speed up recovery. A very small subset of patients may need these therapies long-term.

The majority of Guillain-Barre Syndrome patients improve within a few weeks and eventually can make a full recovery. However, some patients with Guillain-Barre Syndrome have lingering symptoms including weakness and abnormal sensations in arms and/or legs; rarely patients may be bedridden or disabled long-term.

Guillain-Barre Syndrome and Pandemics

As the COVID-19 pandemic sweeps across the globe, many neurologic specialists have been on the lookout for potentially serious nervous system complications such as Guillain-Barre Syndrome.

Though Guillain-Barre Syndrome is rare, it is well known to emerge following bacterial infections, such as Campylobacter jejuni, a common cause of food poisoning, and a multitude of viral infections including the flu virus, Zika virus and other coronaviruses.

Studies showed an increase in Guillain-Barre Syndrome cases following the 2009 H1N1 flu pandemic, suggesting a possible connection. The presumed cause for this link is that the body's own immune response to fight the infection turns on itself and attacks the peripheral nerves. This is called an "autoimmune" condition. When a pandemic affects as many people as our current COVID-19 crisis, even a rare complication can become a significant public health problem. That is especially true for one that causes neurological dysfunction where the recovery takes a long time and may be incomplete.

The first reports of Guillain-Barre Syndrome in COVID-19 pandemic originated from Italy, Spain and China, where the pandemic surged before the U.S. crisis.

Though there is clear clinical suspicion that COVID-19 can lead to Guillain-Barre Syndrome, many important questions remain. What are the chances that someone gets Guillain-Barre Syndrome during or following a COVID-19 infection? Does Guillain-Barre Syndrome happen more often in those who have been infected with COVID-19 compared to other types of infections, such as the flu?

The only way to get answers is through a prospective study where doctors perform systematic surveillance and collect data on a large group of patients. There are ongoing large research consortia hard at work to figure out answers to these questions.

Understanding the Association Between COVID-19 and Guillain-Barre Syndrome

While large research studies are underway, overall it appears that Guillain-Barre Syndrome is a rare but serious phenomenon possibly linked to COVID-19. Given that more than 10.7 million cases have been reported for COVID-19, there have been 10 reported cases of COVID-19 patients with Guillain-Barre Syndrome so far – only two reported cases in the U.S., five in Italy, two cases in Iran and one from Wuhan, China.

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Due to the pandemic and infection-containment considerations, diagnostic tests, such as a nerve conduction study that used to be routine for patients with suspected Guillain-Barre Syndrome, are more difficult to do. In both U.S. cases, the initial diagnosis and treatment were all based on clinical examination by a neurological experts rather than any tests. Both patients survived but with significant residual weakness at the time these case reports came out, but that is not uncommon for Guillain-Barre Syndrome patients. The road to recovery may sometimes be long, but many patients can make a full recovery with time.

Though the reported cases of Guillain-Barre Syndrome so far all have severe symptoms, this is not uncommon in a pandemic situation where the less sick patients may stay home and not present for medical care for fear of being exposed to the virus. This, plus the limited COVID-19 testing capability across the U.S., may skew our current detection of Guillain-Barre Syndrome cases toward the sicker patients who have to go to a hospital. In general, the majority of Guillain-Barre Syndrome patients do recover, given enough time. We do not yet know whether this is true for COVID-19-related cases at this stage of the pandemic. We and colleagues around the world are working around the clock to find answers to these critical questions.

Sherry H-Y. Chou is an Associate Professor of Critical Care Medicine, Neurology, and Neurosurgery, University of Pittsburgh.

Aarti Sarwal is an Associate Professor, Neurology, Wake Forest University.

Neha S. Dangayach is an Assistant Professor of Neurology and Neurosurgery, Icahn School of Medicine at Mount Sinai.

Disclosure statement: Sherry H-Y. Chou receives funding from The University of Pittsburgh Clinical Translational Science Institute (CTSI), the National Institute of Health, and the University of Pittsburgh School of Medicine Dean's Faculty Advancement Award. Sherry H-Y. Chou is a member of Board of Directors for the Neurocritical Care Society. Neha S. Dangayach receives funding from the Bee Foundation, the Friedman Brain Institute, the Neurocritical Care Society, InCHIP-UConn Center for mHealth and Social Media Seed Grant. She is faculty for emcrit.org and for AiSinai. Aarti Sarwal does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

Reposted with permission from The Conversation.


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Reposted with permission from Common Dreams.