Black Clouds and Silver Linings: Exploring the Psychosocial Consequences of the COVID-19 Pandemic on Expatriates Living in Hong Kong

: Background: While global media, international and local health organisations, epidemiologists, and opinion makers disseminate regular updates on the spread and mortality of COVID-19, the psychosocial effect of the pandemic is often neglected. This is amplified for expatriates living outside their native country as stringent quarantine measures make travelling to their home countries prohibitive, if not impossible, in terms of time and money. Objective: The aim of this study was to understand the psychosocial consequences of the COVID-19 pandemic on expatriates living in Hong Kong. Method: An exploratory qualitative research design was employed. Qualitative data from semi-structured interviews and surveys were analysed using template analysis. Findings: Data revealed that COVID-19 adversely affected the mental and social wellbeing of most of the respondents. There were silver linings in finding new ways to connect, appreciating a slower pace of life and the opportunity to reassess priorities, although the black clouds of separation from family, concern for youth, missing milestones and mental & financial concerns dominated most of the data. These negative consequences were exacerbated by the lack of reasonableness, inclusivity, openness and transparency of the COVID-19 restrictions and regulations. Conclusion: As the psychosocial consequences of the pandemic are expected to continue for some time, this study has implications for public health policy and practice in HK, and internationally, in planning how to mitigate the negative effects of the pandemic.


Introduction
Since the World Health Organisation (WHO) declared the outbreak of the coronavirus disease (COVID-19) a pandemic in March 2020, one cannot imagine a population in the world that has not been affected by the virus in one way or another.While global media, international and local health organisations, epidemiologists and opinion makers disseminate regular updates on the spread and mortality of COVID-19, the psychosocial effect of the pandemic is often neglected.Extant research of pandemics such as SARS, Ebola and COVID-19 shows that the psychological effect of the contagion is not limited to the fear of contracting the disease [1].Factors such as separation from loved ones, loss of freedom, uncertainty and feelings of helplessness affect more of the population [2][3][4].
Hong Kong (HK) has been lauded as a model of successful control of the pandemic without having undergone the mass lockdowns that have taken place in other countries.Many suggest that this is principally due to HK citizens' selfdiscipline, high compliance of mask wearing and social distancing, rather than recommendations from the HKSAR authorities [5][6][7].Despite the low numbers and civil compliance, the city's quarantine measures are among the strictest in the world.Anyone who tests positive for COVID-19 is hospitalised, with close contacts placed in austere surveillance facilities for up to 21 days.These, and increasingly stringent mandatory quarantine measures for inbound travellers, have left many HK residents concerned for their psychological and social wellbeing [8].This is amplified for expatriates* who, far from family support, face the real possibility of being separated from one another should anyone test positive.Moreover, the ban on residents coming in from high-risk countries, and the COVID-19 Pandemic on Expatriates Living in Hong Kong stringent quarantine regulations of 21-days # in a government appointed hotel, means that many expatriates are finding travelling to their home countries to see their families prohibitive, if not impossible, in terms of time and money.The effects of this on their mental wellbeing are yet to be fully understood.
* Expatriates refers to people who are living outside of their native country.In HK expatriates comprise 8% of the population, including Foreign Domestic Helpers (FDH) 9.
Many HK expatriates work in the financial services sector which accounts for about 20% of the city's gross domestic product.# Since conducting this research, inbound travellers from many countries are now required to quarantine in government facilities for 4-7 days prior to completing their 21-days in a government designated hotel at their own cost.
(https://www.coronavirus.gov.hk/eng/inboundtravel.html)Appreciating that governments, public health authorities and policy makers have to make difficult decisions during a pandemic, a number of countries (e.g.Canada, Ireland, New Zealand, United Kingdom) have developed procedural values to guide ethical decision-making including openness & transparency, reasonableness, inclusiveness, responsiveness and accountability [10].Key considerations in planning and responding to a pandemic involve balancing the rights, interests, and values of all stakeholders.Moreover, understanding the guiding principles surrounding public health policies could help promote trust and ameliorate distress under austere circumstances [11].
Although confinement measures of lockdown, social distancing, quarantine and home isolation are essential public health measures to contain the spread of the COVID-19 virus, they pose a serious threat to mental wellbeing at both an individual level and population level [12][13][14].Higher rates of anxiety, depression, fear, anger, panic, loneliness and despair have been reported on an individual level, while at the population level the pandemic has been associated with psychosocial adversities ranging from economic hardship, financial losses, unemployment and reduced income, closure of educational institutions and domestic violence [12,15].Ogrodniczuk et al's study exploring the psychosocial effect of COVID-19 on online help-seeking men in Canada [16], found that 79.3% of respondents were negatively affected by the pandemic, two-thirds indicating that the government imposed social distancing regulations had negatively affected their mental wellbeing.Additionally, half mentioned moderate financial stress and 37.7% felt that COVID-19 had a negative impact on their relationship with their intimate partners.Similarly, Gadermann et al. [17] found that families with children under 18 at home experienced deterioration in mental health due to the pandemic.Although parents reported more frequent negative interactions (e.g. more conflicts) with their children, there were also increased feelings closeness.For the most part, children seem to be low risk for the morbidities and mortalities associated with COVID-19 [18].However, school closures, social distancing, and quarantine have resulted in children and adolescents facing long periods of physical isolation from their peers, teachers, extended families, and community networks [19].
It is difficult to predict the long-term effect that this will have on the mental health of the youth.Preliminary research suggests social isolation can lead to depression and causes mental health risks for children during and after the pandemic [13,20,21].Recent studies have shown that more than 30% of adolescents report high levels of loneliness and almost 50% of 18-24 year-olds report feeling lonely during lockdown [19].Researchers maintain that there are established links between loneliness and mental wellbeing [22].
While some studies suggest a loss of learning due to school closures during the pandemic [23,24], there is also evidence of an increase in children's behavioural problems (e.g.aggression, irritability, inattention) during the COVID-19 pandemic, with home-schooling being the factor that had the strongest negative effect [25,26].A study in China found that while home-schooling was acceptable, there were concerns over the students' interest, focus and academic performance [27].Additionally, almost 20% of the students were thought to have emotional and behavioural issues, while parent and teacher anxiety levels were higher than usual.Conversely, results from a Japanese study demonstrated that children were more prosocial and developed better digital skills during the pandemic, although they experienced more problems in their peer relationships [28].
Not all psychological outcomes of potentially adverse experiences are negative, indeed some studies have shown post-traumatic growth following hardship [29][30][31][32].Reappraising negative events in a positive light can lead to constructive psychological changes in one's self-perception, philosophy to life and relationships with others [33,34].Post-traumatic growth differs from the notion of 'bouncing back' with resilience and is rather a case of 'bouncing forward' [35].This presents an opportunity to improve aspects of one's life rather than returning to the way things were pre-event.The main factors indicative of post-traumatic growth are appreciation of life, new possibilities, relating to others, personal strength and spiritual change [36][37][38].Positive adjustment could also ameliorate the negative psychosocial consequence of stress-inducing events [39].
Whilst there have been a few qualitative studies that have explored the effects of COVID-19 on mental wellbeing, these have been the experiences those hospitalized [40]; older adults [41]; Filipina domestic helpers [42] and caregivers of COVID-19 patients [43].Absent from the literature are insights into the psychosocial consequences of the COVID-19 pandemic on expatriates living in HK.
It should be noted that while this study focuses on expatriates living in HK, it is not the intention of the researcher to overlook others who are facing difficulties during the COVID-19 pandemic.However, it is beyond the scope of this study to examine other populations.
This study is not claiming that expatriates are in any way disadvantaged, nor is it overlooking the fact that the pandemic has disproportionately affected the poor, the vulnerable, migrants and other marginalised groups.Although expatriates form a minority of the overall HK population, their contribution to the economy and international trading cannot be ignored.Therefore, it is imperative to evaluate the relevant psychosocial consequences and impact of COVID-19 in this stratum of society.Due to the investigative nature and its execution within the real-world situation, the research would be limited to expatriates in HK and thus the results may not be generalizable across other populations or settings.

Research Design
This study adopted a social constructivist paradigm, founded on the principle that knowledge is actively and socially constructed through interaction with others, emphasising the importance of culture and context in understanding and applying knowledge [44].Psychosocial experiences occur within the realm of relations and interactions; they are embedded, delivered and coconstructed within contexts.Thus, in order to obtain a profound understanding of the psychosocial consequences of the COVID-19 pandemic for expatriates in Hong Kong, SAR China, this study utilised an exploratory research design.

Participant Recruitment
Participants (N=75) were recruited via social media, in particular Facebook, and snowball sampling.From this pool of participants, a smaller sample (N=8) was selected via purposive sampling for in-depth semi-structured interviews.This was done to ensure that the sample was representative of the expatriate population in terms of demographics, experiences and opinions.All participants were required to be 18 + years or older, Hong Kong residents and able to read and write in English.

Ethical Consideration
Ethical approval was granted through the institutional research ethics board, and informed consent was obtained from each participant.Survey responses were anonymous and interviews were confidential with interviewee names removed from the data.The data will be stored securely for five years as required, with access limited to the researcher and only used for the purposes of this study.

Data Collection and Analysis
Data collection took place between 22 nd February 2021 and 12 th March 2021.Data was collected through online surveys and followed up with semi-structured interviews, primarily utilizing Zoom calls.Surveys took approximately 15-20 mins to complete and interviews typically ranged between 30-45 minutes.Data from surveys and semistructured interviews (transcribed verbatim) were analysed using Template Analysis [45].Implementing King's procedural steps [46], coding was undertaken through: defining a priori themes; familiarisation with the data by initial coding; initial template development and application to data; interpretation of findings; quality and reflexivity checks and producing the report.

Reflexivity
Reflexivity, as an inter-subjective reflection, forms an important factor in improving the rigor and trustworthiness of qualitative research [47].This refers to the researcher's reflections on the influences that may have affected the design, collection and interpretation of the data (i.e.personal background, beliefs, values and biases).The researcher is cognisant of their own opinions, preconceived ideas and assumptions as well as recognising the role of their own reflections on the findings.As an expatriate living in HK and having conducted extensive research on the subject, the researcher attempted to bracket their own knowledge and experience of the subject and, whilst not ever fully possible, to allow the findings to emerge from the data.

Findings and Discussion
Consistent with previous research, findings from the survey conducted revealed that COVID-19 adversely affected the mental and social wellbeing of most of the respondents.As expected in qualitative research, individual differences resulted in different opinions and experiences, from those for whom the pandemic has been disastrous to those that have appreciated the opportunity to slow-down and focus on other aspects of their lives.Overall, the data suggest that, for most participants, it was fear of separation from family and the profound sadness of not being able to visit close relatives in their home country that concerned them the most about the pandemic.
In order to glean an overall understanding of the psychosocial consequences of COVID-19 for the participants, word clouds were generated from the survey responses.The most frequently used words are depicted bolder and bigger (see Figures 1 and 2).The word clouds provided the overarching a priori themes: Black Cloud and Silver Linings.The initial template was expanded upon with secondary themes emerging as illustrated in Table 1.In what follows, each of these themes will be explored with references both to the evidence in the data, as well as links made to the literature.

Separation from Family
One of the 'perks' of being an expatriate in Hong Kong and in an attempt for those on international assignment to maintain ties with family and friends, many companies offer annual home leave benefit.Indeed, anecdotal evidence suggests that many expatriate families return to their home countries in the summer months and often for Thanksgiving or Christmas holidays too.Due to COVID-19 restrictions and stringent quarantine measures, international travel is no longer an easy undertaking, which means that many expatriates have not been able to return to their home countries for 18-24 months.This has caused many participants to question living abroad.
Everything Their sense of separation is often borne alone as they do not want to cause further distress to their families by articulating their own pain.
For me it's huge.Every call I make I connect with the heart.I also want to moderate my response.I don't want them to be in trauma knowing that I'm in trauma.'When asked what their biggest concerns were regarding the pandemic, one of the most common responses was the very real possibility of parents being separated from their children should anyone test positive for COVID-19 or be considered a close contact.An article in the SCMP suggested that being sent to quarantine was more likely than catching COVID-19 [48].
A massive worry has been that we get separated, that my children could end up isolated in a hospital or quarantine facility and the damage that could do to them psychologically would be worse than the virus.

Concern for Youth
As with previous research, participants in this study expressed concern for the youth with specific reference to social and emotional development and education [20,21].HK schools were fully open for >3 months in 2020, with closures continuing into 2021 (and once again in January 2022 for primary schools).Given that schools are fundamental to not only providing academic instruction, but also for developing social and emotional skills and providing opportunities for physical activity, these closures are bound to affect our youth in a myriad of ways.In addition to their concerns about missing out on face-to-face teaching, participants mentioned a noticeable lack of motivation, increased frustration and emotional outbursts in their children with online learning.
He is completely frustrated with what he has to do, and twice he refused, absolutely refused to go back into the hangout because he was done with it.But you can assume that certain behaviours, at least we presume that certain behaviours are a result of the stress.So, my son, he is six, he seems to cry a lot now.Higher levels of anxiety in my children and myself.I worry a lot about the mental health of my children as their behaviours and outlooks are changing.Some participants sought professional help for behavioural issues such was their concern for their child, although this is expensive and perhaps not affordable for all.
He struggled so much and he displayed behaviour that is not normal for him.Actually, he has been seeing a child psychologist for the last four weeks because he acted out….I was actually afraid he might jump out of the window.

(i). Social and Emotional Development
Consistent with studies mentioned above [27,28], many parents referred to the lack of social interaction particularly in younger children and expressed concerns as to the effect this would have on their social emotional development: I'm very worried about the three or six-year-olds.I think they are missing out on some very crucial skills.Social and emotional development.So the social development I think, missing out, again, on formative years and stages of development….andyou can't make it up.You can't catch it up.

(ii). Academic
In keeping with extant research [23], teachers and parents expressed concern about the academic progress of the children.This was particularly evident for those students who were writing their final exams.Depending on their age and stage of education, many parents opted out of the online teaching for their very young children, citing that it was more beneficial for them to be out playing than sitting through a zoom lesson.For others, online schooling was the main source of conflict, although some parents chose to scale back on the amount of home-schooling in order to preserve the relationship.
If I don't get involved with his remote learning, our relationship is OK! Participants with older children lamented how their children had missed out on these years that they can't get back, particularly those graduating from school or starting university.This is illustrated by the following quotes: But the kids are missing their graduation ceremony, or those leaver's trips… I mean they don't get… Like starting university.You don't get that back again.You know, and this year, he was meant to find people to share a house with, and he hasn't met anyone….Like he's meant to be doing all this lab work but it's not happening.And the motivation, he is finding so hard, to be motivated.And I just really feel for him because he's missing out on what's meant to be the best years of his life.

Missing Milestones
COVID-19 has not only upended classes and other school activities; it has also meant no graduation and no celebrations for many students and their families.Celebrating life's milestones and rites of passage is important for relationships and family bonds [49], it helps create a sense of community and is important for social and emotional development.Thus, missing these milestones is bound to have an effect on families.Other milestones that have been missed include significant family birthdays, weddings and even funerals.As seen in previous research, participants are having to find new ways to celebrate or memorialise these events [3,14].
So James' mother is 90 in September and she's basically been… Her motivation for living has been for her 90 th birthday.She will have all her family.She's got seven children.And they would all be back, wherever they live in the world....And she's realised now that's not going to happen.…restrictions, not seeing family and dealing with grief as my father passed away in May 2020 and I was unable to get home before he passed or grieve with my family, saying goodbye using an iPad is not ideal.My brother got married and we attended over zoom… Her parents weren't there so it was like … everyone meeting on zoom, and that was sad.

Mental Effects
As illustrated by the Black Cloud (figure 1) and consistent with the research [12,13,20], participants reported increased levels of anxiety, stress, frustration and sadness.

I've had a lot of anxiety, crying a lot. Feeling hopeless at times. My child has not seen her dad since early 2020 and has been anxious and agoraphobic. A lot of stress, bordering on depression at times about job uncertainty, about where we're going to live long-term.
Where we send our kids to school now.All things we thought were sorted we now have to review.

…not being able to see my children. Causing great mental anguish. Feeling torn between the husband and children in HK and the children studying in Australia.
The seemingly randomness of some of the rules and regulations left people feeling uncertain and powerless, resulting in many losing trust in the government.Participants referred to a lack of scientific rationale for many of the regulations, querying the sense in many of the measures.
Using scientific data to back up decisions.The Government here has floundered and many decisions feel arbitrary or political.

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.
Overall, it was this lack of reasonableness, inclusivity, openness and transparency of the COVID-19 restrictions and regulations that seemed to cause most of the adverse mental effects.

Arbitrary Measures
Notwithstanding the important role that governments play in the context of a pandemic, its effectiveness is very much dependent on the public's trust and perception of the legitimacy of the government [50].In order to mitigate negative psychosocial consequences of the pandemic, research suggests that governments and policy makers follow COVID-19 Pandemic on Expatriates Living in Hong Kong bioethical values (reasonableness, openness & transparency, responsiveness and accountability) when implementing rules and regulations [10].Unfortunately, anecdotal evidence suggests that this was not the case in Hong Kong.
Most participants felt that, while the government's response to the pandemic was successful in keeping the numbers low, scant attention was given to mental health issues.This has left many people questioning the validity of HK as a destination for an international workforce.
I feel like we're going along with it because we have no choice.We're not going along with it because we agree with it or we understand the decisions or anything.But we had no choice.And I understand it would have been much more effective if… You know, the reason for the decisions, like 'Why is quarantine three weeks?Why do they go on for three weeks?'There may be a very good reason but it's never been communicated.'Why were things closed for so long?Why outdoor exercise banned?'.They are very random and it's been decisions that have been made that affect the powerless.The government's response to the pandemic has caused more mental health issues than it realises and while lives have -thankfully -no doubt been saved by their actions, the economic and mental health impact has been underestimated.
We feel more strongly about leaving HK to return to [home country] sooner than anticipated.

Financial Concerns
While some expatriates had job security and did not experience financial concerns due to COVID-19, not all participants were so fortunate.For some, the financial implications of the pandemic were profound, with salary cuts and constant concerns about redundancies.The stress of not knowing if they could pay rent, food or electricity was very real for some participants while others questioned whether HK remained a feasible option for them, particularly those in the tourist and airline industry.Some participants referred to financial implications stemming from the flight bans, which trapped many residents abroad.In order to return to HK, participants were forced to go via a third, low-risk, country for 21 days and then pay for 21 days quarantine in a hotel on their return to HK.
We survived the first round of redundancies, but we're on a much-reduced package.We're sure more redundancies are coming.…stress of never knowing if we can pay rent, food, electricity, food.

Silver Linings
The old adage 'every cloud has a silver lining' is used to convey the notion that, no matter how bad the situation might seem, there are always some good aspects to it.As with previous research [29][30][31][32][33][34], this study found elements of personal growth in the face of adversity.Participants were able to find new ways to connect with themselves, their families and loved ones, realising the importance of community.Many experienced a deepening sense of gratitude, slowing down and appreciating the stillness.A few participants remarked on our essential humanity and interconnectedness illustrated by the fact that the coronavirus does not seem to pay attention to borders, passport or politics.

New Ways to Connect
For many expatriates, their jobs involved extensive travel and/or children who were educated in their home countries, which meant they did not spend much day-to-day time with their children.Restrictions on travel during COVID-19 meant that many families who were able to get back to HK, were able to spend more time together.Also working from home meant that parents were able to be more involved with their children and their online learning.This was clear from the following comments and collaborates previous research where participants noted that a primary benefit of COVID-19 was more time and more satisfaction with family and friends [29,32].
We were all together in HK for the first time in years since the kids had been at boarding school together.Husband worked from home -so I'm -so aspects [of] being together then, was something I'll treasure.My husband has spent much more time with the children than he would have.He also has bonded better with our third child.Somewhat ironically, a few participants mentioned that they were able to connect more frequently with family and friends abroad as the social distancing afforded them more time.I think my family and friends in the UK and I have all become far more chatty and have far much more time to "spare" for phone calls and Facetiming.

Slowing Down and Gaining Time
Similar to the results of Kowalski et al.'s study [29] where one the most common benefits of the pandemic included more time with family and friends and a slower pace of life, participants in this study also reported that they got to slow down and spend more time with their families and loved ones which was an unexpected silver lining.Their lives were less frantic and calmer without "racing around to a million different activities".Working from home meant less time spent commuting and with most events and activities cancelled, participants found they had more time to spend with family, pursue hobbies and exercise.
…life is less frantic and calmer.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.And then there'd been the other advantages for me.In that, I'm not rushing for a plane.I was seeing more of our old friends in Hong Kong… In addition to all of this, many participants mentioned how the pandemic gave them an opportunity to contemplate what they want in their future.

Reassessing Priorities
For many expatriates, the seismic shift around the world has forced a reassessment.For everyone who experienced some kind of loss during COVID-19, it was still a time for reflection and reframing.Just as the pandemic forced most participants to reorganise their lives in terms of working from home and supporting children with online schooling, it also inspired many to reflect on their longer-term priorities and goals.This was illustrated by the following: 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.It gave us time to contemplate what we want in our future.This is consistent with the views of Jans-Beken [31] who suggests confronting our existential vulnerability during a pandemic can present an opportunity to view our lives in a different way.Jans-Beken proposes that times of crises gives us chance to reflect on and reframe our lives and future plans through a positive lens which encourages resilience and coping skills.One of the ways to do so, is through gratitude.

Gratitude
Research has found that state and trait gratitude is associated with better mental health [37,38].Many participants mentioned an appreciation for all they have, no longer taking travel for granted, while a few participants expressed gratitude when comparing the HK restrictions with other the lockdown in other countries.Most participants expressed gratitude for having more time to spend with their families.Others were grateful for the small things in life and all that HK has to offer.
I think a general sense of gratefulness as I'm fully aware that other family members and friends have had a very tough time.Here in HK for us it's been annoying and frustrating, but manageable.Actually appreciate all HK has to offer rather than taking a holiday somewhere every break.Gratitude for the simple things.I'm also glad I live in a community where people actually care if they make others sick (no anti-mask rallies, etc).For a few participants, the pandemic has afforded them an opportunity to be more productive.
Actually, the silver lining for me is that now I can be on top of a lot of stuff.Just clearing up.So it's been more than a silver lining.It's been like a silver cloud.And I'm motivated and energetic and stuff, and I know from my home stuff from my own field of learning and education that goal-setting is very important.

Personal Development and Life Skills
There is no doubt that the COVID-19 pandemic has resulted in a withdrawal from the patterns of daily life, necessitating significantly reduced contact with other people.While for many these changes have caused major distress, for others this sort of withdrawal has become an integral part of personal development and developing life skills [51,52].

I have found it to be an experience which I have grown as a person, really developing more knowledge in areas of interest, which I don't think would have happened otherwise.
This is similar to the findings of large-scale narrative inquiry conducted in the early stages of the pandemic in Italy [32], which found that some participants were already beginning to represent the pandemic not just a crisis, but as a time for re-evaluation of personal and social priorities.Moreover, participants mentioned learning new hobbies, getting fitter and slimmer due to having more time to exercise.
Working out with exercise a bit more.So we both lost a little bit of weight and put on a bit of muscle.So we try to keep going with that.
Although studies have shown that physical distancing measures and school closures have had many implications on the mental and physical development and wellbeing of children [20,21,24], a few participants found that having the time at home to interact with their babies and young children was in fact beneficial for their physical development.
They definitely develop faster when they're not being dragged outside all the time, but they get the flat to run around.Her walking came in leaps and bounds because she had nowhere else to go, and wasn't being carried everywhere, or being put in a pushchair.
For the majority, online school was a cause of tension and stress for children and parents alike although there were the odd few that loved home-schooling their and their friends' children.Participants mentioned that although their children did not enjoy online learning and zoom classrooms, they did become more technologically aware and competent than they were pre-Covid.Others reported that their children learnt to sail or another language, while some participants took the opportunity to teach their children life skills such as cooking and cleaning.
Without a doubt the COVID-19 pandemic has created social, mental and financial stresses, leading to increased levels of depression and anxiety (i.e.black clouds), which is often exacerbated for expatriates who are away from their families and usual support system.The findings from this study support previous research suggesting an increase in stress, anxiety and depression [12,13,20].However, findings also observed that many participants discovered silver linings from their COVID-19 experience, such as finding new ways to connect with themselves, their families and loved ones; an appreciation of the slower pace of life and being able to reassess their priorities.Participants also experienced a deeper sense of gratitude and renewed appreciation for all that they had in life.

Limitations and Future Research
Despite this study being the first of its kind to explore the psychosocial effects of the pandemic on HK expatriate families living away from their native countries, there are several limitations of this study that need to be noted.Due to the investigative nature and its execution within the real-COVID-19 Pandemic on Expatriates Living in Hong Kong world situation, the research would be limited to expatriates in HK and thus the results may not be generalizable across other populations or settings.These data are preliminary and exploratory and require further replication and investigation.Another limitation is the possibility of the researcher influencing the interviews and data collection due to her own preconceived ideas surrounding quarantine measures.

Implications
This research sheds light on people's perspectives and experiences that can inform interventions and policies in the future.As the psychosocial consequences of COVID-19 are expected to continue for some time, governments and mental health practitioners should be planning how to meet these needs.In particular, policy makers should follow bioethical values when making decisions during pandemics [10].Understanding the guiding principles surrounding public health policies could help promote trust in the government and mitigate distress during the pandemic.Additionally, interventions should be designed to encourage people to look for silver linings, to discover small things for which they can be grateful.Teaching people coping strategies for positive reappraisal may help decrease the negative psychosocial consequences of COVID-19 and other aversive situations.Furthermore, accessibility to affordable mental health professionals for those that require it, should be made available during and after the pandemic.

Conclusion
The themes of black clouds and silver linings in this study reveal the psychosocial consequences for expatriates in HK during the COVID-19 pandemic.While there were silver linings for some, most participants struggled to find any silver linings.The unique circumstances of expatriates meant that many were separated from their families and missing significant milestones, which caused distress and concern for the youth in particular.The seemingly arbitrary measures and lack of ethical values guiding government-imposed measures exacerbated these negative effects.As the psychosocial consequences of the pandemic are expected to continue for some time, this study has implications for public health policy and practice in HK, and internationally, in planning how to mitigate the negative effects of the pandemic, particularly for those living outside of their home countries.

Declaration of Conflict of Interest
The author declared no potential conflict of interests with respect to the research, authorship and/or publication of this article.

Table 1 .
Themes emerging from the data.
mean that's a scary or daunting part of your life.The final exams anyway and doing that with all of the restrictions with not having access to teachers at that time.Even though schools are open, the classroom experience is still compromised with the necessary COVID-19 restrictions.
In the classroom, teaching and learning is really different with masks.You know, it's not… People say it is face-toface, but they're not really.It is mask-to-mask, which is quite a different experience.We can't do the same activities that we would do in the classroom, because of social distancing.I think that the learning experience with kids at school is hugely impoverished.