A single horrifying image summed up Hong Kong’s latest coronavirus outbreak. Published by the Hong Kong Free Press on 11 March, it showed three elderly patients being treated on a ward at the Queen Elizabeth Hospital next to six corpses in grey body bags. A spokesperson for the hospital authority said that mortuaries had filled up so quickly because of the surge in Covid-19 cases that they had not been able to move all the bodies from the wards and asked for “understanding” from patients and their families.
For almost two years Hong Kong had largely succeeded in controlling the spread of the virus. There were strict quarantine requirements for anyone entering the territory and flights were banned from countries such as the US and the UK. The authorities focused their efforts on keeping the virus out and swiftly containing any local outbreaks. Under what they called the “dynamic zero” strategy, which aimed to keep infections as close to zero as possible, entire neighbourhoods were locked down if a single case was detected. It was a harsh but effective approach that seemed to be working until the arrival of the highly transmissible Omicron variant.
Beginning in mid-February, the daily infection rate began to creep up. Where previously the city had generally reported fewer than a hundred cases a day, by 21 February it was reporting more than 5,000. On 4 March Hong Kong reported more than 66,000 infections in a single day. On a graph the rate of infections looks like a statistical error, shooting up in a near vertical line, high above the peaks experienced by Italy or the United States at the height of the pandemic as a proportion of the population. The number of people dying from the disease has also spiked, with Hong Kong now experiencing the world’s highest death rate.
“In less than two months, Hong Kong has run out of coffins and space in the morgue,” writes the Hong Kong-based journalist Ilaria Maria Sala in an article that urges others to learn from Hong Kong’s mistakes. “Pictures of sick elderly patients on hospital beds outdoors -- and of body bags piling up next to patients in a chaotic hospital ward -- have shocked the population.”
Siddharth Sridhar, a clinical virologist at Hong Kong University, described the situation as “a plane crash in slow motion”. The main factors that have caused the crisis, Sridhar told me, were the “under-vaccination of the elderly, a key vulnerable segment of the community, and a healthcare system that couldn’t withstand a massive surge of Covid cases presenting to emergency departments”. While the situation appeared to be slowly stabilising, he said much more needed to be done to prevent more people dying in the densely populated city of 7.4 million people. “My immediate concern is that we need to mitigate the effects of this wave on vulnerable elderly folks and residents of nursing homes, many of whom are still unvaccinated,” Sridhar said.
At the start of the latest surge, more than two thirds of Hong Kong residents over 80, the group that is most vulnerable to Covid-19, were unvaccinated, compared with 6 per cent of the same group in Singapore. To make matters worse, the majority of elderly Hong Kongers who have been vaccinated have opted for the Chinese-made Sinovac vaccine, which has proven less effective than the Pfizer-BioNTech vaccine (which is also available in Hong Kong) in preventing infection by the Omicron variant and its even more transmissible new sub-variant BA.2. However, studies have shown that both vaccines provide protection against serious illness and health officials note that more than 90 per cent of those who have died in the outbreak were unvaccinated.
While vaccines have been freely available in Hong Kong for almost a year, concerns about their safety and possible side effects have contributed to lower rates of vaccination overall, as has a lack of trust in the local government, which has been brought under much tighter control by the Chinese Communist Party in Beijing in recent years. The territory’s previous success in controlling the spread of the virus has also undermined efforts to encourage more people to get vaccinated and led to low levels of natural immunity. Before the start of the current wave in February, only around 1 per cent of Hong Kong’s population was estimated to have been infected. Public health experts say that the authorities failed to do enough to prepare for a large-scale outbreak by educating Hong Kongers about the importance of getting vaccinated.
The outbreak in Hong Kong also has ominous implications for countries such as the United States, where 41 per cent of people over 65 have yet to receive a booster dose and 15 per cent of the population remains unvaccinated. With scientists warning that more outbreaks around the world are inevitable, many political leaders are grappling with lingering vaccine hesitancy and widespread fatigue over pandemic restrictions.
Even in Hong Kong, despite the recent surge in cases, Carrie Lam, the region's chief executive, announced on 21 March that quarantine requirements would be eased and travel bans would begin to be lifted on 1 April as she acknowledged that public support for the measures was “fading”. She said, however, that it was too early to set out a long-term plan or to consider abandoning the dynamic zero strategy and moving to a model of living with the virus. For now, the priority is to get the current desperate situation under control.
[See also: How Covid ends]