This month saw Hong Kong’s death rate from Covid-19 become the highest in the world, with more than 37 deaths per million people. The recent outbreak came as a brutal shock to the 7.4 million residents of the bustling metropolis, which until recently had kept Covid-19 cases under control. admirably low levels† Hong Kong was once praised for his response to Covid-19† Then it became the global epicenter of the pandemic†
Other cities in China like Shenzhen and Shanghai have also seen huge increases in infections, and countries in the eastern pacific such as South Korea, Vietnam, Singapore and Australia have also seen a rise in cases this month. That’s largely due to the emergence of BA.2, a highly contagious, hard-to-identify subvariant of omicron, itself a more transmissible version of the virus that causes Covid-19. Some of these countries also started easing restrictions on trips and public gatherings just as the new sub-variant was taking root.
But a skyrocketing spike in cases doesn’t necessarily mean hospitalizations and deaths will make a similar jump. In South Korea, even when reaching a new daily record of 470 Covid-19 deaths in March, the death rate so far was 6 per million inhabitants.
So Hong Kong stands out because the latest Covid-19 wave was particularly deadly. Happy, cases and deaths are decreasing† But it’s worth asking: why has the latest Covid-19 wave hit Hong Kong so hard?
To find out, I spoke to Dr. Kelvin Toc, a clinical associate professor of microbiology at the University of Hong Kong. He is both a researcher studying Covid-19 and a doctor at Queen Mary Hospital treating patients. To explain that residents took some of Hong Kong’s past successes for granted, making them complacent in critical public health measures, such as vaccinating people at high risk for serious diseases.
The conversation has been edited for length and clarity.
What are the factors that appear to be most important to the Covid-19 outbreak in Hong Kong right now? Why are we seeing it now? Which variables should we pay attention to?
I think the main thing is the vaccination problem in Hong Kong, the extremely low vaccination coverage among the elderly, especially those over 80 years old. The vaccination rate for them was only about 20 percent at the end of 2021. That is the most vulnerable population, and they are not protected at all. The data from our pandemic on this wave is very clear: The elderly who were not vaccinated had a much, much higher death rate than those with the vaccination.
Another reason is that the infection incidence in Hong Kong has been so low in the past. By the end of 2021, we had about 12,000 cases of the 7.3 million people in Hong Kong, which is less than 0.2 percent. So actually very, very few people in Hong Kong have natural immunity to the virus.
Third, in the past waves, you got about a hundred cases in a day, and that’s a lot. But in those days with only a hundred cases, you can actually put everyone in the hospital, in isolation, in quarantine camps. But if it’s not hundreds but thousands of cases per day, then people can only quarantine at home.
And you know, Hong Kong is very busy. Basically most people live in apartments and many of them live in very, very small apartments. Unfortunately, there are many poor people who share a flat with many other people. So this space is virtually impossible for you to take preventive measures in those institutions.
And of course the virus is very different this time. In the past in Hong Kong we saw the virus, we see infections and then we isolate people. Usually the spread is very limited once you do that. But this time, especially at the beginning of the ommicron wave, when we had very, very few cases, we’ve done a lot of research on each of the clusters.
You see that in a restaurant an infected patient who was sitting in one corner of the restaurant and another customer on the other side of the restaurant became infected. It not only spreads to people around you, but can even spread over long distances. For example, there have been cases in apartment buildings. And what people have discovered is that the spread is not due to direct contact between neighbors, but because contaminated air removed from one flat by an exhaust fan can pass through the air to the other apartments.
Given all these factors, was this preventable?
If Hong Kong had been vaccinated much, much better, this wave could have been prevented in my opinion.
In Hong Kong, the vaccination campaign was very aggressive. Almost every day you heard on the news that you should get vaccinated. And the government is doing everything it can to vaccinate people. They were trying to get vaccine tickets before you can go to certain restaurants and things like that.
But the problem is, some people just don’t want to get vaccinated, or worse, they don’t want their elderly parents to get vaccinated. The reason is that they thought – and many still think – that the Covid-19 vaccine is very dangerous.
Another reason why people in Hong Kong don’t want to get vaccinated is that they think they won’t get the infection because the incidence of Covid-19 has been so low in the past. So they thought, okay, if I stay inside, I don’t go out, I always wear protection, then I don’t get infected.
This is something that happens when you overdo it in some ways, so people think it’s not important to get vaccinated.
Hong Kong is not the only place where there is an outbreak in China. There are outbreaks in Shenzhen and Shanghai. I wonder how obvious the Hong Kong outbreak is, or what it has in common with these other major cities?
The big difference in Shenzhen or Shanghai is that they still have enough facilities to isolate or quarantine people. They also shut down the towns very early. They had PCR testing for the whole population, we are talking about millions of people. In principle, they could do a mass screening for the entire city in a short time. They very quickly isolated anyone who was infected. As a result, they were able to really stop it within a week. Shenzhen is of course much bigger than Hong Kong and not as crowded.
What does this mean for China’s zero-covid strategy?
It’s not really an absolute zero policy. The Chinese government calls it dynamic zero† What they mean is that you try to catch it early and then try to prevent it from spreading. It worked more or less well because the Chinese economy and the people live quite normally. But of course you can’t cut yourself off from the rest of the world forever. It’s a matter of timing when to start relaxing.
If you suddenly open up now, many cities in China could become like Hong Kong and the health care system could collapse in a matter of weeks. So a full opening is very dangerous at this point. When to open depends on many things. And I think the most important thing is vaccination coverage and the availability of effective Covid-19 drugs.
What do you think of the way the Hong Kong leadership is handling this? How could they improve?
I think there are clearly things that could be improved. I think, for example, that the government should look at what happened in this wave. Was there a time when more aggressive measures could have been taken early on, especially in mid-February?
Secondly, there must be better coordination in the field of quarantine or isolation of people. You can never have enough space to isolate everyone in Hong Kong. It’s impossible. But the government should in any case have plans to convert existing places into insulation facilities more quickly.
For those of us watching from the outside, what lessons do you think we should take with us?
In Hong Kong, people didn’t believe it would happen. People didn’t believe the health care system would collapse. The government had some plans, but they probably didn’t expect it to collapse like it did in Hong Kong.
For the rest of the world, as good as it is now in terms of pandemic, all I can say is that Covid may just surprise you. Omicron is happy this time in a way it is milder than previous variants† But you never know, you might have a variant that is just as transmissible or more transmissible than omicron, or even more serious than the previous strains.
I think people all over the world shouldn’t expect you to just think it’s gone. I’m not saying people should be scared, but at least there should be some sort of preparation plan. The odds of stopping an outbreak are very, very slim. Once the healthcare system collapsed, everything is like a domino effect.
How do you, your family and your colleagues keep up with all this?
We’re okay. Of course we lost our social life. I haven’t eaten out in a long time and I haven’t seen many friends. The great thing about being a doctor is that I still have to go to work every day, just like in normal life, but even busier. For me, there are still some social interactions at work, which I prefer. I don’t like working from home myself because I prefer real personal contact.
I’d say I’m very lucky. I’m a doctor and I didn’t lose my job. Many people in Hong Kong have almost lost their income due to all the restrictions. This wave has certainly taken their toll.