Hong Kong’s citywide COVID-19 testing has become a barometer of public trust

September 9, 2020, 4:03 AM UTC

At the Hong Kong Park Sports Center in central Hong Kong, just opposite the U.S. consulate, the basketball hoops are tucked up into the rafters, and volleyball nets are hidden out of sight. In their place, dozens of chairs are spread six feet apart. Ten COVID-19 testing stations manned by medical workers in full personal protective gear encircle the seats.

The gym, usually a hub for basketball, badminton, and volleyball leagues, as well as pickup games, has become a makeshift testing center. It’s one of 141 sites across Hong Kong that the government is using to conduct its Universal Community Testing Program, which offers a free, voluntary COVID-19 test to every resident of the city of 7.5 million. 

A woman standing in line for a coronavirus test asks one of the officials if the test—a nose and throat swab—hurts. No, the official says.

The nose swab, if not painful, is certainly intrusive, as a Fortune reporter found out. It feels like a strong tickle in a space behind the eyes and is capable of inducing tears. The throat swab is less invasive, requiring only a quick brush of the back of the tongue. Once the plastic sticks, one for each sample, are retracted and sealed in a bag marked “biohazard,” the residents are hustled out of the facility.

They’re informed of their test results by text message. A Fortune reporter who got tested received a ping from the Hong Kong government almost exactly 48 hours later: “Your result is negative,” it said.

Mass-testing apparatus

The Hong Kong Special Administrative Region is in the middle of an ambitious scheme to test the majority of its residents for COVID-19 in less than two weeks as it battles a “third wave” of COVID-19 that has more than tripled the city’s caseload. Hong Kong now has 4,896 coronavirus cases and 99 deaths. No small feat, the scheme has deployed 2,000 medical professionals to more than 100 stations across the city where tests are administered from 8 a.m. to 8 p.m. daily.

But the initiative, which began on Sept. 1 and is being carried out in partnership with China’s central government, is measuring more than the infection rate; it’s become a barometer for public trust in the government of the embattled city—both local officials in Hong Kong and China’s central authorities in Beijing.

Immediate controversy

The universal testing scheme was controversial as soon as it was announced, coming amid months-long social unrest that has strained the relationship between Hong Kong residents and their leaders.

According to the Hong Kong Public Opinion Research Institute (PORI), trust in both the local and national government has fallen to all-time lows, with distrust of local leadership at more than 60%. The decline accelerated last year when Hong Kong’s government pushed a bill that would have allowed extraditions to mainland China.

Local residents line up for nucleic acid testing for the COVID-19 coronavirus at a testing site on Sept. 1, 2020, in Hong Kong, China. Authorities have set up 141 testing sites across the city to test as many Hong Kong citizens as possible.
Li Zhihua—China News Service/Getty Images

The bill kick-started a year of intense protest by Hong Kongers, which the local government failed to quell. Tired of the unrest, Beijing imposed a sweeping national security law in Hong Kong in June. The law, aimed at silencing dissent, shattered the notion that Hong Kong’s legislature is independent from Beijing.

Since the law’s enactment, local authorities have used it to restrict protests and free speech.

The latest crackdown occurred on Sunday, when crowds took to the streets to oppose the government’s decision to postpone for an entire year legislative council elections that were supposed to take place on Sunday. Police in riot gear—and others camouflaged in plain clothes—made nearly 300 arrests, citing the majority for “unlawful assembly.”

The government says the elections were put off because of COVID-19 risks, but critics see irony in potential polling places now being used as mass testing sites; if it’s safe for Hong Kongers to stand in line for COVID-19 tests, they argue, Hong Kongers would be safe queuing to vote. Critics believe the elections were postponed because the pro-Beijing government fears an embarrassing groundswell of support for pro-democracy councillors.

Hong Kong Chief Executive Carrie Lam says drawing parallels between the transmission risk of citywide voting and citywide COVID-19 testing are “inappropriate and unreasonable.” Unlike the elections, Lam says, the universal testing scheme is not being carried out on a single day.

Virus strategy scrutiny

The government’s response to the pandemic itself also has fueled public distrust. Hong Kong was swift to recognize the threat of the coronavirus outbreak in Wuhan, China, but residents have criticized the government for not doing enough to prevent transmission.

“I think the Hong Kong government has failed over a matter of months to convince the public that they have a solid strategy for controlling the virus,” said Ma Ngok, an associate professor of government and public administration at the Chinese University of Hong Kong.

A man wearing a “Voting Is a Right” placard faces off with riot police during an anti-government protest on Sept. 6, 2020, in Hong Kong. Pro-democracy activists in Hong Kong have called for boycotts of the city’s universal testing program.
Anthony Kwan—Getty Images

Last month, for example, the government banned dining in restaurants as part of its effort to suppress the third wave, effectively forcing manual laborers to eat on the street. Following public outcry, the government backpedaled on the dining ban a day later. 

The government also was slow to plug a loophole that had allowed over 200,000 people to enter Hong Kong without undergoing quarantine—an exception experts say is responsible for starting the third onslaught of the virus.

Concerns about state control

The increase in Hong Kong’s oppressive policies under the new national security law has created fear that the universal testing scheme is just another apparatus of state control. Local media reports that Beijing initiated the idea of universal testing, rather than Hong Kong’s Legislative Council, have compounded those concerns.

Democratic Party councillor Ted Hui told the Wall Street Journal that the people of Hong Kong are “deeply worried” their DNA could be harvested during testing and used by the local police or Beijing for “other purposes, like what has happened in Xinjiang in the concentration camps.” Central government authorities were accused last year of tracking China’s oppressed Uighur minority in Xinjiang using DNA samples collected under the ruse of free health checks.

The Hong Kong government denies that the COVID-19 tests would even provide a viable sample from which to extract a person’s DNA. It also says that samples will be anonymized, not transported from Hong Kong, and destroyed within a month.

Yanzhong Huang, senior fellow for global health at the Council on Foreign Relations, says such fears are “not entirely illegitimate” given reports of similar incidents in mainland China. BGI Genomics, the Shenzhen-based lab Hong Kong is using to conduct COVID-19 tests, is also one of the world’s leading genetic sequencers. “I don’t doubt that it has the ability to collect genetic data in Hong Kong,” Huang says.

‘Nothing confidential about myself’

Evidently, not everyone is concerned. As of Monday, 1.2 million Hong Kong residents had registered for the free coronavirus test. At the sample station in the Hong Kong Park Sports Center last week, an office worker undergoing the test told Fortune she was not afraid of the data collection.

“There is nothing confidential about myself actually,” said the woman, who declined to give her name. “I think the most important thing is to consider what is good for the overall community, and we all want the overall society to recover as soon as possible.”

Chief Executive Lam has said it is everyone’s “civic responsibility” to get tested, but the local leader refused to set a mandatory quota for how many tests would be carried out. So far, the turnout is well below the government’s early predictions of 5 million.

Hong Kong Chief Executive Carrie Lam Cheng Yuet-ngor speaks to the media during a news conference about an outbreak of the coronavirus on March 31, 2020, in Hong Kong. Lam has denied allegations that Hong Kong would share genetic data from its mass-testing program with Beijing.
Qin Louyue—China News Service/Getty Images

Ivan Hung, head of the infectious diseases division at Hong Kong University, told local broadcaster RTHK that the number of tests carried out was “still a little bit low if the population is 7 million.” Hung said that at least 1 million people would need to be tested before experts could estimate the number of asymptomatic cases in Hong Kong.

Meanwhile, other experts have questioned the efficacy of Hong Kong’s mass testing as a preventative measure since people are still free to circulate around the city. Hong Kong is currently easing restrictions on public gatherings that it imposed five weeks ago amid the third spike in cases. Daily infection numbers began rising at the end of June and peaked at 149 on July 30. On Tuesday, there were six new cases.

Lam has responded to the testing scheme’s critics, accusing experts who oppose the effort of “smearing” Beijing in an attempt to “sever Hong Kong’s relations with the central government.”

The head of Hong Kong’s Public Doctors Association, Arisina Ma, retorted that medical experts were only pointing out flaws in the system and recommended that high-risk groups receive testing, rather than trying to include everyone.

As of Monday, Hong Kong’s push for universal testing had covered 856,000 people and turned up 16 positive results—four of which were already known cases. At a press conference on Friday, Civil Service Secretary Patrick Nip declined to say how much the scheme had cost to date, and he extended the operation until Sept. 11. 

“Even if we find just one case, this is very important,” said Health Secretary Sophia Chan. “Actually it’s a good sign that we’re not uncovering many cases. If we didn’t look for the cases, we wouldn’t know if there are lots of people infected in the community or not.”

Testing tradeoffs

Worldwide, few jurisdictions have attempted universal testing. In the first months of the pandemic, South Korea’s test and trace methods were widely praised as exemplary, demonstrating how the technique can reduce transmission by isolating the infected and other potential carriers from the general populace. South Korea’s testing was extensive, but it was hardly universal.

The closest parallel to Hong Kong’s scheme occurred in Wuhan, where authorities tested 6.5 million people over 10 days in May, identifying over 200 cases. Residents were compelled to participate. Roving medical workers made house calls to test people with restricted movement and visited construction sites to test migrant workers. The sweeping tests allowed the city where the pandemic began to relax after months of intense lockdown. Known and suspected cases were isolated while those cleared were free to move around.

“Wuhan is an exception because they have very strong community management, and, at that time, they can strictly control people moving from place to place,” Ma said.

According to Ma, without that level of government control, a universal testing scheme needs public trust in local leadership. Hong Kong has neither.