Hong Kong bought time against COVID—then squandered it

January 24, 2022, 12:15 PM UTC

Late on Friday night, Hong Kong health officials locked 2,700 residents of a public housing project inside their multistory apartment building, in a desperate bid to trap an Omicron outbreak traced to the building. Earlier that day, community testing had linked 20 local COVID cases back to the crowded complex and officials feared a super-spreader event.

The lockdown, which will last for five days, was sudden and without warning. Residents of Yat Kwai House on Kwai Chung estate woke up Saturday morning to find the exits barred. That evening, a second building on the same estate was thrown into lockdown, too, and residents complained they had been trapped without food. Health officials moved in to conduct tests on all of the compound’s residents.

On Sunday, after testing the locked-down residents, the government confirmed 140 new cases of COVID-19—the highest number of daily cases the city of Hong Kong has recorded in a year.

In total, Hong Kong has only clocked 13,286 infections and 213 deaths since the pandemic began. Last year, the city even logged a seven-month stretch without recording a single case of local transmission for COVID-19. That window closed on Dec. 31.

Now the arrival of Omicron in Hong Kong, which broke through the city’s strict three-week quarantine requirement for arrivals, has thrown the government into a frenzy.

Authorities are desperate to contain the virus before it rips through the city’s large cohort of unvaccinated elderly residents. But the panic shows how the city bought time for itself, then squandered it, failing to capitalize on the success of its COVID-zero policies. Had the government worked harder to boost vaccine uptake when the virus was at bay, it wouldn’t be stuck without a COVID-zero endgame.

Lockdown

Hong Kong has implemented sudden lockdowns to stymie the spread of COVID before. In January last year, officials sprang lockdowns on several neighborhoods in the city’s bustling Jordan area, taping off entire city blocks to tackle a rising tide of 145 COVID cases.

The lockdowns, which targeted 10,000 people, were clumsy. A number of residents were locked out rather than locked in. After testing 7,000 people and uncovering 17 new COVID cases, the lockdown was lifted after two days. Now, as the government battles the more transmissible Omicron, its outbreak response has reached a whole new level of zealotry.

Last week, Hong Kong rounded up and culled 2,000 small animals after health officials detected COVID in a couple of hamsters at a pet shop where an employee had tested positive for Omicron. The government called on any recent customers of the shop to hand over their pets, too, to be dealt with “humanely.”

Over the weekend, at the lockdown at Kwai Chung estate, trapped residents complained that trash was piling up. Authorities had sent all 40 of the compound’s cleaners to the government-run Penny’s Bay quarantine camp after one of their colleagues tested positive for COVID.

When Hong Kong Chief Executive Carrie Lam showed up at Kwai Chung estate on Monday, trapped residents jeered at her from their windows, telling her she shouldn’t be there if the government thinks the building is so dangerous.

The previous Friday, health officials mandated that anyone who had walked along a particular stretch of sidewalk, around a hundred meters long, between 9 a.m. and 5 p.m. during workdays the week before must get a COVID test.

At a press conference last Saturday, Lam justified the city’s ongoing “dynamic zero COVID” approach, saying the region still “does not possess the pre-requisites” for relaxing its pandemic-era restrictions—tacitly admitting the government’s failure to use its hard-won COVID-free days to prepare.

Vaccines

The primary hold-up to Hong Kong relaxing its pandemic restrictions—besides the politics of appeasing central authorities in Beijing—is the city’s low vaccination rate. Although vaccines have been available in Hong Kong since February last year, local uptake trails other economies.

“Our vaccination rate is not yet ideal,” Lam said during the press conference on Saturday. “We are still, as far as the first dose is concerned, at 77.5%. Especially it is very low amongst the elderly.”

The elderly are among the most vulnerable to hospitalization and death from COVID, yet, in Hong Kong, vaccination rates among that demographic are the lowest of all age groups. As of Saturday, only 53% of 70- to 79-year-olds and just 20% of the over-80s cohort had received one jab.

“This very low rate of vaccine uptake amongst the most vulnerable segment of society is a relatively unique phenomenon that we have not seen in other parts of the world,” says Karen Grepin, a health policy expert at the University of Hong Kong.

“I worry that now that Omicron is in the community, it might be too late to save thousands of seniors who could have otherwise protected themselves against the worst outcomes of COVID by simply getting vaccinated last year,” Grepin says.

To some extent, Hong Kong was a victim of its own COVID-zero success. With no cases in the local community, residents felt safe to remain unvaccinated. Other issues, such as local media and doctors misrepresenting the risk of vaccine side-effects, further dissuaded the elderly from getting vaccinated sooner, Grepin says.

“It is known that many doctors had been providing information to their patients that they should not get vaccinated due to types of co-morbidities that were not contraindicated by government policy,” Grepin says.

“This type of misinformation could have been relatively easy for the government to address, and it would have been where I would have put more energy,” Grepin says. But the government also balked at imposing mandates that might have compelled the elderly to get vaccinated sooner.

Last April, the government aimed to boost vaccine uptake among younger crowds by making vaccination mandatory for entry to nightclubs and late-night bars. The elderly were unmoved by the nightclub-only vaccine passport.

Only now, nearly a year after introducing vaccines is the Hong Kong government making jabs mandatory for an activity Hong Kong’s retirees live for: afternoon tea, otherwise known as yum cha.

The Yum Cha effect

On Jan. 4, the government announced a new regulation prohibiting restaurants from serving the unvaccinated. The rule change was slated for Feb. 24—after Chinese New Year—but last Friday, the government moved it up to Feb. 1.

Almost immediately, lines began forming at the city’s vaccination centers.

“I was afraid that the vaccines could harm my body, so I wasn’t vaccinated,” a 68-year-old due to receive their first jab this month, told the Washington Post. “I feel frustrated, but since I need to get into restaurants, I’m forced to get vaccinated.”

After announcing the yum cha ultimatum on a Friday, daily vaccine deliveries jumped 35% the next day and hit a four-month high the following Tuesday. The uptick in vaccination could also be due to the arrival of Omicron in the city, scaring holdouts into action. But it will take months for the newcomers to complete the three-dose course that will protect them against the fast-spreading variant.

Given Omicron’s high transmissibility and the suffering it could inflict on the roughly 350,000 elderly people in Hong Kong who remain unvaccinated, the government says it has little choice but to enact flash lockdowns like in Kwai Chung estate.

Yet, if authorities had worked harder to enforce vaccine mandates sooner, perhaps 5,000 residents wouldn’t spend this week locked inside their apartments.

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