Live with COVID or lock down? Omicron is forcing Hong Kong to do a bit of both

February 7, 2022, 12:34 PM UTC

For two years, Hong Kong has lived relatively free of COVID-19. It stymied waves of Delta and other COVID variants with border restrictions and contact tracing. But a record Omicron outbreak has breached Hong Kong’s COVID defenses and may force the city to rethink its response system.

On Monday, Hong Kong reported 614 COVID-19 infections, nearly doubling the city’s single-day record set the previous day. The 614 cases in Hong Kong—population 8 million—also top any single-day total in mainland China—population 1.4 billion—has recorded since February 2020.

“The situation is not optimistic,” Dr. Edwin Tsui, controller of the Centre for Health Protection (CHP) at Hong Kong’s Department of Health, said at a press conference on Monday. “[But] if we work together, hopefully we can gradually suppress the spread of the disease. We hope we will be able to contain this wave.”

Hong Kong has kept the virus at bay by imposing strict border controls and intense contact-tracing tactics. Under Hong Kong’s “dynamic COVID-zero” policy, all inbound travelers have served 14- or 21-day mandatory hotel quarantines. And officials have tracked down close contacts of positive cases and subjected them to weeks of quarantine, too. As a result, residents have lived somewhat normal lives, never facing the acute fear of catching COVID or losing a family member to the disease.

But now that infections are doubling every three days, experts project cases could reach into the thousands or tens of thousands per day in coming days and weeks.

“Dynamic COVID-zero strategy was about managing [some cases of] COVID but being able to stop community transmission,” says Nicholas Thomas, a professor of global health governance at the City University of Hong Kong. “I think that’s gone out the window…There’s quite overwhelming evidence [that COVID-zero] is not going to be possible.”

To stop the Omicron wave in its tracks, Hong Kong may need to impose the types of mass lockdowns and testing campaigns that are commonplace in mainland China, but the city may not have the governing capital or resources to do so. Hong Kong could also transition to living with COVID in a bid to reopen its borders with the outside world, but such a policy may not be politically feasible in a city prioritizing the reopening of its mainland border.

Instead, Hong Kong, once known as “Asia’s global city,” may be indefinitely stuck in an awkward middle ground—imposing restrictions that are hugely disruptive and inconvenient but not quite powerful enough to stop Omicron’s rapid spread.

People queue at a mobile specimen collection station for COVID-19 testing at Edinburgh Place in Hong Kong’s Central area on Feb. 6, 2022.
Bertha Wang—AFP/Getty Images

On Jan. 7, Hong Kong announced that it was imposing some of city’s most stringent social-distancing measures yet after recording its first locally-spread cases in months. Hong Kong closed bars and restaurants after 6 p.m., shut down gyms, movie theaters, and other entertainment venues, and urged people to work from home.

Similar measures largely stemmed previous waves, such as in the fall of 2020. But Hong Kong’s case numbers have spiked to record highs this time owing to the emergence of Omicron. The high transmissibility of Omicron and its even more transmissible sub-variant BA.2 have likely rendered such policies futile.

“Many of the public health tools used for curtailing transmission in the past are simply not as effective anymore [against Omicron],” Dr. Siddharth Sridhar, a virologist at the University of Hong Kong, recently told the South China Morning Post.

On Tuesday, Hong Kong is expected to announce new social distancing measures, sparking fears that authorities will completely bar dining in restaurants, close down shopping malls, and enforce more work from home policies.

But even enhanced restrictions may not be enough to curb Hong Kong’s outbreak. “[Omicron] has clearly escaped beyond the capacity of Hong Kong health authorities to track down every case,” says Thomas.

Hong Kong’s new outbreak has pushed some experts to consider whether the city should take early steps toward living with COVID and mitigating the worst effects of the virus, rather than trying to stamp out all infections.

“Successfully containing the current outbreak would only be possible with much more stringent control measures,” Ben Cowling, an epidemiologist at Hong Kong University, wrote on Twitter on Sunday. “If there’s no plan to substantially increase stringency, I wonder if there will be a redirection of resources to mitigation fairly soon.”

Hong Kong could shift resources to ensuring everyone in the city is fully vaccinated. Hong Kong has fully vaccinated 65% of its population compared with 79% and 84% in Australia and Singapore, respectively. Those former COVID-zero countries used vaccines as a means to transition to living with COVID.

On top of being low overall, Hong Kong’s vaccination rate is worst among its most vulnerable population. Just 22% of people in Hong Kong over age 80 are fully vaccinated, and the vast majority of them have received China’s Sinovac vaccine, which does not appear as effective against Omicron and Delta as mRNA vaccines. The mRNA vaccine developed by Germany’s BioNTech, and distributed locally in Hong Kong by China’s Fosun Pharma, is also available to Hong Kong residents.

Hong Kong could “put in place more robust measures for dealing with the virus” such as relying on more effective vaccines and vaccine mandates to build up a more formidable “community transmission firewall,” Thomas says. But the mainland has relied heavily on Sinovac’s vaccine for its own campaign and has not approved BioNTech’s jab, which may make Hong Kong wary of publicly favoring the mRNA jab.

Thomas says that even if Hong Kong’s vaccination rate improves, “living with COVID” would not be “politically feasible” since Hong Kong, a special administrative region of China, has said its first priority is reopening its border with mainland China, which has also adopted zero tolerance for COVID cases.

“International travel is important, international business is important, but by comparison the mainland is more important,” Carrie Lam, Hong Kong’s chief executive, said at a press conference in October.

“So long as [reopening the mainland border] remains the political goal, then all health measures are subordinated to that goal, irrespective of the lived reality on the ground [in Hong Kong] in terms of infections,” Thomas says.

Supporting COVID-zero policies is a popular position among Hong Kong’s Beijing-friendly politicians. Junius Ho, a pro-Beijing lawmaker, recently suggested that criticizing Hong Kong’s COVID-zero policy violated the city’s national security law, which has granted Beijing sweeping powers over city affairs since 2020.

The government responded that it is “not illegal” to criticize the law, but that COVID-zero “is the most effective way to fight against the epidemic and protect public health and safety.”

While Hong Kong and mainland China are ideologically aligned on COVID-zero, the two governments differ in how they have put the policy into practice.

Mainland China has deployed a two-pronged approach of lockdowns and mass testing to stem COVID outbreaks. In Xi’an, officials recently lifted a strict—sometimes brutal—monthlong lockdown after the measure helped curb a Delta outbreak. In Tianjin last month, weeks of lockdowns effectively stopped an Omicron outbreak before it could get out of control. The success of the policies is part of the reason China appears intent on maintaining its COVID-zero strategy for the foreseeable future.

Hong Kong may be tempted to deploy similar measures to curb its own outbreak, but the city has not shown the willingness or capacity to enforce a policy similar to the mainland. For one, Hong Kong’s testing capacity does not match mainland China’s. Tianjin, for example, tested its 14 million residents four times in under two weeks whereas Hong Kong can only handle roughly 200,000 COVID tests per day.

Hong Kong has recently locked down individual housing estates for up to five days, but Thomas says Hong Kong lacks the testing capacity and staff to scale up to citywide lockdowns or testing campaigns.

“The housing estates lockdown pushed the limit of what Hong Kong can actually do,” he said.

Hong Kong may not be able to fully institute a mainland-style lockdown, but it could ask for a hand. In late January, China’s neighboring Guangdong province reportedly deployed officials to Hong Kong at the request of Hong Kong’s government in a bid to ramp up testing capacity.

“Looking for help from the mainland is basically the only option Hong Kong has at this point,” Thomas said.

[Editor’s note: The first sentence has been updated to clarify that Hong Kong has used border restrictions.]

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