Hong Kong contained COVID for 2 years. Now it has more cases than New York City and London

February 17, 2022, 12:04 PM UTC

Exponential growth in COVID case numbers. Patients on gurneys waiting outside overloaded hospitals. Rumors of an impending citywide lockdown.

Such COVID chaos may be reminiscent of northern Italy, New York City, or Wuhan in early 2020, but two years later Hong Kong is facing these scenes for the first time as it battles its biggest outbreak since the beginning of the pandemic.

On Thursday, Hong Kong recorded over 6,000 COVID-19 infections, meaning, in absolute terms, the city is reporting more daily cases than New York City and London for the first time since the spring of 2020. It’s a stunning fact considering both the U.S. and U.K. have long given up on containing COVID-19. Authorities in Hong Kong, meanwhile, are deploying measures like contact tracing and mandatory quarantines in a bid to eradicate the virus from the city.

Up until its most recent wave, Hong Kong, a city of 7.4 million people, had never recorded more than 173 infections in a day. Weeks-long hotel quarantines for residents entering the city, intense contact-tracing, and isolating close contacts of positive cases proved successful in keeping the virus out of the city and allowing residents to live largely COVID-free for the majority of the past two years.

But the virus slipped past Hong Kong’s defenses just as the city rang in the new year. The outbreak has grown exponentially since then and is now starting to overwhelm the city’s health care system. Still, Hong Kong, under pressure from Beijing, has not deviated from its singular focus on eliminating all infections, but the goal it met for two years has all but slipped out of reach.

Getting in

On Jan. 5, Hong Kong authorities sounded the alarm about a potential Omicron outbreak, closing gyms and bars and shutting down restaurants after 6 p.m. in response to the discovery of the city’s first untraceable case—one it could not link to a known cluster—in over three months.

“We believe we are on the verge of another outbreak…We know that once there is an outbreak of Omicron, there is no containing it,” Carrie Lam, Hong Kong’s chief executive, said in a press conference at the time.

Hong Kong contract-traced and sent close contacts of positive cases to government-run quarantine camps—measures that had suppressed waves in the past. But those well-established tactics—plus new ones like culling thousands of hamsters suspected of carrying the virus and locking down entire apartment blocks—proved insufficient. Lam’s dire prophecy came true. Since January, Hong Kong’s case numbers have roughly doubled every three days.

The cases appear to be almost all Omicron—specifically, Omicron BA.2, the subvariant the World Health Organization warns is 30% more transmissible than Omicron’s original strain.

A doctor treats COVID-19 patients on the streets outside Caritas Medical Center in Hong Kong after the hospital was overwhelmed with infections on Feb. 16, 2022.
Bertha Wang—Bloomberg/Getty Images

Epidemiologist and World Health Organization adviser Gabriel Leung warned in a recent study that the BA.2 substrain was too transmissible for Hong Kong’s previous infection control measures to contain. Hong Kong’s relatively low vaccination rate and its lack of natural immunity from previous waves make the city particularly vulnerable to an outbreak, Leung said.

Experts have criticized local authorities for failing to gird for the possibility of a massive outbreak and especially for their dismal performance in vaccinating the city’s most vulnerable residents.

Hong Kong is one of the world’s wealthiest cities and has had early access to the world’s most effective vaccines. And yet the city has one of the lowest elderly vaccination rates among developed countries. Nearly one year into its vaccination campaign, Hong Kong has fully vaccinated only 55% of its population over age 70 and 26% of its population over 80. The U.S., by comparison, has fully vaccinated 85% of its population over the age of 75. The U.S. and U.K. also have provided booster doses to 65% and 92% of their over-65 populations, respectively.

Doctors in the city also say Hong Kong’s hospitals were not prepared for the onslaught of COVID infections, forcing medical staff to treat patients on cots on the streets outside hospitals.

No getting out

Hong Kong’s past choices on how to combat the coronavirus have narrowed its future options.

Some in the city, such as the American Chamber of Commerce, have called for Hong Kong to learn to “live with the virus” and make a transition to opening borders and relaxing social distancing restrictions in a manner following the example of regional rival Singapore. Singapore, like Hong Kong, kept the virus at bay for months with contact tracing and strict quarantines. But Singapore softened its hard-core “COVID-zero” approach once a large majority of its population had been fully vaccinated.

Hong Kong’s leaders insist a Singapore-style transition is impossible—especially since the city’s overseers in Beijing have demanded that Hong Kong maintain its “dynamic COVID-zero” policy at all costs.

In a message delivered on the front page of a state-owned tabloid in Hong Kong on Wednesday, Chinese President Xi Jinping declared that Hong Kong should not deviate from its COVID-zero strategy and must prioritize eradicating cases over other policy goals. Later that day, local media reported that—with the help of its mainland neighbor Shenzhen—Hong Kong would test every resident in the city for COVID-19 three times starting in March.

In China, testing millions or tens of millions of people to contain outbreaks is fairly routine and has become a central component of China’s success in containing outbreaks in Xi’an, Tianjin, and other cities. But China’s testing campaigns have involved mass lockdowns—with residents in heavy-hit areas banned from leaving their apartments under any circumstance—and are often deployed after just a few infections surface.

Hong Kong authorities insist, for now, that a citywide lockdown is off the table. “We have no plans whatsoever to impose a complete, wholesale lockdown,” Lam said at a press conference on Tuesday.

Hong Kong’s high caseload and its reluctance to order the entire city to stay at home may render may undermine the call for mass testing. If too many patients test positive in the campaign, Hong Kong will run out of the quarantine facilities to isolate them, meaning the disease could continue to spread.

“If the government is really hoping to order everyone to undergo three tests, I think it should carefully consider whether to include lockdowns,” Dr. Joseph Tsang, an infectious disease specialist with the Hong Kong Medical Association, told local media outlet RTHK on Thursday.

Hong Kong’s “halfway” measures worked for most of the pandemic; they were strict enough to keep the virus out but still allowed residents inside the city to move freely. But now, says Tsang, “going halfway is meaningless.”

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