The covid plague in Hong Kong

As a resident of Hong Kong, I have to say the territory is having an absolutely rotten time recently. Unlike most of the world which has chosen to live with covid-19, mainland China still continues to run it's "dynamic zero covid" policy. This is quite effective in the mainland and has saved countless lives: Cases in districts are rapidly suppressed through localised lockdowns while elsewhere life continues completely as normal. No deaths from covid, no mask wearing, but a health code on ones smartphone that's required to travel or enter certain premises and continual tracking and tracing of everyone's location through smartphone data.

In the freer parts of the world, we won't accept continual tracking of all of our locations through smart phones, correlated with big data systems and security and guards on transportation and residential compounds to restrict freedom of movement. Hong Kong is of course part of China but it's an international destination where people are used to these freedoms. Hong Kongers until the pandemic were the most regular international travellers in Asia, regularly visiting Taiwan, Japan, Thailand and other destinations. Hong Kong itself is the place where people from all over the world, Europe, Americas and Middle East come to do business with China and where the money flows in and out. Due to substantial economic dependency and a large number of recent immigrants from the mainland, Hong Kong prioritised reopening the mainland border ahead of reopening international borders.

The problems is that the territory is stuck between a rock and a hard place, not just in China<->USA politics but also in virus control. While the government is to be praised in the early days of the pandemic for doing an outstanding job keeping people safe through masking, social distancing and contact tracing, as we know in the rest of the world with Omicron these tools no longer work. People get infected with Omicron sitting in different rooms in restaurants, outdoors when exercising, or walking past each other while masked in railway stations. Through district and city lockdowns and relentless tracking of users locations and restrictions of movement with health codes, the mainland has the tools and controls to suppress these outbreaks but Hong Kong people will not accept these restrictions on their lives and neither will the business people from abroad that go there.

What's followed is an absolute clusterf*ck of a policy, a complete absence of leadership and awful mismanagement. Hong Kong implemented "dynamic zero covid —the mainland's coronavirus control policy—in a territory that will not accept total lockdowns and no freedom. After all, Hong Kong's status as an SAR of China is to be a freer, more open place. This worked well through the Delta variant. A small Omicron outbreak was caused by cabin crew violating home quarantine rules, but then the hotel quarantine requirements—three weeks (!) for inbound travellers from many destinations—caused a passenger to get infected in their hotel during their final days of quarantine which then spread into the community. In an incredibly dense and highly populated place, the rest is as expected.

The false sense of security of "zero cases" and manic news articles talking about deaths after vaccination, almost all of which weren't anything to do with vaccination, lulled people into a false sense of security. The elderly got scared and only a minority got vaccinated. The government failed to address these early concerns resulting in only 53% of people over 70 years old being vaccinated and only 36% of those over 80 years old. Many of these are partially vaccinated elderly with only one shot, and to further make the situation worse, that one shot is commonly Sinovac which is proven less effective than the BioNTech vaccine (which is also freely available to everyone). The vaccination rates among younger, healthier people are much better.

With cases ramping, you'd think the government would have two key priorities: Continue to inoculate as many elderly as possible with BioNTech, as fast as possible; and a second priority, to try to shield the elderly from the general population while this is happening. Instead the government is trying to stick to the techniques of the past with even more restrictions for everyone, building more isolation facilities (how will 10% of the population get isolated?!) and completely missing the boat.

The complete disaster that's unfolding

Isolation: The government tries to isolate all people who test positive, and ideally their close contacts, in hospitals, quarantine centres and hotels. With over 10,000 cases a day, this is already impractical. The government is aggressively trying to procure more sites and isolation facilities but they can't keep up.

Treating the healthy: As a result, everyone with covid is a "patient" and has to be treated. Often said treatment involves panadol/tylenol. Isolation facilities are overflowing with Hong Kongers who are generally healthy causing overload of the healthcare system.

Fear of imprisonment: The isolation facilities where people have to spend 2 weeks are typically tiny rooms with concrete floors, terrible food and no contact with the outside world. People aren't so scared of getting covid (except the elderly) but they are scared of being forcibly taken away from their families and children and isolated.

The plague: The perpetual, 24/7 news drumming about the virus, combined with the population controls on the mainland, have made Hong Kongers believe that coronavirus is the plague or ebola.

Mental health: The mental health of the average Hong Konger is declining rapidly. Hygiene OCD, unable to leave for the mainland, unable to travel, stuck with 24/7 news bombarding about the virus, is making everybody crazy. They can't even go to the gym or join group exercise and are afraid to go to public places. International businesses are migrating to Singapore because their staff can't take it anymore.

Business closures: Many industries are getting hammered due to forced closures, entertainment venues are closed, restaurants can't do business beyond 6pm and can't seat more than 2-4 people at a table, often subdivided by idiotic plastic dividers. Bars are closed. Gyms are closed. Outdoor exercise venues are closed.

Ruining children's immunity: Many children, as well as adults, have now spent their entire lives with masks on. Children several years old have never caught a common cold. Their immune systems aren't developing and it's now likely that Omicron will be the first ever infection they get hit with. Expect higher child death rates. Adults start to be fearful of people without masks. Absolute tragedy.

Ruining children's future: Schools are closed, yet again, to try to save stubborn elderly individuals. This is society's priorities in reverse. It was understandably a reasonable temporary tradeoff to sacrifice a little of kids' future when there were no vaccines available for anyone, but now it makes no sense.

A hermit state: Hong Kong is isolated. Flights are banned for months at a time from most destinations, even when, on a typical day, less than 10 cases come from abroad but 8000+ are locally transmitted. Meanwhile, the many individuals who have families abroad or on the mainland continue to suffer declining mental health, unable to attend funerals, weddings or anything else.

What's changed?

Omicron isn't the original, Wuhan coronavirus, that had a death rate of 2% or so. Omicron is much milder and kills less. We've developed vaccinations that work and are freely available to all in Hong Kong. We've developed treatments to increase the odds of those that still fall ill surviving. Why in Hong Kong are we acting like it's worse than two years ago?

The solution

The solution, unfortunately, requires leadership—something that's not to be found in the upper echelons of the Hong Kong government. With the presence of such leadership, the territory can get through the crisis quickly:

1. Prioritise vaccinating all elderly as fast as possible, financially or otherwise incentivising them to do so. Take time to explain the death rates and risks (mostly unvaccinated, not surprising). Use the best mRNA technology where possible. The mainland has vaccinated elderly, Singapore has done this, HK can do this too.
2. Isolate the elderly, especially the unvaccinated ones, for as long as possible. Within the elderly community (care homes, etc) run "zero covid" or "reverse zero covid" where healthy ones are kept away from infected people. Don't have their choices wreck everyone else's lives.
3. Allow healthy and mildly ill people to recover at home. Yes, their families will get infected too. Yes, that's what happens everywhere else.
4. Incentivise testing across the population now that people are able to recover at home. Provide free testing of all types - at home rapid tests and free PCR tests. Legally require sick people to isolate at home.
5. After getting generally people out of the hospitals and treatment centres, they will be nowhere near as overloaded as they are today.
6. End the stupid flight bans and quarantine on arrival and replace with testing and home isolation, just like everywhere else, to help HK rebuild its business and economy.

It can be argued that this won't reopen the border with mainland China, but the rest of the country views HK as a foreign place when it comes to people movement and controls anyway: Months of zero cases already passed without the border reopening so in practice this makes no difference whatsoever. The border will reopen to HK when it reopens to the rest of the world, perhaps before under a new arrangement.

What will happen anyway?

The Omicron wave can't be stopped without a full lockdown for many months, because even a handful of remaining cases will rapidly escalate back into an outbreak. Such a lockdown at this stage will destroy what's remaining of Hong Kong's soul, people's lives, and kids' futures.

In absence of leadership, I fear the mainland will impose its way upon Hong Kong with movement controls, forced testing and lockdowns. It will further ruin its reputation as the free part of China that people come to do business. The mental health of the population and the economy will continue to decline.

Ironically, regardless of all of this, unless the mainland model is adopted 100% after an extraordinarily long lockdown, in about 6-8 weeks Omicron will have ripped through the population anyway and cases will start to decline naturally. Many elderly will die. However the government will claim victory in declining cases but in fact it will be mother nature that's done its job. The cynic in me worries that even after that, international travel won't be reopened, because there's a greater desire to be isolated for some reason.