Covid-19 cases in Hong Kong are spiking as the omicron variant spreads. But unlike some other places, Hong Kong also has a high number of severe cases, overwhelming hospitals so the number of deaths is soaring.
The main reason is that too few of the older people in Hong Kong are vaccinated. The failure to vaccinate the most vulnerable seems to be a result of trying to please China. Hong Kong continues to pursue a “dynamic zero-covid” strategy that focuses on testing.
“As long as Beijing insists on zero covid, Hong Kong will insist on zero covid – even though it makes no sense whatsoever and they know it,” says at SOAS University of London.
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Hong Kong has reported nearly half a million cases this year, with most occurring in the last week or so. The total number of deaths has shot up to more than 2000, with scenes at hospitals reminiscent of the early pandemic. “We’ve got people who are not able to get into hospital,” says David Owens, a family doctor in Hong Kong. “This is a public health disaster.”
In stark contrast, New Zealand, which also pursued a zero-covid strategy until recently, has so far reported only five deaths during its omicron wave, and 71 covid-19 deaths for the entire pandemic. On 7 March, New Zealand had 13 people with covid-19 in intensive care.
The difference is vaccination. In New Zealand, the highest rates of vaccination are among the oldest. Nearly 100 per cent of people aged 80 or over have had at least two doses. The main vaccine being used is the Pfizer/BioNTech one.
In Hong Kong, vaccination rates are highest in those under 60. Only 30 per cent of people aged 80 or older are vaccinated. “This is the fundamental driver of our fatality risk,” at Hong Kong University.
Plus most of those over 60 had Sinovac Biotech’s CoronaVac vaccine, which is less effective against omicron than the Pfizer/BioNTech one. In younger groups, most had the Pfizer/BioNTech vaccine.
Hong Kong could afford to buy the best available vaccines for its 7.5 million people, says Tsang. “The only reason Hong Kong is using the Chinese vaccines is for a weak government to demonstrate its loyalties to the Chinese Communist party,” he says.
There are several reasons for the low vaccination rates in the oldest people. The main problem, says Owens, is that the government never put its weight behind vaccinating the elderly. Other reasons include some doctors telling vulnerable people not to get vaccinated and unfounded scare stories in local media.
Even now in the middle of a massive wave, the main focus is on trying to test everyone in Hong Kong rather than on getting the oldest people vaccinated.
For mainland China, sticking with zero covid is the right approach, says Owens, because it has the capacity to do this. But Hong Kong lacks that capacity, one key reason being the low level of trust in its government, says Tsang.
Since June 2021, Owens has been calling for the focus to shift to vaccination. “I’ve been banging this drum for months,” he says. “It’s been obvious.”
Two other things contributed to the current crisis. First, until recently, Hong Kong had been extremely effective at protecting the vulnerable, with hardly any flu deaths in the past two years due to covid-19 precautions. There are now more older people than usual who are extremely vulnerable to infections, says Owens.
Second, as the omicron wave began, authorities told people who tested positive to go to hospital for isolation. That took up what little spare capacity there was. Now, more people are dying because they aren’t getting proper care.
Contrary to some claims, there is no reason to think a more dangerous variant is to blame in Hong Kong. The BA.2 omicron variant in Hong Kong does have one extra mutation but this isn’t thought to be significant. BA.2 variants with the same mutation are present in other countries including Singapore and Australia.
Owens thinks Hong Kong’s omicron wave has already peaked, but could yet result in 7000 or even 10,000 deaths. This means Hong Kong could go from having one of the lowest covid-19 death rates worldwide to perhaps more than 1000 covid-19 deaths per million.
That is far less than countries such as the UK and the US, with more than 2000 covid-19 deaths per million, but higher than countries such as Denmark and Canada.
“We were up there competing for the gold medal with Singapore, New Zealand, China and others and we’ve just completely blown it,” says Owens. “We’re going to end up mid-table.”
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