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Thursday, Jun 30, 2022

Experts call for Hong Kong to consider ‘living with Covid-19’ in face of fifth wave

Experts call for Hong Kong to consider ‘living with Covid-19’ in face of fifth wave

Recent surge of infections has experts agreeing ‘dynamic zero-Covid’ cannot go on indefinitely. Low take-up of vaccines, particularly among elderly, remains a cause for worry, authorities say.

When Hong Kong set a daily record of 164 Covid-19 infections last Thursday, officials were forced to confront the previously unthinkable: had the time finally come to dump the city’s “dynamic zero-Covid” strategy and move towards “living with the virus”?

More local health experts back the idea, saying it made sense for a variety of reasons, including the availability of vaccines, the apparently milder effects of the Omicron variant of the coronavirus, the shortage of hospital beds and quarantine spaces, and the fact that the city’s fifth wave of infections was already sweeping through the community.

By Thursday evening, even Chief Executive Carrie Lam Cheng Yuet-ngor appeared to be moving in that direction.

She shortened the city’s notoriously tough 21-day quarantine for travellers to two weeks, extended the use of a vaccine pass for entry to restaurants and entertainment venues from February 24, and announced mandatory vaccination for elderly people applying for care home spots.

An insider told the Post the government was considering going further, to include shopping malls and public transport in the vaccine pass scheme, barring entry to those who are unvaccinated.

For now, however, Lam said Hong Kong did not have the prerequisites for living with the virus, and she meant the city’s vaccination rate was still too low.

As of Sunday, 5.3 million people, or 79 per cent of the population, had received their first vaccine jab, about 4.8 million (or 71 per cent) had their second and only 951,157 (or 12 per cent) had their booster shot.

Among elderly residents, 59 per cent of those aged 70 to 79 had their first jab, 48 per cent had their second, and 8 per cent their third. For those over 80, only 31 per cent had received their first dose, 20 per cent their second, and 1 per cent their third.

“I cannot stand the thought of seeing a lot of old people dying in my hospitals,” Lam said. “We will try our very best to raise the vaccination rate. If it reaches the target of 90 per cent, that will be the moment for us to consider some adaptation to our existing policies.”

She conceded that “dynamic zero infection” was mainland China’s strategy, meaning infections were tolerated as long as the outbreak could be contained as speedily as possible by pandemic measures in place.

That strategy, critical to Hong Kong’s desire to reopen its border with the mainland, meant imposing some of the strictest quarantine and social-distancing measures in the world, but also helped the city keep down the spread of Covid-19 in the community.

Hong Kong officials have clung steadfastly to their tough approach even as many countries switched to “living with the virus” and eased pandemic restrictions, including quarantine requirements for travellers.

Then everything changed swiftly.

In December, two airline crew members infected with the fast-spreading Omicron variant triggered an outbreak in the city after they broke their home isolation rules.

Next, a woman traveller who is believed to have contracted Covid-19 at a local quarantine hotel passed the virus to her husband, who in turn is believed to have passed it to some cleaners at Kwai Chung Estate, sparking a superspreader event there that has since grown to more than 400 infections. Three of the hardest-hit blocks there were locked down for up to seven days, causing chaos for residents.

The city also faces a new threat from the more vicious Delta variant of the coronavirus. In January, officials culled more than 2,000 hamsters imported recently from Europe, blaming infected pets for a cluster of 65 human infections to date. On Saturday, University of Hong Kong (HKU) scientists published a study confirming the transmission of the virus from hamsters to humans.

When the city reported 164 confirmed Covid-19 cases last Thursday, the number eclipsed the previous daily high of 149 recorded 18 months ago.


Covid is here to stay’

For Dr Siddharth Sridhar, a clinical assistant professor at HKU’s Department of Microbiology, it is no longer a question of if, but when Hong Kong switches to living with the coronavirus.

“Everybody is going to have to walk down this road eventually. Covid is not going to go anywhere. It is a new respiratory virus and it is here to stay,” he told the Post.

“We are in a better position to consider opening up than we were at any point earlier in the pandemic, so 2022 is actually a good opportunity to do so.”

Even Professor Yuen Kwok-yung, the usually hawkish government adviser who has been influential in shaping the city’s anti-pandemic policies, hinted at change last week after visiting Omicron-hit Kwai Chung Estate.

“I hope our contact tracing can keep up and pull even with the transmissibility of Omicron, so we can return to a state of dynamic zero infections. If we really can’t, we may have to consider other possibilities,” he said.

He conceded that the city’s purpose-built isolation facilities could not handle the 35,000 residents from the sprawling estate, leaving home quarantine as their only option.

But that resulted in massive disruptions, with chaos in testing, meal deliveries and even rubbish collection. There were complaints that residents who tested positive had to wait 35 hours or more to be moved to hospital, and some became infected during the lockdown itself.

Amid the surge in patient numbers, the Hospital Authority, which runs the city’s public medical facilities, announced it would add 500 isolation beds at AsiaWorld-Expo, on top of 662 already occupied in 14 hospitals.

HKU’s Sridhar made waves on social media last week with a Facebook post criticising the government’s mass culling of hamsters because its current approach meant that any risk of an outbreak was totally unacceptable.

He noted that the zero-Covid strategy was the city’s rallying cry from 2020 to the middle of last year as it aimed to keep infection numbers down while awaiting effective vaccines.

But two years into the pandemic, “as long as Hong Kong has to adhere to zero-Covid, expect things to get worse before they get better”, he said.

“For the rest of the world, 2022 is the beginning of the end of the pandemic. For Hong Kong, it is just the end of the beginning,” he added.

Sridhar said he believed the arrival of vaccines and other factors made “living with the virus” possible.

“We know that three doses of Covid-19 vaccine offer fabulous protection against severe Covid, as well as decent protection against Omicron,” he said. “We have great treatment protocols for early Covid-19 to prevent people progressing to severe Covid. And Omicron is at least inherently slightly less virulent than Delta.”
Official patient profiles appear to support his views.

The Hospital Authority said on Saturday that all 662 patients currently in its care were stable, and the condition of only one patient infected with Omicron became serious. The median length of stay for patients with Omicron was 15 days, and there were no deaths in recent weeks.

Professor David Hui Shu-cheong, another government pandemic adviser, told the Post that none of the dozens of Omicron patients at his Prince of Wales Hospital had pneumonia or needed oxygen support, even though some could still produce high viral loads.

“Their symptoms are very mild, perhaps because most have been vaccinated,” he said.

This is a stark contrast with the situation before Omicron arrived.

Professor Benjamin Cowling, HKU’s chair professor of epidemiology, who reviewed 9,098 local infections mostly in the pre-Omicron period before April 2021 and before widespread vaccination in Hong Kong, estimated the overall risk of death to be 2.3 in every 100 people.

The risk of death grew sharply among the elderly, with those aged between 70 and 80 at 8.8 per cent and those above 80 reaching 34.5 per cent.

Cowling has also been vocal about the “unsustainability” of zero-Covid as a policy. “The mainland may be even more stringent than Hong Kong, yet there are still outbreaks there from time to time,” he said.

Sridhar, however, conceded that Hong Kong’s vaccination rates, particularly among the elderly, remained less than desirable, and more needed to be done to get Hongkongers vaccinated.

“Two years into the pandemic, there’s got to be some kind of ‘inconvenience’ for people who are unvaccinated,” he said.

Access to certain premises should be granted only to those who have had two doses of the vaccine, he said, not merely a single jab as proposed by the government.

But he would not go as far as making vaccination mandatory.

“As a doctor, I hate mandatory health interventions. People have the right to choose. Instead, we have to work with people, we have to empower people to make the best decision for their health,” he said.


No ‘surrendering’ to Covid, some say

Despite the signs pointing to “living with the virus” as the better option, some quarters in Hong Kong might still oppose such a move.

No politicians in the pro-establishment camp that now dominates the Legislative Council support change. They insist that sticking with dynamic zero-Covid is the way to persuade Beijing to reopen the border without quarantine requirements.

New medical sector lawmaker David Lam Tzit-yuen declared last week that changing the policy would amount to “surrendering” the fight against Covid-19.

The debate over a possible policy change heated up after former Hospital Authority chief executive Dr Leung Pak-yin, who led the city’s fight against the severe acute respiratory syndrome (Sars) epidemic of 2003, took to Facebook last week to argue for a shift to a “mitigation strategy”.

“I believe colleagues in the Department of Health and the Hospital Authority know very well the current state of spread of the pandemic. Having reached this stage now, the containment policy is no longer suitable nor sustainable,” he wrote.

He called on the experts to urge policymakers to increase incentives for vaccination to “end the pandemic”.


His remarks prompted Dr Leung Chi-chiu, a former chair of the Medical Association’s advisory committee on communicable diseases, to comment on the post, saying: “We cannot allow our health care system to collapse by lying flat now.”

Leung shot back, saying the city was already in “phase-one mitigation” by locking down Kwai Chung Estate residents at home instead of at quarantine centres. He added that lockdown measures should also differentiate between those who were vaccinated and those who were not.

Expressing his resistance to changing tack, Beijing loyalist and lawmaker Junius Ho Kwan-yiu went so far as to declare in a live-streamed Facebook video that pushing for “living with the virus” contravened the national security law.

“If someone bearing ill will tries to spread the virus through illegal means to cause infections and deaths, it would be biological warfare,” he said.

Responding to media inquiries, however, a government spokesman said general discussion on the effectiveness of the city’s dynamic zero-infection approach did not violate the national security law.

Government adviser David Hui, who saw no reason to rush a change of policy, said it was sensible to cut the quarantine period for incoming travellers from 21 days to 14.

He revealed that the Hospital Authority had found the median incubation period for Omicron-infected arrivals to be four days, while the longest so far was 10.

As antibody levels waned over time and only a low number had taken their third dose of vaccine, he said the city should wait until second-generation vaccines became available and boosted Hongkongers’ immunity sufficiently before moving to living with the virus.

Gauging public opinion, a Democratic Party poll last week found 65 per cent of respondents were in favour of the government studying or preparing for a change of strategy, up from 42 per cent in November. Nearly a third were now prepared to accept between 1,000 and 10,000 daily infections, compared to well below a fifth before.

“More residents agree ‘living with virus’ is the right strategy to deal with the pandemic now and are willing to bear the societal cost,” said Ramon Yuen Hoi-man, the party’s health spokesman.

However, in a survey conducted between January 24 and 28 by the Bauhinia Institute, a pro-Beijing think tank based in Hong Kong, the results were reversed, with two-thirds of 1,063 respondents believing the “dynamic zero-Covid” strategy was more compatible with the city’s interests.

While not advocating overnight change, HKU’s Sridhar said that in the not-so-long term, Hong Kong would have no choice.

“We have to walk down this road,” he said. “It’s time to get our act together, come up with policies to mitigate the impact of the Covid-19 wave in Hong Kong and get on with it.”
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