Hong Kong’s 21-day quarantine requirement, among the toughest Covid-19 prevention measures worldwide, will remain in place for at least several more months as the city aims to maintain zero infections to enable a full border reopening with the mainland.

Secretary for Food and Health Sophia Chan said on Sunday (December 12) that the requirement for Hong Kong residents returning from more than 70 countries to undergo 21-day quarantine had fulfilled local people’s expectations and successfully identified and contained five Omicron cases so far.

Although hundreds of thousands of Hong Kong people have recently expressed interest in visiting the mainland without quarantine, questions remain over why the Hong Kong government cannot shorten the quarantine period for incoming travelers to 10 or 14 days, considered widely as a long enough period to identify nearly all imported cases.

Some mental health experts, meanwhile, say people could get traumatized by such a long period in cramped quarantine rooms. Hong Kong’s lower-end hotels are notorious worldwide for their cramped, matchbox-sized rooms.

Since Covid-19 first started its lethal global spread in late January 2020, Hong Kong has continued to tighten its quarantine measures to prevent imported cases. Initially, the city required people to be quarantined at home for 14 days. In late 2020, it required people to be isolated at designated hotels for 14 days, plus a seven-day home quarantine.

After Hong Kong was hit by a fourth viral wave between November 2020 and February 2021, the city’s government put a dozen countries, including the United Kingdom and the United States, onto a “high-risk” country list and required people arriving from them to undergo 21-days in quarantine.

With the rise of more contagious mutant strains such as Delta and Omicron, the number of nations on Hong Kong’s high-risk list has grown to 75. Only fully-vaccinated Hong Kong residents are allowed to travel from these countries to Hong Kong.

With the rise of Omicron, people from the US and 12 African countries must be isolated at quarantine camps for a week before they can finish the remaining 14-day quarantine period at hotels. Apart from these, newly-arrived domestic workers and flight crews also have to stay at quarantine camps.

On the mainland, all incoming travelers are required to be isolated at hotels for 14 days, plus a seven-day home quarantine. In Taiwan, travelers need to be quarantined at hotels for 14 days only.

The Hong Kong government previously said it implemented the world’s toughest quarantine rules as the city pursued a “zero Covid” policy to resume quarantine-free travel with the mainland.

Asked by reporters whether Hong Kong would lose connections with the wider world due to its stringent quarantine rules, health official Chan said on Sunday that the government would maintain the measures as they could protect the city from the Omicron strain.

At present, there are 11,500 quarantine hotel rooms in Hong Kong, meaning the city can receive around 550 travelers from flights per day on average. It’s a less than welcoming stay.

People can choose to stay in a 10-square-meter room for HK$530 (US$68) per night, a 34-square-meter room for HK$990, or a 40-square-meter room for HK$1,200 with a sea view. A presidential suite with three bedrooms and a kitchenette can cost as much as HK$28,800 per night.

An Asia Times staff member who is currently staying at the cheapest room option said he could not complain about the food and environment due to the low cost, but he needed more space for physical exercise, more fresh air and a proper desk, chair and lamp for using his laptop.

Three meals a day at a quarantine hotel in Hong Kong

In Hong Kong’s quarantine hotels, all the windows are locked as health experts believe open windows could suck air with coronavirus into the room.

The minimum cost of a quarantine hotel room is HK$530 per night

Dr David Owens, an honorary clinical assistant professor in family medicine at Hong Kong University, wrote in an article titled “Is Hong Kong’s 21-day quarantine evidence-based or justified?” in October and answered “no.”

“There is no scientific evidence to support 21-day quarantine. It is neither evidence-based nor proportionate and is almost certainly doing more harm than good,” he wrote. “Why not do simple things with minimal cost which may help? When it comes to locking people up and withdrawing rights of movement there must surely be a high threshold of both evidence and proportionality.”

Owens pointed out that in the three months between June and August 2021, Hong Kong reported 188 imported Covid cases of which 185 (98.4%) tested positive at or before day seven.

He said one of the two people who tested positive on day 19 was discharged from a hospital within three days, while the other could have contracted the disease during quarantine. He said scientific evidence on Covid supported an optimal quarantine period of 10 to 14 days.

Ivan Hung, chief of the Infectious Disease Division at the University of Hong Kong, said whether Hong Kong should relax its quarantine rules for international travelers would depend on the global epidemic situation with the rise of the Omicron strain. Hung said he expected more information would be available in January and February on the new variant.

A recent survey commissioned by the Society of Hospital Pharmacists of Hong Kong and conducted by the Hong Kong Public Opinion Research Institute showed that many Hong Kong people had already mentally prepared to “live with the coronavirus.”

With 10 marks representing full acceptance of a “living with the coronavirus” strategy and zero representing the opposite, the median was 8.1, according to the survey, which collected opinions from 5,000 people between October and November.

In fact, many people may have underestimated the mental angst they would feel when staying in a cramped quarantine hotel room.

“Whether it’s a camp room or a hotel room, self-isolation in any room for 21 days away from the outside world and human touch is abnormal and has negative health impacts,” Gira Patel, a Hong Kong-based mental health counselor, wrote in an article in May. “We are social beings and our brains need daily social stimulation for our general wellbeing.”

A woman undergoes a Covid-19 test at a mobile specimen collection station in Hong Kong on May 3, 2021.

Patel said she had not traveled to see her family in the UK for nearly two years because she did not want to be locked up in a hotel room in Hong Kong for three weeks. She said people could suffer from “quarantine trauma” after isolation, especially those with pre-existing mental health issues.

“Whilst some may choose to do some yoga or watch Netflix while in quarantine, it’s not the same as being forced to have to do that because your choice to do pretty much anything else has been removed,” she added.

The Hong Kong government has so far not responded to questions about the medical grounds for the city’s 21-day quarantine requirements and the mental and physical needs of those who are locked in at designated hotels.

A total of 390,000 people in Hong Kong had registered as of Monday noon for a newly-launched health code system, meaning they are interested in visiting the mainland if quarantine-free travel between Hong Kong and the mainland is allowed later this month. Officials have previously said the border reopening would kick off later this month.