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Hong Kong Omicron deaths expose limits of fraying zero-Covid policy World’s worst spike in coronavir

World’s worst spike in coronavirus fatalities shows impact of lower vaccination rates than regional peers

As countries in Asia have one by one abandoned the zero-Covid strategy that aims to completely eliminate the disease, Hong Kong has doggedly adhered to the policy.

Despite being one of the last torchbearers for zero-Covid, the Chinese territory is in the grip of the most deadly Omicron surge in Asia Pacific. In recent days Hong Kong has recorded the highest daily death toll in the world.

As morgues reach capacity, large freezer containers have been sent to public hospitals to store bodies. “We don’t have the knowledge and equipment to fight,” said Stephanie Law, an executive at Hong Kong’s Elderly Services Association, pointing out that 70 per cent of elderly homes were dealing with outbreaks.

A crucial factor driving the surge is that the vast majority of Hong Kong’s vulnerable population remains unvaccinated, despite the wide availability of jabs.

Ben Cowling, a professor of epidemiology at the University of Hong Kong, said the drive to protect older people by raising vaccination rates was “too little, too late”. “We’re catching up with the wave, when we could have been ahead of it,” he added.

Every country in the region has faced a rude awakening after two years of minimal Covid transmission but, unlike Hong Kong, most have been spared a wave of severe illness after using the time bought by zero-Covid to vaccinate large swaths of their vulnerable population.

As of Sunday, Hong Kong had registered 3,993 Covid deaths — three-quarters of which occurred in the previous 12 days. The territory’s seven-day rolling average of new Covid deaths has reached 284, or 38 fatalities per million residents, the highest such rate recorded anywhere in the world during the pandemic.

The city’s daily death rate has surpassed several European countries and now far outstrips that of nearby nations which abandoned their zero-Covid ambitions: it is 10 times greater than South Korea, 23-fold higher than Singapore and 37-fold higher than New Zealand.

The diverging paths of Hong Kong and its neighbours have brought the city’s fraying elimination strategy into sharp relief, forcing health experts to reassess the policy and highlighting the lethal impact of Omicron’s rapid spread in a non-immune population.

Singapore last summer became the first Asian country to abandon zero-Covid, before it was hit by a large wave of the Delta variant in the autumn, while New Zealand shifted away from the policy when the Omicron surge took hold in January.

“Public health measures and closed borders could only carry us so far, we knew that vaccination was the route back to normality,” said Rod Jackson, professor of epidemiology at the University of Auckland.

Both nations this month eased travel restrictions that were central to their previous zero-Covid strategies, yet Hong Kong’s strict controls on entering the city remain firmly in place.

Its adherence to a zero-Covid strategy has been driven in large part by the need to maintain links with the Chinese mainland, where eradicating the virus is still government policy. China, where around 40 per cent of over-80s are unvaccinated, is also contending with its worst Covid outbreak of the pandemic.

The local government failed to motivate older and vulnerable Hong Kongers resulting in low vaccination coverage, particularly among care home residents. Confusing public health messaging, media panic as well as a policy of advising those with chronic illness to seek medical advice before getting inoculated slowed the roll out.

In early February, 69 per cent of Hong Kong residents aged 80 and above were unvaccinated. The equivalent figures in Singapore and New Zealand were 6 per cent and 2 per cent, respectively.

“Hong Kong is a unique exemplar of having early and sustained, privileged access to vaccines — and yet people shunned them,” said Prof Gabriel Leung, dean of medicine at the University of Hong Kong.

Leung said there was “less self-perceived urgency for older people to get vaccinated” because of the city’s Covid-free status, adding that potential side effects for people with underlying health problems were also “magnified” by some healthcare professionals.

The problem is compounded by the fact that of the 31 per cent of elderly Hong Kongers who have had at least one dose of a vaccine, more than two-thirds have had Sinovac, the Chinese-made vaccine. One or two doses of that vaccine offers negligible protection against Omicron. The remainder have had the more effective BioNTech vaccine which is distributed by China’s Fosun Pharma.

Since Omicron began, every Covid case has been between 20 and 50 times more deadly in Hong Kong than in peer countries. Five per cent of cases in Hong Kong have resulted in death, compared with 0.3 per cent in South Korea, 0.2 per cent in Japan, and 0.1 per cent or less in Singapore, South Korea and New Zealand.

The varying degrees of pressure felt by their respective health systems highlights a widespread point of confusion over Omicron’s mildness, according to Prof Michael Baker, an adviser to the New Zealand ministry of health.

“Omicron is milder than Delta, but it’s not mild by any stretch of the imagination,” said Baker. “It’s really less severe because of the vaccines and the boosters. Without them, we’d all still be in a whole lot of trouble.”

The latest data suggest Hong Kong, New Zealand and Singapore have now all passed the peak of infections from the Omicron wave.

“New Zealand’s success compared with Hong Kong is a reminder that the three most important defences against the pandemic are: vaccination, vaccination and vaccination,” said Prof Jackson. “It’s the only sustainable intervention.”

Additional reporting by Tabby Kinder in London