In what can serve as important lessons for global health systems, the surge of COVID-19 cases in China and Hong Kong despite their strict “zero-COVID” strategies points to the need for adaptive and responsive policy measures instead of blanket bans and stringent lockdowns. The two countries are seeing their largest spike in COVID-19 cases in more than two years, despite committedly pursuing amongst the strictest virus elimination policies in the world.
China, the country where the novel coronavirus was first detected in 2019, is among the last remaining countries to attempt to stop community transmission of COVID-19 as soon as it is detected, through the “zero-COVID” approach as it is called. Hong Kong, too has been following a similar approach from the beginning. Among other measures, China’s strict zero-COVID policy means stringent lockdowns and hospitalization of all positive cases.
China’s zero-COVID strategy served it well in containing the spread of the virus in the early phase of the pandemic is now losing strength as the country records the highest infection caseload since February 2020. The omicron variant is driving the surge in parts of China to levels not seen ever since the pandemic first broke out. Trying to contain the case numbers at this point means continued disruptions and lockdowns, at a time when much of the world is reopening. This is causing repeated setbacks to the economy of both mainland China and its independent governed territory and global financial hub Hong Kong.
The daily caseload in China started rising steadily beginning the last week of February and from less than 200 cases a day, the graph has sharply climbed to over 16,000 reported daily cases as on April 5. In Hong Kong, daily new cases were well under a 100 before they started rising sharply at the end of January and seemed to have peaked in early March at a whopping 67000 plus cases on March 5. During this time, Hong Kong has reported one of the highest daily death rates in the world, particularly among unvaccinated elderly residents.
China was praised at the beginning of the pandemic for its efforts in almost completely eliminating the virus. And yet, two years later, the strategies needed to keep case numbers at the minimal are evaded by the more virulent, vaccine-evading omicron variant. While in vaccinated individuals, the variant has been shown to cause less severe illness, the unvaccinated elderly population has taken the worst hit in both China and Hong Kong.
The government’s restrictions in response to the crisis have driven the economy back into contraction. Early in the surge, the government banned flights from nine countries, including the US and the UK, tightened social distancing to groups of two people and shut schools. Though Hong Kong kept COVID-19 at the minimum throughout much of the pandemic, the highly transmissible omicron variant eventually broke through the city’s defences, which have included some of the world’s toughest border restrictions.
The resulting surge in infections has overwhelmed the public healthcare system, stretching the capacity of isolation wards, intensive care facilities and mortuaries to their limit. Patients are routinely turned away from hospitals, while high-risk elderly admissions have been left waiting outside. Moreover, Hong Kong’s zero COVID strategy, implemented to align with mainland China, has resulted in an exodus of foreign businesses and talent. Hong Kong has seen a net outflow of almost 157,000 residents since the beginning of the year, according to immigration data.
The stringent methods implemented to maintain zero COVID while not putting enough focus on vaccinating all eligible population have invited criticism from multiple quarters. The virus is becoming more transmissible but less lethal, leaving health authorities more challenged to maintain zero COVID. At the same time, people have strong lockdown fatigue and the economy has been hit harder than before. The latest round of quarantining is China’s largest since the coronavirus outbreak was first identified in Wuhan at the end of 2019.
When Hong Kong was hit by its deadliest wave at the start of the year, driven by the omicron variant, authorities implemented a tightly-enforced two-person gathering limit, dining curfews, bar and gym closures, and a return to remote learning at schools. The measures came on top of strict travel restrictions in place to various degrees since March 2020, including flight bans for “at risk” countries and up to 21 days of mandatory hotel quarantine for incoming arrivals.
Lockdowns in some form or other have affected tens of millions of people living in China too, over the past month, leading to considerable economic disruption.
The unexpected speed of the virus transmission far exceeds contact tracing and other conventional public health measures. Moreover, the general public is experiencing COVID induced lockdown fatigue that have continued on and off over the past two years.
China on April 5 reported 16,649 new coronavirus infections, the highest number since the peak of the first pandemic wave more than two years ago. Outbreaks of the disease, have now hit more than a dozen provinces, with Shanghai the worst-affected region. However, the current outbreak is unlikely to change the dynamic zero-COVID policy in the near future. The government is likely to stick with zero COVID strategy.
The city of Shanghai with its 25 million people, has been under lockdown for days. It has registered 70 percent of the national infection caseload amid mass testing. Thousands are in state quarantine, while health workers are reaching the limits of their capacity. The current lockdown could turn out to be costly for the world’s second largest economy as Shanghai is a hub for semiconductor, electronics and car manufacturing. It is also the world’s busiest shipping port.
Critics have highlighted Hong Kong’s insistence on sticking with an elimination strategy to align with Beijing as a misstep that fuelled complacency and poor preparation in the run-up to the inevitable outbreak.
Experts believe that even if China and Hong Kong do manage to achieve zero Covid with exceedingly high cost, another accident might cause another major surge. The world now largely believes in living with the virus as the only viable option. A large part of “living with the virus” is to do with an effective vaccine. Government officials have begun talking openly about mRNA vaccines in the recent times.
The shift from the stringent zero-COVID policy to living with the virus requires a transition for such official messaging and public health education, and also learning from both successes and failures of other nations’ response to COVID,
On March 18, health officials told a press conference that only about 51 percent of Chinese citizens over the age of 80 have received two doses of a vaccine, while only around 20 percent of the same group have received booster shots. Data shared by officials also shows that China’s vaccination rate drops with age. Moreover, only about 30 per cent of Hong Kong residents over 80 have been double vaccinated despite vaccines being freely available for more than a year, amid widespread vaccine hesitancy among the elderly. A study released by scientists at HKU this week shows that two doses of China’s Sinovac vaccines offer only a moderate level of protection against severe symptoms or death caused by coronavirus infection while a booster shot can enhance the protection significantly.
Even as much of the rest of the world opens borders and eases restrictions, China still looks unlikely to shift away from its strict approach to the coronavirus. Because of the initial success of the strategy, the majority of the population within China still favour the zero-Covid policy, despite the increasing economic costs. However, the government has been working on easing policies from both fiscal and monetary front which have the potential to stabilise the domestic growth momentum for the time being, and ensure that China maintains it supply chain to minimise the global interruption of supply chain.
Photo Credits: Al Jazeera