Why China and Hong Kong face a devastating new Covid wave

East Asia once led the global charge against Covid-19, but the region’s defences are now struggling to keep the highly infectious omicron variant at bay. 

South Korea and Vietnam are chalking up the highest number of daily cases in the world, while China – which saw cases more than double on Tuesday, to 5,280 – has forced more than 50 million people back into stringent lockdowns. 

And in neighbouring Hong Kong, a “plane crash in slow motion” is unfolding, with apocalyptic scenes of the sick sharing hospital wards with the dead emerging as mortuaries are overwhelmed. It’s a dramatic shift for a city that had, until late last year, largely kept daily Covid-19 figures in the single-digits. 

But amid the spiralling case-counts, the contrast between the countries which used the time bought by restrictions and border closures to vaccinate the most vulnerable – and those that didn’t – is striking. 

Vaccines first

On Tuesday South Korea recorded its deadliest day yet of the pandemic, with 293 fatalities, and infections are surging as omicron spreads across a country with limited prior immunity – of the overall caseload of 7.2 million, 6.4m infections have been reported since February. This week has seen daily infections soar beyond 400,000 for the first time.

Yet health officials in the world’s tenth largest economy remain confident that the healthcare system will not be overwhelmed, as the government used the space it gained through stringent border restrictions to protect the most vulnerable. 

Covid deaths since January 2020 have only just breached 10,000 and the country so far has 17.6 fatalities per 100,000 people – compared to 285.5 in the United States and 237.5 in Britain – according to the Korea Disease Control and Prevention Agency.

Although serious and critical cases are now inevitably rising, more than 30 per cent of intensive care units remain available.

“Vaccines work to some extent to prevent infection, and to a much larger extent to prevent severe infection, hospitalisation, and death,” said Dr Jerome Kim, director general of the International Vaccine Institute in Seoul, pointing to Korea’s vaccination of more than 90 per cent eligible people.

Some 60 per cent have been boosted, particularly in the most at-risk groups, he said, adding that drugs including antivirals are also reducing the number of people needing intensive care. 

“Finally, Korea has a defined ICU capacity and an ability to increase that and a plan for isolation and “care at home” with escalating care for people who progress,” he said. “The country has never locked down, the vast majority of people are fully vaccinated, and many of us are watching and waiting to see when the numbers start to decrease.

“As for timing, omicron is a very difficult variant because of transmissibility, but it may be less virulent, so this approach, which keeps some aspects of distancing and mask wearing, may have some chance of success,” Dr Kim said. 

Lifting stringent restrictions

In February, as omicron hit, South Korea announced plans to drop its sophisticated test and trace system – which combined mass testing and rigorous contact tracing based on GPS monitoring – to focus on treating vulnerable priority groups like the over-60s or over-50s with underlying diseases.  The country also intends to remove quarantine mandates for fully vaccinated foreign travellers from March 21.

Dr Jung Jae-hun, who models disease forecasts for the government, said it was an inevitable “paradigm shift in policy” from containing the spread to minimising the damage.

“The government is actively administering oral therapeutics to high-risk groups, and the vaccination rate is very high, so it seems to be successful in suppressing the number of serious cases and deaths,” he said. “But despite this, South Korea is now seeing hundreds of deaths every day, showing the tragedy of the pandemic.”

However, the increase of the even more transmissible BA.2 sub-variant of the omicron strain, now making up 26.3 per cent of analysed cases, could impact the epidemic’s peak – currently predicted within one to two weeks.

Meanwhile Vietnam, which has seen daily cases averaging about 165,000 in the past week, also intends to loosen entry requirements for the vaccinated from this week after a two-year closure. 

On Sunday, country crossed the 200 million mark of Covid-19 jabs among its 97 million-strong population, and has administered a mixture of Western, Chinese and Russian vaccines, some 40 per cent of which have come from the Covax system.

With a double vaccination rate of about 80 per cent and hospitalisations under control, it has been able to shift away from its previous “Covid zero” strategy and ease social distancing restrictions, health officials said.  

Doubling down on ‘Zero-Covid’

China, however, which is now seeing its worst outbreak since the start of the pandemic, is doubling down on its ‘zero-Covid’ strategy and forcing more than 50 million people back into varying degrees of lockdown, including stay-at-home orders, across 13 cities nationwide.

Zhang Wenhong, a top Chinese medical expert, has raised the prospect of easing the strategy in the face of the omicron variant and, according to state media, the country is also starting to push vaccinations for the elderly as omicron spreads. But in the short term, at least, he warned any relaxation of mass testing and lockdowns was impossible.

Meanwhile, Shenzhen, the southern tech hub of 17.5 million people, has seen a return to lockdown panic buying, and Shanghai is sealing off entire neighbourhoods. 

But it is Hong Kong that paints the grimmest picture of the tragedy that can ensue from failing to adequately prepare for an explosion of cases while tightly clinging to a zero-Covid policy that cannot match omicron’s transmissibility rate – and experts say the city’s experiences should be a lesson for China.

“China has a smaller proportion of the oldest [unvaccinated] than Hong Kong, and ‘about 50 per cent’ is an improvement on ‘about 30 per cent’,” Paul Mainwood, a Covid analyst, wrote on Twitter. “But even allowing for that, the slow-motion car crash of Hong Kong looks ready to be replicated a bit slower and ~100 times bigger.”

Hong Kong has reported 4,066 deaths in the latest wave, which began on December 31. The seven-day rolling average of Covid deaths reached 285, setting a global record for the highest daily Covid death toll per million people. 

The fatality rate has been worsened by the dangerously high number of vaccine-hesitant elderly, who were once shielded by 21-day quarantine mandates for travellers arriving in the city. 

A potent reminder of the role of vaccines

Critics say that the government has focused on stringent restrictions at the expense of basic public health measures – especially boosting vaccine uptake. Though many hope the wave is past its peak, medical experts warn that the outbreak is far from over, as the number of cases in reality is likely much higher than the official figures.

Many residents are disinclined to report their own infections over fears of being sent to quarantine facilities. Pandemic fatigue among the public could also lead to a rebound in infection. 

Dr Julian Tang, Honorary Associate Professor and Clinical Virologist at the University of Leicester, said the current death rate in the mostly unvaccinated elderly in Hong Kong was similar to that in the UK’s first wave prior to the vaccine rollout.

“This is compounded by the widespread use of the CoronaVac vaccine, which has been shown to be relatively poorly effective against previous variants – and which produces no detectable neutralisation of Omicron,” he added.

“Ideally, Hong Kong needs to boost or vaccinate all their citizens with the mRNA vaccines to better control the spread of omicron – and consider moving away from a zero-Covid strategy.”

A new modelling study by the Chinese University of Hong Kong suggested even bleaker statistics than previous predictions – of the nearly 7.5 million population in Hong Kong, 4.5 to 5 million would contract the coronavirus by the end of the current wave and the death toll could reach up to 9,000.

“Given current situation in Hong Kong, it's astonishing that there's anyone still out there who thinks that not taking Covid seriously in 2020-21 would have worked out fine,” Dr Adam Kucharski, an epidemiologists and modeller at the London School of Hygiene and Tropical Medicine, wrote on Twitter.

“[Hong Kong] is a reminder of what happens when there's a large epidemic in a still susceptible population – so large epidemics in countries pre-vaccination wouldn't have ended well.”

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