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6 min read . Updated: 09 Mar 2022, 05:53 PM IST City was caught unprepared for a massive increase in cases as elderly vaccination rate remained low after monthslong stretches of zero infections
Almost a year ago, Rio Ling decided to hold off on vaccinating his 86-year-old father against the coronavirus because he was more worried about possible side effects than the virus itself, given that Hong Kong had kept cases low under its “Zero-Covid" policy.
By the time he gave the go-ahead in January, after the Omicron variant had broken through the city’s defenses, it was too late. A few hours after finally receiving the inoculation in late February, Mr. Ling’s dad, who has high blood pressure and dementia, tested positive for Covid-19.
Half a million people over 70 weren’t vaccinated when Omicron began surging through the city. Like other places, Hong Kong gave its elderly priority to get their shots, but persistent fears about vaccine safety, fueled by local media reports about deaths following vaccinations, and Hong Kong’s low case count led many to delay.
“For such a long time, getting the vaccine seemed more risky than getting Covid here," Mr. Ling said. “Now, everything’s changed and there is a scramble to get the shots." His father is recovering, he added.
The low vaccination rate among the city’s elderly has driven Hong Kong’s death rate to the highest in the world: Its seven-day rolling average of confirmed Covid-19 deaths as of March 6 was 25.5 per 1 million people—more than five times that of the U.S.—and topping a global chart maintained by Our World in Data, a project based at Oxford University.
More than 90% of people who lost their lives in the current outbreak were unvaccinated, health officials have said. The vast majority were aged over 60. On Wednesday, the city’s chief executive, Carrie Lam, said her government’s priority now will be to protect the elderly and reduce deaths and severe sickness from infected cases, delaying a plan for mandatory citywide testing to an unspecified date.
As the number of sick has mushroomed, Hong Kong is engulfed in a crisis that it sought to avoid by isolating itself from the rest of the world using strict travel restrictions and quarantines. Help lines go unanswered, ambulances take hours to come, patients cram into hospitals and mortuaries are running out of space. In one instance, a woman had to bring feeding tubes for an elderly relative being treated for Covid-19 at a public hospital. Cases are rampant in the city’s crowded housing developments and nursing homes, which have accounted for about 60% of deaths.
Hong Kong, many health experts say, has contributed to its own predicament by squandering months of zero cases without preparing enough for an inevitable large-scale outbreak.
“We simply did not do enough to protect our most vulnerable citizens," said Karen Grépin, an associate professor at the University of Hong Kong’s School of Public Health.
Public health experts repeatedly told the government it needed to do more than rely on strict border controls and contact-tracing. They urged an exit plan from Zero-Covid policies such as the one Singapore developed: Open up slowly once the most vulnerable are protected with vaccines to keep fatalities low.
Singapore’s vaccination rate was higher than 90% for those over 70 years old as of mid-February, bolstered by restrictions on the unvaccinated, mobile vaccination teams and even home visits. The death rate per million in Singapore, which is also currently gripped by an Omicron wave, was about 1/13 that of Hong Kong’s in the week to March 6, according to the Oxford data set.
Hong Kong’s Civil Service Bureau, which runs the vaccination program, said it has undertaken proactive and vigorous measures to encourage vaccinations among the elderly, including publicity campaigns and setting up mobile stations.
Omicron’s spread in densely populated Hong Kong was fierce. In 2020 and 2021 combined, the city logged 13,000 cases and 213 deaths. Since the latest outbreak began in late December, the city of 7.4 million people has logged more than 500,000 cases—a number health officials acknowledge is vastly undercounted due to testing bottlenecks—and 2,365 deaths.
The wave of fatalities offers a warning for mainland China as Beijing begins to explore ways out of its Zero-Covid strategy. Although almost 90% of China’s population is fully vaccinated, barely half of the country’s 35.8 million citizens aged over 80 year are, according to official data.
The biggest criticism leveled by public health experts against officials in Hong Kong is that they didn’t do more to push the elderly away from a wait-and-see stance.
While Hong Kong’s private companies offered apartments and raffles to incentivize inoculations last year, it was only after Omicron began spreading that government officials introduced plans for a vaccine mandate. From Feb. 24, unvaccinated residents have been barred from restaurants, supermarkets and shopping malls, a measure that helped spur an uptick in numbers of those seeking vaccines.
Wong Siu-fan, an 80-year-old woman, said it prompted her to finally book her shot, which she had delayed because she was worried about the side effects.
“Who would have known the outbreak would be so bad?" said Mrs. Wong, leaning on a cane outside a vaccination center on Feb. 22. “I gave in because the new rules meant daily life would become so bothersome without the vaccine. And now, I’m also really scared of getting Covid."
Many residents opted to wait in part because local media and government news releases initially highlighted the deaths of anyone who had been vaccinated, either with a vaccine co-developed by BioNTech SE and Pfizer Inc. or CoronaVac from China’s Sinovac Biotech Ltd.
In one instance, a newspaper reported that a man who drowned while swimming had been vaccinated two months earlier—events that were clearly unrelated—said Dr. Grépin, the health professor.
The government put out news releases for a time in the weeks after vaccines first became available in the city that noted deaths or medical issues that it termed “suspected serious adverse events following Covid-19 vaccination."
Public fear of vaccines escalated and lingered through the pandemic.
Government officials in Hong Kong also suggested residents should speak to their doctors before getting vaccinated if they had concerns.
A whole industry of “pre-Covid-19 vaccination" health checks was created, a phenomenon that Dr. Grépin said she hadn’t seen elsewhere. Such checks led some elderly people to opt for elective surgery, such as heart procedures, months before they would consider the vaccine again, exasperated healthcare officials say privately.
With isolation centers and hospitals beyond capacity, the city’s cramped nursing homes are facing the brunt of the city’s outbreak.
About 60,000 elderly people live in nursing homes in Hong Kong, which has one of the highest life expectancy levels in the world, at 82.9 years for men and 88 years for women in 2020. Some sleep in dormlike rooms and share bathrooms, while care worker numbers are dwindling as more get infected.
As of Tuesday, Omicron had found its way into nearly 87% of the city’s 800 nursing homes. And without enough spaces to properly isolate the infected, it is continuing to spread.
Officials said Friday they would give priority to vaccinating the elderly in the coming two weeks and transferring infected elderly people into isolation. Many nursing home operators say help can’t come fast enough.
“We have to race against time and Omicron," said Stephanie Law, who runs several elderly homes in the city, adding that many of her colleagues feel exhausted and helpless. “We are losing."
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