For more than two years, Hong Kong managed to keep out the novel coronavirus. Thanks to China’s extremely strict limits on crowds and travel—the so-called “COVID Zero” approach to the pandemic—daily new cases in the city of 7.5 million rarely exceeded a hundred, even during the worst global surges.
Then came Omicron. Starting in January, the extremely transmissible new variant of the SARS-CoV-2 virus punched right through Hong Kong’s restrictions. Authorities logged a record 3,570 new infections on Monday—and a record 30 deaths on Sunday.
“We did really well in keeping COVID variants out of Hong Kong between April and December 2021, but our luck finally ran out over the new year,” Ben Cowling, a professor of epidemiology at the University of Hong Kong, told The Daily Beast. Now hospitals are filling up. Testing sites are overwhelmed. City leaders are getting desperate.
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Omicron’s takeover in Hong Kong underscores the flaws in the COVID Zero strategy. Locking down entire populations delays, but doesn’t entirely prevent, viral transmission. And when the pathogen finally finds transmission pathways, there’s very little natural immunity to slow its subsequent spread.
But as bad as COVID is in Hong Kong right now, it’s possible much better days are coming. Some epidemiologists are cautiously optimistic that this is Hong Kong’s “exit wave”—a final surge in cases before the virus becomes “endemic.” That is, manageable without major restrictions.
Hong Kong’s initial success against COVID is all the more striking because the pandemic originated just 500 miles away in the city of Wuhan back in December 2019. Once it was clear just how deadly and transmissible SARS-CoV-2 was, China locked down hard.
There were periodic citywide lockdowns, widespread business and school closures, and strict limits on travel into and out of the country. This COVID Zero approach made sense in the early months of the pandemic when the virus was still poorly-researched and COVID-specific therapies and vaccines weren’t yet available.
But China largely stuck with COVID Zero for the next two years, even after health officials authorized the world’s first COVID vaccine—the locally-developed CoronaVac jab–starting in August 2020. On-again, off-again lockdowns helped tamp down on the virus’ spread, with obvious short-term benefits in big, crowded cities such as Hong Kong.
While much of the rest of the world was suffering through their deadliest waves in January 2021, Hong Kong logged just one death a day, on average. The disparity was even greater during the global surge in infections caused by the Delta variant last fall. Hong Kong counted one death during the months-long Delta surge.
But the same periodic lockdowns that kept Hong Kong safe for two years ultimately made the city vulnerable. When a community weathers a wave of viral infections, it emerges with a degree of natural immunity—the lingering protection resulting from all those antibodies and T-cells in the bodies of those who caught the virus and survived.
Natural immunity is a powerful backstop for vaccine-induced immunity. And it’s one of the reasons that in countries that didn’t lock down the way China did the Omicron wave has been smaller or less deadly—or both—compared to previous waves.
Prior to this year, Hong Kong had practically no natural immunity, Cowling explained. He estimated just 1 percent of the city population had any COVID antibodies.
That wasn’t a problem as long as the dominant variant of SARS-CoV-2 was unable to spread through a mostly immobile population. “The measures that Hong Kong put in place worked reasonably well for variants that had lower basic reproductive rates,” Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection in Singapore, told The Daily Beast.
But Omicron with its dozens of key mutations is much more transmissible than any other lineage. Some virologists have described it as the most contagious respiratory virus they’ve ever seen.
Omicron is so transmissible that it needs only fleeting contact to spread from one person to another. It’s nearly impossible, in a city as crowded as Hong Kong, to eliminate all contact between families, neighbors, and coworkers. COVID Zero simply doesn’t work against Omicron.
It doesn’t help that the government in Beijing has only authorized Chinese “killed-virus” vaccines which work by exposing a person to a weakened form of SARS-CoV-2. Those two-dose vaccines, while safe, are widely considered to be less effective than the leading messenger-RNA vaccines developed in the United States and Europe.
Worse, uptake of these middling Chinese vaccines has been unimpressive. Just two-thirds of Hong Kong residents have gotten both “prime” doses. One in five has gone back for an additional booster shot. Cowling estimated that 85 percent of recent COVID deaths in Hong Kong are among the unvaccinated.
No natural immunity. Mediocre vaccines. Inadequate vaccine-uptake. It’s no wonder that Omicron is ripping through Hong Kong. “There was always going to be some dam that was going to burst,” Amesh Adalja, a public health expert at the Johns Hopkins Center for Health Security, told The Daily Beast.
But it’s not all bad news. For one, even the worst day in Hong Kong has been much less deadly than the worst day in New York City, which has only slightly more people.
COVID claimed 30 lives on the deadliest day so far in Hong Kong. It claimed more than 1,200 lives on the deadliest day in New York City back in April 2020. “From a purely population health perspective, even if Hong Kong has a disaster in its exit wave, it will be nowhere near the population mortality levels of the U.S.,” David Owens, co-founder of OT&P Healthcare in Hong Kong and a practicing doctor in the city, told The Daily Beast.
Omicron has thwarted COVID Zero. But the strict lockdown strategy probably saved a whole lot of lives prior to the new variant’s appearance.
And it’s possible this is as bad as it will ever get in Hong Kong. COVID isn’t going anywhere. Unless nearly everyone in the world gets vaccinated fast—a remote possibility, to say the least—SARS-CoV-2 will always have human hosts and opportunities to mutate and produce new lineages.
But the combination of natural and vaccine-induced immunity plus new and highly effective antiviral therapies are blunting the pandemic’s worst impacts. More and more countries are declaring COVID endemic, eliminating their last few restrictions on travel, businesses and schools and simply getting on with life.
The current surge in infections in Hong Kong could be the last before city and national leaders—to say nothing of millions of everyday Chinese—–decide that Hong Kong has all the tools it needs to handle COVID without shutting down the city.
There are signs that moment is coming. Even as cases and deaths spiked a little over a week ago, Hong Kong Chief Executive Carrie Lam vowed there would be no new total lockdown in the city.
