The primary time the Omicron variant breached Hong Kong’s coronavirus defenses, in late 2021, the town stamped it out, cementing its standing as one of many world’s most formidable redoubts of “zero Covid.”
However a number of weeks later, Omicron got here to the metropolis once more, this time inflicting an outbreak amongst cleaners at a public-housing property that spiraled uncontrolled. The conflagration of ensuing instances is now killing folks at a charge exceeding that of just about any nation for the reason that coronavirus emerged.
Over your entire pandemic, Hong Kong’s demise toll per capita, as soon as far decrease than these of Western nations, is not distinctive. A month in the past, Individuals had died from Covid at 90 occasions the speed of individuals in Hong Kong. By Monday, the cumulative American toll was three and a half occasions as excessive.
As the US braces for its personal, much less punishing rise in instances, and mainland China battles its greatest outbreak in two years, scientists have regarded to Hong Kong for clues concerning the menace Omicron poses in a completely totally different setting: a dense metropolis the place folks weren’t solely largely untouched by earlier infections, however whose oldest and most susceptible residents have been additionally largely unvaccinated.
A number of important classes emerged, well being specialists stated.
Within the period of Omicron and its much more infectious subvariant, BA.2, vaccinating a broad swath of the inhabitants remained necessary, scientists stated. However inoculating as many older folks as attainable had develop into far and away the highest precedence.
That message, they stated, was most urgent for China, the place vaccinations in older age teams additionally look like lagging and there’s little immunity from earlier infections.
However it was related once more in the US, too, the place subpar vaccination and booster charges amongst older folks have left scientists involved a couple of potential surge of BA.2 instances. Partly as a result of so many extra Individuals have been contaminated and killed by the coronavirus throughout earlier waves, scientists don’t anticipate the US to face as critical a scenario within the coming months as Hong Kong.
Hong Kong’s dreadful outbreak additionally indicators the perils of attempting to get rid of the virus and not using a plan for what would come subsequent, well being specialists stated. Omicron’s excessive transmissibility, they stated, made outbreaks nearly inevitable.
Hong Kong, which together with mainland China had been among the many final holdouts of a technique of tight restrictions and border controls to eradicate the virus, was left susceptible by how few of its residents had any immunity from prior infections: Earlier than the Omicron surge, scientists estimated that just one p.c of Hong Kong’s inhabitants had contracted the virus.
These low ranges of immunity can depart locations susceptible to waves of instances, as extra contagious variants sneak in or restrictions are lifted. However governments can nonetheless put together for these waves, stated Dr. Gabriel Leung, the dean of medication on the College of Hong Kong.
Lower than one-quarter of individuals aged 80 and over in Hong Kong had been given two doses of a vaccine earlier than Omicron surged, in contrast with greater than 90 p.c of individuals in Singapore and New Zealand.
Due to the variety of unvaccinated older folks in China, scientists stated, it may additionally have some problem lifting “zero Covid” restrictions. Greater than 87 p.c of China’s inhabitants have been vaccinated. However simply over half of individuals 80 and older have had two pictures, and fewer than 20 p.c of individuals in that age group have acquired a booster, Zeng Yixin, a vice minister of the Nationwide Well being Fee, stated on Friday.
“I don’t suppose it’s fairly prepared for the transition,” Dr. Leung stated.
Quite a few Asian and Pacific nations had largely stored the virus at bay for 2 years, solely to face Omicron outbreaks as a result of the virus was so contagious and their populations had prevented earlier infections. However excessive vaccination charges, together with amongst older folks, have helped lots of these nations keep away from extra devastating surges.
In South Korea, for instance, the place 87 p.c of individuals are vaccinated and 63 p.c have booster pictures, the cumulative demise toll per capita is one-tenth of America’s, regardless that South Korea has recorded greater than three-quarters as many instances as the US over your entire pandemic.
Well being specialists stated that Hong Kong’s difficulties vaccinating older folks resulted from a mix of complacency, given the town’s earlier success in containing the virus, and unfounded fears that older folks and people ill confronted explicit dangers from vaccines.
The town has now vaccinated 39 p.c of residents aged 80 and above, regardless of having inoculated nearly two-thirds of 12- to 19-year-olds.
Many individuals in Hong Kong have been given the Chinese language vaccine Sinovac, which seems to supply comparatively little safety from Omicron infections however a greater protection towards extreme illness. Scientists famous that nearly 90 p.c of people that died through the newest wave weren’t totally vaccinated, suggesting that getting pictures to probably the most susceptible is extra necessary than the actual model.
“The issue in Hong Kong is, we haven’t succeeded in vaccinating our most susceptible inhabitants — the aged, particularly these staying in elderly-care properties,” stated Dr. Siddharth Sridhar, a scientific virologist on the College of Hong Kong. “And in consequence, we’re in a really unhealthy scenario.”
The US has vaccinated many extra of its older residents than Hong Kong however fewer than Western Europe and has seen a excessive demise charge. And as immunity from early vaccinations wanes and booster pictures develop into important for shoring up safety towards Omicron amongst older folks, the US finds itself uncovered on that depend, too. About 41 p.c of individuals 65 and over haven’t acquired a booster shot.
In contrast to different components of Asia that had step by step lifted restrictions in latest months, Hong Kong was not prepared for its defenses to fail, scientists stated.
“From the federal government’s perspective, there was such a powerful fixation on ‘zero Covid’ that so long as that labored, vaccination was not essentially the precedence,” stated Ben Cowling, a professor of epidemiology on the College of Hong Kong.
Many older residents and their households adopted the identical view, public well being specialists stated. If Hong Kong’s inflexible social-distancing measures and cautious border controls have been going to maintain the virus out anyway, the traditional considering went, was getting a vaccine well worth the bother?
“When you’re telling those who the illness isn’t going to get in, then there’s much less of an incentive to go and get vaccinated,” stated Dr. David Owens, a household physician in Hong Kong. “To an extent, the messaging round elimination confounded the necessity to vaccinate.”
Dr. Cowling, of the College of Hong Kong, stated that his metropolis may have responded in one in every of two methods to indicators that instances would surge: both double down on “zero Covid” via measures like constructing higher quarantine services for abroad arrivals, or acknowledge that outbreaks are unavoidable and lift vaccination charges.
“Zero Covid is a very good technique when you can keep at zero,” Dr. Cowling stated. “However as we present in Hong Kong, it doesn’t final endlessly.”
Hong Kong finally took steps to influence older folks to develop into vaccinated, as soon as earlier inducements like vaccine passes proved ineffective. In January, the federal government introduced that it could ban unvaccinated folks from eating places that serve dim sum, that are in style amongst older residents. However it was too late.
With instances and deaths now declining, Hong Kong introduced on Monday that it could raise sure restrictions.
Singapore started abandoning “zero Covid” insurance policies in the summertime. Dr. Ooi Eng Eong, an infectious illness professional at Duke-Nationwide College of Singapore Medical College, stated that it took a wave of the Delta variant to boost vaccination charges and disabuse folks of the notion that they didn’t want safety.
Now, instances in Singapore have surged, however deaths are comparatively low.
“It’s a lot extra transmissible that I believe carrying a face masks and all — that helps however to not the extent that it has impacted the epidemiology,” Dr. Ooi stated of Omicron. “The tendencies are actually pushed by vaccination.”
Nonetheless, even after 5 or 6 waves of the pandemic, the explanations that some nations have succeeded whereas others have suffered stay unclear.
Japan, for instance, has tamped down on instances all through the pandemic with out resorting to full-fledged lockdowns, scientists stated.
The nation benefited from its authorities sharing sound public well being recommendation early within the pandemic. As a lot as residents uninterested in precautions, they largely took the recommendation severely, stated Taro Yamamoto, a professor on the Institute of Tropical Drugs at Nagasaki College.
Roughly 80 p.c of individuals in Japan have had their preliminary vaccine sequence. However regardless that the nation is lagging in administering booster doses and had a surge of Omicron infections, demise charges throughout Omicron have remained significantly decrease than in close by South Korea.
“Partly it’s a thriller,” Professor Yamamoto stated. “We can’t clarify all of it.”