It is no longer a matter of when the fifth wave of Covid-19 overwhelms hospital and quarantine capacity, as it was a few days ago. It has already done so, with alarming speed, after previous waves were contained. It has also caused Hong Kong’s first Covid-19 deaths in six months. Two years into the pandemic, the city finds itself inadequately vaccinated against its biggest outbreak and facing limited options. These do not include living with the virus, as in Europe and America, or mainland-style lockdowns. Both would be very difficult to adopt here. The first would be irresponsible, given the low vaccination rate. It would mean accepting the risk of many deaths, particularly among the elderly and the sick, going by overseas experience. For total lockdowns of specific areas the city does not have the necessary infrastructure in place, never mind the lack of a mainland-style traceable health-code system or the political will. As a result it is relying on a growing combination of emergency measures to cope with exponential increases in case numbers, from hotel confinement of asymptomatic cases to home isolation to earlier discharge from hospital for recovered patients. These are aimed at helping to buy time to make a real difference to the vaccination rate, a passport to living with the virus eventually without the unacceptable risk of paying a high price in serious illness and death. Hong Kong public hospitals ‘overwhelmed’ by asymptomatic Covid-19 patients Instead of lockdowns or living with the virus now, a more realistic approach is to identify a pattern of contagion and then implement measures to combat it. Then perhaps the authorities may consider innovative ideas such as one expert’s suggestion of “reverse quarantine”, meaning isolating uninfected people at a higher risk such as the elderly or sick, as a way to protect them. Meanwhile, Hong Kong needs to strengthen its defences, firstly by prioritising vaccination, secondly by boosting hospital emergency ward capacity, then increasing testing capacity so people are not waiting in long queues or travelling about to get tested. Testing is one area in which neighbouring Guangdong province may be able to help with personnel and material resources. The city needs to build up its capacity to absorb shocks such as the one the health system is enduring at the moment. It is a pillar of the community. We cannot afford for it to be overwhelmed. The public and the government have complementary roles to play, for example in fighting vaccination resistance among the elderly and parents of young children and enforcing social distancing. The government also needs to do more to boost public morale, for example with measures to speed up testing. If people at least know that help is on way it will calm a sense of panic and helplessness amid ever-lengthening testing queues and overcrowded hospitals.