When Covid-19 began to make its grim progress around the world in early 2020, Hong Kong looked on with alarm. Health systems were overwhelmed and death tolls mounted. The city, scarred by the deadly severe acute respiratory syndrome (Sars) outbreak in 2003, fared better. Masks were widely worn from the start and social-distancing rules observed. We lamented the slow response in other places which did not appear to understand the danger. Hong Kong was spared the terrible scenes witnessed elsewhere, quickly overcoming each outbreak. This was done with a zero-Covid approach, involving rapid testing, tracing and isolation. A strict quarantine regime for travellers kept the virus out of the community. Carrie Lam Cheng Yuet-ngor, the city’s leader, hailed the strategy in the Legislative Council on January 12, with a slew of statistics to show Hong Kong was a world leader in tackling Covid-19. But even as she spoke, the Omicron variant was spreading. Hong Kong quickly went from self-congratulation to crisis. Last week’s events were harrowing. Case numbers have risen dramatically. People are dying. It is heartbreaking that young children are among the victims. Hospitals have been overwhelmed. The need for patients, many of them elderly, to lie outside in cold weather for as long as three days before admission is shocking. We never thought we would see this in Hong Kong. Chinese medical staff rally for Hong Kong Covid-19 campaign The speed at which the crisis developed and its scale have caught the city by surprise. Everyone is asking: How could this happen? How could Hong Kong be so ill-prepared? The answer may lie in the nature of the zero-Covid strategy. It proved effective when tackling a small number of cases. But it is ill-suited to the rapid spread of the highly transmissible Omicron variant. Experts have long stressed that zero-Covid is not sustainable in the long term. What it has done is buy Hong Kong time, allowing more than 80 per cent of the community to get vaccinated. But those months should have been better used. The city has a low level of intensive care beds compared to other parts of the developed world. The number needed to be increased. More should have been done to persuade the elderly to get vaccinated. The vaccine pass, to encourage people to get jabs, only comes into force this week. Vaccination centres had been scaled back. Now, as demand soars, it is difficult to get an appointment. Then there is the mindset created by the zero-Covid approach. Every case has been treated as serious. Anyone testing positive was taken to hospital, even if they had no symptoms. It is not surprising that, as cases rose, people flocked to accident and emergency departments regardless of whether they were ill. With children at risk, ‘living with Covid’ is out of the question There has been some relaxation of the city’s strict measures to ease pressure on facilities amid the surge. Hospital beds are now reserved for those that really need them. Patients recovering from the virus are being released earlier. Close contacts and their families no longer go into quarantine. These are sensible steps, more in keeping with “living with the virus”. The policy is now called dynamic zero-Covid. But the word “zero” has become obsolete. It serves as a constant reminder of the city’s failure to contain the virus. As for “dynamic”, the government has been slow to react. Now, with help from mainland China and a rallying cry from the country’s president, more comprehensive measures are on the way. Hong Kong people have made great sacrifices in support of the zero-Covid strategy. Many are wondering whether those efforts were worthwhile as the city now experiences the same dreadful scenes as other parts of the world. It is to be hoped that, with community support, the spread of the virus will be slowed. There will be a need for creativity, flexibility and compassion. It is more about coping with the virus than eliminating it. We certainly need a dynamic approach, but the days of zero cases are gone.