Covid-19 persists amid puzzling hepatitis cases and monkeypox outbreaks – welcome to the new abnormal

Compared with countries like the UK that are living with the virus and the mainland’s citywide lockdowns, Hong Kong’s measures have been more balanced, albeit with some oddities
A sensible approach would be to now focus on a few science-driven initiatives, like improving air quality

Martin Williams

Published: 9:45am, 4 Jun, 2022

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On February 1, 2020, as the coronavirus yet to be named Covid-19 was starting to spread, Andrew Noymer, an epidemiologist at the University of California who studies infectious diseases, tweeted, “Duck tape your underpants. 2020 is going to be a wild ride”.

And what a wild ride it was, with the outbreak rapidly becoming a pandemic and – according to the worldometer website – causing 1,954,817 deaths by December 31, 2020. Not that the wild ride ceased at the end of 2020: Covid-19 is still here, with the official death toll now at over 6.3 million, and still rising.

Even this figure probably belies the true toll: a study published in The Lancet estimated that from January 1, 2020 to December 31, 2021, 18.2 million people had died worldwide because of the pandemic.

Scientifically, we’ve learned a lot about Covid-19 and ways to combat it, even developing vaccines that greatly reduce the risk of death. Yet the virus remains an issue, no matter how much we might wish it gone.

Worldwide, responses to Covid-19 vary greatly, beset by fuzzy thinking, and with people also prioritising economic growth, retaining positions of power and so forth. Meanwhile, like a relentless sci-fi automaton, Covid is set on its goal: “Must … infect … more humans...”

At one end of the response spectrum are countries like Australia, Denmark and the UK, where politicians are aiming for acceptance of Covid-19 as just another disease. Yet even with widespread vaccinations, this results in high levels of “ long Covid”, an umbrella term for a mix of chronic conditions, including accelerated brain ageing.

This, in turn, means people are unable to work, or work with reduced efficiency, impacting businesses: in April, the Institute for Public Policy Research forecast that the UK economy faces an £8 billion (US$10 billion)-a-year hit because of a lack of government plans for long Covid.

Commuters go mask-free in London, on February 22. The UK government is aiming for acceptance of Covid-19 as just another disease. Photo: EPA-EFE

Along with the widespread immobilising of society, Covid-19 deaths are still occurring at rates that would have grabbed headlines a couple of years ago. On May 29, Twitter handle dr tom – evidently a doctor in Australia, where Covid-19 is now a leading cause of death – remarked, “Let’s face it, we‘re not living with Covid, we’re just tolerating a lot of death.”

Hong Kong’s anti-Covid-19 measures have become more balanced, but still feature oddities – like quarantine for all on arrival, and campsites and barbecue facilities closed while bars are open – that are not supported by science, and significantly dampen the economy along with quality of life.

Then, at the other end of the spectrum, there’s mainland China, which especially in Shanghai has seemed intent on achieving zero Covid or bust. While residents have been confined to their homes or quarantine camps, squads of hazmat-suited workers have been spraying disinfectant on surfaces ranging from flat interiors to food packages and airport tarmac areas. This may all appear splendidly proactive, yet Covid-19 spreads mainly through airborne transmission.

Workers in protective suits cram into a lift to disinfect a residential building in Shanghai, on May 18. Photo: Reuters

This “Shanghai strategy” echoes and was perhaps inspired by China’s response to a pneumonic plague that infected the northeast in 1910-1911, killing around 60,000 people. As outlined in a CNN article, measures included specially constructed quarantine hospitals, mask-wearing ordinances and travel restrictions. These effectively contained and suppressed the epidemic.

While there are similarities to current anti-Covid-19 measures, a huge difference is that we are now dealing with a pandemic: even if a place achieves zero Covid, the virus will return if it’s not sealed off from the outside world.

Another issue facing all countries is that, while there were hopes that vaccination and/or infection could confer lasting immunity, and the coronavirus might become less dangerous, it turns out that reinfections are relatively common, and Omicron appears “milder” at least partly thanks to better immune responses in vaccinated or previously infected people.

Plus, on May 27, Professor Kei Sato of the University of Tokyo reported on a preprint study of two new variants: “BA.4 & BA.5 variants seem to be more contagious and pathogenic [able to cause disease] than BA.2 variant”.

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New Covid-19 subvariants can reinfect Omicron-recovered patients, early studies find

Add cases of hepatitis in children, and outbreaks of monkeypox in several places worldwide – which may be linked to Covid-19 infections affecting the immune system – and it’s clear that we are not back to pre-Covid-19 normality. Instead, this is a new abnormal.

Hence, face masks remain important for reducing transmission, with better-quality masks advisable if you figure there is a higher chance of breathing in other people’s air. The risk of transmission is lower outdoors, and in well-ventilated places.

Indoors, HEPA filters can reduce amounts of airborne pathogens such as Covid-19, and disease experts like Professor Trish Greenhalgh, professor of Primary Care Health Sciences at the University of Oxford, advocate a shift towards emphasising clean indoor air, along with clean drinking water.

This surely seems common sense; even in 2020, Japan recognised ventilation and air filtration as the key defence against Covid-19. Yet clean air seems a low priority in too many places, including Hong Kong. This is perhaps partly because of deep-rooted beliefs in diseases being caused by germs amid surface dirt, and outdated notions of diseases borne in droplets that travel a couple of metres at most.

Lessons to be learned after Shanghai slowly returns to normal

While we mostly take clean drinking water for granted, advocates formerly faced resistance, including in Hong Kong.

Though concerns were expressed about the filthy sewers and more during the late 19th century, several officials and businessmen resisted costly improvements, and it took a severe pandemic of bubonic plague to prompt work on better sanitation – including by adopting recommendations from engineer Osbert Chadwick, son of Edwin Chadwick, who had pioneered clean water supplies in the UK.

Now, Hong Kong similarly has the opportunity to improve indoor air flows and air quality in apartment buildings, shopping centres, schools and office towers – maximising health, while minimising Covid-19.

Martin Williams is a Hong Kong-based writer specialising in conservation and the environment, with a PhD in physical chemistry from Cambridge University

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