In the first of a two-part series on Hong Kong’s battle with the Covid-19 pandemic, the Post looks at the successes and failures of the past 12 months, and how residents have been coping with the physical and emotional toll of the health emergency. This time last year, Hong Kong was in the grip of its fourth coronavirus wave, with seemingly no end in sight. Experts at the time were already warning of a potential fifth wave, with the looming spectre of even more lockdowns and social-distancing rules for a city already weary from a year’s fight with Covid-19. Leading epidemiologist Professor Benjamin Cowling, from the University of Hong Kong (HKU), was among those bracing themselves for the worst, but 2021 was not the annus horribilis he and many others expected – though neither was it a banner year for pandemic-hobbled Hong Kong. The feared fifth wave did not materialise for the better part of the year, even as the more infectious Delta and Omicron variants spread like wildfire across the rest of the globe. Travel bubbles with other destinations were floated and burst, and the city’s border with mainland China never fully reopened despite repeated promises from top officials. A citywide vaccination drive gradually picked up steam, but after nearly a year, a substantial portion of the population, the elderly in particular, remain vexingly unjabbed. Looking back on another year of the pandemic, Cowling gave credit to the city’s relentless pursuit of a zero-Covid strategy. “It has certainly been a success, but we also have a bit of luck, in the sense that a number of opportunities for Covid transmission haven’t resulted in community outbreaks,” he said. But with Hong Kong about to mark the inauspicious two-year anniversary of Covid-19’s arrival in the city on January 22, 2020, a familiar foe is back. The dreaded fifth wave, kept at bay by closed borders, finally reared its ugly head as the Omicron variant slipped into the community. The chink in the city’s anti-pandemic defences turned out to be quarantine-exempt aircrew who broke home surveillance rules and visited local restaurants in late December and earlier this month, sparking coronavirus clusters that had grown to include more than 60 cases as of Thursday. 2 ex-Cathay employees charged over alleged anti-pandemic rule violations Cowling said more dangers still lurked in the year ahead, not least of all the stubbornly low vaccination rate among the city’s elderly. At the start of 2021, things were looking grim for Hong Kong. A group of local singers and recreational dancers emerged as superspreaders in November 2020, forming the core of a cluster of cases that eventually grew to become the city’s largest yet, numbering 732 patients at the start of the new year. Infections soon spread to other parts of the community, hitting hospitals, schools, shopping malls and construction sites. By March, just as infection numbers were starting to dip, another large cluster emerged, centred on a fitness centre in Sai Ying Pun and involving 155 patients. But by late May, government pandemic adviser Yuen Kwok-yung had declared the end to the city’s fourth wave, with zero local infections recorded for 28 days. Since then, Hong Kong has not recorded a daily case count of more than 20, with almost all infections imported and caught in quarantine. “The city’s steady toughening of its quarantine and testing regime has played a large part in keeping the virus out of the community,” Cowling said. Throughout the year, Hong Kong stuck to its famously tough 21-day quarantine requirement for many countries, occasionally resorting to flight bans on certain countries in response to the global Delta and Omicron threats, and on airlines that brought in too many infected passengers at one time. In August, Hong Kong streamlined its five-tier entry system to just three categories, linking quarantine periods with vaccination status. The new rules allowed fully vaccinated non-residents to fly in from medium- and low-risk countries, which at one time included popular destinations such as Singapore, Japan and the United States. However, the relaxation was short-lived, as those countries and many others were bumped into the city’s high-risk categories due to rising case counts. For high-risk countries, only fully vaccinated Hong Kong residents are allowed to travel to the city, but even they have to undergo three weeks of quarantine at a designated hotel and complete six coronavirus tests during their stay, as well as a seventh one afterwards. As of Friday, 140 countries were in the high-risk group. ‘Quarantine isn’t punishment’: angry voices from Hong Kong’s Penny’s Bay The emergence of Omicron led to even tighter restrictions on certain countries. Early last month, the government once again revamped its rules, putting countries that had detected Omicron into the high-risk group, and creating an enhanced tier for those that exported an Omicron infection to Hong Kong, or were considered especially high-risk for the variant. Travellers from those countries, including the United Kingdom, US and several African nations, must spend their first four days of quarantine in the government’s facility at Penny’s Bay before moving to a designated hotel for the remainder. Hong Kong has recorded 506 Omicron infections so far, the vast majority of them imported. But despite the strict rules on quarantine, Cowling said he believed there would still be sporadic Omicron outbreaks locally. “Mainland China may even be more stringent in its rules than Hong Kong, yet it still has outbreaks from time to time,” he said. “Omicron certainly poses a risk to Hong Kong, in the coming months and years.” Experts have said the current local outbreak of Omicron has not been “exponential” due to quick responses, including the suspension of primary school and kindergarten classes, a ban on dine-in services after 6pm at restaurants and the closure of 15 business and entertainment venues, including bars, karaoke lounges and mahjong parlours. Karen Grepin, a health economist from HKU, said the city had been one of the most successful places in the world in achieving local elimination of the virus over the past year. Measures such as border restrictions, widespread testing and quarantining of close contacts had played an important role in this, she said. “This strategy has saved thousands of lives and has allowed us to resume almost-normal lives – especially by international standards,” Grepin noted. But she agreed that the strategy had also come at a “very high cost” to the city. Hong Kong has been isolated from the rest of the world for nearly two years, with “no end in sight”. Trade and travel with the mainland and abroad had also been greatly affected, and there were important economic and social consequences, she said. Many cultural events, such as concerts and conferences, were also cancelled under the strict pandemic-control rules, and that in turn affected the cultural fabric of the city, Grepin added. Chan Hung-ying, a mother of three, saw 2021 rob her children of valuable opportunities. But she believes vaccination is the way out. Her eldest, a daughter in Form Four in secondary school, performed worst in English, which was already her weakest subject, while her second child, a girl in Form Two, experienced deteriorating eyesight from long hours of online classes and staring at phone screens. Chan has been unable to afford a computer or register her kids for interest classes. Her youngest child, a son in Form One, frequently complains of loneliness. “I have seen how Covid-19 has affected them for the worse and there is nothing I can do. But the moment vaccines were available, I got jabbed along with them [in the hope] that classes could reopen sooner.” In September last year, a Tuen Mun school became the first in the city to fully resume physical classes after more than 70 per cent of students had their first vaccine dose, meeting the requirement for reopening, with the inoculation rate for its staff also hitting the same mark. Developmental-behavioural paediatrician Dr Fanny Lam Wai-fan said she noticed that recovery for some of her patients requiring speech therapy had slowed amid the pandemic, attributing this to mask-wearing. “When you teach a child … the child will need to look at the mouth of the therapist. But now with masks, they can’t see [mouth movements] and fully observe facial expressions of people,” Lam said. Therapists would also not be able to see and assess the tongue movement of children. In general, she found that treatment time for children with special needs had doubled during the pandemic, compared with the pre-Covid era. The government’s zero-Covid strategy also led to twice-foiled travel bubble plans – once hailed as the world’s first – with Singapore, as Hong Kong last August cited differences in pandemic management between the two cities in ending its intention to stay on course for the arrangement. As Singapore opened up to the vaccinated world, Hong Kong has prioritised border reopening with the mainland, and in the process, even ramping up its tough measures to convince Beijing. Those rules included a health code that required cross-border travellers to submit a record of their whereabouts in the last 21 days, more frequent testing for aircrew and other key workers, and even isolating recovered patients for two more weeks after discharge from hospital. The last policy was criticised by epidemiologist Cowling, who blasted it as “unethical” and lacking in scientific basis. Secretary for Food and Health Sophia Chan Siu-chee fired back, saying even one repositive case could spark community transmissions. But as the end of 2021 approached, the rumoured border reopening near Christmas never materialised. A Hong Kong delegation led by Chief Secretary John Lee Ka-chiu, the third in the year centred on reopening, came back with no concrete announcement of an exact date. Much of this also hinged on local vaccination rates, officials argued. After a sluggish start, Hong Kong’s inoculation drive received a boost from tycoons and businesses. A lottery was held, dangling a HK$10.8 million (US$1.38 million) flat as the grand prize, to encourage residents to get their jabs. The US$24.4 million in lottery prizes, perks for vaccinated Hongkongers But as 2021 closed, vaccination perks rolled out in the earlier part of the year had dried up, with the daily inoculation rate once again slowing, especially among the elderly. The numbers picked up slightly at the start of the new year, under the threat of Omicron, and when the government signalled an extension of vaccine bubble plans that would bar the unjabbed from restaurants and leisure venues. By Friday, more than 10.6 million vaccine doses have been administered to Hongkongers, and 77.2 per cent of the city’s eligible population have had their first shot. But convincing those wary of the jabs is still an uphill battle. Tabby, who only gave her first name, has been a Cathay Pacific flight attendant for 7½ years. She lost her job as she refused to comply with the company’s inoculation policy. “I have my doubts about the efficacy of the vaccine and we see every day Covid-19 patients who have been vaccinated,” she said. She said she was also worried about the side effects. “Even if I am not dead but I end up with facial paralysis, would I still be considered fit for work and continue to be hired by my company? “More importantly, I am a daughter who has to take care of my ageing mother.” Her mother, now in her 80s, is also unvaccinated as Tabby felt the older woman was too frail to take the risks. Experts have said the elderly and weak should actually be first in line for the jabs, as the risks of Covid-19 complications outweigh those of vaccination. Tabby is now taking her former employer to court for unfair dismissal. She claimed to see a wider trend emerging in her city. “Freedom is diminishing, in more ways than one,” she said. “We hear now of a vaccine passport that can ban locals from even going to restaurants.” Vaccine passports or bubbles have been gradually extended from karaoke lounges and bars to restaurants seeking to operate longer hours. Chief Executive Carrie Lam Cheng Yuet-ngor recently said the bubble would be expanded given the Omicron outbreak and officials’ hopes of reopening the border with the mainland. Grepin, the economist, warned that the low vaccination rate among the elderly was a key concern. “The success of the zero-Covid strategy has taken too much urgency out of our response to the pandemic,” she said. “Omicron, or another variant, could break through our defences any day and if we are not prepared, we may not be able to win the next round of this battle.” She pointed out that just roughly 20 per cent of the elderly aged 80 or older, among the most vulnerable groups in the city, had been vaccinated. Her point may be substantiated by the experiences of other countries, such as Singapore and Australia, where vaccination rates far outpaced Hong Kong’s and the urgency to get the jabs is higher amid surges in cases. In Hong Kong, the number of daily Covid-19 cases has risen from single digits to nearly 40 in recent days, fuelled by clusters involving the Delta and Omicron variants across the city. A now-notorious birthday bash, held for local delegate to the national legislature Witman Hung Wai-man and attended by more than 200 high-ranking officials, lawmakers and socialites, put hundreds in quarantine after two guests were confirmed with Covid-19. ‘Invisible guests’ haunt Covid-19 birthday party scandal in Hong Kong The saga morphed into a political scandal for the government, with the city’s leader vowing an investigation . Amid the new challenges for the city this year, Cowling said looking back on 2021, Hong Kong had scored some great successes, but one single issue loomed large. “For me the greatest issue in the last 12 months is that we have widespread availability of the vaccine … but the government hasn’t really planned for the pandemic to end, despite having the tool to end it,” he said. A close to the pandemic, according to Cowling, would also be an end to Covid-19 rules and the start of living with the virus. That, he said, should be the path ahead for Hong Kong in 2022. Additional reporting by Elizabeth Cheung