Hong Kong’s care homes for the elderly managed to weather successive waves of Covid-19 infections over the past two years. Then the fifth wave hit and things fell apart rapidly. The highly transmissible Omicron variant of the coronavirus tore through the homes from early last month, leaving about 11,000 residents infected and at least 680 dead as of Saturday. About 3,100 staff were also infected. Overall, 589 care homes for the elderly – three in four of all such facilities in Hong Kong – have recorded Covid-19 infections. Hong Kong elderly left it late for Covid shots, families fear time running out Medical experts and operators of the homes blamed not only the speed with which Omicron spread, but also the low vaccination rate among their residents, already vulnerable because of their advanced age and underlying health issues. “The infection and death rate of the elderly residents in care homes will keep rising, unless isolation and vaccination are implemented promptly,” said Dr Leung Chi-chiu, an expert in respiratory disease and public health. “Omicron, the particularly low vaccination rate among residents and the unsuitable environment of care homes for on-site quarantine have led to where we are today.” Infectious diseases expert Professor Yuen Kwok-yung estimated that only 20 to 30 per cent of care home residents remained uninfected, and expected the death rate among them to remain high. With the city recording tens of thousands of new infections daily, the shortage of hospital beds and quarantine facilities has left many infected elderly people confined to care homes without proper isolation facilities, causing the virus to spread among residents. The new wave of infections also worsened the staffing situation at the homes, which have long suffered a chronic shortage of care workers, as many carers caught Covid-19 or had to be quarantined. Hong Kong recorded 31,008 new coronavirus infections on Sunday, taking the total to 471,617 cases, with another 153 deaths reported over the previous 24 hours. The death toll has now reached 2,007. According to the database Our World in Data, Hong Kong’s seven-day rolling average of 19.99 deaths per million people was the highest in the world as of Friday. What went wrong? The state of the care homes was an urgent issue, said Dr Lam Ching-choi, a member of city leader Carrie Lam Cheng Yuet-ngor’s de facto cabinet and chairman of the Elderly Commission. He said pandemic measures, including banning family visits, cutting volunteer services and vaccinating staff, had helped care homes fend off earlier waves of infection before Omicron broke through those defences. The explosion of cases in the community resulted in infected staff members bringing the virus to the care homes, where many elderly residents were not vaccinated. Only about 20 per cent of elderly residents in care homes were vaccinated when the fifth wave began, although operators estimated that the rate rose to about 40 per cent after the government introduced the vaccine pass scheme on February 24, barring unvaccinated people from entering various premises. 56 per cent of Hong Kong care homes have coronavirus infections William Chui Chun-ming, president of the Society of Hospital Pharmacists of Hong Kong, said their advanced age and chronic medical conditions meant the elderly faced a high risk of infection and complications. “They are the most vulnerable, but this group has the lowest vaccination rate,” he said. Public health expert Leung said Covid-19 cases at the care homes began spiralling out of control when health authorities could no longer move infected residents out because there was no room at hospitals and quarantine facilities. Infected residents should have had priority for quarantine, but did not get it. Authorities also failed to increase hospital capacity at the start of the fifth wave by designating some hospitals for Covid-19 patients. As a result, Leung said, as more elderly residents became infected and hospitals could not take them in, the patients had no choice but to remain at the homes. “It formed a vicious circle,” he said. The situation led to continuous outbreaks with even more residents falling ill. The government revealed last month that a total of 88,000 community isolation units at eight venues, for residents with mild or no symptoms, were expected to be ready in the next few months. These new facilities could not come up fast enough for the explosion of cases and given the current shortage, the Social Welfare Department asked care homes to keep infected residents isolated within their premises. But Leung said the homes were not designed to isolate patients effectively. For that, a home needed at least a separate floor for sick patients, with a dedicated team of carers to avoid cross-infection. Many homes, especially private ones, had neither the space nor manpower to cope with the sharp rise in the number of residents falling sick. The Social Welfare Department requires care homes to have a designated isolation room for every 50 beds to isolate residents with infectious diseases. But Kenneth Chan Chi-yuk, chairman of the Elderly Services Association of Hong Kong, said these isolation rooms were merely separated from other rooms, and did not meet the standards needed to isolate Covid-19 patients. “Care homes are not designed to be used as medical or quarantine facilities to handle infections,” he said. Chan pointed out that all along, care homes were not supposed to admit residents with infectious diseases, and had to report and evacuate any infected resident immediately. That was what helped them survive earlier waves of Covid-19 infections, he said. The homes were not prepared for the Omicron onslaught and the city’s overwhelmed medical system made it impossible for them to evacuate sick residents during the fifth wave, he added. Chaotic arrangements at some homes Cheng Ching-fat, secretary of the Community Care and Nursing Home Workers General Union, said the situation was nothing short of a disaster. He said some homes isolated those with Covid-19 in conference or therapy rooms, while others used only a folding screen to separate infected residents from others. With sick residents still on the premises, thorough cleaning and disinfection became a challenge. “Some put all residents on one side of the home while disinfecting the other side, and some just sterilised the beds of those infected,” he said. Making matters worse, the homes began running out of workers. The government delivered rapid antigen test kits to the homes and required staff to test for the coronavirus every day. Only those who tested negative were allowed to work. But as workers fell victim to Omicron too, the homes soon faced an acute manpower shortage. On Tuesday, the government announced that 1,000 temporary care workers would be brought in from mainland China to help. Chan said many homes had lost half their workforce, and the sector needed at least 5,000 more care workers. He revealed that some small homes were so strapped for staff, they asked infected workers to stay on the job. There were also complaints about worsening service and chaotic arrangements at the homes. May*, in her 70s, said she had been worried about a family member in a private care home, where most of the elderly residents were not vaccinated. She said on February 26, the home called her at night to tell her that her relative had a cough and runny nose, and they suspected it might be Covid-19. The home wanted to send the resident to hospital, but May insisted on a rapid test first, and it turned out negative. A few days later, May was informed that her relative was sent to hospital for nutritional deficiency, and was kept waiting outside hospital in the cold before admission. May said her relative, in her 60s, had diabetes and Parkinson’s disease and could not look after herself. “The arrangements at the care home have been so chaotic,” she said. “I’m so worried about her being left alone there.” Medical experts and home operators have been encouraging elderly residents to get vaccinated, and urged authorities to prioritise those from care homes for quarantine and treatment. Social welfare legislator Tik Chi-yuen suggested that authorities appeal to retired civil servants to help in care homes, and also recruit others to help with basic services such as cleaning, changing sheets and feeding residents. He urged the government to meet operators of the care homes to understand their challenges and establish clear guidelines and a contingency plan. “We have to take action, even if only one step at a time, to prevent the situation from becoming even worse,” he said. *Name changed at interviewee’s request.