Hong Kong can break free from its zero-Covid corner. Here’s how

The world is largely split between living with Covid-19 and the zero-tolerance approach, but a balance between saving lives and returning to normality is possible
Here’s a five-step plan for what is needed. Hint: quarantine exemptions for celebrities aren’t a good idea, but shorter stints for vaccinated people are

Donald Low

Published: 11:44am, 20 Aug, 2021

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It is becoming increasingly clear that across the developed world, government responses to Covid-19 have split into two camps.

The first camp believes that coexisting with Covid-19 is both inevitable and acceptable. Governments that subscribe to this belief point to the scientific consensus that Covid-19 will become endemic, and conclude that seeking elimination is not only extremely costly but is also doomed to fail unless their societies wish to be hermetically sealed forever. That Covid-19 will become endemic also means that once vaccination has reached a certain threshold, say at least 70 per cent of the population, the authorities can take decisive steps to loosen restrictions on social activities and travel.

The second camp has a zero-tolerance view of Covid-19. Governments in the second camp point to the rising infections in countries like Israel and the United States as evidence that high levels of vaccination do not mark the end of the pandemic. They argue that the high transmissibility of the Delta variant, the risk of “breakthrough infections”, and the fact that vaccinated people can still transmit the virus justify the continuation of strict suppression measures, including periodic lockdowns whenever there are new infections and lengthy quarantines for travellers.

Hong Kong recently retreated from a short-lived experiment to use serology tests to reduce quarantines back to its defensive, zero-Covid posture. This is probably because it sees having zero cases as the only way to reopen the border with the mainland.

But as economists remind us, corner solutions are seldom efficient. As other global hubs such as Singapore return to normality and open up to international travel, Hong Kong must find a better balance between the two extremes of suppression and coexistence with Covid.

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The right balance

Continuing with strict suppression would save lives and minimise infections. But at a time when we have highly effective vaccines that reduce death and disease from Covid-19 (even if infection numbers would increase when such measures are lifted), suppression is too costly: it causes too much damage to people’s livelihoods and the economy.

Meanwhile, lifting all social distancing, quarantine and masking requirements may bring about economic recovery sooner, but it would also put vulnerable groups that cannot be vaccinated at risk. For instance, even if Hong Kong were to vaccinate an enviable 80 per cent of its population, an outbreak that causes just one per cent of the unvaccinated population to require hospital care over a short span of time would overwhelm our public hospitals.

In short, either approach – suppression or coexistence with Covid – entails significant costs and risks. How should the Hong Kong authorities move from its current zero-Covid stance to one that achieves a better balance between protecting public health and allowing people to get on with their normal lives?

First, they should start by communicating the (increasing) likelihood that Covid-19 will become endemic even as (some) suppression measures remain in place. Back in February 2020, even before the novel coronavirus had a name, I had argued in a commentary that it was “not too early for governments to start planning for mitigation and to prepare their populations for it”, and that “this begins with communicating the possibility that unlike Sars, this novel coronavirus does not just go away and that we have to think about how we lead our lives as normally as possible – while taking the public health and personal hygiene precautions to minimise the spread of this virus – in the knowledge that the virus may never be eliminated.”

Comment from the past: Why we must accept this new coronavirus is here to stay

In the absence of such communication, large parts of the population may have naive and unrealistic expectations that Covid-19 can be eliminated. Many of us already have a zero-risk bias, believing wrongly that novel risks should be eliminated or minimised rather than mitigated and managed. The longer governments delay in communicating to the public that we may have to live with Covid-19, the greater will be the public’s disillusionment when coexisting with Covid becomes unavoidable – with a corresponding erosion of the government’s credibility and people’s trust in the experts who have advised against adapting to Covid-19.

Second, governments must engage their populations on what they consider an acceptable level of risk. People mostly have a sketchy understanding of underlying health risks, but their risk perceptions are malleable and can be improved. For example, few people know that before the arrival of Covid-19, the flu caused more than 500 deaths each year in Hong Kong. In the winter flu season alone, Hong Kong used to have more than 300 deaths.

Airport staff at Hong Kong International Airport are tested for Covid-19. Photo: Xiaomei Chen

As a result of the social distancing and universal masking rules that the pandemic has brought about, the most recent flu season in Hong Kong saw just one death. With high levels of vaccination and widespread (particularly indoor) masking, it is possible that Covid-19 causes about as many fatalities each year as the flu did previously. This is probably a level of risk – fewer than one death in ten thousand people – that Hongkongers are prepared to live with in return for a resumption of normality.

Third, in the case of Hong Kong, raising vaccination levels among its seniors is an urgent priority. At current rates, the population that is below 60 years of age would reach high levels of vaccination (of above 70 per cent) by the end of September. But among those in their 60s, only about 60 per cent of them would be vaccinated. Among those in their 70s, it would be only 40 per cent. And among those in their 80s, it would be less than 20 per cent.

It is an indictment of Hong Kong that the segments of the population that are the most vulnerable to severe disease and death from Covid-19 are also the least vaccinated. The large disparity in vaccination rates between the young and the old could also become a source of intergenerational conflict if suppression measures have to be maintained only because many older people are unwilling or hesitant about getting vaccinated. And when (not if) the Delta variant reaches Hong Kong, it is almost inevitable that deaths and severe disease will be concentrated among the old and unvaccinated.

People queue up to receive the Sinovac vaccine at Kowloon Bay Sports Centre in Hong Kong. Photo: Edmond So

Fourth, the Hong Kong authorities should set out a risk mitigation framework to help society transit to a situation in which Covid-19 is endemic. This should include targets and timelines on vaccination, the (new) metrics that they would use to calibrate the stringency of containment measures (for example, instead of the number of new infections daily, the authorities should pay greater attention to the actual and expected number of hospitalisations and ICU beds taken up by Covid-19 patients), the public health measures (such as indoor masking) that would remain in place for the foreseeable future, and a road map for opening up to travel with shorter quarantine requirements.

Giving quarantine exemptions to celebrities not only makes a mockery of the existing regime, but breeds public disgust at the unfairness and arbitrariness of such exemptions. What Hong Kong needs is a coherent, publicly defensible framework that manages the risks of Covid-19 while protecting vulnerable groups.

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Finally, as part of this risk mitigation strategy, Hong Kong should also introduce more differentiated measures between vaccinated and unvaccinated residents – both to encourage more people to get their shots and to protect those who cannot (or choose not to) be vaccinated as social and travel restrictions are relaxed. For instance, if vaccination were to reduce quarantines by more than the current seven days (say by 10 days), or if vaccinated people can do part of their quarantines at home, that would send a strong signal – to residents and to the rest of the world – that Hong Kong is open for business and that it seeks a better balance between suppression and living with Covid-19.

Donald Low is Professor of Practice in Public Policy at the Hong Kong University of Science and Technology, director of the university’s Institute for Emerging Market Studies, and director of Leadership and Public Policy Executive Education