Hong Kong Chooses Fear Over Living With Covid
(Bloomberg Opinion) -- Hong Kong has decided to live with the fear of the virus, instead of the virus itself. If the territory wants to survive in a post-pandemic world, then the false bubble of security it has created can’t last.
Last week, a 38-year-old vaccinated woman tested positive with the L452R mutant strain, present in the Delta variant of the virus. She had recently returned from the U.S., quarantined for seven days in a hotel, and was in the second week of self-monitoring at home when she received the result. A compulsory testing notice for people who had been on public buses, shops and markets where the woman had been was issued.
As fear and paranoia escalated, a government adviser said the quarantine for incoming travelers was “very likely” to be tightened again. On Monday, Hong Kong imposed stricter measures for travelers arriving from certain countries, including the U.S. Officials had loosened requirements – only slightly — depending on the point of departure in recent weeks.
At around 40%, the territory still has one of the lowest inoculation rates in the developed world, despite an excess supply of one of the most effective vaccines. Hong Kong also has had effectively zero locally transmitted cases on average for the past several weeks. Still, it continues to impose one of the longest, strictest quarantine measures on the planet for inbound residents — up to three weeks. Little scientific evidence suggests that anything beyond the World Health Organization’s recommended 14 days is effective.
The financial, physical and emotional cost of this strategy — which involves spending, in many cases, thousands of dollars, to live in a government-mandated hotel room for days on end — falls entirely to travelers and returning residents. They have to undergo antibody testing from specific labs and test multiple times throughout quarantine. Anyone wanting to leave or come in has to think hard.
All the while, Hong Kong’s hotels and swimming pools are full of staycation-ers. Restaurants, bars and public transportation are jammed. The city has given its residents a sense of safety within the confines of its borders, while creating fear of what’s on the other side.
Quarantines are a must to lower transmission rates. They also buy time as vaccinations and testing increase worldwide, and people establish behaviors to live with Covid, such as masking and staying home when sick. Yet the length and mode of the isolation is still up for debate. When the pandemic hit, 14 days became the global standard because it’s the outer limit of the virus’s incubation period. The U.S. Centers for Disease Control and Prevention reiterated this recommendation last December, but acknowledging the burden of a two-week period, outlined alternatives to shorten it in specific cases. Proposed measures involved increasing testing, monitoring and evaluation.
That did little to change things in Hong Kong, even as the costs were becoming apparent. In March, Chief Executive Carrie Lam said: “The 21-day quarantine that Hong Kong has imposed on arrivals from outside China is, I will confess, very stringent,” adding that “we continue to have positive cases confirmed beyond the 14th day while in quarantine.” She said she would “personally” look into the matter at the time.
It’s true that some cases have been reported after quarantine, but that doesn't change the fact that infection rates in the broader community have remained exceedingly low. The government has failed to adapt its policy to return closer to normalcy, and hasn't communicated any comprehensive or transparent plans that lay out the pros and cons of its interventions. This approach skews perceptions and provides the wrong incentives. As a result, people have avoided getting vaccinated and shrug off social responsibility, while the burden of protecting the unvaccinated is borne by the individuals who are masking, testing and getting shots.
Hong Kong isn’t facing this challenge alone. Yet in many other parts of the world, rules governing isolation have adjusted to what’s happening in the community as vaccination rates and awareness increase, and a post-pandemic economic reality sets in. That’s allowed countries, such as France, to cautiously reopen. Meanwhile, Australia, which went into lockdown after months of relative stability, shows that closing off national borders is not feasible as Covid-19 becomes endemic.
Hong Kong’s government-mandated “centers” are hotels – not specifically designed for medical isolation with the right ventilation and drainage systems, manned by staff who are tested but not necessarily vaccinated. Many are located in the middle of the dense city, connected to other buildings. In some cases, the quarantined have to get permission to open windows and, when they do, can’t have them at more than a 45 degree angle. They have to consent to keeping windows closed overnight. Safety and liability issues aside, that’s not quite in line with the WHO’s guidance for “adequately ventilated rooms with large quantities of fresh and clean” air. The small, confined spaces aren’t child-friendly settings, either.
At one central and crowded location on Queen’s Road East, windows are dotted with signs displaying the number of days people have been in quarantine. A few blank faces — including very young ones — stare out the window into the crowded and sweltering streets of Hong Kong that are humming with masked activity. There are no balconies. As one mother who’s currently isolating with her children under the age of 10 said to me: Even prisoners get a walk out in the yard.
The manpower running this operation could be better put to use by shortening hotel quarantines and surveilling longer home stays, in addition to overseeing more testing and other monitoring measures. The government also could consider conditionally mandating vaccines for those using public transport or working in public office.
We are no longer in the early days of the outbreak. We’re more informed, and have vaccines to protect us from getting very sick and depriving those with acute illnesses of hospital beds. Yet at no point over the past few days did the government recognize the effectiveness of the shot the 38-year-old woman had taken. She was asymptomatic and, in theory, unlikely to get severely ill. Instead of using this as an opportunity to aggressively boost the vaccination rate, the city’s health experts fell back on the instinct to turn inward.
There is increasing evidence that vaccines are an effective way to reduce spread and transmission, even if vaccinated individuals get infected. As Marion Pepper, an immunologist at the University of Washington, told the Atlantic recently, “the same amount of virus might be there at the beginning [for the vaccinated and unvaccinated], but it can’t replicate in the airways and lungs” for the inoculated, who are less likely to get the virus and subsequently spread it. That’s a case for Hong Kong to be pushing shots, not quarantines.
Quarantines were first imposed in the 14th century, when Europe was battling the Black Death, and ships arriving in Venice from infected ports had to sit at anchor for 40 days. While there was little knowledge about diseases and treatments, one thing became clear: Segregation and isolation measures were used “to reduce contact between persons sick with a disease and persons susceptible to the disease,” in the “absence of pharmaceutical measures,” according to a study on the history of quarantines.
While many parts of the world are taking steps forward – and at times backward — Hong Kong remains in stasis. A public health strategy needs to evolve with the situation, and include goals for opening up, aggressive vaccination mandates and campaigns, as well as early and consistent testing. At its core, Hong Kong is a trading port that depends on the free flow of people, capital and ideas; closing itself off from the world is not sustainable.
After a successful immediate response to the outbreak, Hong Kong is failing to come up with a viable, long-term coping strategy and risks losing even more public trust. The strongest of defenses are built from within. Safety bubbles, on the other hand, inevitably pop — unexpectedly and quickly.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Anjani Trivedi is a Bloomberg Opinion columnist covering industrial companies in Asia. She previously worked for the Wall Street Journal.
©2021 Bloomberg L.P.