Covid in HK & China, part 2: Where do we go from here?

Covid in HK & China, part 2: Where do we go from here?
Overflowing hospitals; at risk of happening again

I've had a "taste of Omicron" myself recently: Having been repeatedly exposed to different forms of Covid at work and outside for the last few months, the virus finally took hold and infected me. I had one night with poor sleep perhaps due to a mild fever, a day or two of runny nose and an occasional hourly cough, and then nothing but phlegm/post nasal drip for the following 8 days until testing negative two days in a row to rejoin society. I am fortunate to have been vaccinated three times which made the experience far more like a cold than a flu. I'd catch Omicron again in preference to another booster, personally: The booster caused two days of aches, exhaustion and fever which required two days off work. Omicron didn't require any time off.

Hong Kong: How we got to here

My last article on this subject went completely viral with over a hundred thousand views, lots of feedback and even some citations. The article claimed that the only useful, sustainable thing that could be done to minimise impact of Covid in Hong Kong would be to aggressively vaccinate the elderly. The article claimed that if the end goal was to go back to zero Covid in Hong Kong, this could not be accomplished without a mainland-style lockdown, and all the mucking around locking down buildings, testing and building quarantine centres was a waste of time. The concluding comments were as follows:

Ironically, regardless of all of this, unless the mainland model is adopted 100% after an extraordinarily long lockdown, in about 6-8 weeks Omicron will have ripped through the population anyway and cases will start to decline naturally. Many elderly will die. However the government will claim victory in declining cases but in fact it will be mother nature that's done its job. The cynic in me worries that even after that, international travel won't be reopened, because there's a greater desire to be isolated for some reason.

Indeed, I don't claim to be a prophet of any kind, but this is exactly what happened. The Covid cases peaked at probably well over 100,000 cases a day in early March, ripping through an estimated four million people, approximately two thirds of the population, and by late April had dropped back to triple-digits again. The cynic also proved right: International travel has not been reopened, continuing to harm the reputation of the city as the business and financial gateway to China. More and more business functions are moving to Singapore or elsewhere.

The quarantine policy has become asymmetric: People who catch coronavirus internationally have to quarantine in a hotel however people who catch coronavirus in the general Hong Kong society are afforded the luxury of home quarantine (if they even bother to declare the infection; I've heard of many people who caught covid and didn't even bother telling anyone and just stayed home for fear of being quarantined). Flights are rare and still get cancelled, unnecessarily punishing airlines and passengers, kids' lives and education continue to get disrupted and everyone has to walk around in the stifling heat - even outdoors, like idiots - with masks on. The population's mental health is in decline and suicides are up.

A tale of Shanghai and the mainland

Hong Kong took the path of allowing Covid to rip through the population, perhaps unwillingly with futile attempts at building lockdowns and testing, but it happened anyway. Shanghai has taken the opposite approach, the heavy-handed lockdown. Although such lockdowns worked well during the early days of the pandemic, with Omicron they won't work well. Such lockdowns are happening all over China, districts, neighbourhoods or buildings at a time. Friends there are fed up and stressed and people who can leave, are leaving. The mainland economy is probably in the worst shape of the last three days, with an economic crisis unfolding due to these draconian lockdowns.

Some of the justification for the lockdowns is, again, the relatively low vaccination rate among the elderly. This is particularly frustrating because it turns out in many cases doctors and government workers in China had been actively discouraging the elderly from getting vaccinated, and the vaccines were initially only approved for healthy people under 60 which is the less vulnerable part of the population. High blood pressure? Diabetes? Undergoing cancer treatment? Don't get vaccinated, it's dangerous. This wasted time and is shameful policy because data from the rest of the world clearly shows that, in these fragile groups, the risk of dying from covid is far higher than dying from the vaccine. I've even heard stories of doctors in Hong Kong discouraging their elderly patients from being vaccinated for the same reason.

A result of this is after almost 2 months of lockdown and substantial economic damage, maybe only a couple of percent of the Shanghai population has been infected by the virus. This is a relatively low level of immunity for such an economic catastrophe. It's policy formulated as though it was the original virus in Wuhan, two years ago, with no vaccines available. People standing in the streets in hazmat suits (大白) spraying themselves down with disinfectant as though there's a fatal plague on every surface. People spraying down sidewalks and even breaking into private property to disinfect it and putting up iron gates to stop folks leaving their homes. An inability to travel easily within the country, let along outside it: Borderline madness.

Fortunately the vaccination trend among the elderly is changing. The mainland appears to be aggressively vaccinating the elderly with Sinovac in a way Hong Kong was unable. This should be completed soon. This brings us to a comment on lying flat:

躺平: Lying flat aka doing nothing

While the Covid wave was ramping in Hong Kong, and cases were being extinguished in neighbouring Guangdong province, the ongoing narrative from the government is "we can't just lay flat and do nothing like the Western countries." This completely missed the point. The well-run western countries without irreparable political divisions (i.e. not the USA - how the f*ck did getting vaccinated become a political choice? Only in America) did the single most important thing: Vaccinated their elderly.

In the UK, over 94% of people over 70 years old have two shots of Covid vaccine. In countries with such high vaccination rates, the death rates among the elderly are comparable with that of the flu according to several studies, and in the rest of the general population - which is also about 90% vaccinated - far lower. New Zealand is 95% vaccinated. Singapore has 97% of the elderly vaccinated.

But wait, isn't Sinovac crap? No, actually, it's not!

According to data out of the University of Hong Kong, three shots of Sinovac protect against severe injury and death just as well as two shots of Biontech. This isn't half bad. The original paper is here and the economist has a nice graphical summary here. On the surface this looks like mainland China, if it can innoculate its entire population with three shots of Sinovac, doesn't need an mRNA vaccine after all.

However we have seen in most societies the rates of people getting boosted are far lower than those getting the second dose. Even in compliant Singapore, only 75% took boosters as of recently, and the pattern plays out across other nations, including China thus far. Without a booster, the rate of protection against severe disease differs greatly. Severe and fatal disease after two jabs was twice as frequent with people with Sinovac than Biontech.

Putting people's lives first... or not.

Admirably, Greater China did the best possible job before vaccines were available: Allowing most people to go about normal lives without lockdowns. Omicron and vaccination have changed things: With vaccination, people won't die en masse, and Omicron is far more transmittable making lockdowns far more costly, painful and long-lasting for less reward.

If Greater China were to put people's lives first, just as in the first article, the priority as of the last year would be to buy and procure the best vaccines in the world (Moderna or Biontech) and vaccinate as many of the elderly as quickly as possible with at least two doses, preferably three. Assuming not everyone will get boosted, this will give the highest level of protection to the population.

With this done, there's no need for the madness of lockdowns, white people in hazmat suits, break-ins to private property, economic fallout, mental health stress among the population and people don't have to die. The propaganda likes to talk about the ongoing death rate in the USA, but that's because the majority of those people have chosen not to get vaccinated, and it's the worst possible example in the world.

New Zealand and Singapore offer great lessons on how to manage the pandemic: Excellent management in the early stages, like China, but aggressive vaccination and freedom in the latter stages. The result being in New Zealand's case less than 1,000 deaths in a population of 5m, and in Singapore's case 1,300 deaths in a population of 5.6m. The excess death count in both populations will be as good as zero.

Given this, the motivation for policy in the mainland is clearly not as pure as would be made out. It's verging on borderline madness and clearly motivated by different factors that are beyond discussion here. This has been reported on in Shanghai, where the new phrase is - when instructed to do something by the authorities because of covid - "don't ask why, why doesn't matter, just do it."

Hong Kong: Where do we go from here?

This is the big question. Hong Kong has had an omicron wave and vaccinated everyone that wants to get vaccinated, mostly with Sinovac. Unfortunately only 47% of the population is boosted, which lead to the overflowing hospitals and a very high death rate among the elderly, perhaps a record high death rate because, without being boosted, Sinovac isn't that good. Simply, the vaccination rate of the elderly with 3 Sinovacs or 2 Biontechs just isn't good enough.

It's estimated that 3m-4m people got infected, around or slightly more than 50% of the population of 7.5m. People on message boards incorrectly state that Hong Kong 'should open up now because it has a 90%+ level of immunity if we combine fully vaccinated with the infection rate' but this simply doesn't hold like it does in other countries due to the choice of Sinovac in the majority of the population: Fully vaccinated with Sinovac is 3 doses, not 2. This means the next wave will still cause a large number of unnecessary deaths.

Every day in the news, the heading is about how many cases have been reported. The goal is still "dynamic zero," whatever that means - to stamp out coronavirus and reopen the border. The borders aren't even open between cities in the mainland, let alone with Hong Kong. It appears little is being done to further encourage vaccination. The lessons of Singapore - if you're not fully vaccinated, you pay for your own healthcare and go bankrupt - hasn't carried over still. The stupid cat and mouse games have started again, overnight lockdowns of buildings, compulsory testing notices, tracking clusters in restaurants. Sewage is being tested. What a waste of everyone's f***ing time, mental health, money and livelihoods.

There are three choices:

  1. Somehow force or encourage more vaccination of the population, then reopen.
  2. Reopen anyway, and allow more deaths.
  3. Keep the stupid cat and mouse games, masks outdoors, wait for the next wave, inflict more misery and more deaths and still not reopen.

The likely choice, the result of zero leadership, is action (3). The border with the mainland still won't open. International borders still won't open. The economy and mental health of the people will continue to suffer. This is the likely path and, unfortunately, my view this time is being driven by observing what's going on, not purely by cynicism. So incredibly sad.

For Hong Kong, there is also no point to ask "why?" There is no why. It makes no sense. It's headless, leaderless and going nowhere. I will try to be a better Buddhist and not get angry.