Are we facing the end of the covid-19 pandemic?
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Hong Kong (CNN) --
Morgues are nearly full, hospitals are overwhelmed and, as fears of a full city lockdown mount, terrified shoppers have left supermarket shelves empty.
Hong Kong, once lauded as a zero-Covid success story, is now battling a deadly outbreak reminiscent of the early days of the pandemic, despite having had more than two years to prepare.
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With locally transmitted cases topping 312,000 in the city of 7.4 million in just the past two weeks, struggling hospitals and healthcare workers have been pushed to the limit.
The figures are likely to be much higher due to suspicions that people are not reporting positive test results for fear of being separated from their families and placed in government isolation facilities.
Although the rampant rise has been driven by the less deadly omicron variant, Hong Kong deaths are also on the rise, particularly among the city's unvaccinated elderly.
According to Our World in Data, which uses data from Johns Hopkins University, Hong Kong reported more deaths per million people in the week to March 3 than any other country or territory.
Empty shelves at a grocery store in Hong Kong on March 1, 2022.
Hong Kong leader Carrie Lam said the city faced an "unprecedented challenge" and insisted no one could have predicted the latest wave.
But according to the clinical virologist at the University of Hong Kong, Siddharth Sridhar, the situation was a "predictable and preventable disaster".
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For two years, as the pandemic spread across the globe, Hong Kong largely contained the virus and there was a growing sense that the city could keep the virus out forever.
As cases surged this year, the government reimposed its strictest rules, limiting public gatherings to two, closing restaurants and bars after 6 p.m. and cordoning off public playgrounds.
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But still it was not enough.
With few other levers to pull, the government plans to launch a massive mandatory testing campaign in a bid to purge the city of covid-19.
Schools will be released earlier for the summer and will be repurposed as isolation, testing and vaccination facilities.
And it is not yet clear if a total closure of the city is envisaged.
"March is going to be a very, very difficult time," Sridhar said.
"(It's) definitely an unprecedented health crisis for Hong Kong."
For a city that has already endured two years of harsh restrictions, news of citywide testing has proven too much for some residents desperately looking for a flight.
And while the vaccines mean Hong Kong is better off than it would have been two years ago, immunization rates still lag among its elderly population, meaning many of the city's most vulnerable are still unprotected.
What went wrong in Hong Kong
At Queen Elizabeth, one of Hong Kong's largest hospitals, patients sit in a sparse, windowless observation room as they wait for a bed in an isolation ward.
Two nurses, who asked not to be named because they fear repercussions for speaking out, told CNN last week that the observation room smells like feces: There are no bathrooms, so patients are forced to use bedpans.
Nurses say staff shortages mean there is often a backlog of patients as more arrive for care, and there are too many people wanting treatment and not enough beds.
"A patient is unlikely to go into an isolation room unless they are about to die," a staff member said.
"No matter how hard we work, the situation doesn't change, but we still can't stop. The situation is desperate."
The hospital morgue is overflowing and some bodies sit for hours at room temperature, according to one of the nurses.
A doctor of medicine and geriatrics at another hospital in Hong Kong, who asked not to be named for fear of repercussions, said the sheer number of patients was "staggering", with some waiting up to four days to see a doctor.
"It's so crowded and understaffed, you have one nurse taking care of 20 patients," he said last week.
"What we're seeing here is nothing I've seen before."
Covid-19 patients lying on beds outside the Caritas Medical Center in Hong Kong.
In a statement to CNN, the Hospital Authority said it was facing "unprecedented challenges" and apologized to patients who had experienced long waiting times.
With a sharp rise in Covid-19 deaths due to cold weather, "storage space in hospital morgues has reached full capacity," the statement said.
In a briefing Tuesday, health officials said they are adding refrigerated containers and speeding up construction of a new morgue to provide at least 800 additional units.
To date, Hong Kong has recorded 1,554 deaths since the start of the pandemic, up from 213 at the end of December 2021.
Covid patients outside the Caritas Medical Center in Hong Kong on February 25, 2022.
That surge in cases is also putting pressure on hospital wards.
Previously, all positive covid cases were admitted to hospital and any close contacts in government-run quarantine, even if they were asymptomatic.
But with the rise in cases, it was no longer feasible to quarantine all positive cases and close contacts.
“Our health system is on the brink of collapse,” the Hong Kong Doctors Union said in an open letter in February.
But some positive cases are desperate to be admitted to government-run facilities, no matter how sick they are, because for much of the pandemic they have been told it is the right thing to do, University of Hong Kong professor Jin Dong said. -Yan.
That not only puts pressure on the system, he said, but also exposes others to infection.
"They just stay, they come to this or that hospital, just hoping to be admitted," he said last month.
“They could transmit the virus to others.”
The situation is also exacerbated by the high proportion of unvaccinated people in Hong Kong.
As of this week, 78% of the population, excluding those ages 3 to 11, have been double-vaccinated, but only 48% of people age 70 and older have received two doses.
At the beginning of this year, only 25% of people aged 80 and over had been vaccinated.
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On Friday, government officials said vaccinating the elderly was now a public health priority, describing nursing homes as "hot spots" for the virus.
And starting Friday, the waiting time between the first and second doses of the Chinese-made Sinovac injection would be reduced from 28 days to 21 days for the elderly.
The low vaccination rate among the elderly appears to be affecting the city's death toll.
Almost all of the city's Covid-19 deaths reported this year are older and unvaccinated people, and many of them lived in nursing homes.
Stephanie Law, a member of the executive committee of the Hong Kong Association of Services for the Elderly, said that for many older residents, concerns about side effects from the Covid vaccine outweigh the risks of contracting the disease.
"In the past, a lot of people felt that it was not a priority to have the vaccine," he said.
Now caregivers feel "powerless" as the virus spreads through homes, where some residents live with four or six people to a room, she said.
Karen Grepin, an associate professor at the University of Hong Kong's School of Public Health, said the narrative in the city had evolved to the point where people had begun to believe that Hong Kong could keep the virus out forever.
"People really started to believe that even the miniscule risk associated with vaccination was greater than the risk of Covid," he said.
"We are paying for that complacency."
Why Hong Kong can't change
Hong Kong is not the only place in the covid-zero world to experience an outbreak.
Both New Zealand and Singapore spent more than a year isolated from the world.
During that time, they prepared for an inevitable outbreak.
They increased vaccination rates, especially in their most vulnerable populations, and adjusted their public messages from eradicating covid to living with the virus, albeit with precautions.
And while both countries are now seeing a spike in cases, neither is seeing the same level of deaths as Hong Kong.
In both countries, more than 90% of people aged 70 and over are fully vaccinated, far more than in Hong Kong, despite the fact that vaccines have been available in the city for a year.
Health workers collect swab samples at a Covid-19 testing center in Hong Kong on February 24.
Experts say Hong Kong could have done more to emphasize the importance of vaccination, especially among the elderly and vulnerable.
Unlike many places in the West, Hong Kong has not pushed for vaccinations as a way out of the pandemic because the option of living with the virus has so far been rejected.
The Hong Kong government is ultimately accountable to China's ruling Communist Party, which maintains a strict "Covid Zero" policy that has touted its suppression of the virus as evidence of the alleged superiority of its one-party system over democracies. Westerners, especially the United States.
Last month, Chinese President Xi Jinping instructed Hong Kong to "take all necessary measures" to contain the outbreak.
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"With the support of the central government and the unity of the Hong Kong people, we will certainly triumph over this pandemic," Lam said last Tuesday.
"After the storm we will see a rainbow again."
Lam has maintained that the latest measures are not dictated by Beijing, but are the result of "exchange of ideas" between the two sides.
Dr. Ramanan Laxminarayan, founder and director of the Center for Disease Dynamics, Economics and Policy, says Beijing believes its Covid policy is superior to that of other countries.
“It is the narrative that China will always be Covid-free that will be problematic for China in the future,” he said.
"A theory based on this idea that you can keep covid out of your population forever just defies any kind of logic."
China's strategy is also driven by public health concerns.
Mainland China, unlike Hong Kong, has yet to license an mRNA vaccine, despite doubts about the efficacy of its domestically produced injections.
And a study by mathematicians at the country's prestigious Peking University found that China could face more than 630,000 Covid-19 infections a day if it abandons its zero-tolerance policies by reopening its borders.
Zeng Guang, chief epidemiologist at the China Center for Disease Control and Prevention, said this week that the covid-zero policy will not remain unchanged forever, but added that "there was no need to open the door at the peak of the global epidemic.
Workers build isolation units in Hong Kong on February 27, 2022.
An uncertain future
As other places around the world open up and learn to live with covid, Hong Kong still has some of the strictest border rules in the world, including barring most non-Hong Kong residents from entering.
And for many in the city, the apparent absence of a more progressive plan is hard to bear.
Within days of the announcement of the mass testing, a new Facebook group for tips on relocation had attracted more than 3,900 members, with some saying they wanted out before the citywide testing began.
A 37-year-old mother of two who asked not to be named for privacy reasons said last week she was leaving the city for Australia and was not sure if or when she would return.
She was concerned that Hong Kong's public health measures could mean that her son, who has an autoimmune disease, could not receive the hospital treatment she needs and that her children could be separated from her if they test positive.
“I feel that the children are the ones who are being punished the most during this whole thing.
It's not fair to them,” she said, referring to the restrictions.
"(Public health policy) scares me more than the virus itself."
Many locals are also becoming increasingly frustrated.
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James Hov, 31, invested his life savings in a barbershop that has been closed for weeks due to restrictions.
He worries about losing his business and struggling to pay for the engagement ring he bought for his future spouse.
“Covid cannot be ended.
Closing hair salons but having a group of people on the trains for their daily commute is stupid.
I'm not so sure there's any logic behind this,” she said.
A 25-year-old tattoo artist who asked not to use her real name for fear of repercussions said last month that she continues her underground business despite the current ban.
She refuses to get vaccinated because she doesn't trust either Chinese or Pfizer vaccines that are available in the city.
She is skeptical of Hong Kong's policies, which she said were simply there to satisfy China.
"It's hurting society, it's hurting the economy, it's hurting people's well-being," she said.
For Hong Kong, an unprecedented health crisis looms, and then little light at the end of the tunnel: Even if the city opens up, another wave is inevitable, said virologist Sridhar.
"We're just waiting for the next wave or a change in stance from the powers that be."
Hong Kong