Covid-19: Why Hong Kong’s ‘Third Wave’ is a Warning
By Helier Cheung
Until recently, Hong Kong was considered a poster child in its handling of the Covid-19 pandemic.
Despite sharing a border with mainland China, where the first cases were reported, Hong Kong kept its infection numbers down and was able to avoid the extreme lockdown measures introduced in parts of China, Europe and the US.
But now, it’s been hit by not even a second, but a third, wave of infections. The government has warned its hospital system could face collapse, and it’s just had a record high number of new infections in a day.
What went wrong, and what lessons are there for countries juggling both the pandemic, and the economic pain caused by lockdown?
Quarantine exemptions and ‘loopholes’
Hong Kong had its first Covid-19 cases in late January, leading to widespread concern and panic buying, but infection numbers remained relatively low and the spread was controlled quite quickly.
It experienced what became known as its “second wave” in March, after overseas students and residents started returning to the territory, leading to a spike in imported infections.
As a result, Hong Kong introduced strict border controls, banning all non-residents from entering its borders from overseas, and everyone who returned was required to undergo a Covid-19 test and 14-day quarantine.
It even used electronic bracelets to track new arrivals and make sure they stayed at home.
That, combined with the widespread use of masks and social distancing measures, worked - Hong Kong went for weeks without a locally transmitted case, and life seemed to be heading back to normal.
So how did the “third wave” - that has led to more than 100 new cases for nine days in a row - arrive?
“It’s quite disappointing and frustrating because Hong Kong had really got things very much under control,” says Malik Peiris, Chair of Virology at the University of Hong Kong.
He believes there were two flaws in the system.
First, many returnees opted to quarantine for 14 days at home - an arrangement that’s common in many countries including the UK - rather than in quarantine camps.
“There is a weakness there because other people in the home are not under any form of restriction, and will still be coming and going,” says Prof Peiris.
However, he believes the more serious problem came from the government’s decision to exempt several groups of people from testing and quarantine when they entered Hong Kong.
Hong Kong had exempted about 200,000 people, including seafarers, aircrew and executives of companies listed on the stock exchange, from quarantine.
It said the exceptions were needed to ensure normal daily operations continued in Hong Kong, or because their travel was necessary to the city’s economic development.
As an international city and trading port, Hong Kong has a high number of air links, and many ships change crews there. The territory also depends on imports from mainland China and elsewhere for food and essential goods.
Joseph Tsang, an infectious diseases specialist and doctor, describes the exemptions as a significant «loophole» that increased the risk of infection, particularly from seafarers and air crew who also visited tourist spots and used public transport.
The government initially said that the quarantine exemptions were not to blame, but later admitted there was evidence that the exemptions were behind the latest outbreak.
They have now tightened rules for air and sea crews - but it can be difficult to enforce. There was alarm earlier this week when a foreign pilot was reportedly spotted sightseeing while awaiting Covid-19 test results.
And balancing public health, practical concerns and the economy can be hard - a union representing pilots at FedEx has asked the company to stop flights to Hong Kong because it says the stricter Covid-19 measures, including mandatory hospital stays for pilots who test positive, create “unacceptable conditions for pilots”.
Benjamin Cowling, a professor of epidemiology at the University of Hong Kong, says Hong Kong›s experience with quarantine problems could also happen in other countries.
«In the UK, you also have a 14-day quarantine at home, so you would have the same potential issue with leakage.»
Meanwhile, New Zealand and Australia have a mandatory hotel quarantine policy, which is «a good concept… although there›s the issue of who pays for it», he adds.
Like Hong Kong, the UK also exempts certain travellers from border rules, including drivers of goods vehicles, seafarers and aircrew.
Social distancing measures were lifted
Hong Kong’s quarantine exemptions have been around for months, but the third wave didn’t hit until July.
Prof Peiris believes this is because of a second crucial factor - social distancing measures were significantly rolled back in June.
“As long as social distancing measures were in place the system could cope - but once measures were relaxed” the imported infections spread rapidly, he says. “It’s a lesson for everybody.”