Hong Kong is at war with COVID-19. The fifth wave of the pandemic has spread like a forest fire in the city since two Cathay Pacific aircrew who flouted the quarantine rules and later tested positive roamed the city, which, for seven months, had been free from local infections. The Hong Kong Special Administrative Region government responded by locking down apartments where residents tested positive until other residents in the buildings were tested. All patients found positive were sent to the Penny Bay’s temporary facility to be isolated lest they infect healthy residents in the community.
That seemed to work for a while, until more and more cases without a clear linkage to the index case tested positive. These “invisible chains of transmission” portended gloomier months ahead for the people and the businesses in the special administrative region.
With no precedent to reference, country leaders in the world drafted pandemic policies of very different flavors. The United States and Britain decided that the economic costs of a prolonged lockdown were too high to bear. They resigned themselves to the notion of “living with the virus”, which was the code for capitulating to COVID-19 — everybody was fair game, including vulnerable children and the elderly.
If COVID-19 offers any lesson, reliance on the healthcare industry alone to solve a public health crisis is barking up the wrong tree
Some European countries imposed stricter policies to protect the lives of their people. Despite travel restrictions and vaccine mandates being vehemently opposed by populists across the continent, several leaders displayed resolve to act in the best interests of the people they had vowed to serve.
China, a country with insatiable domestic demands for the vast supplies it offers, judged the lives of 1.4 billion people to be too invaluable to sacrifice. President Xi Jinping instructed regional governors to “do everything they can” to curb the spread of the virus. The director-general of the World Health Organization warned that the pandemic is far from over and that leaders around the world should muster all their influence to protect the lives of people. Where does this leave Hong Kong, an international port city that is as extensively connected to the Chinese mainland as it is with the rest of the world?
The survival of Hong Kong, a region closest to the land and economy of the Chinese mainland, is contingent upon reconnecting with our mainland compatriots. Moreover, the local culture sees death as a taboo. A case in point was the recent passing of a child who was found COVID-19-positive in the mortuary, causing an uproar in society. Compare that to the US, where almost 1,000 child deaths across the country captured minimal attention (Biden is fixated on Ukraine, where few Americans reside; some Americans are busy blasting Eileen Gu, an American Chinese skier, on social media even before she won two Olympic gold medals representing China). Dense population is fodder for widespread infection that likely overwhelms the healthcare system if not kills our loved ones. All the more reason to suppress viral activity in Hong Kong, where the urban density is one of the highest in the world.
For policies to be leak-proof of the virus, resource management is crucial. Vaccination is the most cost-efficient way, and by far the only way, of lowering the risks of death and severe illness. Vaccine passports and vaccine mandates help to incentivize residents to equip themselves with the most protective and natural armamentarium against the virus. It is encouraging that vaccine centers now receive four times the number of bookings compared with three months earlier.
The inoculation rate in elderly residents has also surged since the government implemented old-age-home vaccination programs. Besides formal public campaigns, the government can collaborate with NGOs and local communities to propagate the safety and effectiveness of COVID-19 vaccines. Those who distrust the government are likely to place much confidence in the words of professionals and anecdotal experiences of close friends.
Mass testing must be implemented alongside effective isolation strategies. It helps little for an infected patient to scuttle across different lands across Hong Kong, all the while interacting with other residents. School halls, community centers, cruise ships and sports centers can be retrofitted to serve as quarantine camps. COVID-19-positive patients who suffer from mild illnesses should stay in these facilities until they no longer pose a biological threat to society at large. That means low counts of viral genes and high antibody titers in the body. The public needs to be educated on health-seeking behavior, not only about when to seek hospital care but also when not to. Take Singaporeans, for instance: They refrain from attending emergency clinics unless necessary because they know flooding the hospitals will bring down their healthcare system altogether.
Doctors and nurses can help educate patients about isolation without the need for hospitalization — the treatment of milder illnesses remains symptomatic medications, as with the flu. Healthcare workers may answer hotline inquiries from infected patients and reassure them. The government can also call upon civil servants whose job nature is unlikely to be productive during the lockdown to provide for the people isolated within these camps. Food, water and blankets are essential under this frigid weather. This is because civil servants are bound to shoulder the fiduciary responsibility of defending local citizens during the darkest hours.
As for those who are frail and may require acute medical support (oxygen supplements, close vital monitoring, intravenous antibiotics), they should be sent to the hospitals for inpatient care. In case of resource limitations, geriatric and pediatric patients must be prioritized. The majority of young adults are adequately fit to survive the illness with just a few pills. To cope with the gush of demand for acute medical care, doctors whose workload has eased during the pandemic — surgeons perform fewer elective procedures; radiologists read fewer scans for elective surgical planning — should be arranged to service patients who attend hospitals for COVID-19. Essentially, postponing elective procedures in public hospitals should spare more doctors (albeit top-down management is needed to deploy them in emergency departments and isolation wards). Rather than shunting more lucrative surgeries to the private sector during a crisis, money can be directed toward general practitioners who are willing to help in public hospitals. In the same vein, private hospitals should not be allowed to capitalize on the crisis by extorting from taxpayers’ pockets in exchange for caring for the weak. As with wartime, it is simply base for private hospitals to refuse treatment or charge a premium to treat wounded civilians. If moral principles fail to constrain them, the government should.
The current fragmented system for coordination during a crisis is hardly conducive to putting an end to our predicament. In fact, this could be the perfect moment to introduce telemedicine and digitization of the healthcare system in Hong Kong. Remote consultation and monitoring can be set up for citizens staying in quarantine camps. Importantly, back-end data should harmonize with the systems in the Guangdong-Hong Kong-Macao Greater Bay Area. So should policies around data privacy and protection be reviewed (by the Department of Justice and mainland legal authorities).
The Department of Health should set up central command centers to coordinate digitally the flux of healthcare demands in accordance with real-time hospital attendance rates and bed statistics. And this has to include both public and private hospitals. Such data can be analyzed to make rapid-cycle adjustments to policies. Besides maximizing efficiency, digitization of health data also fuels the development of artificial intelligence tools and future medical research.
Drawing lessons from groceries, legislators can reimagine identity cards as the bar codes of each individual. Technologies allow giant detectors placed at bottleneck entrances to sift out unvaccinated people if some health data were included in identity cards, just as unpaid groceries would sound the alarm. No longer will customers cram to focus their cameras on LeaveHomeSafe bar codes outside restaurants. The elderly can be spared the ungainly moment of fiddling with their phone with one hand and balancing themselves on a cane with the other. In the future, such technologies may even conveniently expand into the realm of crime reduction.
To exert maximum pressure on the virus, the integrity of a closed-loop system must be preserved. COVID-19-positive patients should remain out of contact with those who test negative or recovered. Taxis are inefficient vehicles to move people around en masse. Abandoned shuttle buses, which used to ferry tourists before the pandemic, can serve this purpose well. The government can leverage public transport systems to organize these parallel closed loops. The mass-transit railway can close to the public after late evening and reserve trains to carry citizens who belong to each of the “loops”. Similarly, designated buses can shuttle people from quarantine camps back home when their infectivity subsides. Drivers and other volunteer workers may be arranged to stay in quarantine hotels until fewer cases emerge.
The central government has come to the rescue by pumping in a deluge of resources. It is unwise for the chief executive, Carrie Lam Cheng Yuet-ngor, to think this alone can render the region virus-free. President Xi has instructed Hong Kong to “do everything and anything” to keep the virus at bay. This entails reimagining healthcare to be a wholesale community enhancement rather than an isolated industry. If this virus can cause such wreckage to Hong Kong, it is unfathomable what terrorist attacks of large-scale biochemical warfare can do. Hong Kong, as a melting pot where East meets West, plays a strategic role in geopolitical and cultural aspects. The pandemic thus far exposed the region as the weakest link in the country during war-like crises. Amid a world where some extremists in the West are itching to sabotage peace, we are minimally prepared.
At times of crisis, the special administrative region cannot fail its duties to guard the rest of the 1.4 billion people in China. Global crisis responses can hardly succeed when top-down leadership and preparedness are immensely lacking. Consider the pandemic a dress rehearsal; Hong Kong needs to set up a crisis response center. Situational clout should be bestowed upon an elite team comprising public health experts, security forces, biologists and chemists to coordinate across public and private sectors. Cross-cutting special powers will be allowed during exceptional times as such — citizens and civil servants are bound to whatever mandates and conscripts are drafted by the team. Biannual rehearsals are needed to keep up with technological advancements and the shifting sand of inter-country dynamics.
These are barely novel ideas. Since COVID-19 hit the US two years ago, plans have been afoot in every major city to formalize a global crisis response for fear of malicious assault by biological warfare that mimics this pandemic. Under extraordinary circumstances, local health authorities collaborate with top universities and experts to override existing legislation regarding the management of public infrastructure, transportation, human activity, food and medicine. If COVID-19 offers any lesson, reliance on the healthcare industry alone to solve a public health crisis is barking up the wrong tree.
In an era when countries are more interconnected than ever, war among humans seems a farfetched notion. But it is from the past wars that we learn how best to manage crises — coordination of human activities, forcible mandates, resource management and structured logistics. Beijing is right to see the pandemic as an adversary to defeat. And Hong Kong may have remained too comfortable sitting on piles of free cash from land sales. As the ancient Chinese saying goes, we can no longer “indulge and forget our duties at home”. It is time we muster the grit to defend our country.
The author is a licensed medical doctor in Hong Kong and holds a Master of Public Health degree from Johns Hopkins University in the US state of Maryland.
The views do not necessarily reflect those of China Daily.