Hong Kong May Not Be Ready for Another COVID-19 Surge

Wong Wing-yan has taken to closing the doors of the empty bedrooms at the suburban Hong Kong nursing home where she works, so she doesn’t have to think about the residents who once occupied them. Some rooms have been converted into haphazard storage spaces, filled with wheelchairs and mothballed furniture. The walls still have the marks of tape on them, which are where photographs of family members were displayed.

“There are many empty rooms now,” said Wong, a bespectacled nurse in her thirties, as she walked TIME through the facility in late April. “I’ve known [the inhabitants] for so long, and now when I see those empty rooms, I am depressed.”

After being spared for the past two years, COVID-19 arrived at the Kei Tak Home For The Aged (Tai Hang), on February 13. Next day, 17 people tested positive. It was then 30. Soon, 98% of the residents had been infected—and after two months, 27 of the nursing home’s 200 residents had died.

“Our elderly home turned into a battlefield as hospitals were overloaded and the healthcare system collapsed,” said Wong, who has worked at Kei Tak for more than 10 years.

A temporary area was set up for patients outside Caritas Medical Center, Hong Kong. It is used by them until February 16, 2022.

Leung Man Hei—NurPhoto/Reuters

She was a foot soldier in Hong Kong’s battle against the fifth wave of COVID-19—a fight the city spectacularly lost. From February through April, Hong Kong was a pandemic success tale and the country with the highest death rate from COVID-19. Hong Kong, with a population estimated at 7.5 million people lost nearly 9,000 of its inhabitants in just 10 weeks. This was due to the Omicron variant which can be contagious.

Overburdened hospitals quickly emerged. Images of frail elderly men, mostly seniors, wrapped up in blankets and lying on gurneys on the streets of hospital driveways became a disturbing trend on social media. The morgue was full, so thousands of bodies had to stay in containers. Some hospitals used body bags to pile up on top of the bodies of patients still alive. It was difficult to obtain coffins quickly and the crematoriums were unable to meet demand. Many bodies eventually died before being buried or cremated.

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The tragedy took place despite vaccines being widely available for a year prior and Hong Kong imposing some of the toughest infection control measures in the world—including periodic entry bans for non-residents, mandatory quarantine for travelers, strict mask mandates, a mandatory track-and-trace app, and quarantine camps or hospitalization for anyone testing positive. Overreliance on these measures has led to vaccine complacency. A low level of vaccination among seniors made them particularly vulnerable to faster-growing variants. Only 25% of Hong Kong’s 80-year-old residents had received vaccinations in January. The rate for residents living in care homes was even lower. Nearly 72% of the people who died in the fifth wave were not vaccinated.

Kei Tak suffered a heavy death rate that was comparable to those in other aged care facilities. At the conclusion of the fifth wave, 1.5% had died in Hong Kong, the majority of them in nursing homes. Now, as COVID-19 begins to spike in the city once more, it’s not clear that Hong Kong has learned the lessons from earlier this year. The government reported three more deaths due to COVID-19 on July 25, all of them over 70. Two of the dead hadn’t received any vaccine doses at all. Unknown is the status of third.

On May 6, boxes of supplies piled up on the beds that are normally reserved for those who require special care.

Anthony Kwan for TIME

Hong Kong’s vaccination campaign failed its elderly

Most experts attribute the high toll of Hong Kong’s fifth wave to the low rate of elderly vaccination.

Two vaccines have been made available by the authorities at no charge to the public. One is CornaVac which was developed in China by Sinovac and the other is an mRNA vaccine that BioNTech has manufactured in Germany. Both use the same technology used by the Pfizer vaccine. Wong says she and other nurses at Kei Tak tried their best to get their residents jabbed, but in many cases this required authorization from the residents’ families, who were often hesitant, fearing that underlying conditions like high blood pressure, or a history of strokes, made elderly people unsuitable recipients of a dose. These residents were despite vaccines being safe administered in Europe and the U.S. to thousands of people with these conditions.

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It was common to hear rumors that vaccinations have caused deaths. Local newspapers sowed stoked fears by repeatedly publicizing instances of people who died within 14 days if being vaccinated—even if vaccination played no part in the fatalities. Uncertainty was further exacerbated through government messages. Mar. 6, then health secretary, Sophia Chan, suggested “to the public that if they are uncertain about their own situation whether they have serious chronic illness or uncontrolled chronic illness, they can actually consult their family doctors to understand more before they make a booking for vaccination.”

Many people living in elderly care and their families concluded that vaccinations are dangerous. Kei Tak’s consequences were pretty predictable.

The deputy head at Hong Kong’s Kei Tak Home for the Aging (Tai Hang), Dr. Poon Yui pan conducts an antigen test quickly on a resident.

Anthony Kwan for TIME

Poon Yuipan, 42, is a doctor who was deputy head of the facility. Calling emergency services didn’t bring immediate assistance. According to local media, the wait time for ambulances was more than 30 hours during the fifth wave. The hospitals were packed so many people in Hong Kong had to wait for beds while they recovered.

Kei Tak, like many nursing homes, did not have sufficient space to isolate infected residents. The virus quickly spread. As a result, the staff was constantly in short supply. Many workers stopped working or left because they were worried that they might catch the virus. Wong herself was positive for COVID-19 but she carried on with her job. All of the residents that she cared for had contracted the virus. “I felt a great sense of responsibility to take care of them,” she says.

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Wong remembers the 92 year-old, very special resident who she called kai ma—Cantonese for godmother—and anxiously touches her necklace while she talks about how the woman’s family had declined to have her vaccinated. Reminisces on afternoons spent together kai maShe was watching her favourite TV program, which is a 1990s local drama. When she was young, the resident was a farmer. She smiled often and shared stories about her families. When Wong was eating, Wong would ask her if Wong has eaten before she started to eat.

“She was like family to me,” the nurse says.

The elderly lady died during the fifth wave, one of many Hong Kong’s COVID-19 victims who have passed away in relative anonymity. The many victims’ deaths have been overlooked and there has not been much public mourning. There have not been any memorials and there are very few stories in the local media about the lives lost. TIME declined to interview the family of many COVID-19-affected patients at Kei Tak Nursing Home. They also refused to share their names.

People are uncomfortable talking about death. Hong Kong is a special case of this reticence. “In Chinese culture, people avoid talking about death because they believe it may bring bad luck,” says Chan Kai-woon, a 31-year-old funeral director.

The tape holding up the family photos was once used to mark them. They were found in Kei Tak (Tai Hang), Home for the Aging, Hong Kong.

Anthony Kwan for TIME

Accountability for Hong Kong’s pandemic failures

Months later, no one has really accounted for the many preventable deaths.

In a rare admission, the city’s then leader, Carrie Lam, said in a mid-June interview with Bloomberg TV that her administration could have done more to prevent elderly deaths with a stronger vaccination drive. When asked by Bloomberg TV if she would like to apologize for any of the events that occurred during her tenure, Lam said no. In late June’s last public appearance before the legislature, Chan, the outgoing health chief denied that she was responsible for the fifth round.

Some things have improved. New residents of nursing homes must now be vaccinated with COVID-19. In addition to sending outreach teams out to senior homes, the government also offers a home vaccine service for anyone 70 years and older. Although the vaccination rate has increased, only 59% and 38% respectively of people aged 70-79 and 80 had received at least three vaccine doses by July 20. However, the U.K.’s 75-year-old population had already received their fourth dose of vaccines by May 2022. This was two months after becoming eligible.

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In an effort to protect those who are not vaccinated, the city still uses social distancing methods such as track and trace and mask mandates. This could prove to be problematic. On July 26, Hong Kong saw 4,276 additional cases. Officials are warning again that the hospital system could be in serious danger. Spikes may occur if the government yields to intense pressure from the business community to open Hong Kong’s borders and loosen COVID-19 controls.

Around 100 homes reported cases in July. Grace Li Fai (chairwoman of the Elderly Services Association of Hong Kong) stated that residents and staff are now being tested more frequently to cut down transmissions. Instead, it appears that COVID-19 is spreading among elderly who don’t live in care facilities. Only about 10% of those currently hospitalized for COVID-19—the great majority of whom are over the age of 65—are residents of care homes, according to the South China Morning Post.

Yip Fung Cheung (82), a Hong Kong resident at Kei Tak Home for the Aged. She eats her dinner in her dorm room.

Anthony Kwan for TIME

Wong said that Kei Tak’s life is still moving. Wong says that life is moving on at Kei Tak. Residents who had been too sad to eat in the first wave of residents have now regained their appetites and are now able to live again. “We’re accepting new residents, so there are a lot of new faces,” she says.

Kei Tak’s preparedness for the new surge is evident, says she. Officials have checked the ventilation system and have put together a stock of PPE. The home’s vaccination rate has now reached nearly 100%. No new confirmed cases have been reported at the residence. “I have been mentally ready that there might be a sixth wave,” Wong says.

The scars aren’t gone. She describes COVID-19 as “a catastrophe” for the city’s aged care facilities. “Hong Kong is supposed to be a civilized society,” says Wong. “How could something like this happen here?”

A person’s personal effects, as left behind by their deceased loved one. This was seen in a Hong Kong Kei Tak (Tai Hang), Home for the Aging.

Anthony Kwan for TIME

Send an email to Amy Gunia can be reached at amy.gunia@time.com