Friday, Mar. Thursday, March 4 marked a turning point in China’s history with the COVID-19 epidemic. Two hundred and ninety-four cases of coronavirus were reported by Chinese health authorities. 233 of these cases had been imported. These figures are a source of envy for countries all over the globe that chose to live with coronavirus, tally daily cases in the thousands and make their own decisions. China refuses to permit the virus to gain entry to its country, despite its zero-COVID policies.
Worryingly, nearly half the imported figure—117 cases—were recorded in China’s most populous province, the southern economic powerhouse of Guangdong. The city of Shenzhen was the epicenter of all those cases (96), which is also a major technology and financial hub. The others were discovered in nearby cities like Zhuhai and Zhongshan—and all but two of the imported cases originated from Hong Kong, where cases have exploded, fueled by the highly contagious Omicron variant. The incident occurred on March 2. 2. The British colony of Mar. 2 had recorded 55,000 cases in one day. This earned it the terrible distinction as the location with the highest COVID-19 mortality rate in the developing world.
Hong Kong’s differences with China are often emphasized. While it is an independent Chinese territory, the Hong Kong government issues travel documents and has its own legal, financial, and political systems. But while Hong Kong has an administrative border with China, it and the eight other cities of Guangzhou’s Greater Bay Area are physically part of one vast, contiguous conurbation of 86 million people. The office towers of Shenzhen loom over Hong Kong’s northern suburbs and the two municipalities are connected by ferry, bus, and rail services that, at their quickest, take just 20 minutes.
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Although only limited movement between Hong Kong and the mainland has been permitted during the pandemic, with significant restrictions on travelers, it is inevitable that Hong Kong’s COVID-19 crisis would spread to the densely populated hinterland, given its proximity. The damage has been contained in seven Guangdong provinces, where there have already been cases of imported Hong Kong victims.
There are huge implications. Chinese researchers have projected that the spread of hundreds of millions upon thousands of infections across China would result in at least 3 million deaths if there were no aggressive zero-COVID strategies. Due to its poor healthcare system and low ICU beds, any breach of the COVID defenses could lead to disaster.
For now, most of the imported cases “will not spread infection because of the very strict precautions, the testing and the quarantine,” says Ben Cowling, who heads the division of epidemiology and biostatistics at the University of Hong Kong’s (HKU) School of Public Health. But, he warns, “the more opportunities the virus has, sooner or later, it will find a way.”
Leo Poon is the head of HKU’s public health laboratory science section. He points out that even if travelers from Hong Kong present negative tests when entering mainland China, “they may still be in the incubation period” and “be able to spread the disease.”
Hong Kong’s COVID-19 exodus
There was a dramatic exodus from Hong Kong during the first two years of the pandemic, as businesses and individuals chafed under onerous travel restrictions—including a notorious 21-day quarantine—imposed by local authorities to keep COVID-19 out. As the latest round of COVID-19 infection continues to spread, thousands of people are choosing to either leave Hong Kong or stay put.
People are fleeing from stringent isolation policies that result in babies being separated from their parents. People who have fully recovered from COVID-19 were left to languish at makeshift government-run holding facilities for days upon meeting the discharge criteria. Extended confinement can have a severe mental impact on the mind. In February, four suicide attempts were recorded in just over 24 hours at the notorious Penny’s Bay quarantine center, which one inhabitant described as like “living inside a mad house.”
“We don’t know what the government situation is going to be like, what sort of measures they’re going to take,” Hong Kong resident Edward Zhao tells TIME. “It’s just the uncertainty of what happens in the situation where the government decides to put you in quarantine.”
New Zealand is a possibility for the 32-year-old. Another popular destination is Singapore. Another popular bolt hole is Singapore. This spike was mainly caused by middle-aged Hong Kong residents who are now enrolled in Australian degree courses in the hopes that their dependents will be able to accompany them on student visas.
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To be honest, there are thousands of others who simply want to try their luck on the mainland Chinese. All illegal immigrants must complete the two-week mandatory quarantine at a government-specified hospital. According to media reports, a few have paid people smugglers to get them across the border—potentially bringing COVID with them.
Guangdong’s authorities are now motivated to take action. Some cities are offering the equivalent of almost $80,000—more than four times the province’s average annual salary—as a reward for information leading to the detention of anyone from Hong Kong on the mainland illegally. Shenzhen has placed strict restrictions on the city areas that border Hong Kong. Security personnel train powerful searchlights on the coastline nightly, looking for Hong Kong’s COVID-19 refugees.
Hong Kongians are not unaware of this irony. In Hong Kong’s short history, this affluent region has provided refuge to those fleeing from war, hunger, and communist revolution. This pattern has not been reversed since then.
How bad is Hong Kong’s current COVID-19 situation?
Hong Kong saw a total of just over 12,000 cases and 200 deaths between the outbreak in 2020 and the current surge in December 31st. This was in addition to a 7.4 million population. While strict travel restrictions might have cut Hong Kong off from the outside world, it allowed the city to stay out of dangerously overburdened health systems as well as the death tolls due to the coronavirus. Even better, the local economy rebounded in 2021 with 6.4% growth that overtook the 6.5% contraction the previous year.
These days, however, Hong Kong’s COVID-19 defenses are in stunning collapse. Over two months, more than half of all cases are now in Hong Kong. Meanwhile, deaths have increased 10 times. Because mortuaries have been overcrowded, bodies are accumulating in ER rooms. There are many COVID-19 patients flooding hospitals. Many thousands of patients are waiting in line for the mandatory testing, which is required if there’s a suspicion that a person may be the closest contact for a particular case. The results may take up to 10 days, which severely hampers their utility.
Hong Kong’s desperately overcrowded housing—which can see as many as eight people share a 200 sq. ft. apartment—meanwhile makes self-isolation a luxury. People who are positive have been known to sleep in public stairwells or in parks in order not to infect their family members. The government’s equivocal messaging on whether or not a lockdown will be imposed has sparked waves of panic buying, with supermarket shelves stripped bare. Adding to the confusion, neither Hong Kong’s top official, Chief Executive Carrie Lam, nor the health secretary, Sophia Chan, held a press conference on the crisis between Feb. 22 and Mar. 9. There were hundreds of thousands of these cases recordedThis crucial period.
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“The [Hong Kong] government is sending conflicting signals,” says Jean-Pierre Cabestan, professor of political science at Hong Kong Baptist University. “It’s really a mess.”
The most striking aspect of COVID-19 is its failure to protect elderly residents. Coronavirus has rampaged through more than 80% of the city’s residential care homes for seniors, infecting over 19,000 residents and 5,300 staffers. A mere 15% of the residents of care homes were jabbed. It is not surprising that nine of the 10 COVID-19-related deaths in Hong Kong occurred among those who were unvaccinated. Most of these people are over 70.
Karen Grépin, associate professor in health economics and policy at HKU’s School of Public Health, says sensationalized media coverage of side effects fueled vaccine hesitancy. Grepin believes early government messaging, in which vaccinations should be accompanied by a medical evaluation, led to the belief that vaccines are only for healthy people. “The elderly and those with underlying medical conditions began to believe that they were not good candidates for vaccination,” she tells TIME via email.
It has had devastating consequences. One local user of Twitter said it best. put it, while posting a photo of patients lying on gurneys in the forecourt of an overcrowded hospital: “Hong Kong, you’ve had two years to prepare for this.”
What is China doing about Hong Kong’s COVID-19 crisis?
The central government has not hidden its disappointment in the city’s leadership. The February 16th, front pages of two pro-Beijing Hong Kong papers ran stories about a message President Xi Jinping sent to Chief Executive Lam. He reportedly asked her to “mobilize all power and resources to take all necessary measures to ensure the safety and health of the Hong Kong people.” That the instruction was delivered so openly was considered highly significant—in effect, it was letting the Hong Kong public know that Xi had put Lam on notice.
Two weeks later, the head of Beijing’s Hong Kong and Macau Affairs Office, Xia Baolong, tersely reminded Hong Kong’s most senior officials to uphold their oaths of office. “Top Hong Kong officials must have the courage to shoulder arduous responsibility, and do a good job in organization and leadership, and fulfill their inaugural oath with concrete actions in the battle against the pandemic,” he said. A mainland expert on Hong Kong’s constitutional affairs told local media that the remarks amounted to “a warning letter” and that “the central government is saying that this is huge trouble.”
Recenty, in Mar. 6, Chinese vice premier Han Zheng met Hong Kong delegates to the nation’s top advisory body, the Chinese People’s Political Consultative Conference. He told them that this was no time for “weariness” in the fight against COVID-19, expressed concern at the territory’s mortality rate, and voiced the hope that reports of Hong Kong’s private hospitals turning away coronavirus patients were “fake news.”
Shortly afterward, Liang Wannian of China’s National Health Commission appeared to rebuke Hong Kong officials, who have made compulsory universal testing the cornerstone of their strategy to tame the current surge in infections. “Reducing infection, severe cases and deaths is Hong Kong’s most urgent and top priority at the current stage,” Liang told China’s Xinhua news agency, adding that mass testing could come “after we achieve the first target.” The local administration seemingly backed down, with unnamed insiders telling local media that the exercise could be postponed for a month.
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Sensing the threat that Hong Kong poses to its zero-COVID record, Beijing has involved Vice Premier Sun Chunlan, who leads the mainland’s fight against COVID-19. Wang Hesheng (Deputy Head of the National Health Commission), is helping. Wang Hesheng has been a victim of the Wuhan original outbreak. Reports claim hundreds have created a Shenzhen Command Center to handle developments in Hong Kong. The center is open 16-hour days, and has the authority to reduce any bureaucratic red tape as necessary.
These weeks are crucial. The month of March. 6, China reported some of its highest COVID-19 figures since Wuhan—and of the 214 new cases, nearly a third were found in Guangdong, the province bordering Hong Kong.
China’s zero-COVID strategy has been extremely successful. Since the start of the pandemic, the world’s most populous nation has registered just over 111,000 cases, with 4,636 deaths. Even the Winter Olympics was held in Hong Kong without major disasters. Could that be about to change as a result of Hong Kong’s Omicron surge?
“I would imagine in the mainland, there’ll be a lot of concern right now about the risk posed by people traveling from Hong Kong,” says HKU’s Cowling.
“There’ll be an unlucky event, where there’s transmission to, maybe, local staff in a hotel, or to local testing staff, or something—and then that will start an outbreak.”