Health experts disagree over whether Covid-19 has become endemic in Hong Kong, as city logs 313 new infections

·7-min read

Covid-19 will persist in Hong Kong and the government should review how it wields social-distancing curbs, lockdowns, border closures and other tools at its disposal to ensure the most appropriate response to the lingering threat, infectious disease experts have said.

But they disagreed over whether to label the coronavirus “endemic”, which the United States Centres for Disease Control and Prevention defines as a constant presence of a low number of new cases among a population, as opposed to an epidemic, which involves a sudden increase in infections. Such definitions have implications for Hong Kong’s policy, as it tries to emulate the containment approach of mainland China, which is based on “social zero Covid”.

Calling Covid-19 endemic, leading government adviser Professor David Hui Shu-cheong noted on Wednesday the daily number of cases had continued to gradually decline, even after the government launched the first phase of social-distancing easing on April 21.

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“It has become endemic, as we can see that the daily caseload is still dropping slowly after [infection numbers] have been reduced to three digits,” said the infectious disease specialist from Chinese University.

Professor David Hui from Chinese University, a government pandemic adviser. Photo: Winson Wong
Professor David Hui from Chinese University, a government pandemic adviser. Photo: Winson Wong

Health authorities on Wednesday confirmed 313 coronavirus cases, 22 of which were imported, and three deaths related to the virus.

Hui pointed to the difficulty of eradicating a disease following a large outbreak, given asymptomatic patients could still lead to silent transmission chains and antibody levels of vaccinated residents would also fade over time.

“Even for other places such as Singapore, which has a higher vaccination rate than us, they still cannot reach zero cases. It has become endemic,” Hui told a radio programme. “The disease will continue to exist in the community.”

The infectious disease specialist said Covid-19 was expected to pose less of a threat locally as more residents got vaccinated or gained natural immunity from infections.

Asked whether the government should adjust its overall Covid-19 strategy, Hui said it depended on the central government’s approach, as Hong Kong had to align its response with the mainland’s model.

“We need to know whether reaching zero cases [in Hong Kong] is a must or whether achieving ‘social zero Covid’ in the community is already fine,” Hui said.

Hong Kong currently follows a “dynamic zero” Covid-19 strategy, an approach advocated by the mainland since August last year in its fight against the Delta coronavirus variant. This encompasses a slew of measures, such as mass testing, stringent border controls, extensive contact tracing and snap lockdowns, aimed at swiftly stamping out new outbreaks when they occur.

But a new objective for pandemic control, known as “social zero Covid”, has emerged across the border recently amid outbreaks in Shanghai and Jilin. According to health authorities there, this strategy seeks to cut off all transmission chains at the community level, with new infections and asymptomatic patients ideally identified only at isolation facilities and locked down neighbourhoods.

Beijing had been changing strategies constantly, Hui noted, adding he believed Hong Kong would adjust its approach accordingly.

For example, whether the city still needed to conduct mass testing would depend on the decision of mainland health authorities, when both sides discussed details of reopening the border to quarantine-free travel.

People in Hong Kong wait for their turn to be vaccinated. Photo: Xiaomei Chen
People in Hong Kong wait for their turn to be vaccinated. Photo: Xiaomei Chen

When asked if he agreed that Covid-19 had become endemic, Albert Au Ka-wing, the Centre for Health Protection’s principal medical and health officer, said the daily number of infections had hovered “at a stable level” of about 300 cases over the past four days.

“Our prevention and control strategy is still, hopefully, to control the disease as much as possible through a series of social-distancing measures,” he said. “If some high-risk groups contract the disease, such as the elderly, their mortality and complication rates remain high.”

In late March, Professor Gabriel Leung of the University of Hong Kong’s medical faculty said the coronavirus was likely to become endemic and advised authorities to implement a “controlled transition” through measures such as boosting the inoculation rate among elderly residents and ensuring a sufficient supply and liberal use of Covid-19 oral drugs.

Ben Cowling, chair professor of epidemiology at the University of Hong Kong, agreed that the disease would persist for a long period of time, but he would not label it endemic at this stage.

“Like we wouldn’t say that influenza is endemic … I’m not sure that endemic is the right word. But I think we will have Covid cases in the community for the coming years,” he said. “That’s not a plateau.”

New variants would eventually trigger fresh waves of infections, he warned, and the city needed an ultimate road map to full reopening and a response plan to deal with new strains.

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Another government pandemic adviser, Professor Yuen Kwok-yung, also expressed reservations about calling Covid-19 endemic.

“The Hong Kong situation depends on how much effort we put into getting the virus eliminated, for example by full lockdown, testing with strict isolation and quarantine while completely closing the border,” Yuen said. “If we do that, there will be temporary elimination.”

If even a few cases were missed when the border was fully opened up, infections could rise as tens of thousands of residents were not yet fully vaccinated, he added.

“Unfortunately, if we go for full lockdown and compulsory universal testing with stringent isolation of cases and quarantine of contacts at hospitals and camps, we may have to do it again and again, as border [measures] cannot be foolproof, and our contact tracing speed and capability cannot cope with the highly transmissible Omicron,” he said.

If a long-term local elimination of the virus was not feasible, the government could consider allowing the virus to circulate at a low level while still pushing full vaccination above 95 per cent, he argued.

“This will continuously boost our population immunity so that we can fare better in the coming winter,” Yuen said.

New Covid cases drop below 300 mark in Hong Kong, ‘fifth wave under control’

Hong Kong has announced a further easing of social-distancing curbs ahead of schedule, including allowing eight diners per table at restaurants, up from the current four. Residents will also be allowed to take off their masks when running or at country parks and outdoor sports venues such as basketball and tennis courts, while private swimming pools, beaches and water playgrounds will be reopened. The relaxations take effect on Thursday.

Hui agreed it was the right time to relax social-distancing measures, but said further easing should be done gradually to prevent any quick rebound in infections.

Meanwhile, health authorities confirmed the death of a 59-year-old man at the Penny’s Bay quarantine centre. The man suffered from chronic illnesses, including hypertension, diabetes, sleep apnoea and renal failure, said the Hospital Authority’s chief manager Dr Larry Lee Lap-yip.

On Sunday afternoon, officers from the Civil Aid Service found him unconscious in his room. He was pronounced dead at North Lantau Hospital.

Lee added that, if necessary, the authority would help to assess patients before they were transported to a quarantine facility or to a hospital.

With about 2,200 kindergartens and secondary schools carrying out face-to-face classes on Wednesday, health officials logged 17 infections, comprising 12 students and five teachers from 17 schools.

Meanwhile, the Social Welfare Department announced that four sports centres previously used as holding centres for elderly patients requiring special care would be handed back to the Leisure and Cultural Services Department, given the falling number of cases.

Hong Kong’s Covid-19 tally stood at 1,205,396 infections, with 9,328 related deaths.

Additional reporting by Victor Ting and Elizabeth Cheung

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