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Why has Hong Kong’s Covid wave been so bad?
00:10:18
What’s behind one of the worst Covid death rates ever?
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- [00:00]
A
Hello and welcome to More or Less on the BBC World Service. When numbers are feeling under the weather with a programme which tucks them up in bed with a cup of hot cocoa. And I'm Tim Harford. Since the emergence of the omicron variant late last year, several parts of the world which had until then avoided mass coronavirus outbreaks, found themselves dealing with a wave of infections. Stringent measures, often called zero COVID policies, had worked for nearly two years and. And now we're working no longer. Nowhere has been more shockingly affected than the city of Hong Kong. A special administrative region of China, Hong Kong has been hit by a surge in coronavirus infections that has overwhelmed the territory's healthcare system. I'll show you some pictures from the Caritas Medical center in Hong Kong, where dozens of patients are being treated on stretchers outside the hospital in the open air. More than 4,000 new cases. Both the pictures and the figures have been stark, with some media reports claiming that Hong Kong has seen the worst spike in daily death rates of anywhere at any time during the pandemic. I spoke to Ben Cowling, Chair professor of epidemiology at the University of Hong Kong. I asked him to explain how things went so wrong.
- [01:16]
B
We did really well in the first two years of the pandemic. We had a zero Covid plan. We kept the virus out of the community. Unfortunately, earlier this year, Omicron Ba2 was able to get into Hong Kong and then there was a large community epidemic. And we've estimated that until now about 60% of the population have been infected within the last two months, we think there's been about four and a bit million, 4.3 million infections, about 60% of the population. And along with that, unfortunately, we've had quite a large number of deaths.
- [01:52]
A
One number I've seen for the number of deaths is 30 deaths per day per million people in Hong Kong, which I guess is about 200 deaths overall, which some people have said that is the worst spike in death anywhere in the world at any stage in the pandemic. Do you recognize that claim?
- [02:10]
B
It's very unfortunate. We've had over a period of few weeks, we've had about that level, about 200 or so deaths a day in Hong Kong. And it's very fortunate, of course, Omicron, the epidemic curve goes up very, very quickly and then it does come down again very, very quickly. So in terms of the area under the curve, the total number of deaths in this current epidemic in Hong Kong, I suppose there are other cities in the world that have also had a lot of mortality in previous waves. But in terms of that sharp spike, I think Hong Kong may be one of the worst in that particular statistic.
- [02:43]
A
I remember in the first wave in the uk, which was one of the worst waves in the world at the time, it was about 1,000 people a day dying. The UK has about 10 times Hong Kong's population. So 200 deaths a day in Hong Kong would be the equivalent of 2,000 deaths. So it would be twice as bad as that UK wave, albeit, as you say, briefer. It's horrific. Why has it been so bad?
- [03:04]
B
Well, we know that vaccines are highly effective in preventing severe disease with COVID And in Hong Kong overall, we have a very high vaccine coverage, higher than many other parts of the world. Overall, I think it's about 83% vaccine coverage among people 12 years of age and older. But unfortunately, at the start of this year, we only had in individuals 70 to 79, only 46% of them had received two doses of vaccine. And in those 80 years of age or older, who were the most vulnerable to severe Covid, the coverage of 2 doses was only 18% 1, 8. So 83% overall, but only 18% in the over 80s. And that's been our big problem with the current epidemic wave. The majority of deaths have occurred in the elderly who are not vaccinated.
- [03:58]
A
Can you say anything about why coverage rates are so low in the over 70s and the over 80s? Because I know many countries absolutely prioritize. These are the people who we need to vaccinate first, because, as you say, they're the most vulnerable. Why have things been different in Hong Kong?
- [04:15]
B
In Hong Kong, older adults were also the number one priority group at the beginning of the vaccination campaign a year ago. They were the only group that could receive vaccination for a period of time. They were the top priority. Unfortunately, there were a number of events occurring in people who just received vaccination. For example, within a week of getting a vaccination, maybe an older person had a heart attack or a stroke. And there was a lot of media coverage of these events, hypothesizing that it might be a cause and effect relationship. The government did come out with investigations and saying that there was no indication that it was cause and effect. It was most likely just coincidental. But it put a lot of older people off getting vaccinated at that early stage of the vaccination campaign. And the government, of course, has been doing a zero Covid strategy where the priority for zero Covid is firstly, keeping the virus out of the community and secondly, minimizing any outbreak that does occur. And so I think there was maybe a diversion of attention to, towards the strategies required to maintain zero Covid and there was maybe less attention given to the low vaccine coverage in the elderly. There's other parts of the world, I would say Singapore and New Zealand, where they very successfully sustained zero Covid for almost two years. And then when the virus came in, they had a high vaccine coverage in their elderly. So we haven't seen anything like the same impact there.
- [05:38]
A
Is it true to say that Singapore, that New Zealand are not having the same kind of problems now?
- [05:42]
B
Well, that's right. I can give you the statistics, actually. Hong Kong, 7.3 million population. In the past three months, we've had a million confirmed cases and 6,100 deaths. Singapore population 5.7 million. They've had 700,000 confirmed cases, almost as many as Hong Kong. They've only had 400 deaths. That's less than 10%. New Zealand population, 5 million. They've had 500,000 confirmed cases in the last three months and only 120 deaths. Now, the epidemics in Singapore and New Zealand are still ongoing. I'm sure there will be more impact in the coming month or two. But there's a very stark difference in terms of the mortality rates among these locations. And the big difference is vaccine coverage in the elderly. None of the three locations has a high level of natural immunity.
- [06:27]
A
Interesting what I'm hearing. There is all three places fairly similar populations and actually fairly similar numbers of cases, but very different numbers of deaths.
- [06:36]
B
Right.
- [06:36]
A
I think a lot of people will be looking at what has happened to Hong Kong and wondering whether the same thing is going to happen in China. Is the same kind of sudden and really sharp wave coming for mainland China?
- [06:51]
B
Well, firstly, in mainland China, the vaccine coverage is similar to Hong Kong. It's more than 80% overall. But there are groups of older adults in some provinces, at least where the coverage is below 50%. So certainly if Covid was to spread widely in China, there would also be a concern about larger numbers of deaths occurring. But that's an issue that is being addressed in mainland China, just as it's now finally being addressed in Hong Kong. So I would expect vaccination rates to go up in the elderly in mainland China, and then that would mitigate any epidemic that does occur.
- [07:25]
A
One final thought. When Omicron hit various countries, South Africa and then the UK and started to spread a few months ago, there was a lot of quite confusing Talk about how Omicron was much milder than the Delta variant. I guess what the Hong Kong situation is telling us is that maybe that's the wrong emphasis and that the fact that it's milder had more to do with previous exposure and vaccination than a dramatic difference in the intrinsic severity of the virus.
- [07:56]
B
That's right. And actually, in Hong Kong, we can look at intrinsic severity because of the number of unvaccinated people in our population who don't have any previous infections and therefore any previous immunity. We can see that Omicron is a little bit milder, maybe 25% milder in terms of the risk of mortality. It's not much milder. It's a little bit milder. But then, of course, in people who've been vaccinated, that substantially reduces the severity. And so it's not correct to say that Omicron is mild. We can say that Omicron in much of the world is not having much impact, but it's not because of a difference in the intrinsic severity as much as it's a difference in the the level of immunity in the population due to vaccinations and also prior infections.
- [08:39]
A
Our thanks to Professor Ben Cowling from the University of Hong Kong. That's all for this week. If you've got any statistical questions or questionable statistics, do please get in touch. Our email address is more or lessbc.co.uk. we'll be back next week, and until then, goodbye. Ukraine's capital smouldered as the early sirens wailed once more.
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