Covid-19: Why Hong Kong's 'third wave' is a warning

Until recently, Hong Kong was considered a poster child in its handling of the Covid-19 pandemic.

Despite sharing a border with mainland China, where the first cases were reported, Hong Kong kept its infection numbers down and was able to avoid the extreme lockdown measures introduced in parts of China, Europe and the US.

But now, it's been hit by not even a second, but a third, wave of infections. The government has warned its hospital system could face collapse, and it's just had a record high number of new infections in a day.

What went wrong, and what lessons are there for countries juggling both the pandemic, and the economic pain caused by lockdown?

Quarantine exemptions and 'loopholes'

Hong Kong had its first Covid-19 cases in late January, leading to widespread concern and panic buying, but infection numbers remained relatively low and the spread was controlled quite quickly.

It experienced what became known as its "second wave" in March, after overseas students and residents started returning to the territory, leading to a spike in imported infections.

As a result, Hong Kong introduced strict border controls, banning all non-residents from entering its borders from overseas, and everyone who returned was required to undergo a Covid-19 test and 14-day quarantine.

It even used electronic bracelets to track new arrivals and make sure they stayed at home.

That, combined with the widespread use of masks and social distancing measures, worked - Hong Kong went for weeks without a locally transmitted case, and life seemed to be heading back to normal.

So how did the "third wave" - that has led to more than 100 new cases for nine days in a row - arrive?

"It's quite disappointing and frustrating because Hong Kong had really got things very much under control," says Malik Peiris, Chair of Virology at the University of Hong Kong.

He believes there were two flaws in the system.

First, many returnees opted to quarantine for 14 days at home - an arrangement that's common in many countries including the UK - rather than in quarantine camps.

"There is a weakness there because other people in the home are not under any form of restriction, and will still be coming and going," says Prof Peiris.

However, he believes the more serious problem came from the government's decision to exempt several groups of people from testing and quarantine when they entered Hong Kong.

Hong Kong had exempted about 200,000 people, including seafarers, aircrew and executives of companies listed on the stock exchange, from quarantine.

Dr Tsang recalls that by late June the government had allowed public gatherings of up to 50 people, while there were celebrations for Fathers' Day and Hong Kong's handover anniversary.

"Many citizens were fatigued after months of social distancing, so when the government said things seemed fine and relaxed restrictions, they started meeting with friends and family.

"I think it's very unfortunate - many factors combined at the same time."

However, Prof Peiris stresses that Hong Kongers had been "extremely compliant" with social distancing and hygiene measures during in the first and second waves - "in fact, they were even a step ahead of government instructions, wearing face masks before they were compulsory."

He believes the reintroduction of social distancing measures now are already having an effect, and hopes that Hong Kong will be back to close to zero local infections within four to six weeks.

At that point, he adds, the challenge will be to stop imported infections - particularly once social distancing measures are lifted.

It's a challenge other countries will also face once they are successful in containing the virus within their borders, because "when you get to low levels of transmission within your population, having unregulated introductions from outside can lead to disaster."

However, health experts say there is no evidence of them causing the spike in infections.

Prof Cowling says scientists "are able to link together cases to identify chains of transmission, and there are no clusters attributed to those events," while Prof Peiris argues that the events "may have aggravated things slightly, but I don't think it was a major determinant one way or the other".

Meanwhile, Dr Tsang says research has shown that "the strain of coronavirus in the third wave is different from those in previous waves" - in particular, it has type of mutation seen in aircrew and seafarers from the Philippines and Kazakhstan, so he believes the strain was imported.

However the move has been welcomed by some, including former Legislative Council president Jasper Tsang, who told local media: "The government won't be able to absolve itself of blame if polling stations turn into hotbeds for spreading the virus.

"It's also nearly impossible for candidates to canvass votes given the social distancing rules."

Prof Cowling says that social distancing measures reintroduced by the government have already stopped case numbers from accelerating over the past week.

"I'm not sure it's necessary to delay the elections - certainly not for a year. You could consider delaying them for two weeks or a month, because by then we'd almost certainly have [local infection] numbers back down to zero."

He adds that there are many ways to make elections safer, including increasing the number of polling stations and staff to reduce wait times, ensuring polling stations are well-ventilated, and testing all polling station staff two days before the election. ทีเด็ดบอลวันนี้

Singapore held its general elections earlier this month - and had its highest turnout in recent years, says Eugene Tan, a law professor and political commentator at Singapore Management University.

"There is never a good time for an election during a pandemic," he says, but the vote went ahead with several safety measures in place and "demonstrates that it is possible to protect public health even as people go about exercising their democratic right to vote."

However, he believes that making a decision on whether to proceed with elections is a tough judgement call for governments, particularly if public trust is low.

"If you delay elections you could be accused of waiting for a more favourable time [for the government] - but if you go ahead you could be accused of playing fast and loose with people's lives. The worst thing would be to have an election, and then have a spike in the number of cases."

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