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What next?

For the third day in a row, there are no new COVID-19 cases in Hong Kong.  Things already seem to be returning to normal, with more people out and about at the weekend.  The rules on restaurants capacity have been removed, but tables are still supposed to be 1.5 metres apart (or with a physical barrier to separate people).  Bars are still closed.

According to the FT, most government services will resume next week and outdoor sports facilities and libraries will reopen.  Ah, here it is in the HKFP: Coronavirus: Majority of Hong Kong gov’t staff to return to work next Monday

This is a rather good summary (from David Webb):

COVID-19: where do we go from here?

Hong Kong is now at or close to zero local transmissions. The latest known local transmission was probably case #1026 inside HK Airport, a 47 year-old Virgin Atlantic ground crew member, probably infected by an arriving passenger from the daily UK flight. She recalls coughing on 6-Apr but she didn't visit a doctor until 14-Apr and was confirmed on 19-Apr. There were 3 cases on the Virgin flight on 6-Apr but then none until 12-Apr, so given an incubation period, it is more likely that she was infected on 12-Apr. Not all coughs are COVID-related.

Outside of the airport, the last known transmission was case #1008 reported on 13-Apr, when he was asymptomatic but already in government quarantine, because he is the 66 year-old father of case #884, who had symptoms on 30-Mar and was confirmed on 5-Apr. That means his father caught the virus on or before 5-Apr and was then placed in quarantine.

Webb thinks that people from Mainland China will be allowed into Hong Kong before long.  This afternoon it has been announced that the current restrictions will continue till 7 June, but “cross-border teachers and students, and people whose business activities are ‘beneficial to Hong Kong’ will be allowed to enter Hong Kong without having to undergo 14 days of quarantine.”  [RTHK]

This all sounds quite positive, but it’s not long ago that Hong Kong and Singapore were being used as examples of how to handle COVID-19.  Unfortunately Singapore now has 15,000 cases, mainly migrant workers living in dormitories. 


Guardian front page

And now a rant…

My problem with much of the reporting on COVID-19 is that it can be difficult to see the "big picture".  For example, the front page of The Guardian (right) seems to have been designed by someone who wants to draw attention to 14 different blue-coloured panels (all with COVID-19 stories).  Can they all be really important?


Cold hard maths

Paul Christensen posted a comment and directed my attention to something he had written in the SCMP

The cold, hard maths of whether a coronavirus shutdown is worth everyone’s loss of quality of life

Do the benefits of the Covid-19 economic shutdown justify the costs? This is a fundamental question that governments need to address, and they should address it explicitly, regardless of how uncomfortable it may make people feel.

In his comment he said that “Much more rational analysis is needed on whether the years of poverty that will result for many people from this lockdown are worth the lives saved.”

Rational analysis like this?

An argument for lockdowns is that the alternative would be an overloaded hospital system. But this shouldn’t be a factor that overrides all others.

There is no doubt that a rigorous triage system could be put in place to keep the hospital system functioning for cases where larger numbers of QALYs are at stake. If society keeps running, then the government could spend the tax revenue it receives on expanding hospital capacity so that fewer hard decisions have to be made when, say, Covid-25 comes along.

Yes, sure, a rigorous triage system would solve the problem.  

And after a few thousand (mainly old) people had died we'd definitely spend more money on hospitals and facilities and nurses so we’d be ready next time.

No, of course we wouldn’t.  Both in the US and the UK (and elsewhere, no doubt) there have been exercises done to test readiness for a pandemic.  And governments have decided not to spend the money needed to be fully prepared.  Hospitals in the UK were running at close to full capacity when it is recommended that they should be operating at around 85% in order to be able to handle any emergencies.  That, of course, is because of lack of money.

Currently hospitals in most developed countries are just about coping, but many staff are exhausted from over-work, and tough decisions have to be made about who can be transferred to Intensive Care.  

This is with lockdowns in place.  What would it be like without them?

Lockdowns aren’t just needed to ensure that hospitals will be able to handle the outbreak.  There’s also the hope that better treatments can be identified and a vaccine can be found (and progress seems fairly encouraging on both fronts).

Paul Christensen seems to be getting carried away:

The current restrictions on economic activity are condemning many thousands of people who had basically comfortable lives to years or decades of poverty. There may be significant increases in suicide, divorce and domestic violence rates as people are cooped up to an unprecedented degree in small living spaces

Decades of poverty?  Restrictions apply to a relatively small part of the economy.  We are talking about Hong Kong here, aren’t we?

[To summarize what I wrote in my response by Paul's comment, I accept that some people will suffer significant hardship from the lockdown (UK) / restrictions (HK).  But the solution to that is not to accept more deaths it's for the government to make payments to people who lose their jobs.]

And Hong Kong apartments are definitely small, but we don’t have a lockdown and the only people who can’t go out are those who are in quarantine.  Those social problems are real, but they existed before COVID-19 and they will be there afterwards.  The impact of a few thousand people being in quarantine for 14 days is not really significant.

Certainly the restrictions everywhere will be eased in the coming weeks and months and maybe Hong Kong (and Singapore) offer a template for how it can be done:

‘Suppress and lift’: Hong Kong and Singapore say they have a coronavirus strategy that works 

Despite setbacks, Hong Kong’s and Singapore’s targeted strategies for fighting COVID-19 may yet succeed—and provide a model for other countries emerging from their first wave of cases.


Day 80

In the last three weeks the number of COVD-19 cases in Hong Kong has increased from around 270 to 1,001.  That sounds a bit scary, but other countries have seen much larger increases over the same period (25x in US, 15x in UK).

The biggest factor by far has been the large number of people who returned from overseas, but there have also been “local” cases in Lan Kwai Fong and karaoke bars

The government has responded in typically haphazard manner.  Our great leader Carrie Lam Cheng Yuet-ngor wanted to ban the sale of alcohol because “people get intimate when they’re drunk.”  Hemlock explains that this was a typical over-reaction to a specific case of a “super spreader”.  It’s a Hong Kong thing, to be sure, but we still have to take off our shoes for airport security checks in some countries because of one failed terrorist incident nearly 20 years ago. 

Oh, and don’t be fooled by this headline (from news.gov.hk) CE explains alcohol sales ban - she doesn’t.

It took a few days for the government to figure out that they actually needed to close bars and pubs because, er, large number of people gathering in small spaces will spread COVID-19.  

They also ordered Karaokes, clubs, and mahjong parlours to close but it took longer to get round to beauty parlours.  Cinemas have also been ordered to close, even though they had already blocked alternate rows and were a long way from being full. 

More sensibly, restaurants have to keep tables 1.5 metres apart and no more than 4 people can sit together.  That’s obviously a rather arbitrary set of rules that works better in some places than others, and there have been suggestions that police have been rather over-zealous in applying this in “yellow” restaurants, but the basic idea is sound.

It seems inevitable that the restrictions will be eased based on the number of cases and then re-imposed (or possibly tightened) based on evidence of where it is spreading.

Visitors are also banned from Hong Kong and residents have to go to quarantine camps or “self-isolate” for 14 days after arrival.

Meanwhile, the rest of the world is slowly coming round to the idea that wearing masks might be a good idea.

Of course, masks are just part of the solution, but it’s hard to see how anywhere can properly emerge from lockdown without them.  “Social distancing” simply isn’t practical if you have large numbers of people in public places.

And, of course, there are other benefits: Hong Kong’s coronavirus response leads to sharp drop in flu cases