All masked up

Well, Hong Kong has finally abandoned the requirement to wear masks. 

You may remember that people in Hong Kong started wearing masks back in January 2020, though initially the government was absolutely not in favour of this (having made it illegal a few months ago during that thing we don't talk about anymore).

It was only in July 2020 that it was made compulsory everywhere indoors, and then within a few days it applied outdoors as well.  This was when the government also announced a total ban on eating in restaurants  for 7 days - which was swiftly abandoned. 

The rules for restaurants have changed many times over the last three years.  At one time we had the bizarre spectacle of families spread across two or three tables (because of the maximum of two per table), and tables split in two with a glass (or perspex) screen so that larger groups could be accommodated without breaking the rules.  There have been a lot of changes since then, and according to this list the maximum number of people per table was increased to 12 in October 2022, and of course the LeaveHomeSafe QR code scanning requirement ended in December.  

But those mask rules have remained in place for more than two and a half years, even after Mainland China abandoned them, with only one concession (no need to wear one when taking exercise).  

You might have expected that everyone would stop wearing masks when the restrictions ended. 

But, no, the vast majority of people are still wearing masks on public transport and in shops and shopping centres.  

Even outdoors, a lot of people are wearing them.

Probably there is a certain amount of peer pressure that encourages people to wear them rather than being the odd one out.  Maybe that will gradually change, but it seems that people are quite comfortable wearing masks in public. 

Which begs the question: was it really necessary to have laws to make them compulsory everywhere  for everybody for nearly 1,000 days?

Super abundance of caution

Hong Kong has one of the best COVID vaccines (Comirnaty from BioNTech in Germany) freely available. 

Or if an mRNA vaccine with 91.3% efficacy isn’t to your liking, you’re in luck because the Sinovac vaccine, with an efficacy rate of just 50.7% is also available. 

Political theatre is never far away and all true patriots are choosing the vaccine from the PRC (though there’s another, more practical reason - if you need to travel to the PRC). 

Both vaccines offer remarkably good protection against severe disease and death, and side effects are minimal, but the vaccination centres are not operating anywhere close to capacity.

There are many reasons why people are not choosing to get vaccinated.image

  • Is it because Hong Kong has had less than 12,000 cases in total and only 210 deaths? 
    • Probably yes.  The risk of getting COVID here is very low
    • Singapore has had more cases than Hong Kong (but far less than many places) and more than 80% are willing to take the vaccine and they are way ahead on the number of jabs.
  • Could it because the media here report on deaths of people who have had the vaccine?
    • That certainly doesn’t help. 
  • Maybe it’s because many medical professionals don’t seem keen on the vaccines. 
    • I have to say that I find this fairly shocking
  • Clearly it can’t be because people don’t trust the government. 
    • We all know that the National Security Law is a good thing and those pesky demonstrators should all be in prison.  Glad we’ve cleared that up.

Here’s a Twitter thread with a link to an article with more information:


Or there’s this article from HKFP: Don’t trust the science or don’t trust the gov’t? Why many Hongkongers are shunning Covid vaccination.

Meanwhile, the government has been applying a super abundance of caution in quarantining so-called “close contacts” and almost everyone arriving in Hong Kong.

The definition of “close contact” was extended to everyone living in the apartment blocks of variant cases, because, well, just because.  This led to thousands of people being sent to one of the government camps for 21 days. 

They did back down on this after numerous complaints and no actual cases being detected.  Oh, and some dodgy food.  They also reduced the number of days quarantine for anyone who is fully vaccinated.  But there are still quite a lot of people being sent into quarantine.

There has been a minor relaxation for quarantine of arrivals.  Recently, the UK was moved from group A2 to B, meaning that if you are fully vaccinated you “only” have to stay for 2 weeks in one of the approved hotels.  Australia and New Zealand are currently in the lowest group (14 or 7 days) but this list keeps being reviewed so you can never be certain.

Last year the default was home quarantine with electronic monitoring:  they gave you a bracelet to wear and you had to install an app on your mobile phone.  This option was withdrawn for the UK in October, and for almost everywhere else in late December, so you have to pay to stay in a hotel room with no fresh air (and lousy food in many cases).  There is a choice of hotels, but many are fully booked, particularly in the coming months when students will be returning from studying overseas.

Apparently the Joint Scientific Committee recommended that home quarantine should be re-introduced, but this was vetoed by the CHP.

Some interesting comments from Ben Cowling (Professor at the School of Public Health, University of Hong Kong), who proposes that the government should:

set a timeline to end quarantines-on-arrival, say, after September. That means Covid-19 will find its way back into the community sooner or later — and if that happens without vaccine coverage it means more restrictions and social distancing, except for those who are vaccinated. And at the same time, we immediately allow vaccinated people to skip quarantine.

Seems logical enough.

The COVID dance

The latest cluster of cases in Hong Kong comes clubs.  

Who'd have guessed that a lot of people not wearing masks in an enclosed space could cause the spread of COVID-19?  

Well, maybe anyone who remembered the several large clusters earlier in the year from banquets where groups of people were dancing without masks. 

That also seems to be happening again, though possibly on a smaller scale (and maybe with less dancing).  Of course they follow the law by having the guests all seated in tables of four (or six previously), but people move from table to table without putting on masks.

On the other hand, it was very noticeable on Sunday that there were fewer people out and about, so there is some hope.  Well, that and the vaccines, of course.

Eating Out

So, how’s it going on another very hot (and wet) day in Hong Kong?

Hongkongers dine on the roadside [Hong Kong Free Press]

Across the city, Hongkongers were forced to eat outdoors as the government ban on dine-in services at restaurants kicked in. Photos from local media and the internet showed many people – especially construction workers – sitting on the sidewalks, in gutters and in parks finishing their lunchtime takeaway meals.

[..] “During the sweltering summer, asking workers to eat under the sun and rain is not only inhumane, it also leads to different kinds of hygiene issues. The situation is worrying,” the Construction Site Workers General Union said on Tuesday.

The government’s latest dine-in ban was criticised by both pro-democracy and pro-establishment lawmakers. Democrat Claudia Mo told HKFP that two-persons per table at eateries should be allowed: “Miserable, unthinking, unfeeling bureaucrats taking Hong Kong down the drain.”

For kitchen-less Hong Kongers, new ban on restaurant dining is a bitter pill [Reuters]

Hundreds of thousands of Hong Kongers live in subdivided tiny apartments, shared by multiple families and which often do not have kitchen facilities or even if they do, are too cramped to be used often.

“Many people don’t cook or cannot cook. Lots of old people cannot cook. Most of my friends don’t have kitchens - they eat out for every meal,” said a car driver who gave his surname as Chong as he walked through the bustling Wan Chai district where food stalls line the streets.

For the seven-day duration of the ban, people without a kitchen will have to make do with takeout or food purchased at supermarkets.

RTHK offers this response from the government:

With a ban on dine-in services now in effect, health authorities also addressed concerns about some employees, such as construction workers, forced to eat outdoors – sometimes under pouring rain and in groups. Dr Chuang Shuk-kwan from the the Centre for Health Protection (CHP) said even though she doesn’t see an outbreak at construction sites, she urged people to maintain good hygiene and not to talk much while having meals.

But, to be fair, the government are doing something:

There’s more analysis:

Hong Kong was a pandemic poster child. Now it’s a cautionary tale [Washington Post]

At the start of this month, restaurants here had waiting lists , bars were overflowing, and beaches were dotted with umbrellas and sand seekers. Three weeks had elapsed since the last locally transmitted novel coronavirus case, and the pandemic appeared to be down, if not entirely beaten .

All of that progress has come to a halt, as government missteps and a mutated strain of the coronavirus that some scientists believe is more contagious have led to the most severe wave of infections in Hong Kong since the onset of the crisis in January.

So, yes, it's all going very well.

Drastic measures

It’s the sixth day in a row with over 100 COVID-19 cases in Hong Kong.  These seem like quite unusual stats.  We don’t have exponential growth, and this isn’t really “flattening the curve” because that usually comes after weeks of growth.  But whatever we call it, 1100+ cases in the last 2 weeks is obviously putting a strain on hospitals (and quarantine facilities). 

The government seems to be responding in slow motion.  When it emerged that more than 20,000 people had been exempted from testing and self-isolation - and that some of these rules had recently been further relaxed - it seemed a fairly obvious explanation for the surge in cases.  They insisted that it wasn’t - and anyway it was necessary for the economy.  Fortunately, some challenged this argument:      

'People exempt from quarantine behind new wave'

Gabriel Leung, dean of the faculty of medicine at the University of Hong Kong, said that the current wave of Covid-19 infections was brought in from outside of Hong Kong, most likely by people exempted from mandatory quarantine

The government eventually announced several changes to the rules to take effect from July 29th. 

Health experts questioned why the changes would only come into effect from Wednesday rather than immediately, saying such workers were likely to be the reason for the recent surge in infections and that the measures were too little, too late.  [SCMP]

Apart from that, the problem here was not that the government wanted to make life a little easier for sailors, it was that they failed to put in place any proper procedures.  It was surely predictable that sailors would go to places where social distancing was difficult (small restaurants, cheap lodging houses) and potentially infect some of the local population, which seems to be what happened in East Kowloon.     

But the really big news is that Wednesday will bring even more drastic restrictions that will affect almost everyone in Hong Kong.

  • No dine-in at restaurants (for 7 days)
  • 2 person limit on groups gathering
  • Masks to to be compulsory outdoors in public places

No eating out?  Hong Kong has some very tiny apartments (and also a lot of modestly sized apartments with three generations living in close proximity to each other).  Eating out is almost a necessity for many (and a lot more affordable than in other parts of the world), but it will simply not be possible for at least seven days.  One might almost think that our very highly paid Chief Executive and her well-paid advisors and senior civil servants don’t quite understand the way ordinary people live.

Talking of which, Chief Secretary Matthew Cheung was asked where working people can have lunch (given the dine-in ban and mask rules): "You can eat takeaway in the office. And we do not have restriction on country parks.”  That’s a great idea - everyone can go to a country park for their lunch (in their chauffeur-driven car, perhaps).

Maybe you can try to work from home in your crowded apartment.  If it’s possible and allowed - and if you work in an office, that is.  Otherwise, well good luck.

Ah, yes, you might say, but there are lots of clusters around restaurants, so action was needed.  Well….one was the very large dinner gathering in Mong Kok which clearly broke the rules that were in place at that time (and 33 people from there have been infected as of yesterday).  A birthday party with 20 tables in a Tuen Mun restaurant led to a similar number of cases and there have been 15 cases from a large group in a Kwai Fong restaurant [more info].

What if the limit of 8 people dining together had been left in place for a while longer?

Meanwhile, it’s hard to see how the limit on gatherings can be enforced.  Or wearing masks outside, for that matter. 

And we have the obvious problem that imposing so many different restrictions will make it impossible to know what has worked.  And people have been staying at home, which must have an effect. 

Watch this space.

Getting worse

So here we are on Day HowLongHasThisBeenGoingOn of COVID-19.

Things in Hong Kong have changed significantly recently with 500 new cases in the last two weeks, mostly locally transmitted and many of unknown origin.

Things are particularly bad in East Kowloon.  There were 40+ cases in restaurants in Tsz Wan Shan Shopping Centre and 50+ in two elderly care homes (a big problem in the UK, Sweden and elsewhere). 

It can’t be a coincidence that this is happening a couple of weeks after many of the restrictions were lifted, including the re-opening of gyms, and more people being allowed in bars, karaoke, restaurants, etc.

Some say it’s the 200,000+ who have come to Hong Kong without being tested or having to quarantine for 14 days.  One theory is that “case zero” in this wave was a taxi driver taking someone from the airport, and it was then spread more widely via a 茶餐廳 (Cha Chaan Teng).  It’s not surprising that people can get infected in a small café.

But wait, it turns out it wasn’t that - it was the pro-democracy march on 1 July and the primaries on 11 & 12 July.  All those people outdoors wearing masks, or briefly indoors wearing masks.

It definitely wasn’t the 100 - 200 people attending a dinner in Mong Kong on 9 July  and not wearing masks, including 40+ people dancing.  This was on a day when 42 new cases were announced and people were reminded to follow the guidelines, which (at that time) included a limit of 50 people gathering in one place.  

Maybe if you’re celebrating the return of Hong Kong to China those rules don’t apply.   But at least four people at that dinner have contracted COVID-19 and it seems certain that there will be more. 

The government announced several measures last week, including the limit on social gathering going back down from 50 to 4, the closure of schools (because that’s what they always do), and all bars, gyms, cinemas and karaoke lounges had to shut down.  Restaurants are not allowed to operate between 6 pm and 5 am - because obviously people are more infectious at night.

Many wondered why the government wasn’t asking civil servants to work from home, and they eventually got around to doing that on 19 July.  The significance of this is that it would encourage other employers to follow suit.  

It was ever thus - at the beginning of all this when we first heard rumours of a SARS-like disease in Wuhan, everyone started wearing masks on public transport and in shopping centres - and the initial response of the government was that this was a bad thing.  Hmmm…   Now, many months later it is compulsory to wear masks on public transport, and yesterday this was extended to all indoor spaces.  The government seems not to have to have enforced their new rules, but they are definitely planning a meeting to arrange for that.

Unsurprisingly, people rushed to supermarkets to stock up on rice and toilet rolls, but without any major supply issues that should pass fairly quickly.

Common sense

Hong Kong had gone for 23 days without any locally transmitted cases of COVID-19, and was within sight of the totally arbitrary milestone of 28 days.  That’s “two incubation periods”, because, obviously that’s twice as good as “one incubation period” (the normal maximum time between becoming infected and having symptoms). 

Except that the incubation period can be longer than 14 days, and people with no symptoms can infect other people.  Also, people are still coming to Hong Kong from overseas.  So even if that 28 day milestone had been passed, there could still be new cases. 

Anyway, there are two confirmed cases and others in the immediate family who have symptoms.

But the government seems to be going ahead with its previously announced plans to re-open schools and leisure facilities (including swimming pools) in the coming weeks, so the 28 day target would appear to have been abandoned, which seems to be a rare case of common sense triumphing.

Bars have already re-opened and restaurants can now have tables of up to 8 people.  Life really seems to be getting back to normal.

Needless to say, this is a much better state of affairs than in the UK or US, and this article in The Atlantic attempts to explain How Hong Kong Did It

[Carrie Lam] dragged her feet in closing the city’s borders, and never fully closed down the land border with China. The hospitals suffered from shortages of personal protective equipment.

Lam wavered on masks, and even ordered civil servants not to wear them. There were shortages of crucial supplies and empty shelves in stores, as well as lines for many essentials. In early February, the financial outlet Bloomberg ran an opinion piece that compared Hong Kong to a “failed state”—a striking assessment for a global financial center and transportation hub usually known for its efficiency and well-functioning institutions.

And yet there is no unchecked, devastating COVID-19 epidemic in Hong Kong. The city beat back the original wave, and also beat back a second resurgence due to imported cases. But unlike in Taiwan or South Korea, this success can’t be attributed to an executive that acted early and with good governance backed by the people.

[..] In response to the crisis, Hong Kongers spontaneously adopted near-universal masking on their own, defying the government’s ban on masks. When Lam oscillated between not wearing a mask in public and wearing one but incorrectly, they blasted her online and mocked her incorrect mask wearing.

[..] As Taiwan and South Korea show, timely response by a competent government can make the difference between surrendering to a major outbreak and returning to a well-functioning, open society without lockdowns or deaths. But Hong Kong also teaches that people aren’t helpless, even when their government isn’t helpful.

Hong Kong people may have relaxed very slightly over the last few weeks, but it’s still very unusual to see anyone indoors without a mask.  Anyone who doesn’t wear a mask is regarded as crazy, though it has to be admitted that many are crazy foreigners.

Outdoors is a different matter.  In this part of the New Territories, roughly 50% of people are wearing masks when outside walking, which seems fine anywhere that isn’t crowded.  In busier parts it’s probably 95% or more.

I suppose we all think that we are getting it right and other people are not - whether it’s the small minority with high-spec masks, things hanging round their neck to ward off evil viruses, huge glasses or visors, gloves and plastic from head-toe, or the small minority who take no precautions.  But I’d far rather be here in Hong Kong than almost anywhere else!      

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 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