What Happened to Hong Kong?

The city was once lauded for controlling the coronavirus’s spread. But this month, it recorded one of the highest death rates in the world.

Patients sleep at a makeshift COVID-19 treatment area outside a hospital.
Tyrone Siu / Reuters

Two years on from the start of the coronavirus pandemic, let me tell you what life is like in my Hong Kong neighborhood. Playgrounds are wrapped in red-and-white caution tape and barricaded with plastic fencing to keep children out, and the swings have been tossed over the crossbar to ensure that no illicit amusement takes place. The government’s disastrous public messaging about a possible citywide lockdown has led to widespread panic-buying, so gossip swapped while I’m out walking my dog focuses on which shops have restocked.

All restaurants have to close at 6 p.m., and bars aren’t open at all. A restaurant down the street from my apartment now offers happy-hour deals starting at 10 a.m. Gyms, movie theaters, campsites, and beaches have been shut down entirely. If I want to take a walk on my own in a remote country park, I am legally required to wear a mask.

This situation feels all the more shocking because in early 2020, Hong Kong was ahead of the COVID curve, not lagging behind it. As soon as news emerged of a still-mysterious virus, everyone here began wearing masks and adapted to social distancing almost immediately; I wrote article after article about what life would look like in the weeks to come in America, having seen the future myself. While the West was caught off guard, Hong Kong felt prepared.

Now medical facilities are overwhelmed with sick patients, and because morgues have struggled to keep pace, body bags are piled up in hospitals alongside patients still receiving treatment. Coffins are being shipped in to meet the demand. Construction workers are racing to build isolation facilities, including one that looks like a wartime field hospital on the border with the mainland. Some 300,000 people are in isolation or under home quarantine. After recording only 213 deaths and about 13,000 cases of COVID-19 from January 2020 to early 2022, the city is swamped by the current Omicron wave, which began at the start of the year and has led to more than 960,000 cases and more than 4,600 deaths.

Hong Kong was lauded for controlling the coronavirus’s spread with its “zero-COVID strategy.” It has ample vaccine doses. It is wealthy enough to support its poorest people if it chooses to. It has effectively shut down swaths of its economy, including its lucrative tourism sector, to battle the virus.

And yet this month, it recorded one of the highest COVID death rates in the world. What just happened?

Hong Kong has employed its zero-COVID strategy since the onset of the pandemic. The approach has not been as restrictive as the one used in mainland China, which calls for shutting down whole metropolises and testing their population over a handful of COVID cases. The city has an aggressive test-and-trace program, as well as toughened border controls, to catch infections and break transmission lines, and enacts social-distancing measures when cases spike. All of this helped Hong Kong buy itself time in the early stages of the pandemic, when vaccines were not available, keeping deaths to a minimum.

But now it clings to measures not based on sound science, and which experts have dismissed as largely performative (while also being heavily damaging to its travel- and service-based economy). It has neither pivoted to a more flexible approach nor prepared for an outbreak that analysts repeatedly warned was inevitable.

The missteps are almost too numerous to recount, but the worst ones have to do with Hong Kong’s singular inability to vaccinate its population. The government’s efforts were from the start imbued with politics and marred by poor messaging. It initially rushed through approval of the China-made Sinovac vaccine, and city leaders made a show of being inoculated with it, despite a better option—BioNTech’s mRNA jab—being available. (The large majority of deaths have been among the unvaccinated, but officials refuse to disclose data on which vaccine was administered to those who died after being vaccinated.) Press releases highlighting, with little context, the vaccine’s adverse effects were amplified by the media, leading to intense skepticism. Distrust in the government, still lingering from its handling of prodemocracy protests in 2019, did not help the cause. And most troubling has been the poor vaccination rate among the city’s elderly population, a persistent problem. Today, just 55 percent of people older than 80 have received one vaccine shot, and 36 percent have received two.

Lam Ching-choi, a physician and a member of Chief Executive Carrie Lam’s cabinet, told me that the government’s early reliance on family doctors to advise patients on vaccination was a mistake: Many warned the elderly to be cautious about receiving the vaccine. Predictably, COVID has swept through residential care homes—more than 29,000 elderly care-home residents have been infected during the current wave. Lam also told me that the government should have offered at-home vaccination for residents with mobility issues, and said the authorities would soon begin implementing that program. Yet it will start only next week, more than two months into the surge and more than a year after the vaccine rollout initially began.

The 21-day hotel quarantine required for all arrivals into Hong Kong, even for those without COVID, is dangerous and unscientific, experts told me, but the government has continued the practice anyway, leading to cross infections and a spike in cases. A government-funded study published last year warned about vaccine hesitancy, but officials did little beyond sloganeering and a perfunctory poster drive. The government also insisted on issuing compulsory testing notices to residents even when testing and quarantine facilities were already overloaded, leading to more stress on a teetering health system. Flight bans from countries including the United States and Britain are scheduled to be in place until next month, though the government’s own advisers say there is no reason for this to continue.

In sum, decision makers ignored public-health expertise, driven instead by politics and overly enthusiastic efforts to show fealty to Beijing. The result has been an embarrassingly shambolic effort that has created a preventable public-health disaster, yet another glaring failure of governance from an administration whose defining characteristic is catastrophic ineptitude.

“The question to ask, not unreasonably, would be: How come we either didn’t have a good plan or didn’t execute a good plan?” Gabriel Leung, the dean of medicine at the University of Hong Kong and a pandemic-response adviser to the government, told me. When I asked whether he had any thoughts on the answer to that question, Leung responded, “Suffice to say that we have done our very best to generate the best science to inform policy decisions. And, as Margaret Thatcher once said, ‘Advisers advise; ministers decide.’ Let’s put it at that.”

A customer wearing a mask buys fresh meat at a supermarket.
Tyrone Siu / Reuters

Much of the world has struggled with various phases of the pandemic, but Hong Kong’s difficulties are in no small part due to the fact that the city no longer has even its previous limited democratic accountability to push the government to review public-health decisions, thanks to a crackdown by Beijing and the imposition of a draconian national-security law. For varying reasons, many residents believed the government’s fiction that only a small minority of people would be affected by these changes, but the mishandling of COVID has highlighted how the reengineering of Hong Kong will touch all aspects of life.

With opposition voices silenced, Hong Kong’s rulers claimed they could more efficiently govern. But in the city legislature, overhauled last year to ensure that nationalism and obedience are valued over competence and political know-how, suggestions on how to tame the outbreak have included the wildly impractical (using cruise ships as temporary isolation facilities) and the patently absurd (dropping fresh food into Hong Kong by drone). Even this newfound sense of urgency on the part of lawmakers and the government has emerged only after Chinese President Xi Jinping spoke last month of the “overriding mission” to bring the current outbreak under control.

At the same time, pro-Beijing pundits and mainland officials have cast pandemic response, and adherence to “dynamic zero COVID,” as a loyalty test. (Determining what exactly “dynamic zero COVID” means is futile; the description shifts from official to official and day to day. Nevertheless, authorities insist that it shouldn’t be questioned.) The director of China’s Hong Kong and Macau Affairs Office said this month that “patriotic forces must forcefully expose, criticize, and sanction with laws the anti-China destabilizing forces who launched smearing attacks, spread rumors, and created panic to disrupt the anti-pandemic efforts.” Addressing the United Nations, a Hong Kong doctor said that the idea of living with the virus was tantamount to the U.S. creating “biological terrorists,” in a melodramatic screed that seemed scripted for a comic-book villain. Hong Kong’s civil service has become a targeted group, fingered as being polluted by Western ideas for questioning the COVID strategy.

“Hong Kong’s pandemic response definitely shows the NSL [national-security law] new order is not only about election and activists, but extends to all realms of life,” Ho-Fung Hung, a professor at Johns Hopkins School of Advanced International Studies and the author of the forthcoming book City on the Edge: Hong Kong Under Chinese Rule, told me by email.

As they did with the imposition of the national-security law, mainland officials felt the need to step in to address COVID-related problems that the Hong Kong government had created for itself, a move that has been met with slavish praise. Newspapers controlled by the Chinese government here have splashed their pages with adoration for workers arriving from over the border. Pro-Beijing lawmakers have rushed to social media to post their gratitude to the “motherland” for its support. My inbox fills up daily with statements thanking Beijing for taking control. The city’s secretary of health applauded the mainland’s donation of traditional Chinese medicine. (Authorities in Singapore, by contrast, have warned that there is “no scientific evidence” that one such remedy, called lianhua qingwen, can be used “to prevent or treat COVID-19,” while Australia has banned the sale of the treatment entirely.) The endless, unrestrained flattery seems akin to the celebration of an arsonist who lights his house on fire, cuts the water hose, and then cheers as the fire brigade arrives to extinguish the flames.

All the while, the broader political purge and repression of rights that was already under way in Hong Kong has carried on undisrupted. Half a dozen people were arrested and charged with sedition last month. In early March, the former head of the bar association, a British lawyer, was questioned by national-security police before he left the city, followed through the airport by reporters from Chinese state media. Authorities accused a U.K.-based rights group of endangering national security and demanded that it take down its website. Carrie Lam, the city’s chief executive, employs wartime rhetoric as an excuse to exercise emergency powers. The longer the coronavirus outbreak persists, the more policies to combat it become intertwined with the ever-expanding security apparatus.

Listing Hong Kong’s mistakes triggers a sense of déjà vu: a politicized and inept response, an unwillingness to adapt existing strategies to the virus’s mutations, an inability to overcome vaccine skepticism, long-running fissures in society torn open by COVID. For years, we were told by pro-Beijingers that these were the West’s problems, not ours.

Two years ago, we looked at the U.S. and Europe, dumbstruck at how badly they were managing the pandemic. Two years on, we are experiencing what Siddharth Sridhar, a virologist at the University of Hong Kong, describes as a “plane crash in slow motion,” having apparently learned little from the West’s—or our own—experience.