More than 10 places have issued a reward for reporting "smuggling", and experts speculate that the increasing epidemic in Hong Kong is nearing 10,000

On 20 February, 6,067 new positive cases were added in Hong Kong, China.

In the past four days, there have been more than 6,000 positive cases on three days, "which has gone numb," a Hong Kong resident told Eight Points.

More relevant experts speculate that the current data is only limited by the level of testing, and the current epidemic situation in Hong Kong is increasing by more than 10,000.

According to publicly available data released by the Hong Kong Hospital Authority, the cumulative death toll since February has reached as many as 90. Publicly disclosed information on some of the deceased shows that most of the deceased who died due to COVID-19 were elderly people, including young children aged 3 and 4.

According to the university's epidemiological model forecast released on February 11, if the health care system is overloaded, the number of deaths is expected to soar to 7,000 by mid-June.

The fifth wave of the epidemic in Hong Kong has spilled over to Hunan, Shanghai, Guangdong and other provinces and cities, especially to Zhuhai, Shenzhen and other places adjacent to Hong Kong, which has caused huge input pressure, at present, More than 10 places such as Guangdong, Fujian, and Hunan have issued rewards for reporting "smuggling".

The elderly and children, the Achilles heel of the epidemic in Hong Kong

In 20 days, the death toll in Hong Kong reached 90, equivalent to more than 4 people dying of COVID-19 every day, while mainland cities have not had new deaths for more than a year.

The aging of the population and the low vaccination rate among the elderly population have also become the Achilles heel of Hong Kong in this epidemic.

According to the data disclosed by the Ta Kung Pao, the case fatality rate (i.e., the number of deaths/infections) of the elderly in Hong Kong after infection in this epidemic is about 0.77%, which is 6.7 times that of seasonal influenza. According to Lu Hongzhou, president of the Third People's Hospital of Shenzhen and academician of the American Academy of Microbiology, among those infected with the new crown virus, the case fatality rate of people over 80 years old exceeds 10%.

BGI CEO Yin Ye wrote an article citing data released by the British Health Service that the case fatality rate of the elderly over 80 years old without vaccination is as high as 21.3%.

"In fact, most young people like us may feel that they have nothing to do with themselves, but everyone is really afraid to infect the family around them, whether the family is in their 60s and 80s, or children who are only a few years old or a few months old." Miss Lee, a Hong Kong native, told Eight Points Kenwen.

Miss Li has a grandmother in her 90s who lives alone. In the morning, the old man goes downstairs to a familiar café to drink coffee and eat breakfast, then buy vegetables, cook it himself at noon, and in the evening, the people from the community bring dinner, and the people who come to see the health of the elderly are also seen by the people who come to see the health of the elderly - that is part of the welfare provided by Hong Kong for the elderly. And "because of allergies in the past influenza virus vaccination", the grandmother has not been vaccinated against the new crown so far.

In Hong Kong, the population aged 65 and over accounts for 18% of the total population, or about 1.292 million.

As early as mid-January, the US medical news website STAT pointed out that in Hong Kong, the vaccination rate of young people is very high, and the vaccination rate of the elderly is very low.

Statistics for September 2021 show that the proportion of complete vaccinations for the elderly aged 70-79 in Hong Kong is only 32.17% of the population in this age group, and only 9.76% of those over 80 years old. Until February 19, the proportion of people who completed the second shot was only 6.2% of people aged 70 to 79, and only 2.2% of people over 80 years old.

According to a survey by Hong Kong Baptist University, the main reasons why the elderly are reluctant to be vaccinated include: they think that they are not suitable for vaccination because they are in poor health and long-term illness; they think that they are not suitable for vaccination at an old age; and many people are worried about the safety, side effects and sequelae of vaccines.

Children's vaccinations are also not encouraging. On 15 February, the minimum age for Hong Kong children to receive COVID-19 vaccines dropped from 5 to 3. The latest data show that 16.3% of children aged 3 to 11 years receive the first dose, compared with only 0.2% of those who complete the second dose.

Both data are much lower than for the age groups aged 20 to 69.

The elderly and children at highest risk of the pandemic are precisely the depressions of Vaccination in Hong Kong, where vaccines fail to form immunization among those most in need of protection. Data released by the Hong Kong Department of Health shows that from 17 January to 13 February, the proportion of unvaccinated patients who visited hospitalization and emergency departments was significantly higher than that of those who had been vaccinated.

Virology expert Chang Rongshan pointed out that this is one of the most important reasons for the sudden outbreak of the epidemic in Hong Kong. He believes that children can also survive this wave of the epidemic by postponing the opening of schools and grounding, but how to protect the elderly and minimize the death of the disease will be a big problem.

The increase in the number of elderly infected people is bound to cause a shortage of medical resources. At a briefing on 19 February, Cheung Chuk-kwan, director of the Infectious Diseases Division of the Hong Kong Centre for Health Protection, revealed that of the 46 deaths since 31 December 2021, only 6 of the dead had vaccination records. The 15 new deaths on that day were all between the ages of 50 and 99.

Relevant reports show that in addition to infections of families and the elderly living alone, infections in nursing homes also occur from time to time. According to the speech of Zhang Zhujun, director of the Infectious Diseases Division of the Hong Kong Centre for Health Protection, on the 19th, more than 190 nursing homes in Hong Kong have reported cases of infection, involving 450 elderly people and more than 120 staff.

Previously, in the REPORT AT STAT, some scientists said that if the epidemic breaks out in Hong Kong, perhaps humans will have the opportunity to clearly observe the spread of different mutant strains in people with little immunity - the elderly.

Why is Hong Kong's healthcare system collapsing?

Epidemiologists are more worried about the huge impact on the health care system if this happens in this highly aging city.

The outbreak has had an unprecedented impact on Hong Kong's healthcare system, and the high level of medical resources has become the norm. According to the "Key Data on Peak Service Periods in Public Hospitals" released by the Hong Kong Hospital Authority on 18 February, the hospitalization rate in internal medicine wards is as high as 92%, and the hospitalization rate in pediatric wards is 72%.

Adding to the strain on medical resources is that as a high-risk group, infections by healthcare workers are not uncommon in the Hong Kong outbreak, and according to the Hong Kong Hospital Authority, 631 staff members of Hong Kong's public hospitals were diagnosed or initially confirmed with COVID-19 in a week from February 12 to 18 alone.

According to Hong Kong media reports, the reserve of 7,100 isolation beds under the jurisdiction of the Hong Kong Hospital Authority has long been exhausted, and the government is requisitioning facilities originally used to isolate and quarantine close contacts for use by mildly ill confirmed patients. It is also reported that starting from February 19, Hong Kong will start to build a temporary isolation facility "Square Cabin Hospital" with the assistance of the mainland team.

Serious aging, a super-spreading virus, can Hong Kong's healthcare system withstand it?

Statistics from the Hong Kong Department of Health show that since January 23, the number of hospital admissions has increased almost exponentially as the number of reported cases has surged, and as of February 18, the number of COVID-19-related hospital admissions and waiting for admission has reached between 5,000 and 10,000.

In media reports, there are constantly patients who cannot be admitted to the hospital, waiting for hours in the tent in front of the hospital, and elderly patients lying on the bed with aluminum foil to keep warm...

All indications point to a serious run on Hong Kong's medical resources and the imminent collapse of the healthcare system.

In fact, the run on medical resources is almost the most concerned and worried about the outbreak of the epidemic in recent years.

Is the situation in Hong Kong really that tense?

According to Lu Hongzhou, there are indeed a number of public hospitals that place beds and tents to accommodate confirmed patients outdoors. To free up more resources to cope with COVID-19, Hong Kong's public hospitals have also cut non-emergency services by 40% to 50%, including rehabilitation and paternity. There are also situations such as manpower shortage in many hospitals.

Public data shows that the average utilization rate of Hong Kong's public hospitals has reached 95%, and many hospitals such as Caritas Hospital and Tseung Kwan O Hospital have been full of internal medicine wards.

Behind the severe situation, some experts pointed out that compared with the tens of thousands of cases in Singapore and the lack of a run on medical resources, Hong Kong's medical resources could have responded to the epidemic.

The number of nucleic acid positives in this outbreak has exceeded 40,000, but the number of deaths and severe cases is relatively low, and Jin Dongyan, a virologist at the University of Hong Kong, told Eight Point Jianwen that mild and asymptomatic of all cases accounted for more than 98%.

There are 43 public hospitals and medical institutions under the jurisdiction of the Hong Kong Hospital Authority, plus specialist hospitals, with a total of 29,000 beds. With such medical resources, if only for the provision of medical services for seriously ill patients, it is completely coped with.

At present, in the case of the continuous exponential growth of reported cases, a large number of mild and asymptomatic flocks to hospitals has become one of the important reasons for the shortage of medical resources.

In the mainland, mild and asymptomatic patients will be arranged in hospitals for isolation treatment. This does not apply in Hong Kong, where the number of reported cases is doubling every day. Many of Hong Kong's hospital-barred patients fall into this category. These people do not need medical care and can be completely isolated at home or in other prescribed locations. It is precisely this type of personnel that squeezes out hospitalization resources, increasing the pressure on anti-epidemic disciples, but making it impossible for seriously ill and elderly patients who urgently need to be admitted to the hospital to receive effective treatment in a timely manner.

Hong Kong's can't and can't

According to the plan released by the Hong Kong Department of Health on 18 February, infected persons, including those who test positive for nucleic acids and those who are initially positive, except for those at higher risk, who have no symptoms or mild symptoms, are required to isolate at home or in community isolation facilities as much as possible.

Jin Dongyan told Eight Points of Health That the so-called dangerous symptoms are mainly high fever that does not go away, or shortness of breath, that is, shortness of breath, "this may be a problem with blood oxygen."

In addition, the hospital will further divert patients, and the elderly with hypertension and diabetes, pregnant women and children can be hospitalized first. Others "can't be hospitalized, and they don't need to be hospitalized."

Many experts have told Eight Point Kenwen that the mainstream Omikejong BA2.0 strain actually comes quickly and is also good fast, and for young people with strong immunity, it is generally all right by the fifth day. "After many people are diagnosed, they have not had time to go to the hospital, and they have already waited at home."

An infected person in Hong Kong who was interviewed by us also mentioned that she submitted deep throat saliva on February 9, began to queue up after finding a positive result on February 11, and finally came to take her to the hospital on February 13, at this time, she had tested negative for antigen twice, the symptoms of fever and cough eased a lot, and the whole person began to recover.

When analyzing the epidemic situation, Chang Rongshan also pointed out to Eight Points Kenwen that the main epidemic strain in Hong Kong at present is Omi Kerong BA.2, which has increased its transmission power by 30% compared with Omilon, and its pathogenicity is the weakest in two years. In the case of an exponential increase in infected people, many routine measures are too late, and it is almost impossible to "clear zero" in the next 2 months.

Therefore, the focus of prevention and control in Hong Kong should shift to early medical treatment and reduce the number of deaths. He suggested that mild diseases should not be left in the hospital as much as possible, "and now the hospital beds are almost exhausted."

Some local experts in Hong Kong pointed out that some people are particularly nervous and run to the hospital, the hospital can't set up a tent outside, he just waits in the tent for dozens of hours, but in fact, "they should not go."

However, for a long time in the early days of the epidemic, the Hong Kong government did not have clear home isolation guidelines, and a Hong Kong respondent complained to Eight Points of Health That many infected people waiting in line for admission to the hospital had to refer to a traditional version of the "Important Information for Ensuring Safety During Home Isolation" issued by the British government for home isolation.

On the other hand, even with clear triage and official guidance, there are many obstacles to strict home isolation in Hong Kong.

In practice, due to the problem of living conditions, Hong Kong cannot meet the needs of many asymptomatic and mild patients in home isolation. "Many families cannot guarantee home isolation for a room with a separate bathroom. Once infected, many people are worried about the infection to their families, do not want to isolate at home, but choose to go to the hospital. "An insider told Eight O'Clock Kenwen.

Because there has been no large-scale outbreak before, Hong Kong's community isolation and cabin hospitals are not fully prepared. By the end of January this year, the number of beds in Hong Kong's square cabin hospital had just increased to 1,000. According to Hong Kong Wen Wei Po, local community treatment facilities have long been saturated.

Referring to the response to the outbreak, several experts compared it to Singapore.

Singapore and Hong Kong are similar in size, population and strategy, but because Singapore has the condition of home isolation and the vaccination rate is higher, "although the number of confirmed cases is relatively large, the case fatality rate and hospitalization rate are relatively low, and there is no collapse of the medical system." Chang Rongshan told Eight Points Kenwen.

Where is Hong Kong going?

At present, according to the data released by the Hong Kong Defense Center, in the seven days before February 18 (February 12 to 18), the average number of cases reported per day was 2940.1 cases, almost 4 times that of the previous 7 days (5 to 11 February 2022), while the average number of cases reported on the 7 days at that time was 771.9 cases.

A number of relevant experts told Eight Points that the epidemic is still in the outbreak period, and its follow-up development will be closely related to the response measures taken.

Lu Hongzhou mentioned that Hong Kong's epidemic prevention model is between Chinese mainland and Western countries. Some residents of Hong Kong are very worried about the harm of the epidemic; and some people are "not afraid of getting sick and afraid of being isolated.". The cognitive contradiction of this population increases the difficulty of patient control.

Under such circumstances, whether it is the anti-epidemic means such as lockdown and nucleic acid testing used by the mainland, or the epidemic prevention strategies of Singapore, Europe and the United States and other countries, direct replication is not feasible, and Hong Kong needs to break out a road of anti-epidemic that suits local characteristics.

Lu Hongzhou mentioned that the current epidemic situation in Hong Kong is grim, and it is necessary to increase the nucleic acid testing capacity as soon as possible and set up sufficient square cabin hospitals as soon as possible, isolate all positive people for observation and treatment, and cut off the transmission route to control the spread of the epidemic.

Some experts also revealed to "Eight Points of Health" that according to the deployment of epidemic prevention and control, Hong Kong has a five-level prevention and control system, including: conditional home isolation of asymptomatic and mild patients, community isolation of unconditional asymptomatic and mild patients, square cabins, and intermediate patients in hospital isolation beds and ICU (intensive care unit) wards for critically ill patients.

According to HKU's epidemiological model forecast released on 11 February, if the healthcare system is overloaded, the number of expected deaths will soar to 7,000 by mid-June. Under the current circumstances, under multiple constraints, it is still unknown whether the Hong Kong government can truly achieve effective control over the epidemic and minimize innocent deaths.

A city where almost no one in the population has been infected, thus lacking natural immunity, a city that has no experience and objective conditions for antigen self-testing and home isolation, for the first time, faces the virus with the highest spread, its response and gains and losses, and what kind of impact will its medical system be affected... Hong Kong today, perhaps, will be a good mirror for other Chinese cities in the future.

Chen Guangjing and Yan Shengnan wrote

Li Shanshan, Li Shanshan | responsible editors

Chen Xin also contributed to this article.

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