According to data released by the Centre for Health Protection of the Department of Health of the Hong Kong SAR Government, on March 21, there were 14,152 new confirmed cases in Hong Kong in a single day. Among them, 4296 confirmed cases were confirmed by nucleic acid testing, and the remaining 9856 cases were reported positive for rapid antigen tests.
So far, the cumulative number of confirmed cases in Hong Kong has increased to 1.06 million.
However, on March 19, the team of the University of Hong Kong School of Medicine estimated that 3.58 million people in Hong Kong have been infected with the new crown virus, close to half of hong Kong's population.
Jin Dongyan, a virologist at the University of Hong Kong, told the health community that the super-large-scale human infection, coupled with the fact that about 90% of people have been vaccinated, has basically formed a "copper wall".
"In other words, the HKSAR is close to herd immunity levels." Jin Dongyan said.
Under such circumstances, on the morning of March 21, Carrie Lam, chief executive of the Hong Kong Special Administrative Region, said at a regular anti-epidemic press conference that the compulsory nucleic acid testing work for the whole people was suspended.
The fifth wave of the epidemic in Hong Kong has been nearly two months since the outbreak at the end of January. During this period, the voices calling for national nucleic acid testing have not stopped. However, nearly a month has passed since Chief Executive Carrie Lam Cheng Yuet-ngor announced on February 22 that three compulsory nucleic acid tests will be conducted in March, and Hong Kong has not carried out relevant work for a long time.
Jin Dongyan commented that the suspension of nucleic acid testing for the whole people is a key decision to stabilize and control the epidemic, and Chief Executive Carrie Lam is leading Hong Kong's anti-epidemic work in the right direction.
In the anti-epidemic work of the Chinese mainland, screening out infected people through national nucleic acid testing is an effective means to quickly block the transmission channels of the epidemic and curb the spread of the epidemic. Why doesn't Hong Kong do national nucleic acid testing? Behind the decision to suspend mandatory nucleic acid testing for the whole people, where is the epidemic situation in Hong Kong heading?
Analyzing the costs and benefits, the nucleic acid testing of the whole people in Hong Kong is not cost-effective!
Jin Dongyan told the health community that the central government hopes that the Hong Kong SAR government will meet the requirements of stable control of the epidemic through precise prevention and control and scientific prevention and control methods, and Chief Executive Carrie Lam's suspension of nucleic acid testing for the whole people is a "reasonable and timely" decision based on scientific prevention and control.
He analyzed that many of the current infections in Hong Kong have been infected, and most of the remaining ones will not be infected. Even if you are infected, because you have been vaccinated twice, you are basically asymptomatic or mild. In these mild patients, due to the low viral load, after about 3 days, the symptoms have lessened and the viral load has been greatly reduced or even disappeared. A round of nucleic acid testing in Hong Kong takes 3 days.
"If the speed of nucleic acid testing can't keep up with the speed of patient self-healing, it doesn't make much sense after doing it." In addition, Hong Kong's current prevention and control goals are to reduce severe illness and death, he said. Nucleic acid testing for all employees has not been of much benefit to this goal.
Jin Dongyan introduced that since the large-scale outbreak of the epidemic, Hong Kong has not received corresponding support due to insufficient isolation facilities and insufficient medical resources. Hong Kong people rely on civic awareness, self-consciousness, and the degree of civilization of the city to self-isolate and treat at home.
The number of infections in Hong Kong is now large, probably well above the announced 1.06 million. It is already difficult to find all infected people through full nucleic acid testing.
Even if the majority of infected people are identified, there is still a real problem: there are not so many isolation facilities.
Moreover, if a larger figure is announced, it may also cause widespread anxiety among the public.
He said that at present, what Hong Kong needs to do is to treat seriously ill patients, provide the needed materials to the mild patients in home isolation in the community, and give them psychological support and spiritual support, so as to achieve the purpose of stabilizing and controlling the epidemic, "If at this time, Hong Kong will allocate a large number of manpower and material resources to do nucleic acid testing for all staff, it will take care of one or the other, which is a loss of resources, and may even make Hong Kong disorderly."
"The biggest lesson Hong Kong has learned is to vaccinate the elderly as soon as possible." Jin Dongyan analyzed that compared with Singapore, the epidemic in Hong Kong is an accidental outbreak, and Singapore is artificially open. But thanks to the planned liberalization, the vaccination rate for the elderly in Singapore is 97%, and most have three injections, at least two injections. Therefore, although the number of infected people in Singapore is comparable to that in Hong Kong, the mortality rate is 1/5 of that in Hong Kong.
Therefore, vaccination is a top priority for the prevention and control of the epidemic in Hong Kong. He said that instead of using large-scale manpower and material resources to do nucleic acid testing for all employees and establish isolation facilities, it is better to concentrate more forces and resources to let everyone vaccinate, especially the elderly.
The opportunity for nucleic acid testing of all employees has long been missed
Why doesn't Hong Kong conduct nucleic acid testing for all staff as soon as possible? Issues involving the timing of initiating nucleic acid testing for all employees.
According to Hong Kong's previous reports, positive cases began to be detected in Hong Kong in mid-January, and there is more than one source of infection in this round of epidemic. Judging from the development of the epidemic situation, since February 4, the number of confirmed cases in Hong Kong has begun to rise sharply, and the upper limit of the number of confirmed cases in a single day has been continuously refreshed. On February 21, the number of new confirmed cases in Hong Kong in a single day has reached 7533.
On February 22, Chief Executive Carrie Lam announced that nucleic acid testing would be conducted for all employees. Jin Dongyan analyzed that at that time, there was already a super-large-scale epidemic in Hong Kong, and it was impossible to clear zero through the national nucleic acid test.
According to the experience of Chinese mainland, the timing of nucleic acid testing for all employees should be early and should be carried out immediately after the outbreak is detected. "It is clearly too late for Hong Kong to plan a compulsory nucleic acid testing for the whole people a few weeks after the outbreak." Zhang Hongtao, a former associate professor at the University of Pennsylvania School of Medicine, also told the health community.
Image source: Xiaomu Digital Station
In addition, Hong Kong has not been able to carry out nucleic acid testing for all employees, and there are also the necessary manpower, material resources, places, and community organization capacity.
Li Dachuan, head of the testing and medical team of the central government to support Hong Kong's anti-epidemic work and deputy director of the Medical Administration Bureau of the National Health Commission, proposed in an interview with the media in late February that the launch of nucleic acid testing for all employees, in addition to preparing sufficient isolation points and treatment manpower, also has very high requirements for organizational capabilities.
The first condition is that all employees are involved, and the second is that the organization is effective.
"Within the specified time, all personnel can collect nucleic acids, which is very demanding for the organization." He said that there are some good practices and experiences in the interior, the whole city does grid management, there is a grid member in a grid, find out how many people are in the grid, and then make preparations in advance, according to how many people to arrange the appropriate sampling force.
The third condition is that those who test positive should be able to get timely isolation and control, so as to achieve the purpose of cutting off the transmission route.
At a press conference on March 21, Carrie Lam said that in order to achieve the goal of thoroughness, orderliness and effectiveness, the SAR government has continuously refined the testing plan in the past month, assessing the manpower, material resources and venues required for the work, and also needing to formulate supporting measures to restrict the movement of people.
According to reports, the assessment results show that the total number of people tested is about 7.2 million, a total of 500 testing stations need to be set up, operating for 14 hours a day, if the testing cycle is 3 days, 2.4 million people are sampled for nucleic acids every day, and 80,000 staff members are required to participate, including testing station operators, samplers from the mainland, drivers carrying confirmed cases to community isolation facilities, and disciplined forces to maintain order.
Carrie Lam also mentioned that after visiting Hong Kong, mainland experts admitted that Hong Kong's community organization capacity is weak. She also said that there are many street management organizations in the mainland that can completely "leave no household" in the national test, while Hong Kong's ability in this regard is weak. Even if there is a legal basis for compulsory inspection by the whole people, I am afraid that it will be difficult to achieve the goal of national screening.
Antigen testing has gained mass adoption in Hong Kong
In addition to the unsatisfied conditions for nucleic acid testing for all employees, There is also a big difference between Hong Kong's fight against the epidemic and the mainland - it is more dependent on antigen testing.
It is reported that under the attack of the fifth wave of the epidemic, the Hong Kong SAR government has also purchased a large number of rapid antigen test kits for testing by different groups of people. The Centre for Health Protection of the Hong Kong Department of Health also launched the "2019 Covid-19 Rapid Antigen Test Positive Result Declaration System". Citizens can test and report on their own. Antigen test results can be counted in the government's COVID-19 case statistics.
With the popularization of antigen detection reagents in late February, the number of new confirmed cases in Hong Kong in a single day soared. On 3 March, Hong Kong saw a daily increase of more than 56,000 cases, setting a record for a single-day increase. Jin Dongyan said that this is not caused by the "surge" in patients, but due to the change in the official statistical strategy: confirmed by the company and the government twice positive for nucleic acid, it can be reported to a positive nucleic acid.
According to the official data released by Hong Kong, as of March 20, the cumulative number of positive people in the fifth wave of the epidemic in Hong Kong has exceeded 1 million, of which 679452 cases have been tested for nucleic acid and 355607 cases have been reported by antigen testing. Jin Dongyan said that antigen testing is the best supplement to nucleic acid testing, and it has won a lot of time to find cases during the outbreak.
In terms of risk assessment triage, high-risk, medium-risk, and low-risk patient assessment criteria are taken as the criteria. High-risk patients (such as severely ill elderly, people with warning conditions, etc.) will be sent to the hospital for treatment; medium-risk patients (such as stable physical condition but no home isolation conditions) will be sent to the community isolation point until they meet the discharge conditions and then leave; low-risk people (mild illness and home isolation conditions) will be isolated at home, and when the condition improves, they can be released from isolation.
In addition, in order to prevent the test results from being falsified, patients who declare positive need to provide a photo of the rapid antigen test results and an ID photo as a record. Thereafter, the CENTER for Health Protection will provide appropriate isolation treatment measures to patients who are positive applicants, such as arranging medical assistance and admission to treatment or isolation facilities.
Source: Wenhui Network
Will Hong Kong passively "coexist with the virus"?
"National antigen testing is not necessarily necessary at this time." Jin Dongyan analyzed that because the scale of infection in Hong Kong is now too large, it is estimated that there are about 3 million people, and these people will not be infected again in the short term. Most of the remaining people have been vaccinated to produce antibodies, or have been exposed to the virus, and their own antibodies have been activated, "these people will be fine if they close their eyes."
He said that even if he took 10,000 steps back, these vaccinated people were infected, their course of illness would be very short, the symptoms would be very mild, "even if there are sequelae, it will not be more serious, not worth worrying too much."
Jin Dongyan said frankly that the current situation of the epidemic in Hong Kong has made it difficult to stop the pace of the spread of the virus. We can only wait for the epidemic to develop to a certain extent and show a natural decline. There are also some who have not been vaccinated, or who are not protected enough after vaccination, and the virus will find them. When the virus has fully found the person it is looking for, it will not be able to run and stop.
"It's basically close to herd immunity." But, he said, it's also better than doing some useless work.
Fortunately, the number of new daily infections in Hong Kong is already showing a downward trend, "sometimes it will go down faster, sometimes it will be slower, but it will eventually go down, and it will eventually subside".
Jin Dongyan said that now Hong Kong should focus on saving seriously ill patients and vaccinating the elderly. In addition, it should also be placed on the next step of the opening plan and how to resume normal production and life.
"Otherwise, the lives of some ordinary people will become a problem."
Resources:
1. Beijing News: "Hong Kong Suspends Compulsory Nucleic Acid Testing for the Whole People and Why Is It Difficult to Implement Verification"
2. Southern Metropolis Daily: "Lam Cheng Yuet-ngor's Latest Announcement"
3. Phoenix TV: "8674 new confirmed cases in Hong Kong, Why doesn't Carrie Lam respond to the national test as soon as possible"
4. Interface News: "How is COVID-19 antigen testing implemented in Hong Kong?" 》
Exhibit | Health Community
Written by | Liu Wenyang