True aim of Hong Kong’s mass Covid-19 testing is not virus eradication but preparedness

Hong Kong now has experience organising large-scale, rapid community testing and screening, which gives it a big advantage as the winter flu season approaches along with the risk of a new spike in coronavirus cases

Bernard Chan

Published: 6:45am, 11 Sep 2020

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It took less than five minutes. True, it was not a completely comfortable five minutes. The nasal swab tickles and you feel like you need to sneeze. But, in a second, it is over. It was easy, fast and free. What is more, it helps medical professionals and the government gather invaluable information to track the spread of Covid-19 in Hong Kong.

So why has the public not been more enthusiastic about the Universal Community Testing Programme? As of Wednesday, health officials have collected specimens from more than 1.3 million people, and about 1.1 million have been tested. We have discovered 19 cases. While these numbers are good, they are still a minority of Hong Kong’s 7.5 million people.

I realise many Hongkongers are reluctant to participate in the government testing. Some have political or data privacy concerns, some do not trust Beijing. (The central government generously contributed all the mobile laboratories, tests and lab technicians to Hong Kong for this project).

Others say: “I feel fine – why should I get tested?” Motivation is another factor. Many people would grab the chance for a free Covid-19 test if they needed proof of health to travel. But without an immediate incentive, they will not bother.

A Hong Kong clinic recently surveyed 3,000 patients about the testing programme. Surprisingly, more than 80 per cent of respondents said they did not plan to register.

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Even more surprising, politics and privacy worries did not top the list of concerns. Rather, people were fearful of being pulled from their families and put into government quarantine if they or another family member tested positive. This is something the government should have considered at the planning stage, to encourage broader participation.

Looking back, there are many other tweaks and improvements we probably could have made to encourage participation in the programme. But, remember, it was put together rapidly, and under rapid fire as Hong Kong was battling an unexpected third wave spike in cases.

Governments and health officials around the world are struggling with the same issues: we have limited time, an incomplete understanding of the virus and its spread, yet we still have to move forward, however imperfectly.

Considering the timing pressure and the sense of urgency, medical teams from both mainland China and Hong Kong showed extraordinary professionalism. The mainland team had to arrange to move laboratories and trained technicians down to Hong Kong, with enough capacity to process up to 300,000 tests a day, possibly more. (To give you a sense of scale, Hong Kong’s testing capacity was only 30,000 per day).

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The Hong Kong team, meanwhile, had to coordinate the on-the-ground logistics, from training thousands of technicians to locating test venues and equipping them for sterile, socially distanced testing, Important decisions about the test procedure and format needed time for debate and consideration. Experts wondered: should we do nasal tests or throat saliva ones? (We ended up doing both).

Was it all worth it? Many, including some expert medical doctors and epidemiologists, would say no – that mass testing like this is a waste of time, money and effort in eradicating Covid-19. They argue that it does not work unless you can ensure universal compliance followed by a mandatory lockdown. And, of course, neither of these things would be possible in Hong Kong.

I think these arguments miss an important point. The goal of this testing scheme was not to eradicate the virus, but to prepare Hong Kong for a possible fourth or fifth pandemic spike. Hong Kong was late getting on board with public mask distribution back in May. The testing scheme, on the other hand, is a proactive, early response to a potential crisis. That is a much better position to be in.

Tough decisions lie ahead after testing

Working with China’s laboratory technology and experts has given Hong Kong invaluable new tools. Hong Kong now has experience organising the complex logistics for large-scale, rapid community testing and screening. We have refined our ability to conduct target testing of high-risk groups and clusters, which will be a big advantage in the months ahead.

Winter is Hong Kong’s flu season, and with cold, dry weather comes the threat of another dangerous spike in Covid-19 infections. But we are prepared now, because we know we can mobilise testing on a scale we could not have before. That is nothing to sneeze at – and absolutely worth it.

Bernard Chan is convenor of Hong Kong‘s Executive Council

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