How Hong Kong can find a way to live with the coronavirus – like with flu

With Covid-19 vaccines boasting better efficacies than flu vaccines, Hong Kong needs to shift its focus to tackling disease, rather than infections
However, testing, quarantine and vaccinations must stay on our road back to ‘normal’

Nikolaus Osterrieder

Published: 8:30am, 9 Aug 2021

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A total of 18,369 cases in Hong Kong, among them 667 classified as severe, and a case fatality rate of a little less than 1 per cent. These are the numbers, not of the Covid-19 pandemic but the 2018/2019 season for the influenza virus, SARS-CoV-2’s staunchest pandemic competitor, according to the Centre for Health Protection.

While the numbers are a sobering reminder of how vulnerable we are, even to known infectious diseases, they also offer a glimmer of hope and a playbook for how we can move forward.

After 20 months of Covid-19, a lot has changed in Hong Kong and the world. The speed at which the viral agent was identified was remarkable. Even more so were the efforts to produce safe and efficacious Covid-19 vaccines, the proven best weapon against viral disease. Within a year, Covid-19 vaccines were available to virtually all adults, and soon after, even to adolescents.

Vaccine efficacies that few dared to dream of were achieved: greater than 90 per cent for the novel mRNA vaccines, greater than 70 per cent for adenovirus-vectored vaccines, greater than 60 per cent for inactivated vaccines. We would be thrilled to be even close to such vaccine performances for influenza.

And despite the possible side effects, all vaccines are, according to current data, very safe with extremely low numbers of severe adverse reactions.

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Despite these encouraging observations, vaccine hesitancy is a problem in many parts of the developed world. It is an affront to people in many countries that do not have the choice, simply because vaccines are not (yet) available or are unaffordable.

Fortunately in Hong Kong, vaccine acceptance seems to have increased since the introduction of communal vaccinations in February this year, with more than 65,000 doses administered on average every day over the past week. At this rate, 60 per cent of the population could be vaccinated in a month.

But let us look ahead and not waste time on what could have been done differently or better, or on speculating on the origins of SARS-CoV-2. This is not helpful at this critical juncture; we must focus on how to exit the pandemic and enter the endemic state of affairs.

Bluntly spoken, we need to overcome our fears and move forward from zero-Covid-19 strategies. While avoidance and trying to keep viruses out of communities, cities and countries was right in the absence of options, this approach has to come under scrutiny now. There are many examples of the vulnerability of populations with low previous or current infection and vaccination rates, such as Australia and Taiwan.

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We need to face the obvious: SARS-CoV-2 has a foothold and we are unlikely to eradicate it. We need to learn to live with it, as we do with influenza, for example. But we must start thinking more in terms of disease and not infection, as it is the former that is relevant. What is more, we must avoid allowing this virus to continue to get the better of us and our way of life. This virus tyranny needs to stop!

So what do we do? Moving away from zero-Covid-19 strategies and messaging does not mean we cannot and should not use the very tools that have enabled us to have virus-free communities. The main pillars of this success are frequent and comprehensive testing, quarantine and vaccination.

The way forward will not be one-size-fits-all. It will also depend on how good (or bad) Covid-19 was handled initially. Countries that had high infection, hospitalisation and death rates now ironically have herd immunity advantage. Having had 10 per cent or more of the population infected contributes significantly to herd immunity.

Add a comprehensive and quick vaccination campaign and these countries could be in very good shape, provided other precautions are taken and the health system is a well-oiled machine.

Where Covid-19 cases have remained extremely low, such as in Hong Kong, the road to a “normal life” should also involve a mix of measures. Just getting 60 per cent of the population vaccinated will reduce the impact of even the Delta variant. Evidence is accumulating globally that the risk of Covid-19 hospitalisation or death for those vaccinated is less than 1 in 100.

But this does not mean that we can fling open all doors and allow the unregulated movement of people. It does not mean we should do away with masks on the MTR, bus or when meeting indoors. But do we really need them when climbing Ma On Shan or skipping on the pavement?

For travellers, a combination of quarantine or self-isolation upon arrival in Hong Kong that includes regulated transport to sites of seclusion with frequent testing will greatly reduce, if not abolish, the Covid-19 risk. Travel in and out of Hong Kong and social life could also be made contingent upon vaccination status or negative test results, now that everyone 12 years and older have had the chance to get one’s favourite vaccine.

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Finally, moving forward will require the health authorities to be able to trace infections and clusters. Contact tracing apps, for example, remain necessary until we are out of the woods. So if you want to visit a nightclub or gym, show that you are vaccinated or not infected. The same holds for going to Ocean Park, Disneyland or boarding a plane.

Importantly, we must allow these activities so as to incentivise people and spread the hope that we will get out of this quagmire. Positive messaging is important and we have every reason to be confident of returning to pre-pandemic routines this year.

There will be no happy ending to Covid-19. Far too many people have fallen seriously ill, still battle the acute and chronic consequences of the infection or have died. We must acknowledge that there will be more Covid-19 hospitalisations and, yes, deaths.

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Look at what endemic viruses and other pathogens do to us on a recurrent basis. But that must not deter us from doing the right thing. Think of our children: babies and toddlers in Hong Kong might start to believe that most human faces consist of a rectangle under the eyes, and that the only purpose of ears is to support the rectangle’s loops.

Let’s be a bit braver without letting the pendulum swing to the other side. I am confident that there is a good way out of this nightmare and that we will have a very different conversation in six months.

Professor Nikolaus Osterrieder is dean of Jockey Club College of Veterinary Medicine and Life Sciences, and chair professor of Virology and One Health at City University