March 11, 2022 - 3:00pm
Hong Kong
Hong Kong is currently experiencing the highest Covid death rate, per capita, of anywhere in the world, at any time during the pandemic. Until Christmas, it had seen just over 200 deaths caused by Covid; the figure now stands at just shy of 3,500 and it’s going up fast. Today brought another 196. (For a rough UK equivalent, multiply by ten.) The local press, which until recently was lauding Hong Kong as a model of how to do it, is now running why-oh-why pieces about why things have gone so wrong.
On one level, the answer is pretty simple: the vaccination programme was a failure. Overall take-up was OK, if a bit sluggish, but take up among the elderly was dismal. Even when overall rates hit respectable levels, the vaccination rate among the over 80s was still under 30%. There’s no Captain Hindsight here. I first described the vaccine programme in print as a policy failure a year ago, and I wasn’t the only one.
That was fine while Covid could be kept out at the border, or any outbreaks quickly detected and suppressed. But once Omicron broke through, it soon overwhelmed the system. It is now ripping through residential care homes, killing the unvaccinated at appalling rates. About half of today’s deaths were in care homes. More than half were entirely unvaccinated.
Hong Kong is providing a natural experiment into quite how lethal Omicron can be when it is let loose among a vulnerable population — and it turns out it can be plenty lethal enough.
We can’t ignore people’s own responsibility. Most of those now getting seriously ill or dying actively chose not to get vaccinated. But there were also local quack doctors, urging caution on the slightest of pretexts, while local media played up the risks associated with the vaccine, giving overdue prominence every time someone got a bit dizzy after being injected.
And then there’s the Hong Kong government.
True, it encouraged vaccination. But there was never any sense of urgency, and the policy involved little beyond exhortation. Hong Kong had months in late-2021 when it was effectively Covid-free which could have been used on an intensive vaccination drive, to prepare for the inevitable and to scenario. The things the government is now doing — vaccine passports or systematic outreach to care homes — are now all much too late. Plus, throughout this period so much focus went on border controls and keeping cases at zero that the implicit message was that there was no great rush to get vaccinated. The result has been some of the most avoidable Covid deaths of all, anywhere in the world.
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SubscribeTwo facts stand out: 30% vaccination rate in the most vulnerable population and ‘more than half’ of recent fatalities are unvaccinated. I’m no math whiz but to me that doesn’t suggest vaccination would have done much. In fact that almost sounds like negative efficacy. Oh wait, we aren’t allowed to talk about that. Hubris indeed.
That struck me as well. Also, the “see how dangerous Omicron can be” bit. If they had indeed managed to suppress covid 19 out prior to Omicron, they are now simply playing catch-up, albeit rapidly. The total mortality rate is still pretty low.
I remember that when I was living just across the border in Canton, Hong Kong had the longest life expectancy in the world. So I guess, having so many old people, the death rate will be higher than in other places. Hong Kong Chinese still have a lot of respect for the elderly, so forcing them to be vaccinated would be an issue.
Here in Western Australia, where the borders were shut for 700 days while just about everybody got vaccinated, the omicron variant (and its variants) are spreading and expected to peak in a week or two. Very, very few people have died. What we need is for some place to have vaccinated just the over 65 year olds to see what the death rate would be with that experiment.
That would be interesting, but the assumption that ‘people over the age of 65’ are the same the world around may not hold. All of south-east Asia did not have a high death count when alpha-from-Wuhan broke out, no matter how severe your non-pharmaceutical interventions were. When Delta showed up, people started getting really sick and dying, all over the region, despite those same measures. The inference is that people in south-east Asia had already been exposed to a different corona virus that gave them considerable protection from alpha but wasn’t protecting them against Delta, and now Omicron.
But the experience with flu vaccines says that if you get a vaccination that is too close to something you have previously been vaccinated with, it gives a worse result in preventing disease than not getting it, which is why health authorities many places are now recommending that people who want to be vaccinated for flu only get a shot every second year. Successive year’s shots are (most of the time) too much like each other.
It will be good to see what is going on in those people who are getting sick in Hong Kong. It is quite possible that the vaccine didn’t produce new antibodies in these people — they just made more of the ‘whatever made me sick in 2006 <or whenever>’ antibodies, which being effective against alpha ought to be effective against the vaccine, too.
If half the elderly dying are vaccinated, and 30% of them are unvaccinated, this means that about 70% of the dying are vaccinated, whereas 30% are unvaccinated.
So if the unvaccinated are dying at a rate of x%, and the vaccinated at a rate of y%, then in order to reach approximate parity in the number of deaths, y must be about 2.33 times x.
But this assumes that half of the elderly who die are unvaccinated. So it would be good to know what “more than half” actually means. Presumably it also refers to the population as a whole (which has a higher vaccination rate), and not just the elderly. There might also be some weird effects such as “Simpson’s paradox” creeping in, if the population is stratified in some way.
What is ‘more than half’ were unvaccinated? What figure are we talking about? Slightly more than half? A lot more than half? This mention of the half says to me that almost a half were vaccinated?
Indeed. A casual, all too casual, reference to unadjusted relative risk ratio. And we know that health characteristics vary by vaccination status. Once adjusted, the vaccination programme is likely a failure not due to insufficient rollout, but due to what we now know to be the case: the vacccines have vary limited efficacy.
CDC data says 95% of people over 65 in the U.S. have at least one dose and 88.5% are fully vaccinated. Yet the rate of less virulent Omicron deaths over the last few months has been higher than the worst period with more virulent Delta. But yeah, vaccine vaccine vaccine.
However Americans were still living under restrictions under the previous variants, and with them being seemingly less transmissible perhaps it was the case the few Americans actually caught the virus hence the lower level of deaths?
A better comparison would be to compare Hong Kong to New Zealand, who are both now going through their first waves of the virus. NZ is highly vaccinated, and their deadliest day so far has only seen 7 deaths compared to Hong Kongs almost 200. Even accounting for HK higher population (7m vs 5m) and being much more densely populated the difference is quite stark
Some Americans were living under restrictions.
And I’d say that Tanzania is a better comparison than New Zealand. Or Congo. Or Niger. Or Burundi.
How are those countries anything like NZ?
Just having a quick look it seems that the median age of HK is 43, while NZ is 37.5; because Hong Kongers are older, I would expect more deaths. I don’t know about the health systems, but I would expect NZ’s is more comprehensive, so ‘underlying conditions’ would be better treated??
The median age is slightly higher, and the population denser, but does that explain a death rate nearly treble that of NZ?
Also NZs health system is a shambles, Hong Kong has almost double the ICU capacity of NZ (7.1 beds per 100k vs 4 per 100k) The vaccines work, even if not as well as intended
I agree that it’s a good idea to be vaccinated if you’re older. Looking at the ‘age pyramid’ for the two countries, HK has more of the bulk of its population in the older age brackets, so I would expect a higher death rate.
I just had lunch with two friends who worked for several years in NZ and they said that if one of them had ever gotten sick in NZ they would have immediately flown back to Australia for treatment, so perhaps the NZ health system is not so good! My impression of the HK system was that it depended quite a bit on charitable foundations for funding. Luckily I only ever needed to go to the dentist in HK – you definitely wouldn’t go to the dentist in China! – and the dentist was expensive and excellent.
Nobody has mentioned the relative performance of the Chinese made vaccine. Chile used it very early in the pandemic, had a very high take up accompanied by high hospitalisations and deaths.
I’ve seen pictures of bodies stacked in hospital wards with still living patients at Queen Elizabeth Hospital in Hong Kong. On the flip side, I was on FaceTime with an engineer in one of the pathology labs in the same hospital, helping him troubleshoot some instrument issues. With my own first hand experience, I didn’t see any bodies stacked up on the floor in the lab nor did I see anything to suggest this wasn’t just a normal day in a lab in a busy hospital. I find it odd that they would be stacking bodies with patients due to overflowing morgues, but they wouldn’t be putting bodies in relatively lightly used lab space. This whole thing feels a bit like the footage we saw of people dropping dead in the streets of Wuhan. Also, with so many PCR tests being processed in the mainland, do we really trust the number of deaths “with” covid. Martial law via covid is easier to justify than just crushing HK politically
This really is an incredible story. I had assumed that the zero covid countries were efficiently vaccinating their population in the background but apparently not in Hong Kong (apologies to the author who apparently reported this a year ago).
The main issues surrounding vaccines relate to vaccinating young people who are at very little risk from serious disease and for whom side effects (though rare) may present a greater threat. But it’s always been clear this virus is deadly among very elderly people. That’s a piece of science almost no one argues about. Hard to believe a science-minded jurisdiction like Hong Kong didn’t act accordingly. They are quite an authoritarian place; they could have coerced the very elderly into being vaccinated.
If the Chinese produced a vaccine which they discovered isn’t effective in preventing death among the elderly, then not vaccinating the elderly may have been the secret policy. That way, when they start dying it can be blamed on them for not getting vaccinated rather than blamed on the vaccine for being a dud.
I certainly don’t want to justify in any way the draconian and authoritarian reactions of the Hong Kong and Chinese governments in a futile ‘Zero Covid’ strategy (as Lionel Shriver recently said, be very wary of people trying to achieve ‘zero’ in anything, they are likely to be single-issue fanatics).
But nor do I think that forcing vaccinations on people who do not wish to is the right way to go. Don’t a significant proportion of elderly people always die of respiratory viruses? My mother certainly had that (non-covid) as one cause on her death certificate. We can perhaps ‘save’ a significant fraction of these vulnerable people through vaccinations, but aren’t they likely to do down with something else within a fairly short period? We all die, that is an inevitability. Of course omicron hitting Hong Kong in one explosion must result in horrific death rates in some institutions as that variant is no doubt extremely contagious. (I caught it during a 10-minute car journey despite being triple-jabbed).
What I would like to hear much more about, scientifically, is to what extent people in densely populated cities really need to be exposed to respiratory viruses on a regular basis so that their immune systems can respond. (If we lived in small band societies as we did during most of human evolution it would be a different matter. But we do not. Mind you, they have other dangers to deal with). My own, admittedly anecdotal evidence, is that keeping isolated reduces your resistance to all sorts of bugs when, inevitably they do eventually hit. And of course we would expect such isolation measures contribute to contribute to strong evolutionary pressures for the virus to become more and more contagious.
“Don’t a significant proportion of elderly people always die of respiratory viruses?”
Pneumonia used to be referred to as the “old man’s friend” because it led to a relatively painless and peaceful death.
To be fair, Israel had THE highest vaccination rate and is now suffering a massive outbreak. Why? Pfizer doesn’t offer long term protection – 3 months tops.
So either we need to continually offer vaccines every 3 months, or we need exposure to develop natural immunity (with the vaccines reducing fatal outcomes the first time we experience it).
The UK has finally twigged this and is offering regular vaccines for the most vulnerable and stopping it for others now 98% of the population has anti-bodies.
Lock down on its own only defers the inevitable.
“The result has been some of the most avoidable Covid deaths of all, anywhere in the world”
How I wish for the same level of apoplexy over the number of abortions daily.
The author’s thinking on the matter is, well, ignorant. Here in the States, there was a commercial than ran long ago regarding a business that either sold motor oil or a chain of service stations that performed oil changes. I can’t remember which. I do remember the tagline, though: You can pay me now or you can pay me later. The bill has come due in all the countries where draconian (and I don’t use that word lightly) measures seemed to work but now the piper is collecting his wages. Like all generations before us, we think we are just so damn smart we have it all figured out. And, just like all generations before us, history is already proving us to be a bunch of idiots.
Absolutely correct. Let us not forget in the early stages of this fiasco the narrative emerged, “in this country, we are good people. We care for each other and emphasise community. That is why COVID-19 will not be allowed to kill us. On the other hand, those people over there, they are bad people. They don’t value life. Look at the fool they elected as their leader. That is why COVID-19 is rampant among them.”
This is from July 2020:
Speaking of the U.S, Dr Bogoch said:
Why is this incompetent, politically motivated fool still in a job?