The concept of “herd immunity” got off to a bad start in Hong Kong, because it was the catchphrase used to describe a disastrous – and fortunately short-lived – UK policy response to the coronavirus outbreak.
The dictionary definition is “resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination”. So herd immunity is in fact a desirable situation to bring about. As a prominent epidemiologist put it on a RTHK radio show last week, it is a destination, not a strategy. And there are two ways to reach that destination: mass vaccination; or allowing the disease to run its course, accepting that this might result in the death of many thousands of the vulnerable.
Even though the mortality rate of COVID-19 seems to be at the lower end of the spectrum – around 0.5 per cent was being quoted last week – that is still five times the rate of seasonal flu and would involve loss of a great number of citizens if allowed to spread unchecked. Not surprisingly, most governments are steering clear of the second route. Instead they are trying to limit spread of the virus by containment measures, pending development of the vaccine.
Meanwhile, unlike Ebola and Mers, which were confined to limited geographical areas and quickly contained, this new virus has spread rapidly around the world and infected over three million people. It is now a part of life on earth and will remain so unless and until subject to a concerted global eradication exercise with the help of a vaccine. The genie is well and truly out of the bottle.
We do not yet have a vaccination for this virus, and most estimates point to some time in 2021 before one could be tested and approved. Then production would have to be massively ramped up before there could be mass vaccination on a global scale.
This timescale leads us to one inescapable conclusion: although there is much talk of an exit strategy from the social distancing/lockdown policy that most governments have adopted, there is in fact only one option. We have to manage as best we can hold to society together until there is a vaccine. We are in this for the long haul.
The negative side effects of the strong containment strategy have at least three strands: the economic/livelihood issues; social consequences of keeping large numbers of people cooped up in small apartments; the effect on overall health and fitness levels of denying people many opportunities to exercise.
The Hong Kong community has basically done a good job with respect to limiting the spread of the virus. Whether this is due to wise government policies, or the self-discipline of most Hongkongers, or a combination, is a discussion for another day. But what it does mean right now is that we are in a position to move aggressively to ease the restrictions on daily life. Our city is one of the few places in the world where the number of infections has been kept low, identification of suspects and their contacts has generally gone well and the quarantine arrangements worked reasonably smoothly. We should cash in on these achievements by relaxing as many constraints as possible within the local community. It has become urgent to ease the economic, social and health pressures. Moreover, there is a danger – as experience on recent sunny days has shown – of a breakdown in social discipline. If the government is perceived to be moving too slowly, it could find it has lost control of the situation as citizens take the decisions into their own hands.
Outdoor sporting venues, parks and playgrounds could be opened immediately. All education institutions should reopen, and classes resume, within May at the latest. We can also look at ways to progressively loosen restrictions in other areas. There is a small risk of a slight uptick in the number of infections, but this will have to be tolerated. We cannot sacrifice the whole society on the altar of complete elimination. It is an impossible yardstick.
The real problems will come when we and other societies start to open up to the outside world. Bearing in mind that Hong Kong’s main role in the global economy has been to act as an intermediary between China and the rest of the world, there will be a lot of pressure to ease up. However, if the balance of advantage within Hong Kong lies with moving quickly, the external situation argues for a more cautious approach. There is a danger of a political backlash, particularly with respect to the mainland.
Not all countries have equally reliable statistics because of differences in testing policy and other variables. Does anyone seriously believe, for example, that India has fewer cases than Peru? So we should start small, and grow at the speed supported by evidence. Say we permitted visitors from Macau and Taiwan to enter Hong Kong without going into quarantine, but subject to 100 per cent health check at the border. If after a week or so our own checks confirmed there was little or no risk involved in allowing people from those places to enter, then the border check could be dropped. A similar approach could be adopted for New Zealand, and perhaps Australia.
If people see we are being even-handed and applying the same standards to arrivals from any source, then it would avoid the impression that Hong Kong authorities were being told what to do by Beijing. If we than adopted the same approach to visitors from the mainland – perhaps province by province, or by category (schoolchildren from Shenzhen attending schools here?) – there would be a lot less room for controversy. We know that some people are looking for an excuse to protest: don’t give them one.
Nor should we get too hung up on the issue of reciprocity, insisting on equal rights for Hong Kong citizens to visit those places. As we have shown with our containment practices, Hongkongers are leaders, not followers. If what we do works, other places will follow us.