Health Issues

Recent events in Hong Kong’s health care situation are revealing some interesting – and alarming – facts, in particular the continuing widespread reluctance to get vaccinated. Our accident and emergency wards have been under siege, as families have rushed their children and seniors (the two most vulnerable groups) to be treated at the first sign of flu symptoms. Waiting times have skyrocketed to eight hours and beyond in some hospitals.

The immediate cause of the panic has been the coincidental arrival of the annual flu season together with a wave of the latest Covid variant. Although the latter seems less virulent than earlier waves, there is public anxiety that contracting both illnesses together could have some nasty outcomes.

The subject was discussed on a radio show last week with a panel of experts comprising a frontline emergency ward doctor from Caritas, a prominent pediatrician member of the Hong Kong Medical Association, the chairperson of the Department of Microbiology at the School of Clinical Medicine at the University of Hong Kong, and the president of the practicing pharmacists association. I also subsequently filed some questions with the Department of Health.

The consensus seems clear that there is no need for members of the public to panic when flu symptoms first appear. Most cases can be treated by the individual staying home from work or school for a day or two and drinking lots of water. Common medicines obtainable without prescription will in most cases fix things. If recovery is still delayed, then a visit to the local doctor is warranted. Only if the patient’s condition deteriorates sharply at any point is it necessary to visit the nearest public hospital. Triage nurses are there to distinguish more genuinely serious cases from milder ones, not to marshal crowds of people with nothing more serious than a cough or cold.

On one point all the experts were clear and emphatic: everyone would benefit from getting the annual flu shot. As with Covid vaccination, there is no such thing as complete immunity, but symptoms and severe effects will be reduced. What does the vaccination situation look like? In a simple word, poor.

The two most vulnerable groups are children up to five (vaccination rate 48 per cent) and the elderly aged 65 and above (vaccination rate 46 per cent). Outside these two groups the numbers fall off sharply. Those in the 50 – 64 age category are estimated to have a vaccination rate of just 17 per cent. Overall, our community is nowhere close to achieving herd immunity.

I find it very hard to have sympathy for those now falling sick or their families as they have not taken the elementary step to protect themselves. I have had the annual jab for many years, and no fewer than six Covid shots (plus the disease itself). I get sick from time to time like everyone else, but not often and seldom seriously.

What is the government’s position? The Committee on Vaccine Preventable Diseases recommends healthcare workers receive seasonal influenza vaccination (SIV) to reduce morbidity and reduce absenteeism among the workforce. In other words those vaccinated would be less likely to die themselves or need time off work. SIV in healthcare workers can also reduce the risk of transmitting influenza to patients who are at high risk of complications and mortality from influenza. This is surely a very important point: the staff are working in close proximity to those they take care of. Even if they don’t feel a responsibility for themselves or their families, they surely have a duty to the residents and patients.

Under the Government Vaccination Programme, healthcare workers of Residential Care Homes (RCHs) for the Elderly and Persons with Disabilities, Residential Child Care Centres, Department of Health (DH), Hospital Authority (HA) and other Government Departments are eligible for receiving SIV for free. As at January 7, 2024, the overall SIV coverage for healthcare workers at DH and HA was about 55%, while the overall coverage rate of RCH healthcare workers was 37%. Frankly I don’t think these numbers are anywhere near good enough. The Department of Health says this situation, lamentable as it is, is actually an improvement over the previous year.

How can we expect the public to treat the matter seriously when even the professionals do not?

A number of suggestions have been floated for addressing the situation of overloading of casualty wards. One is to have a differential charge so that minor cases, which in fact are making poor use of the emergency facilities, are charged more while only bona fide serious ones are subject to the lower subsidised rate. I am not clear how in practice this could work. Would the decision of the triage nurse be final? Or would everyone have to pay a very high initial fee with partial refund for those cases the doctor endorses? That sounds like a recipe for chaos.

Another idea is just to push charges up so that private clinics become more competitive by comparison. Issues of affordability then arise, and there are no easy options.

Meanwhile reports are emerging of former Hong Kong residents who emigrated many years before but who still hold valid permanent ID cards returning here for medical treatment at subsidised prices. This is another tricky area which merits a closer look. Up to now we have always operated under the principle of “Once a Hongkonger, always a Hongkonger” which sounds fine and has an emotional ring to it. If someone is returning here to live, that works. But what if someone has emigrated for a long time, has established a permanent home in the destination country, changed nationality and only pays tax there? Would it be fair if they continue to be a drag on local resources?