HONG KONG — For two years, Hong Kong had largely avoided a major coronavirus outbreak with tight border controls and strict social distancing measures. Then Omicron triggered an explosion of infections, exposing the city’s failure to prepare its older — and most at risk — residents for the worst.
In a matter of weeks, the outbreak quickly overwhelmed Hong Kong’s world-class medical system. Ambulances arrived at emergency units in droves. Hospitals ran out of beds in isolation wards. Patients waited in gurneys on sidewalks and in parking lots, given emergency blankets for warmth during the coldest and wettest time of the year.
Hong Kong’s early success in keeping the pandemic at bay was the starting point of a complacency that has now had deadly consequences. Officials have moved too slowly to prepare for a broader outbreak, and did too little to address misinformation around vaccines, social workers and experts say. For many of the city’s one million residents who are 70 or older, the risk of getting sick had long seemed so low that they avoided getting inoculated.
Before the current outbreak, less than half of people in that age group were vaccinated. Among residents of care homes, the rate was even lower, at just 20 percent, according to the Hong Kong Council of Social Service. Now they are bearing the brunt of the city’s worst outbreak. More than 200 people have died this month from Covid, many of whom were over 70 and unvaccinated.
The hesitancy over vaccines has been attributed to misinformation about the vaccines’ potential side effects and efficacy, as well as a high level of public distrust of the government. But even as Hong Kong recorded more deaths in just over two weeks than it did in the last two years, some residents remained reluctant to get inoculated.
“I worry that the side effects of vaccination will kill me,” said Lam Suk-haa, an 80-year-old resident who stopped to talk on her way to a restaurant in the working-class neighborhood of North Point on Wednesday. “For sure, I don’t dare get the shot.”
Ms. Lam said she was skeptical of Western medicine in general. She also said she had heard from a television news report that people like her who have high blood pressure, cholesterol and blood sugar levels could be at risk of severe side effects from vaccination. (The Centers for Disease Control and Prevention, in fact, recommends that older people with medical conditions get vaccinated to reduce the risk of severe illness.)
Health officials in recent days have repeatedly urged older people to get vaccinated and are working to ramp up the inoculation of residents at care homes. The government also imposed rules requiring proof of vaccination to enter restaurants, malls and supermarkets. These measures have helped: Now, three-quarters of people in their 70s, and nearly half of those age 80 or older, have received at least one shot.
The vaccine entry requirement was what ultimately persuaded Ella Chan, 73, to get her first shot this week. She said she had initially hesitated because she had a cold, and then continued to put it off because of reports she had read that made her concerned.
“I didn’t want to get vaccinated then because I had read the newspapers and I had many worries, and I kept pushing it back and back, until now,” Ms. Chan said as she left a government building in North Point where she got her vaccination.
Such worries point to the misinformation about vaccines that has spread rapidly in Hong Kong, where residents can choose between the vaccine developed by Pfizer and BioNTech or the one developed by Sinovac, a private Chinese company.
Infrequent reports of deaths following inoculations turned into rumors about the dangers of vaccines that circulated widely on WhatsApp groups and social media, even though officials have not attributed any of the fatalities to either vaccine.
Terry Lum, a professor of social work at the University of Hong Kong, said that the government had been slow to correct misconceptions about the efficacy of the vaccines and their side effects. He said many older residents believed that the Sinovac vaccine was not effective and that the BioNTech vaccine caused many severe side effects.
“When that misinformation is circulating and no one comes out to clarify the information, and we have such low cases, the people wonder, ‘Why would I take the risk?’” Mr. Lum said. Some residents in the semiautonomous Chinese city were also suspicious of the government’s promotion of Chinese-made vaccines. “People felt there was a political reason for the government to push Sinovac,” he said.
The situation in Hong Kong is striking especially when compared to Singapore, an island of about five million people where 95 percent of people 70 and older are vaccinated. Ho Ching, the wife of Prime Minister Lee Hsien Loong of Singapore, took to Facebook to urge Hong Kong’s older people to “put aside their distrust or mistrust of government, their memories of their flight from China, or any other reason for distrust of authorities.”
To some degree, the government’s cautious approach to vaccinations early on may have fed concerns about the risks. In March of last year, for instance, officials noted that the Sinovac vaccine should not be given to people with “uncontrolled severe chronic diseases,” and urged residents who weren’t sure about their medical conditions to consult their doctors before getting vaccinated.
“The fear around vaccination took hold and it was reinforced by the health care system,” said Karen Grépin, an associate professor at Hong Kong University who specializes in economics and health systems. “We created this idea that people needed to become healthy candidates in order to get vaccinated.”
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A new C.D.C. framework. The Centers for Disease Control and Prevention is expected to release new guidelines that will help counties determine when and where people should wear masks, practice social distancing and avoid crowded indoor spaces.
Now, officials are scrambling to get more older residents protected, but that addresses only one problem. Nursing home operators and social workers say the government’s lack of preparedness for the explosion in cases has created unnecessary chaos. When public hospitals ran out of beds, care homes didn’t have the staff or equipment to care for those who fell sick, nor the space to isolate them from the rest of the residents.
Nursing homes in Hong Kong have been closed to visitors since last fall. Still, cases have appeared in many homes in recent weeks, industry officials say. At meetings of representatives of some 300 homes this week, more than 70 percent said they had recorded Covid cases in residents or staff members, said Joe Chan, secretary of the Elderly Services Association of Hong Kong, an industry group.
“For us, the situation right now is really not healthy,” said Mr. Chan, who is also the managing director of the Granyet Elderly Care Group, which runs six homes with 640 beds. “There are no quarantine centers for our staff or close contacts with cases. All of them are stuck in elderly homes, which is not a good environment.”
The Hong Kong government has yet to issue official guidelines to nursing homes on how to handle an outbreak, said Chua Hoi-wai, the chief executive of the Hong Kong Council of Social Service. Despite having had two years to prepare for such an event, the rapid spread caught many by surprise.
“No one had ever expected we would have so many confirmed cases in so few weeks,” Mr. Chua said. Some care facilities, he said, are looking at waits of as long as a month for public health workers to visit and administer shots.
The spiraling outbreak might not sway the attitudes of Hong Kong residents like Ms. Lam, the 80-year-old who has yet to get the jab, unless the government makes inoculations mandatory.
“I won’t get vaccinated as long as I have a choice,” Ms. Lam said. “Let young people get the shot.”
Joy Dong contributed reporting.