The painfully simple reason Hong Kong has had one of the highest COVID death rates

Enlarge / Healthcare workers wearing personal protective equipment carry the body of a deceased patient on a hearse outside the morgue of Queen Elizabeth Hospital in Hong Kong, China, Wednesday March 2, 2022. Hong Kong has reported more than 55,000 cases on Wednesday, its hospitals are flooded and the city’s morgues are nearly full.

For much of the pandemic, China has kept the coronavirus at bay. The country has adopted an aggressive COVID-Zero plan, rigorously identifying, containing and tracking cases to prevent viral spread. It seemed to work remarkably well, until the arrival of the ultra-transmissible omicron variant.

The seemingly uncontrollable virus is now exploding in China, shattering records daily and exposing a tragic flaw in China’s COVID policies: the country’s most vulnerable people – the elderly – are among the least protected by vaccination. As such, death rates are bound to skyrocket.

This has already happened in Hong Kong, which experienced its own towering omicron wave between January and March. In its wake, one of the highest death rates the world has seen amid the pandemic. In a study released Friday by the Centers for Disease Control and Prevention, the US CDC partnered with China CDC for a post-mortem on the death spike. The analysis highlighted the fatal flaw of neglecting to vaccinate the elderly.

By the end of December 2021, around 67% of Hong Kong residents eligible for the vaccine had been vaccinated with at least one dose. About 64% had two doses and only 5% had boosters. But the numbers declined with age. Among people aged 60 and over, only 52% received one or more doses. For people aged 70 to 79, only 48% had at least one. And for people aged 80 and over, only 20% had at least one dose.

On Jan. 6, Hong Kong officials detected the city’s first cluster of omicron cases, sparking an outbreak that peaked on March 4. As of March 21, officials had recorded a total of 1,049,959 cases and 5,906 deaths associated with COVID-19. The death rate was 38 per million people, one of the highest in the world.

Fatal error

Of the 5,906 COVID-19 deaths during the omicron wave, 96% were in people aged 60 and over. Overall, comparing death rates with people under 30, people 60 and older were 253 times more likely to die, and people 80 and older were 946 times more likely to die . Of those aged 60 and over who died, 70% (3,970 of 5,655) were unvaccinated and a further 18% (1,023 of 5,655) had received only one dose of vaccine. Overall, unvaccinated people aged 60 and over were 21 times more likely to die than people in the age group who had received at least two doses.

It is unclear why relatively few elderly people in Hong Kong and elsewhere in China have been vaccinated. The authors of the CDC analysis noted that a June 2021 survey in Hong Kong found that 57% of people were hesitant or resistant to COVID-19 vaccines. “The dynamic COVID-Zero strategy, successful until the emergence of the omicron variant, could have resulted in greater complacency, especially among older people,” the authors speculated.

They noted that since the start of the omicron wave, vaccination among the elderly has increased “significantly”. As of March 21, vaccination among people aged 60-69 has increased from 65% to 81%; among 70-79 year olds, vaccination increased from 48% to 69%; and among those aged 80 and over, vaccination increased from 20% to 39%. Yet these figures are low compared to those of the United States and Europe. And in mainland China, only about half of people aged 80 and over have been fully vaccinated, according to March data.

As the omicron surges in Shanghai, the analysis makes a clear call to action. “This report highlights that vaccination reduces COVID-19 mortality rates in older adults and draws attention to the importance of monitoring age-specific vaccination coverage, identifying disparities in vaccination rates by age and to close these coverage gaps,” the US CDC wrote in a statement.

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