After isolating itself from the world with its harsh COVID-zero policy and strict border controls, Hong Kong is losing its battle against the Omicron variant.
On Wednesday the city recorded 4,285 new cases — more than 40 times the level at the start of February.
Modelling from Hong Kong University predicts the city will reach more than 28,000 cases per day by mid-March.
The city's COVID hospital and testing systems have been overwhelmed, with local media reporting residents are lining up outside PCR testing venues for six to seven hours, while hospitals have been treating patients in beds outside due to lack of space.
In response to the crisis, China's leader Xi Jinping has demanded the Hong Kong government control the outbreak as their "overriding mission".
Beijing also announced plans to send mainland healthcare workers and medical supplies to support the city's failing hospital system.
Local authorities have introduced a series of restrictions in hopes of containing the outbreak, including extending international flight bans, capping public gatherings to two people only, and making it mandatory to scan COVID-tracing QR codes.
But even with Beijing's support, experts say it is now unlikely that Hong Kong can prevent the current outbreak from reaching the majority of the public.
"That doesn't mean everyone will get infected, but I would expect the majority of people in Hong Kong to become infected within the next two months," University of Hong Kong epidemiologist Ben Cowley said.
One step away from victory
Before the Omicron outbreak began in Hong Kong, the city of 7 million people was merely one step away from being the most successful example of China's COVID-zero strategy.
After eliminating its fourth outbreak in May 2021, Hong Kong recorded zero COVID cases for almost eight months, until a Cathay Pacific flight attendant who flew in from the US tested positive for Omicron in late December.
According to The Economist's normalcy index, the city had ranked among the top 50 countries and regions in terms of how close activities were to pre-COVID levels, scoring 96 per cent.
Peter Chan, an epidemiologist at Oxford University and member of Hong Kong Public Health Research Collaborative, said the Hong Kong government had adopted the COVID-zero policy "as a reflex", rather than having a long-term strategy.
"Whenever there's a case, we just lock down, mass testing, or killing animals [that have tested positive for COVID]," Dr Chan said, referencing a controversial cull of hamsters by the Hong Kong government after a pet shop staff member tested positive for COVID.
He also noted Hong Kong's low vaccination rate, an issue Dr Chan said the government "doesn't seem to be doing enough to tackle".
While Hong Kong began rolling out vaccinations as early as February 2021, figures show that by February 15 this year, only 74.5 per cent of the population had received two doses, and only 43.03 per cent of people aged 70 and above were fully vaccinated.
Dr Chan said the government had failed to communicate effectively with the public regarding vaccination and its side effects, contributing to vaccine hesitancy among some Hongkongers.
He added that many people in Hong Kong, especially elderly residents, had received Sinovac, which studies have found to be ineffective in generating antibodies against the Omicron variant.
"So that's very concerning," Dr Chan said.
Public fatigue and policy confusion
Research found that the local community played a key role in countering COVID outbreaks in Hong Kong during the early stages of the pandemic before the government stepped in with strict measures.
Professor of public health practice Vivian Lin, from Hong Kong University, said due to the city's experience with SARS in the early 2000s, people in Hong Kong had treated COVID with more caution when the outbreak began in China.
"Many people in Hong Kong were getting their masks on. In every office building and in residential buildings, the sign [telling people to wear masks] went up on the lifts," she said.
But with the Hong Kong government continuing its COVID-zero approach two years in, the public has become fatigued, according to Dr Chan.
"People are talking about even if they have symptoms of COVID, they're not going to get tested, they will just continue working, have some medication to suppress the symptoms in order to avoid all these excessively stringent controls from the government," he said.
Kris Hartley, an assistant professor at the Education University of Hong Kong who has looked into government trust during the pandemic, said political turmoil and the arrests of pro-democracy activists had chipped away at public trust in the government's COVID measures.
He said the political climate had left little space for policy debate.
"The government's only path in its resolute commitment to COVID-zero is to insist on full compliance and punish divergence," Mr Hartley said.
The private behaviour of some in government has also damaged public trust, after 30 senior officials and high-profile politicians broke public gathering restrictions to attend a birthday party in January.
The party, for a Hong Kong delegate to China's legislature, hosted more than 200 guests at a time when public gatherings were capped to four people. Guests were also found to be not wearing masks or scanning QR codes.
It was later identified as one of the first COVID clusters that sparked Hong Kong's Omicron outbreak, and a senior official who attended the party resigned.
For Eva Lam, a 23-year-old office worker in Hong Kong, the incident further lowered her confidence in the Hong Kong government's control of the Omicron outbreak.
"I feel the government is getting worse and worse in controlling COVID outbreaks," she said.
"Even the officials break the rules and attend parties. While residents are fatigued with COVID, it's just hard to expect the government would do well."
Will Hong Kong ditch its COVID-zero policy?
Even before Hong Kong's Omicron outbreak, there were calls from both domestic and international communities for the city to ditch the COVID-zero policy, with concerns the strict border controls could see Hong Kong lose its status as an Asian financial hub.
The Australian Chamber of Commerce in Hong Kong (AustCham) said it had not seen a mass exodus of Australian companies from Hong Kong over the past two years, but there were some Australians leaving the city due to ongoing border uncertainty and a desire to be closer to family back home.
"The Hong Kong government's unpredictable changes to many travel restrictions have caused significant inconvenience for our members and the business community," AustCham chief executive Stefanie Evennett said.
In response to an ABC News enquiry, a Hong Kong government spokesperson said the city remained "a competitive city globally and a major regional base for international companies despite current challenges related to the global pandemic".
The spread of the highly transmissible Omicron variant has seen countries across Europe, North America and Oceania, including Australia, give up elimination strategies and choose to live with COVID.
As the Omicron surge continues in Hong Kong, Professor Cowley suggested the city should turn its focus from containment to mitigation, which includes allowing patients with mild symptoms to isolate at home.
He said it would be difficult for Hong Kong to continue with an approach like China's that involved lockdowns, contact tracing and mass testing, given the healthcare system was already stretched beyond capacity.
"The outbreaks in the mainland have been Delta, not Omicron. We're yet to see large Omicron outbreaks in the mainland. Local governments in the mainland act very very quickly to track and isolate cases, close contacts," he said.
Professor Cowley said it was inevitable that Omicron would continue spreading in Hong Kong until April or May when the majority of the population developed immunity "not just from the vaccines but from the infections".
"But the current indication is that the government is keen to go back to zero, which is actually easier once you have more immunity in the community."
Beijing has made it clear that Hong Kong must stick with the COVID-zero policy, in line with China’s "dynamic zero-infection" strategy that aims to eliminate outbreaks through rapid testing and treatment.
Chinese state media has criticised those who suggest the Hong Kong government should move to a living-with-COVID strategy, describing the idea as "irresponsible".
Prominent pro-Beijing politician Junius Ho said health experts who suggested it should be viewed as "violating the National Security Law" — legislation implemented in 2020, in response to Hong Kong's mass protests.
Professor Hartley said as Beijing deepened its policy integration with Hong Kong, it would become increasingly difficult for the city to give up COVID-zero.
"The fate of Hong Kong and China regarding COVID, and almost any other policy issue, will be more or less the same," he said.
"I do not have high hopes that either will come out of COVID in the long term without substantial losses.
"Abandoning zero-COVID at this stage would be a great leap into the abyss — they are stuck with it."
