Hong Kong’s experience with the COVID-19 pandemic offers a distinct case study in public health management. As a densely populated international travel hub with close ties to mainland China, the city adopted a unique strategy. Influenced by its 2003 SARS epidemic, this approach showed initial containment successes but faced significant challenges in later waves. Public health policies, societal responses, and economic realities shaped Hong Kong’s pandemic journey, leaving a lasting impact.
The “Dynamic Zero-COVID” Strategy
Hong Kong adopted a “dynamic zero-COVID” policy, similar to mainland China. The core philosophy centered on swift, decisive actions to stamp out outbreaks, preventing widespread community transmission.
Its key components included extensive testing to rapidly identify infected individuals, aggressive contact tracing to isolate close contacts, and stringent border controls to minimize imported cases. These measures sought to contain the virus at its source.
Key Pandemic Waves and Responses
The pandemic unfolded in distinct phases. Initial waves in 2020 and 2021 saw the dynamic zero-COVID strategy largely succeed, maintaining low case numbers and a minimal death toll. Prior to the fifth wave, Hong Kong recorded approximately 12,636 confirmed cases and 213 deaths, reflecting an incidence of about 1685 cases per million population.
However, the highly transmissible Omicron variant triggered a devastating fifth wave starting in early January 2022. This surge overwhelmed Hong Kong’s healthcare system, peaking at over 50,000 new daily cases by March 3, 2022. Hospitals faced severe strain, with isolation wards scarce and public mortuaries operating beyond capacity.
This period saw a dramatic rise in fatalities, with 6,356 lives lost between December 31, 2021, and March 23, 2022. On March 12, 2022, Hong Kong recorded one of the highest 7-day rolling averages of deaths worldwide. The Omicron wave, resulting in 1,200,068 cases, highlighted the zero-COVID strategy’s limitations against such a transmissible variant. By the end of 2022, total COVID-19 related deaths reached 9,291, mostly from the fifth wave.
Public Health and Social Control Measures
Hong Kong implemented public health and social control measures to enforce its zero-COVID policy. Strict border controls were a cornerstone, with mandatory institutional or hotel quarantine for inbound travelers. This isolation period progressively lengthened, reaching 21 days, before being shortened to 14 days, then 7 days for vaccinated travelers. Later adjustments introduced a “3+4” model (three days of hotel quarantine followed by four days of medical surveillance) and eventually a “0+3” model for arrivals.
Widespread testing was routinely conducted, including targeted group testing and compulsory testing for buildings linked to outbreaks or positive sewage samples. Contact tracing identified and isolated close contacts quickly. The “LeaveHomeHomeSafe” contact tracing application became mandatory for entry into public venues, assisting exposure notifications.
The “Vaccine Pass” system, introduced in February 2022, required proof of vaccination for entry into most public places, including restaurants, shopping malls, and supermarkets. Social distancing rules were strictly enforced, limiting gatherings and closing facilities. A universal mask mandate also required mask-wearing in public areas.
Vaccination Campaign and Public Hesitancy
Hong Kong’s vaccination program began in February 2021, offering CoronaVac and Comirnaty vaccines. Despite free availability, public hesitancy was considerable, especially among the elderly. This reluctance stemmed from concerns about vaccine safety and potential side effects, a perception of low personal risk due to the city’s initial containment success, and misinformation.
By December 23, 2021, before the Omicron wave, only 49% of individuals aged 60 and above had received two vaccine doses, dropping to 18% for those over 80. This low coverage among vulnerable groups directly contributed to the high mortality during the Omicron-driven fifth wave. Among 2022 COVID-19 deaths, 70% were aged 80 or older, with 73% of these unvaccinated. Unvaccinated persons aged 60 and above faced a 21.3 times higher death risk compared to those with two or more doses. In response, the government intensified vaccination efforts, including the Vaccine Pass and home services for the elderly.
Economic and Social Consequences
Prolonged and stringent pandemic policies inflicted substantial economic and social consequences on Hong Kong. Key sectors like tourism, aviation, and retail suffered damage. The city saw an 81% drop in tourist arrivals. This downturn, coupled with reliance on mainland Chinese tourists who delayed international travel, contributed to a slower recovery compared to other regional destinations.
The economic fallout extended to local businesses. Consumer spending shifted towards mainland China due to lower prices, contributing to declining retail sales. The food and beverage industry saw widespread closures, with an estimated 3,000 restaurants shutting down. Labor shortages emerged in tourism and transport as laid-off workers did not return.
Socially, strict rules and prolonged isolation led to a “brain drain,” with both expatriates and local residents leaving. Travel curbs and mandatory quarantine also caused mental health strain, including increased stress, anxiety, and uncertainty, particularly due to family separations.