Staff meetings are often mundane affairs and rarely end in tears. But on Wednesday Ho Hiu-fai, the accident and emergency chief at Hong Kong’s Queen Elizabeth hospital, broke down in front of his team. “It has been so hard for our colleagues to hold up this past month,” he could be heard saying in a video, shortly after the hospital was converted into a Covid treatment facility and 400 non-Covid patients were transferred elsewhere. Chaotic scenes reminiscent of the early days of the pandemic in Wuhan and Italy have played out across Hong Kong’s public hospitals in recent weeks, as the city battles its fifth and worst wave of Covid-19. Almost 3,000 people have died and more than half a million have been infected. Patients – most of them elderly, many unvaccinated – lie on gurneys in lift lobbies and waiting areas, or worse, outside, where they are at the mercy of capricious spring weather. These makeshift treatment spaces lack a central oxygen supply, so patients often rely on oxygen cylinders to survive. Doctors working in overcapacity A&E departments are so overwhelmed that they struggle to monitor patients’ oxygen levels. “We would see a patient wheeze more seriously and then realise their tank was empty,” one A&E doctor told Hong Kong Free Press (HKFP). Without sufficient oxygen, “it’s easy [for patients] to tip from serious to a critical condition”, the doctor, who declined to be named, said. On 27 January, the Hong Kong chief executive, Carrie Lam, said she would “not stand seeing a lot of old people dying in my hospitals”. However, that is now happening. Images of hospitals crowded with cadavers zipped into silver body bags haunt social media feeds, and refrigerated containers have been brought in to relieve overburdened mortuaries. Some unverified images show patients surrounded by body bags on wards. Many residents in the former British colony chose to remain unvaccinated for most of 2021, due to the minimal number of infections and fear of side-effects, particularly among elderly people. While there has been a rapid pick-up in vaccinations – more than 90% of the population have had at least one dose – rates among more vulnerable elderly people have lagged behind the rapid spread of the Omicron variant in the city. Just over 53% of those over 80 are vaccinated, government data shows. On 9 March, the city’s seven-day rolling average of Covid-related deaths stood at 3.28 per 100,000 citizens. That is comparable to London’s highest death rate, which edged over 3 in 100,000 in April 2020, long before vaccines had been developed and when much about the virus remained unknown. At present, Hong Kong has the highest death rate in the developed world, prompting criticism that authorities were ill-prepared and spent too much time, manpower and funds using Covid to crack down on dissent in 2021 rather than preparing for Omicron. Medics interviewed by HKFP expressed incredulity at the state of the city’s efforts – many of them saying it did not have to be this way. Speaking on condition of anonymity, one said: “Everything – from vaccination to our zero-Covid policy to the way we triage patients – all of those things have a lot to do with politics.” Hong Kong’s “dynamic zero-Covid policy” – which echoes the approach adopted by mainland China – highlights elimination over mitigation. For two years, universal mask-wearing, limits on public gatherings, early detection of infections, aggressive contact tracing and isolation bore fruit. In 2021, the city counted fewer than 4,000 Covid-19 infections – many of which were imported – largely because of stringent travel restrictions, its first line of defence against the virus. But Covid-19 evolved, even as Hong Kong’s anti-epidemic strategy remained stubbornly static. Omicron The more transmissible but less severe Omicron variant escaped hotel quarantine and engulfed the city. What followed ranged from the absurd, including a decision to cull 2,000 hamsters, to the tragic, with marginalised communities disproportionately affected by Covid and its consequences. “It’s a very desperate situation,” Preston Cheung, senior advocacy and communications officer for Justice Centre Hong Kong, an NGO that offers legal services to refugees and asylum seekers, told HKFP last week. The sheer scale of the fifth wave has forced some shifts in policies. Social distancing was tightened further and the 21-day hotel quarantine for incoming arrivals was reduced to two weeks, although a flight ban remains from nine countries, including the UK and the US. As isolating all cases at government facilities became impossible, home quarantine became permissible, though for residents in sub-divided housing or “cage” dwellings, that presented its own challenges. One family told HKFP they waited two weeks to hear from the health authorities after three of them tested positive. During that time, the sole breadwinner lost their job and fevers spread to all six who stayed in their rooftop shanty home. “It feels like we are left to die, do you understand?” said the young mother, Siu. By late February, the government had about-turned again, saying it would add positive results from rapid antigen self-tests to its daily totals after laboratories were unable to cope with the tens of thousands of samples from positive PCR tests. But some are reluctant to report their infections to authorities. “I was too afraid that once you report, you will lose control of what could happen to the family and be subject to arbitrary rules,” Francis told HKFP, using a pseudonym. He said the government’s Covid-19 policies lacked “humane treatment” for families with young children. There have been reports of Covid-positive infants being separated from their parents. Francis was not alone in being spooked by the authorities’ approach to Covid. Although Lam said there would not be a Wuhan-style lockdown during compulsory citywide testing – originally planned for March but now postponed – reports of the possibility swirled in local media. Uncertainty peaked when the secretary for food and health, Sophia Chan, said the possibility was still being discussed and citywide panic-buying ensued as fears of food shortages translated into real-world supply issues. Supermarket shelves are being restocked but discontent with the government’s handling of the pandemic runs deeper. Since the fifth wave began, the suicide prevention group the Samaritan Befrienders Hong Kong has received 272 Covid-related calls for help. The NGO chief told HKFP that the “uncertainty surrounding the city’s health policies has “made people anxious”. Among those appealing for help, 53 – or close to 20% – were aged 60 or older. The figure was revealed days after two elderly Covid-19 patients killed themselves.