Compounding the first failure to build up the capacity to achieve zero-Covid was the refusal, on the part of the Hong Kong government, to consider the possibility that given its constraints and circumstances, a mitigation approach to Covid-19 may be more sustainable and realistic for Hong Kong.

Transiting to a mitigation approach, however, requires a very high vaccination rate (of at least 80 per cent for the whole population, and higher for the most vulnerable elderly population) to minimise the number of cases who would fall severely ill, and ensuring sufficient capacity in the health care system (especially ICU beds) for those who do.

In the absence of these two conditions, living-with-Covid places significant pressure on the health care system – as Hongkongers are also now discovering.

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The authorities squandered most of 2021 to raise the vaccination rate of those aged 70 and above. Perhaps they were too confident that their suppression measures – especially long quarantine periods – would keep the virus out, making a high vaccination rate a good-to-have rather than a necessity. Or they may have thought that since Hong Kong had no option but to mirror the mainland’s zero-tolerance of Covid, boosting vaccination rates wasn’t a top priority. Consequently, Hong Kong had no Plan B (mitigation) when its Plan A (suppression) failed.

Whatever the reasons for the twin failures, Hong Kong now finds itself in the worst possible situation. It is unable to implement suppression effectively so there is no end in sight to the containment measures already in place.

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As a result, Hong Kong finds itself stuck with most of the costs of an unworkable zero-Covid strategy (no matter how desirable it is in theory), but enjoys none of its benefits (low number of cases that helps to maintain smooth functioning of the health care system).

How would the pandemic unfold in Hong Kong over the next several months? Is there light at the end of the tunnel? Answering these questions requires us to think in terms of scenarios. Here are three major ones.

Scenario 1: Doubling down on dynamic zero-Covid

The most likely scenario is one in which, with the help of mainland authorities, Hong Kong intensifies its containment efforts. It is already quite likely that compulsory testing would soon be introduced. But mass testing would only be effective in bringing down the reproduction rate of the virus if it is combined with some form of lockdowns. But given Hong Kong’s circumstances, a lockdown is more likely to be implemented on a rolling basis, district-by-district.

It is hard to say how effective such measures would be in ending the current wave quickly. The Omicron variant is at least two times more transmissible than the Delta variant, which was already much harder to contain than the original virus.

At the current rate at which the virus is spreading in Hong Kong, it is only a matter of weeks before cases stabilise and even start to decline (sharply) as the virus runs out of people to infect.

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Under this scenario, it is quite possible that when lockdowns are imposed, case numbers might already be stable or falling. This would allow the authorities to save some face and say this vindicates their zero-Covid stance all along.

Even without a lockdown, Hongkongers can expect the current wave to end by May. By then, the combination of vaccinations and prior infections would potentially give the Hong Kong population a level of immunity that makes living-with-Covid possible – even if gaining this immunity has come at a high price.

Scenario 2: Living with Covid, by stealth

The second scenario is less likely than the first, but is not improbable. In this situation, the mainland authorities realise that zero-Covid is either futile or impractical in Hong Kong’s context and that insisting on it might backfire. While still pledging support for the local authorities, they begin to distance themselves from Hong Kong’s public health crisis lest this undermines the credibility of the dynamic zero-Covid strategy on the mainland.

What is more likely under this scenario is that the Hong Kong government continues to maintain the rhetoric – and official policy – of dynamic zero-Covid, but Hong Kong society adapts to life with Covid.

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Indeed, one can argue that the latter is already the case. In what is probably the only silver lining in the current Omicron wave, Hongkongers have mostly responded to the high case numbers with calm and stoic resilience. There has been little evidence of the public fear and anxiety that we saw at the start of the pandemic in early 2020, even though the daily number of cases now is many times higher. Clearly, Hongkongers have moved on even if their government has not.

This gap between the official rhetoric of dynamic zero-Covid and the social reality of living-with-Covid is, of course, a very familiar pattern to Hongkongers. Still, this gap would result in suboptimal outcomes. For instance, we can expect strict quarantine rules for travellers to be the last thing to be relaxed even as Hong Kong society exits the pandemic. This is because quarantine rules may be the only thing that authorities can point to as evidence of their adherence to the official zero-Covid policy.

Scenario 3: Hong Kong the pathfinder

The final scenario is also the least likely. In this scenario, Beijing decides – deliberately – to allow Hong Kong to experiment with, and forge, its own path out of the pandemic – with a view to learning from it. If Hong Kong is able to find a way to coexist with the virus – with Covid deaths not greatly exceeding deaths caused by flu in a normal year – it may serve as a model for how Chinese cities can live with the virus. The chief epidemiologist of China’s Centre for Disease Control and Prevention recently said that researchers were “actively thinking” how anti-pandemic policies can be improved in light of growing economic pressures.

Hong Kong must walk the talk to achieve ‘dynamic zero-infection’

This scenario is the least likely because it would first require Beijing to accept – cognitively at least – that Covid becoming an endemic disease is inevitable even if it is not desirable. This is emotionally and politically difficult to accept, not least because Chinese citizens have come to view Covid as their mortal enemy. It is also difficult because the living-with-Covid strategy pursued by most Western countries has been denigrated and demonised by the state’s propaganda machinery. A sensible, and probably inevitable, public health approach – mitigation – has become unnecessarily ideologised and politicised.

Faced with a population that is highly mobilised against accepting the risk of having Covid be part of their daily lives, it is hard for most of us to imagine the Chinese authorities having the autonomy (and courage) to persuade the populace of this necessary but unpalatable reality.

At the same time, one should not underestimate the ability of the Chinese state to make sudden, decisive policy changes when it chooses to. If and when the Chinese leadership changes its mind on zero-Covid, Hong Kong must seize the opportunity to show that not only is living-with-Covid tolerable, but that it is possible to emerge stronger and more resilient from the pandemic – and in so doing, be a model for the mainland to reopen to the rest of the world.