East Asia is not suffering the kind of out-of-control pandemic that has been rampaging across the United States, where more than four million people have now been affected.
However, early Asian successes against Covid-19 have not stamped out the virus and clusters continue to pop up in major cities across the region.
Authorities in various cities have deployed a range of tactics in response.
While Beijing and Seoul have adopted mass testing, Hong Kong and Tokyo have been reluctant to over-stretch medical resources. In recent days Beijing, led by an authoritarian government that can take strong measures without obtaining public consent, has been arguably the most effective.
China’s capital has taken aggressive measures designed to crush infections to zero, while three other cities have adopted a “flattening the curve” strategy that preserves medical resources and balances health risks against social and economic activities.
Seoul’s daily infections, in the double digits, look stable for now. However, questions hang over the authorities’ responses in Hong Kong, which is registering more than 100 cases per day, and Tokyo, where daily new infections are in the high 200s.
A so-called “third-wave” of the virus outbreak in Hong Kong started on July 5. It is believed some taxi drivers were first infected by incoming flight and ship crews, who were exempt from virus tests. These drivers then passed the virus on, resulting in community outbreaks in different districts.
Between July 5 and 23, a total of 991 patients had been identified, including 158 imported cases and 833 local infections.
The city government has been escalating its response in phases.
On July 8, it announced that flight and ship crews would no longer be exempt from virus tests. On July 10, it said school summer holidays would start early.
During the second week of the outbreak, the number of local infections climbed from approximately 30 to 60 per day. Clusters appeared in different buildings, including an elderly care home.
On July 15, Chief Executive Carrie Lam tightened social distancing rules and ordered the closure of 12 kinds of premises, including karaoke and massage parlors. On July 20, she permitted civil servants to work from home.
However, these measures have not curbed the spread. In the third week, beginning this Monday, infections in the city of 7.4 million have been increasing to approximately 110 per day.
On Thursday, the government strengthened mask rules but had not launched a mass testing scheme or gone to lockdowns. The number of virus tests stands at about 7,000 per day with the Centre for Health Protection saying people without symptoms should not stretch testing resources.
Ho Pak-leung, the head of the University of Hong Kong’s Centre for Infection, slammed the government for launching anti-epidemic measures “bit by bit” and for slow responses. It took authorities five days to disinfect two markets after patients were identified there.
Zhang Wenhong, a doctor at the Department of Infectious Diseases at Huashan Hospital, said Hong Kong had adopted a strategy to keep local infections at a low level, instead of clearing them to zero.
That strategy, he said, meant that Hong Kong had conserved medical resources in the short term but increased socio-economic costs over the long run.
The Hong Kong government had previously said it was inevitable to have some local infections in the city and that it had to strike a balance between epidemic control and economic activity.
Lo Chung-mau, Hospital Chief Executive at the University of Hong Kong-Shenzhen Hospital, said after outbreaks in February and April the Hong Kong government did not prepare for upcoming clusters and failed to identify asymptomatic patients in the community.
He also criticized a government policy that, between February and May, exempted more than 200,000 incoming travelers from Taiwan, Macau and the mainland from 14-day quarantine requirement and virus tests.
However, the government has rejected medical experts’ criticisms that the quarantine exemptions created loopholes and that the latest wave of virus outbreak was attributable to these.
In Beijing, stringent and extensive emergency measures appear to have proven highly effective.
On June 6, China’s capital lowered its public health emergency level from Grade 2 to the laxer Grade 3. On June 11, a man was found to have been infected after he visited the Xinfadi Agricultural Produce Wholesale Market. China’s markets have proved to be a key vector of the virus since the original outbreak in the city of Wuhan.
That single case sparked mass testing. By June 15, the Beijing Municipal Government had tested about 200,000 people who had been at or near the market, canceled all sporting and cultural activities and categorized districts by epidemic risk.
Health officials were deployed to check people’s temperatures on the streets. Food delivery and express service workers were only permitted to travel from one district to another if they had Jiankang Bao, or Health Kit, a mobile app launched in early March that monitors users’ health conditions, installed.
On June 16, the city moved to Grade 2 emergency level and ordered the early closures of bars, shops and restaurants.
During the first week of the outbreak, a total of 158 cases were identified with 356,000 people having being tested. At the end of the second week, the total number of patients rose to 269 after 2.34 million tests.
As of July 5, the total number of patients had increased to 335 with 10.41 million people – about half the city’s population – having been tested.
That number dwarves the total tests for all of South Korea – 1,510,327 – a nation that has been praised globally for its widespread testing regimen.
The response seems to have worked and no new cases have been recently identified. On July 20, Beijing returned to Grade 3 emergency level, meaning public facilities can reopen but they have to maintain foot traffic below 50% of normal levels. Meetings of up to 500 people are allowed.
Lo of Hong Kong-Shenzhen Hospital said Beijing had successfully contained the virus by setting up more than 2,000 sample collection points in the city and running millions of tests within weeks. These tests cost only US$10.70 due to Beijing’s economy of scale, compared with about $193.50 per test in Hong Kong.
Seoul has about 10 million residents, but its port city of Incheon, dormitory towns and the surrounding province are home to half of South Korea’s population of 51 million.
Seoul has had a total of 1,217 infections, according to the Korean Center for Disease Control and Prevention, compared to 6,881 cases in the city of Daegu, the scene of the country’s most serious outbreak.
The capital’s daily new infections are in manageable double digits with 19 cases on Friday, 11 on the 23rd, 16 on the 22nd, and 18 on the 21st.
Though the Seoul area has seen clusters emerge in various premises – a call center, a nightclub zone, an out-of-town logistics center and multiple churches – it has benefitted from central government policy that had things right from the start.
National policy has focused on three pillars. The first is an affordable, extensive testing regimen. Tests, which cost approximately $130, are free if positive and all treatment is also fully covered by the national health system.
The second is an aggressive, high-technology contact tracing enabled by a data network that combines the databases of the immigration department, police CCTV operators, credit card companies, telcos and public transport operators.
The first two tactics enable the third, isolation and early-stage treatment at Covid-19 dedicated medical facilities.
A transparent, democratic approach has been followed. For example, health authorities deliver a televised briefing daily, aggressive contact tracing is underwritten by a privacy-related law passed during the MERS crisis and no lockdowns have been mandated in either Seoul or nationwide.
This has provided a welcome economic cushion to the populace – even early in the crisis, when the country was facing stringent social distancing measures. Traffic in high-risk locations such as Seoul’s gyms, bars and restaurants has returned, though visitors are required to log in using QR codes on smartphones, or manual handwritten lists.
Mask use is almost universal in public and is mandated for public transport. On Friday, the city reopened museums and libraries and also lifted a temporary ban on church services.
Despite the city’s success in combatting the virus, residents say they have changed their personal habits.
“I am definitely meeting friends less. Before I used to go out every day, and sometimes went to crowded entertainment spots. But now, we meet about twice a month,” said Seo Ji-eun, a 21-year-old researcher who lives in a satellite city but works in Seoul.
“We try to find places that are not well known and I do a lot more outdoor activities, like climbing mountains.”
After early panics about clusters aboard the cruise ship Diamond Princess and the northern island of Hokkaido subsided, Tokyo has, this month, emerged as Japan’s pre-eminent hot zone.
The densely populated city is on its highest alert phase and “infections are spreading.”
National policy has been to use public health centers to manage the virus by tracing clusters and to minimize stress on the health system by minimalizing testing.
There are also strict procedures to be followed by those who have Covid-like symptoms. Tokyo has published a flow chart and opened a telephone hotline to instruct those who believe they are infected on how to proceed to a testing and treatment location.
Japan’s capital has suffered a cumulative total of 10,690 infections.
However, concerns are rising as from early July infections have been increasing with clusters emerging in various premises, from bars to theaters. Cases hit more than 200 per day on July 9 and have been fluctuating, but largely rising since.
According to the city’s dedicated website, StopCovid, there were 237 on the 21st, 238 on the 22nd, a record 366 on the 24th and 260 on Friday.
Worryingly, some 142 cases have an unknown route of infection.
A total of 964 Tokyoites are hospitalized with the disease, 168 are receiving treatment at dedicated quarantine facilities and 392 are in home quarantine. This week, Tokyo Governor Yuriko Koike secured 2,400 extra hospital beds and reserved 2,000 rooms at hotels to be used as quarantine centers for patients with mild or no symptoms.
There has been some disunity between Koike and her former political ally and current political opponent, Prime Minister Shinzo Abe. On Wednesday, Koike said that while it was uncertain if Tokyo was suffering a “second wave,” the city must prepare for it. But Abe said the current situation does not warrant a return to a state of national emergency.
Since March, Koike has been arguing for a more aggressive anti-virus policy than Abe. A nationwide state of emergency proclaimed by Abe on April 15 briefly granted Koike some additional powers and the city entered a mild lockdown.
But since Abe lifted the state of emergency on May 25, her ability to mandate strict measures has evaporated.
As a result, she has been reduced to urging Tokyoites to work from home, refrain from unnecessary travel and to avoid nightlife. But anecdotally, residents say life appears to be largely normal.
“It is 80-90% as usual,” a source told Asia Times on Thursday.
Even so, with Tokyo now home to more than one-third of nationwide cases, the city has been dropped from the nationwide “Go To Travel” program which was launched on Wednesday.
Under the program, the national government subsidizes approximately half the costs of summer vacations taken by domestic tourists who travel to Japanese destinations this summer.