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LCQ12: Coronavirus Disease 2019
     Following is a question by Dr the Hon Dennis Lam and a written reply by the Secretary for Health, Professor Lo Chung-mau, in the Legislative Council today (February 8):


     It is learnt that since the outbreak of the fifth wave of the Coronavirus Disease 2019 (COVID-19) epidemic in January last year, a number of dominant mutant strains have emerged. On the other hand, according to the data analysis on COVID-19 death cases released by the Government in early January this year, the fatality rates of those who were unvaccinated among the persons belonging to the three age groups in Hong Kong of aged 60 to 69, aged 70 to 79, and aged 80 or above, were as high as 1.57 per cent, 4.27 per cent and 14.33 per cent respectively. In addition, the numbers of those unvaccinated among the persons belonging to these three age groups are all around 100 000, while the numbers of those who have received one to two doses of vaccination are only about 10 per cent. In this connection, will the Government inform this Council:

(1) whether the authorities have formulated new plans for boosting vaccination that target at those unvaccinated among the persons belonging to the aforesaid three age groups to raise their vaccination rates;

(2) whether the authorities have conducted studies, on their own or by commissioning local universities, in respect of the dominant mutant strains which were once/are still prevalent in Hong Kong in the fifth wave of the epidemic, including making a horizontal comparison of the characteristics of such strains, and their resultant severe illness rates and fatality rates; if so, of the details; if not, the reasons for that; and

(3) of the respective numbers of severe illness cases and death cases in Hong Kong in the first half and the second half of last year which were caused by COVID-19 infection?



     In consultation with the Civil Service Bureau, the Home Affairs Department and the Hospital Authority (HA), the reply to the various parts of the question raised by Dr the Hon Dennis Lam is as follows:

(1) Elderly is subject to higher health risks after COVID-19 infection as compared with other age groups, and hence they need to receive suitable doses of the COVID-19 vaccine on time to sustain the protection conferred by the vaccine. Targeting the elderly, the Government has been taking forward various measures to encourage and facilitate them to get vaccinated against COVID-19 and introduced a basket of facilitation measures. As at early February 2023, the second dose vaccination rates for people aged 60 to 69, 70 to 79, and 80 or above have reached 89 per cent, 83 per cent and 70 per cent respectively. For the relevant age groups, the effective vaccination rates after infection equivalent to having received two doses are 92 per cent, 87 per cent and 75 per cent respectively; while the effective vaccination rates after infection equivalent to having received three doses are 95 per cent, 90 per cent and 72 per cent respectively.

     In order to promote and facilitate the COVID-19 vaccination of elderlies aged 70 or above or persons with impaired mobility due to illness of physical disability who have not received COVID-19 vaccination before, the Government launched the Home Vaccination Service (HVS) in April 2022 covering all 18 districts to provide free door-to-door Sinovac vaccination service. The registration website and hotline for the service are www.covidvaccine.gov.hk/hv/ and 5688 5234 respectively. In addition to answering calls from the public, the call centre also took the initiative to contact about 190 000 persons, including the elderly or persons with disabilities who were recipients of relevant allowances from the Social Welfare Department and were yet to get vaccinated, as well as people referred by the Hong Kong Council of Social Service, to assist them to register for vaccination. Starting from end of December 2022, persons receiving vaccination through the HVS can have options of vaccines to choose from. Apart from choosing the Sinovac vaccine as any dose of COVID-19 vaccination, they can also opt for the BioNTech ancestral strain vaccine as any of their doses or the BioNTech bivalent vaccine as their third to fifth dose. For users of the HVS, the medical organisations will contact them when they are due for their next dose and let the eligible persons choose the type of vaccine to be administered as well as arrange an appointment for door-to-door vaccination service. Since the launch of the HVS, over 58 000 vaccine doses have been administered to elderly persons aged 70 or above and persons who have difficulties to go out for vaccination due to illness or disability across the city.

     At the same time, the Civil Service Bureau commissioned the Senior Citizen Home Safety Association (SCHSA) in September 2022 to reach out to users of its care-on-call service to brief the elderly persons who have yet to get vaccinated on the importance of vaccination, with a view to effectively disseminating the message of receiving vaccination to them through their trusted companions. The SCHSA has also arranged for registered nurses to make phone calls to elderly persons in need so as to effectively provide suitable professional advice to them in accordance with their health conditions with a view to dispelling their worries on vaccination. If the elderly persons agree to get vaccinated, staff of the SCHSA will assist them to make vaccination appointments. Elderly persons in need can also use escorting services provided by the organisation for going to vaccination venues to take a jab with the cost borne by the Government. As at end-January 2023, the service has assisted around 150 elderly persons to receive COVID-19 vaccination.

     At the district level, since August 2022, various District Offices have organised multiple vaccination activities across the city together with various district units. As at early January 2023, a total of about 135 vaccination activities have been held to provide COVID-19 vaccination to more than 19 000 persons, including more than 3 200 elderly aged 70 or above. Furthermore, since September 2022, the Health Bureau, the Civil Service Bureau, the Home Affairs Department and the Housing Department have joined hands to launch the scheme to visit elderly to encourage COVID-19 vaccination (the Scheme), which was coordinated by District Offices in collaboration with district organisations and the property management sector. Under the Scheme, door-to-door visits were made to households in public housing estates with tenants aged 70 or above who have yet to receive COVID-19 vaccination and persuade them to get vaccinated as soon as possible. Elderly persons who are willing to receive vaccination will have arrangements made for them to receive vaccination under the HVS or participate in district vaccination events. Since its launch, the Scheme has been implemented in Wong Tai Sin, Kwun Tong, Kwai Tsing, Central and Western, Eastern, Southern, Wan Chai, Kowloon City, Sham Shui Po and Yau Tsim Mong Districts, covering more than 20 000 tenants aged 70 or above who have yet to receive COVID-19 vaccination. The Scheme will continue to be extended to public housing estates in the remaining eight districts and "three-nil" buildings in all 18 districts in Hong Kong.

     In order to facilitate the vaccination of the elderly in the community, the Government launched the COVID-19 Mobile Vaccination Station (MVS) service from December 2021 to May 2022. The MVS provided BioNTech or Sinovac vaccination services at different locations in Hong Kong with free medical consultation services available to people who were planning to get vaccinated on the spot. Over 102 000 doses of vaccine were administered during the period. Furthermore, Community Vaccination Centres (CVCs) (except private hospitals) have been distributing same-day tickets to persons aged 70 or above since July 2021, and the arrangement has been expanded to cover people aged 60 or above since August 2021. The arrangement enabled the elderly who have not made any prior booking to receive COVID-19 vaccination in a CVC at a designated timeslot on the day of distribution. The elderly can present their Hong Kong identity cards to get a same-day ticket at CVCs or authorise their family members or carers to get a ticket on their behalf at CVCs. If necessary, the elderly can seek assistance for making online bookings from post offices (except mobile post offices) or the estate management offices of the public housing estates where they reside.

     On the other hand, the Government is committed to protecting targeted groups, especially residents of residential care homes for the elderly and residential care homes for persons with disabilities. The Government has launched the outreach vaccination service special programme for residential care homes (RCHs), where medical teams will be arranged to visit the RCHs at least once a week to provide outreach vaccination service, with a view to administering COVID-19 vaccines to every resident who is due to get vaccinated as soon as possible, in particular the fourth dose as a booster dose. In addition, medical teams will also provide seasonal influenza vaccination concurrently for residents to attain dual protection. Owing to the efforts of the RCH sector and medical teams, over 12 000 doses of COVID-19 vaccine have been administered to RCH residents under the new round of special programme since its launch in November 2022. At present, the vaccination rates of the first four doses in RCHs are 96 per cent, 95 per cent, 89 per cent and 22 per cent respectively. Taking into account the recovered residents who had received three doses of vaccine, the effective vaccination rate equivalent to that of having received the fourth dose in RCHs has surpassed 75 per cent. In fact, infected RCH residents constitute only a relatively low proportion among all hospitalisation cases so far. This indicates that the protection barrier built by driving up the vaccination rate can effectively lower the risks of severe cases and deaths for RCH residents in case of infection.

     The Government will continue to implement the above measures, and will consider the need to adjust the measures having regard to the progress of vaccination and the development of the overall epidemic situation.

(2) The Centre for Health Protection (CHP) of the Department of Health (DH) and the University of Hong Kong have been performing testing on nucleic acid specimens to monitor COVID-19 variants, and have been sharing the related data with international organisation.

     Surveillance results during January to December 2022 showed that the Omicron sub-lineages were the most common variant. Over half of the total cases with variant detected involved BA.4/BA.5 and its descendent lineages, followed by BA.2 and its descendent lineages; while newly emerging variants like BA.2.75.2, BA.4.6, BF.7, BQ.1.1, XBB and XBD accounted for small proportions. The Government note that there is no significant difference between the percentage distribution of variant amongst death cases and all cases with the aforesaid Omicron sub-lineages detected.

     Since April 2020, the Health Bureau and the Health and Medical Research Fund (HMRF) have approved a total of $556 million to support 70 COVID-19 related medical research studies from bench to bedside and at the community level through application of new technologies. These studies address important research areas including transmissibility and infectivity of the virus, effective detection and surveillance, prevention strategies of the disease and development of vaccines, treatments and therapies.

     There are a number of studies related to the research of variants, including the applications of sewage surveillance and genomic surveillance approaches to monitor the activities of the variants and their transmission chains in the community, the use of cell lines and animal models to investigate the viral characteristics of different variants, the association between clinical symptoms and variant infection, and the immune protection from different doses and types of COVID-19 vaccines against the variants. Some of these research findings have already been published in top-tier international journals.

(3) A total of 9 343 and 2 347 death cases fulfilling reporting criteria were recorded in the first half and the second half of 2022 by the CHP of the DH respectively. Specifically, a COVID-19 death case is defined as a death in a person tested positive and died within 28 days of the first positive specimen collection day. The underlying cause of death may have been unrelated to COVID-19. In particular, the HA has been categorising the cause of death into related or unrelated to COVID-19 according to preliminary analysis since January 4 this year. As at January 29 this year, among the 1 291 deaths of positive cases in public hospitals reported by the HA, 648 cases or about 50.2 per cent were related to COVID-19 while the remaining 643 cases or about 49.8 per cent were unrelated.

     In fact, the COVID-19 case fatality rate in Hong Kong has been decreasing due to various timely anti-epidemic measures (including vaccination and the provision of COVID-19 oral drugs), as well as a substantial number of natural infections brought by the fifth wave of the epidemic. According to figures from the DH, the COVID-19 case fatality rates in the first half and the second half of 2022 were 0.76 per cent and 0.17 per cent respectively. Meanwhile, the Government of the Hong Kong Special Administrative Region (HKSAR) has been reviewing the effectiveness, assessing the impact and drawing the experiences periodically in response to the epidemic development in the past three years, so as to continuously improve the epidemic responses on all fronts. The crude COVID-19 mortality rate in Hong Kong (approximately 180 deaths per 100 000 population) is lower than that of many developed western economies (approximately 200 to more than 300 deaths per 100 000 population).

     Starting from January 30, 2023, the Government of the HKSAR has revised the reporting criteria of COVID-19 under which persons tested positive (including by nucleic acid and rapid antigen tests) are not required to report to the CHP, while doctors are only required to report to the CHP death cases and severe cases. Besides, the announcement of death figures has been adjusted to cover a death in a person tested positive and died within 28 days of the first positive specimen collection day and the underlying cause of death may have been related to COVID-19 upon preliminary assessment. Under the new arrangement, since not all cases tested positive are reported, the Government cannot calculate and should not compare the COVID-19 case fatality rate thereafter. The criteria for the announcement of COVID-19 death cases have also been changed, and hence they cannot be compared with the previous figures.

     Furthermore, according to the figures prepared by HA, among the inpatients diagnosed with COVID-19 in public hospitals, 5 220 were in serious or critical conditions in the first half of 2022, and 2 921 in the second half of the year. The above serious or critical situations are not necessarily caused by COVID-19, and the relevant figures do not include death cases.
Ends/Wednesday, February 8, 2023
Issued at HKT 17:20
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