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Residents queue at a COVID-19 testing facility in Hong Kong on Thursday, Feb. 17, 2022. Image Credit: Bloomberg

Hong Kong is stepping up efforts to root out COVID-19 cases, with plans to mass test the entire city and fine those who refuse, according to local media, as the financial hub faces its most challenging outbreak yet.

Chinese medical workers will be brought in to test 1 million residents a day, with those who resist subject to a HK$10,000 ($1,280) fine, Sing Tao Daily said late Wednesday, citing people it didn’t identify. HK01 said the citywide testing will begin in early March and be conducted once a week for three weeks, though Hong Kong and the mainland are still discussing details, according to the report.

A representative from the Hong Kong government did not immediately respond to a request for comment.

Outbreaks on the mainland have been successfully contained through frequent and mass testing, but China has never used the measure in an outbreak of this size. And it’s unclear where Hong Kong, which is currently struggling to find more isolation and quarantine units, would house those who test positive, even as the city insists on its pursuit of COVID Zero.

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Staff members wearing personal protective equipment (PPE), set up tents to protect patients lying in beds from the rain, at a makeshift treatment area outside a hospital, following the coronavirus disease (COVID-19) outbreak in Hong Kong, February 17, 2022. Image Credit: REUTERS

“At current rate of spread, there could be tens of thousands of new cases each day in early March, and we know that not every infection is being confirmed so the number of infections picked up in mass testing could be very large at that point,” said Benjamin Cowling, a professor and chair of epidemiology at the University of Hong Kong. “Doing mass testing in April or May, when the fifth wave will have subsided and we would then have capacity to isolate the positives, might be able help the city return to zero daily cases if that were the objective.”

President Xi Jinping has called for the city of about 7.5 million people to take “all necessary measures” to contain COVID-19, as the widening outbreak - which came after months of being virus-free - undermines China’s zero-tolerance approach to keeping the pathogen out. While other parts of the world start to live alongside COVID-19, Beijing is continuing to pursue elimination, including testing as a key tool in an arsenal that also includes tight border controls and lengthy mandatory quarantines.

It would be the first time since the pandemic began that Hong Kong has enforced citywide testing, with the more contagious omicron variant providing the steepest challenge yet to maintaining the COVID Zero strategy. Hong Kong’s infections tally continues to set records, with 4,285 new cases on Wednesday, as well as 7,000 preliminary infections. The latter figure reflects specimens that are awaiting a second, confirmatory test.

There are 16 patients in a critical condition - all adults - and officials announced 10 deaths, including a three-year-old girl.

A policy to isolate all positive cases and their close contacts is straining the city’s medical system. Hong Kong Chief Executive Carrie Lam has asked major property developers to make hundreds of hotel rooms available to house positive cases, according to a person familiar with the discussions. Omicron has exposed Hong Kong’s lack of preparation for a major outbreak, with policy shifting on an almost daily basis to try and maintain a strategy that other places left behind in favour of treating COVID-19 as endemic.

The chaos of the current outbreak - with hospitals overwhelmed and placing elderly patients in makeshift tents outside - has undermined already-damaged public confidence in the Hong Kong government’s abilities following unprecedented unrest in 2019, says Joseph Cheng, a retired political science professor and veteran democracy activist. Many may be dissuaded to participate by tales of hours-long lineups for mandatory tests for close contacts in the current outbreak, he said.

“There’s a lot of worry about the lack of competence, the lack of preparation of this government - there’s a lack of hospital beds, and people are having to wait up for days to be contacted if they’re positive,” said Cheng, who left the city for Australia when China imposed a national security law on Hong Kong in 2020, adding that “the majority of the people are willing to cooperate.”

“They are pragmatic, they are practical,” he continued. “If tests are made compulsory, they’ll be willing to accept that. They just want to be able to go back to work. Hong Kong people will grumble a lot, but most people will still go and queue up.”