COVID cases are on the rise in Asia and Europe. Is the US next?

Even as COVID-19 cases and deaths have continued to decline in the United States, there are some worrisome developments around the world. I’ll walk through them — and explain their implications for the United States.

After more than two years of mostly fighting off COVID, Hong Kong has become the world’s worst hot spot. The main problem, as in so many other places, is vaccine skepticism.

Heading into the current outbreak, nearly 40% of Hong Kong’s population was not vaccinated, and more than half of people older than 70 — the age group most vulnerable to severe COVID — were unvaccinated.

Why? Many Hong Kong residents do not trust the government, given the increasing repression by China. Others are dubious of Western medicine or have been influenced by misinformation, as my colleagues Alexandra Stevenson and Austin Ramzy have reported. “I worry that the side effects of vaccination will kill me,” Lam Suk-haa, 80, told The New York Times last month. “I won’t get vaccinated as long as I have a choice.”

Until recently, Hong Kong — like mainland China — had been largely successful in keeping out the virus, which meant that vaccine skepticism did not bring large costs. But the omicron variant is so contagious that it overwhelmed Hong Kong’s “zero-COVID” strategy.

Adding to the problem, many residents have received Sinovac, a Chinese-made vaccine that is less effective than the vaccines designed in the U.S. and Europe — by Moderna, Pfizer, Johnson & Johnson and AstraZeneca. Although the Pfizer vaccine is available in Hong Kong, many residents wrongly fear that it has dangerous side effects. Sinovac still provides meaningful protection against severe illness, but not as much as the Western vaccines.

The death rate in Hong Kong has soared this month, surpassing 25 per 100,000 residents in the past week. That’s not as high as New York’s peak death rate in the spring of 2020, but it is higher than in any country today. And Hong Kong’s rate will probably continue rising, because new case numbers did not start falling until about a week ago; death trends typically lag case trends by about three weeks.

“I’m not sure people appreciate quite how bad the COVID situation is in Hong Kong, nor what might be around the corner,” John Burn-Murdoch of The Financial Times wrote Monday. “What’s driving this? Vaccines. Or more specifically: the elderly vaccination rate.”

Many older residents of mainland China are also unvaccinated, and it, too, could be on the brink of an increase in COVID deaths. Monday, outbreaks led to the closures of many theaters and restaurants in Shanghai, while several large factories — including a major maker of iPhones — suspended production. The shutdowns could ripple across the global economy, exacerbating goods shortages and inflation.

COVID is also spreading rapidly in New Zealand, Singapore, South Korea and several other Pacific countries that had kept caseloads low. The death rates in those countries are far lower than in Hong Kong, because of higher vaccination rates.

Europe has often been a few weeks before the U.S. with COVID trends — and cases are now rising in Britain, Germany, Italy and some other parts of Europe. The main cause appears to be an even more contagious version of omicron, known as BA.2.

BA.2 has already begun to spread in the U.S., as well. It accounted for about 12% of newly diagnosed cases last week, according to the Centers for Disease Control and Prevention. The variant may also be the reason that the amount of COVID virus detected in wastewater is rising in about one-third of American cities that track such data. Wastewater samples tend to be a leading indicator of case counts.

If that pattern repeats, BA.2 would be about to end two months of falling case counts in the U.S. Since mid-January, the number of new daily COVID cases has dropped more than 95% and is now at its lowest level since last summer, before the delta surge.

The magnitude of any BA.2 increase may be limited by the fact that about 45% of Americans have already contracted omicron. “That should be highly protective,” Andy Slavitt, a former Biden administration adviser, wrote Monday. On the other hand, a 45% infection rate means that most Americans did not contract omicron, leaving many of them susceptible to BA.2.

Even if cases rise, as seems likely, there are good reasons not to panic. Vaccination tends to turn COVID into a mild illness, especially for people who have received a booster. For the unvaccinated and unboosted, BA.2 is another reason to get a shot.

It’s also a reason for the federal government and states to expand access to Evusheld — a drug that can help protect the immunocompromised — and Paxlovid — a post-infection treatment. Finding either is often difficult.

The bottom line: COVID isn’t going away, but vaccination and other treatments can keep future increases manageable. The biggest problem remains the millions of people who remain unvaccinated, many of them by choice. That’s the case in the U.S., in Hong Kong and across much of Europe, Africa and the rest of the world.

Inducing more people to get shots — through persuasion or mandates — would probably save more lives than any other COVID policy.

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