HONG KONG — The three people who took their own lives on the same day last week in Hong Kong used different methods. One hanged herself with a cotton rope in the cubicle of a public toilet. The other two jumped to their deaths.
Their cases are examples of the acute mental crisis afflicting Hong Kong as it battles one of the worst covid outbreaks in the world, more than two years into the pandemic. Depression stemming from isolation and a sense of hopelessness has hit especially hard for the elderly population, a group that has the lowest vaccination rate in Hong Kong and makes up a disproportionate part of the more than 4,900 covid deaths in the city since the start of this most recent outbreak.
Hong Kong’s covid death rate is higher than anywhere in the developed world, at 1 death per every 20 infections.
Like mainland China, Hong Kong adhered to a “zero covid” policy, which focuses on eliminating the virus or at least keeping local infections as low as possible. But the methods that worked previously, such as mandatory masking, social distancing measures, limited foreign arrivals and mandatory quarantine regimes, have not stopped the spread of the more transmissible omicron variant.
Since February, infection numbers have been rising exponentially, overwhelming the hospital system, which has been forced to scale back accident and emergency services and instead convert most wards to covid treatment facilities.
The social distancing restrictions have led to isolation across the board — especially for the vulnerable elderly. Schools, bars and gyms are closed, and outdoor gatherings are limited to two people. Meanwhile, overcrowded government quarantine facilities are struggling to process and discharge covid patients, prolonging their forced isolation and leading to protests and a few suicide attempts.
In a news conference Thursday, Hong Kong’s chief executive, Carrie Lam, announced a review and “comprehensive update” next week regarding the social distancing and border control measures, as public morale is low and financial institutions are “losing patience.”
“I have a very strong feeling that people’s tolerance is fading,” Lam said.
Mental health issues are most acute among the elderly, many of whom have faced long-term isolation either in care homes or in small flats for two years. According to government census figures, the number of elderly residents living alone had increased by more than 50 percent from 2006 to 2016.
The closure of centers for the elderly and other recreational facilities, often the main support system for seniors who live alone, heightened their sense of loneliness and led to depression, social workers said. Long-term isolation at home, coupled with grim death reports and images of the elderly lying in outdoor triage areas in the news, magnified their fear of getting infected.
Just 66 percent of seniors ages 70 to 79, and 36 percent of those over 80, are fully vaccinated, with many still hesitant over the shots’ reported side effects.
“Some seniors have lots of questions, don’t know how to solve the problems, but don’t want to trouble their adult children,” said the chairman of Hong Kong Patients’ Voices, Alex Lam (no relation to the chief executive). “This could lead them to the ‘wrong path,’” he added, referring to suicide.
According to Samaritan Befrienders Hong Kong, a suicide prevention group, nearly one-fifth of the 270 people who sought help amid the latest wave of infections were seniors. In July last year, the group recorded 438 deaths by suicide among people older than 60, the highest yearly number since 1973.
Joyce Chan, 70, said she was unable to sleep at night after watching the daily news on infections and deaths. Forced to isolate at home every day, Chan found her mental health deteriorating. The nights alone were particularly hard to bear. Every rash, blister and body discomfort caused panic, Chan said, but she did not want to bother her children. The television became her only comfort, but also a source of stress with constant updates on the rising covid death toll.
“When I hear the sirens of the ambulance passing by my street … I feel very scared,” said Chan, who is unvaccinated. “If anything happens to me, no one will know.”
Chan was one of the many elderly residents who reached out to Crystal Yuen, a social worker at the Society for Community Organization, for advice on hospital appointments, emotional support and practical needs like rice and surgical masks. Yuen, who is also a member of the government’s advisory committee on mental health, said a majority of seniors who reached out showed signs of depression.
“There are extreme cases of some seniors who haven’t left their flats for two years,” Yuen said. “With no contact with sunlight and just communication via the phone, they will feel depressed.”
The stress has also affected elderly couples who have only each other for support. Dede Leung, 68, is the caretaker of her 80-year-old husband, but she also suffers from chronic ailments. Unvaccinated, the couple have isolated together. Her husband, who has dementia, cannot share her fears and worries.
Leung recalled an accident when her husband fell off his chair. With jammed emergency lines and ambulance services prioritizing severe covid cases, Leung called for help from neighbors in desperation, but no one responded. After a half-hour struggle, she managed to leverage her husband back into his chair with a towel wrapped around the sofa edge.
“I sometimes cry because I feel like I am suffering too much, but I’ve pulled myself together,” Leung said. “How else can I be — it’s not like I can consider death, can I?”
Hong Kong’s adherence to the mainland’s zero-covid policy, which experts say is unsuitable to the dense and culturally diverse city with a population of 7.5 million, is the root cause of low morale in the city, said Lam, of the Patients’ Voices organization.
Constantly shifting government policies, such as a mandatory testing program announced weeks ago but with no further details, have caused residents to lose confidence in the government. Rumors of a lockdown continue to bubble up, leading to panic buying in supermarkets and pharmacies.
The lack of support and uncertainty “doubles or triples the pressure” for the elderly, Lam said, because they are more reliant on feeble government subsidies and far more isolated than the rest of the population.
“Everyone is paying a price,” Lam said. “But is the price we pay worth it?”
Coronavirus: What you need to know
Vaccines: The CDC recommends that everyone age 5 and older get an updated covid booster shot designed to target both the original virus and the omicron variant. Here’s some guidance on when you should get the omicron booster and how vaccine efficacy could be affected by your prior infections.
Variants: Instead of a single new Greek letter variant, a group of immune-evading omicron spinoffs are popping up all over the world. Any dominant variant will likely knock out monoclonal antibodies, targeted drugs that can be used as a treatment or to protect immunocompromised people.
Tripledemic: Hospitals are overwhelmed by a combination of respiratory illnesses, staffing shortages and nursing home closures. And experts believe the problem will deteriorate further in coming months. Here’s how to tell the difference between RSV, the flu and covid-19.
Guidance: CDC guidelines have been confusing — if you get covid, here’s how to tell when you’re no longer contagious. We’ve also created a guide to help you decide when to keep wearing face coverings.
Where do things stand? See the latest coronavirus numbers in the U.S. and across the world. In the U.S., pandemic trends have shifted and now White people are more likely to die from covid than Black people. Nearly nine out of 10 covid deaths are people over the age 65.
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