For much of the pandemic, these places have been held up as Covid-19 success stories as strict border rules helped them avoid high cases and deaths – even as the pandemic took hold around the world.
Now they are among a number of locations in Asia-Pacific battling unprecedented outbreaks.
While the rise in cases can be partially explained by the highly contagious Omicron variant breaching the region’s defenses, that’s not the whole story.
In some places, rising case numbers are a symptom of living with Covid as governments accept that trying to eradicate the virus is an unrealistic proposition. Elsewhere, skyrocketing cases are being blamed on a lack of planning by authorities, who were caught off guard despite a two-year warning.
Asia’s highest peak ever
Many of the places reporting the most cases per capita in the Asia-Pacific region, which stretches across East and South Asia and Oceania, were previously considered success stories.
These include South Korea, New Zealand, Vietnam, Australia, Hong Kong and Singapore.
Of these, two countries that have both eased restrictions are driving Asian case counts — South Korea and Vietnam.
Vietnam reopened fully to international tourists earlier this month – even as cases surged. In South Korea, the presidential election earlier this month may have played a role in its rise. Woo Joo Kim, a professor of infectious diseases at Korea University’s Guro Hospital, said the government eased restrictions in the weeks leading up to the election to address the economic losses faced by small business owners.
“(The Korean government) eased the current measures and social distancing despite the increasing number of Covid cases,” he said.
Abhishek Rimal, the International Federation of Red Cross and Red Crescent Societies (IFRC) regional emergency health coordinator, said the Lunar New Year celebrated in both countries earlier in the year may also have contributed to the outbreaks.
Another factor is that both Vietnam and South Korea have large testing capacities, which could also explain why they find more cases than other countries.
“They test, therefore they get it,” he said.
The countries that are now seeing large numbers of cases all closed their borders at the start of the pandemic, largely cut off from the world. As Covid broke through, they used tracing, tracing and social distancing measures to bring outbreaks under control.
In recent months, most have begun to turn to a new approach: living with the virus.
After years of banning most foreigners, all places – except Hong Kong – have eased border restrictions and eased rules on citizens.
The reasons for this vary from place to place.
Singapore led the way in June when it announced it would break the zero Covid club and find a way to live with the virus. Other countries followed, although not all voluntarily. Australia and South Korea only switched to a similar model after failing to eradicate local outbreaks.
“We’ve been in the pandemic for more than two years … and people are really trying to get back to their normal lives,” Rimal said.
But people in Hong Kong and China are still waiting to get on with their lives. In both places governments have adhered to strict border rules – and people are still living with social distancing measures and the risk of sudden Covid lockdowns.
Vaccines are key
Even with case numbers rising, some authorities in Asia Pacific don’t seem fazed for one simple reason: vaccines.
Alongside the tiny Pacific island nations of Tonga and the Cook Islands, New Zealand and South Korea are reporting the highest cases per capita in the region – but their death tolls remain relatively low.
“The sacrifices and hard work got us here today, and now with more tools and one of the most vaccinated populations in the world, we can safely move on,” New Zealand Prime Minister Jacinda Ardern said last week. “Covid is here to stay.”
The South Korean authorities have been spreading the same message.
“The number of confirmed cases continues to increase significantly, but the severity and mortality rate and the responsiveness of the medical system are considered manageable,” health official Son Young-rae said in a March 23 briefing. “(We) believe that once the peak of this Omicron wave is past, we will be able to transition to a system that is closer to normal life.”
Both South Korea and New Zealand have high vaccination rates – but crucially they have vaccinated their elderly, who are most vulnerable to serious illness and death from the virus.
And so far that has meant that while these countries have seen an increase in deaths as cases rise, they have still been able to keep death rates relatively low.
Although funeral homes are struggling to keep up with a surge in Covid deaths in South Korea, the country’s death rate was 0.13%, below the UK’s 0.18%, the US’s 1.2% or the 0.59% in France, said health official Lee Ki- He said on Friday, citing statistics from the World Health Organization (WHO).
It’s similar in New Zealand – while the country had one of the highest reported Covid cases per capita over the past week, it doesn’t even make the top 20 globally for the past week when it comes to deaths per capita.
Again, Hong Kong is the outlier of the region.
Hong Kong, with a population of 7.4 million, has reported more than 7,300 Covid deaths since late December. The city’s per capita death rate is the highest in Asia and Oceania every day since February 28. In Hong Kong, 84.5% of the population aged 12 and over received two shots, but crucially only 60% of those aged 70 and over received two doses.
The virus was able to spread in retirement homes, where vaccination rates were low.
The question of whether tough measures are worth it is also playing out in mainland China, which is facing the largest outbreak since the outbreak in Wuhan at the beginning of the pandemic.
And like Hong Kong, immunizations among the elderly are lagging behind, raising concerns that the city’s deadly outbreak could herald a deadly surge across the border.
About 40 million Chinese over 60 have yet to receive a vaccine, according to China’s National Health Commission (NHC). Only about half of those over 80 are fully vaccinated, the NHC said in its most recent breakdown on March 18. Of those over 80, less than 20% have received a booster shot, although the WHO said last year that all older people receive vaccinations. China’s inactivated vaccines require three shots to be fully protected. For now, it looks like China is sticking to its zero-Covid strategy – and relying on strict lockdowns to keep its spiking cases under control.
CNN’s Yoonjung Seo and Simone McCarthy contributed to this report.