How accurate are China’s Covid death figures? | China

The sudden end to China’s controversial zero-Covid strategy has caught the country’s fragile healthcare system off guard, with hospitals scrambling for beds, pharmacies scrambling for medicine and authorities rushing to build clinics. specials.

On Thursday, a senior World Health Organization official said China may struggle to keep a tally of Covid-19 infections as it experiences a sharp rise in cases. Experts say China could face more than a million Covid deaths next year.

But despite evidence of overwhelmed hospitals and crematoriums, the Chinese government has recorded fewer than 10 Covid deaths in the past two weeks.

Official statistics

China’s narrow criteria for identifying Covid deaths will underestimate the true toll of the country’s current wave of infections and could make it harder to communicate the best ways people can protect themselves, experts have warned. health aliens.

Only deaths caused by pneumonia and respiratory failure after contracting Covid will be classified as having been caused by coronavirus, a leading Chinese medical expert said on Tuesday.

Deaths due to complications at other body sites, including underlying conditions aggravated by the virus, would be excluded from the official toll, said Wang Guiqiang, head of the infectious disease department at the University’s First Hospital. from Beijing.

Experts familiar with hospital protocols in China said such cases were not always previously ruled out, although sometimes Covid is ruled out as a cause of death if a previously positive patient had tested negative a day or two before dying.

Wang said the criteria changed because the Omicron variant was less likely to cause other life-threatening symptoms, although Chinese hospitals are still required to judge each case to determine precisely whether or not Covid was the ultimate cause.

Methods of counting Covid deaths have varied by country in the nearly three years since the start of the pandemic.

Yet disease experts outside China say this specific approach would miss several other widely recognized types of life-threatening Covid complications, from blood clots and heart attacks to sepsis and kidney failure.

Some of these complications can increase the risk of death at home, especially for people who are unaware that they need to seek treatment for these symptoms.

The new definition “clearly won’t capture all Covid deaths,” said Dr. Aaron Glatt, an infectious disease expert at Mount Sinai South Nassau Hospital in New York and a spokesperson for the Infectious Diseases Society of America. . “To say that you are going to ignore everything that happens in the body makes no sense and is scientifically inaccurate.”

Last month, Korean researchers reported that 33% of Omicron-related deaths between July 2021 and March 2022 in a major hospital were due to causes other than pneumonia.

hidden numbers

With one of the lowest Covid death rates in the world, China has been regularly accused of downplaying infections and deaths for political reasons.

A June 2020 study of the country’s initial outbreak in Wuhan from late 2019 estimated that 36,000 people could have died at the time, 10 times the official figure.

A study published by the Lancet in April, which looked at Covid-related mortality in 74 countries and territories over the period 2020-2021, estimated that there were 17,900 additional deaths in China during the period, compared to an official death toll of 4,820.

Globally, the study estimated 18.2 million additional deaths in 2021-2022, compared to 5.94 million reported Covid deaths.

China’s new announcement raised concerns that the government was seeking to conceal the true impact of easing its draconian zero Covid controls after nearly three years of disruptive shutdowns and mandatory mass testing.

Despite numerous reports that funeral homes and crematoriums are struggling to cope with increased demand, the official death toll in China has not increased, with no new deaths reported for December 21. and only seven deaths reported since the government announced on December 8 that the zero-Covid restrictions would be lifted.

China actually reduced the death toll accumulated on December 20 by one, bringing the total to 5,241.

China’s National Health Commission did not immediately respond to requests for comment on the country’s Covid statistics and excess mortality.

Even if China were to continue defining Covid deaths more broadly, official data was still unlikely to reflect the situation on the ground, given how quickly infections were now spreading, said medical researcher Chen Jiming. at Foshan Chinese University.

“The number of reported cases and deaths represent only a very small part of the true values,” he said.

Ben Cowling, an epidemiologist at the University of Hong Kong’s school of public health, said the official death count would be very low even if a broader definition was used, ‘because so little testing is being done’ now. that China has halted mass surveillance. .

On the other hand, Cowling said, labeling every person who died while testing positive for Covid as having died of the disease could lead to overcounting. Such an approach “can also be criticized because it can, and has, included incidental deaths such as in people hit by a bus while having mild Covid”.

Dr Mai He, a pathologist at Washington University in St Louis who was involved in the Wuhan study published in 2020, said there was still a lack of confidence in the integrity of China’s numbers.

“The persistent critical problem is the lack of transparency – people cannot use their data for research and analysis, [or] provide guidance for the next step,” he said.

Lack of confidence in Chinese statistics has also caused panic among members of the public, said Victoria Fan, senior global health researcher at the Center for Global Development.

“It’s in the interest of the government to be more transparent, because a lot of the behavior of the public is due to lack of information.”