#17,644
During the first 3 years of the COVID pandemic, China - with a population of 1.4 billion - only admitted to 5242 deaths from the virus. While many countries attempt to `manage' bad news, China has elevated that skill set into an art form.- In 2002-2003 China managed to hide a raging SARS-CoV epidemic (see SARS And Remembrance) for nearly 6 months until it spread beyond their borders.
- Despite hospitals filling up with patients in December 2019, China denied that SARS-CoV-2 was contagious until January 18th, 2020 (see 2019-nCoV: `Evidence of Limited Human-to-Human Transmission' - WHO WPRO).
- China rarely reports HPAI outbreaks in wild birds or poultry, and often delays reporting human infections for months.
- And last December, after their Zero-COVID policy crashed and burned, China stopped their (already highly limited) reporting on COVID infections, hospitalizations, and deaths (China: NHC Will No Longer Release Daily COVID Figures).
Last week, in JAMA Open: Excess All-Cause Mortality in China After Ending the Zero COVID Policy. we saw an estimate of roughly 1.87 million excess deaths in China in the two months following the collapse of Zero COVID.
Today we've a slightly more conservative estimate published in the CDC's EID journal. While their estimate was 1.41 million deaths over 60 days, that was more than 17-fold higher than `officially' reported by China (n=82,000).
Due to its length, I've only reproduced some excerpts. Follow the link to read the report in full. I'll have a postscript after the break.
Volume 29, Number 10—October 2023Dispatch
Zhanwei Du, Yuchen Wang, Yuan Bai, Lin Wang, Benjamin John Cowling, and Lauren Ancel Meyers
Abstract
China announced a slight easing of its zero-COVID rules on November 11, 2022, and then a major relaxation on December 7, 2022. We estimate that the ensuing wave of SARS-CoV-2 infections caused 1.41 million deaths in China during December 2022–February 2023, substantially higher than that reported through official channels.
For almost 3 years, China maintained a zero-COVID policy that effectively suppressed SARS-CoV-2 transmission. China began rolling back those rules on November 11, 2022, and ended most restrictions on December 7, 2022 (China Focus, 2023, link , in response to the reduced severity of the Omicron variant or the growing socioeconomic and political costs of the restrictions. COVID-19 immediately surged; China reported nearly 82,000 COVID-19–related deaths during December 16, 2022–February 17, 2023 (1).
In December 2022, China disbanded its national COVID testing system and twice modified its criteria for classifying COVID-19–related deaths (2,3). The resulting uncertainties in reported occurrences and low official death counts have spurred speculation that official mortality reports from China substantially underestimate the full burden of the December 2022–January 2023 wave (4).In early December of 2022, the Chinese Center for Disease Control and Prevention (China CDC) launched a sentinel household surveillance program, tracking SARS-CoV-2 test positivity in 420,000 people in 22 provinces across China (5). We used those data to estimate a plausible range for the total number of COVID-19–related deaths during December 2022–January 2023. We classified a death as COVID-19–related if it occurred within 28 days of confirmed infection (6).
(SNIP)
Conclusions
COVID-19 deaths are related to a variety of health complications, including septic shock, multiorgan failure, respiratory failure, heart failure, and secondary infections (8). China’s official reports may underestimate the COVID-19 death toll by a factor of 17 (95% CrI 14–22). Our analyses suggest that, in barely a month, COVID-19 killed >1 million persons in China. The difference between China’s official mortality reports and our estimates may stem from delays in hospital reporting (9), omission of deaths happening outside of hospitals (2), gaps in China’s vital registration system (4), or intentional reclassification after the insurance industry in China largely stopped covering COVID-19 in December 2022 (South China Morning Post, December 17, 2022, LINK).
(SNIP)
Our findings rely on the validity of data from the China CDC’s sentinel household surveillance program, which might have some quality issues (e.g., double counting of persons who test multiple times). China CDC reports include graphs of daily positivity in this sample that enable rapid approximation of epidemic trends on a national scale (5). In addition, we assume that reported vaccinations were the only source of prior immunity and that all infections were by Omicron variants; surveillance data suggest that only 0.4% of specimens collected during this period were not Omicron (5).
In summary, our study suggests that the official mortality reports from China substantially underestimate the full burden of the December 2022–January 2023 COVID-19 wave, raising concerns about the accuracy and transparency of China’s reporting system, as well as potential underestimation of reports from other countries that limit data collection and reporting. The decision to relax China’s zero-COVID policies without adequate measures to protect high-risk populations had severe consequences. Other countries prioritized vaccines for older age groups and other vulnerable populations (13), and many studies have indicated that targeting medical countermeasures and protective measures toward groups with high infection-fatality rates can be life and cost saving (14,15). We expect that the true toll of COVID-19 in China will become clearer as additional epidemiologic data become available.
Dr. Du is a research assistant professor in the School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China. He develops mathematical models to elucidate the transmission dynamics, surveillance, and control of infectious diseases.
We will probably never know the full impact of COVID on China - or the rest of the world - because there are so many economic and political incentives for officials (from local level up to the national level) to downplay the numbers.
Officially, roughly 7 million people have died from SARS-CoV-2 globally since December 2019, but the real number is likely 2 or 3 times higher. Today, 90% of countries no longer report COVID hospitalizations or deaths to the WHO on a regular basis.
While `sanitized' numbers may be good for the economy, or help politicians get re-elected, they can also mask new and emerging threats. But that isn't really a problem until it happens, and in the meantime, we can party like its 2019.
