The way China classifies coronavirus cases and reports deaths masks the true impact of the Omicron wave and complicates its public health response more than two years into the pandemic, medical experts say.
Authorities have reported more than 443,000 cases since March 1 and just two deaths, both in the northeast Jilin province. No deaths have been recorded in Shanghai, as 26mn City has been reporting more than 20,000 daily cases for nearly two weeks. Several Shanghai residents also told the Financial Times that their relatives had died after testing positive for Covid-19.
Experts believe the low official toll is the result of shortcomings in how China counts deaths and that more people have been killed by the virus.
It is difficult to accurately estimate the number of Covid-related deaths given doubts over the number of official cases, uncertainty over the effectiveness of the vaccine and the lack of publicly available data on overall Chinese mortality, have added the experts.
Questions over the data could reignite criticism of the Chinese government’s handling of the pandemic, after Beijing was accused of downplaying the initial spread of the virus in Wuhan in early 2020.
Jin Dong-yan, a virologist at the University of Hong Kong, said mainland China has taken a different approach than places like the United States or Hong Kong, where people who died after contracting Covid-19 were included in official death data.
Jin said Chinese hospitals tended to focus on chronic diseases such as cancer, heart disease or diabetes as the cause of death, even when people had contracted the virus, and would not be included in the official Covid mortality statistics.
“The numbers aren’t exact, but hospitals in Shanghai aren’t necessarily doing it on purpose. From the beginning, China had this method of registering deaths,” he said.
Chen Zhengming, professor of epidemiology at Oxford University, noted that even before the pandemic, China generally underreported seasonal flu deaths compared to Western countries.
“It’s hard to say this is a deliberate cover-up. It seems more consistent with China’s tight death certification process for infectious diseases,” he said.
But Mai He, an associate professor of pathology and immunology at Washington University in St Louis, said the Chinese government was “playing games with statistics” to show it could handle Covid better than Western countries. .
“The city may be different, the variant may be different, the pandemic may be two years old now, but still the same is the lack of transparency and political pressure on science and medicine in China,” he said. .
Doubts over death data for the Omicron wave echo similar concerns about the 2020 outbreak in Wuhan.
Researchers affiliated with the Chinese government’s Centers for Disease Control published an article in the British Medical Journal which estimated that actual Covid deaths in the city from January to March 2020 were at least 16% higher than the official figure.
Analysis by The Economist magazine concluded that there were 13,400 additional deaths in Wuhan during this period, more than three times the official Covid death toll.
China is not the only country accused of underreporting or misrepresenting the impact of Covid. A study published in the Lancet estimated that the number of people killed worldwide by the pandemic could be three times the official record.
Delays in reporting – common in other countries – could also play a role in China’s low death toll. “It may take some time for deaths to go through the system,” Chen said.
Chen expects the Omicron wave in China to lead to a higher death rate than in Western countries and the number of deaths will increase in the coming weeks due to the large number of cases and the “very high proportion “of elderly people who are not fully vaccinated.
Authorities’ understanding of Omicron’s impact in Shanghai has been heightened by how the city differentiates between asymptomatic and symptomatic cases, experts said, with the former vastly outnumbering the latter in official reports. Over the past week, more than 92% of confirmed cases in Shanghai have been reported as asymptomatic.
A Chinese official close to the Chinese Centers for Disease Control and Prevention (CDC) said the city was having trouble predicting how long the outbreak would last, in part because the counting system greatly underestimated the number of cases. symptomatic.
Shanghai only registered patients as “symptomatic” after a lung scan confirmed the infection, the person said. This means that tens of thousands of people who tested positive and had cold symptoms were registered as “asymptomatic”, unlike many other countries.
The CDC and its Shanghai branch did not respond to requests for comment.
China’s approach to recording Covid mortality has left bereaved family members unsure of the cause of death of their loved ones.
According to family members of residents of Shanghai Donghai nursing home, at least 27 people have died at the facility in recent weeks after testing positive for Covid.
A 73-year-old resident tested positive on March 24 as Omicron swept through the facility and forced many staff into quarantine, his daughter said.
“I was worried because my dad can’t move or talk after he suffered a stroke in 2013,” his daughter said. “I couldn’t reach the hospital or the nursing home until March 30, when a doctor from Donghai called me to tell me that my father had passed away.”
The Donghai Nursing Home did not respond to a request for comment on whether any residents died of Covid-19 during the outbreak.
Chinese authorities have sought to silence public debate over Donghai’s death. Online local media reports of the outbreak have been deleted.
A man said his mother died at the nursing home and was offered 15,000 Rmb ($2,360) in compensation, but in return he had to delete complaints on social media.
The man said he was also warned by local police not to post any comments that would damage China’s image.
“I’m just telling the truth,” he said. “Why can’t I do this when a member of my family has died?”
Additional reporting by Maiqi Ding in Beijing