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Statistics controversy after China’s coronavirus response takes sharp turn

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On January 14, the National Health and Medical Commission announced at the press conference of the State Council’s joint prevention and control mechanism that from December 8, 2022 to January 12, 2023, a total of 59,938 deaths related to new coronavirus infection occurred in medical institutions across the country. Among them, there were 5,503 deaths from respiratory failure caused by new coronavirus infection, and 54,435 deaths from underlying diseases combined with new coronavirus infection.

After the release of the “New Ten Measures” on December 7, 2022, China’s epidemic statistics, especially the cases of infection and death, have been questioned by the people of the country, the WHO and the international community. The National Health and Medical Commission has finally responded positively and improved transparency and credibility. This is progress and a good thing.

The data of infection and death cases are seriously distorted

The author continued to track and study the new crown epidemic, and found that the infection cases reported on the official website of the National Health and Medical Commission from November 17 to 22, 2022 were basically stable, and I began to suspect that the data was distorted. With Omicron’s strong transmission power, as long as the restrictions are relaxed, in Shijiazhuang in mid-November or Baoding in late November, the number of infection cases in a prefecture-level city exceeds the number reported nationwide.

During the implementation of the “Class B and A Control” for the new crown virus infection, the epidemic information is published on the official website of the National Health and Medical Commission every day. After the implementation of “Class B and B Control”, it is difficult to accurately count the number of infection cases, and the data is increasingly questioned, and normal people will not believe it. The National Health and Medical Commission itself was embarrassed to release it, so it decided that it would no longer publish the data of asymptomatic infections from December 14, 2022; it would no longer publish daily epidemic information from December 25, and authorized the China Center for Disease Control and Prevention to release it for reference and research use.

The China Centers for Disease Control and Prevention has opened a column of “Epidemic Trends” on its official website since December 25, but the publication has been suspended until January 8. There is a high probability that the content of the press conference on January 14 will be prepared on January 9. Update caliber, update data. On January 15, a new column “National Novel Coronavirus Infection Epidemic Situation” was opened, forwarding the data of infection and death cases announced by the National Health and Medical Commission on January 14 as of January 12. This new column is not updated on a daily basis. It remains to be seen whether it is intended to be updated weekly, or to regularly publish the new crown infection and death data in the “National Statistical Table of Infection and Death Reports of Notifiable Infectious Diseases” every month.

The data on death cases is seriously distorted, and the public and the international community are more suspicious. A prominent example is that according to data from the official websites of the National Health Commission and the China Centers for Disease Control and Prevention, from December 8, 2022 to January 8, 2023, China reported only 37 deaths in 32 days. So much so that netizens complained that I knew all of these more than 30 deaths.

It must be pointed out that the 59,938 deaths reported by the National Health and Medical Commission are obviously still incomplete statistics, with many omissions. As of the end of 2021, there are 2,843 county-level administrative divisions in China, which means that the average daily death case in each county-level administrative division in 32 days is only 0.66 cases, that is, 2 people died in 1 county in 3 days, and the experience and feelings of the people The contrast is too great.

The National Health and Medical Commission hinted at two limiting conditions for statistics: first, in the hospital; second, positive nucleic acid. This means that the death cases that were not hospitalized were not counted, and the death cases that were not tested positive for nucleic acid (even if they were antigen positive) were not counted. After December 7, due to the substantial cancellation of nucleic acid testing, many people were eager to see a doctor. It was impossible to wait until the nucleic acid test and other reports were positive before going to the emergency room. Antigens are in short supply in a large number of rural areas, and it is even less likely to be diagnosed positive through more expensive nucleic acid.

Take the author’s circle of friends as an example. A friend’s 90-year-old father-in-law was sent to a nationally famous tertiary hospital because of “white lung”. There was no time for cremation, so they had to be sent to the outer suburbs for cremation; some friends told that the old man who passed away in his community in December dragged away at home for 4 days, and the funeral parlor was too busy; although a local civil affairs department refuted the rumor, “the implementation of single-person single-furnace “Cremation”, in fact, there are still mixed burnings. After a relative of a friend passed away in a tertiary hospital, the family members were forced to accept mixed burnings; many old people in the countryside died, and a younger sister’s hometown recently left more than a dozen old people to do funeral things There are constant noises, these elderly people have not been hospitalized, and it is impossible to count them as deaths from the new crown infection.

WHO continues to exert pressure

The WHO has repeatedly criticized China’s statistical data, especially the data on death cases, and expressed “understanding” for other countries’ entry prevention measures, which has put tremendous pressure on China.

On December 21, 2022, Director-General Tan Desai called on China to provide detailed information on severe cases, hospitalization rates, and ICU ward utilization rates at a regular press conference. On December 29, Tan Desai tweeted that due to the opacity of China’s coronavirus data, some countries’ restrictive measures in response to the epidemic in China are “understandable”. On December 30, after the WHO and China held a meeting, they again asked China to regularly report specific data on the domestic epidemic situation and vaccination status.

On January 4, 2023, Tan Desai once again called on China to provide timely and accurate hospitalization and death data on a regular basis, and emphasized that the WHO is deeply concerned about the epidemic situation in China; The definition of new crown death cases is too narrow. “In the absence of (China’s epidemic) data, countries have decided to take preventive measures, which the WHO believes is understandable.”

On January 11, Tan Desai stated at a regular epidemic briefing that “China’s new crown-related deaths are underreported”; Ryan also believes that China’s new crown deaths have been “severely underreported”, reiterating that “because There is insufficient data, and it is understandable for countries to adopt quarantine measures for people entering China.”

China revises definition of death case

On December 20, 2022, the National Health and Medical Commission confirmed at a press conference of the State Council’s Joint Prevention and Control Mechanism that it had recently “issued a notice to clarify the scientific classification of related death cases.” There are mainly two aspects: pneumonia and respiratory failure caused by the new coronavirus are the primary death diagnoses, which are classified as deaths caused by the new coronavirus infection; deaths caused by other diseases and basic diseases, such as cardiovascular and cerebrovascular diseases, myocardial infarction and other diseases , not classified as a death due to COVID-19.

The notice defining the death cases is likely to be issued in mid-December. The author searched the official website of the National Health and Medical Commission, but did not find this document, which obviously does not belong to the category of “active disclosure”.

On December 29, the National Health and Medical Commission responded to the death cases at the press conference of the State Council Information Office. An official introduced that the current global standards for judging the death of new crowns are mainly divided into two categories. One is nucleic acid after infection with the new crown virus. Positive, due to respiratory failure caused by the new coronavirus, which directly leads to death, it is judged as a new crown death; there is also a category where all deaths within 28 days after being infected with the new crown virus are included in the death of the new crown virus, claiming that “Since 2020, China has been Adopt the first type of death judgment standard”; another expert claimed, “The current (prevention and control policy) adjustment is appropriate, scientific, and legal, and in line with China’s actual prevention and control.”

Whether these claims can be established requires a big question mark. Shanghai officially reported 588 deaths during the Spring Lockdown in 2021. Are they all based on the first category of criteria? Isn’t there a temporary relaxation of standards? Isn’t there a deliberate consideration of releasing more death cases data to warn the people of Shanghai and the whole country that the new crown will cause many deaths, so is it necessary to strictly block and control?

According to the “Washington Post”, Jin Dongyan, a professor at the School of Biomedical Sciences of the University of Hong Kong, pointed out that during the outbreak in Shanghai, some people who died of underlying diseases were counted “to emphasize that the new crown disease can cause many deaths.” provide a basis for control.

Obviously different from the two public statements on December 20 and 29, the National Health and Medical Commission substantially publicly confirmed on January 14 that it has relaxed the definition of death cases, that is, death cases related to new coronavirus infection not only include the original “new coronavirus infection caused Respiratory failure death” also includes the previously excluded “basic disease combined with new coronavirus infection death”. Of course, these two categories are limited to “in the hospital”, and the death cases outside the hospital are not counted.

On January 14, the director of the National Health and Medical Commission quickly called Tan Desai. The WHO welcomed the latest outbreak data released by China on the same day and asked China to “continue to share this type of detailed information with us and the public.”

Two ways to count deaths

One is a more precise method.

Given the Chinese government’s control over the grassroots, it will not be difficult if we are determined to accurately pinpoint the death toll. The death cases are mainly composed of two parts: 1. The cremation data directly obtained by the funeral homes under the civil affairs department, mainly including counties and cities; 2. Some rural areas in China, especially the north, have relaxed restrictions on burials in recent years. There is a set of ceremonies, and you have to go up the mountain. The data on the death cases of direct burials in rural areas can be mastered by the local village committee.

The total number of deaths can be obtained by adding the cremation and burial data of these two parts since December 7. China has a huge population base, about 10 million people die every year, and the elderly also die more seasonally in winter. Therefore, it is also necessary to use the death data of December and January held by the civil affairs department for the period of 2017-2021, first take the five-year average, and then take the two-month average, and subtract the five-year average and two-month average from the previous total death data After averaging the data, the excess death data is obtained, which is very close to the real death data of the first wave of the epidemic in China.

The other is a rough estimate method.

During the closure of Shanghai from March to May 2022, the official announced that there were 588 deaths from February 26 to June 1, and the number of infection cases (confirmed cases + asymptomatic infections) in Shanghai during this period was about 627,000. The case fatality rate is 9.4 per 10,000, which is very close to the case fatality rate of Australia, New Zealand, South Korea, Singapore and other developed countries, which proves that the case fatality rate of Shanghai is quite reliable.

In 2021, the aging rate of the population over the age of 60 in the country will be 18.9%, and it will be as high as 36.3% in Shanghai, which is 17.4 percentage points higher than the national rate. However, there are four obvious favorable factors in Shanghai, namely: the medical conditions are significantly higher than the national average; Shanghai’s city closure season is spring, which is significantly better than winter when the first wave of the epidemic peaked rapidly; Shanghai’s BA.2 epidemic was prevalent when the city was closed The virus strains are not as good as the BA.5 and BF.7 strains that are popular throughout the country in winter in terms of transmissibility and immune escape ability; Shanghai and the whole country generally receive booster shots in the second half of 2021, and the vaccine booster shots are still in the protection period when the city is closed in the spring of 2022 However, when the lockdown was lifted in winter, the protection period for almost all Chinese people to be vaccinated had passed. The above-mentioned pros and cons factors offset each other, and the case fatality rate in Shanghai when the city was closed can be used to calculate the national case fatality rate in the first wave of the epidemic.

Since China no longer counts asymptomatic infections and does not carry out nucleic acid testing for all employees, it is difficult to accurately count the existing infection cases in China, but it is not difficult to make the statistics close to each other. Local disease control departments have already started to take action, that is, stratified random sampling, and some areas do not only do it once, but once a week.

On January 9, the Health and Health Commission of Henan Province announced at a press conference that as of January 6, the infection rate of the new coronavirus in the province was 89.0%, including 89.1% in urban areas and 88.9% in rural areas. This is the only province so far that has announced the infection rate, and it is very consistent with the feelings of the people. The author randomly consulted a number of relatives and friends, and generally answered that 80% to 90% of the epidemic units or hometowns have been positive.

Even with a conservative calculation of 80% infection rate, multiplied by the national population of 1.41 billion, China has had about 1.128 billion infections in the month since December 7, with an average of about 37 million infections per day. Multiplying this by the case fatality rate of 9.4 per 10,000 when Shanghai was closed, it can be calculated that there were about 1.06 million deaths in the first wave of the epidemic in China.

Singapore’s “Lianhe Zaobao” reported on January 14 that Dr. He Meixiang, a part-time researcher at Taiwan’s “Academia Sinica”, analyzed in an interview that based on Taiwan’s epidemic situation, the number of deaths in the mainland is expected to reach at least 900,000.

The peak of the first wave of epidemics in rural areas has passed

Some “bricks” still follow the old public health experience, believing that the infection rate of the first wave of the new crown epidemic is about 30%, there will be a peak of infection in rural areas after the Spring Festival travel, the peak of the national incidence will continue for two to three months, and the epidemic this winter will have “one peak and three waves” (That is, the first wave is from mid-December 2022 to mid-January 2023, mainly in cities; the second wave is from late January to mid-February 2023, caused by the movement of people before the Spring Festival; the third wave is from February 2023 From late March to mid-March, due to returning to work after the Spring Festival), etc.

Facts have shown that these were misjudgments. Omicron has a strong transmission power. The first wave of infection rate in the country is not less than 80%, and even as high as 90% in many areas; the south is about a week later than the north, the rural area is about a week later than the city, and the peak of severe cases is one week later than the peak of infection and lasts for a long time longer. However, within a month, almost the whole country passed the peak quickly, and there was no first wave dominated by cities, and the peak of infections only appeared in rural areas during the Spring Festival.

The infection data reported by Henan on January 9 also conveyed two key messages: first, the peak of infection in the province has passed; second, the infection rates in urban and rural areas are very close, with a difference of only 0.2 percentage points. This survey is closer to reality, and it is also in line with the author’s survey and judgment.

The National Health and Medical Commission disclosed at a press conference on January 14 that the number of fever clinics nationwide peaked at 2.867 million visits on December 23, 2022, and then continued to decline, falling back to 477,000 visits on January 12. , the number decreased by 83.3% from the peak, and the rural area also showed a downward trend, indicating that the urban and rural trends are converging; as of January 12, there were 15,800 severe COVID-19 positive patients in the county, accounting for 15.1% of the national total. There were 518 cases of severe virus infection, accounting for 6.7% of the country’s severe cases of new coronavirus infection.

This clearly confirms that the first wave of the epidemic in rural China has generally passed, and the medical conditions of the severely ill patients in rural areas are far inferior to those in cities (the National Health Commission only counts “in hospital”), which indirectly confirms that a large number of death cases in rural areas are not “in hospital” , but not included in official statistics.

When this wave of epidemics was spreading rapidly across the country, the joint prevention and control mechanism of the State Council hastily set up a “special team for epidemic prevention and control in rural areas”. Elderly people in rural areas can’t expect any help from the special work class or the government.

The difference is that the elderly in rural areas do not have the right to speak, are not familiar with smartphones and computers, have the energy and culture to fill out questionnaires online, and are not as good as urbanites and young people. Chinese farmers have always been simple and docile, and they never blame the government or the society for their misery.

The only fortunate thing is that the three weeks from December 20 to January 10 in the south are generally warm. For example, the highest temperature in Shanghai is usually around 15 degrees. If the temperature during the three weeks of the outbreak is as low as 0-5 degrees, like this week, more elderly people will not be able to survive this winter.

It is a fact that China has survived the peak of the first wave of epidemic infections in rural areas. There will be second, third, and N waves of epidemics in the future. Countries that coexist with the virus may have as few as five waves or as many as nine waves. Therefore, the top priority in rural areas is to improve medical capabilities, strengthen team building, conduct emergency drills, promote urban and rural counterpart assistance, and properly stockpile antigens, N95 masks, antipyretics, small molecule antiviral drugs and other materials.

(Note: The author is an independent reviewer, WeChat official account: SSWYPL. This article only represents the author’s personal opinion. The email address of the editor is bo.liu@ftchinese.com)

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