True COVID death toll in China estimated in hundreds of thousands

TThe nearly 60,000 Covid-related deaths China has reported in the first five weeks of its current outbreak, the largest the world has ever seen, may underestimate the true toll of hundreds of thousands of deaths, experts said.

China’s abrupt turnaround from Covid Zero in early December unleashed a surge in omicron infections and led to 59,938 virus-related deaths in the nation’s hospitals through Jan. 12, the National Health Commission revealed this weekend.

Read more: China’s extraordinary U-turn on Zero-COVID shifts from suffocating scrutiny to callous inaction

While the number surpasses the few dozen deaths previously recorded in the official tally – which has drawn widespread criticism both at home and abroad, including from the World Health Organization – experts say it is likely still a underestimate given the massive scale of the epidemic and the death rates observed at the height of the omicron waves in other countries initially pursuing a Covid Zero strategy.

“This reported number of Covid-19 deaths may be the tip of the iceberg,” said Zuo-Feng Zhang, chair of the department of epidemiology at the Fielding School of Public Health at the University of California, Los Angeles.

While the figure is roughly in line with what Zhang said could come from the country’s hospitals, he said it was only a fraction of the total number of Covid deaths across the country.

Using a report from Peking University’s National School of Development that found 64 percent of the population had been infected in mid-January, he estimated that 900,000 people would die in the previous five weeks based on a conservative death rate of 0 ,1%. This means that the official count of hospital deaths is less than 7% of the total mortality observed during the epidemic.

The official toll translates to 1.17 deaths per day for every million people in the country over the course of five weeks, according to an analysis by Bloomberg. It is well below the average daily death rate seen in other countries that initially pursued Covid Zero or managed to contain the virus after easing their pandemic rules.

When omicron hit South Korea, daily deaths quickly climbed to nearly seven for every million people. Australia and New Zealand saw mortality approaching or exceeding four per million per day during their first winters with omicrons. Singapore, which has had a gradual and well-planned move away from its zero-tolerance approach, has also seen a spike in deaths of around two people per million per day.

“These figures would suggest that China is experiencing a very mild wave, with very few deaths by accident,” Louise Blair, head of vaccines and epidemiology at the London-based predictive health analytics company, said in an email. London Airfinity. “It would be the lowest of any country/region abandoning a zero Covid policy.”

It could be that many of the country’s deaths occurred in nursing care facilities or at home, explaining some of the underreporting, he said, as China’s latest disclosure only counted hospital deaths. Reports of overloaded crematoria across the country suggest that excess mortality is at a high level.

Read more: Satellite images appear to show the high COVID death toll in China

The group currently estimates the total count of Covid-related deaths in China at around 390,000, with a potential range of 77,000 to 945,000 based on deaths seen in other countries, it said.

WHO Director-General Tedros Adhanom Ghebreyesus welcomed the new numbers from China, saying they allow for a better understanding of the situation and potential impact of the Covid surge in China. He also asked the country to continue sharing that information and to provide a more detailed breakdown of the data by province over time.

New definition

China has narrowed its definition of Covid mortality after dismantling its zero-tolerance approach, with health authorities asking hospitals to limit Covid deaths to those who died of respiratory failure after contracting the virus.

This has led to a shortage of reported deaths throughout December and into early January. Of the 60,000 Covid deaths reported over the weekend, just over 9% died of respiratory failure, the NHC said. The rest died of underlying illnesses following a Covid infection, the agency said.

The number of deaths is expected to rise as the virus continues its relentless journey across the country, as mortality tends to delay infections by a few weeks, officials said. The Lunar New Year holiday, which starts on Jan. 21 and involves millions of people traveling to their hometowns, could increase its prevalence, said Ali Mokdad, a professor at the Institute of Health Metrics and Evaluation and head of strategy for population health at the University of Washington.

The group’s modeling efforts predict 1.2 million to 1.6 million deaths in China by the end of 2023, depending on the mitigation measures the country puts in place, Mokdad said.

China is able to accurately track Covid mortality despite the size of its current outbreak, UCLA’s Zhang said, thanks to data from its public safety, civil administration and hospital systems.

“More detailed information and transparent data on the coronavirus situation in China must be shared with the World Health Organization, other countries and the Chinese people,” he said.

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