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Wednesday, February 15, 2023

How Deadly Was China’s Covid Wave? - The New York Times

How Deadly Was China’s Covid Wave?

"Two months after China ended “zero Covid,” rough estimates suggest that between 1 and 1.5 million people died — far more than the official count.

China’s official count

Model based on Shanghai outbreak

1.6 million deaths

Estimate using travel patterns

Estimate using recent testing data

1.5 million deaths

Estimate based on U.S. death rates

1.1 million deaths

After China relaxed the world’s most stringent Covid-19 restrictions in December, the virus exploded. Hints of the surge were everywhere: Hospitals turned away patients. Crematories were overwhelmed with bodies. A wave of top scholars died.

But China’s official Covid death toll for the entire pandemic remains strikingly low: 83,150 people as of Feb. 9. That number is a vast undercount, researchers believe, in part because it only includes infected people who died in hospitals, excluding anyone who died at home.

While a precise accounting is impossible, epidemiologists have been working to piece together the mystery of the outbreak that accelerated in December. Four separate academic teams have converged on broadly similar estimates: China’s Covid wave may have killed between a million and 1.5 million people.

All of the researchers consulted by The New York Times cautioned that without reliable data from China, the estimates should be understood as informed guesses, with significant uncertainty — although the estimates fit the evidence far better than the official figures do.

The question of how many people died has enormous political relevance for the ruling Communist Party. Early in the pandemic, China’s harsh lockdowns largely kept the coronavirus at bay. Xi Jinping, the top leader, has portrayed that earlier success as evidence of China’s superiority over the West, a claim that would be hard to maintain with a high death toll.

The differences between China’s figures and researchers’ estimates are dramatic. The official numbers would give China the lowest death rate per capita of any major country over the entirety of the pandemic. But at the estimated levels of mortality, China would already have surpassed official rates of death in many Asian countries that never clamped down as long or as aggressively.

How death rates in China may compare

Covid deaths per 100,000 people since 2020

China, higher estimate

China, lower estimate

China, official count

Source: Center for Systems Science and Engineering at Johns Hopkins University; Chinese Center for Disease Control and Prevention; The New York Times. Note: Estimates for China were calculated using official cumulative deaths from Jan. 22, 2020, to Dec. 9, 2022, plus the death counts from the lowest and highest estimates obtained from scientists. Values for other countries are as of Feb. 7, 2023.

At the same time, China would rank below Germany, Italy, the United States and other countries where outbreaks accelerated before vaccines became available.

Two of the estimates were in papers published in academic journals or posted for peer review, while two other analyses were shared by epidemiologists in response to queries from The Times.

Researchers used a variety of approaches to gauge how many people may have been infected and — a crucial question — how effective China’s homegrown vaccines were at preventing death. Some drew on how the virus behaved in past outbreaks in Hong Kong and Shanghai, where data was more reliable, and a few used detailed computer models to simulate the epidemic.

Still others turned to official sampling data, based on China’s systematic testing of hundreds of thousands of people, to develop a model that estimated deaths to be far beyond the government's tally.

“If the data say what we think they say, this was an explosive wave,” said Lauren Ancel Meyers, a professor of biology and statistics at the University of Texas at Austin.

Why official data underrepresents China’s outbreak

China’s official count on Feb. 9

China has a narrow definition of what counts as a Covid-19 death.

As crematories were inundated in December, Chinese officials only announced deaths that involved respiratory failure, leaving out infected people who died of liver, kidney or cardiac failure — an omission that was met with widespread skepticism. In mid-January, the government started releasing data on other deaths, but the figures are still incomplete.

Most glaringly, they exclude people who died outside hospitals. While it is impossible to know exactly how many deaths at home have been missed, from 2018 to 2020, only around one-fifth of all deaths in China occurred in hospitals.

The official figure is “certainly an underreport of all Covid deaths,” said Yong Cai, a demographer at the University of North Carolina at Chapel Hill who studies mortality in China. “There’s no question about that.”

While government data shows that China has doubled the number of intensive care beds since 2020, hospitals were still overloaded during the recent surge. Experts believe hospital deaths probably still account for only a small proportion of total deaths.

“With such a rapid spread, the I.C.U. beds definitely were not enough to cope with the peak,” said Shengjie Lai, an epidemiologist at the University of Southampton.

China reported few deaths until the recent outbreak

New reported deaths by day

Peak deaths reported on Jan. 4.

Source: Chinese Center for Disease Control and Prevention; Center for Systems Science and Engineering at Johns Hopkins University. Note: Death figures are seven-day trailing averages. Figures after Dec. 8, 2022, are approximate and drawn from a chart published by the Chinese C.D.C., as Chinese officials no longer publish exact daily values. Data as of Jan. 30.

The number of people infected is unknown, which further complicates understanding the reach of the epidemic. After two years of widespread testing and quarantining, the Chinese government in December shuttered once-ubiquitous testing centers and made the reporting of self-test results voluntary.

Other data is missing. At least nine cities in different parts of China, including Beijing, have stopped publishing quarterly cremation totals.

An earlier estimate, based on the Shanghai outbreak

1.6 million deaths

Assuming full vaccine protection

Assuming lower vaccine efficacy

1.6 million deaths

Assuming full vaccine protection

Assuming lower vaccine efficacy"

How Deadly Was China’s Covid Wave? - The New York Times

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