A little over a week before celebrating the turn of year 4721 on the lunar calendar, health authorities in China finally revealed what appears to be more realistic and reliable information about the number of deaths in the country resulting from the most recent COVID-19 outbreak, which may be its first wave of national scale. Between December 8, 2022, and January 12 of this year, 59,938 people died as a direct or indirect consequence of infection by the novel coronavirus. Most (56.5%) were aged over 80. The number recorded in these just five weeks is roughly 11 times greater than the total reported by China in the three previous years of the pandemic. Between the moment the SARS-CoV-2 virus emerged in the city of Wuhan in November 2019 and last December, China only officially recorded 5,241 deaths from the infection. With a population of 1.4 billion inhabitants, this is one of the lowest mortality rates in the world. The USA, the country hardest hit by the disease, recorded 1.1 million deaths in the same period.
The new Chinese data was presented at a press conference on January 14 after weeks of questioning from international authorities. Days earlier, the World Health Organization (WHO) had once again complained about the Asian country’s lack of transparency about the current outbreak and claimed that it was underreporting deaths. Until the day before the announcement, the Chinese government continued to state that only 37 people had died from COVID-19 since the beginning of December.
When reporting the latest data to the press, Jiao Yahui, head of the National Health Commission’s Bureau of Medical Administration, specified that 5,503 deaths were due to respiratory failure caused by the virus and the other 54,435 were a result of underlying causes of the infection. She also said that the hospital admissions peak had passed and the number of people in hospital is continuing to decline.
China has kept the world in the dark about the extent to which COVID-19 is spreading in the country since early December, when authorities decided to relax the strict containment policy that had been in force for the prior three years. The so-called Zero-COVID strategy, adopted at the beginning of the pandemic in 2019, consisted of mass testing, travel restrictions, prolonged quarantines for the infected, and even lockdowns of entire cities that could last for weeks. “This approach was good at the beginning, but the way they ended it was reckless,” says Raquel Stucchi, an infectious disease specialist from the University of Campinas (UNICAMP) who has been closely following the current outbreak in China.
According to official data, three years of the pandemic resulted in 397,000 cases of the disease and 5,241 deaths in the country—during the same period, Brazil registered 36.6 million cases and 695,000 deaths. Imposing such restrictive measures for such a long time caused problems for various sectors of the economy and the public had begun showing signs of resistance. In November, when the current outbreak began, people in numerous cities took to the streets to demand the rules be loosened.
In response to the protests, the Chinese government quickly changed its COVID containment policy, reducing testing, eliminating quarantines, and banning lockdowns. A change to how COVID-19 deaths are defined also distorted the data. Since ending its Zero-COVID policy, China has been using highly restrictive criteria to determine which deaths are caused by the disease, which has brought down the numbers. Only deaths from pneumonia or respiratory failure caused by the novel coronavirus are being classified as COVID-19 deaths. Patients who suffer a heart attack or any other fatal incident as a result of systemic damage caused by the virus are not included in the figures.
Projections suggest there will be 300,000 to 500,000 deaths in China by early April
Evidence that the official numbers do not reflect reality continued to come to light throughout December as images of crowded hospitals, bodies piled up in morgues, and queues at crematoriums circulated worldwide via social media and online news reports. An article published in the journal Science on January 3 reported that while the Chinese Center for Disease Control and Prevention (CDC) had confirmed just over 35,000 cases in the last week of December, leaked notes from an internal CDC meeting indicated that nearly 250 million Chinese people (18% of the population) were infected with the coronavirus in the first 20 days of the month. According to a December 25 report by the The New York Times, an official from Zhejiang, a province of 65 million people on China’s east coast, stated at a press conference held in late December that the number of estimated daily cases in the region had passed one million. Other cities were seeing hundreds of thousands of cases a day.
At the end of December, epidemiologist Ali Mokdad of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, USA, told the Think Global Health website that the institute had projected that 300,000 to 500,000 people would die of the disease in China by the beginning of April, depending on the measures adopted by the government. It is estimated that the total number of deaths in the country will exceed 1.2 million by the end of the year.
“The Chinese government could have planned a smoother transition out of Zero-COVID, better structuring health centers to aid the public and promoting initial and booster vaccination campaigns, including with more efficient vaccines provided by other countries,” says Stucchi, from UNICAMP. “This would have allowed people to gradually expose themselves to the virus with less risk of getting sick.”
Xu Wenbo, head of China’s National Institute of Viral Disease Control and Prevention, said in an interview in late December that around 130 strains of the Omicron variant had been detected in the previous three months, many of them, such as XBB, low in frequency but more transmittable. The dominant strains were BA.5.2 and BF.7. One of the fears among nations in the West is that highly transmittable new variants with unknown characteristics could emerge as a result of the virus freely circulating in such a large population.
“By completely lifting the containment measures and with people moving freely between major cities and the countryside for the Chinese New Year celebrations, there is a risk that previously limited variants will begin to circulate more,” warns José Eduardo Levi, a microbiologist from the Institute of Tropical Medicine at the University of São Paulo (USP) and head of research and development at DASA diagnostic medicine. The New Year holidays, during which millions of people travel, began on January 22.
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