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How deadly was China’s Covid wave?

Via The New York Times: How Deadly Was China’s Covid Wave? Excerpt:

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. 

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.

‘It was all for nothing’: Chinese count cost of Xi’s snap decision to let Covid rip

Via The Guardian: ‘It was all for nothing’: Chinese count cost of Xi’s snap decision to let Covid rip | Coronavirus. Excerpt:

When Sunny[not her name] thinks back to March last year, she laughs ruefully at the ordeal. The 19-year-old Shanghai student spent that month locked in her dormitory, unable to shop for essentials or wash clothes, even banned from showering for two weeks over Covid fears. In April, the entire city locked down.  

It was the beginning of the chaos of 2022, as local Chinese authorities desperately tried to follow President Xi Jinping’s zero-Covid decree while facing the most virulent strain of the virus yet: Omicron. “Everyone was panicking, no one was ready,” she tells the Observer.  

By the end of the year, zero-Covid was gone. Sunny says she felt instantly “relieved” that lockdowns were over but her feelings soon turned to anger as it became clear China’s government had opened up the country, knowing it wasn’t ready. “I felt it was all for nothing,” Sunny says.  

Over the last two months, the virus has rapidly spread through the country. Up to 10,000 critical cases were registered in hospitals every day. Morgues were overwhelmed, pharmacies reported shortages of basic medications, and supply of antiviral drugs was held up by protracted negotiations with foreign suppliers. Online and in the streets, people spoke of almost everyone they knew having caught Covid, and of elderly relatives dying.  

Sunny’s grandfather was among those who died in that wave. “It was the morning, and my mum walked into my room and said: your grandpa is in the emergency room,” she recalls. “A few hours later, he passed away. My grandmother was in tears, saying he had left her behind.”  

Xi’s extraordinary backflip left analysts alarmed and confused. China was not the only country to choose a zero-Covid strategy, and certainly not the only one to “let it rip” once it dropped it. But it was the last, and global health experts say there were plenty of lessons it could have heeded – primarily, making sure vaccinations and health resources were high before the tsunami of cases hit.  

“All governments had to decide to open up at some stage or risk the consequences of lockdowns far outweighing the problems of Covid,” says Professor Emma McBryde, an epidemiologist at James Cook University, Townsville, Queensland, Australia. 

 “Most models suggest that it would be better for the health system to open up slowly. Although there would be little change in how many people get infected, it could mean some lives are saved if the health system can function well.”  

But Xi threw the gates open. Right up until the day of repeal, local governments were still developing and enforcing zero-Covid measures and infrastructure. The city of Chongqing was building a 21,000-bed quarantine centre.  

Experts on health and Chinese politics have told the Observer they believe the local authorities were hamstrung. Any preparations for ending zero-Covid would be seen as a vote of no confidence in both the policy and Xi – an act of political suicide.

China says peak COVID-19 infections exceeded 7 million daily, deaths more than 4,000 daily

Via CNA: China says peak COVID-19 infections exceeded 7 million daily, deaths more than 4,000 daily.

HONG KONG: China's daily new COVID-19 infections hit a peak of more than 7 million per day around Dec 22, while deaths reached a daily peak of more than 4,000 on Jan. 4, the country's Centre for Disease Control and Prevention said on Wednesday (Jan 25).  

The figures, published on the centre's website, come after a prominent government scientist said over the weekend that 80 per cent of China's 1.4 billion population have already been infected, making the possibility of a big COVID-19 rebound over the next two or three months remote. 

"Around Dec 22, 2022, the number of infected people and the number of fever outpatient consultations reached a peak," it said, with the number of new infections "exceeding 7 million per day and the number of daily fever outpatient consultations peaking at 2.867 million".

China has passed the peak of COVID-19 patients in fever clinics, emergency rooms and with critical conditions, a National Health Commission official said last week.  

Nearly 60,000 people with COVID-19 had died in hospital as of Jan 12, roughly a month after China abruptly dismantled its strict zero-COVID policy, according to government data.  

But some experts said that figure probably vastly undercounts the full impact, as it excludes those who die at home and because many doctors have said they are discouraged from citing COVID as a cause of death.

China records almost 60,000 Covid-related deaths after abrupt shift in policy

Via the South China Morning Post: China records almost 60,000 Covid-related deaths after abrupt shift in policy. I wish I could believe it. Excerpt:

China said on Saturday it had recorded almost 60,000 Covid-related deaths between December 8 and January 12, and the current wave has already peaked.   

It is the first time China has released a death toll since its abrupt pivot away from the zero-Covid policy last month.  

Jiao Yahui, director of the National Health Commission’s medical affairs department, said medical institutes had recorded 5,503 deaths as a result of respiratory failure triggered by Covid infection and 54,435 deaths of people infected with Covid-19 but with underlying conditions, such as cancer or cardiovascular diseases.  

The average age of those who died was 80.3, and 90 per cent of fatalities were aged 65 or over.  

Jiao also said the current wave of cases had peaked. “The number of fever clinic visitors is generally on a downward trend after peaking, both in cities and rural areas,” she added.  

Jiao said the number of emergency patients was also declining and the ratio of patients who had tested positive for Covid-19 was steadily falling as well.  

Jiao said there had been 128,000 patients with severe Covid-19 on January 5, but the number had dropped to 105,000 by January 12.  

The use rate for intensive care hospital beds was 75.3 per cent, she added.  

Among the critically ill Covid-19 patients on January 12, there were 97,000 patients with severe underlying conditions, accounting for 92.8 per cent. The remainder, some 7,357 people, had Covid only.

The dire aftermath of China’s untenable “Zero COVID” policy

In The New Yorker, Druv Khullar writes: The Dire Aftermath of China’s Untenable “Zero COVID” Policy. Excerpt:

In “How to Lie with Statistics,” a best-selling book from 1954, the journalist (and tobacco apologist) Darrell Huff details common techniques for manipulating people’s understanding of reality, among them truncating the y-axis of a graph. A trend line starts in a chart’s midsection and moseys up and to the right—a gradual rise over time. But if you hack off empty space at the bottom and zoom in on the action, the line takes off like a rocket. The axis transforms the narrative.  

Throughout the pandemic, we have truncated not the y-axis but the x-axis: stopping time to pass judgment on a nation’s performance instead of waiting to consider the broad sweep of the covid-19 years. Cut the graph at the summer of 2020 and the United States is a catastrophic outlier, a beacon of pandemic mismanagement. Let it roll a few more months and European countries botch their reopening, unleashing a wave of deaths. Press play again and India is engulfed in a viral inferno that threatens not only its own citizens but, because it stopped exporting vaccines for half a year, millions of lives around the world.  

Last month, China, after suppressing the virus for three years through its often draconian “zero covid” policy—recording just five thousand covid deaths in a population of 1.4 billion—abruptly abandoned that approach and is now consumed by an enormous viral surge. The country that was home to the first coronavirus outbreak may now experience its worst. The axis transforms the narrative.  

In the past month in China, hospitals, pharmacies, and funeral homes have been overwhelmed, but the scale of the misery is anyone’s guess. The country no longer tallies asymptomatic infections or reliably reports covid deaths—employing not the distortion of statistics but their omission. According to minutes from a meeting of the National Health Commission, however, a quarter of a billion people are thought to have contracted the virus in the first three weeks of December; an estimated thirty-seven million were infected on a single day.  

Experts expect the initial surge to peak in the cities later this month, but a second, possibly more punishing wave could tear through rural areas in February or March, after millions of people trek home for the Lunar New Year. Projections of the eventual fallout vary, but some models anticipate that one to two million people will die of covid in the coming months.

WHO says China releases COVID hospital data after reporting gap

Via Reuters: WHO Says China Releases COVID Hospital Data After Reporting Gap. China's National Health Commission, however, hasn't updated its COVID-10 reports since December 24. Excerpt:

GENEVA (Reuters) -The World Health Organization received data from China on new COVID-19 hospitalisations after a reporting gap, with figures on Thursday showing a nearly 50% increase in the week to Jan. 1.  

The U.N. health agency received no data from China in the weeks after Beijing lifted its zero-COVID policy in early December, prompting some health experts to question whether it might be hiding information on the extent of its outbreak. 

The WHO's latest report showed 22,416 new hospitalisations for mainland China in the week to Jan. 1 versus 15,161 the previous week. This was still below the all-time peak of nearly 29,000 admissions in early December.  

Over the same week, the report showed China had 218,019 new cases and 648 new deaths, although these figures typically include Hong Kong, Taiwan and Macau as well as mainland China. During the same period, the Chinese Center for Disease Control and Prevention reported nine deaths.  

The WHO did not release a report last week due to end of year holidays.  

On Wednesday, WHO officials gave their clearest criticism yet of China's recent handling of the pandemic, saying COVID-19 data is not giving an accurate picture of the situation and under-represents the number of hospitalisations and deaths.

China is flying blind as pandemic rages

Via Science: China is flying blind as pandemic rages. Excerpt:

Most scientists believe China’s decision to end its zero-COVID policy was long overdue. But now they have a new worry: that the country is collecting and sharing far too little data about the rough transition to a new coexistence with the virus.  

China abruptly dropped virtually all controls a month ago, after protests, a sagging economy, and the extreme transmissibility of the virus’ latest variants made clinging to zero COVID untenable. Now, “SARS-CoV-2 has an open goal in front of it: a population with very low levels of standing immunity,” says evolutionary biologist Edward Holmes of the University of Sydney. But how the epidemic is unfolding is a mystery because the country has practically stopped collecting basic epidemiological data.  

Models that predicted a massive wave of infection and death if China ended zero COVID appear to have been correct. Press reports and social media posts have shown intensive care units stretched beyond capacity, with crowds of patients in wheelchairs and on gurneys in hallways. Doctors and nurses are reportedly working while sick. Crematoriums are overwhelmed. 

But China’s official COVID-19 death toll is widely considered laughably low. And some scientists worry a genomic monitoring plan unveiled last month doesn’t have the power to detect new SARS-CoV-2 variants arising as the virus works its way through one-fifth of the world population.

Earlier in the pandemic China’s daily counts of COVID-19 cases and deaths, based partly on its exhaustive testing programs, were generally believed to be accurate. Now, they are anyone’s guess. Patients with mild symptoms are not encouraged to get tested, let alone those who are asymptomatic. People testing positive at home are not asked to report their results.  

The China Center for Disease Control and Prevention (China CDC) put the number of confirmed cases the last week of December 2022 at more than 35,000—a fraction of the official number in the United States. But leaked notes from an internal meeting suggest a very different reality: The agency was told that almost 250 million people in China—roughly 18% of the population—may have caught COVID-19 in the first 20 days of December. Some experts said the number is implausibly large, but Yanzhong Huang, a global health specialist at the Council on Foreign Relations, a U.S. think tank, says it’s “not unreasonable,” given credible reports that 80% of Beijing residents have been infected by now.  

As to the death toll, China’s reporting had long been inconsistent, Huang says, with some regions reporting all fatalities in which SARS-CoV-2 was a factor, as most countries do, and others excluding people who died from other conditions, such as heart attacks, even if they had COVID-19. In early December, China’s government decided the narrower definition should be used nationwide.  

Even then, the official count is astonishingly low: just eight deaths for the entire last week of December, which is “not matching media reports and what is being seen on social media,” says Louise Blair, who tracks China’s COVID-19 outbreak for Airfinity, a London-based health analytics firm that estimates about 9000 people were dying of COVID-19–related causes every day in late December.  

Also missing are data on case fatality rates, the average number of new infections stemming from each case, and hospital and intensive care admissions. “These are critical data” that would help health authorities get a handle on the surge and further the world’s understanding of the pandemic, says Xi Chen, a public health scientist at the Yale School of Public Health.

Up to 70% of Shanghai population infected with COVID-19: Top doctor

Via Channel NewsAsia: Up to 70% of Shanghai population infected with COVID-19: Top doctor. That means about 17.5 million people in Shanghai alone have COVID-19.

SHANGHAI: A senior doctor at one of Shanghai's top hospitals has said 70 per cent of the megacity's population may have been infected with COVID-19 during China's huge surge in cases, state media reported Tuesday (Jan 3).  

The steep rise in infections came after years of hardline restrictions were abruptly loosened last month with little warning or preparation, and quickly overwhelmed hospitals and crematoriums.  

Chen Erzhen, vice president at Ruijin Hospital and a member of Shanghai's COVID-19 expert advisory panel, estimated that the majority of the city's 25 million people may have been infected.  

"Now the spread of the epidemic in Shanghai is very wide, and it may have reached 70 per cent of the population, which is 20 to 30 times more than (in April and May)," he told Dajiangdong Studio, owned by the Communist Party mouthpiece People's Daily.  

Shanghai suffered a gruelling two-month lockdown from April, during which over 600,000 residents were infected and many were hauled to mass quarantine centres.  

But now, the Omicron variant is spreading rampantly across the city and experts predict infections there will peak in early 2023. In other major cities, including Beijing, Tianjin, Chongqing and Guangzhou, Chinese health officials have suggested that the wave has already peaked.  

In neighbouring Zhejiang province, disease control authorities said Tuesday that there had been one million new infections in recent days and that the province was entering a peak plateau for COVID-19.  

Chen added that his Shanghai hospital was seeing 1,600 emergency admissions daily - double the number prior to restrictions being lifted - with 80 per cent of them COVID-19 patients.  

"More than 100 ambulances arrive at the hospital every day," he was quoted as saying, adding that around half of emergency admissions were vulnerable people aged over 65.  

At Tongren Hospital in downtown Shanghai, AFP reporters saw patients receiving emergency medical attention outside the entrance of the overcrowded facility on Tuesday.  

The corridors overflowed with dozens of elderly patients lying on beds crammed together, hooked up to IV drips. Some patients wore oxygen masks attached to bedside canisters.

Airfinity’s COVID-19 forecast for China infections and deaths

Via Airfinity: Airfinity’s COVID-19 forecast for China infections and deaths. Excerpt:

Daily Infections: 1.8 million  

Daily deaths: 11,000  

Cumulative cases since 1st December: 20.4 million  

Cumulative deaths since 1st December: 110,000  

Data last updated on 30th December 2022  

Airfinity is forecasting COVID-19 infections to reach their first peak in China on the 13th January with 3.7 million cases a day.  

Deaths are estimated to peak 10 days later at approximately 25,000 a day, by that stage a total of 584,000 since the virus began surging across the country in December. We predict 1.7 million deaths across China by the end of April 2023.  

Airfinity’s model is based on data from China’s regional provinces, before changes to reporting infections were implemented, combined with case growth rates from other former COVID-zero countries when they lifted restrictions such as Hong Kong and Japan.  

Using the trends in regional data our team of epidemiologists has forecast the first peak to be in regions where cases are currently rising and a second peak driven by later surges in other Chinese provinces.  

Airfinity predicts cases in Beijing are likely to have peaked by now, with hospitalisations and deaths likely to peak in the next 1-2 weeks.  

Our model estimates a second peak will occur on the 3rd March 2023 where daily cases are likely to reach 4.2 million a day. It is expected that rural areas with be more impacted in this later wave.

Shanghai hospital warns of 'tragic battle' as COVID spreads

Via Reuters: Shanghai hospital warns of 'tragic battle' as COVID spreads. Excerpt:

SHANGHAI/BEIJING, Dec 22 (Reuters) - A Shanghai hospital has told its staff to prepare for a "tragic battle" with COVID-19 as it expects half of the city's 25 million people will get infected by the end of next week, while the virus sweeps through China largely unchecked.  

After widespread protests against strict mitigation measures, China this month began dismantling its "zero-COVID" regime, which had taken a great financial and psychological toll on its 1.4 billion people.  

China's official death count since the pandemic began three years ago stands at 5,241 - a fraction of what most other countries faced - but now looks bound to rise sharply.  

China reported no new COVID deaths for a second consecutive day for Wednesday, even as funeral parlour workers say demand for their services has increased sharply over the past week.  

Authorities - who have narrowed the criteria for COVID deaths, prompting criticism from many disease experts - confirmed 389,306 cases with symptoms.

Some experts say official case figures have become an unreliable guide as less testing is being done following the easing of restrictions.  

Infections in China are likely to be more than a million a day with deaths at more than 5,000 a day, a "stark contrast" from official data, British-based health data firm Airfinity said this week.  

Airfinity said it examined data from China's regional provinces, noting that cases are rising quicker in capital Beijing and southern province Guangdong.

The Shanghai Deji Hospital, posting on its WeChat account late on Wednesday, estimated there were about 5.43 million positives in the city and that 12.5 million in China's main commercial hub will get infected by the end of the year.