China narrows definition of COVID-19 deaths in official count – The Diplomat


China only counts deaths from pneumonia or respiratory failure in its official COVID-19 death toll, a Chinese health official said, a narrow definition that limits the number of deaths that will be reported if the virus surges after the easing of pandemic-related restrictions.

Deaths in patients with pre-existing conditions are not counted as COVID-19 deaths, said Wang Guiqiang, chief of the infectious diseases department at Peking University No. 1 Hospital.

China has always been conservative in counting diseases, whether it’s the flu or COVID-19. In most countries, including the United States, guidelines provide that any death in which COVID-19 is a factor or contributor is counted as a COVID-19-related death.

In fact, Wang’s comments on Tuesday publicly clarified what the country has been doing during the pandemic.

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On Wednesday, China reported no new COVID-19 deaths and subtracted one death from its total, bringing it down to 5,241, according to a daily tally by the National Health Commission, which didn’t explain the drop.

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The clarification on how China officially records COVID-19 deaths comes as cases have surged across the country amid the easing of restrictions. But the total remains blurry as China has stopped requiring daily PCR testing and many people are testing at home. Anecdotally, many people in cities like Beijing and Shanghai have fallen ill.

Earlier this year, Shanghai was hit by an outbreak caused by Omicron. Several people told the AP at the time that their elderly family members who tested positive for COVID-19 and died were not counted in the city’s official death toll. If patients had underlying diseases, the deaths were attributed to them.

An AP investigation then showed the numbers were clouded by the way health officials collect COVID-19 statistics and apply a much narrower, less transparent, and sometimes changing standard as Shanghai has changed the definition of positive cases .


These tighter criteria mean that the death toll from COVID-19 in China will always be significantly lower than in many other countries.

An Associated Press reporter saw several bodies being wheeled out of funeral homes in Beijing last week, and two relatives said their loved ones had died after testing positive for COVID-19. However, last week the country reported no deaths due to COVID-19.

Medical resources in smaller cities and rural communities, home to about 500 million of China’s 1.4 billion people, lag far behind those of big cities like Beijing and Shanghai. The rural medical infrastructure includes 17,000 county-level hospitals, many of which do not even have a single intensive care unit bed, 35,000 community health centers and 599,000 village clinics.

In southwest Beijing, hospital emergency rooms in smaller towns are overwhelmed. On Wednesday, AP journalists saw dozens of elderly patients in critical condition being wheeled into overcrowded hospital wards in Zhuozhou, China’s industrial province of Hebei.

Two undertakers and a crematorium worker in Zhuozhou said deaths have increased since the government eased COVID-19 restrictions. One of the shopkeepers, who did not give his name because of the sensitivity of the issue, added that the city’s crematorium burned 20 to 30 bodies a day, from three to four before COVID-19 restrictions were lifted.

Different countries count cases and deaths differently, and patchy testing means direct comparisons are often misleading.

But experts have repeatedly warned that authorities should err on the side of caution when counting deaths. The World Health Organization notes in guidelines that “probable” COVID-19 cases and deaths where COVID-19 was a contributing factor should also be counted as COVID-19 deaths. Problems with the number of deaths have raised questions in countries from South Africa to Russia.

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The WHO estimated in May that nearly 15 million people died from COVID-19 or from overwhelmed health systems in the first two years of the pandemic. That’s significantly more than the official death toll of over 6 million for that period.