Are China’s Coronavirus Numbers Suspicious?

With the worldwide spread of the novel coronavirus accelerating, the old focus on China as the locus of the infection has shifted. This change of focus has helped China to avoid some questions, which still remain, about the reliability of the data that they have been providing to the WHO.

While some journalists have been sceptical about whether China is providing the WHO with the most accurate data on the infection and death rates, there has been, for the most part, a general consensus that China’s numbers are not grossly inaccurate. The numbers received by the WHO may have been massaged a little, or they may have received a touch of politically expedient “cosmetic surgery”. Sure, they have changed a definition here or there. But overall, the numbers are close enough to a reasonable outside estimate anyway.

And hey, perhaps we should give China some credit! It was last year, on the 31st of December, that the WHO was first contacted by the Chinese National Health Commission. 27 patients from Wuhan had been infected, it was said, with a viral pneumonia in what appeared to be a new epidemic, the cause of which was under investigation. On the 9th of January, just ten days later, the cause of the viral pneumonia outbreak was diagnosed as a novel strain of coronavirus, now dubbed COVID-19.

In response, Chinese authorities hardly pulled any punches. They took drastic and unprecedented measures to contain the virus. The entire city of Wuhan was quarantined on the 23rd of January (the largest quarantine in world history). Additional quarantine measures were enacted in other major Chinese cities, including Shanghai, Shenzhen, and Beijing. Despite China’s best efforts, the virus soon escaped its borders. By the 6th of March, nearly 100,000 patients worldwide had contracted COVID-19, and the death toll was nearing 3,500. Outside of China, fast-growing centres of outbreak have settled in countries as diverse as South Korea, Italy, and Iran, with nearly 18,000 infections across the globe.

We are nearing, if we are not already in the midst of, a global pandemic, the likes of which has not been seen since the global outbreak of Spanish Influenza in 1918. In this new climate of emergency, we ought to not lose focus on China and the warranted suspicion that any numbers coming from China’s official mouthpieces will be less than reliable.

For a taster, let’s rewind the clock to 2003.

In that particular year, another epidemic of coronavirus was spreading through China. This was the outbreak of SARS. In February 2003, when the Chinese Centre for Disease Control (CCDC) was first made aware of the outbreak, Chinese authorities were quick to discourage the press from reporting on SARS, and the government also deliberately delayed reporting the epidemic to the WHO. When researchers from the WHO finally traveled to Beijing during the height of this crisis, they were not even allowed access to Guangdong province, the epicentre of the crisis, for several weeks. At first, Chinese authorities reported that 305 patients had been infected, and five had died. Some weeks later, these numbers were revised. Apparently, 806 patients had been infected, and 34 had died. What was the true tally? We may never know.

In the aftermath of the mismanagement of SARS, we are told, China has taken measures to ensure greater transparency in the event of any future epidemic. Reforms were made within the CCDC, and the Chinese National Health Commission was established in 2018. Its role would be to oversee CCDC as well as other health agencies. The Commission compiles and freely publishes regular reports on the status of various health indicators in the country. So, surely now China has learnt its lesson. Shouldn’t we now feel a little more secure with the official numbers coming from China about COVID-19?

No.

Unfortunately, we now know that discussion of the outbreak began to appear online in China some time around mid December. Yet the Wuhan provincial government moved quickly to suppress the news. Wuhan Public Security investigated and detained eight doctors who posted on social media about the virus for spreading “illegal and false” information, that had “severely disrupted social order.” These doctors were forced to sign written confessions of their crimes.

Moreover, Chinese app WeChat began censoring coronavirus-related chat messages on January 1st, over a week before the Chinese authorities acknowledged coronavirus as the cause of the pneumonia outbreak. Ironically, one of the keyword combinations relating to the epidemic that the Chinese authorities were keen to suppress was “epidemic+cover up”.

Even in a post-SARS China, issues around transparency and whistleblowing remain. There was, in the early days, clear evidence of an attempted cover-up, which failed clumsily.

But those were just the early days, right? Now, the official reports from China must be fine, right? Well, I’m not so sure.

According to the Chinese health authorities, the number of COVID-19 infections, as of the 6th of March, stands at 80,555. That is a big number. Even so, there are other numbers that do not get much airtime, and which are entirely anomalous in the story of the outbreak. In particular, China’s official numbers on infectious disease, which are published monthly and are freely available through the National Health Commission’s website, give us serious reason to doubt the numbers coming from China. Why, for example, do these published reports show an unprecedented increase in the number of cases of infectious disease in December last year, when the novel coronavirus was supposedly only in its nascent stages? Why did the number of cases of infectious disease skyrocket at the end of 2019? First, I better be clear about what I mean when I say “skyrocket”.

Take the final two months of 2019: November and December. According to the reports of the National Health Commission, the total incidence of infectious disease was 670,999 in November. This number leapt to more than 1.71 million in December. That is to say, December’s reported incidence of infectious disease is roughly a million cases over the previous month’s numbers and, please read this carefully, roughly a million cases over the monthly average across the previous three years. As can be seen, seasonal variation is relatively minor across the previous three years, and goes no way to explaining this spike in infections.

All Infectious Disease Reports (Dec 2016 — Dec 2019)

The question then is where did these million extra infections come from? When we examine the summaries of the National Health Commission’s reports more closely, the breakdown of diagnoses should signal alarm bells. Worryingly, out of the 1.71 million cases of infectious disease reported in December, an unprecedented 1.2 million were diagnosed as cases of influenza, a disease with an extremely similar pathology to COVID-19. Compare December’s 1.2 million cases to November’s: a mere 156,000. November’s low count is not unusual, and it is similar to the reported influenza numbers (which fluctuate between about 50,000–200,000 cases) across the previous three years.

If these numbers are correct (and if we are to believe China’s official explanations) then we are supposed to believe the following two things:

By the end of December 2019, 27 patients had contracted a novel coronavirus about which nothing was known, but this outbreak was enough to warrant alerting the WHO immediately. By the end of December 2019, the combined total of all other cases of infectious disease simultaneously leapt to around a million cases above the monthly average for the previous three years (an increase of around 140%). This included an unprecedented 1.2 million cases of influenza.

These two facts would constitute an incredible coincidence if they were both true. They would suggest that just as China was bracing itself to deal with a new outbreak of coronavirus (which would eventually go on to cripple the economy and overload the health system), an unprecedented outbreak of influenza arrived, which would have been, by its own strength, the most serious public health crisis in mainland China since the SARS panic.

A more worrying explanation for these numbers is that the true rate of COVID-19 infection has been hidden, whether by accident or by design, in the more general infectious disease statistics. To my mind, the question is not whether the spike in the above graph hides some COVID-19 cases; the question is just exactly how many. How many patients among the extra million influenza cases in December were actually suffering from COVID-19?

Despite the fact that only 27 patients had been formally diagnosed as having the novel coronavirus on December 31st when the WHO was first alerted, I think it is clear that China may already have been aware that the leap in influenza reports was explained by a different virus altogether. Given China’s troubling track-record when faced with crises like this, we should continue to apply pressure for greater transparency, greater media liberty, and, most important of all for the present moment, an explanation for 1.2 million anomalous cases of influenza.

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Note to the reader: all of the numbers associated with the above graph are freely available through the official website of the Chinese National Health Commission. To cross-check the data listed here, search 全国法定传染病疫情 with the year and month that you want to check, e.g. “ 全国法定传染病疫情 2018 12”. Then find the data as provided at nhc.gov.cn