China’s novel coronavirus, COVID-19, has killed and infected more people than officially reported.

Consider the latest numbers. In one day, total reported infections and deaths increased 44 percent and 23 percent, respectively. But not “because of any change in the shape of the outbreak,” which is nonetheless growing near-exponentially. Rather, it was merely because “the government changed the criteria by which it tracks confirmed cases.”

The official tally has been an underestimate and is still catching up to reality. As of Saturday, more than 1,500 people had reportedly died of the virus, with more than 69,000 cases reported worldwide. About 99 percent of the cases have been reported in China.

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Even before the adjustment, circumstances suggested weeks ago that “the outbreak is spreading far beyond the official count of cases.”

Many causes contribute to this undercounting.

First, the prevailing diagnostic test for COVID-19 may be only 30 to 40 percent accurate. Some carriers who took the diagnostic test were falsely cleared and erroneously excluded from the official tally.

Second, the diagnostic test itself is scarce. Tests are rationed for the most obviously symptomatic patients. But carriers can be asymptomatic. And they can be contagious before they even show signs of infection.

Third, Chinese hospitals have been overwhelmed with patients. Some people were turned away at the door. Others waited in day-long triage. The sickest may have been too weak to even attempt a hospital visit. Others were deterred from treatment by the wait times and shortages, so they self-quarantined. Yet only those who obtained medical treatment and also tested positive for the virus were included in the official tally.

Fourth, resources and public attention have concentrated on Wuhan, a city of 11 million, where the first cases of COVID-19 were reported. However, tens of millions more live in Wuhan’s surrounding province, Hubei, which is less equipped with healthcare services. To the extent uncounted cases exist in Wuhan, more uncounted cases exist in Wuhan’s exurbs.

In order for China's ruling Communist Party to have responded to COVID-19 this drastically, the death toll would first have had to exceed local officials’ capacity to cover it up, and then also convinced the nation’s top officials that it represents an existential threat.

Fifth, on top of these logistical challenges, politics also prevents an accurate appraisal. China’s communist government is a totalitarian, one-party state. The party justifies its monopoly by promising social stability and economic growth. News of an outbreak threatens both objectives, so the party has an existential interest in suppressing bad news.

“Political issues are at any time the most fundamental major issues,” said Hubei governor Wang Xiaodong.

For example, Dr. Li Wenliang noticed the virus in his hospital before it was publicly reported. He told his colleagues to take extra precautions.

So when government authorities learned of Dr. Li’s discovery, they did not contain the virus. They contained Dr. Li, instead. He was arrested and forced to sign a false confession for spreading “rumors.” Officially, there was no virus.

Dr. Li died of COVID-19 several weeks later.

Meanwhile, two others who also exposed the virus’s impact, Chen Qiushi and Fang Bin, were uploading videos from inside Wuhan. Government authorities tracked them down and disappeared them. Chen’s family believes he was detained in quarantine with COVID-19 carriers, even though he appeared healthy.

For decades, China’s communist party has treated dissidents like an “evil” virus to be isolated and eliminated. Victims include a Nobel Peace Prize laureate and human rights activists guilty of merely appealing to China’s own laws for relief from abusive officials. The party shoots the messenger.

In this environment, censorship is the rule. Dissenters are the exception.

The severity of the Chinese government’s actual response to COVID-19 is a more reliable indicator than the disease’s publicly acknowledged tally. While admitting to just 17 deaths from the virus, the party quarantined a region of about 60 million people. This decision guaranteed multibillion-dollar economic losses.

It is inconceivable that the Chinese government would wilfully suffer such a cost for the sake of a few dozen — or even a few hundred — lives.

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The party is generally insensitive to public health. Air pollution contributes to roughly 1.6 million deaths per year. About half the country’s water is too polluted to touch. Food poisoning is routine; infants have starved to death when their parents relied on counterfeit baby formula. Approximately a quarter-million people per year die in traffic accidents, partly because perverse incentives in tort law make it cheaper for a negligent driver to kill a pedestrian than to cripple one.

In order for the party to have responded to COVID-19 this drastically, the death toll would first have had to exceed local officials’ capacity to cover it up, and then also convinced the nation’s top officials that it represents an existential threat.

After all, before coronavirus, the biggest story out of China was its gulag-style network of detention camps where Uighur people are concentrated because of their religion and ethnicity.

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The party of Mao Zedong did not suddenly experience a “come to Pasteur” moment while it was in the middle of committing a possible genocide.

This does not suggest the Chinese government is wrong to take extreme measures against COVID-19. To the contrary, it suggests the problem is even worse than the party admits.

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