As Chinese social media circulated photos and videos showing crowded fever clinics and people lining up outside of hospitals, China's National Health Commission (NHC) reported no new COVID-related deaths on Wednesday and 3,101 new confirmed cases nationwide.
The day before, the NHC reported seven deaths in total over the first two days of recording all COVID deaths in the nation of 1.4 billion people.
A person working in a crematorium in Beijing who requested anonymity due to the sensitivity of the situation told VOA Mandarin on December 21 that the wait list for cremations is stretching into January.
The disconnect between their accounts and the strikingly low official tally is one reason for public skepticism.
At a press conference held Tuesday by the Joint Prevention and Control Mechanism of the State Council of China, Wang Guiqiang, director of the infectious diseases department of Peking University First Hospital, clarified the criteria China uses for recording a death as caused by COVID.
“Deaths caused by pneumonia and respiratory failure caused by the coronavirus are classified as deaths caused by COVID infection, while deaths caused by other diseases and basic diseases, such as cardiovascular and cerebrovascular diseases, myocardial infarction, etc., are not classified as deaths from COVID-19,” he said. “From clinical practice, [and] in the current study, the main cause of death after infection with the omicron strain is the underlying disease.”
Writing in The Guardian, Devi Sridhar, chair of global public health at the University of Edinburgh, said “Experts following the situation estimate that 60% of the Chinese population (accounting for 10% of the world’s population) will be infected in the next 90 days.”
Twu Shiing-jer, former minister of Taiwan’s Department of Health and chairman of the Development Center for Biotechnology in Taipei, said that if China's standard is to exclude patients with underlying diseases, then its COVID death toll is underestimated by at least 75% compared to international standards.
"The vast majority of COVID-related deaths are due to underlying diseases,” said Twu. “According to a study that was done in New York in 2020, in general, only about 0.7% of COVID-related deaths were purely due to infection without other causes.”
Chiang Kuan-yu, a Taiwanese doctor, believes that China’s standards are unreasonable, and that the purpose of those standards is to make the government “look good.”
“In Taiwan, as long as you are infected with COVID within 60 days [before death], it will be regarded as a death from COVID-19,” he said. “For example, a car accident will certainly not be counted. If it is related to a COVID emergency or sequelae within 60 days of death, it will be counted as COVID-19 deaths.” A medical term, sequelae means the aftereffects of a disease, condition, or injury.
Twu said that in Taiwan, as of the end of May 2022, as many as 74% of the deaths from COVID-19 were persons who had a history of chronic diseases.
Recounting the strains on China’s healthcare system, Shridhar said, “If the healthcare system collapses, patients will die from all causes requiring medical care — whether a heart attack or a road traffic accident. This has always been the main challenge of COVID-19, given its high hospitalization rate.”
According to the WHO, many countries have turned to excess mortality statistics as a more accurate measure of COVID deaths. This is the difference in the total number of deaths in a crisis compared to those expected under normal conditions.
WHO data show 565 COVID-19 deaths in the Americas and 539 deaths in Europe on December 17 with 141 deaths in Southeast Asia on the same day.
Another example of how different totals arise due to methodology comes from the Institute for Health Metrics and Evaluation (IHME), an independent global health research center at the University of Washington.
In a study that concluded on December 16, IHME researchers projected a worldwide toll of 7,727,905 deaths by April 1, 2023, using officially reported COVID cases. Tracking total deaths, which are the estimated number of deaths attributable to COVID, including unreported deaths, the study projects a global death toll of 18,572,492 by April 1, 2023.
Adrianna Zhang contributed to this report.