China has moved to a narrower definition of Covid deaths, which will drastically cut its death statistics as cases increase following the relaxation of zero-Covid rules.
Authorities reported no new fatalities in the latest Covid statistics update on Wednesday, despite widespread reports and images of overloaded hospitals and crematoriums and queues of hearses. The official number of deaths since the pandemic began in Wuhan three years ago even had one struck off on Wednesday and now stands at 5,241 – an extremely low number compared with many less populous countries.
The infectious disease expert Prof Wang Guiqiang told a State Council news conference on Tuesday that the National Health Commission had recently revised its guidelines to “scientifically and objectively reflect deaths caused by the coronavirus pandemic”, classifying only fatalities caused by pneumonia and respiratory failure in patients who had the virus as Covid deaths.
“Deaths caused by other diseases such as cardiovascular or cerebrovascular diseases and heart attacks are not classified as deaths caused by coronavirus,” Wang said.
He said that compared with the first outbreak of Covid-19 in early 2020, when most patients died of respiratory failure, “the main cause of death from infection with Omicron is the underlying diseases. Respiratory failure directly caused by the new coronavirus infection is rare.”
But the new method is at odds with World Health Organization (WHO) guidance, which says many countries now use “excess mortality” as a more accurate measure of the true impact of the pandemic.
Excess mortality is defined as the difference in the total number of deaths in a crisis compared with those expected under normal conditions. Covid-19 excess mortality accounts for both the total number of deaths directly attributed to the virus as well as the indirect impact, such as disruption to essential health services or travel disruptions, the WHO says.
By these criteria, China’s new method of tallying Covid deaths that excludes underlying diseases would make it difficult to compare fatalities with other countries.
Prof Chung Kim-wah, a social scientist formerly of Hong Kong Polytechnic University, told the Guardian that the Communist party had often adjusted concepts and definitions to justify its latest policies. “[They] can’t give the impression that lots of people are dying, so it would be seen as an outcome of the government’s policy change,” he said.
Since the abrupt scaling-back of the stringent zero-Covid regime following unprecedented protests against the restrictions, cases have rocketed in China. A full picture of the impact is difficult to gauge, but the narrow parameters for attributing deaths to the virus mean the official count – fewer than 10 this week – is at odds with widespread anecdotal reports of fatalities and high traffic at funeral homes.
Benjamin Mazer, an assistant professor of pathology at Johns Hopkins University, said the classification would miss “a lot of cases”, especially as people who are vaccinated, including with Chinese shots, are less likely to die of pneumonia. Blood clots, heart problems and sepsis – an extreme body response to infection – have caused countless deaths among Covid patients around the world.
Wang Guangfa, a leading respiratory expert, forecast a spike in severe Covid cases in Beijing over the coming fortnight, according to the state-run Global Times newspaper. Wang expected the Covid wave to peak in late January, with life likely to return to normal by late February or early March.
He urged medical institutions to expand intensive care units and boost emergency and severe treatment resources to ensure there is no breakdown in the impending wave of infections.
Several leading scientists and advisers to the WHO have warned it may be too early to declare the global end of the Covid-19 pandemic emergency because of a potentially devastating wave to come in China.
Their views represent a shift since China began to dismantle its zero-Covid policy last week, after a spike in infections and unprecedented public protests. Projections have suggested the world’s second-largest economy could face more than a million deaths in 2023 after the change in course.
China’s zero-Covid approach kept infections and deaths comparatively low among the population of 1.4 billion, but the relaxation of the rules has changed the global picture, experts said.
“The question is whether you can call it post-pandemic when such a significant part of the world is actually just entering its second wave,” said Dutch virologist Marion Koopmans, who sits on a WHO committee tasked with advising on the status of the Covid emergency. It’s clear that we are in a very different phase [of the pandemic], but in my mind, that pending wave in China is a wild card.”
China’s NHC also played down international concern about the possibility of virus mutations, saying the likelihood of new strains that are more pathogenic was low.
Paul Tambyah, president of the Asia Pacific Society of Clinical Microbiology and Infection, supported that view. “I do not think that this is a threat to the world,” he told Reuters. “The chances are that the virus will behave like every other human virus and adapt to the environment in which it circulates by becoming more transmissible and less virulent.”
Reuters contributed to this report
• An earlier version of this article was amended on 21 December 2022 to remove a headline reference that had the potential to be understood as an official statement of the WHO, which was not the case.