China narrows definition of Covid deaths as official toll is questioned

Beijing has sharply narrowed its definition of a Covid-19 death, as the official toll from one of China’s worst outbreaks since the pandemic began diverges from anecdotal evidence, the experience in other jurisdictions and analysts’ modelling.

The national health commission confirmed the change on Tuesday evening in response to a local media question about the low official counts compared with reports of funeral homes working overtime. This week, financial news outlet Caixin reported that China had adjusted how it classified Covid deaths.

Wang Guiqiang, a doctor speaking at an NHC press conference, said that people who were considered to have died of other conditions while positive for the virus would not be counted in the official Covid death toll. Wang said the NHC would only count those who had died of respiratory failure or pneumonia after testing positive for the virus.

China has embarked on a stunning retreat from its zero-Covid playbook in recent weeks, lifting lockdowns, slashing testing and quarantine requirements and retiring contact-tracing systems after nearly three years of strict protocols.

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Chongqing, a mega-city of more than 30 million residents in China’s southwest, this week said that Covid patients with mild or no symptoms could go to work “as normal”.

Experts have questioned China’s death toll since the country abruptly dismantled its zero-Covid controls in early December. The mainland’s death toll increased by seven since that point, though the NHC revised that number down by one on Wednesday. That compares with Hong Kong, a city of more than seven million people, where the daily death toll is in the double digits. It reported 39 deaths on Monday and 33 on Tuesday.

China’s change to the death classification follows a move this month to stop counting asymptomatic infections, which previously made up the majority of cases in official records. The country’s case numbers have since plunged dramatically, from a peak of nearly 40,000 daily cases last month to about 2,000 most days this week.

Leo Poon, head of the division of public health laboratory sciences at the University of Hong Kong, said that accurate case figures were “essential” for China to tailor its response, adding that the country’s previously low levels of infection left much of the population “naive” to the virus.

“I think we need to have this number to try to reallocate our resources ... to the right regions or right cities to try to minimise the impact of the virus,” he said. “Like do we have enough clinicians, do we have enough healthcare support?”

Several models, including one partly funded by the Chinese Center for Disease Control, have predicted that China could suffer as many as one million deaths during its reopening phase if Beijing continues to dismantle curbs.

The definition of a Covid death varies in different countries. The UK compiles one tally of fatalities that mention Covid as a cause of death on death certificates and a separate count of those who die within 28 days of testing positive, with some variation in reporting standards for each of the UK nations.

The US counts any mortality where coronavirus is recorded to have contributed to the cause of death.

– Copyright The Financial Times Limited 2022