China’s Missing COVID-19 Data

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China’s Missing COVID-19 Data

Center-local dynamics are incentivizing a cover-up of China’s COVID-19 statistics well before they reach the public.

China’s Missing COVID-19 Data

Elderly patients are checked as they arrive at an emergency hall of a hospital in Beijing, Thursday, Jan. 19, 2023.

Credit: AP Photo/Andy Wong

Considering aggregate data, anecdotal accounts, and common sense, it is difficult to downplay the significance of Beijing’s sudden decision to reverse its once prized zero COVID policy, which Chinese President Xi Jinping had claimed as a national and personal victory.

On January 18, during a Lunar New Year message, Xi made his first public comments on the wave of infections that follow China’s reopening, saying that he was “most worried about its spread in China’s vast countryside, where medical services and resources are insufficient.” The following day, health authorities announced that critical COVID-19 cases have peaked in China’s hospitals.

But reliable data on the ongoing COVID-19 surge is hard to come by.

In the wake of the December 7 announcement that Beijing would abruptly abandon its zero COVID policy, relatively trustworthy data has been largely limited to the provincial level. On December 24, the National Health Commission halted its daily data release. During the first two weeks of the post-zero COVID era, the government released implausibly low case numbers (only thousands of new cases per day nationwide).

The official national-level sources that remain are considered by foreign public health experts to be radically off-base. On January 14, China reported 59,938 COVID-19-related deaths between December 8 and January 12, a huge spike compared to the previous cumulative official death toll of 5,272 over three years. Yet this is likely still an underestimation.

The National Bureau of Statistics recorded a total of 10.41 million deaths in 2022, averaging 867,500 deaths per month. The announced 59,938 COVID-19-related deaths over a month, representing 7 percent of 2022’s monthly average deaths, is in no way consistent with reports from crematoriums suddenly overwhelmed by a surge in demand.

Rather, there is an ongoing, intentional obfuscation of how severe China’s post-zero COVID outbreak has been. Because the central government stopped tracking cases and narrowed the criteria for COVID-19-related deaths to further limit the count, it can maintain plausible deniability.

Data released on January 17 shows that in 2022, China’s deaths outnumbered births for the first time in 60 years. Despite this announcement, the National Bureau of Statistics still refused at a press conference to disclose how many deaths occurred in December. It is a common technique employed by China’s authorities to release only aggregated data – central instead of local and annual instead of monthly – leaving room for ambiguity that can be manipulated to paint a rosier picture when necessary.

Officially, China denies any shortcomings in its COVID-19 statistics. Foreign Ministry spokespeople, for example, routinely insist that China “has been sharing information and data with the international community in a timely, open and transparent manner in accordance with the law.”

While authorities face genuine challenges in tracking case numbers, the drastically low official death tolls are more likely the result of deliberate concealment than logistical difficulty. Chinese social media posts show local authorities encouraging people to sign documents claiming that their relatives’ cause of death had no relation to COVID-19. Doctors are also being discouraged from citing COVID-19 on death certificates.

That said, local-level data is most reliable. In developed places like Shanghai and Zhejiang, government and health officials released rough and shocking estimates through targeted data collection. Zhejiang province, for example, reported about 1 million new cases a day on December 25, calculated by “case monitoring and sampling survey in local communities.” A leading Shanghai doctor said on January 3 that up to 70 percent of Shanghai’s population had been infected.

Authorities in urban areas are in some ways better equipped for collecting data. Over the past three years, more developed provinces imposed clearer and more consistent restrictions. When zero COVID was dropped, they were better prepared for the ensuing wave of infections and more willing to disclose infection data. Urban residents are also generally better informed about the global state of the pandemic and less likely to feel the stigma of the virus, which can be a major roadblock for data gathering since community surveys rely on self-reporting.

Even urban centers, however, are clearly withholding death counts. Satellite images have showed long lines of vehicles outside funeral homes in some Chinese cities at the end of December. Traffic flows at one funeral home in Guangzhou and another in Shenyang have been more crowded over the last month than they have been in the past five to 10 years. The extraordinarily high demand at morgues was corroborated by staff interviews showing that the workload has doubled or tripled. Images captured by Maxar Technologies show an increase in activity at funeral homes in six cities including Beijing, Nanjing, Chengdu, and Kunming.

In the absence of reliable numbers, the international media has relied on approximations. Airfinity, a U.K.-based firm, estimated that 9,000 people could have been dying of COVID-19 per day in December. That number made headlines (though some reports cite Airfinity’s estimates as 5,000 deaths per day).

A big part of the uncertainty is the lack of testing, which means Chinese government officials themselves have no way of knowing how many cases there truly are. China had been able to keep track of its COVID-19 numbers primarily through the 9 billion nucleic acid tests authorities conducted between the start of 2020 and April of last year. Compared to at-home antigen testing, nucleic acid testing costs more, introduces a higher risk of cluster infection (since people often have to wait in lines for hours), and even contributes to greenhouse gas emissions.

Despite the criticism, nucleic acid testing has been the only reliable nationwide COVID-19 data-gathering channel since the start of the pandemic. Without it, we can only guess the real number of infections and deaths might be. From Beijing’s perspective, that could well be by design.

This state-sponsored silence mirrors the playbook from 2020, when the local government in Hubei covered up the initial outbreak of the virus that would become known as COVID-19. More local authorities are likely to cover up death tolls in the coming weeks.

While most people tolerated daily nucleic acid testing during the zero COVID era, the mandate mindset does not transfer to reporting infection for the public good, especially considering the deeply ingrained stigma toward contracting the virus – a stigma the government played a crucial role in cultivating with, for example, relentless its state media broadcasts depicting the threat of COVID-19. The Japanese government encourages individuals to report their cases by sending quarantine packages to those who self-report infection. The Chinese government offers no such incentive.

While the short-term situation constitutes a public health crisis and has induced an economic slowdown, longer-term projections suggest China should return to a version of normalcy within approximately three months. The sudden abandonment of the policy – along with the only data collecting method – and lack of preparedness have, however, caused significant public health consequences and public panic. In the long run, Xi Jinping’s zero COVID about-face may at least to a degree undermine his political legitimacy.

The collapse of top-down mandates left only the naked chaos of unpreparedness, a testament to the pervasive lack of bottom-up trust in contemporary China. Data transparency, like ICU bed capacity, is an unevenly distributed resource. In China, which province you’re born into can be a major indicator of not only the quality of healthcare you receive, but also the degree of truth you are trusted with.