Lu Muying died on April 1 in a government quarantine facility in Shanghai, with her family on the phone as doctors tried to resuscitate her. She had tested positive for COVID-19 in late March and was moved there in line with government policy that all COVID cases be centrally isolated. But the 99-year-old, who was just two weeks shy of her 100th birthday, was not counted as a COVID-19 death in Shanghai's official tally. In fact, the city of more than 25 million has only reported 25 coronavirus deaths despite an outbreak that has spanned nearly two months and infected hundreds of thousands of people in the world’s third-largest city.
Lu’s death underscores how the true extent of the virus toll in Shanghai has been obscured by Chinese authorities. Doctors told Lu's relatives she died because COVID-19 exacerbated her underlying heart disease and high blood pressure, yet she still was not counted. From the AP:
- A marked undercount. Interviews with family members of patients who have tested positive and an internet archive compiled by families of the dead all raise issues with how the city is counting its cases and deaths, almost certainly resulting in a marked undercount.
- A much narrower standard. An AP examination of the death toll sheds light on how the numbers have been clouded by the way Chinese health authorities tally COVID-19 statistics, applying a much narrower, less transparent, and at times inconsistent standard than the rest of the world. In most countries, including the US, guidelines stipulate that any death where COVID-19 is a factor or contributor is counted as a COVID-related death. But in China, health authorities count only those who died directly from COVID-19, excluding those, like Lu, whose underlying conditions were worsened by the virus, said Zhang Zuo-Feng, an epidemiologist at UCLA.
- Deaths ascribed to underlying conditions whenever possible. "If the deaths could be ascribed to underlying disease, they will always report it as such and will not count it as a COVID-related death, that’s their pattern for many years,” said Jin Dong-yan, a virologist at the University of Hong Kong’s medical school. That narrower criteria means China's COVID-19 death toll will always be significantly lower than those of many other nations. Both Jin and Zhang said this has been China’s practice since the beginning of the pandemic and is not proof of a deliberate attempt to underreport the death count.
- An unusual definition of "asymptomatic." However, Shanghai authorities have quietly changed other standards behind the scenes, in ways that have violated China’s own regulations and muddied the virus’ true toll. During this outbreak, Shanghai health authorities have only considered virus cases where lung scans show a patient with evidence of pneumonia as “symptomatic,” three people, including a Chinese public health official, told the AP. All other patients are considered "asymptomatic" even if they test positive and have other typical COVID-19 symptoms like sneezing, coughing, or headaches.
- Overlapping systems sometimes conflict. Further adding to the confusion, the city has overlapping systems to track whether someone has the virus. City residents primarily rely on what's called their Health Cloud, a mobile application that allows them to see their COVID-19 test results. However, the Shanghai health authorities have a separate system to track COVID-19 test results, and they have the sole authority to confirm cases. At times, the data between the systems conflict.
- China's CDC has "wiggle room." In practice, these shifting and inconsistent processes give China's Centers for Disease Control and Prevention "wiggle room" to determine COVID-related deaths, said the Chinese health official, allowing them to rule out the coronavirus as being the cause of death for people who didn’t have lung scans or positive test results logged on their apps.
- Reports on COVID deaths have been censored. Chinese media reports on the unrecorded COVID-19 deaths have been swiftly censored, and many criticisms of Shanghai’s stringent measures expunged online. Instead, state media has continued to uphold China's zero-COVID approach as proof of the success of its political system, especially as the world's official death toll climbs past 6.2 million.
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