Milton Leitenberg, Senior research associate at the center for international and security studies at the University of Maryland is concerned about the numbers and the credibility of the Chinese government CBRNeWORLD The Question of Covid-19 Mortality in China review in the New York Review It is difficult to understand how a medical colleagues on a WeChat group, of Books on 5 November 2020, seasoned China observer could have after which he was detained by the local Aby the independent China repeated that number. The public health police and reprimanded. A day later the scholar and journalist, Ian Johnson, measures undertaken by the Chinese Wuhan Municipal Health Commission bore the title: How Did China Beat Its government after 21 January were verified this, by which time it was also Covid Crisis? It discussed two books: draconian and they unquestionably understood that the virus was aerosol Wuhan Diary: Dispatches from a saved millions of lives. The current transmissible from person to person Quarantined City by Fang Fang, and Chinese administration's record of because medical personnel had become The Art of Political Control in China information suppression is equally infected. No Chinese official admitted by Daniel C. Mattingly.2 draconian however, and Johnson that publicly, however, until the Fang Fang’s book describes events certainly is aware of China's influential hero of the 2003 SARS that took place in Wuhan in the early problematical 70-year record of official outbreak, Dr Zhong Nanshan, did so on months of 2020 and is by a well-known statistical manipulation, as well as the 20 January. Throughout December Chinese writer working within the city. statistics it does not report at all. people from Wuhan and elsewhere in This brief commentary discusses just The epidemiological pattern of China were flying to other cities in one particular aspect of Johnson’s SARS-CoV-2 (shortened to Covid-19) China, and all over the world from discussion of her book. infection and mortality reported by Wuhan as they always did, because Ian Johnson is a prize-winning China since January 2020 does not Wuhan airport is a major Chinese air author who lived and worked in China resemble that of any other nation in the hub.5 In December 2019 and January for 20 years and wrote about China for world, including those of other nations 2020 approximately 185,000 people flew years before that. He covers a range of that have succeeded in keeping out of Wuhan to other countries. issues concerning China, including mortality quite low.3 Moreover between 31 December historical memory, religion and The CIA reportedly informed the US 2019 and 21 January 2020 when the literature. Most recently he taught at government that 'China has vastly Chinese government isolated Wuhan, the Beijing Centre for Chinese Studies, understated its coronavirus infections between 5 and 7 million people left the however, he was expelled from China in and that its count could not be relied city by air and railroad. Multiple maps March 2020, together with several other upon…’ and that holds equally true for published by the New York Times US journalists. He was therefore not China's reported Covid-19 mortality recorded this exodus and several of under any constraints when he wrote figures.4 The Covid-19 mortality them displayed the relative numbers of the review for the New York Review of numbers reported by the governments people who arrived in different Books, which would have been the case of China, Russia, Iran and Brazil are Chinese cities.6 had he still been in China. considered to be highly unreliable, and It is inconceivable that two thirds of In discussing Fang Fang’s book, those of China perhaps the most all the Covid-19 deaths in China Johnson wrote: ‘The result is that unreliable of all. occurred among the million or more China, the pandemic’s epicentre, a The Covid-19 virus was spreading people who remained in Wuhan, and country of 1.4 billion people, has had throughout December 2019 in Wuhan only a third in the rest of China, 4,634 deaths – a seventh of Spain’s, an and Hubei province, and possibly during including Wuhan citizens who had left eighth of Italy’s, a ninth of Britain’s and November 2019 as well. At that time it the city. Several published peer reviewed less than a fortieth of the US’s.' was diagnosed as an atypical papers that appeared early in the However, the number 4,634 is pneumonia. On 30 December 2019 Dr pandemic strongly indicated the fraudulent and impossible. Li Wenliang reported this privately to number of cases, and by implication More information on our range of events via www.cbrneworld.com 8 CBRNe WORLD December 2020 www.cbrneworld.com CBRNeWORLD deaths, had to be higher than the more than 10,000.9 ‘ in the province, about 15%, however official figure. One article outlined the Other informal estimates within the 15% number is of no significance. shifting case definition, which would China are far higher, and they also are That is because the documents indicate that the early numbers, never for Wuhan alone: ‘Some social media demonstrate multiple reasons why the subsequently revised, should have been posts have estimated that all seven official numbers were very substantially much higher. In addition, these studies funeral homes in Wuhan are handing undercounted. The authorities had little made no attempt to capture the number out 3,500 urns every day in total. understanding of the actual prevalence of mild or asymptomatic cases, which Funeral homes have informed families of the disease for about two months. In other studies have shown were more that they will try to complete addition, the documents primarily cover than 40% in China.7 cremations before the traditional grave- the period from 1 January to 10 In a more recent manuscript that is tending festival of Qing Ming on 5 April, February 2020, and they concern events still undergoing publication review, and which would indicate a 12-day process and statistics that for the most part which examined Covid-19 reporting data beginning on 23 March.’ Such an were within the city of Wuhan. from several countries the author wrote: estimate would mean that 42,000 urns • They double the number of identified ‘The underlying reasons for the two would be given out during that time. of cases of Covid-10 in the province. distinctly different age profiles for age Another popular estimate is based • They suggest that the first recorded specific infection rates reported from on the cremation capacity of the funeral case was on 17 November 2019. the two groups of countries included in homes, which run a total of 84 furnaces • As many as 200 cases are expected to this analysis, are not yet entirely clear. with a capacity over 24 hours of 1,560 have occurred during December 2019, Sampling bias due to the use of case urns city-wide, assuming that each and not 40 as reported in a Chinese definition criteria which have either (1) cremation takes one hour. This publication. restricted testing to symptomatic cases calculation results in an estimated • There was also a wave of respiratory and contacts of previously confirmed 46,800 deaths. A resident of Hubei disease in Hubei province in December cases, or (2) the exclusion of positive province, of which Wuhan is the capital, 2019 that was attributed to influenza. A diagnostic testing results from persons said: ‘Most people there now believe that possibly large subset of influenza-like who were judged to be asymptomatic or more than 40,000 people died in the city diseases in December 2019 in Hubei non-symptomatic at the time of testing before and during the lockdown.’10 province that had not been tested for flu appears to have been a major factor in The numbers derived from urns and and shown to be positive could have the case of China and the US.8’ cremation rates are obviously crude been Covid-19. As for the city of Wuhan, a local guesstimates, and should only be • On 10 February 2020, provincial infectious disease MD who is quoted in considered illustrative. officials privately reported more than a recent report published in the New On 30 November 2020,CNN released twice as many Covid-19 cases in Hubei Yorker estimated that: ‘…the actual a long report based on 117 pages of as the government of China publicly total [who died in the city] could be leaked documents from the Hubei reported on that day for the entire three to four times higher than the Provincial Centre for Disease Control country. government's figure…‘ He referred to and Prevention.11 Wuhan is the largest • The average time for a confirmed the early period of the pandemic, when city in Hubei province, and the diagnosis was 23.3 days, at the same overwhelmed hospitals turned patients documents had been provided by a time as the test kits used in the first away. 'If you were infected and not whistleblower. The documents provide week of January 2020 regularly diagnosed, then you weren't counted,' some but not a very great increase in produced false negatives. The two he said. 'I think the total is probably specific numbers for Covid-19 mortality factors combined to facilitate spread. The impact of Covid on the Chinese people, and the heroism of the medical staff, can't be judged until the true figures come out ©Macau Photo Agency More information on our range of events via www.cbrneworld.com www.cbrneworld.com December 2020 CBRNe WORLD 9 The Question of Covid-19 Mortality in China CBRNeWORLD • The most significant finding in the include people who died at home and information.