Surprisingly low Shanghai COVID death count brings up questions
TAIPEI, Taiwan – 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 coronavirus 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.
Interviews with family members of patients who have tested positive, a publicly released phone call with a government health official 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.
The result is a blurred portrait of an outbreak that has sweeping ramifications for both the people of Shanghai and the rest of the world, given the city’s place as an economic, manufacturing and shipping hub.
An Associated Press 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 United States, 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 the University of California, Los Angeles.
“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.
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.