China fires of­fi­cials as in­fec­tions soar

Bei­jing steps up ef­forts at da­m­age con­trol as virus cases in­crease by 15,152 overnight.

Los Angeles Times - - THE WORLD - BY ALICE SU

BEI­JING — Po­lit­i­cal of­fi­cials were fired and in­fec­tion cases sky­rock­eted in China on Thurs­day, re­mind­ing a na­tion stuck at home and sci­en­tists watch­ing world­wide just how lit­tle is known about the coro­n­avirus out­break that has in­fected more than 64,000 and killed more than 1,400 people.

Pre­vi­ous num­bers had been re­as­sur­ing, with daily con­fir­ma­tions of new in­fec­tions drop­ping from sev­eral thou­sand to around 1,000. Of­fi­cials in Bei­jing, in­creas­ingly wor­ried about the eco­nomic toll of the out­break, urged people to go back to work. State me­dia ran ed­i­to­ri­als about re­sum­ing in­ter­na­tional flights to China.

But on Thurs­day the case num­bers shot up. Chi­nese health au­thor­i­ties re­ported 15,152 new cases of COVID-19 — the World Health Or­ga­ni­za­tion’s new name for the vi­ral dis­ease — overnight. Hubei prov­ince, the epi­demic’s epi­cen­ter, ac­counted for most of the in­crease: The num­ber of in­fec­tions went up by 14,840, more than nine times the 1,638 new cases re­ported there a day ear­lier.

Then came the purge. Bei­jing an­nounced that both the Com­mu­nist Party chiefs of Wuhan and sur­round­ing Hubei prov­ince were fired and re­placed with of­fi­cials known for “sta­bil­ity main­te­nance” and closely al­lied with party chair­man and Pres­i­dent Xi Jin­ping. The sack­ings fol­lowed ear­lier dis­missals in­clud­ing the Hubei health com­mis­sion’s party chief and its di­rec­tor.

The un­der­re­port­ing of the breadth of the out­break, which orig­i­nated in Wuhan, has been blamed on of­fi­cials who sup­pressed in­for­ma­tion on the virus’ spread to save face among their su­pe­ri­ors. Ex­perts say the sud­den in­crease in the num­ber of con­firmed in­fec­tions, al­though alarm­ing, is a step to­ward iden­ti­fy­ing and con­tain­ing the ill­ness.

The new fig­ures don’t in­di­cate a rapid overnight spread of the virus in Hubei, but rather a change in the way pa­tients are counted there, which may pro­vide bet­ter ac­cess to treatment on the front lines. New cases of COVID-19 are be­ing con­firmed based on symp­toms and a CT scan of the pa­tient’s lungs. Pre­vi­ously, con­fir­ma­tions were based on time-con­sum­ing lab tests, which cre­ated huge back­logs.

Many crit­i­cally sick pa­tients with symp­toms but no confirmati­on of in­fec­tion had com­plained of be­ing turned away from hos­pi­tals. An un­known num­ber have died with­out be­ing di­ag­nosed as hav­ing the virus.

Nearly 90% of the new cases re­ported in Hubei on Thurs­day were “clin­i­cally di­ag­nosed” un­der the new rules.

The change re­veals China had been un­der­count­ing its COVID-19 cases. It is also a trou­bling re­minder that there is no clar­ity yet on the ex­tent or sever­ity of the out­break.

“The pic­ture is evolv­ing day by day . ... It is a con­stantly mov­ing tar­get,” said John Ni­cholls, a pathol­o­gist at the Univer­sity of Hong Kong who worked on the SARS out­break in 2003. “We re­ally have got no idea about the true num­ber of cases.”

Both Chi­nese and for­eign epi­demi­ol­o­gists be­lieve that a large num­ber of mild COVID-19 cases have still not been counted. The rea­sons abound: a short­age of tests, over­whelmed care­givers, and many in­fected pa­tients whose symp­toms aren’t se­vere enough to qual­ify for tests, which are not al­ways re­li­able.

Wang Chen, pres­i­dent of the Chi­nese Academy of Med­i­cal Sci­ences, told Chi­nese me­dia Thurs­day that the change in re­port­ing re­quire­ments was “ex­tremely nec­es­sary” be­cause the lab­o­ra­tory test to de­tect a par­tic­u­lar se­quence of nu­cleic acids of­ten failed.

“Many pa­tients who ap­peared to be [in­fected with COVID-19] based on their epi­demi­o­log­i­cal history, con­tact history and clin­i­cal symp­toms were not able to test pos­i­tive on the nu­cleic acid test, and were listed as ‘sus­pected cases,’ ” he said.

Hubei prov­ince’s new re­port­ing stan­dards are an im­prove­ment, said Ben­jamin Cowl­ing, head of the Divi­sion of Epi­demi­ol­ogy and Bio­statis­tics at the Univer­sity of Hong Kong’s School of Pub­lic Health.

“Is it 10 mild cases for ev­ery se­vere case? Is it a hun­dred mild cases for ev­ery se­vere case? That makes a big difference in how we think about con­trol­ling in­fec­tions,” Cowl­ing said, adding that he hoped the rest of China would adopt Hubei’s re­port­ing stan­dards.

Peng Zhiy­ong, an in­ten­sive care unit doc­tor in Wuhan, said in an in­ter­view with the Chi­nese out­let Caixin that ini­tial re­quire­ments for con­firm­ing coro­n­avirus cases, in­clud­ing whether a pa­tient had vis­ited a Wuhan seafood mar­ket that had been linked to the out­break, were with­held from the pub­lic, mak­ing it nearly im­pos­si­ble to con­firm new in­fec­tions as the num­ber of cases rose in early Jan­uary.

“The di­ag­nos­tic cri­te­ria were too harsh — with that cri­te­ria, it would be very dif­fi­cult to di­ag­nose any­one,” Peng said. “In this pe­riod, our hos­pi­tal lead­er­ship re­flected this to the health com­mis­sion many times, and other hos­pi­tals were reflecting the same.”

On Jan. 18, Peng said, he com­plained to an­other group of vis­it­ing ex­perts from the Na­tional Health Com­mis­sion. “This makes it very easy to miss real pa­tients,” he’d said. “This is an in­fec­tious dis­ease. If the di­ag­nos­tic cri­te­ria are too tight, the sick people we let go will be a great risk to so­ci­ety.”

Only af­ter Jan. 20, when prom­i­nent SARS sci­en­tist Zhong Nan­shan an­nounced on state TV that there was hu­man-to-hu­man trans­mis­sion of COVID-19, did Chi­nese au­thor­i­ties take se­ri­ous ac­tion to con­tain the out­break.

The tim­ing of Thurs­day’s po­lit­i­cal shake-up — co­in­cid­ing with fresh num­bers closer to Hubei’s re­al­ity — sug­gests that Bei­jing wants the newly ap­pointed lead­ers to be seen as prob­lem solvers dis­patched to fix a cri­sis that lo­cal of­fi­cials had al­lowed to spin out of con­trol. Xi’s aim is to pre­vent fur­ther pub­lic anger and en­sure “so­cial sta­bil­ity.”

The goal of sci­en­tists is to get ac­cu­rate data and hon­est in­for­ma­tion. “The con­firmed cases and even the prob­a­ble cases are only reflecting the tip of the ice­berg,” Cowl­ing said. “We don’t re­ally have a pre­cise im­pres­sion of what that ice­berg looks like. We just know there’s an ice­berg.”

Kevin Frayer Getty Im­ages

A BOY ar­riv­ing on a train in Bei­jing has his own makeshift pro­tec­tive cover against the coro­n­avirus. Ex­perts say China’s sud­den in­crease in re­ported cases is a step to­ward iden­ti­fy­ing and con­tain­ing the ill­ness.

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