The 99-year old, who was two weeks away from her 100th birthday in Shanghai, was not included in Shanghai’s official COVID-19 death tally. Despite an outbreak that lasted nearly two months and infected hundreds, of thousands of people in Shanghai, which is the third-largest in China, only 25 coronavirus cases have been reported by the city of over 25 million.
Lu’s tragic death highlights how Chinese authorities have obscured the true scale of the virus epidemic in Shanghai. Lu’s family was told by doctors that COVID-19 had caused her death. However, she was still not counted.
Interviews with relatives of patients who tested positive, a public phone conversation with a government official, and an archive that families have compiled on the internet all raise questions about how the city counts its cases and deaths.
This blurred picture of an outbreak has broad ramifications both for Shanghai’s residents and those around the world. It is due to Shanghai’s status as a shipping, economic and manufacturing hub.
An Associated Press investigation of the death toll reveals how numbers are clouded by Chinese health authorities who tally COVID-19 stats, using a narrower, less transparent and sometimes inconsistent standard than that used for the rest of the globe.
Most countries, including the United States of America, have guidelines that state that any COVID-19-related death is one where COVID-19 has been a contributor or factor.
However, in China, the health authorities only count those who died from COVID-19 directly, and exclude those like Lu whose underlying conditions were made worse by the virus. Zhang Zuo-Feng is an epidemiologist at University of California, Los Angeles.
Jin Dong-yan, who is a virologist at University of Hong Kong’s medical college, stated that if the deaths can be attributed to an underlying disease, they will report them as such and not count it as COVID-related.
This narrower criteria means that China’s COVID-19 death rate will always be lower than many other countries.
Zhang and Jin both stated that this was China’s practice from the start of the pandemic. This is not evidence of an intentional attempt to underreport deaths.
But, Shanghai authorities quietly altered other standards behind-the scenes. This violated China’s regulations and muddied what the true cost of the virus.
Three people, including a Chinese public-health official, said to the AP that Shanghai health authorities only consider cases of virus infection if lung scans reveal evidence of pneumonia. All other patients are considered “asymptomatic,” even if they have symptoms such as sneezing and coughing that are typical of COVID-19.
This classification of asymptomatic cases is inconsistent with China’s previous national guidelines. This is a marked change from January when Wu Fan, a member Shanghai’s epidemic prevention expert team, stated that anyone with the slightest symptoms like fatigue or sore throat would be “strictly”, classified as a symptomatic patient.
To add to the confusion, there are multiple systems in the city that can track whether someone has the virus. Residents rely heavily on their Health Cloud mobile app to view their COVID-19 test results. The Shanghai health authorities, however, have their own system for tracking COVID-19 test results and have sole authority to confirm cases. Sometimes, data from different systems may conflict.
These inconsistent and shifting processes allow China’s Centers for Disease Control and Prevention to “wiggle room” in determining COVID-related deaths. According to the Chinese health official the officials can rule out the coronavirus being the cause of death for those who don’t have lung scans or positive tests logged on their phones. To discuss this sensitive topic, the official spoke under anonymity.
China’s top medical authority, The National Health Commission, responded to questions regarding Shanghai’s COVID-19 numbers. It faxed that there was “no basis for suspecting the accuracy of China’s epidemic data and statistics.” Shanghai’s government didn’t respond to a request for comment.
The relatives of the deceased are not comforted by the statements made by the authorities. Chinese internet users have created a virtual archive of deaths since Shanghai’s lockdown, based on firsthand information. So far, they have recorded 170 deaths.
Reports by Chinese media on unrecorded COVID-19 death have been quickly censored and many online criticisms of Shanghai’s strict measures were removed. State media, however, has maintained China’s zero COVID approach as evidence of the political system’s success, particularly as the official death toll in the world climbs to 6.2 million.
Earlier in the month, doubts about the data surfaced when a Shanghai resident uploaded a recording from a conversation he had with a CDC official. He questioned why his father was told by city health officials that he had tested positive to COVID-19 but data on his father’s mobile app showed it as negative.
Zhu Weiping, an official, said, “Didn’t I tell you not to look at the Health Cloud?” referring to the app. “The positive cases can only be from us notifying people.”
Family members of Zong Shan (an 86-year old former Russian translator who passed away March 29th) are also skeptical about the data. Online tests showed Zong was not positive for COVID-19, despite her being tested positive and being transferred to a quarantine facility by the government.
“My relative, along with most people in Shanghai who were notified positively, all reported negative results” to the Health Cloud app, Zong’s family said. He declined to name him out of fear of reprisal.
Zong was transferred to the Donghai Elderly Care Hospital and taken to a quarantine facility. She died there that night. Staff at the hospital informed Zong’s family that she was being transferred to another facility after she had tested positive for COVID-19. They didn’t believe the virus was the greatest threat to her health. Instead, they believed it was the lack of nursing care in the quarantine facility. Zong had to be given liquids as she couldn’t eat on her own.
A relative said that she was in stable condition prior to the transfer. The family asked doctors for the cause of her death but they didn’t provide an answer.
“They gave me very vague responses. The relative said that they initially said it was stroke and then said that this was just a hypothesis. “But they were clear on one point. They said it had nothing do with COVID. Her lungs were clear.”
Lu was also transferred from Donghai. She would have celebrated her 100th Birthday on April 16. Her relatives had ordered a cake, and were allowed to host a small celebration on Thursday. The family began making mental preparations to her death after she was confirmed positive.
A relative explained that the most bizarre thing was that the doctor called her family the night before her death to inform them that Lu had tested negative for COVID-19. The relative said that the doctor ultimately said she died from the virus, which had made her more sick.
The family also knew about a neighbor who was a patient at the same hospital and died on the same day. He had been transferred to quarantine on March 25, but his death wasn’t counted.
Jin, a Hong Kong virologist, pointed out the political benefits that Shanghai’s official COVID-19 death rate could bring to the country.
Jin stated, “They might claim that this is their achievement and this is the victory.”
