Moon of Alabama Brecht quote
April 01, 2020

China Did Not Deceive Us - Counting Death During An Epidemic Is Really Difficult

The anti-China campaign, which the Deputy National Security Advisor Matthew Pottinger is running, presented its April fools joke. It leaked to Bloomberg that a secret U.S. Intelligence Report claims that China concealed the real numbers of its Covid-19 cases:

China has concealed the extent of the coronavirus outbreak in its country, under-reporting both total cases and deaths it’s suffered from the disease, the U.S. intelligence community concluded in a classified report to the White House, according to three U.S. officials.
...
While China eventually imposed a strict lockdown beyond those of less autocratic nations, there has been considerable skepticism of China’s reported numbers, both outside and within the country. The Chinese government has repeatedly revised its methodology for counting cases, for weeks excluding people without symptoms entirely, and only on Tuesday added more than 1,500 asymptomatic cases to its total.

Stacks of thousands of urns outside funeral homes in Hubei province have driven public doubt in Beijing’s reporting.

China did not conceal its number of Covid-19 cases. Nor did it hold back any information.

Reporting numbers during an outbreak of a new disease is actually very difficult.

When does one start to count? China only knew that it had a new virus epidemic in early January. By then those who died during the month before were already cremated. How could it count them?

Does one include co-morbids or not in the count? What about casualties of a car accident that also test positive for Covid-19 when they die? What about those who died with Covid-19 symptoms but could not be tested for lack of test kits? Are the tests really working reliably? At one point China included all pneumonia cases in the Covid-19 case count even after they tested negative for Covid-19. The Chinese epidemiologists thought that their test had been wrong and only later found out that that was not the case.

What about asymptomatic cases that test positive. Are these false positives or do these people really have the virus? One can only know that by testing them a month later for antibodies. If they developed antibody cells against the virus they must have had it. That may well be the reason why China only now added the 1.500 asymptomatic cases to its total count.

The most important number during an outbreak is the one that lets one plan for resources and model for countermeasures. That number is the Case Fatality Rate.


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But that is the wrong number if one asks how likely one is to die of the disease:

You may have heard a term being used: the “case fatality rate”, or CFR. That is the number of deaths divided by the number of confirmed cases. When journalists talk about the “death rate”, that’s often what they are referring to. If a country has 10,000 confirmed cases and 100 deaths, then the CFR in that country is (100/10,000), or 1%.

That is not what we are looking for, and it is probably not even very close to what we are looking for.

Instead what we want is the “infection fatality rate”, or IFR. That is the number of deaths divided by the number of people who actually have the disease. The number of people who have tested positive for the disease is probably only a fraction of the total number who had it, because only a fraction of the population has actually been tested. 

Obviously, the IFR is much harder to determine accurately. The only people getting tested will be the people who are most ill, so your IFR is probably much lower than your CFR, because your denominator — the number you’re dividing by — is probably much bigger. 

So if your country has tested absolutely everyone and found all cases of the disease, then your IFR is the same as your CFR, or 1%. But if it has only found 10% of the people with the disease, then your 10,000 confirmed cases are just the tip of a 100,000-person iceberg. With those 100 deaths, your IFR would be (100/100,000) or 0.1%.

China, and everyone who followed its data, knew that the number of cases were different from the number of infections. But we did not know by how much. It was also clear that China was not counting all Covid-19 death. Italy shows how that problem arises:

As hospitals become overcrowded, patients are being asked to stay at home until they display the most serious symptoms. Many will die in their houses or nursing homes and may not even be counted as Covid-19 cases unless they’re tested post-mortem.

Last week, two researchers from northern Italy made this point forcefully when looking at Nembro, a small town near Bergamo that has been very severely hit by the outbreak. Writing in Italian newspaper Corriere della Sera they found there had been 158 deaths in the town in 2020 so far, as opposed to 35 on average in the previous five years. They noted that Nembro had only counted 31 deaths from Covid-19, which looks like an underestimate.

In other towns nearby, including Bergamo itself, the trend seemed identical. The researchers made the point that the only reliable indicator in the end will be “excess deaths” — namely, how many more people have died in total compared to a “normal” year.

Death per month in Bergamo over the last ten years*

*The data refer to deaths until March 26th 
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The UK produces two different numbers. The Office for National Statistics says that it counts more Covid-19 death than the official GOV.UK site by the Department of Health and Social Care:

  • We include all deaths where COVID-19 was mentioned on the death certificate, even if only suspected: the GOV.UK figures are only those deaths where the patient had a positive test result
  • We include deaths that happened anywhere in England and Wales, for example some might be in care homes: the GOV.UK figures are only those that happened in hospital.

The definition who to count can change over time and not only in China:

[C]ountries may have good reasons to change the way they collect data as circumstances change, but it apparently happens often enough that the World Health Organisation feels that they have to ask countries to notify them when they do it. Famously, China did so earlier in the epidemic, but others do too: in complying with the WHO’s request, Australia has noted that it has changed its definition of a Covid-19 “case” (and therefore a Covid-19 “death”) at least 12 times since 23 January. 

As for the number of urns delivered to funeral homes in Hubei after the quarantine was lifted one has also to consider the number of regular death. Hubei province has some sixty million inhabitants. The regular mortality rate in China is 726 per 100.000 inhabitants per year. The regular expected number of death from January 1 to March 31 in Hubei province without the epidemic was 108.900. In Wuhan, which has 14 million inhabitants, the expected number was 25.410. Photos that show the delivery of a few thousands of urns to large funeral homes in Wuhan are thereby not a sign for a higher Covid-19 death rate. To claim such is propaganda nonsense.

There is no reason to criticize China for publishing incomplete and a times confusing numbers. That is normal during any epidemic and the U.S. will certainly do likewise. The real problem with the various numbers flowing around lies elsewhere.

People do try to make predictions about how many will get infected and die from the virus. These models are needed to prepare ones resources. But prediction is extremely difficult to do as the various models are very sensitive to the input data. A model that works in country A may give the wrong results when it is used for country B. Cities and towns are different. Local circumstances can make huge differences. With the real infection numbers and the real death rate unknown during an outbreak we can only hope that our epidemiologists, who are trained to make and interpret such models, get it right.

To claim that China deceived the U.S. and the world about its numbers or that China tried to make it look as if the epidemic was not as serious as it is makes no sense at all.

China took extreme and drastic measures at high economic costs to prevent a larger outbreak. It did not do that to deceive anyone but because it saw the seriousness of the problem. It acted in the global interest and to defeat the virus.

China gave the world time to prepare for the pandemic. Unfortunately that time was not used well. One reason that the U.S. will now experience a very large outbreak is that it is not willing to follow China's example. If one declares that gun shops and shooting ranges are critical businesses that must stay open during a lockdown one is not serious about fighting the epidemic.

To blame China for that is simply nonsensical.

The real number of casualties the SARS-CoV-19 outbreak will cause will only be known when it is over and when we compare the new death statistics to those of previous years. One thing is assured. The "excess death" numbers will be lower in those countries that did use the time China gave them and prepared for what was coming at them.

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Previous Moon of Alabama posts on the issue:

Posted by b on April 1, 2020 at 18:45 UTC | Permalink

Comments
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Salut to all the true believers fending off the varmints here today. I will shout the bar for you all. Send whisky and tequila to the battlements and keep those ancientarchers and hospital docs exposed and in open ground. Ready the boiling oil slingshots.
Enough already! Hoho good sport. Blackadder would be proud.

Posted by: uncle tungsten | Apr 3 2020 5:42 utc | 301

Lots of China apologists on the site nowadays.
There was a time when b used to provide unbiased reporting on global affairs, especially neocon wars. Now it seems the shop of b has been bought over by the Chinese and the site infested with clearly paid for agents singing the praises of comrade Xi and the great Chinese civilisation.
b is not interested in the truth but in pushing an agenda and he has a (Chinese) army of trolls to help him

Posted by: ancientarcher | Apr 3 2020 11:12 utc | 302

@Bemildred #292
So in other words - testing is good. Do more of it.
Well, you've provided zero insight.
Nor have you addressed the points that it may well be the medical investigation that matters more than lockdowns or testing.

Posted by: c1ue | Apr 3 2020 17:53 utc | 303

"But it is a remarkable coincidence that the Wuhan Institute of Virology was researching Ebola and SARS-associated coronaviruses in bats before the pandemic outbreak, and that in the month when Wuhan doctors were treating the first patients of COVID-19, the institute announced in a hiring notice that “a large number of new bat and rodent new viruses have been discovered and identified.” And the fact that the Chinese government spent six weeks insisting that COVID-19 could not be spread from person to person means that its denials about Wuhan laboratories cannot be accepted without independent verification."
https://www.nationalreview.com/2020/04/coronavirus-china-trail-leading-back-to-wuhan-labs/

They may very well have not intended to deceive anyone with respect to the numbers of infected and dead. They sure as heck were deceptive about quite a number of other things. To be fair, they are not the only deceptive people involved. And all too frequently, we tend to deceive ourselves at times.

Posted by: Bruce | Apr 5 2020 18:26 utc | 304

@ Bruce | Apr 5 2020 18:26 utc | 305

Well, since you decided to post that anti-China screed twice, I think it's only fair that it get debunked twice, as follows:

That National Review article has been torn to shreds. They cut out words and phrases to change meanings or to hide facts, they told some out-and-out lies, etc. It's an outrageous piece of destructive propaganda, with no resemblance to the truth.

See the autopsy on that article, here --
https://www.youtube.com/watch?v=JIMadIbCK6A

The first minute or so is a harangue by some guy who bases his hate-filled rant on that National Review article, and then he in turn, along with that article, are thoroughly skewered by one Nathan Rich.

Posted by: AntiSpin | Apr 5 2020 22:40 utc | 305

Well well, it looks like the cat is out of the bag and the existence of the CIA report detailing Chinese lies has been leaked already.. and the useless agitation of the small fry commie internet agents is not gonna make a bit of a difference in regard to the price that China will have to pay. First I wonder if B posted this one on April Fools ? Will see if he will have the will to clean the blog of the disinfo pests, or no....

Posted by: hospital doc | Apr 6 2020 2:34 utc | 306

Here's the thing -- to believe China's data, you have to believe that they have fully contained transmission of the virus at about 81,000 cases out of a population of 11.8 million in Wuhan. Their case load was flattening out before other countries were even aware of asymptomatic transmission. From my POV, the US hasn't presented any evidence that China was deliberately hiding cases or anything like that, but the late February/early March numbers from China just don't make sense. Even with a full lockdown, other countries are seeing exponential growth for twice as long as China did.

Posted by: BC | Apr 6 2020 20:50 utc | 307

BC 308 "Even with a full lockdown, other countries are seeing exponential growth for twice as long as China did."

Non quarantine confirmed cases. Non have broad scale temperature monitoring. Non are trying to eradicate corona virus.

Posted by: Peter AU1 | Apr 6 2020 21:02 utc | 308

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