Shanghai, China’s largest city and a financial hub, is at the epicenter of the country’s worst COVID-19 outbreak since the virus emerged in Wuhan more than two years ago.
The city of 26 million people has entered a fourth week under , with residents confined to their homes and increasingly angry, frustrated and rebellious.
Beijing has steadfastly defended its “” approach, with its mass lockdowns and sweeping testing. China repeatedly cites its low death counts as proof of superiority of the “China model.” But experts have questioned China’s official COVID data since pandemic began.
On April 21, Shanghai reported , bringing the total from this wave of Omicron-variant infections to 36 – strikingly low compared to the more than 400,000 infections reported so far.
For comparison, Hong Kong has a population less than a third the size of Shanghai. When Omicron swept in back in January, nearly 9,000 reportedly died among 1.18 million cases.
According to , growth of Shanghai’s infections closely tracked that of Hong Kong’s. Both have large elderly populations, including .
What’s going on?
Claims of unreported COVID-19 deaths are circulating on social media. Those reports are often censored. China also narrowly defines what’s a COVID-caused death. A broader measure known as “excess deaths” – those above normal levels – suggests a much higher COVID toll.
On March 31, The Wall Street Journal on a significant reporting gap: “Shanghai’s government hasn’t reported any COVID-related deaths or outbreaks in its hundreds of elderly-care centers since cases began climbing in the city in March,” the newspaper reported.
Orderlies at one center said “they had witnessed or heard of the recent removal of several bodies from the facility, where they said at least 100 patients had tested positive for COVID-19.”
According to the , Chinese media such as Caixin and The Paper also reported on those deaths, but their reports were quickly censored. AP also reported on the case of Muying Lu, a 99-year-old who died on April 1 in a government quarantine facility in Shanghai after testing positive for the virus.
Lu’s family told the news agency that doctors said she died because the virus had worsened her underlying heart disease and high blood pressure. That wasn’t enough to be attributed to COVID-19 in the city’s official tally, however.
“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,” AP wrote of Shanghai’s statistics.
In fact, China doesn’t count cases in which where COVID-19 merely contributes to or exacerbates conditions that cause death.
Zhengming Chen, a professor of epidemiology at the University of Oxford, told The New York Times that mainland China counts only those who die directly from COVID-related pneumonia. Zuofeng Zhang, a University of California epidemiologist, confirmed that to AP.
“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,” Dongyan Jin, a virologist at the University of Hong Kong, also told AP. “That’s their pattern for many years.”
That counting method diverges from the rest of the world.
In most countries, including the United States, health authorities follow rules in accordance with the World Health Organization’s (WHO) International for Certification and Classification (Coding) of COVID-19 as Cause of Death.
Unlike China’s method, the WHO specifies that deaths in which COVID-19 is a contributing cause must be counted.
“COVID-19 should be recorded on the medical certificate of cause of death for ALL decedents where the disease caused, or is assumed to have caused, or contributed to death,” the guidelines state.
In the United States, the Centers for Disease Control and Prevention () that fatality counts include “deaths with COVID-19 as the underlying or contributing causes” and “deaths with confirmed or presumed COVID-19.”
According to the CDC, of the 990,592 COVID-19 deaths recorded in the United States as of April 16, 2022, designated COVID-19 as the underlying cause, which means that COVID-19 was the disease that “initiated the train of morbid events leading directly to death.”