Above photo: Xiao Yiju/Xinhua News Agency.
A lesson with application far beyond Covid-19.
The world is now in the throes of another wave of Covid-19, with another surge in infections, sickness and deaths, this time due to the more infectious and apparently more lethal Delta variant.
Are there lessons to be learned from the previous waves of Covid-19 that might help us now?
There are, and they were evident long ago, but in the West, they have been largely ignored. Up to now, for example, the US has suffered over 617,000 deaths; China in contrast has suffered fewer than 5,000 deaths in a population four times as large as the US. Could there not be some lessons that might serve us in the West now and in the future?
In the US and throughout the West, the response to China’s success has all too often been to ignore or deny it. As an especially egregious early example, in April 2020 Donald Trump and his assistant Dr. Deborah Birx called into question China’s mortality data with a none too clever lie of omission; they were caught in this embarrassing ploy by Asia Times. The denial of these fatality figures persists in much of the media. Certainly, there are many reports from those in China, foreigner and native alike, on the largely Covid-19 free environment there. But the many who regard China as a vast, impenetrable Potemkin Village are refractory to such accounts.
China tells the truth about Covid-19 Deaths
Is there any way in which the truth can be established about China’s death tally? One method is to examine excess deaths, that is, deaths during the pandemic compared to the same period in the previous five years, a measure used in many countries. Fortunately, a study of excess deaths in China has now been published in the peer-reviewed British Medical Journal (BMJ) by a team of scientists and physicians at Oxford in the UK and at China’s CDC.
The study was massive. EurekAlert!, a publication of the American Association for the Advancement of Science, recognizing the importance of the study, captured its magnitude as follows: “The researchers used official records from China CDC’s nationally-representative Disease Surveillance Point (DSP) system. It covered more than 300 million people from 605 urban districts and rural counties, representing more than 20% of the entire population in China.” The DSP gathers deaths that are reported by local doctors, hospitals, funeral directors, police and others. The study covered the period from January 1 2020 to March 31, 2020, a period when most all reported deaths occurred. The lockdown in Wuhan, the most stringent, was begun on January 23 and lifted on April 8, 2020, a total of 74 days.
The two main findings of the BMJ study are simple and straightforward.
First, the number of deaths due to Covid-19 pneumonia in Wuhan was very much the same as the Chinese government reported. The BMJ study states:
“In Wuhan city, the most recent official figures released on 17 April 2020 suggested that 3869 deaths were directly attributable to covid-19, including 3653 deaths from covid-19 related pneumonia and 920 excess deaths from other types of pneumonia, primarily unspecified viral pneumonia.”
The tally based on the study of excess deaths that can be attributed with confidence to Covid-19 was 3653, somewhat lower than the 3869 given by the official count at the time. The demographics of the excess deaths attributable to Covid-19 matched deaths elsewhere from Covid-19 (more male than female, more old than young). And the time course of the official and excess death fatalities matched.
What about the 920 deaths from pneumonia of uncertain etiology due to absence of Covid-19 tests during the early days? If we include them in the total to get a worst-case number there is only a 20% difference in the estimates given by excess mortality and those given by the official count at the time. Later China included these unconfirmed cases in its official tally, making the two tallies almost exactly equal. No matter how one slices it, the round number of less than 5000 is correct. It turns out China’s official account is remarkably accurate.
Second, the number of excess deaths in the rest of China decreased! As a result, overall deaths in China during the pandemic compared to the previous five years actually declined. In the words of the report:
“Except in Wuhan, no increase in overall mortality was found during the three months of the Covid-19 outbreak in other parts of China. The lower death rates from certain non-Covid-19 related diseases might be attributable to the associated behaviour changes during lockdown.”
They suggest that the reduced number of deaths outside Wuhan was due to behavior changes like masking and social distancing which would reduce other respiratory diseases like the common flu and to less road traffic.
The Lessons From China’s Handling of the Pandemic
The authors of the BJM study state the immediate lessons succinctly:
“Furthermore, the findings highlight the need for rapid and coordinated actions during major outbreaks of infectious diseases to contain, suppress, and eradicate transmission and minimize detrimental effects on human health and societal and economic activities.”
Such actions in China have included rapid and massive testing followed by tracing to find contacts of those who test positive and then quarantining when necessary, whenever even a small outbreak was detected. An example is the response in October, 2020, in Qingdao a coastal city in Shandong Province. As reported in the New England Journal of Medicine three case of Covid-19 were detected and this triggered testing of almost 11 million people in less than a week with appropriate quarantining when necessary. Nine additional cases were quickly found and the limited lockdowns were quickly terminated. China has responded in the same way to every outbreak, in the process learning how to restrict lockdowns to subpopulations of one area, such as a single neighborhood, and for a shorter time.
When the lockdown began in Wuhan on January 23, 2020, there was only one death due to Covid-19 in the U.S. The second U.S. death occurred on February 28. By April 8 when the lockdown in all Chinese cities ended there were 19,000 deaths in the US, still a small fraction of the more than 617,000 we have today. It was apparent that China’s actions were a success by April 8, 2020, and yet the U.S. took no similar action. The U.S. had a warning from China on January 1, 2020, and on January 11 Chinese scientists published the viral genome sequence which made immediate testing possible worldwide.
At the time of this writing China is coping with the new scourge of the delta variant of SARS-Cov-2, that began in July. There are now as many as 100 cases reported in a day, still miniscule by Western standards (The U.S. reported over 100,000 new cases recently, August 8, 2021.) but a genuine surge by China’s. Today, we learn that Wuhan has completed citywide Covid-19 testing in six days and found 37 cases plus 41 asymptomatic carriers among 12 million residents. A rapid vaccination campaign had already begun months earlier, added on to the containment measures. By August 4, over 1.7 billion jabs have been administered, 127 doses per 100 population; for comparison the US has 105 per 100 population. And the total death toll for the pandemic as of August 9 remains at 4629, the same as February 1, 2021 before the recent July surge. In the event of the need for a booster, China stands ready with capacity to produce more, including the BioNTech mRNA vaccine, which Fosun Pharma has contracted to produce in China up to 1 billion doses a year. Clearly China is willing to learn from the West, a strength. China’s measures seem to be holding the line at the moment, still a success story. What happens next is anyone’s guess, but for the first year and a half of the pandemic China’s measures were exemplary.
One lesson for us here in the U.S. is to put in place public health containment measures for the next wave of Covid-19 and for the next pandemic. These are certainly necessary before a vaccine arrives and the population can be vaccinated. We might also do well to generalize this lesson. Proceeding from reason, not blindness, exceptionalism, arrogance or condescension, might serve us well in all areas of US-China relations. If not, far more than 600,000 deaths may be the price to pay.