The World Health Organization is ramping up pressure on China to share key data on its latest coronavirus outbreak, using public statements and behind-the-scenes meetings to push Beijing as it tries to map the largest surge of the pandemic — even if it risks the government’s wrath.
But the new approach might be paying off. On Saturday, China’s National Health Commission (NHC) announced a significant revision of its data, raising the death toll in hospitals since severe coronavirus restrictions were lifted in December from 37 to nearly 60,000.
At the same time, Ma Xiaowei, director of the NHC, shared much of the same data with Tedros, according to a WHO readout of a call between them.
WHO officials are unsure why China released the data now — and in interviews were hesitant to take responsibility. The numbers appear to show an outbreak similar to the waves of omicron that washed over other countries a year ago. It also suggested that the new wave of infections had peaked — possibly reassuring news before the Lunar New Year, a period of intense holiday travel.
But there are also significant gaps, including in detailed regional data and information over time. The new data also lacks the detailed genome sequencing that the WHO and others have requested to track any new variants.
“It’s really sad to see the number of hospital-related deaths of 60,000 in the last month, but that should be considered the minimum,” said Maria Van Kerkhove, the WHO’s technical lead on covid-19. The data, she noted, does not appear to include deaths outside of hospitals.
Still, it is more information than China has typically provided. Before Saturday, Beijing had released little data on the outbreak, which grew exponentially after the government lifted its “zero covid” policy on Dec. 7, ending mass testing, harsh lockdowns and lengthy quarantines.
Chinese Foreign Ministry spokesperson Wang Wenbin said Monday that Beijing would continue to “share information with WHO and the rest of the international community in a timely, open and transparent manner, in accordance with the law.”
The secrecy around the latest outbreak had heightened concern among global health officials and analysts that new variants could be spreading undetected.
Van Kerkhove said the release confirmed to the WHO one important thing: “It tells us that this data exists.”
The NHC stopped reporting daily case counts in December. From Nov. 1 to Jan. 13, the Chinese Center for Disease Control and Prevention reported fewer than 50 deaths, a figure analysts said was implausibly low.
J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies, called that data “ludicrous” and said it undermined China’s reputation. “No one believes it,” he told said. “What’s the point?”
For much of the past three years, Chinese authorities blocked international travel and imposed strict quarantines to stamp out the virus — and avoided the worst of the pandemic. But as this winter approached, more-contagious offshoots of the omicron variant began to spread, despite the harsh restrictions, and rare protests against the restrictions prompted officials to reverse course, lifting almost all of them.
Soon, authorities in many major cities, including Beijing, were reporting fast-spreading outbreaks. Satellite imagery of crematoriums suggest that China has suffered many more deaths than the government has acknowledged, The Washington Post reported last week.
As reports drew an increasingly dire picture, the WHO increased pressure, publicly and privately. Tedros repeatedly called on the Chinese government to report the number of hospital admissions and other information. The WHO urged China to share data on disease severity, the number of patients in intensive care and genomic sequencing.
The WHO also held several private meetings with Chinese officials, in addition to their regular contact in Beijing, where the organization maintains an office.
The meetings have been professional, according to those involved, but the message is clear: Where is the data?
Van Kerkhove said the WHO and other officials know the quality of China’s health data, having seen it on visits in early 2020. “The scientific capacity in China is pretty incredible,” she said.
The WHO has no authority to compel China to release data — but it can keep asking.
One shortcoming in the data is the way that China counts its deaths, which WHO officials consider unusually restrictive. According to WHO emergencies head Mike Ryan, China registers deaths as coronavirus-related only if the cause is respiratory failure and a positive coronavirus test has been recorded.
The new data is more expansive — it breaks out 5,503 who died of respiratory failure caused by the virus and 54,435 who died of underlying diseases combined with covid-19. Still, some analysts remain skeptical.
“The new official numbers are most likely not a reflection of the total number of covid-related deaths,” said Louise Blair, head of vaccines and epidemiology at Airfinity. The science-forecasting group estimates that China’s omicron wave has caused over 608,000 deaths as of Tuesday morning. “These numbers imply a much lower number of deaths per capita in China than all other major countries have experienced.”
Ali Mokdad, professor at the Institute for Health Metrics and Evaluation at the University of Washington, said the 60,000 figure was “plausible but could be an underestimate” because of a lag in data collection or misattribution of deaths.
The institute predicts that China could see as many as 1.6 million deaths by the end of the year if new preventive measures are not put in place, Mokdad said.
Liu Pengyu, the spokesperson for the Chinese Embassy in Washington, said last week that China has followed the same standard for counting deaths since 2020. Liu said China had been sharing “information and data with the international community in an open and transparent manner” since the coronavirus was first identified, including sequencing data for the virus.
“In the past month alone, we had five technical exchanges with” the WHO, Liu said.
WHO officials confirmed an uptick in meetings with China. Officials from China’s CDC this month attended a virtual meeting of the WHO’s Technical Advisory Group for Virus Evolution (TAG-VE) to present genomic data. Chinese officials also gave an update on the situation at a meeting of member states.
According to TAG-VE, the China CDC data showed a predominance of omicron lineages BA.5.2 and BF.7 circulating. Both are already common around the world.
Elodie Ghedin, a Canadian virologist who was present at the meeting, said the discussion included an overview of how genomic surveillance is working in China. CDC officials there choose one hospital in a key city in each province to monitor, then extrapolate a broader view.
“They run it through the same analysis pipeline that everybody else in the world does,” Ghedin said. Sequencing has declined worldwide, so China’s approach isn’t unusual, but the scale of the surge there makes it worrying, she said.
“In China, I would have hoped there would have been a bit more surveillance,” she said. “It seems a little low, in my opinion.”
Meeting participants raised concerns that China was not sharing more of its genomic sequencing from the outbreak with GISAID, a global platform for coronavirus data. According to Ghedin, Chinese officials responded that they hoped to study the data first and then publish their own research.
“We’ve heard this argument for decades,” she said. “People are always going to get scooped.”
So far, the Chinese response to the WHO’s pressure has been relatively muted compared with previous episodes.
Chinese officials reacted with fury in 2021 when Tedros criticized the results of a joint WHO-China probe into the origins of the coronavirus that dismissed the idea that the virus could be linked to a lab in Wuhan. Beijing censored Tedros on online platforms last year after he said its zero-covid policy was unsustainable.
But at a news briefing earlier this month, Foreign Ministry spokesperson Wang called on the WHO to “look at China’s covid response scientifically and rationally,” and with “objectivity and impartiality.”
In the meantime, Van Kerkhove said, work at the WHO’s office in Beijing’s diplomatic district continues. But staff members there are dealing with another problem: their own outbreak.
“Many of them have been sick,” Van Kerkhove said. “You know, like most people across the country.”