COVID-19 and Ireland – Part 16

It is now the received opinion that the city of Wuhan—in Hubei Province, China—was ground zero for the COVID-19 Pandemic. From there, the story goes, a deadly pathogen spread across the globe, infecting billions. At the time of writing (6 April 2022), the World Health Organization is reporting a total of 6,155,344 deaths from COVID-19. Other sources claim that up to 24.4 million deaths may be attributable to the pandemic, making it “one of the deadliest in history”:

After rigorous probes, tests, analyses, and other medical practices, the Chinese authorities made a global announcement (Huang et al., 2020) that they [had] successfully identified the virus as a novel coronavirus, similar to the one associated with SARS and the Middle East Respiratory Syndrome (MARS). Prior to this ground-breaking discovery, the officials had 2 days earlier, on January 5, ruled out that the virus they were dealing with was either SARS or MARS, hence concluding that it was indeed a new type of virus. Upon its successful identification, it was tentatively named as “2019-nCoV.” The identification came after Chinese scientists successfully isolated the virus from one of the patients quarantined in a hospital in Wuhan (Huang et al., 2020). According to an article by Singhal (2020), the identified virus had greater than 95% (>95%) homology with the bat coronavirus and was also greater than 70% similarity with the virus responsible for causing SARS (SARS-CoV).

As the identification occurred, it was also reported that the samples previously collected from the Wuhan market tested positive, thus confirming the fears that the virus could have originated from there. (Allam 3)

Wuhan and Hubei Province in China

This is all questionable: no virus has ever been isolated, identified or sequenced to my satisfaction. But for the sake of argument let us concede that all this has in fact been done. It stands to reason, then, that as the epicentre of one of the deadliest pandemics in history China must have been one of the hardest hit countries in the World. All-cause mortality for 2020 should have been significantly higher than one would have expected compared to recent years. Was it?

Trusting China’s Statistics

Before taking a look at the official figures released by the Chinese government, we ought to at least acknowledge the question of credibility. Can we trust the Chinese government to publish accurate statistics? One month ago, Ben Lowson, a freelance Sinologist and military strategist, addressed this very issue in an article that appeared in The Diplomat:

[There] is an important question about China’s statistics that most reporting never addresses: Absent independent verification, how reliable are they? ... Anyone studying China should be aware that, at the most basic level, Beijing’s official data are subject to the whims of the Chinese Community Party (CCP). There is simply no independent verification of Chinese government statistics. In everything from COVID-19 cases and deaths to the size of the Uyghur population and macroeconomic statistics, the Chinese government is the only player producing these data, and a highly interested one at that ... The hope has been that after Mao’s reign of terror a more open China would provide better statistics. Perhaps it has, but as COVID-19 has shown, the motive and means to misrepresent data remain. (Lowson)

Ben Lowson

Lowson’s article is bookended with similar warnings:

Beijing has both the motive and means to fudge its statistics ... [US lawmakers, regulators and business people] should take PRC [the People’s Republic of China] statistics with a healthy serving of salt.

Unfortunately, we have no source of data to draw upon other than the CCP’s official statistics. The reader should bear in mind, therefore, that any conclusions we come to ought to be taken with Lowson’s healthy serving of salt.

2020 All-Cause Mortality in Wuhan

In February 2021, The BMJ (formerly known as the British Medical Journal) published an article by eighteen Chinese doctors—most of whom worked for China CDC in Beijing—which looked at all-cause mortality in Wuhan City and other parts of China during the first three months of the covid-19 pandemic (January-March 2020). The authors based their report on the country’s nationwide mortality registries. What they found is not what one would expect during a global pandemic that has caused 6-24 million deaths to date.

Wuhan City was, as expected, hit hard by the outbreak, but the rest of the country, including Hubei Province, seems to have been spared:

China Center for Disease Control and Prevention

The DSP [Disease Surveillance Point] system recorded 580 819 deaths from January to March 2020. In Wuhan DSP districts (n=3), the observed total mortality rate was 56% ... higher than the predicted rate (1147 v 735 per 100 000), chiefly as a result of an eightfold increase in deaths from pneumonia (n=1682; 275 v 33 per 100 000 ...), mainly covid-19 related, but a more modest increase in deaths from certain other diseases, including cardiovascular disease ... and diabetes ...

In Wuhan city (n=13 districts), 5954 additional (4573 pneumonia) deaths occurred in 2020 compared with 2019, with excess risks greater in central than in suburban districts (50% v 15%).

In other parts of Hubei province (n=19 DSP areas), the observed mortality rates from pneumonia and chronic respiratory diseases were non-significantly 28% and 23% lower than the predicted rates, despite excess deaths from covid-19 related pneumonia. Outside Hubei (n=583 DSP areas), the observed total mortality rate was non-significantly lower than the predicted rate (675 v 715 per 100 000), with significantly lower death rates from pneumonia ... chronic respiratory diseases ... and road traffic incidents ... (Liu et al 1)

Observed (Orange) and Expected (Blue) Mortality Rates

These figures are difficult to explain:

In Wuhan City there was significant excess mortality: 56% overall, with eight times as many deaths from pneumonia, mainly “covid-19 related pneumonia”.
In the rest of Hubei Province, there were ... deaths from “covid-19 related pneumonia”, but all-cause mortality was from 23% to 28% lower than expected.
In other parts of China, all-cause mortality was slightly lower than expected (about 6%), while death rates from pneumonia were significantly lower.

Note also the sharp rises in some non-covid related diseases in Wuhan: myocardial infarction, ischaemic stroke, diabetes, and COPD. None of these is contagious, so the sudden spike in their mortality can only be the result of the lockdown measures.

Extract of Table 1 (Liu et al 4)

The conclusion drawn by the authors of this study is as follows:

Except in Wuhan, no increase in overall mortality was found during the three months of the covid-19 outbreak in other parts of China. (Liu et al 1)

The authors speculate on the possible cause of the decrease in all-cause mortality outside Wuhan:

The lower death rates from certain non-covid-19 related diseases might be attributable to the associated behaviour changes during lockdown. (Liu et al 1)

This opinion, however, is at odds with the finding in other jurisdictions that lockdowns caused excess mortality in many non-covid-19 related diseases. We looked at this phenomenon in an earlier article in this series: Did Lockdowns Save Lives. Harsh lockdowns did more harm than good. The authors of this paper even observed an increase in non-covid related diseases in Wuhan:

In Wuhan ... a more modest increase in deaths from certain other diseases, including cardiovascular disease ... and diabetes ... (Liu et al 1)

Lockdown: Chinese Style

Covid-19 Related Pneumonia

Jiangmei Liu and her colleagues refer to “covid-related pneumonia” several times in their paper. This disease is differentiated from “pneumonia”. Apparently, this is the disease that came to be known as COVID-19. But how did the authors of the paper distinguish between this and regular pneumonia? The PCR test that Christian Drosten had developed by 23 January 2020 was not used in this study. It is not even mentioned in the paper. Instead we read:

As covid-19 is a newly emerged infectious disease without a formal ICD code in the online reporting systems, most early deaths from covid-19, whether confirmed or suspected, during the outbreak in Wuhan were typically notified as “viral pneumonia without known organism” ... or “unspecific pneumonia” ... From 2 February 2020, the China Health Commission requested that any pneumonia related deaths, including those from covid-19, were to be reported online to China CDC within five days through its DSP mortality surveillance reporting system and separately through its infectious disease surveillance system. For confirmed covid-19 deaths a new ICD-10 code (U07.1) was used, whereas for suspected covid-19 deaths (without microbiological confirmation), an existing code (J12.8) was used. (Liu et al 2)

In other words, it was impossible to clinically distinguish COVID-19 from pneumonia. We are never told precisely how many of the covid deaths were classified as U07.1 and how many as J12.8. Instead, we read:

In each DSP area, local Centers for Disease Control and Prevention (CDC) managed the death registry at district or county level. Qualified medical staff in local hospitals usually determined the causes of death and coded these according to ICD-10 (international classification of diseases, 10th revision) codes. For deaths that occurred outside of hospital without recent medical attention, trained staff at local community health centres determined the causes of death using standardised procedures. (Liu et al 2)

Symptoms of Selected Respiratory Illnesses and Allergies

Clearly, COVID-19 was clinically and symptomatically indistinguishable from regular pneumonia, and the CDC staff simply used their own judgment in determining whether a case was covid or pneumonia. I would go so far as to suggest that there is no such disease as COVID-19. Every covid case—at least every covid case in which the patient was clearly suffering from a respiratory disease—was subject to misdiagnosis if the covid symptoms observed in the first three months of 2020 were indistinguishable from those of regular pneumonia.

At one point in their paper Liu and her colleagues speak of “excess deaths from covid-19 related pneumonia” occurring in other parts of Hubei Province at the same time that there was a large drop in “the observed mortality rates from pneumonia and chronic respiratory diseases” (Liu et al 1, 4). Apparently, what they mean is that although fewer people died overall from respiratory illnesses, some of these deaths were attributable to COVID-19. As this is a novel disease, there were 0 covid deaths in previous years. Therefore, all deaths in 2020 from COVID-19 are “excess deaths from covid-19 related pneumonia”. This sounds like the same phenomenon experienced in the west, where we were told that the flu was essentially non-existent in late 2020 and early 2021. If every flu case is misdiagnosed as COVID-19, then it will appear that influenza has disappeared.

The Growing List of Covid Symptoms

Conclusions

We are being asked to believe that the following scenario is realistic:

A deadly novel coronavirus emerged in Wuhan around November 2019. It spread throughout the city, causing a spike in excess mortality for the first three months of 2020.
The Chinese government’s quick and energetic reaction to the outbreak succeeded in preventing the virus from becoming epidemic outside Wuhan. As a result, there was no excess mortality in early 2020 anywhere in China with the exception of Wuhan. Even Hubei Province recorded a negative excess mortality—fewer overall deaths than one would have expected. The measures taken were so successful, in fact, that “the lockdown was lifted in all provinces of China from early or mid-April 2020, including Wuhan city” (Liu et al 2).
Nevertheless, the virus was transmitted from Wuhan to other countries around the world, with the result that a global pandemic ensued, leading to the deaths of at least 6 million people and possibly as many as 24 million.

Is this a credible scenario? How could China do such a good job of preventing a pandemic in their own country, while infecting the rest of the planet? Why did repressive lockdowns in other jurisdictions—some of them harsher that anything the Chinese did—not have similar success? Here in Ireland we were forced to endure a lockdown that lasted about two years, while Wuhan was back to the old normal in the summer of 2020:

A Nightclub in Wuhan in August 2020

In their paper, Liu and her colleagues put the total covid death toll for all of China at 4600 on 31 March 2020, of which 3870 occurred in Wuhan. Today (12 April 2022), the official Chinese death toll stands at 4638. Ireland—ie the Irish Republic—has experienced a total of 6668 deaths! This makes no sense. Not only are we being asked to believe that a tiny sparsely populated country like Ireland suffered more deaths than the whole of China, where the pandemic began, but also that in the two years that have elapsed after 31 March 2020, the Chinese death toll has increased by just 38.

It is of course possible that the solution to this conundrum is that China’s statistics are simply not credible. But, then again, are any country’s covid statistics credible?

And that’s a good place to stop.

References

Zaheer Allam, Surveying the Covid-19 Pandemic and Its Implications: Urban Health, Data Technology and Political Economy, Elsevier, Amsterdam (2020)
Ben Lowson, How Reliable Are China’s Statistics?, The Diplomat, 1 March 2022, Washington, DC (2022)
Jiangmei Liu et al, Excess Mortality in Wuhan City and Other Parts of China during the Three Months of the Covid-19 Outbreak: Findings from Nationwide Mortality Registries, The BMJ, Volume 372, Number 415, BMJ Publishing Group Ltd, London (2021)

Image Credits

Observed (Orange) and Expected (Blue) Mortality Rates: © 2022 BMJ Publishing Group Ltd, Jiangmei Liu et al, Figure 1, Fair Use
Lockdown: Chinese Style: Copyright Unknown, Fair Use

China and Excess Mortality