Chinese numbers - Printable Version
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Chinese numbers - OutsiderFan - 03-29-2020
There was a thread where I was getting some flak for suggesting China's numbers are the product of its propaganda machine. I have no idea how accurate these claims are. They come from someone who is a Hong Kong activist of some sort, but these are the reasons I use to justify my belief China has been less than transparent. I do think scientists make an effort to share accurate information with each other when it comes to specifics about the virus, but the public health numbers leave a lot of room to be skeptical, IMO.
[tweet]https://twitter.com/joshuawongcf/status/1244098907715407873[/tweet]
Oh, and look at this:
https://www.rfa.org/english/news/china/wuhan-deaths-03272020182846.html
RE: Chinese numbers - magnus - 03-29-2020
(03-29-2020, 01:45 PM)OutsiderFan Wrote: There was a thread where I was getting some flak for suggesting China's numbers are the product of its propaganda machine. I have no idea how accurate these claims are. They come from someone who is a Hong Kong activist of some sort, but these are the reasons I use to justify my belief China has been less than transparent. I do think scientists make an effort to share accurate information with each other when it comes to specifics about the virus, but the public health numbers leave a lot of room to be skeptical, IMO.Regarding the funeral urns...one could argue that they're not all for Covid19. =/
[tweet]https://twitter.com/joshuawongcf/status/1244098907715407873[/tweet]
Oh, and look at this:
https://www.rfa.org/english/news/china/wuhan-deaths-03272020182846.html
Then again, that's a ton of urns, and rumors about rejecting sick people to keep the count down have been going on since the outbreak blew up back in January. That, along with not testing post mortem (patient would die of say pneumonia, and then be cremated immediately without a test to see if Covid19 caused it, for example) were two of the big ones floating around back in Jan/Feb.
RE: Chinese numbers - 2006alum - 03-29-2020
To have a full accounting, it's certainly important to learn the truth, so I definitely think we should keeping digging to find out the official numbers, for posterity's sake, among other things. Behind an FT paywall, there's a great article on this, a snippet of which is:
Quote:Experts have highlighted the existence of unreported cases, as well as the large number of asymptomatic cases that the government refuses to publicise in its official tally. It is extremely worrying to continue to publicise ‘zero new cases’ Wuhan nurse Two nurses in Wuhan, who wished to remain anonymous because of the sensitivity of the pandemic, told the Financial Times of “hidden” infections that met the national criteria for confirmed cases but were not being recognised in the city’s official count, helping to keep it at or near zero. “The medics I know are all telling me that the hospital and the [National] Health Commission are using all their means to control the new case count,” said one of the nurses.
That said, I don't think China's numbers, whatever they are, are that helpful to us now that we have transparent data from examples of relatively effective public health responses (South Korea and Taiwan) and relatively ineffective responses (Italy and Spain). At this point, the most useful thing China is contributing is supplies and knowledge related to treating the virus and developing a vaccine. I certainly would not look to them for examples of public health responses.
The other reason I think this debate is of relatively limited utility is that almost every country's data is pretty suspect whether or not there's been a coverup. For one thing, different countries (and different jurisdictions within each country) have different testing and coding protocols. From the same article:
Quote:The [Chinese] National Health Commission, the government agency that sets guidelines for how cases are reported and disclosed, has always maintained that asymptomatic cases should not be counted in its confirmed case total. Asymptomatic cases are patients who test positive for Sars-Cov-2, the virus that causes the disease Covid-19, but have “no clinical symptoms”.
This means that the numerator of those who have had the disease will never get anywhere near the denominator of the overall population in total, so it would be very hard to estimate penetration rate. Other jurisdictions are purposefully undercounting by declining to test those with "light" symptoms who are instead told to stay at home so as to save tests for healthcare workers and those for whom a positive test might alter the course of treatment. And some countries are so swamped that it may not even be possible to diagnose every death that may have resulted from COVID-19. In countries like Italy and Spain, there are well documented cases of individuals who almost certainly died from COVID-19 but were never diagnosed with it, because in some towns where a dozen or so people died last March, many dozens more have died so far this March, and yet only a handful of those deaths were attributed to COVID-19. For example:
[tweet]https://twitter.com/DellAnnaLuca/status/1242105241350234112?s=20[/tweet]
All of which to say, substituting the soft nationalism of the Olympics with comparative analysis and boasting/shaming about positive case and mortality rates is only so useful. I'd be much happier if our news coverage was focused primarily on what each of us can do and on effective public health responses, drawing on those jurisdictions that have transparent and uniform protocols and seem to have had especially effective responses.
RE: Chinese numbers - akiddoc - 03-29-2020
(03-29-2020, 02:15 PM)magnus Wrote:(03-29-2020, 01:45 PM)OutsiderFan Wrote: There was a thread where I was getting some flak for suggesting China's numbers are the product of its propaganda machine. I have no idea how accurate these claims are. They come from someone who is a Hong Kong activist of some sort, but these are the reasons I use to justify my belief China has been less than transparent. I do think scientists make an effort to share accurate information with each other when it comes to specifics about the virus, but the public health numbers leave a lot of room to be skeptical, IMO.Regarding the funeral urns...one could argue that they're not all for Covid19. =/
[tweet]https://twitter.com/joshuawongcf/status/1244098907715407873[/tweet]
Oh, and look at this:
https://www.rfa.org/english/news/china/wuhan-deaths-03272020182846.html
Then again, that's a ton of urns, and rumors about rejecting sick people to keep the count down have been going on since the outbreak blew up back in January. That, along with not testing post mortem (patient would die of say pneumonia, and then be cremated immediately without a test to see if Covid19 caused it, for example) were two of the big ones floating around back in Jan/Feb.
The Chinese numbers may not be accurate, but RFA is not a trustworthy source of information.
Here in the USA, we (as in doctors) are telling most patients that they do not need to be tested. Better to stay at home when you are not terribly sick and sit it out. Our numbers are going to be terribly inaccurate as well.
After everything dies down and we have a good test to look at antibody titers, epidemiologists will be able to look at the prevalence of the disease with more accuracy.
For children, we are not testing much at all. I am telling people to assume it could be Covid 19 if the symptoms are consistent with the diagnosis. Hydrate, use Tylenol to control the fever, stay at home, and self isolate. If there is a household member who is working, we bring the kid in and swab them. If they are short of breath we see them or send them to the ER. We generally test those kids. If the kid has had a fever for 5 days or more we see them and get a chest X-ray and test them. We haven't seen many at either of my jobs who really would benefit from testing. Testing capacity is not unlimited and more likely of use in the adult population.
RE: Chinese numbers - BostonCard - 03-29-2020
I largely agree with you 2006. However, I will note that a transparent accounting of cases still has value inasmuch as it allows us to make informed decisions about what course of action we should take as a society. A Chinese style clampdown might be more acceptable to people if they knew it would be effective. If, on the other hand, they knew that, to paraphrase Chris Berman, "You can't stop coronavirus; you can only hope to contain it", then maybe they wouldn't subject themselves to such a strict clampdown.
The most transparent way to go is:
# of tests administered
# of tests negative
# of tests positive, of which
# of positive but asymptomatic
# of positive with mild symptoms
# of positive requiring hospitalization
# of positive requiring ICU care
# of deaths
Also, worth accounting for number of excess deaths due to other causes.
BC
RE: Chinese numbers - OutsiderFan - 03-30-2020
I agree it doesn’t matter what China’s real numbers are or were at this point in time. They really only matter later in time when the complete data set is needed to understand what happened for the sake of history and future learning.
That said, the lack of transparency from China gave countries around the world an inaccurate sense of reality and led to the misinformation about “this is just flu” in many parts of the world.
For me, the only thing I needed to see was the images of all those excavators mobilizing to build an emergency hospital on Jan. 23. That was the canary in the coal mine, and all I needed to see to conclude this thing was a very big deal and China knew it. At that moment I went from casual observer to “I better take this really seriously so I’m prepared.”
RE: Chinese numbers - Snorlax94 - 03-30-2020
(03-30-2020, 04:09 AM)OutsiderFan Wrote: I agree it doesn’t matter what China’s real numbers are or were at this point in time. They really only matter later in time when the complete data set is needed to understand what happened for the sake of history and future learning.
That said, the lack of transparency from China gave countries around the world an inaccurate sense of reality and led to the misinformation about “this is just flu” in many parts of the world.
For me, the only thing I needed to see was the images of all those excavators mobilizing to build an emergency hospital on Jan. 23. That was the canary in the coal mine, and all I needed to see to conclude this thing was a very big deal and China knew it. At that moment I went from casual observer to “I better take this really seriously so I’m prepared.”
There was plenty of early warning for those willing to listen:
https://www.businessinsider.com/coronavirus-taiwan-case-study-rapid-response-containment-2020-3
“On December 31, Chinese officials notified the World Health Organization that China had several cases of pneumonia. That day, the Taiwan Centers for Disease Control began monitoring passengers who arrived in the country from Wuhan. Government officials boarded flights from Wuhan as soon as they landed, monitoring passengers for symptoms.
Less than a week later, the government began monitoring people who had traveled from Wuhan since December 20.
"Suspected cases were screened for 26 viruses, including SARS and MERS," the Stanford Health Policy report said. "Passengers displaying symptoms were quarantined at home and assessed whether medical attention at a hospital was necessary."”
And from Jamanetwork on Taiwan’s response:
https://jamanetwork.com/journals/jama/fullarticle/2762689
“For the past 5 weeks (January 20-February 24), the CECC has rapidly produced and implemented a list of at least 124 action items (eTable in the Supplement) including border control from the air and sea, case identification (using new data and technology), quarantine of suspicious cases, proactive case finding, resource allocation (assessing and managing capacity), reassurance and education of the public while fighting misinformation, negotiation with other countries and regions, formulation of policies toward schools and childcare, and relief to businesses.
Border Control, Case Identification, and Containment
On January 27, the National Health Insurance Administration (NHIA) and the National Immigration Agency integrated patients’ past 14-day travel history with their NHI identification card data from the NHIA; this was accomplished in 1 day”
In terms of Americans’ lack of preparation, here is an image from march 8
https://m.imgur.com/a/UAvUSO3
![[Image: UAvUSO3]](https://imgur.com/a/UAvUSO3)
![[Image: UAvUSO3]](http://m.imgur.com/a/UAvUSO3)
RE: Chinese numbers - 2006alum - 03-31-2020
Another interesting story on anecdotes (since that's the best we can hope for) suggesting China's vastly undercounting COVID-19 mortalities in Wuhan:
[tweet]https://twitter.com/DrEricDing/status/1244864160434982917?s=20[/tweet]
RE: Chinese numbers - burger - 03-31-2020
(03-31-2020, 07:23 AM)2006alum Wrote: Another interesting story on anecdotes (since that's the best we can hope for) suggesting China's vastly undercounting COVID-19 mortalities in Wuhan:
[tweet]https://twitter.com/DrEricDing/status/1244864160434982917?s=20[/tweet]
Let's not forget that deaths from other causes were still happening in Wuhan. It's more than likely that deaths from other causes increased because hospitals were overrun. I saw an interview with a cancer patient in Wuhan who couldn't get treatment. No doubt there were others.
So, assigning all excess deaths* in Wuhan to Covid-19 is baseless.
*I have yet to see an authoritative figure for the "normal" death rate in Wuhan, much less the death rate in mid-winter when influenza, etc. were probably going around as ewll.
RE: Chinese numbers - Farm93 - 03-31-2020
(03-31-2020, 08:13 AM)burger Wrote: Let's not forget that deaths from other causes were still happening in Wuhan. It's more than likely that deaths from other causes increased because hospitals were overrun. I saw an interview with a cancer patient in Wuhan who couldn't get treatment. No doubt there were others.You, as a person outside of the Chinese Communist Party leadership, will not likely see those numbers, at least not for a while.
So, assigning all excess deaths* in Wuhan to Covid-19 is baseless.
*I have yet to see an authoritative figure for the "normal" death rate in Wuhan, much less the death rate in mid-winter when influenza, etc. were probably going around as ewll.
Right now, for the Chinese Community Party, the narrative is perfect. "There was a deadly outbreak, but thanks to our one party system we took action and we had fewer deaths across our 1.3 billion people than Italy, Spain and the USA had with much smaller populations. In those places politicians argued for weeks rather than take action, and their citizens died as a result."
There is no reason to change that story.
In time, some with real knowledge will disclose more information, but not now. The official death count likely includes those that died in the hospitals. Some/many/most that died outside of hospitals probably were not tested so are not in the official count.
I won't go as far as to say I know the Chinese government intentionally lied, but I am fairly confident they didn't march through the countryside to confirm COVID-19 wasn't involved in the at home deaths of every 70+ year-old that the local officials declared were the result of natural causes/old age/heart failure/cancer/flu/pneumonia/etc.
There is really not much value for China to circle back and figure that out, and even less value in them disclosing that to their citizens or people outside of China.
The tally of fatalities for the Spanish Flu took several decades to uncover, and even today the estimates vary dramatically. COVID-19 will likely end up in a similar place.
RE: Chinese numbers - OutsiderFan - 04-01-2020
This is not shocking:
https://www.bloomberg.com/news/articles/2020-04-01/china-concealed-extent-of-virus-outbreak-u-s-intelligence-says
I'm not going to cut the POTUS any slack for the federal level mismanagement of this pandemic crisis, but I do believe it is quite possible that federal planners were skeptical about the severity of this outbreak in part due to China's numbers.
In fact, I believe the whole world underprepared based on China's faulty numbers. It is infuriating that people like me had to go to "boutique" sources of information to really understand what was coming with this pandemic, in part because I stopped believing Chinas's numbers very early in the game. The U.S. and other countries would have been much more likely to mobilize sooner had China been transparent.
WTF did China have to gain by purposely lying about the severity of its outbreak? How is it benefitting from the rest of the world being economically nuked as a result of its truly unhelpful reporting?
RE: Chinese numbers - burger - 04-01-2020
(04-01-2020, 09:15 AM)OutsiderFan Wrote: This is not shocking:
https://www.bloomberg.com/news/articles/2020-04-01/china-concealed-extent-of-virus-outbreak-u-s-intelligence-says
I'm not going to cut the POTUS any slack for the federal level mismanagement of this pandemic crisis, but I do believe it is quite possible that federal planners were skeptical about the severity of this outbreak in part due to China's numbers.
In fact, I believe the whole world underprepared based on China's faulty numbers. It is infuriating that people like me had to go to "boutique" sources of information to really understand what was coming with this pandemic, in part because I stopped believing Chinas's numbers very early in the game. The U.S. and other countries would have been much more likely to mobilize sooner had China been transparent.
A few things here. First, US intelligence lost most of its credibility years ago. It's well known that they will slant their findings to suit whoever is in charge. And Trump and his people have basically done nothing but blame China.
Also, who cares if the numbers are wrong. The world had plenty of warning that this was incredibly serious. Would China turn Wuhan into a prison if it wasn't? Building all of those temporary hospitals? Epidemiologists were sending out warnings in January, but they were ignored.
Quote:WTF did China have to gain by purposely lying about the severity of its outbreak? How is it benefitting from the rest of the world being economically nuked as a result of its truly unhelpful reporting?You've answered your own question. If they had nothing to gain, why lie? It's not like tourists are going to be traveling to China now because it's supposedly virus free.
And, again, the argument that the outbreak only happened because China lied is so specious that I am almost embarrassed to see it here. We had advance warning from Italy, South Korea, etc., and Trump used that time to mainly lie about the "hoax." Were those other countries fudging numbers, too? Come on.
RE: Chinese numbers - OutsiderFan - 04-01-2020
I'm mostly with you, burger, though I hold USIC in more esteem.
It's just a matter of fact that the 3,000 or so Chinese deaths most people used as their reference point didn't really get challenged until Italy's outbreak started. If anyone was relying on China's reports to guide their own planning, they were off, I'm guessing they were caught woefully unprepared when they started realizing they were planning for something 10x less severe.
We freak out about people saying "it's just the flu" when Covid-19 has a 10x CFR. Miscalculating by this much is devastating in any endeavor, and especially so when they involve lives and treasure.
RE: Chinese numbers - 2006alum - 04-01-2020
Here are my two cents.
First, there's no one person responsible for the undercount - every district level party leader had an incentive to undercount. It's a well documented phenomenon that in authoritarian regimes, underlings who are punished for bad news will deliver only good news, even if it's false. Anyone recall the parable of the Potemkin Village? So assume that this wasn't just one conspirator purposefully releasing wrong data, but a massive, somewhat decentralized effort to undercount wherever possible.
Second, I find it astonishing that anyone is that surprised at this point. China locked down 60 million people in Wuhan when there were 800 reported cases. In retrospect, that was by far the biggest response to the fewest number of cases of any government, even now, with everything we've known since. And many of the epidemiologists and public health experts I've been following since late January have been warning that China's data seemed dubious and that it was was probably significantly undercounting cases and deaths. Anyone paying attention knew this. Indeed, the Bloomberg article itself acknowledges this:
"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."
Laurie Garrett, a veteran epidemic reporter who has covered epidemics on 6 continents for over 30 years, said in an interview this AM that every epidemic she has covered has had the same four-step political/societal response:
1. First, it's "only a handful of cases." Authorities downplay the importance or significance, and there is skepticism in both media and among politicians. (Think the President's responses in mid-February where he claimed it was "only 15 cases" and "sometime in April it will just disappear.")
2. As powers that be realize they have a real problem, cover up begins. Some as a matter of actual policy (think China in early January), but in many cases it's downplaying the significance to avoid being shown to have erred. (Think: "anyone who wants a test can get tested, so there's nothing to worry about.")
3. As it becomes an epidemic, lower level politicians are shoved aside and someone high up steps in, claims to be in charge, going to take the bull by the horns. (Think when the White House daily press conferences started, and Trump is now front and center talking about how well the government has been managing things.) At the same time, popular skepticism argues that it's not as bad as people say (Think Fox News through mid-March), or that some specific "other" is responsible (think the move, now, to blame it all on China, or on the Impeachment effort distracting the President).
4. The final stage is a massive mobilization that starts to be commensurate with the level of threat, lots of money, often police or military forces. In developing countries, there's a cry for international aid, and a slowly evolving international response emerges.
What is terrifying, Garrett noted, is that there is a response necessary with every country on earth, at once.
(04-01-2020, 09:39 AM)OutsiderFan Wrote: We freak out about people saying "it's just the flu" when Covid-19 has a 10x CFR. Miscalculating by this much is devastating in any endeavor, and especially so when they involve lives and treasure.
The problem with this narrative is that the WHO announced a 3.4% CFR on March 3. And by that point, Italy was already in severe crisis. London Breed declared a State of Emergency on February 26. The people who were paying close attention knew how bad this would be. The problem is that the people in charge in the U.S., largely, did not want it to be bad, so they preferred to look away.
RE: Chinese numbers - OutsiderFan - 04-01-2020
There are some people who feel they have more freedom to act than others. CA and WA clearly had the leadership in place to act much more proactively than other places.
I'm not saying the evidence wasn't there. It was for people who bothered to inform themselves, but the body politic doesn't bother to inform itself and only pays attention to multinational corporate sources of information. There is going to be a lot of public skepticism when things aren't self-evident, which makes government action difficult.
If China had reported 1.2 million cases and 50,000 deaths, I'm certain other countries and the U.S. would have acted sooner. We can thank our lucky stars that Italy got hit before the U.S. because if we didn't have Italy as an example, OMG would we have been hit by a tsunami we never saw coming and things would be WAY worse. At least Italy gave us the opportunity to see it approaching to at least brace for it.
RE: Chinese numbers - Snorlax94 - 04-01-2020
https://www.cnn.com/2020/04/01/politics/mike-pence-coronavirus/index.html
Pence seeks to blame CDC and China for any delay in US coronavirus response -- not Trump's initial failure to face reality
Pence isn't the only one...
If it's obvious enough for senators to dump their stocks, it is obvious enough for the administration to actually do something.
On Dec 31, Taiwan closed its borders with China.
On January 27, Senator Inhofe starts dumping stock.
On February 27, ***YOU*** are the one who started the conversation on the Carboard, opening with "Given we are on the verge of an unprecedented public health crisis, I hope the mods don't shut this down because it is too "controversial" to discuss here, but information is power, and I have some that I feel will help people at least a little."
So YOU yourself called this an "unprecedented public health crisis". On February 27. And the thread was started because it was already obvious, for a while, that this was potentially a massive issue and the government was failing to respond.
If only there were a pandemic response team on the National Security Council that could have been watching this develop far in advance...
RE: Chinese numbers - OutsiderFan - 04-01-2020
Pence can say whatever the hell he wants, while looking really pathetic and weak trying to blame others for his and his boss's failures. None of this changes the fact they were responsible. You want the big job, you put on your big boy pants and take the responsibility that comes with it.
That said, there is a difference between deflecting blame and understanding why failure occurred. Just because they have a reason they may not have acted with as much urgency as the situation called for, that doesn't absolve them for failing to be prepared because that is the job.
My only point is I'd rather not have seen them fail so spectacularly (even though I predicted they would), and I can understand how faulty China numbers might have led to a false sense of security that led to inadequate action. Again, this doesn't clear anyone of responsibility, just explains a piece of why the mismanagement occurred.
RE: Chinese numbers - 2006alum - 04-01-2020
Stuff like this is why I think we should focus less on Chinese numbers and more on working with their scientists - every country in the world is highly incentivized to find effective treatments and eventually preventative care:
[tweet]https://twitter.com/Reuters/status/1245435765456138241?s=20[/tweet]
RE: Chinese numbers - M T - 04-01-2020
Gosh, why didn't all the people who knew China was lying call up their senators and representatives and say "Drop everything else, we've got an existential threat coming out of China"?
The rumors quoted in an article posted here make guesstimates at 45K deaths in Wuhan, which is approximately 11K deaths above a steady state death rate for 2.5 months for an 11M person city with average life span of 67.6 years, plus the 3500 health-system deaths. So, that makes an attack rate of 4x of what showed up in the health system. The CFR should still the same.
It is interesting that a CFR quoted today for Hubei (in another thread) of 1.38% is less than the naive CFR South Korea reports currently (1.67% overall, 18.6% 80+, 7% 79-79) but then demographics suggest S. Korea should be about 40% higher than China. (The thread today suggests a more pedestrian rate of 13.4% for 80+ in Hubei. )
Oh yea, today's CFR numbers are in a report from the UK. Today's daily report from China indicates a naive CFR of 4.7% for Hubei for the entirety of the epidemic. I believe the corresponding number from the UK report to be 3.67%
-----------
I have known a number of people that I would expect to (try to) refuse to be sent to the hospital in a situation of getting COVID-19. "If I'm going to die, I want to die at home, not be poked & intubated & isolated in a hospital." I do NOT presume that the same sentiment would happen in China, but I can believe so. It isn't clear whether these extra deaths in China were known to the health system. As I said earlier, I saw a video of the authorities breaking down a door to get to an 80yo man (allegedly because he was suspected of having the disease), sitting quietly in his apartment. If you added the deaths of people who chose not to seek medical help, the CFR would not be representative of the disease as it can be treated.
RE: Chinese numbers - BostonCard - 04-01-2020
(04-01-2020, 01:14 PM)2006alum Wrote: Stuff like this is why I think we should focus less on Chinese numbers and more on working with their scientists - every country in the world is highly incentivized to find effective treatments and eventually preventative care:
[tweet]https://twitter.com/Reuters/status/1245435765456138241?s=20[/tweet]
Now there is concern about ADE (antibody-dependent enhancement).
https://www.sciencedirect.com/science/article/pii/S1286457920300344
and
https://jvi.asm.org/content/94/5/e02015-19
ADE means that antibodies against other coronavirus actually make infection worse. This is a phenomenon seen with dengue fever; the first case is usually mild, but by the time someone gets infected by a third or fourth strain of dengue it can be deadly. It might also explain the age gradient in severity (older patients are more likely to have been exposed to other coronaviruses). If this is true, the rush to a vaccine, and convalescent serum might wind up being a mistake.
BC