[M T]

There's a lot that is being said about the possibility of China under-reporting COVID numbers.  It struck me that maybe (like the US) it had problems with its tests to detect COVID-19.

On January 5, Wuhan indicated it had 59 apparent cases of the disease.  (The numbers I find are:  Dec 30: 27,  Jan 3: 44,  Jan 5: 59).  [Btw, their first death was Jan. 9.  Second was Jan. 15]

Up to that point the numbers look similar to outbreaks here.  Remember, these are clinically diagnosed cases.  The virus hasn't been identified, and no test is yet available.

The genome was sequenced January 7.  A test was released on January 9 and distributed to Wuhan on January 10.   A report published on January 11 at 7AM indicated 41 patients with the disease.  A WHO release the next day refers to these as "confirmed cases".
Of those 41, the latest admission was January 2.
Wuhan reported these new case counts:
From Jan. 11 to Jan. 15, zero.
Jan. 16,  4 new
Jan. 17, 17 new
Jan. 18, 59 new
Jan. 19, 77 new

On Jan. 20, China realizes the disease is spreading from human to human, and classifies it as such.

On Jan. 20, China has 72 new cases in Hubei (77 total), resulting in 270 in Hubei (291 total).

So, what happened between when it was 59 on Jan. 5, to 41 on Jan. 15?  
Per a NEJM article, a tailored surveillance protocol was established to identify potential cases on Jan. 3.  Possibly this protocol was overly restrictive (perhaps requiring an association to the sea food market).

Also, the test was introduced.  Perhaps the test had a large number of false negatives (at least 18 out of 58).   Although they may have been getting new cases in the hospital, they weren't being counted as confirmed because the tests came back negative.  (It is also possible that those with symptoms avoided medical care.)

Compare the numbers above for January 3 to 20 to the cases shown in the chart in the NEJM article.



I found this of interest about Li Wenliang, who apparently was exposed on January 8:

Li developed a fever and cough on 10 January, which soon became severe.  On 12 January, Li was admitted to intensive care ..., where he was quarantined, treated, and tested for the virus several times until he tested positive for the infection on 30 January. He was diagnosed with the virus infection on 1 February

If the tests (or, perhaps, how the swabs were taken) resulted in a very high rate of false negatives, this may be the cause of some of the screwy low numbers in that first 1 to 3 weeks after the test was created.

If this hypothesis is true, and Fauci were aware of this, he might have been reticent to use anyone else's test.

[M T]

There's a lot that is being said about the possibility of China under-reporting COVID numbers.  It struck me that maybe (like the US) it had problems with its tests to detect COVID-19.

On January 5, Wuhan indicated it had 59 apparent cases of the disease.  (The numbers I find are:  Dec 30: 27,  Jan 3: 44,  Jan 5: 59).  [Btw, their first death was Jan. 9.  Second was Jan. 15]

Up to that point the numbers look similar to outbreaks here.  Remember, these are clinically diagnosed cases.  The virus hasn't been identified, and no test is yet available.

The genome was sequenced January 7.  A test was released on January 9 and distributed to Wuhan on January 10.   A report published on January 11 at 7AM indicated 41 patients with the disease.  A WHO release the next day refers to these as "confirmed cases".
Of those 41, the latest admission was January 2.
Wuhan reported these new case counts:
From Jan. 11 to Jan. 15, zero.
Jan. 16,  4 new
Jan. 17, 17 new
Jan. 18, 59 new
Jan. 19, 77 new

On Jan. 20, China realizes the disease is spreading from human to human, and classifies it as such.

On Jan. 20, China has 72 new cases in Hubei (77 total), resulting in 270 in Hubei (291 total).

So, what happened between when it was 59 on Jan. 5, to 41 on Jan. 15?  
Per a NEJM article, a tailored surveillance protocol was established to identify potential cases on Jan. 3.  Possibly this protocol was overly restrictive (perhaps requiring an association to the sea food market).

Also, the test was introduced.  Perhaps the test had a large number of false negatives (at least 18 out of 58).   Although they may have been getting new cases in the hospital, they weren't being counted as confirmed because the tests came back negative.  (It is also possible that those with symptoms avoided medical care.)

Compare the numbers above for January 3 to 20 to the cases shown in the chart in the NEJM article.



I found this of interest about Li Wenliang, who apparently was exposed on January 8:

Li developed a fever and cough on 10 January, which soon became severe.  On 12 January, Li was admitted to intensive care ..., where he was quarantined, treated, and tested for the virus several times until he tested positive for the infection on 30 January. He was diagnosed with the virus infection on 1 February

If the tests (or, perhaps, how the swabs were taken) resulted in a very high rate of false negatives, this may be the cause of some of the screwy low numbers in that first 1 to 3 weeks after the test was created.

If this hypothesis is true, and Fauci were aware of this, he might have been reticent to use anyone else's test.

[OutsiderFan]

There were a lot of early Chinese cases where multiple test had to be run to find positive results. The false negatives seemed to happen at a high rate, and there is reason to believe a good number of false negatives were never tested again.

This is one of the reasons I stopped believing the Chinese numbers in February.

[OutsiderFan]

There were a lot of early Chinese cases where multiple test had to be run to find positive results. The false negatives seemed to happen at a high rate, and there is reason to believe a good number of false negatives were never tested again.

This is one of the reasons I stopped believing the Chinese numbers in February.

[magnus]

I recall some conspiracies at the time included...
1) hospitals were refusing to admit/test patients when they were full,  to keep the count down. 
2) the numbers conveniently matched some mathematical model,  indicating tuned numbers.

[magnus]

I recall some conspiracies at the time included...
1) hospitals were refusing to admit/test patients when they were full,  to keep the count down. 
2) the numbers conveniently matched some mathematical model,  indicating tuned numbers.

[BostonCard]

Also, on February 12, Wuhan reported about 14,000 cases that were assessed as positive on the basis of clinical suspicion:

https://www.worldometers.info/coronaviru...ase-surge/

Starting on February 12, in the Hubei province only, a trained medical professional can classify a suspected case of COVID-19 as a clinically confirmed case on the basis of chest imaging, rather than having to have a laboratory confirmation.

This allows clinicians to move and report cases more quickly - not having to wait for lab confirmation - ensuring that people get adequate care faster and also allowing for public health responses - such as contact-tracing - to be initiated.

This suggests a problem with testing.

BC

[BostonCard]

Also, on February 12, Wuhan reported about 14,000 cases that were assessed as positive on the basis of clinical suspicion:

https://www.worldometers.info/coronaviru...ase-surge/

Starting on February 12, in the Hubei province only, a trained medical professional can classify a suspected case of COVID-19 as a clinically confirmed case on the basis of chest imaging, rather than having to have a laboratory confirmation.

This allows clinicians to move and report cases more quickly - not having to wait for lab confirmation - ensuring that people get adequate care faster and also allowing for public health responses - such as contact-tracing - to be initiated.

This suggests a problem with testing.

BC

[Genuine Realist]

Also, on February 12, Wuhan reported about 14,000 cases that were assessed as positive on the basis of clinical suspicion:

https://www.worldometers.info/coronaviru...ase-surge/

Starting on February 12, in the Hubei province only, a trained medical professional can classify a suspected case of COVID-19 as a clinically confirmed case on the basis of chest imaging, rather than having to have a laboratory confirmation.

This allows clinicians to move and report cases more quickly - not having to wait for lab confirmation - ensuring that people get adequate care faster and also allowing for public health responses - such as contact-tracing - to be initiated.

This suggests a problem with testing.

BC

The most significant factoid to me in the whole mess is the sanctioning of the doctors who discussed the matter on social media. for engaging in 'slander'. To the trial lawyer in me, this suggests a 'consciousness of guilt' on the part of the government. Commentary suggests that the WHO came to the pandemic declaration only after that leak, which may not be a coincidence.

I don't believe the CCP has any credibility on error analysis at this point.

[Genuine Realist]

Also, on February 12, Wuhan reported about 14,000 cases that were assessed as positive on the basis of clinical suspicion:

https://www.worldometers.info/coronaviru...ase-surge/

Starting on February 12, in the Hubei province only, a trained medical professional can classify a suspected case of COVID-19 as a clinically confirmed case on the basis of chest imaging, rather than having to have a laboratory confirmation.

This allows clinicians to move and report cases more quickly - not having to wait for lab confirmation - ensuring that people get adequate care faster and also allowing for public health responses - such as contact-tracing - to be initiated.

This suggests a problem with testing.

BC

The most significant factoid to me in the whole mess is the sanctioning of the doctors who discussed the matter on social media. for engaging in 'slander'. To the trial lawyer in me, this suggests a 'consciousness of guilt' on the part of the government. Commentary suggests that the WHO came to the pandemic declaration only after that leak, which may not be a coincidence.

I don't believe the CCP has any credibility on error analysis at this point.

[BostonCard]

The most significant factoid to me in the whole mess is the sanctioning of the doctors who discussed the matter on social media. for engaging in 'slander'. To the trial lawyer in me, this suggests a 'consciousness of guilt' on the part of the government. Commentary suggests that the WHO came to the pandemic declaration only after that leak, which may not be a coincidence.



I don't believe the CCP has any credibility on error analysis at this point.

On this we agree.  The central CCP used it's usual playbook of blaming local officials for the outrage after the fact, without of course acknowledging that the way it aligns incentives encourages this sort of local cover-up.  Before you started positing in this forum, a few posters had praised the way China handled the epidemic on the basis of how they managed to bring the epidemic under control in Wuhan and more broadly, ignoring the CCP's actions before late January.  My response to them is that the entirety of the CCP's response to the outbreak, including the initial weeks in which they mishandled it, needs to be considered.

BC

[BostonCard]

The most significant factoid to me in the whole mess is the sanctioning of the doctors who discussed the matter on social media. for engaging in 'slander'. To the trial lawyer in me, this suggests a 'consciousness of guilt' on the part of the government. Commentary suggests that the WHO came to the pandemic declaration only after that leak, which may not be a coincidence.



I don't believe the CCP has any credibility on error analysis at this point.

On this we agree.  The central CCP used it's usual playbook of blaming local officials for the outrage after the fact, without of course acknowledging that the way it aligns incentives encourages this sort of local cover-up.  Before you started positing in this forum, a few posters had praised the way China handled the epidemic on the basis of how they managed to bring the epidemic under control in Wuhan and more broadly, ignoring the CCP's actions before late January.  My response to them is that the entirety of the CCP's response to the outbreak, including the initial weeks in which they mishandled it, needs to be considered.

BC

[cardcrimson]

The most significant factoid to me in the whole mess is the sanctioning of the doctors who discussed the matter on social media. for engaging in 'slander'. To the trial lawyer in me, this suggests a 'consciousness of guilt' on the part of the government. Commentary suggests that the WHO came to the pandemic declaration only after that leak, which may not be a coincidence.



I don't believe the CCP has any credibility on error analysis at this point.

On this we agree.  The central CCP used it's usual playbook of blaming local officials for the outrage after the fact, without of course acknowledging that the way it aligns incentives encourages this sort of local cover-up.  Before you started positing in this forum, a few posters had praised the way China handled the epidemic on the basis of how they managed to bring the epidemic under control in Wuhan and more broadly, ignoring the CCP's actions before late January.  My response to them is that the entirety of the CCP's response to the outbreak, including the initial weeks in which they mishandled it, needs to be considered.

BC

Agree completely, except with "a few posters had praised" line. T'was more than a few and they were quite vocal with their praise of the Chinese government. . . .

[cardcrimson]

The most significant factoid to me in the whole mess is the sanctioning of the doctors who discussed the matter on social media. for engaging in 'slander'. To the trial lawyer in me, this suggests a 'consciousness of guilt' on the part of the government. Commentary suggests that the WHO came to the pandemic declaration only after that leak, which may not be a coincidence.



I don't believe the CCP has any credibility on error analysis at this point.

On this we agree.  The central CCP used it's usual playbook of blaming local officials for the outrage after the fact, without of course acknowledging that the way it aligns incentives encourages this sort of local cover-up.  Before you started positing in this forum, a few posters had praised the way China handled the epidemic on the basis of how they managed to bring the epidemic under control in Wuhan and more broadly, ignoring the CCP's actions before late January.  My response to them is that the entirety of the CCP's response to the outbreak, including the initial weeks in which they mishandled it, needs to be considered.

BC

Agree completely, except with "a few posters had praised" line. T'was more than a few and they were quite vocal with their praise of the Chinese government. . . .

[M T]

There were a lot of early Chinese cases where multiple test had to be run to find positive results. The false negatives seemed to happen at a high rate, and there is reason to believe a good number of false negatives were never tested again.

This is one of the reasons I stopped believing the Chinese numbers in February.

Are the negative tests a problem with the test, the procedures, or a characteristic of the disease, at least in some patients?
A case of SARS-CoV-2 carrier for 32 days with several times false negative nucleic acid tests

it took a total of nine nucleic acid tests to confirm the diagnosis, among which the first eight RT-PCR results were negative or single-target positive. In addition to coughing up phlegm during her stay in the hospital, she did not develop chills, fever, abdominal pain, diarrhea and other clinical symptoms. Since initial antiviral treatment, the lung lesions were absorbed. But the sputum nucleic acid test was still positive

(She did have coughing, and initial CT indicated the disease.)

[M T]

There were a lot of early Chinese cases where multiple test had to be run to find positive results. The false negatives seemed to happen at a high rate, and there is reason to believe a good number of false negatives were never tested again.

This is one of the reasons I stopped believing the Chinese numbers in February.

Are the negative tests a problem with the test, the procedures, or a characteristic of the disease, at least in some patients?
A case of SARS-CoV-2 carrier for 32 days with several times false negative nucleic acid tests

it took a total of nine nucleic acid tests to confirm the diagnosis, among which the first eight RT-PCR results were negative or single-target positive. In addition to coughing up phlegm during her stay in the hospital, she did not develop chills, fever, abdominal pain, diarrhea and other clinical symptoms. Since initial antiviral treatment, the lung lesions were absorbed. But the sputum nucleic acid test was still positive

(She did have coughing, and initial CT indicated the disease.)