When it comes to the level of justifiable fear and equally justifiable concerns that people are simply not getting the truth, the coronavirus pandemic surely rivals any event this side of World War II. It certainly doesn’t help that some of the most harmful rumors—such as the idea that nurses are stealing personal protective gear, or that states are sitting on unnecessary stories of ventilators—are coming straight out of daily self-praise events hosted by Donald Trump.
But there are some persistent questions that keep coming up which need to be addressed, both because there is something to these rumors, and because they shape important aspects of how people see and respond to the crisis. Among these are rumors about the “real” numbers in China.
When it comes to China, every number coming out of the government there comes laden with the question … are they lying? And the answer is: almost certainly. After all, this is a repressive, single-party regime where all the incentives are to make things seem rosy. That’s especially true in this case, where after some early, obvious fumbles, party chairman Xi Jinping took personal responsibility for the outbreak in Hubei Province. The odds that Xi was going to come back and report himself a failure, or put in huge numbers of deaths next to his name seem … let’s say “remote.”
But the idea that the numbers coming out of China were enormously off, especially on the number of cases, is unlikely. For several reasons. First, the numbers that China reported were not good. Neither were the measures they used to get there. This is the age of the cell phone, even in China—especially in China—and the Internet was rife with videos of Chinese families being hauled from their homes and forced into quarantine facilities. The information coming out of Hubei was also very clear when it came to conditions of those facilities—harsh, sparse, and awful. Scenes of empty streets, suspended public transport, and genuinely brutal actions from police weren’t just allowed to circulate by Xi and other officials … they were encouraged.
But the best reason for believing that the numbers that came out of China were basically correct on the number of cases was simply that those numbers look very much like the numbers outside of China. Charts circulating on the Internet showing a much sharper rise to millions of cases in the time that China was reporting tens of thousands simply are not possible, because we understand enough about the transmission rate and time before the next set of victims become vectors to know how fast the 2019 novel coronavirus can spread even in the most ideal conditions.
Also, the numbers coming out of China was not a single value laid down from Beijing, but hundreds of daily reports from cities and regions large and small. Most of these reports were available to anyone tapping into local and regional health officials and a quick pass through Google translate was enough to show that the numbers were detailed and believable. They had the right level of noise. They had a frightening, but believable, level of growth. They were often messy, as when local officials in Hubei decided, mid-outbreak, that they could no longer manage to keep up with testing and threw another 15,000 suspected cases on the pile in a single day.
Could all that have been faked by guys in a university basement cranking out numbers, calling up local officials and telling them what to report each day? Sure it could. But there seems to be no evidence that it was. For China to have reached the kind of numbers that are being thrown around when people talk about millions of cases, would have simply taken longer and been more visible.
The inexorable march of exponential curves has become scarily visible to everyone as the United States has gone from 100 cases to over 180,000 in almost exactly a month. But there are limits, and China imposed genuinely draconian measures at a time when their total number of reported cases was only around 500. It is not possible that their numbers were off by an order of magnitude at the time they indicated they had “flattened the curve,” and since then images out of Hubei show quarantine facilities closing, hastily constructed hospitals being idled, and a nation gradually returning to normal—all of which would not have happened at this point had the total number of cases been vastly higher.
And now … deaths. The even more persistent rumor concerning China is that the number of deaths, and particularly the number of deaths in Hubei Province, have been under-reported by a factor of, well, several. This is completely possible. But it doesn’t necessarily mean that China is lying.
In fact, there’s one very good reason to believe many more people have died due to the outbreak in Hubei, and it’s not because someone passed on a rumor, who passed on a rumor, who passed on a rumor about urns. The reason is something that affects not just China, but every country, and has been repeatedly demonstrated in Italy—and is even now being seen in New York City. As hospital beds fill up with COVID-19 patients, those patients go into competition with those who arrive at the hospital with other life-threatening conditions. Deaths from COVID-19 may be slanted toward the elderly, but caseloads do not appear to be. Younger patients catch COVID-19 just fine.
This is not true of heart disease, or strokes, or any number of conditions that preferentially affect the elderly. So medical personnel all over the planet are coming down to the same brutal calculus: An otherwise healthy young patient stricken with COVID-19 isn’t just competing for attention with older COVID patients who may have additional underlying conditions, that patient is also competing with heart attack patients, with car accident patients, with stroke patients … and so on.
The result of COVID-19 overloading the healthcare system is that standard of care plummets for everyone whether or not they have COVID. Already in the United States, ventilators are being pulled from cardiac care and other specialty units. A bed is a bed is a bed, and doctors in China, Italy, or the U.S. are unlikely to kick a 25-year-old COVID patient out of that bed to replace them with a 60-year-old heart attack victim whose odds aren’t great on the best day.
In a couple of communities that have been examined so far, the overall rate of death has been much greater than just the numbers that are being written down for COVID-19. Like two or three times higher. This is almost certainly true of Hubei Province, just as it is of every other facility. During the period in which their facilities were overloaded, deaths from all causes soared in Hubei. Those people are also victims of the pandemic, but their numbers definitely do not make the daily totals.
Any claims that there were more funeral urns coming out of, or going into, Hubei than could be accounted for by the number of people who died, not of COVID-19, but because of it.
Is it possible that China also under-reported the sheer number of deaths directly resulting from COVID-19? Sure it is. Unlike the sheer number of cases, the effects of those deaths would be much harder to spot. And both Xi and the government as a whole have every reason to paint the situation in terms of a victory and if that took shifting a few hundred, or a couple of thousands, deaths under the carpet … why wouldn’t they?
But the danger in all this comes when “China lied” is translated into either “COVID-19 is much more dangerous” or “COVID-19 is much less dangerous” than we’ve been told. That does not appear to be the case. The overall case fatality rate in China works out to almost exactly 4%. That fits squarely in the middle of nations like South Korea where the outbreak never strained a strong national healthcare system (1.6%) and nations like Italy where a system running with little excess capacity has been absolutely flattened by the flood of cases (11.7%). Might China’s numbers really be close to those of Italy, and the total number dead be more like 10,000? Yes. Might they be ten times off, with results more like 30,000? No. Because we understand the percentage of cases of COVID-19 that will be critical, and getting to numbers like that would require many more cases in China, and that brings us back to the pure math of the situation that says … that didn’t happen.
China may have lied. Hell, China probably lied. And China absolutely, without a doubt, didn’t advertise the other three or six or nine thousand people who died because all those hospital beds were full of COVID-19 patients. So … don’t trust them.
But none of this really affects how we should be handling COVID-19 or what we should expect. In the overall pandemic, what happened in China is already becoming just a foothill that was out in front of a terrifying mountain.