TAIPEI, Taiwan (AP) — Lu Muying died on April 1 in a government quarantine facility in Shanghai, with her family on the phone as doctors tried to resuscitate her. In accordance with government policy, all coronavirus cases must be isolated centrally. She had been tested positive for COVID-19 in March.
But the 99-year-old, who was just two weeks shy of her 100th birthday, was not counted as a COVID-19 death in Shanghai’s official tally. In fact, the city of more than 25 million has only reported 25 coronavirus deaths despite an outbreak that has spanned nearly two months and infected hundreds of thousands of people in the world’s third-largest city.
Lu’s death underscores how the true extent of the virus toll in Shanghai has been obscured by Chinese authorities. Doctors told Lu’s relatives she died because COVID-19 exacerbated her underlying heart disease and high blood pressure, yet she still was not counted.
Interviews with loved ones of patients who have tested positive for HIV, a phone call with a government health official that was made public and an internet archive that has been compiled by the families of the deceased raise concerns about the city’s method of counting cases and deaths. It is almost certain that there will be a significant undercount.
The result is a blurred portrait of an outbreak that has sweeping ramifications for both the people of Shanghai and the rest of the world, given the city’s place as an economic, manufacturing and shipping hub.
An Associated Press analysis of the death count sheds light on the ways in which the numbers have been clouded. This is due to the way that Chinese health authorities tally COVID-19 data, using a more narrow, less transparent, and sometimes inconsistent standard than the rest.
Most countries, including the United States of America, have guidelines that state that any COVID-19-related death is one where COVID-19 has been a contributor or factor.
However, in China, the health authorities only count those who died from COVID-19 directly, and exclude those like Lu whose underlying conditions were made worse by the virus. Zhang Zuo-Feng is an epidemiologist at University of California, Los Angeles.
“If the deaths could be ascribed to underlying disease, they will always report it as such and will not count it as a COVID-related death, that’s their pattern for many years,” said Jin Dong-yan, a virologist at the University of Hong Kong’s medical school.
That narrower criteria means China’s COVID-19 death toll will always be significantly lower than those of many other nations.