Undercounts at the COVID Olympics ... Revised 5/8/22

Last update: Monday 5/8/22 

Which countries have suffered the most deaths from COVID per hundred thousand residents? Which have suffered the least? Statistics about COVID deaths and death rates reported by the world's three most populous countries -- China, India, and the United States -- are of particular interest because 40 percent of the world's total population lives in these three countries ... The world's total population = 7,940 million; China = 1,449 million; India = 1,404 million; and the United States = 335 million. (Note: Population estimates from Worldometer.) Unfortunately, there is reason to question the death tolls and derived death rates cited in the official reports issued by these nations.

COVID deaths and death rates per 100,000

According to Johns Hopkins University's COVID pages, the reported total COVID deaths for the big three nations were as follows on 4/17/22:

• China = 13,748
• India = 521,751
• United States = 988,609

The death rates per 100,000 residents of each country is therefore:

• China = 13,748 / 1,449,000,000 * 100,000 =  0.95
• India = 521,751 / 1,404, 000,000 * 100,000 = 37.16
• United States = 988,609 / 335,000,000 * 100,000 = 295

Clearly, the U.S. has been the most dangerous place to live during the pandemic so far; 295 out of every 100,000 U.S. residents have died from COVID. China was the safest; only one out of every 100,000 residents have died. India was second with 37 out every 100,000 dying from COVID. So China gets the gold, India gets the silver, and the U.S. earns a tragic bronze for its 295 deaths for every 100,000 residents.

Modest U.S. undercounts

The number of U.S. deaths was probably somewhat higher than its reported official death count because this official count did not include persons who died, but would not have died had there been no pandemic. For example, this "excess mortality" would include persons who died because hospitals were so crowded with urgent COVID cases they could not treat everyone with life-threatening non-COVID conditions. Epidemiologists argue that "excess mortality" plus direct counts of COVID deaths provide more valid estimates of the impact of a pandemic.

Substantial Indian undercounts

Indeed, high estimates of "excess mortality" in India convinced the World Health Organization (WHO) that about 4.7 million people in India died during the pandemic from COVID. In other words the WHO estimates that the direct death toll was about 8 times as large as the official toll of 521,751. If the death toll was about 8 times as large, then the Indian death rate = 37.16 X 8 = 297 ... which is about the same as the reported U.S. rate of 295. So India and the U.S tie for the gold ... and the shame.

• "Global excess deaths associated with COVID-19, January 2020 - December 2021", WHO, 5/5/22 ... Download the Excel data tables from HERE

Suspicions of very substantial Chinese undercounts

No one doubts that the Chinese government has been comprehensive and ruthless in its efforts to enforce its "Zero COVID" pandemic management policies. Consider the following sample of headlines from 2020 until April 2022:

• China, "China’s Coronavirus Back-to-Work Lessons: Masks and Vigilance", Alexandra Stevenson and Cao Li, NY Times, 5/12/20
• "Over 100 Million in China’s Northeast Face Renewed Lockdown", Bloomberg, 5/18/20
• "Wuhan Tests Millions in 12 Days as China Fears Second Virus Wave", Bloomberg, 5/26/20
• "Facing New Outbreaks, China Places Over 22 Million on Lockdown", Steven Lee Myers, NY Times, 1/14/21
• "China Returns to Its Strict Covid Limits to Fight a New Outbreak", Keith Bradsher, NY Times, 6/9/21
• "Near-Daily Covid Tests, Sleeping in Classrooms: Life in Covid-Zero China", Vivian Wang and Joy Dong, NY Times, 11/5/21 
• "Surge of Omicron Infections Prompts Lockdowns in China",  Keith Bradsher, NY Times, 3/14/22 
• "China’s economy pays a price as lockdowns restrict nearly a third of its population.", Alexandra Stevenson, NY Times, 4/14/22 

Distrust of China

From time to time, the Chinese government has acted in ways that encouraged even the most objective observers to distrust that government's motivations:

• "China Peddles Falsehoods to Obscure Origin of Covid Pandemic", Javier C. Hernández, NY Times, 1/14/21
• "China Spins Tale That the U.S. Army Started the Coronavirus Epidemic",  Steven Lee Myers, NY Times, 7/7/21
• "On W.H.O. Trip, China Refused to Hand Over Important Data", Javier C. Hernández and James Gorman, NY Times, 2/13/21

Too good to be true???

In this context of pervasive suspicion, it was inevitable that reputable U.S. mainstream media would begin to challenge the Chinese government's statistics, as in the following op ed by the Editorial Board of the Washington Post.

• "The pandemic statistics from China are too good to be true", Editorial Board, Washington Post, 4/16/22 

The op ed raises the following challenges:

• China reported 300,000 infections in Shanghai, but no deaths. The editors claim that this is much lower than the worldwide average of 195 deaths "for every 100,000 population". Notice that the editors are hereby stepping on their own punchlines. Infections are always a subset of an entire population; no surge infects every single resident. So a claim of no deaths out of 300,000 infections is really a claim of no deaths in a population larger than 300,000,  which is even more inconsistent with experience of 195 per 100,000 throughout the world. It's also inconsistent with the one death per 100,000 population that China itself has previously reported. Of course, something "unusual" may be happening in Shanghai to push the already low Chinese death rate even lower.
  
  
• The editors claim that asymptomatic cases elsewhere in the world are usually no more than 40 percent of all infections. But on 4/10/22 Shanghai reported 25,173 new asymptomatic infections against only 914 symptomatic; in other words 914 / 25,173  = 3.6 percent symptomatic vs. 96.4 asymptomatic. The editors conjecture that the Chinese may have misclassified mild infections with asymptomatic. If this is correct, the Chinese are still correct in reporting 3.6 percent moderate to severe infection ... which is consistent with experience elsewhere.
  
  
• The editors conjecture that the Chinese may have attributed most COVID related deaths to other causes. But if they did, this would lead to substantial levels of "excess mortalities". However the editors cite a publication in Lancet that estimated COVID death rates, but adjusted for excess mortalities for a number of countries, including China. Nevertheless this study found that China's adjusted death rate was 1 in 100,000, the same death rate reported by China itself.
  

A more sinister possibility

In summary, the editors of the Washington Post have not made their case. Perhaps a simpler, but more sinister version of their hypothesis might be more persuasive. Perhaps the Chinese are undercounting all COVID deaths, not just the ones that involve other conditions. They are not shoving them into other categories because this would be detected as "excess mortalities". 

The editors claimed to have data that the vaccination rate in China is "low among the elderly". This is quite different from the U.S. where the elderly are more highly vaccinated than younger age groups. Nevertheless, three quarters of U.S. COVID deaths have occurred among those 65 and older. If the elderly are not highly vaccinated in China, then an even larger super majority of COVID deaths would be inflicted on this group in China. According to the CIA Worldbook, there are about 172 million Chinese who are 65 and older.

The high number of deaths that resulted from the recent Omicron surge in Hong Kong, a semi-autonomous component of China, were mostly among the elderly, who were not as highly vaccinated as younger members of that society. It is reasonable to assume that a high majority of COVID deaths on mainland China would also occur among the mainland's unvaccinated elderly. 

• "High Death Rate in Hong Kong Shows Importance of Vaccinating the Elderly", Benjamin Mueller, NY Times, 3/21/22 

These deaths were reported in Hong Kong, but if they were not reported on the mainland, this might account for the low reported death rates on the mainland. It would be far easier to undercount deaths among the elderly, a group that would suffer many deaths in the next few years anyway, than to undercount deaths among younger age groups. However, when all is said and done, all we have is suspicions fueled by suspicious actions by the Chinese government; but suspicions are not data.

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Links to related notes on this blog:  

• "Putting six million lives lost to Covid into perspective", Last update: 3/9/22