After spending several weeks in a crowded hospital in eastern Jiangsu province caring for her 53-year-old father when he succumbed to pneumonia caused by Covid, Wang was shocked to learn that the illness, which he was stricken with on Saturday cost life, could not be printed on his death certificate.
“It’s absurd. Someone is dying and we can’t even write down the exact cause,” the 23-year-old said, asking to be identified by her last name only.
Since China lifted zero Covid controls, hospitals have been inundated with patients and crematoria have struggled to keep up with demand. As a result, many analysts have expressed surprise that the official death toll is no higher.
In the period from December 8 to January 12, the official death toll was 59,938, according to revised health facility deaths figures presented by the National Health Commission last weekend, down from their original claims of just 37 deaths.
Airfinity, a health data analysis group, estimated the death toll at 10 times that number, or 641,000 deaths assuming 104 million infections in the month ended Jan. 18. Peking University researchers said China may have seen as many as 900 million infections as of January 11, but have not released an estimate for the total number of deaths.
One possible reason for the lower-than-expected numbers, according to several relatives and medics across the country, is that Chinese officials are keeping “Covid-19” off the death certificates of many people dying with the virus.
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Six relatives who have lost loved ones to coronavirus in recent weeks said they were dismayed to see death certificates being filled out with “pneumonia” or “heart disease” or other causes of death instead of Covid.
Several medics told the Financial Times that local officials discouraged them from including the coronavirus in the official documents, either by making the process difficult or actively telling medical institutions not to include the words.
In China, if they die at home, death certificates are issued by the hospital or local community clinic or neighborhood committee. In some cases, the police can issue death certificates, which are needed for the cremation of bodies.
In Wang’s case, the hospital referred her family to a community hospital to process the death. Officials there gave the official cause of death as “viral pneumonia (unspecified)”.
“They said we cannot include Covid. My mother was a little frustrated and asked her – can common pneumonia kill people? . . but we didn’t want to argue with them, so we just agreed to write Pneumonia,” she said.
Her account is echoed by hundreds of people posting online and in interviews with family members who have lost loved ones to Covid asking not to be named.
In Beijing, the grandson of a man in his 90s who died in hospital after three days of Covid fever said doctors gave “heart disease,” his previous condition, as the cause of death. Another woman in the capital said her 93-year-old mother-in-law died of Covid after being hospitalized for 10 days, but the family could only write “pneumonia” on the certificate. The granddaughter of an elderly man who died of Covid-related respiratory failure in eastern Jiangsu province said his death was officially attributed to an “underlying condition”.
In northern Jilin province, a woman told the FT a scan showed Covid ravaged her grandmother’s lungs, but the hospital would not allow a Covid test and would officially list her death as “coronary artery disease,” a previous medical problem. classify.
The omissions have sparked a litany of complaints on Chinese social media. “What are you trying to hide? Why is Covid taboo? We had a positive test result, the truth is Covid,” said a Weibo user in Liaoning province.
These attempts to leave the coronavirus out of death certificates call into question the reliability of China’s latest Covid death count, especially given the delay in updating it.
Jiao Yahui, a senior NHC official, said Saturday it took a long time to release the updated figures because hospitals have to comb through death certificates and produce a “relatively large amount of data and information” for analysis. She did not say whether they had relied on death certificates, and the NHC did not respond to a faxed request for comment.
Doctors speaking to the FT said the official impetus to undercount Covid deaths is clear. An emergency doctor in a small town in southern Guangdong Province said he and his colleagues were told, “Death certificates must not contain ‘Xinguan.’ [Covid-19] those two characters.”
Another doctor at a major hospital in nearby Guangzhou added: “I don’t understand, but that’s what the [hospital] Guides have told us to do. Maybe it’s just to save face.”
In the Chinese capital, three community hospital nurses tasked with preparing death certificates for those who died at home said they either didn’t have the “qualifications” to attribute a death to Covid or gave other reasons why they couldn’t include it . “The best we can do is write ‘suspected Covid’ if they have a PCR test,” said a nurse in central Beijing.
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While a doctor at a major Shanghai hospital said he never received direct instructions to omit Covid from death certificates, “they made it very strict and complicated” to include it, he said. “Lock in [Covid-19] the case must be reviewed by the local Center for Disease Control. There is no benefit at all in issuing this certificate with Covid on it.”
For loved ones of those who have contracted Covid, the failure to acknowledge the cause of death adds to an already traumatic experience.
Wang said the hospital where her father died was overrun with sick Covid patients. “Until the very end, he couldn’t get a ventilator,” she said. “I felt helpless. We were in a hospital but I couldn’t get treatment for my father.”