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China’s unexpected decision to end its strict Covid Zero policy in December 2022 led to nearly 1.9 million excess deaths in just two months, according to one of the first independent studies to estimate the virus’s devastation as it rampaged across the vast country.
The shocking figure — even more so considering fewer than 7 million deaths worldwide have been formally attributed to Covid — applies only to adults over the age of 30 who died between December 2022 and January 2023, according to the paper published in the journal JAMA Network Open. The Chinese government had previously disclosed about 60,000 Covid-related deaths in health facilities from early December to the middle of January.
The researchers’ estimate is consistent with forecasts from other academic researchers and health groups that also calculated the number of excess deaths China would experience if it abruptly ended its Covid Zero policy. Beijing stopped its precise tracking of the virus once it lifted the rules, creating uncertainty about its subsequent toll.
“Despite being the first place to be hit by Covid-19, China was able to quickly suppress the disease through stringent measures over an extended period,” said Joseph Unger, the senior author of the paper and a biostatistician and health services researcher at Fred Hutchinson Cancer Center in Seattle. “Because the Chinese population had been largely shielded from infection with limited natural immunity and was not fully or well vaccinated, the sudden introduction of widespread Covid-19 infection had a devastating impact.”
In the US, which reported the highest number of Covid deaths during the pandemic, a cumulative 1.1 million adults aged 45 and older died from the virus, according to the US Centers for Disease Control and Prevention.
China’s National Health Commission didn’t respond to a request for comment.
The Fred Hutchinson researchers used a unique approach that they deemed quasi-experimental to come up with the figure.
They combined information gleaned from published obituaries for employees at three of the country’s most prestigious universities and data collected about queries for terms like funeral parlor, cremation and burial on Baidu, a search engine that accounts for almost all internet queries in China.
The result was a calculation of “excess deaths” among adults in China during the two months after Covid Zero ended. A higher-than-expected mortality rate was found in every province except Tibet, and older people were particularly vulnerable, the study found.
Unger said he was “confident our estimates are a reasonable approximation of excess deaths,” adding that it was “necessary to apply an innovative estimation strategy given the absence of timely and comprehensive official mortality data from inside China.”
Estimating the number of deaths from Covid has been difficult the world over for a myriad of reasons, including the challenges of diagnosing infections early on in the outbreak and tracking everyone affected during the massive waves that followed. Experts agree the figures are almost certainly an underestimate in every nation and that it may take years to calculate the true toll.
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The US has the highest number of confirmed number of deaths cumulatively throughout the pandemic, according to Johns Hopkins University, followed by Brazil and India. The estimated number of excess deaths, another way of calculating mortality that compares death rates among the same groups during different periods of time, puts India at the top with 6.2 million deaths, followed by China at 1.9 million, Russia at 1.5 million and the US at 1.3 million.
“The measure of excess deaths reflects both the direct and indirect effects of Covid on a population,” said Unger. “This is important because the true underlying mortality burden of Covid is routinely underestimated by simply counting deaths known to be attributable to Covid itself.”
In many cases, Covid may have contributed to deaths in ways that aren’t formally recognized, he said, giving the example of a death attributed to a stroke without recognizing that it was triggered by an infection.
True counts were made even more difficult in China because the government narrowed the definition of Covid death shortly after three years of stringent Covid Zero controls were suddenly abondoned in December 2022. That spurred calls for data transparency from the World Health Organization and experts outside the country.
“Our novel strategy for estimating excess deaths is both timely and important,” the researchers said. It “demonstrates how the strategic combination of data sources can provide insights into seemingly opaque public health research questions.”