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is there any reason to doubt the number of deaths announced by China?

More and more voices are rising to question the number of victims of the virus in the host country of the epidemic, while the city of Wuhan is preparing to lift its confinement and the results are soaring in Europe.

Did China lie? The country from which the coronavirus pandemic started is accused of having deliberately minimized the number of deaths linked to Covid-19. “We have not underestimated (…) It is very precise”, replied Tuesday, March 31, Lu Shaye, the Chinese ambassador to France, indicating that the epidemic had killed 3,305 people in mainland China, including 2,500 in Wuhan, the first epicenter of the health crisis.

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Franceinfo details the various elements which allow one to reasonably doubt the assessment put forward by Beijing.

Yes, the numbers are (very) surprising

With 3,305 deaths across mainland China and 2,500 in Wuhan, China is far behind European countries. Thursday, April 2, Italy, the hardest hit country, had more than 13,000 dead in just over a month while China is 20 times more populated. Spain, the second most affected country according to known figures, has passed the 9,000 dead mark. France has recorded more than 4,000 hospital deaths. A figure close to the United States, which counts 5,000 dead, while the peak has not been reached.

“There was a mortality announced by the Chinese which, in my opinion, was certainly underestimated. It is very hard to believe that a country, even with containment measures, has so few deaths”, estimated on Europe 1 Patrick Berche, professor emeritus of microbiology and former director of the Pasteur Institute. Chinese authorities have “probably hidden the real mortality because 3,000 dead, when we see what is happening in Italy or in Spain, we can hardly believe it”, added to LCI Karine Lacombe, infectiologist at the Saint-Antoine hospital in Paris.

Carine Milcent, a CNRS researcher and specialist in health systems, notably that of China, is surprised by the low number of deaths outside of Hubei province, of which Wuhan is the capital. Even though the region was shut down in late January, “I am surprised by their ability to have restricted the expansion of (the epidemic). I don't know how to explain it. “

Beyond the death toll, other data has challenged scientists. “What happened in Italy sounded the alarm and woke everyone up a bit”, Reports to franceinfo Pascal Crépey, epidemiologist at the School of Advanced Studies in Public Health.

The gravity of what we see in Italy is incommensurate with what we have seen in China.Pascal Crepey, epidemiologistat franceinfo

“What worried us when looking at the Italian data was the rate of admission to intensive care for patients”, he specifies. The Italian authorities have identified 19% of critical cases (which corresponds more or less to hospitalizations in intensive care), details the scientist, while on the first 44,000 confirmed cases in China, the proportion of “critical” cases was only 4 , 7%. “Obviously, the definition of 'critical cases' is not necessarily the same. However, this alerted us to the fact that we could not directly transpose what was happening in China to imagine what could happen in Europe “, he explains.

Hard to say, with photos of ballot boxes

Since March 23, relatives of residents who died during the two months of confinement in Wuhan have been invited to go and collect their ashes. And the size of the crowd surprised, especially on a photo of the queue in front of the Hankou funeral home on March 25, shared on social networks. The Caixin site, one of the freest Chinese sources of information on the epidemic, described in a report a wait of six hours in this establishment that day.

Even more intriguing: Caixin attended a delivery of ballot boxes. The delivery man explained to them to transport 2,500 receptacles, and to have delivered as many the day before. A photo taken in the establishment this time shows 3,500 urns stacked in boxes. The site also reports the anonymous comments of an employee of the crematorium, who explains that at the height of the epidemic, in February, he worked up to 19 hours a day.

What trigger a wave of speculation on Chinese social networks. Extrapolating from Caixin's figures, netizens estimated 3,500 the number of ballot boxes delivered daily to Wuhan, says the American site Radio Free Asia. This distribution being supposed to last from March 23 to April 5, they deduce that there are more than 40,000 urns to distribute, and therefore as many dead in two months of confinement. Far beyond the official balance sheet, even taking into account the inhabitants who died of other causes, the number of which is not negligible. According to Le Figaro, in 2019, 14,700 cremations had been recorded during the first quarter in Wuhan. Tuesday, on BFMTV, the Chinese ambassador to France estimated that around 10,000 people were unrelated to the virus during these two months.

Without more elements, difficult to decide. The assessments put forward by Internet users are based on the assumption, not verified to our knowledge, that the crematorium would have operated 19 hours a day permanently. And that the rhythm of the distribution of ballot boxes and the crowds are identical in the eight funeraries of the city and will remain so for two weeks, which is not certain either. The correspondent for France 24 in China, Antoine Védeilhé, explains to franceinfo.fr that he has, through his own local sources, confirmation that the high attendance concerns at least three of the eight establishments. But Gaël Caron, journalist from France 2 in Wuhan, explains on Twitter that there was “not crowd” when he went to a fourth funeral home on Monday.

In addition, according to Caixin, people on site were able to choose their receptacle between three models of different color before it was filled with the ashes of the deceased. This suggests that the number of ballot boxes does not necessarily correspond to the number of dead.

Evidence from Wuhan, however, indicates a certain excitement of the authorities around the delivery of these ashes. “There was a very large police presence, which asked us very quickly to stop filming”, said Arnault Miguet, the other journalist from France televisions present in Wuhan, in “C à Vous”. Relatives who come to collect the ballot boxes are systematically accompanied by members of their neighborhood committee (which also partly explains the crowd), and one of them told to Antoine Védeilhé that he had been forbidden to use his phone near the funeral home. However, none of these elements is enough to prove with certainty that the real assessment of the epidemic in Wuhan is truncated.

Yes, China is used to dealing with reality

If suspicion hangs over China, it is also because the country is not a model of transparency. “Every quarter, when it publishes the figures for its growth, all the experts say that they are to be taken with tweezers”, recalls Antoine Védeilhé. “Why would she be more reliable about the death toll from a pandemic?”, questions the journalist. This communication responds to a logic of domestic policy: the Chinese authorities manage a large population “trying to contain their panic” and the risk of overflows that accompanies it. This leads China to regularly minimize the results of disasters (earthquakes, floods, fires, epidemics, …).

It is obvious that they position themselves as an alternative to the American model, and that they communicate in relation to that, there are necessarily things that we do not know.Carine Milcent, health systems specialist at CNRS

Communication from China has indeed a geopolitical stake. “The more deaths you will have in the world, especially in the United States, the more you will have a battle of numbers”, abounds Antoine Bondaz. He expects to see China use this claimed weak balance sheet to boast of its better management of the crisis than the United States, and to highlight its political model. But Washington is already ready to retaliate: Bloomberg (in English) released on Wednesday the findings of an American intelligence report, according to which the Chinese figures on the coronavirus are false and intentionally incomplete. The British government also tackled Beijing, this time accusing it of having lacked transparency in its communication on “the scale, the nature, the infectivity” of the disease. The Quai d'Orsay, for its part, did not respond to requests from Franceinfo to comment on the information transmitted by the Chinese authorities.

Doubts about Chinese transparency were shared around the world from the start in January. But China has shown reassuring signals. After the SARS epidemic in 2003, characterized by a strong withholding of information from Beijing, “there was suspicion at the outset, but the Chinese authorities opened their doors relatively quickly, playing on transparency”, says Pascal Crepey. Except that since then, several newspapers, including the Swiss daily The weather, have shown that the epidemic actually started in November and not in December, as assured by the official Chinese version.

In its transparency operation, Beijing recognized shortcomings. The central government dismissed on February 11 two senior Hubei officials criticized for their handling of the crisis. Uncommon in China, a leader, the CCP secretary for Wuhan City, admitted errors on state-run prime time television. However, this transparency seems to have its limits since censorship is in full swing. Beijing is waging a merciless “information war” on social media and several whistleblowers have disappeared or are silenced.

Perhaps, but China will in any case find it difficult to establish an exact count

In France too, the official assessment of the epidemic is subject to debate: the tally announced each evening includes only the deaths that occurred in hospital. This method of calculation, sometimes criticized, recalls the difficulty of establishing the mortality of an epidemic in real time, even without the will to hide it. “We can say that in China, they certainly had the same problem, says Pascal Crepey. Once the testing capacity and hospital capacity are exceeded, the number of severe cases and the number of deaths overflow and are not counted. “

According to Carine Milcent, specialist in health systems at the CNRS, certain characteristics of the Chinese system make it difficult to draw up a balance sheet. Patients turn less systematically to hospitals than in France, in particular because all care is not reimbursed.

People in China may have died from this epidemic without going to hospitals.Carine Milcent, health systems specialist at CNRSat franceinfo

Above all, unlike France, China has no system “data centralization” nor calculation methods between different hospitals, the size and level of which are also variable. There is no guarantee that they will all count the deaths of the Covid-19 in the same way, in particular “for the deaths of people who had several pathologies, which can be attributed to different causes”. And China is not transparent about how its health statistics are compiled. Impossible, therefore, to obtain a balance sheet “whose calculation has been unified throughout the Chinese territory” nor to ensure that it is comparable with that of Italy or France. Any perfect balance sheet is illusory but “the Chinese figure falls within a very wide range of truth, surely much more than in France”, sums up Carine Milcent. Whether you think it is falsified or not.

On Wednesday April 1, China also revised one of its reports, that of the number of cases detected in the country. She added people who tested positive without showing symptoms – 1,367, according to the authorities. Implicit recognition that the official balance sheet was previously imperfect. Can that of the dead evolve? Nothing is less sure. Antoine Bondaz potentially sees a “backfire” to end suspicion, and “to stage the idea that China is able to reconsider, in a transparent way, the figures which it announced”. Nothing says, however, that one day we will know exactly how many Chinese died from Covid-19. Nor how this figure was established.

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