Close to two million died in China during the weeks after the Zero-COVID policy was lifted

The Chinese Center for Disease Control and Prevention (CDC) has not made public any real accounting of the death toll since the ruling Chinese Communist Party abandoned its Zero-COVID policy on December 7, 2022, and allowed a tsunami of infections to wash over the country, infecting upwards of 90 percent of the population. 

Despite the deluge of COVID cases, inundated health systems and mass cremations that were underway, Chinese health officials persisted in minimizing the extent of the crisis, stating that at most 60,000 people had died between early December and January 12, 2023. However, daily reporting by the national ministry completely ceased towards the end of December. 

Official total of COVID deaths in China. Most estimates place the death toll at ten times or even more than these figures. [Photo: Our World in Data]

On February 9, 2023, near the tail-end of the winter Omicron wave across mainland China, daily deaths began being reported again. However, the official cumulative COVID death toll stood at a mere 83,150, which was widely understood as a vast undercount. This was because only hospital deaths from respiratory failure and a confirmed COVID test was counted, which excluded those who were not tested or who died from other COVID-related causes or who never made it to the hospital. 

Estimates provided at that time by the UK-based predictive health analytics company Airfinity placed the death toll at a horrific 1.3 million by the first week of February. Other university-based researchers had indicated a range of between one and two million fatalities. More recent empirically based studies have only corroborated these grim early estimates and modeling analysis of the catastrophic loss of life that took place.

Before reviewing these, it bears noting that one year prior, on February 8, 2022, before the Omicron surge began to chip away at China’s public health defenses, Our World in Data (OWD) had placed the official death toll from COVID in China at 5,700, at a time when the official global tally had reached a grim figure of six million and worldwide excess deaths were estimated at more than 22 million. The success of China’s Zero-COVID policy was unassailable. 

However, perceptible shifts in policy and official attitudes became demonstrable after the March 2022 Omicron surge that centered on the Shanghai metropolis. In particular, the campaign in the international bourgeois press calling for ending Zero-COVID assumed fever pitch and Chinese officials were under considerable global financial pressures to end their public health policy and resume normal commercial relations. By mid-November, health authorities had rapidly moved towards a mitigationist posture, then opened the floodgates altogether on December 7, 2022.

Last week, a new study from the Fred Hutchinson Cancer Research Center in Seattle, Washington, published in JAMA Network, estimated that 1.87 million excess deaths occurred in China among those 30 years and older in the first two months after ending the Zero-COVID policy.

What distinguished this study from others was the review of empirical data and the use of Baidu, a commonly used Chinese internet search engine, to conduct syndromic surveillance, which can be used for early detection of outbreaks, to follow the size and spread of outbreaks, and monitor disease trends.

To obtain these estimates, the authors relied on published obituary data about deceased official employees at Peking University (PKU) and Tsinghua University (THU) in Beijing and Harbin Institute of Technology (HIT), in Heilongjiang province, from January 1, 2016 to January 31, 2023. They additionally conducted syndromic surveillance for the same period using unique queries in Baidu search engines for particular keywords such as funeral parlor, cremation, crematorium, and burial. 

As the authors wrote, “Analysis revealed a strong correlation between Baidu searches for mortality-related keywords and actual mortality burden. Using this correlation, the relative increase in mortality in Beijing and Heilongjiang was extrapolated to the rest of China, and region-specific excess mortality was calculated by multiplying the proportional increase in mortality by the number of expected deaths.” 

Not surprisingly, a disproportionate number of deaths occurred among men (76 percent) and the elderly over 85 (80 percent). The peak in deaths occurred in late December 2022. Every province, except Tibet, had seen a significant increase in excess deaths. The data also closely corroborates the modeling of the transmission of the SARS-CoV-2 Omicron variant in China conducted by the School of Public at Fudan University, Shanghai, in July 2022, which  anticipated approximately 1.55 million deaths if Zero-COVID was lifted.

Line-up for mass COVID testing in Shanghai a year ago, before the abandonment of the Zero-COVID policy. [AP Photo/Chen Si, File]

A second report, published in the British Medical Journal on July 31, 2023, relied on cremation figures inadvertently released and then quickly withdrawn by Chinese authorities in Zhejiang province, but not before international researchers had uploaded the information. 

In the comparatively wealthy eastern province where almost every person that dies is cremated, the number of cremations for the first quarter of 2023 was over 170,000, while the first quarter figures for the previous two years were 99,000 (2022) and 90,000 (2021). This 72 percent rise in excess deaths, extrapolated across China, gives a figure of about 1.5 million deaths in this period, consistent with prediction models. This number is considered conservative as the Zhejiang province has a higher uptake of vaccines than the national average and a stronger healthcare system.

A third study, published in Nature Communications on July 1, 2023, modeled the dynamics of the surge to give a numerical figure on the number of COVID cases that were spreading across mainland China. Their analysis found that with full exit from Zero-COVID, the doubling time of infections was 1.6 days during the early and mid-December days, peaking in the last week of the month. This meant that approximately 95 percent or 1.33 billion people were infected in the two months after abandoning all public health measures. The study notes, assuming an infection fatality rate of 0.1 to 0.2 percent for Omicron, that would imply that somewhere between 1.3 million and 2.6 million COVID deaths occurred during December 2022/January 2023.

To understand the impact of abandoning Zero-COVID, it is helpful to review the early weeks of January 2020, when China moved to contain the outbreak that was quickly slipping away.

First public notice of a cluster of pneumonia caused by an unknown pathogen was reported on December 31, 2019, in Wuhan, Hubei province, a month before the Chinese Lunar New Year (January 25, 2020). Soon after, on January 8, 2020, a novel coronavirus was identified as the etiological (causal) agent for the outbreak, which centered around the Huanan Seafood Market. Two weeks later, on January 22, 2020, the World Health Organization (WHO) acknowledged that human to human transmission was taking place. 

By January 23, 2020, Chinese authorities prohibited all travel into and out of Wuhan city and the next day the whole of Hubei province. However, between January 11 and the lockdown, it was estimated that around 4.3 million people had traveled out of the city. Notably, the first recorded case of COVID outside China was in Thailand on January 13, 2020. 

Along with the massive public health efforts underway in Wuhan, China also raised its national public health response to the highest state of emergency. A week later, on January 30, 2020, the WHO declared a Public Health Emergency of International Concern (PHEIC). At that time there had been 7,818 confirmed cases worldwide, the vast majority in China, with only 82 cases reported in 18 other countries. 

The rapid establishment of emergency control measures across 342 cities, which included school closures, the isolation of suspected persons and quarantine of confirmed cases, banning of all public gatherings and entertainment venues, and the suspension of intracity public transport and intercity travel, resulted in daily cases peaking in all provinces outside of Hubei by January 31, 2020 (875 per day) and in Hubei and Wuhan city by February 4, 2020 (3,156 per day). 

By February 19, 2020, authorities estimated that there had been around 75,500 COVID cases. By late March, most COVID cases had been brought under control and on April 8, 2020, the 76-day lockdown on Wuhan was lifted, with the COVID death toll in the city kept under 5,000. Subsequent analysis of these efforts indicate that had such measures not been put into place, there would have been 744,000 COVID cases outside of Wuhan by the second half of February 2020 and countless more across the globe.

What is often forgotten is that the early efforts by China in the hectic weeks when the novel coronavirus began to spread across Wuhan city and Hubei province provided significant breathing room for the rest of the world to act and prepare their public health infrastructure. That the ruling elites globally did not heed these warnings to employ every measure to protect their populations was one of the most egregious and criminal actions imaginable. 

An international campaign to eradicate the virus would have had swift success and would have provided considerable experience in preparing the world for future pandemics. Instead, the world suffered enormous human losses, and the pandemic, having infected billions, was allowed to return to China in the form of a new and more virulent variant.

The Chinese Politburo succumbed to the demands of international capital and joined the rest of the world in following the policy of “forever COVID.” The fundamental issue at stake is that a nationally-based elimination strategy will always be unviable in the era of a truly globalized economy.

Most importantly, it is capitalism and not SARS-CoV-2 that has created the conditions for the crisis and its persistence. An elimination strategy remains viable, but only under an international socialist perspective that places life above profits.