Both Chinese and foreign epidemiologists believe that a large number of mild COVID-19 cases have still not been counted. The reasons abound: a shortage of tests, overwhelmed caregivers, and many infected patients whose symptoms aren't severe enough to qualify for tests, which are not always reliable.
Wang Chen, dean of the Chinese Academy of Medical Sciences, told Chinese media Thursday that the change in reporting requirements was "extremely necessary" because the laboratory test to detect a particular sequence of nucleic acids often failed.
"Many patients who appeared to be (infected with COVID-19) based on their epidemiological history, contact history and clinical symptoms were not able to test positive on the nucleic acid test, and were listed as 'suspected cases,'" he said.
Hubei province's new reporting standards are an improvement, said Benjamin Cowling, head of the Division of Epidemiology and Biostatistics at the University of Hong Kong's School of Public Health. "Is it 10 mild cases for every severe case? Is it a hundred mild cases for every severe case? That makes a big difference in how we think about controlling infections," Cowling said, adding that he hoped the rest of China would also adopt Hubei's reporting standards.
Peng Zhiyong, an intensive care unit doctor in Wuhan, said in an interview with the Chinese outlet Caixin that initial requirements for confirming coronavirus cases, including whether a patient had visited the Wuhan seafood market, were withheld from the public, making it nearly impossible to confirm new infections as cases rose in early January.
"The diagnostic criteria were too harsh -- with that criteria, it would be very difficult to diagnose anyone," Peng said. "In this period, our hospital leadership reflected this to the health commission many times, and other hospitals were reflecting the same."
On Jan. 18, Peng said he complained to another group of visiting experts from the National Health Commission. "This makes it very easy to miss real patients," he'd said. "This is an infectious disease. If the diagnostic criteria are too tight, the sick people we let go will be a great risk to society."
Only after Jan. 20, when prominent SARS scientist Zhong Nanshan announced on state TV that there was human-to-human transmission of COVID-19, did Chinese authorities take serious action to contain the outbreak.
The timing of Thursday's political shakeup -- coinciding with fresh numbers closer to Hubei's reality -- suggest that Beijing wants the newly appointed leaders to be seen as problem solvers dispatched to fix a crisis that local officials had allowed to spin out of control. Xi's aim is to prevent further public anger and ensure "social stability."
The goal of scientists is to get accurate data and honest information. "The confirmed cases and even the probable cases are only reflecting the tip of the iceberg," Cowling said. "We don't really have a precise impression of what that iceberg looks like. We just know there's an iceberg."
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