China limits how it defines COVID deaths in official count

China count COVID-19 cases and deaths differently, means that direct comparisons are often misleading.

China only counts deaths from pneumonia or respiratory failure in its official COVID-19 death toll, a Chinese health official said, in a narrow definition that limits the number of deaths reported, as an outbreak of the virus surges following the easing of pandemic-related restrictions.

Deaths that occur in patients with pre-existing illnesses are not counted as COVID-19 deaths, said Wang Guiqiang, the head of infectious disease at Peking University's No. 1 Hospital.

China has always been conservative in how it counts illnesses, whether from the flu or COVID-19. In most countries, including the United States, guidelines stipulate that any death where COVID-19 is a factor or contributor is counted as a COVID-19-related death.

In effect, Wang’s comments on Tuesday simply clarified publicly what the country has been doing throughout the pandemic.

On 21 December, China reported no new COVID-19 deaths and in fact subtracted one death from the overall toll, lowering it to 5,241, according to a daily tally issued by the National Health Commission, which did not offer an explanation for the decrease.

The clarification of how China officially records COVID-19 deaths comes as cases have soared across the country amid the loosening of restrictions. Yet the overall count remains blurry, as China has stopped requiring daily PCR tests and many people are testing at home. Anecdotally, many people have fallen ill in cities like Beijing and Shanghai.