As Cases Spread, China’s Low Covid Death Toll Convinces No One

The hearses bearing black and yellow funeral paper flowers crept in a steady stream toward the Dongjiao crematory in eastern Beijing. Several dozen people crowded around the closed gate waiting to be let in. A man unable to get a spot in line could only watch, wondering what to do with the body of a relative who had just died of Covid.

The hospital could not keep the body — there were already too many in its morgue. When he called the crematory, an employee told him he had to wait a week. When he called again, nobody answered.

A country trying to mourn its dead from a rapidly spreading Covid outbreak is grappling with a system unprepared for the surge in fatalities. Two weeks after China abruptly abandoned its “zero Covid” policy, cases have soared in cities like Beijing, along with reports of people dying.

Funeral home directors and sellers of funeral supplies describe a flood of phone calls from families needing help handling the bodies of relatives. On Chinese social media, people are sharing videos and photos of morgues crowded with bodies, as well as their own personal accounts of losing loved ones to the outbreak.

But China’s government is painting a less dire picture. In its official statistics and propaganda reports, China has acknowledged only seven deaths from Covid in the past two weeks, and only in Beijing. The National Health Commission even reduced the country’s cumulative Covid death toll on Wednesday by one, to 5,241. Officials have explained that China counts Covid deaths only if the virus was the direct cause of a respiratory failure — a definition the World Health Organization said would lead to a vast underestimate.

The ruling Communist Party may have a political incentive to downplay the toll of an epidemic it has suddenly stopped trying to control. Xi Jinping, China’s top leader, has portrayed his country’s earlier success in limiting Covid deaths as evidence of China’s superiority over the West, a claim that would be hard to maintain with numerous deaths.

“If they were to publicize the death figure, it would amount to a big blow to the prestige of the party,” said Willy Lam, an expert in Chinese politics at the Jamestown Foundation, a research group.

But doctors and international health experts say an underestimate of the toll risks fueling public complacency about the risks of the virus. Chinese commentators and the public have widely criticized the death toll, saying it obfuscates the real picture and hurts the government’s credibility.

“These are an example of ‘believing in one’s own lies,’” Mei Xinyu, an economist at a research institute affiliated with the Commerce Ministry, wrote on his social media page, commenting on a daily report of Covid figures released by the government. He later posted an announcement that the father-in-law of a prominent economist had died from pneumonia induced by Covid. The man’s family, he wrote, waited hours for an ambulance to arrive and take him to the hospital.

“In the end, he could only be left on the floor of the hospital mortuary, awaiting cremation,” Mr. Mei wrote. He said that the family was having trouble getting a cremation slot and hiring a hearse. “The family members are heartbroken.”

As is the case elsewhere, deaths in China tend to rise in winter, because of an increase in flu and other respiratory infections, even in normal times. But people working in funeral services say they have noticed a larger increase than usual. At the Yong’an funeral services business in Shijiazhuang, a city about 200 miles southwest of Beijing, an employee said that he used to handle 10 deaths per month but is now getting calls for about five each day.

Some Chinese media reports have acknowledged a handful of Covid-related deaths. Wang Ruoji, a 37-year-old retired soccer star, died after a Covid infection worsened an underlying condition. Caixin, a respected news outlet, wrote that Zhou Zhichun, a former senior editor at a Communist Party newspaper, died at 77 after getting Covid, with his doctors classifying the cause as sudden cardiac death.

But on social media, users have shared official obituaries of several other prominent people who have died in recent days, including an opera singer and an artist who helped design sports mascots. Many speculated that the true cause of these deaths was being concealed with descriptions such as “severe cold infections.”

At a government news conference on Tuesday, Wang Guiqiang, an infectious diseases expert, said China counts only those who died from pneumonia or respiratory failure caused by Covid in its official toll. He said that cases of fatal pneumonia are less frequent because the Omicron variant that is prevalent now infects mostly the upper airway.

Another official explained why China revised its Covid death toll down by one this week. A review by experts determined that one death reported on Tuesday was a person who had died from other diseases, Yao Xiujun, a publicity official at the Beijing Municipal Commission of Health and Family Planning, said in a phone interview.

China’s limited definition excludes the deaths of people who had underlying diseases that were aggravated by Covid. Deaths in China are also only ascribed to Covid by panels of experts convened by hospitals, potentially leaving out people who died at home or elsewhere.

In contrast, the United States, Britain and Hong Kong tend to include people who died with Covid, and not just of it, to varying degrees.

China might not be alone in its approach. When the Russian government was still publishing Covid death tolls, it said it counted only deaths confirmed to have been directly caused by the virus. It stopped reporting Covid deaths in October.

On Wednesday, Michael Ryan, head of health emergencies at the World Health Organization, suggested that China’s definition was inadequate. “It’s quite focused on respiratory failure — people who die of Covid die from many different systems failures given the severity of the infection,” he said.

China’s methodology, he said, “will very much underestimate the true death toll associated with Covid.”

Such an underestimate has its advantages, health experts say. It could limit public panic and reduce the burden imposed on hospitals by people who are not severely ill. Already, China has been struggling to provide supplies of ibuprofen and other fever-reducing medication as people have rushed to hoard such drugs.

An underestimate could also help businesses at a time when the government has been trying to rescue an economy battered by nearly three years of disruptive lockdowns and costly testing programs. In some large cities, companies and officials are encouraging people to go to work even when mildly sick with Covid.

But an undercount could also backfire by undermining the government’s own efforts to urge the public to take necessary precautions. Many seniors in China might continue avoiding vaccination, and younger people might take the virus less seriously than they should, said Jin Dongyan, a virologist at the University of Hong Kong.

Professor Jin said China has for decades recorded deaths from infectious diseases narrowly, including SARS in 2003 and seasonal flu. It made an exception during the Shanghai lockdown in the spring of this year, using a looser definition as the authorities sought to justify what became a bruising, two-month lockdown.

Of the 588 Covid deaths the Shanghai city government reported, one was ascribed to a heart attack, and the rest to “underlying conditions” or “tumors.” Despite this inconsistency, the National Health Commission has never expunged those deaths from the national data.

No matter what the official numbers depict, China is expecting a wave of deaths.

“Although the overall case fatality rate is low, the number of people infected is very large, so this may make the absolute number of deaths caused by this risk relatively large,” Wang Guangfa, a respiratory specialist at Peking University First Hospital, said in an interview.

Already, the strain is fueling public frustration.

“The funeral homes are crazily packed,” said a Beijing resident who would only give her surname, Chen, for fear of retaliation from the government. Ms. Chen said that her grandfather died on Tuesday of Covid complications, including pneumonia and kidney failure, after being in a coma for a week.

It took two days for Ms. Chen’s family to find a funeral home in Beijing that would cremate her grandfather’s body. Ms. Chen also expressed skepticism over the government’s Covid statistics.

“If there are only five Covid deaths in one day, I have known nearly half of them,” she said. “It’s heartbreaking that we Beijing people have to bear the first impact of the massive spread of the virus.”

Li You, Claire Fu and John Liu contributed reporting and research.