Yaxue Cao, April 12, 2020
Summary: Whereas Wuhan Municipal Health Commission reported a total 50,008 Covid-19 cases and 2,575 deaths as of April 9, 2020, by my estimates, the total cases are between 400,000 and 600,000, and the death toll is between 22,000 and 30,000.
According to Bloomberg, the U.S. intelligence community recently briefed the White House, in a classified report, that China had concealed the extent of the coronavirus outbreak in its country, under-reporting both total cases and deaths. But everyone, apart from the journalists reporting that “U.S. Coronavirus Death Toll Surpasses China,” already knows that. The real mystery is to what extent China has shrunk the numbers. Normally, I wouldn’t think myself the right person to do the math, but I’m going to give it a try.
Estimating the Death Toll in Wuhan From January 23 to March 23
March 23, 2020, saw the re-opening of Wuhan’s seven funeral homes, 60 days after the city went into lockdown on January 23. Photos circulated on social media showing throngs of residents standing in long lines to pick up the ashes of their loved ones. Caixin reported on March 26 that the line outside Hankou Funeral Home, the largest of Wuhan’s seven, stretched about 200 meters and people were waiting for up to 5 hours to receive their relatives’ urns. There, Caixin reporters also caught sight of a flatbed truck unloading crates of urns. Workers told the reporters that they were delivering 2,500 urns to the funeral home that day, and that they had delivered another 2,500 the day before. Inside the hall where the crates were placed, the reporters counted 7 crates of 500 urns each.
Caixin reporters learned from the staff that when deaths peaked in February, the crematorium was working 19 hours a day, and all male workers were called on to move the bodies. “There were so many of them,” one said.
Informative as they are, none of these details alone is very helpful in leading us to a specific number of deaths due to the coronavirus, though they do suggest a figure well in excess of the officially acknowledged 2,531 deaths reported on the website of the Hubei Province Civil Affairs Department as of March 25. As one netizen pointed out, had there only been 2,531 corpses incinerated in the seven crematoriums across the city over the two-month period, none of the funeral homes would have had to operate 19 hours a day at any point, and even less would there have been such long lines of people waiting to claim the ashes.
Just how many died in those 60 days? An announcement by another funeral home provides some concrete numbers from which we can begin to make an estimate.
First of all, let me briefly explain why I break down into two sections the period from December 1, 2019, when Wuhan confirmed the first case of Covid-19, to March 23, 2020, when the outbreak was declared under control and the funeral homes reopened. After the lockdown, no one was able to collect ashes of the dead from the funeral homes until March 23. I spoke to a couple of Wuhan residents asking about the local burial customs. I was told that, in Wuhan, families cremate their dead within three days of death, and that the body would be cremated in the morning and ashes are collected and, in most cases, buried before 3 p.m. the same day. Based on these customs, and also given the fact that coronavirus deaths were immediately collected and cremated, I assume that the ashes of those deceased prior to the lockdown on January 23 had already been collected. So funeral homes in Wuhan, when reopened on March 23, were distributing the ashes of those who died from January 23 to March 23. That is 60 days. (For the sake of estimation, I will ignore deaths that occurred since March 23, which shouldn’t be large given that the outbreak has been presumably brought under control.)
On March 23, the second largest crematorium in Wuhan, Wuchang Funeral Home, announced that, “The funeral home will distribute 500 urns per day, and will try to distribute all of them before the Tomb Sweeping Day” (the traditional Chinese holiday to commemorate the dead, also known as Qingming), which was April 4 this year. In other words, Wuchang Funeral Home will distribute approximately 6,000 urns in the 12 days leading up to April 4:
500 x 12 = 6,000
Earlier during the outbreak, a chart listing all the funeral homes in Wuhan and the number of cremation furnaces each facility been circulating on Chinese social media:
These numbers are taken from each funeral home’s website with the exception of Qingshan Funeral Home, which is reported to have a capacity similar to Jiangxia Funeral Home. Altogether, Wuhan has about 84 cremation furnaces.
According to Southern Weekly, the city on January 20 assigned the largest funeral home, Hankou Funeral Home (the first one in the chart), to cremate all coronavirus deaths. But as the death toll climbed rapidly, the government issued an order on February 1 requiring that all coronavirus deaths be handled at the nearest crematorium. Earth burials and body preservation were banned, and the government stipulated to which crematorium each hospital should send their bodies.
Wuchang Funeral Home has 15 cremation furnaces, and burned some 6,000 bodies in 60 days, an average of 400 bodies per furnace during the 60 days.
In other words, from January 23 to March 23, Wuhan’s 84 furnaces cremated 33,600 bodies:
400*84 = 33,600
There have been anecdotal reports of some furnaces being out of order before or during this period. Suppose 8 furnaces (about 10%) were not working, and 76 furnaces were, the adjusted number of cremation during the 60 days would be:
400*76 = 30,400
Of the 30,400 deaths during the 60 days, we subtract non-coronavirus deaths.
According to the city’s official statistics, in 2018, Wuhan’s natural death was 47,900, averaging 131 deaths per day in the city. Based on this rate, during the 60 days from January 23 to March 23, we can estimate that about 7,860 people died of causes other than coronavirus infection:
130*60 = 7,860
Concluding my estimation, during the 60 days from January 23 to March 23, approximately 22,540 people died of coronavirus infection:
30,400 – 7,860 = 22,540
Estimating the Death Toll From December 1 to January 22
Estimating the death toll for this period is tricky; we lack specific numbers to start with as we do for the period from January 23 to March 23. But we can very well estimate when the death toll in Wuhan began to soar.
One of the early papers published by a group of Chinese doctors and scientists placed the date of the first confirmed case on December 1, 2019, the date I use for this estimation. The South China Morning Post reported in mid-March that government data in China traced the first case of coronavirus infection to November 17. though it’s unclear whether this 55-year old person was the “Patient Zero.” From that date onwards, according to SCMP, 1-5 new cases were reported each day, but it wasn’t until mid to late December when the medical community in Wuhan became aware that they were dealing with a new disease and it’s infectious. It has been well documented that Chinese health authorities, taking orders from the central leadership, responded in the last two weeks of December and the first three weeks of January by suppressing information about the epidemic and pretending nothing much was happening despite the fact that coronavirus cases skyrocketed and, starting early January, hospitals were thronged by people suffering from fever. By January 18, more than 1,100 healthcare workers in Wuhan had been infected, according to a leaked internal briefing (whereas the Wuhan Health Commission on January 21 had reported 15 cases of infections among health care workers).
From numerous accounts by doctors and patients, we’ve learned that an infected person begins showing symptoms between three and fourteen days after contracting the disease. A recent article in The Lancet says that “the median time from onset of symptoms to intensive care unit (ICU) admission is around 10 days,” and “the time between symptom onset and death ranged from about 2 weeks to 8 weeks.”
Based on these data, the number of deaths in Wuhan would intensify between January 15 and 26 and soar from that point onwards. This is consistent with first-hand accounts, and it’s probably the most important factor why the government turned around so drastically from still trying to conceal the outbreak in mid-January to locking down the city on January 23.
A report published on January 23 in Chinese media quoted a frontline health care worker as saying, “Our quarantine wards are full. Some colleagues have been infected. Doctors and nurses have been working overtime to deal with the huge increase of patients. …Many of us are working over 10 hours a day, and today I’ve worked almost 13 hours already.”
Dr. Ai Fen (艾芬), head of the ER at Wuhan Central Hospital, said in an interview that was censored in China, “On January 21, our ER received and treated 1,523 patients, three times more than our busiest record, and 655 of them had fever.” “Patients stood in line for over 5 hours to be seen at our hospital’s Fever Clinic. A well-dressed woman dropped dead while standing in line.”
On January 28, while the official number of total deaths in Wuhan was a mere 85, the official Weibo account of the municipal government posted that, “In order to increase capacity for transporting bodies, the city’s Command Center and the provincial Civic Affairs Department have helped provide funeral homes with more vehicles, personnel, and protection gears, so as to ensure their ability to transport bodies and provide service.”
On February 1, a screenshot made the rounds on social media in which a union of funeral home workers in Wuhan was urgently calling for supplies, including body bags.
Also on February 1, Wuhan resident Fang Bin (方斌) visited four hospitals on his own. Outside the Fifth Hospital around noon, he saw a vehicle of Wuchang Funeral Home. He counted three body bags inside the vehicle. Then he went into the hospital, and videotaped busy corridors, crowded waiting areas, and dying patients. He came out in about five minutes, and saw that there were eight body bags in the vehicle and that the funeral home workers were still moving bodies. That’s just one scene from a random time of day, and the Fifth Hospital was only one of the 61 Grade Three hospitals (三级医院, hospitals with 501 beds and more) in Wuhan; it ranked No. 26.
(Fang Bin was taken away and disappeared by police on February 10 from his home. We have received no further information about his whereabouts.)
On February 3, a WeChat public account named “Gu Yu Laboratory” (微信公众号“谷雨实验室”) published the account of a certain Lao Huang who was on the administrative staff at Wuchang Funeral Home. He said that starting the second day after the Chinese New Year (January 26), every single employee was required to work and everyone had to help transport bodies. He added that the funeral home had actually gotten busier before the Chinese New Year, and four workers and an extra vehicle from another city had been added to the workforce. He said that telephone operators were on duty 24 hours a day to answer the four lines of the facility. He said even though the Funeral Home had stockpiled protection gears, masks, and liquid disinfectant at the beginning of the year when the Huanan wet market was closed for being the suspected source of the coronavirus, the needs were so great that they were running out of supplies.
To estimate the death toll of this period, I have consulted various friends whose judgment I trust, and was advised to avoid providing a more or less specific estimate of the death toll from December 1 to January 23. I thought it was shrewd advice and took it. The death toll during this period could be a few hundreds or a few thousands, and we just don’t know.
This said, I’d place my estimate of the death toll in Wuhan from the onset of the epidemic to the present in the range of 22,000 to 30,000, give or take.
Estimating the Total Number of Infections in Wuhan
- Using Wuhan’s Official Death Rate:
Caixin’s Domestic Observation of Covid-19 (境内疫情观察) updates, among other data, the death rate of cities in Hubei Province. As of March 23, the death rate is 5% in Wuhan based on statistics posted by the National Health Commission and the local health commissions. We know for certain that China has been vastly underreporting both cases and deaths, but is the official ratio of deaths to infections any good? When China doctored the numbers day in and day out, did they take care for the ratios to “look right”?
Caixin: Coronavirus death rates in the various municipalities of Hubei Province as of March 23.
Let’s assume so, and see what we get. Applying the 5% death rate to my estimated death toll, the likely number of confirmed cases would fall
between 440,000 to 600,000
2. Inferring from the infection rate of foreign nationals pulled out of Wuhan:
In early February when countries, such as Japan, South Korea, Singapore, and Germany, began to pull their nationals out of Wuhan, netizens noted the percentage of infections of each group, and estimated how many people had been infected in Wuhan using the average infection rate of these groups. I thought it was a fairly acceptable method of estimation, and it was also a conservative method because these groups of foreigners in Wuhan probably had lower than average susceptibility compared to the general population in Wuhan. The data are as follows:
Japan withdrew 565 nationals with 8 confirmed cases, and the infection rate was about 1.42%; South Korea withdrew 368 nationals with 5 confirmed cases, with an infection rate of about 1.36%; Singapore withdrew 92 nationals with 1 confirmed cases, an infection rate of about 1.08%; and Germany withdrew 124 nationals with 2 confirmed cases, an infection rate of about 1.61%. The average infection rate among these four groups is 1.37%.
Domestically, of the 5,239 people who returned from Wuhan to Leqing, Wenzhou City (温州乐清市), there were 69 confirmed cases, the infection rate was 1.32%.
The average infection rate, based on these 5 groups, is 1.358%. I will apply this infection rate to the Wuhan’s population. Before the lockdown, the city’s population is 15 million:
15,000,000*1.358% = 203,700
Now factor in the R0, the average number of people who will catch the disease from a single infected person.
Over the week of January 20, according to an article in The Atlantic published on January 28, “at least six teams of researchers, along with the World Health Organization, have published estimates of R0 for the new coronavirus. All these groups used different methods, but their results have been mostly consistent, with estimates hovering between 2 and 3. WHO was a little more conservative than the others, with estimates of 1.4 to 2.5. One Chinese team is a clear outlier, with estimates of 3.3 to 5.5. And a British-led group initially published a high average value of 3.8 last week before revising it downward to 2.5 as new data emerged.”
These R0 estimates were specific to Wuhan, and R0 2-3 seem to correspond pretty well with the estimates using China’s official death rate in Wuhan: – between 203,700*2 and 203,700*3, or
Between 407,400 and 611,100
I must also note that, while I understand R0 is not a simple multiplier, I’m applying it as a multiplier here anyway given that the virus is new and Wuhan was unprepared and responded to it poorly in the early weeks, and that my purpose is simply making a conservative estimation to refute China’s official numbers that are clearly and deliberately false.
In early February, I attended an event in Washington, D. C. The event, scheduled long before the epidemic, was unrelated to the coronavirus. One of the panelists, it so happened, was a current WHO official and a former high-level official at the Health and Human Services, and another panelist was a professor on public health policy. During the Q & A, I ventured an estimate of 500,000 people being infected in Wuhan, and nobody seemed to have an opinion about it or express concern about a possible outbreak in the U. S. Of course, I was off topic. After the meeting, however, a woman in the audience approached me, gave me her business card, and said, “Our estimate is also about half a million.” I told her my simple, crude method using the infection rate of foreign nationals pulled out of Wuhan. She corrected my pronunciation of R0. “R nought,” she said gently. I didn’t know who she was, and googled her on my way home – she had been on the U.S. government’s team responding to the Ebola outbreak in 2014.
Lying on This Scale Is Hard Work, and the CCP Lies Are a Leaking Ship
According to Wuhan Municipal Health Commission, as of April 9, 2020, Wuhan has had 50,008 confirmed covid-19 cases and 2,575 deaths.
According to “The 2018 Development Briefing of Wuhan Municipal Health Profession,” as of the end of 2018, Wuhan had 109,600 healthcare workers, including 39,600 licensed doctors, 54,400 registered nurses, 4,700 pharmacists, and 5,400 technicians. Wuhan is one of the megacities in China with the best medical resources.
As the coronavirus outbreak intensified, healthcare workers from around the country were mobilized to reinforce Wuhan. By January 28, China’s National Health Commission reported that nearly 6,000 HCWs had arrived in Wuhan. By February 29, 42,000 HCWs from all over China were in Wuhan to help combat the epidemic.
Zhuang Xiaobing (庄晓冰) is an ICU nurse at Changzhou Municipal First People’s Hospital in Jiangsu Province, and sent to work at Wuhan Jiangxia District First People Hospital. He said each day he was in charge of 15-16 beds, and he was constantly running and soaked in sweat.
A nurse from Jiangxi Province said that when she and her colleagues first arrived in Wuhan in early February, three nurses were taking care of 13 ICU patients.
Similar accounts abound on social media and in China’s state and local media. Why were so many HCWs needed for only 50,008 cases? A Weibo user commented the other day, “Living in this land, you only have to have elementary school math to separate lies and facts.”
Not to mention the countless heart-wrenching stories of desperate patients having to wait for days on end to get a hospital bed.
China’s 404 National Memorial
At funeral homes in Wuhan, the atmosphere was solemn. Many died without their family at their side. Relatives would get a death certificate, and then, starting March 23, a notice from the funeral home to collect the ashes of the deceased. Security guards shouted at those who tried to take pictures with their smartphones. To prevent emotional eruptions and crowding, relatives were required to pick up ashes in the company of personnel from their work unit or neighborhood committee. That’s probably why we haven’t seen more similar photos following those that surfaced during the initial period.
China’s State Council named April 4, the Tomb Sweeping Day, the national memorial day to commemorate coronavirus deaths. Flags were on half-staff, sirens sounded, people stood still on streets to observe the moment at 10 am. In Zhongnanhai, China’s zombie-looking Politburo members bowed their heads.
For many Chinese, however, the day is a 404 day: they reminded everyone that, without censorship, without concealment, without suppression of Dr. Li Wenliang and his likes, the virus would not have killed so many people in China and gone on to ravage the world. Their posts were “404ed” and deleted by the government censors.
The commemoration is deeply cynical. Are the zombies in the Politburo commemorating the real deaths, or just the official deaths? By all indications, they are preoccupied with passing on the blame to the U. S., suppressing dissidents, concealing their blunders, and turning this epic tragedy into a grand festival celebrating the leadership of the Communist Party and Xi Jinping.
With each and every disaster, we always say, let’s remember each victim by their name and by their story; let’s not turn them into cold numbers. But in China, in this largely man-made epidemic, many don’t even get to be a cold number.
Now, a suggested task for those so inclined: see if you can estimate the cost of this once-in-a-century pandemic that’s now wreaking havoc in the U.S., Europe, and the rest of the world.
Yaxue Cao is the editor of China Change. Follow her on Twitter @YaxueCao
Going Around Coronavirus-Stricken Wuhan With Fang Bin, Visiting Hospitals, and Being Visited by Police, on February 1, 2020, China Change, February 3, 2020.
The Regret of Wuhan: How China Missed the Critical Window for Controlling the Coronavirus Outbreak, China Change, February 10, 2020.
A Social Media Profile of the Late Dr. Li Wenliang: From a Liberal-leaning Student, to a Party Adherent, to a Whistleblower Who Believes a Society Should Have More Than One Voice, Ye Du, February 26, 2020.
Beijing Has Nothing But Good News for You in the Coronavirus Epidemic, Chang Ping, March 6, 2020.
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