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How Many Coronavirus Cases in China? Officials Tweak the Answer How Many Coronavirus Cases in China? Officials Tweak the Answer
(about 3 hours later)
HONG KONG — The news was abrupt and, to some, surprising: Overnight, a Chinese province near Russia, had cut its count of confirmed coronavirus cases by more than a dozen.HONG KONG — The news was abrupt and, to some, surprising: Overnight, a Chinese province near Russia, had cut its count of confirmed coronavirus cases by more than a dozen.
The revision stemmed from what appeared to be a bureaucratic decision, buried in a series of dense documents from the national government. Health officials said that they would reclassify patients who had tested positive for the new coronavirus but did not have symptoms, and take them out of the total count of confirmed cases.The revision stemmed from what appeared to be a bureaucratic decision, buried in a series of dense documents from the national government. Health officials said that they would reclassify patients who had tested positive for the new coronavirus but did not have symptoms, and take them out of the total count of confirmed cases.
The documents offered little detail or explanation, and skepticism was immediate. A Hong Kong newspaper called the decision a “disguise.” World Health Organization officials seemed caught off guard when asked about the move at a news conference this week.The documents offered little detail or explanation, and skepticism was immediate. A Hong Kong newspaper called the decision a “disguise.” World Health Organization officials seemed caught off guard when asked about the move at a news conference this week.
The change in counting cases is only one factor that has made it difficult for experts to determine the true scale of the epidemic. In fact, the shifting landscape of how infections are defined and confirmed has led to significant variations in the estimates for the extent of outbreak.The change in counting cases is only one factor that has made it difficult for experts to determine the true scale of the epidemic. In fact, the shifting landscape of how infections are defined and confirmed has led to significant variations in the estimates for the extent of outbreak.
Early on Thursday, provincial officials in Hubei province, the center of the outbreak, announced that nearly 15,000 new cases and 242 new deaths were recorded in a single day, largely because the authorities expanded their diagnostic tools for counting new infections.Early on Thursday, provincial officials in Hubei province, the center of the outbreak, announced that nearly 15,000 new cases and 242 new deaths were recorded in a single day, largely because the authorities expanded their diagnostic tools for counting new infections.
Until now, only infections confirmed by specialized testing kits were considered accurate. But those kits have been in such short supply — and so many sick people have gone untested — that the authorities in Hubei Province have started counting patients whose illness have been screened and identified by doctors.Until now, only infections confirmed by specialized testing kits were considered accurate. But those kits have been in such short supply — and so many sick people have gone untested — that the authorities in Hubei Province have started counting patients whose illness have been screened and identified by doctors.
The result was a sudden — and large — spike in the overall tally for the coronavirus: more than 1,300 people killed and well over 50,000 infected.The result was a sudden — and large — spike in the overall tally for the coronavirus: more than 1,300 people killed and well over 50,000 infected.
The surge in cases in Hubei, the result of a local change in how cases are counted, underscored how elusive the exact scale of the epidemic is.The surge in cases in Hubei, the result of a local change in how cases are counted, underscored how elusive the exact scale of the epidemic is.
The change in how cases are counted — both inside and outside the epicenter of the outbreak — reflects a two-headed problem in the global fight against the disease. On the one hand, health officials need to stay flexible in dealing with new outbreaks.The change in how cases are counted — both inside and outside the epicenter of the outbreak — reflects a two-headed problem in the global fight against the disease. On the one hand, health officials need to stay flexible in dealing with new outbreaks.
One the other hand, mistrust of the Chinese government — especially when it comes to being transparent about the threat and extent of the virus — remains pervasive.One the other hand, mistrust of the Chinese government — especially when it comes to being transparent about the threat and extent of the virus — remains pervasive.
“It’s pretty clear that there is an issue with trust about whatever the Chinese government comes out with at the moment,” said Kerry Brown, a former diplomat and director of the Lau China Institute at King’s College, London.“It’s pretty clear that there is an issue with trust about whatever the Chinese government comes out with at the moment,” said Kerry Brown, a former diplomat and director of the Lau China Institute at King’s College, London.
“That may be terribly unfair,” Mr. Brown said. But, he added, “to redefine things — even legitimately — at a moment like this is always going to be a presentational challenge, because people are going to be very sensitive, and they’re going to suspect there’s another agenda.”“That may be terribly unfair,” Mr. Brown said. But, he added, “to redefine things — even legitimately — at a moment like this is always going to be a presentational challenge, because people are going to be very sensitive, and they’re going to suspect there’s another agenda.”
The new numbers out of Hubei came only a day after China reported that new infections had hit the lowest point in a single day since Jan. 30. Experts cautioned then that it was premature to draw any conclusions from the drop.The new numbers out of Hubei came only a day after China reported that new infections had hit the lowest point in a single day since Jan. 30. Experts cautioned then that it was premature to draw any conclusions from the drop.
The shifting case counts are not the only example of conflicting or spotty information. Researchers have given differing estimates on when the outbreak might peak, ranging from a date already past to several months in the future. The Chinese authorities have closely guarded the demographic details about the fatalities, creating uncertainty about who is most susceptible.The shifting case counts are not the only example of conflicting or spotty information. Researchers have given differing estimates on when the outbreak might peak, ranging from a date already past to several months in the future. The Chinese authorities have closely guarded the demographic details about the fatalities, creating uncertainty about who is most susceptible.
Scientists have even debated just how much of a danger asymptomatic transmission poses. Chinese health officials were among the first to raise the prospect of asymptomatic transmission, even as health experts in other countries were skeptical of early reports that the virus could be passed on by such patients. But in recent days, Chinese officials have also played down the asymptomatic transmission risk.Scientists have even debated just how much of a danger asymptomatic transmission poses. Chinese health officials were among the first to raise the prospect of asymptomatic transmission, even as health experts in other countries were skeptical of early reports that the virus could be passed on by such patients. But in recent days, Chinese officials have also played down the asymptomatic transmission risk.
The uneven information comes as China’s leader, Xi Jinping, said that the containment efforts were working.The uneven information comes as China’s leader, Xi Jinping, said that the containment efforts were working.
“After hard work, the epidemic situation has seen positive change, and the prevention and control work has achieved positive results,” he said during a meeting of the Communist Party leadership in Beijing on Wednesday, according to a summary of his remarks by state-run media. “This is hard-won, and all parties have contributed.”“After hard work, the epidemic situation has seen positive change, and the prevention and control work has achieved positive results,” he said during a meeting of the Communist Party leadership in Beijing on Wednesday, according to a summary of his remarks by state-run media. “This is hard-won, and all parties have contributed.”
The changes to the classification of asymptomatic coronavirus cases emerged on Jan. 29, in a set of guidance from China’s National Health Commission. The agency said that it would no longer count patients who had tested positive for the coronavirus but did not display symptoms as “confirmed cases.” Instead, those patients would be counted separately, as “positive diagnosis” patients, and would become confirmed only if they began showing symptoms.The changes to the classification of asymptomatic coronavirus cases emerged on Jan. 29, in a set of guidance from China’s National Health Commission. The agency said that it would no longer count patients who had tested positive for the coronavirus but did not display symptoms as “confirmed cases.” Instead, those patients would be counted separately, as “positive diagnosis” patients, and would become confirmed only if they began showing symptoms.
Updated June 22, 2020 Updated June 24, 2020
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Chinese health officials have given little public justification for the labeling change. The National Health Commission did not immediately return a request for comment.Chinese health officials have given little public justification for the labeling change. The National Health Commission did not immediately return a request for comment.
The changes have prompted debate among some public health experts.The changes have prompted debate among some public health experts.
“Adapting definitions during an outbreak is not unusual, with increasing insights and also with prioritizing where efforts need to go,” said Dr. Marion Koopmans, the head of the viroscience department at Erasmus University Medical Center in the Netherlands.“Adapting definitions during an outbreak is not unusual, with increasing insights and also with prioritizing where efforts need to go,” said Dr. Marion Koopmans, the head of the viroscience department at Erasmus University Medical Center in the Netherlands.
Still, even experts who said that the effect of discounting certain cases would be small said that it would be useful to epidemiologists — and the public — to have a complete count of all cases, including asymptomatic ones.Still, even experts who said that the effect of discounting certain cases would be small said that it would be useful to epidemiologists — and the public — to have a complete count of all cases, including asymptomatic ones.
Dr. Malik Peiris, the chair of virology at the University of Hong Kong, said in an email that mild or asymptomatic infections could form an “invisible iceberg” that made a given virus’s fatality rate much lower than it initially appeared.Dr. Malik Peiris, the chair of virology at the University of Hong Kong, said in an email that mild or asymptomatic infections could form an “invisible iceberg” that made a given virus’s fatality rate much lower than it initially appeared.
Determining the true denominator of the number of people infected — whether symptomatic or not — would, he said, “be most informative to, hopefully, calm current panic in China and the world.”Determining the true denominator of the number of people infected — whether symptomatic or not — would, he said, “be most informative to, hopefully, calm current panic in China and the world.”
In a sign of just how much the changes could further muddle public understanding of the virus, even the W.H.O., which has praised the Chinese government for its cooperation in fighting the outbreak, expressed confusion.In a sign of just how much the changes could further muddle public understanding of the virus, even the W.H.O., which has praised the Chinese government for its cooperation in fighting the outbreak, expressed confusion.
Dr. Chen Bingzhong, a former senior government health official in Beijing who has been vocal in calling for more transparency about public health crises, said a full tally of the number of cases would keep the authorities accountable.Dr. Chen Bingzhong, a former senior government health official in Beijing who has been vocal in calling for more transparency about public health crises, said a full tally of the number of cases would keep the authorities accountable.
He added that a positive test result should be disclosed as such, regardless of symptoms.He added that a positive test result should be disclosed as such, regardless of symptoms.
“Testing positive means it is the new coronavirus,” he said. “If you don’t recognize it, you are covering the truth.”“Testing positive means it is the new coronavirus,” he said. “If you don’t recognize it, you are covering the truth.”
Jin Wu contributed reporting from Hong Kong, and Yiwei Wang contributed research from Beijing.Jin Wu contributed reporting from Hong Kong, and Yiwei Wang contributed research from Beijing.