The deaths represent a new phase of loss for China as well as a very serious political challenge.

Health security expert Nicholas Thomas, assistant professor at City University of Hong Kong, said reporting death figures “is a double-edged sword for the authorities”.

“If the numbers are too low, then not only will there be a confidence issue, it will make quarantine restrictions seem excessive. If the numbers are too high, then lockdowns are justified but the authorities have failed to contain the virus.”

So far, government officials have prioritized suppressing the virus over anything else, even as public discontent and economic risks mount under strict lockdown restrictions.

So far, there is no sign of a change in policy, with Beijing “instead doubling down on its message of stopping the virus,” even as epidemics spread, according to Thomas.

With the zero-Covid policy still explicitly linked to Chinese leader Xi, he said, “it is clear that this line will remain in place for the foreseeable future.”

in numbers

With the number of deaths and severe Covid cases soaring in Shanghai in recent days, city health officials have spoken with increasing urgency about further strengthening the critical care response and increasing vaccination in the elderly — even though lockdowns and mass testing appear to have prioritized. Vaccination so far.

“We need to coordinate the city’s medical resources, increase critical medical teams…reduce the proportion of seriously ill patients…and do our best to reduce the death rate,” Zhao Dandan, deputy director of the Shanghai Health Commission, said Sunday. .

“Eligible elderly people should be vaccinated as soon as possible,” he said.

Now, that authorities have endorsed expectations that the country’s death rates will remain low, they have no choice but to rely on lockdowns to protect the vulnerable.

counting cases

But the Hong Kong comparison also raises questions about how Shanghai has been able to keep death rates so low.

At that rate, Shanghai should have seen as many as 700 deaths per 100,000 cases, according to infectious disease doctor Peter Collignon, also a professor at the Australian National University School of Medicine.

Experts also noted a lack of transparency about the criteria Chinese officials use to classify a Covid-19 death.

“If there is no black-and-white definition of Covid-related deaths or Covid-related deaths or how these deaths should be reported, it is all up to the expert panel to decide,” said Jin Donjian, a professor at the University of Hong Kong. College of Biomedical Sciences. “this is the truth”.

Some of these reflect concerns about whether there was a full accounting of infections and deaths during China’s initial outbreak of 2020 in Wuhan, which overwhelmed hospitals — although China has defended its transparency throughout the pandemic.

“China calculated and reported its confirmed cases and deaths based on facts…The relatively low number of confirmed cases and deaths can be attributed to the comprehensive and strict measures taken by the Chinese government,” the Chinese Foreign Ministry said in a 2020 statement.

But experts also caution that it is difficult to make comparisons between places with different strategies for testing and disease control, social factors and demographics.

For example, Shanghai’s extensive testing has picked up hundreds of thousands of asymptomatic cases, some of which may have missed in case counts elsewhere, potentially distorting comparisons.

Bureaucratic processes and the time it takes for positive cases to succumb to the disease could delay reported deaths, with some experts suggesting the worst in Shanghai may be yet to come.

Meanwhile, understanding the overall toll — not just of the virus — but of the lockdowns that have been deployed across Shanghai and other cities is critical to assessing the true cost of China’s control measures, experts say.

Xi Chen, an assistant professor at the Yale School of Public Health, said the long-term repercussions from the Shanghai lockdown, including missed cancer checks or mental health stress, will take time — and the data — to become clear, and even then they may be difficult to measure.

“We will often look at two types of negative shocks,” he said of the fallout beyond the initial burden of death. “One, for those who eventually died, and the other, for those who survived but live with the trauma associated with them.”