When Bloomberg broke the news on April 1 that a White House intelligence report found that the Chinese government was concealing the number of confirmed coronavirus cases within its borders, some of the world’s biggest fears became realized.
China first reported zero new domestic cases of the virus on March 18, 79 days after the outbreak began, and the world gravitated toward the news as a sign of hope. It established a timeline for countries even with the worst of scenarios — that if China were able to uphold certain public policies to limit the spread, then they could start seeing cases of the virus dwindle to a near minimum within two-and-a-half months.
“China has hailed its success as evidence of what can be achieved when a vast, top-down bureaucracy that brooks no dissent is mobilized in pursuit of a single target,” reads a New York Times article published on March 18.
But soon, when the country reported zero new domestic cases for five consecutive days after the initial reporting, skepticism started to mount among the international community in regards to the accuracy of China’s reporting.
And for good reason, given how China's government has failed to comply with the World Health Organization throughout this pandemic, as well as reports by the Washington Post which found that the local officials had stalled recordings of new cases during the outbreak’s early stages in January.
While China may stand out for these reports coming from independent sources, it is not the only country whose own government is putting people at risk by potentially under-reporting cases. According to the same Bloomberg article which broke the report from the White House, multiple other countries are also being scrutinized for not accurately documenting their data.
“Western officials have pointed to Iran, Russia, Indonesia and especially North Korea, which has not reported a single case of the disease, as probable under-counts,” the article said. “Others including Saudi Arabia and Egypt may also be playing down their numbers.”
This truth is that at this time, with so much variability already existing in the number of COVID-19 cases and deaths around the world due to a deficiency in testing availability, the globe can’t afford to be further brought down by false reporting coming from any country.
Withholding vital information from the public leads to greater distress among the population of whatever region is accused of such acts. Knowledge that a government is concealing important data which could provide clarity is sure to create tension between the government and their own people.
But false reporting is linked to other countries' ability to deal with the virus as well, because the withheld data is essential to researchers who are developing statistical models and figures which are intended to aid governments in being as proactive as possible in slowing the virus’s spread. These models are constructed using pre-existing data, allowing researchers to develop the most accurate formulas to predict an outcome.
Therefore, if a given country were to underreport information, the lack of accurate numbers leads to a less precise model being procured. This leads to these models making predictions that are lower than what is actually set to occur, and then countries are hit with unforeseen problems that they have to scramble to solve before it’s too late.
”If you have poor data, your results will be unreliable no matter how sophisticated your statistical modeling is,” reads an article in The Hill.
For instance, the 3.4% fatality rate that the WHO issued on March 10 has now been far exceeded in parts of the world where the number of cases that need hospitalization and the age demographics of those impacted are being shown to be more widespread than what was initially reported from China.
"The medical community interpreted the Chinese data as: This was serious, but smaller than anyone expected," Dr. Deborah Birx, a U.S State Department immunologist, said during a news conference. "I think probably we were missing a significant amount of the data, now that what we see happened to Italy and see what happened to Spain."
According to data gathered from Worldometer, Spain’s fatality rate stands at around 9.7% while Italy’s is 12.4%.
You can’t attribute all of other nations’ shortcomings with handling the virus to China’s underreporting, but given how China was the original epicenter for the rest of the world, its data acted as the initial indicators for other countries when it came to what to expect.
This is not true just for deaths, but for many other figures that play an important role in the creation of statistical models that create estimations for what’s to come in particular countries.
Let’s take into consideration the Case Fatality Risk (CFR), a calculation for the potential for death in all confirmed cases using previously recorded data on deaths and infections from COVID-19. What’s found when applying those numbers is the naive CFR (nCFR), because the data being used has a considerable amount of volatility due to the delay in time between diagnosis and death for patients who succumb to the disease.
In a scientific research journal titled "Real-Time Estimation of the Risk of Death from Novel Coronavirus (COVID-19) Infection: Inference Using Exported Cases," published by the Multidisciplinary Digital Publishing Institute, researchers constructed a method for calculating CFR which also takes time delay into account in order to yield a more accurate result.
“Estimating the CFR using the ratio of deaths to confirmed cases (cCFR), with an adjustment of the time delay from illness onset to death, can provide insight into severity of the disease, because the naïve CFR tends to be an underestimate due to the real-time nature of the growth of fatal cases,” reads the article.
To develop these equations, researchers are relying on truthful reporting on the number of diagnoses, hospitalizations, recoveries and deaths by countries because that allows for researchers to figure out the average time lapse that occurs for all symptomatic cases between the time of diagnosis and either death or recovery. Once they establish what that average time lapse is, they input those calculated figures into their models in order to apply them to all future scenarios.
If it turns out that portions of the data being used to configure these equations are inaccurate because certain nations are withholding their own findings, then not only do those figures fall under scrutiny, but now those same studies that are intended to guide the medical community toward more clarity are instead being held in contention as well.
Another more accurate model that countries can use to track the severity of the disease is through the Infectious Fatality Risk (IFR), a ratio that takes into account all infected with the disease, regardless of whether or not they exhibit symptoms.
This is because as health officials have learned more about COVID-19, the more apparent it’s becoming that asymptomatic carriers are huge catalysts for the outbreak. Twenty-five percent of COVID-19 carriers show little to no symptoms, according to Director of the Centers of Disease Control and Prevention Robert Redfield.
This is why more than ever it’s of the utmost importance that countries track and record as many asymptomatic diagnoses as possible. Even still, the Chinese government had not been reporting such cases to the WHO until April 1, and we’ve already experienced the impact that has had on the rest of the world.
“In late January and early February, when the disease had begun to spread outside China, leading health officials, including the World Health Organization, told the public that transmission from asymptomatic people was likely ‘rare,’ based on information available at the time,” reads a Buzzfeed News article.
But it’s not as if China was entirely unaware of the role that asymptomatic carriers could’ve played in the spread of coronavirus, as independent sources have found that the government was keeping track of such cases in private.
The South China Morning Post reportedly uncovered classified government information that suggested by the end of February, 42,000 people in China tested positive for coronavirus without showing symptoms, but none of those alleged diagnoses were disclosed publicly.
“If that figure is true, about a third of China’s cases were asymptomatic,” reads a Washington Post article commenting on the findings. “A type of case that researchers around the world are still desperately trying to understand.”
A high amount of asymptomatic cases are already going untested due to a lack of available testing, but the cases that are found must be reported in order to develop a more dynamic understanding of how easily COVID-19 can be transmitted.
Once that information is known, local governments can access the best possible public policy to enact as preventative measures. But without that information being given, then the entire world runs a greater risk of mishandling the entire pandemic.
If China had been more forthcoming with its findings of mild to nonsymptomatic cases to the rest of the world, then perhaps steps that have only been taken as of recent, such as the CDC’s recommendation for civilians to wear face coverings when going outside, may have occurred far earlier and saved more lives.
“Research found that if interventions in [a] country could have been conducted one week, two weeks, or three weeks earlier, cases could have been reduced by 66%, 86% and 95% respectively — significantly limiting the geographical spread of the disease,” reads an article by the University of Southampton highlighting research done by the university regarding nonpharmaceutical interventions in response to COVID-19.
So now, independent news sources are having to rely on context clues such as the number of urns seen stocked outside funeral homes, leaked information coming from doctors and nurses working in the hospitals or predictions being made by outside sources on the true numbers occurring in countries that are underreporting, just to get a clearer picture of what’s actually transpiring.
Still, those estimations and assumptions can’t be used as legitimized data for formulating models, and knowing that certain countries are obstructing progress in that manner leads to greater public unrest around the entire world at a time where those feelings are already at a general high.
If all nations were more forthcoming with the information they have on the virus, then greater international clarity around the issue could be had sooner, allowing for proactive measures to be taken in order to move forward as quickly as possible. Instead of feeling like we’re constantly behind the eight ball in this fight against coronavirus, we could be steps ahead if all nations were willing to disclose the most up-to-date information on all coronavirus cases that they can.
“China was the first country to battle the new virus, and its reports set a precedent for how the rest of the world viewed the threat,” Morgan Mcfall-Johnson, junior science reporter for Business Insider, wrote in an article. “If China had reported higher numbers early on, it's possible that officials in other countries would have made different decisions.”