On Wednesday evening (Thursday morning in China), the Hubei provincial government issued its daily update of novel coronavirus cases, as it has been doing now since the last week of January. On Feb. 11, there were 2,097 new cases and 103 new deaths. On Feb. 12, there were 1,638 new cases and 94 new deaths.
On Feb. 13, there were 14,840 new cases and 242 new deaths. You read that right. Almost fifteen thousand new cases, and more than double the number of deaths. Overnight.
On first viewing, these numbers would seem to represent an explosion of cases that aren’t just terrifying, but also practically impossible. Not even Captain Trips spreads like that. On second viewing—and with some flogging of translation software—things are different than they might seem at first. But not a whole helluva lot better. Even in the best possible light, it’s pretty gloomy.
I honestly started writing this article last night by focusing on a story about how coronavirus had led to the cancellation of the world’s largest phone show, just to provide an example of how the outbreak was disrupting world business. I was confident that, working with the existing data, we were 3-4 days away from the point where recoveries exceeded new cases, the stress on China’s healthcare system began to ease, and, if I had to make a prediction, the whole outbreak could be wrapped up at around 90,000 cases and 3,000 deaths. Terrible. But not insanely terrible.
That was before officials in Hubei lobbed a hand grenade into everything we thought we knew about the course of this epidemic.
The report packing these astounding numbers suggests that the increase didn’t come from a sudden growth of confirmed cases, but from a difference in reporting. On Wednesday, China had indicated over 16,000 “suspected” cases in Hubei alone. In the Feb. 13 report, the total no longer contains just “confirmed” cases, but cases that have been “clinically diagnosed.” From the way things are being defined here, it seems as if many of those suspected cases joined the 45,000 cases that had previously been confirmed, creating an enormous spike in the data—and pretty much invalidating every chart or table made before this point.
If this meant nothing had happened but that officials had changed the place where they drew the line on what constituted a “case,” it would be confusing and frustrating, and make it difficult to take any of the numbers seriously. But it’s worse than that: Tossing in unconfirmed cases, which might be assumed to be cases that are relatively mild, would not account for a sharp overnight increase in deaths. In fact, no shuffling of the numbers would do that.
What these numbers suggest is what some people have been saying in comments all along—the bounds on reporting in Hubei did not represent the actual number of cases. They represented the limits of local authorities’ ability to test for cases. For the last week, I’ve been telling you to breathe a little easier as the daily reports of confirmed cases began a slow decline. It now appears that the values being reported may have been nothing but artifacts generated by the inability of authorities in Hubei to keep up.
There have been reports that they were short of test kits. There have been reports that they were short of doctors. The numbers we’ve been seeing over the last week could have been a result of either scenario. It may have been both. That Hubei is now moving to a definition that includes clinically diagnosed cases seems to suggest that there is still an issue that prevents the accurate measure of confirmed cases.
This does not mean that there were actually 15,000 more people infected in Hubei on Thursday than there were on Wednesday. However, there is no way in which this is not frightening. It means we don’t know.
So now what? It is still possible to produce the charts that I’ve been making over the past few weeks, but the latest numbers out of Hubei would seem to invalidate all but local data from other regions. I mean, look at this nice chart showing how the trend in confirmed cases and the number of recoveries were set to cross within the next few days. I was all set to hit you with this, complete with the new data—only that new data rips this chart wide open.
Confirmed cases vs. recoveries by day … until Feb. 12
In fact, looking at the overall chart of cases on Feb. 13 makes it very difficult to maintain a hopeful outlook.
Total cases COVID-19
It’s not hard to draw a line that indicates that what had appeared to be a flattening of growth was in fact more likely a reporting limitation. It’s either that, or we have to believe that at this point Hubei has thrown up its hands to admit that it can no longer generate a confirmed case number. Maybe Hubei will come back this evening with a big, “Whoopsie, here’s the real case load.” But it will be difficult to accept any number provided at this point—or to understand the abrupt increase in the number of deaths as anything more than indication that it’s been unable either to conduct adequate tests or to provide adequate care. Or both.
All of those things are more than just disturbing in a medical sense: They are also a staggering threat to the political stability of the Chinese government. Chairman Xi Jinping has strongly tied the future of the current government to its ability to cope with this crisis. On Tuesday, several key local officials were replaced by new faces that Xi trusted to be able to handle this—which could definitely be related to the change in reporting if those previously in charge had been trying to make the situation look rosier than it really was. And that may be the rosiest way of viewing this change.
While we’re talking political ramifications, and to draw the worst possible speculations from results that are already verging on the worst possible, all of this could also be a handy Reichstag fire for a nascent fascist authoritarian government seeking a reason to exert greater control over the populace. Gee … know anywhere like that? At this point, feel free to find that old brown paper bag and draw a few deep breaths. I know I am.
Okay. So … where are we? Truthfully, we just don’t know. The numbers coming out of Hubei set every assumption made about conditions in the epicenter of this outbreak on its ear. To what extent is this simply moving the mark? Dunno. To what extent does it represent an inability to confirm cases? Dunno. How long have they been undercounting the number of cases? Dunno … but obviously for some time.
Perhaps the next set of numbers will provide a better clue to the true situation. Maybe not. In the meantime, let’s look at what else we can figure out. Because, believe it or not, there is still some good news hiding among all the Ahh! Ahh! Make it stop!
First off, back on Feb. 9 we looked at what was going on in five other Chinese provinces, the five with the highest number of COVID-19 cases. Since then, those five provinces have added a relatively small 500 new cases among them (about 25 per day for each province), and now there are enough numbers on recoveries within those provinces that it’s possible to make some interesting comparisons.
Covid-19 Outcomes
|
Cases |
Deaths |
Recoveries |
CFR |
OM |
Hubei |
48,206 |
1,310 |
3,441 |
2.7% |
27.6% |
Guangdong |
1,219 |
1 |
275 |
0.1% |
0.4% |
Henan |
1,169 |
10 |
258 |
0.9% |
3.7% |
Zhejiang |
1,131 |
0 |
321 |
0.0% |
0.0% |
Hunan |
946 |
2 |
304 |
0.2% |
0.7% |
Anhui |
910 |
5 |
128 |
0.5% |
3.8% |
|
|
|
|
|
|
Outside China |
523 |
1 |
80 |
0.2% |
1.2% |
Within Hubei, the numbers look terrible. As the World Health Organization has been saying from the beginning, the widely reported Case Fatality Rate is between 2% and 3%, and the very unofficial outcome mortality (deaths/(deaths + recoveries)) continues to be abysmal. But outside Hubei, the picture is completely different. Even within other Chinese provinces, the CFR is below 1%, and the outcome mortality is an order of magnitude lower. In short, the outcome for cases of COVID-19 in other areas of China doesn’t look much different from the outcome in the rest of the world. Within a couple of those provinces, the rate of recovery really is above the count of new cases. Their totals may still be going up, but the number of active cases they are treating is declining.
As on previous days, this suggests that the problem in Hubei is a shortage of resources to handle the huge burst of patients. Just as with the related coronavirus that causes MERS, many of those infected with the virus that causes COVID-19 appear to need some form of respiratory assistance at some point in their illness. Patients outside Hubei are getting that help. Many of those inside are not. Both MERS and SARS also played holy hell on medical staffs, and the same thing could easily be happening in Wuhan.
On Wednesday, there were multiple requests for oxygen bottles from Hubei. Hopefully those requests are being met. But things would look 100% better if China would simply accept the help of the WHO and CDC teams that have been standing by for the last month. They would bring oxygen bottles, trust me. More importantly, they’d bring people.
Meanwhile, U.S. cases in both Chicago and Seattle are now listed as recovered. That leaves the U.S. with 11 active cases, including one that was diagnosed on Tuesday when a patient who had been under close observation since returning from China fell ill. None of those cases is currently listed as serious.
The U.S. isn’t alone in seeing recoveries. Though the count still shows COVID-19 having reached 28 countries, at this point Cambodia, Finland, Nepal, Russia, Spain, and Sri Lanka have sent all their known patients home. So the country count is actually coming down.
Despite that huge jump in numbers, despite all the things I said about the inability to suss out the truth at this point, despite the political concerns I raised, you still shouldn’t, you know, do that thing I tell you not to do every day. Things inside Hubei province are worse than we knew on Wednesday. How much worse is still not clear. Things around the world continue to be remarkably okay.
That said, there is always something that comes along to spoil any upbeat moment. As I was I rolling this together, another 44 cases were announced from the woebegone Diamond Princess. At least authorities have now announced that they are taking passengers who are over 80 years old or who have some complicating factor off the ship to place them in quarantine in Japan. Anything has to be better than sitting in that bay, waiting for the virus to arrive. Those 44 cases will be added to the charts tomorrow, when I’ll try to restore the whole flock of images after seeing what the Hubei announcement has done to all my supposed trends.
Resources
World Health Organization 2019 Coronavirus information site.
World Health Organization 2019 Coronavirus Dashboard.
2019-nCoV Global Cases from Johns Hopkins.
BNO News 2019 Novel Coronavirus tracking site.
Worldometer / Wuhan Coronavirus Outbreak.
Some issues tackled on previous days
Why COVID-19 was not made in a bioweapon lab.
How Case Fatality Rate and other measures are calculated.
Looking at incidence in other Chinese provinces.
The death of whistleblowing Dr. Li Wenliang triggers calls for free speech.