Cremation based estimates suggest significant under- and delayed reporting of COVID-19 epidemic data in Wuhan and China

  1. Mai He
  2. Li Li
  3. Louis P. Dehner
  4. Lucia F. Dunn

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Abstract

Background

China’s COVID-19 statistics fall outside of recognized and accepted medical norms. Here we estimated the incidence, death and starting time of the COVID-19 outbreak in Wuhan and China based on cremation related information.

Methods

Data sources included literature on COVID-19 in China, official Chinese government figures, state-run and non state-run media reports. Our estimates are based on investigative media reports of crematory operations in Wuhan, which is considered as a common data end point to life. A range of estimates is presented by an exponential growth rate model from lockdown (Jan 23,2020) until the intervention started to show effects, which was estimated 14.5 days after lockdown.

Results

For the cumulative infections and total deaths, under different assumptions of case fatality rates (from 2.5% to 10%) and doubling time 6.4 days, the estimates projected on February 7, 2020 in Wuhan range from 305,000 to 1,272,000 for infections and from 6,811 to 7,223 for deaths - on the order of at least 10 times the official figures (13,603 and 545). The implied starting time of the outbreak is October 2019. The estimates of cumulative deaths, based on both funeral urns distribution and continuous full capacity operation of cremation services up to March 23, 2020, give results around 36,000, more than 10 times of the official death toll of 2,524.

Conclusions

Our study indicates a significant under-reporting in Chinese official data on the COVID-19 epidemic in Wuhan in early February, the critical time for response to the COVID-19 pandemic.

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  1. ScreenIT

    SciScore for 10.1101/2020.05.28.20116012: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    While people claimed that the lockdown in Wuhan combined with the national emergency response have averted 96% of the cases by February 19, 2020,27 it should be considered that in the initial period after Wuhan lock down, the effectiveness of countermeasures taken there could be impacted by many factors, including the lack of public awareness, the cross infection at hospitals, the limitation of the medical capacity, the inadequacy of the quarantine facility and space, and the family cluster chain-infections.. However, this is beyond the scope of this manuscript. A potential weakness of this study is that there is no cremation information in medical literature. All cremation related information came from media reports. To reduce bias, we used media reports from both within China and outside China.6–12 Cumulative infections and deaths from cremation-based analysis: Based on data from the seven of eight Wuhan crematories, our conservative estimates of cumulative infections on February 7 are more than 10 times than those of the official data. Chinese media raised concerns about infections and deaths beyond the official statistics; for example, when the director of a fever clinic complained that he could admit only five out of 80 potentially infected patients, which suggested a potential 16-fold difference between possible infected patients and confirmed diagnoses in Wuhan. 4 The report mentioned the limited nucleic acid-based testing, which was available only after the sequencing...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.28.20116012v2 on medRxiv
  3. Version published to 10.1101/2020.05.28.20116012v1 on medRxiv