Why China’s ‘zero new coronavirus infections’ could be cause for optimism – or caution

Simone McCarthy

China reached an apparent milestone this week in the fight against the Covid-19 pandemic, announcing zero new non-imported infections on Thursday and Friday, but experts said the figures needed to be treated with caution.

After reporting thousands of daily new infections for much of February, China had a sharp decline this month while the wider world experienced the opposite trend as the coronavirus spread.

As China closes makeshift coronavirus hospitals in the outbreak’s initial epicentre of Wuhan because of a lack of patients, and eases some quarantine restrictions in the city and the broader Hubei province, there is consensus that its unprecedented measures changed the direction of the epidemic, offering hope for other countries.

But there are concerns over whether China’s rock-bottom case numbers reflect the full picture in the country. The high incidence of mild cases of Covid-19 is one reason, health experts said, warning that there could be infected people who were not counted but still able to spread the disease.

“It is important that China is doing a good job testing and screening throughout the country to ensure that there are no pockets of infection remaining,” virologist Jeremy Rossman, of Britain’s University of Kent, said, adding that the news was “exciting” but needed to be “treated with caution”.

“With many of these cases having mild to no symptoms, ensuring that the whole country remains prepared and is actively looking for new cases is essential,” he said. “While it is possible there are no new cases, it is also very possible that somewhere in the country there are mildly infected people.”

Missing mild cases, and those infected but showing no symptoms, are a “legitimate concern”, according to Xi Chen, an assistant professor at the Yale School of Public Health.

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“Eighty per cent of cases have mild symptoms, so zero cases is a milestone, but not the end of the epidemic in China,” he said. Patients with mild symptoms or who are asymptomatic can still spread the disease to others, he added, and this needed to be monitored carefully in the coming weeks.

China has come under scrutiny for how it treats asymptomatic cases. The National Health Commission excludes patients who test positive yet show no symptoms from its number of confirmed cases, although it monitors those cases when it knows of them.

The extent to which asymptomatic carriers contribute to spreading the disease is yet to be understood by scientists.

In addition, Hubei province in mid-February changed how it classified its confirmed cases, which caused a surge in infection numbers. This decision, which allowed doctors to diagnose a person by a clinical examination, not only by a positive laboratory test, was later reversed, leaving confusion about the true extent of the disease.

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Other commentators said it could not be ignored that political considerations may play a part as China looks to highlight its communist governance model and portray itself as a global leader in combating the disease.

“We are in the midst of the most intensive propaganda operation of the [Communist] Party state in living memory, in trying to project its success in dealing with the virus,” Steve Tsang, director of the University of London’s SOAS China Institute, said. “That narrative requires statistical backup.

“I’m not saying [the zero number] is necessarily wrong; I’m simply saying we don’t know. What we do know is that there is now a political imperative for the statistics to be [low], and now we have statistics that serve the political imperative.”

Data can be trusted when it comes with transparency about how it was collected, so that it can be independently evaluated, Tsang said.

Nis Gruenberg, an analyst with Berlin-based independent think tank the Mercator Institute for China Studies, said that the numbers could be viewed as an “indicator” of a reduction of cases in China.

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“Some [Western critics] have been saying China and its system are ill-equipped to handle this outbreak, and now the Chinese government is trying to invert that argument and say, ‘Look at you, you are not doing it well enough,’” Gruenberg said.

The message from the Chinese government that it has succeeded in containing the virus may “politicise” the figures and is a potential driver for under-reporting around the country, according to Gruenberg.

“If history is any guide in China then there is a massive history of under-reporting for various reasons, both within the system and internationally,” he said. “I’m sceptical that this is the true number, or that anyone really knows the true number.”

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