The Journal Gazette
 
 
Friday, February 14, 2020 1:00 am

How virus cases counted changes, raising death toll

Associated Press

BEIJING – China reported a surge in deaths and infections from a new virus Thursday after changing the way the count is tallied, further clouding an epidemic that has stirred fear as it spread to more than two dozen countries.

The spike came after two days in which the number of new cases dropped and brought little clarity for those desperate to understand the trajectory of the outbreak.

“What we need is some consistency over time to give us an idea of what's actually happening,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University in the United States. “Is transmission happening or is it not?”

The answer has proved frustratingly elusive despite the official reports.

The death toll in China from the disease known as COVID-19 reached 1,367, up 254 from a day earlier, and the number of confirmed cases jumped to 59,804, up 15,152.

Dr. Michael Ryan, the World Health Organization's emergencies chief, said the dramatic increase was due to a revised way of counting cases and cautioned it did not represent a sudden surge in new infections.

“This increase you've all seen in the last 24 hours is largely down to how cases are being diagnosed and reported,” he said, noting that the jump in infections refers to patients that go back days and weeks, including to the beginning of the outbreak.

China's National Health Commission said officials in Hubei province, whose stricken capital of Wuhan is the virus' epicenter, began tallying cases using a lower bar of “clinical diagnosis.” That appears to count cases based on doctors' analyses and lung imaging rather than relying solely on laboratory test results. More than 13,000 of the newly reported infections were a result of the new way of counting.

A spokesman for China's health commission, Mi Feng, said the change was aimed at identifying suspected cases in which the patient has pneumonia so they can be treated quicker and reduce the likelihood of more serious illness or death. It was also seen as a reflection of a chaotic crush of people seeking treatment and the struggle to keep up with a backlog of untested samples.

“Clearly in Wuhan, the health system is under extreme pressure, and so the first priority has to be the patient,” said Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh.

The public has widely criticized local officials for failing to respond quickly and decisively to the new virus. Authorities initially assured people that there was little to no risk of human-to-human transmission, a statement that was later retracted. Wuhan residents said hospitals were overcrowded and lacked sufficient medical supplies. Doctors who tried to share information early on were reprimanded by police for “spreading rumors.”

“This is a society struggling with openness,” said Schaffner. “For people like that who continue to be in positions of authority, to change their thinking must be difficult. So you have to be a bit skeptical when you see these changes in case definition.”

Paul Hunter, a professor of health protection at the University of East Anglia in England, expressed similar frustration with the revised numbers, but said he believed it didn't represent a change in trajectory for the outbreak.

“I suspect but can't be certain that the underlying trend is still downwards,” he said. “It almost certainly does not mean that there has been a resurgence of the epidemic overnight.”

Still, in an unprecedented attempt to contain the disease, the Chinese government has placed the hardest-hit cities – home to more than 60 million – under lockdown.

Also

Cruise ship lands in Cambodia

SIHANOUKVILLE, Cambodia – Hundreds of cruise ship passengers long stranded at sea by virus fears cheered as they finally disembarked Friday and were welcomed to Cambodia by the nation's authoritarian leader, who handed them flowers.

Prime Minister Hun Sen agreed to let the Westerdam dock at the port of Sihanoukville on Thursday after Thailand, Japan, Taiwan and the Philippines had barred the ship earlier. The passengers cheered as they walked toward waiting buses and waved goodbye to other passengers watching from the ship's deck.

The Westerdam was unwelcome elsewhere even though operator Holland America Line said no cases of the COVID-19 viral illness have been confirmed among its 1,455 passengers and 802 crew members.

Local officials told reporters 414 passengers will leave the port Friday and fly to Cambodia's capital before traveling to their final destinations.

The COVID-19 illness has sickened tens of thousands of people in China and a few hundred elsewhere, including 218 on the Diamond Princess cruise ship, which made stops in Hong Kong and other ports before arriving in Japan last week. Its 3,500 passengers and crew are in the midst of a two-week quarantine.


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