China on Saturday reported nearly 60,000 deaths in people who had Covid-19 since early December, offering hard numbers for an unprecedented surge that was apparent in overcrowded hospitals and packed crematoriums, even as the government released little data about the status of the pandemic for weeks.
Those numbers may still underestimate the toll, though the government said the "emergency peak" of its latest surge appears to have passed.
The toll included 5,503 deaths due to respiratory failure caused by Covid-19 and 54,435 fatalities from other ailments combined with Covid-19 since December 8, the National Health Commission announced. It said those "deaths related to Covid" occurred in hospitals, which means anyone who died at home would not be included in the numbers.
The report would more than double China's official Covid-19 death toll to 10,775 since the disease was first detected in the central city of Wuhan in late 2019. China has counted only deaths from pneumonia or respiratory failure in its official Covid-19 death toll, a narrow definition that excludes many deaths that would be attributed to Covid-19 in much of the world.
China stopped reporting data on Covid-19 deaths and infections after abruptly lifting anti-virus controls in early December despite a surge in infections that began in October and has filled hospitals with feverish, wheezing patients.
Hospitals in Beijing and across the country have been overwhelmed with patients, and funeral homes and crematoriums have struggled to handle the dead.
The World Health Organization and other governments appealed for information after reports by city and provincial governments suggested as many as hundreds of millions of people in China might have contracted the virus.
Infection numbers now appear to be falling based on a decline in the number of patients visiting fever clinics, said a National Health Commission official, Jiao Yahui.
The daily number of people going to those clinics peaked at 2.9 million on December 23 and had fallen by 83 per cent to 477,000 on Thursday, according to Jiao.
"These data show the national emergency peak has passed," Jiao said at a news conference.
Whether China truly has passed a Covid-19 peak is hard to assess, said Dr. Dale Bratzler, chief Covid officer at the University of Oklahoma and head of quality control at the university's hospital.
"That's difficult to know," Bratzler said. "China quarantined people indoors, there are many people unvaccinated, and the people are vulnerable."
Dr. Albert Ko, an infectious disease physician, and professor of public health at the Yale School of Public Health said the number of Covid-19 deaths China is reporting may be a "significant underestimation" because of how they define them.
"They're using a very narrow case definition for (Covid) deaths," Ko said. "They have to have a respiratory failure ... to be counted as a case you have to be at a place where they can say you fulfilled all the requirements, and that's at a hospital."
Hospitals in China, Ko said, are located mostly in large cities where Covid outbreaks have been reported, not in isolated rural areas.
"This is the Lunar New Year, people are travelling, going to the countryside where the population is vulnerable," Ko said. "We're really worried about what's going to happen in China as this outbreak moves to the countryside."
For nearly three years, China had kept its infection rate and deaths far lower than those of the United States and some other countries at the height of the pandemic with a "zero-Covid" strategy that aimed to isolate every case. That shut down access to some cities, kept millions of people at home, and sparked angry protests.
Those rules were suddenly eased in early December after some of the largest shows of public dissent against the ruling Communist Party in more than 30 years. That set off new problems in a country that relies on domestically developed vaccines that are less reliable than others used globally, and where older people — those more susceptible to dying from the virus — are less likely to be vaccinated than the general population.
The Health Commission said the average age of people who died since December 8 is 80.3 years, and 90.1 per cent are aged 65 and above. It said more than 90 per cent of people who died had cancer, heart or lung diseases, or kidney problems.
"The number of elderly patients dying from illness is relatively large, which suggests that we should pay more attention to elderly patients and try our best to save their lives," said Jiao.
The United States, South Korea, Japan, and several other countries have imposed virus testing and other controls on people arriving from China. Beijing retaliated on Wednesday by suspending the issuance of new visas to travellers from South Korea and Japan.
This month, WHO Director-General Tedros Adhanom Ghebreyesus said agency officials met with Chinese officials to underline the importance of sharing more details about Covid-19 issues, including hospitalisation rates and genetic sequences.