Over nine days, Chinese authorities had announced a consistent decline in the confirmed number of new cases of COVID-2019 (the disease caused by the novel coronavirus) outside of Hubei province. On Wednesday, however, the province itself, which has been the epicentre of the outbreak, recorded a sharp spike in the number of newly confirmed cases and deaths. What explains this?
How much is the spike
Hubei’s tally was updated with 14,840 new cases to on Wednesday. These brought the total number to 48,206 — the largest 24-hour increase recorded since the outbreak began. The number of new cases marked a nine-fold jump from the new cases declared the previous day.
The death toll, meanwhile, increased to 1,310 which included 242 new deaths.
The spike appears to have been caused due to an adjustment in diagnostic criteria, which experts in China say includes “clinically diagnosed” cases in daily tallies. Zeng Guang, chief epidemiologist at the Chinese Center for Disease Control and Prevention, told state media that the numbers include patients who have similar symptoms to those exhibited by confirmed COVID-2019 cases.
State news agency Xinhua reported that “clinically diagnosed cases are unique to Hubei statistically”. This implies inclusion of those cases drive the surge in numbers.
According to the latest version of the diagnosis and treatment scheme released by China’s National Commission of Health: “Any suspected cases with pneumonia-related computerised tomography (CT) scan results are counted as clinically diagnosed cases.”
The Hubei Province Health Commission said the new classification system has been made so “patients can receive standardised treatment according to confirmed cases as early as possible to further improve the success rate of treatment”.
What the spike may mean
With Hubei’s health infrastructure overwhelmed with rising cases over the last month, this could be an indication that large numbers of sick people may not have been accounted for in the official figures. There is also speculation on the ground that the change in diagnostic criteria may indicate under-reporting of the number of cases previously.
A January 24 study in The Lancet (‘Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China’) noted that all 41 patients admitted by January 2 “had pneumonia with abnormal findings on chest CT”. While 29% exhibited acute respiratory distress syndrome, 15% showed RNAemia, 12% acute cardiac injury and 10% secondary infection.
“The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies,” the study’s interpretation read.
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What the experts say
Wang Guangfa, a respiratory expert at Peking University’s First Hospital, was reported by state media as saying the increase in the number of confirmed cases and deaths in Hubei could also be caused by problems in the technical aspects of clinical diagnosis as some doctors may not have fully understood the clinical diagnosis criteria and only relied on CT scans. “Meanwhile, the experience and skill level of the doctors could also have affected the interpretation of CT scans, as only experienced doctors can make a general prediction about the etiology of pneumonia through a CT scan combined with clinical manifestations,” he was quoted in Global Times as saying. “All this may have resulted in doctors treating pneumonia caused by other pathogens as newly clinically diagnosed cases of novel coronavirus pneumonia.”
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At a press conference on Thursday in Beijing, Mi Feng, spokesperson for the CNHC said some patients had reported experiencing diarrhoea or gastrointestinal disorders. Their stool samples tested positive for the new coronavirus, which suggests that the virus can multiply in the digestive tract of the patient, he was reported to have said. However, he also stressed that the most common clinical symptoms are fever, fatigue and cough.
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