The reason behind China's spike in reported coronavirus cases

The new coronavirus cases appeared to surge almost 10-fold in a day when Hubei, the province of the outbreak, revised its diagnosis strategy. Global health officials say this new approach will accelerate the identification and treatment of patients. 

Ng Han Guan/AP
A traveler stands on a bridge near a display showing government propaganda in Beijing on Feb. 13, 2020. A new method of counting led to a 10-fold increase in reported cases of coronavirus in Hubei, the Chinese province of Wuhan's capital.

China on Thursday reported a sharp spike in deaths and infections from a new virus, but the rise comes from a new classification system in the hardest-hit province. The change broadens the scope of diagnoses to identify and treat signs of the virus sooner in efforts to contain its spread.

The new approach came on the same day that the province of Hubei and its capital, Wuhan, replaced their top officials in an apparent response to public criticism of how authorities have handled the epidemic.

The World Health Organization is seeking more clarity from China on the updates to its case definition and reporting protocol.

"It is our current understanding that the new case definition widens the net, and includes not only lab-confirmed cases but also clinically diagnosed cases based on symptoms and exposure," said WHO spokesman Tarik Jasarevic in an email to The Associated Press.

"The jump in cases today reflects the broader definition," he said.

In breaking down the large number of new cases in China, National Health Commission spokesman Mi Feng said Hubei had adopted a revised diagnosis and treatment plan aimed at accelerating the identification and treatment of patients.

In its statement, the Hubei health commission explained that it had changed its tally of cases to include “clinically diagnosed cases,” in addition to those confirmed by a test. The statement did not elaborate on what clinical diagnosis entails, but the Hubei government had last week said it would start recognizing CT scan results as a way to speed up the confirmation of suspected cases, reported by Quartz. 

The move to include cases confirmed by CT scan results means that case definition has broadened from only laboratory-confirmed to also include probable cases, said Benjamin Cowling, division head of epidemiology and biostatistics at the University of Hong Kong, reported Quartz.

One expert said the changed case definition in Hubei likely speaks to the crush of patients the health system is experiencing and the 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.

He said it wasn't unprecedented for case definitions to rely on doctors' diagnoses rather than wait for laboratory confirmation, and that these kinds of changes usually happen when there are simply too many patients to process in a fast-moving outbreak.

"I'm not surprised that this has happened given the way the outbreak has been going in China," Mr. Woolhouse said. "You have to be pragmatic and take the concerns of the patient first and treat them as if they already have the disease, even in the absence of lab confirmation."

China also appointed new high-level officials in Hubei and Wuhan.

Hours after the announcement of the spike in new cases, the Chinese government announced a political shakeup in Hubei, reported TIME.  On Thursday, the Communist Party secretary of Hubei, Jiang Chaoliang, was removed from his post, according to state media. The mayor of Shanghai, Ying Yong, will replace him. 

“Sacrificing a provincial party secretary is a big deal, and not a step Xi would have taken lightly,” says Steve Tsang, director of the University of London’s SOAS China Institute. “So, it reflects both a sense of pressure as well as a determination to articulate strength and control.”

Mr. Jiang is the highest-ranking party official removed from office thus far over the outbreak, according to the TIME report.

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."

An advance team of WHO experts has been in China since Monday. The team is here to "discuss specific arrangements for the China-WHO joint mission with the Chinese side," Chinese foreign ministry spokesman Geng Shuang said at a daily online briefing. 

"The purpose of the joint mission is that experts of both sides can have in-depth communication on the situation and efforts of prevention and control, and come up with advice for China and other affected countries," Mr. Geng said.

The death toll in China reached 1,367, up 254 from the previous day. The number of confirmed cases jumped 15,152 to 59,804. The unusually large increases of cases were due to the change in Hubei's approach to include "clinical diagnosis" cases.

In an unprecedented measure to contain the disease, recently named COVID-19, the Chinese government has placed the hardest-hit cities – home to more than 60 million – under lockdown. One district in Shiyan, a city in Hubei, has implemented "wartime measures," barring residents from leaving even their apartment compounds for two weeks.

According to a local government notice, neighborhood committees will distribute basic necessities at a fixed time and at fixed prices, as well as help residents purchase any medicine they might urgently need.

Many countries have implemented travel restrictions on recent visitors to China, which has more than 99% of the world's reported infections.

This story was reported by The Associated Press. AP writers Mari Yamaguchi in Tokyo; Sopheng Cheang in Sihanoukville, Cambodia; Grant Peck in Bangkok; Maria Cheng in London, and researchers Liu Zheng and Yu Bing in Beijing contributed to this report. Material from Time and Quartz was used in this report. 

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