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Has China really defeated coronavirus?

The US has now overtaken China in the number of confirmed coronavirus cases. As of Thursday [26 March], America had 85,996 cases, versus 81,894 in China.

There were 17,224 new cases in the US on that day compared to just 56 in China. Meanwhile, China has started easing its own economic lockdown of cities, even Wuhan, where the pandemic originated.

On the face of it, China has conquered the virus, while the US is on a trajectory to be the worst affected country in the world. But is this impression accurate?

There are grounds for caution. First, it's important to remember that these headline statistics that we see are "confirmed" cases, not total cases - an important distinction, says Max Roser of scientific publication Our World in Data. The number of confirmed cases is likely to depend considerably on the level of testing being done in any individual country. Epidemiologists admit that the true number of UK infections is almost certainly many times the number that have been confirmed.

The government's chief scientific adviser Sir Patrick Vallance told MPs on 17 March that as many as 55,000 people in the UK could have the virus. At that stage the UK had fewer than 2,000 confirmed cases from testing.

Germany is now testing 500,000 people a week. By contrast the UK has tested only around 100,000 in total. That may help explain why the Germany fatality rate - the number who die per recorded infection - seems so much lower than some other European countries.

Italy has 80,589 confirmed cases and 8,215 deaths. Germany has 47,373 confirmed cases and 285 deaths.

That gives an Italian death rate of 10 per cent and a German death rate of less than 1 per cent.

It may not be because the virus is somehow less lethal in Germany or because their health service is better at keeping people alive, but simply because Germany is discovering more cases of infection.

There is also a clear correlation between a country's GDP per capita and its number of tests per head of population. That makes comparisons about the prevalence of the virus in different national populations potentially misleading.

It's possible that the disease is more widespread in poorer countries than official reported cases show because they are testing less. Some may be reporting differently too, which brings us to China.

China's National Health Commission says that "asymptomatic" cases of coronavirus infection - where people test positive but do not show clinical symptoms of illness - should not be counted towards its confirmed national total of cases. That's out of line with the practice of the World Health Organisation and also some other countries like South Korea.

Hong Kong's South China Morning Post reports it has seen classified Chinese government documents stating that 43,000 people in China had tested positive for the virus at the end of February but because they were asymptomatic were not counted.

And that could be significant. On Monday the respected Caixin newspaper reported an epidemiologist in Wuhan stating that "every day we can still detect a few, or a few tens, of asymptomatic carriers".

That matters because some epidemiologists think the asymptomatic can still pass on the disease. As the disease expert told Caixin: "We cannot conclude yet that Wuhan's transmission has completely ended."

Some epidemiologists fear that, when the social lockdown is lifted, Wuhan - and China - could be at risk of a second outbreak.

China's success in suppressing the disease is not a fiction. Experts think that number of deaths from the disease being reported by China is a reliable figure, even if the total number of cases may not be.

And that has fallen dramatically, from a peak of 150 on 23 February to just 5 on 26 March. By contrast, on 26 March the US reported 268 deaths.

Yet looking beneath the bonnet of the headline data suggests that declarations of victory against this new virus - not just relating to China but any country - would, at this stage, be dangerously premature.


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