Infection count spikes with new diagnostic criteria, and new men in charge in Hubei

Today, the Health Commission of Hubei Province made an unexpected announcement (in Chinese) that dramatically changed the reporting of numbers of COVID-19 cases from that province — but only that province, not elsewhere in China. The commission said that in order for patients to receive timely treatment, an additional category of testing called “clinical diagnosis” (临床诊断 línchuáng zhěnduàn) would be added to the number of confirmed cases.

What does this mean? First, the numbers (viewable in detail here):

• The global number of reported infections skyrocketed from around 45,000 to over 60,000 in a day.
• Reported deaths increased, but so did recoveries. Those numbers now stand at 1,370 and 6,292, respectively.

Why did the diagnostic criteria change? Caixin explains the problem with the old criteria:

Under previous criteria, a diagnosis of COVID-19 needed to be confirmed by lab tests, specifically a nucleic acid test performed on swabs from a patient’s respiratory tract or blood. Medical staff say the tests have sometimes failed to diagnose people with the disease, with patients who tested negative later found to be infected.

What are the pros and cons of the new criteria? The New York Times has a quick explanation:

Officials in Hubei now seem to be including infections diagnosed by using lung scans of symptomatic patients. This shortcut will help get more patients into needed care, provincial officials said. Adding them to the count could make it easier for the authorities to decide how to allocate resources and assess treatment options…

The few experts to learn of the new numbers on Wednesday night were startled. Lung scans are an imperfect means to diagnose patients. Even patients with ordinary seasonal flu may develop pneumonia visible on a lung scan.

New York Times reporter Sui-Lee Wee explains more in this Twitter thread.

The new reporting criteria make it extremely difficult to compare the longer-term trend of COVID-19 cases, especially because Hubei Province is now using different criteria compared with the rest of China. Simon Rabinovitch, a reporter for the Economist, notes that in Hubei Province’s reporting, “there is at least one data point that has not been redefined: people under medical observation.” That trend continues to show a plateauing, if not peaking, of the spread of the virus — or perhaps, more ominously, a maxing out of medical services.

Hubei officials get the boot

Another major development in Hubei accompanied the new reporting criteria, though this was not as surprising: The top local officials got sacked. The Wall Street Journal reports:

Chinese state media said a protégé of Chinese President Xi Jinping, Shanghai Mayor Yīng Yǒng 应勇 would be Hubei’s new Communist Party secretary, a position with the equivalent responsibilities of a U.S. [governor], replacing Jiǎng Zhāoliáng 蒋超良. China also fired Wuhan’s party secretary, Mǎ Guóqiáng 马国强, state media said. He was succeeded by Wáng Zhōnglín 王忠林, who had been the party secretary of Jinan, another provincial capital.

More COVID-19 updates:

The World Health Organization is just as out of the loop as everyone else — a spokesperson told Reuters that the organization was seeking “‘further clarity’ from China about recent updates to its case definition and reporting protocol for the coronavirus disease outbreak.” A separate Reuters report states that “four days after a World Health Organization (WHO) advance team arrived in Beijing no details have been released on how and when the full mission will deploy.” See also, in Science magazine: Mission impossible? WHO director fights to prevent a pandemic without offending China.

A “Japanese woman from Kanagawa Prefecture, just southwest of [Tokyo], who had not traveled overseas recently, was found to be infected with the virus after she died, health minister Katsunobu Kato said at a press conference,” Kyodo News reports. The only two other deaths outside mainland China have occurred in Hong Kong and the Philippines.

“We need to keep a clear mind of the uncertainties of the epidemic in Wuhan,” said Chén Yīxīn 陈一新, according to remarks reported by Xinhua (in Chinese), in what Xinhua journalist Zichen Wang said was an admission that “the authorities have yet to be confident in having a precise big picture of Wuhan’s situation.” Chen is a protégé of Xi Jinping and was put on the task force overseeing the central government’s response to the epidemic.

A Great Firewall exemption for students locked out of Australia: According to the Guardian, “China has agreed to relax its internet restrictions, after lobbying from the higher education sector, so international students can study online while they are banned from Australia during the coronavirus outbreak.” Australia has extended its travel ban beyond the initial 14-day period, and reportedly 100,000 students have been unable to return to continue their studies.

—Lucas Niewenhuis