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China, Russia, Brazil and the underreporting of Covid-19 cases

At the end of April, national security officials in London and Washington said they believed China was underreporting the true levels of deaths from Covid-19. It followed after officials in Wuhan raised the death toll from Covid-19 by 50 per cent overnight on 17 April. They said the sharp increase reflected updated reporting and deaths outside hospitals, insisting there had been no cover-up.

China is not the only one accused of hiding the true figures. Suspicions are growing that Russia is undercounting its coronavirus death toll and on 11 May, Novaya Gazeta, a Russian newspaper, reported that the real death rate from Covid-19 in Moscow could be almost three times higher than the official figures.

According to data from John Hopkins University, as of 12 May, Russia had 232,243 confirmed cases yet only 2,116 deaths. In contrast, Spain, with a similar level of cases has reported more than 12 times as many deaths. Moscow Mayor Sergei Sobyanin said Russia’s low number is due to mass testing which leads to a high number of confirmed infections.

“No one is hiding anything,” Mayor Sobyanin said, dismissing claims of a cover-up as “absolute nonsense”.

It is uncertain whether some governments are deliberately trying to hide the true figures or if the accurate figure is actually unknown due to limited centralised access to data. Discrepancies can also depend on variations in testing or classification.

While the World Health Organisation has published complicated guidelines for classifying coronavirus deaths, experts complained that they arrived late in the pandemic – on 16 April – when many countries had already made their own decisions on categorisation. Plus, experts said, some countries had by then already counted the bulk of their deaths.

Countries have adopted radically different measures for classifying deaths. Belgium adopted the arguably most liberal method for classifying coronavirus deaths and records coronavirus deaths in nursing homes even if the virus was only suspected in the deceased, not confirmed. Unsurprisingly, its coronavirus mortality rate is the highest in the world.

In the UK, for example, numbers of Covid-19 deaths were underreported initially as people who died at home or in nursing homes were not included in the count. The British government only included people who tested positive for the coronavirus and subsequently died in hospital.

Meanwhile, Italy and the United States, along with many European countries, automatically classify deaths as caused by the coronavirus if the deceased tested positive. Russia, on the other hand, does not automatically list Covid-19 as the cause of death if the deceased tested positive for the coronavirus and has become increasingly transparent about this practice in recent days.

“We can’t put everything down to the coronavirus otherwise we won’t act correctly,” the Health Ministry’s head pathologist Georgiy Frank told the Ekho Moskvy radio station Monday. “The numbers have to be objective. Covid is often the cause, but not always.”

The country is planning to make the two sets of figures – the number of deaths from Covid-19 and the number of deaths of people who had tested positive for Coronavirus but died from other causes – available nationwide by publishing a database that will contain both sets of statistics for all regions within several weeks.

Andrei Chernyayev, a pulmonologist who helped write the Moscow Health Department’s rules for classifying coronavirus deaths, told the Moscow Times: “I believe Russia is counting accurately while others like Italy, Belgium and the United States are over counting.”

Some critics, however, worry that Russia’s classification methodology gives officials the ability to pressure pathologists into undercounting coronavirus death totals or massage figures themselves.

“I myself see that I have diagnosed more patients who died from the coronavirus in these past two weeks than I saw in official statistics,” a pathologist in St. Petersburg who asked to remain anonymous told Moscow Times.

In Brazil, a lack of testing means that nobody knows the real scale of Covid-19’s spread and in early May, the country saw its largest ever daily increase in its coronavirus death toll despite erroneous suggestions from President Jair Bolsonaro that the worst of the crisis was over.

“What’s happening is enormous underreporting,” said Isabella Rêllo, a doctor working in emergency and intensive care in Rio de Janeiro hospitals, in a widely shared Facebook post challenging official numbers. “There are MANY more,” she wrote.

As of 12 May, Brazil had reported 169,594 confirmed cases and 11,653 deaths and is now considered a major global centre of the pandemic.

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