More than 232,000 people might have been infected in the first wave of Covid-19 in mainland China, four times the official figures, according to a study by Hong Kong researchers.

© Provided by The Guardian
Photograph: Sam McNeil/AP

Mainland China reported more than 55,000 cases as of 20 February but, according to research by academics at Hong Kong University’s school of public health published in the Lancet, the true number would have been far greater if the definition of a Covid-19 case that was later used had been applied from the outset.

China has now reported more than 83,000 cases. Globally, the death toll from the coronavirus has exceeded 183,000, with the number of cases worldwide standing at more than 2.6 million.

China’s national health commission issued seven versions of a case definition for Covid-19 between 15 January and 3 March, and the study found these changes had a “substantial effect” on how many infections which were detected as cases.

It comes as China’s ambassador to the US called for “a serious rethink of the foundations” of the two countries’ relationship, while also criticizing US politicians for ignoring scientists and making “groundless” accusations.

The Hong Kong study analyzed data up to 20 February culled from the World Health Organization’s mission to Wuhan.

It estimated that each of the first four changes increased the proportion of cases detected and counted, by between 2.8 and 7.1 times.

“If the fifth version of the case definition had been applied throughout the outbreak with sufficient testing capacity, we estimated that by 20 February 2020, there would have been 232,000 … confirmed cases in China as opposed to the 55,508 confirmed cases reported,” the study said.

As scientific knowledge and laboratory capability evolved, the definition of a confirmed case has broadened to include cases with milder symptoms, or without epidemiological links to Wuhan or other known cases.

The report said these changes should be taken into account when looking at the rate of the epidemic’s growth and doubling times.

China has faced continual skepticism over its reporting of cases. Last week it revealed the death toll in Wuhan, where the virus is believed to have originated, was in fact 50% higher than first reported.

Officers check the body temperature of a person on the street in Bali, Indonesia on April 23.

Employees from the public health department in Mitte stand on the central fairground in the outpatient corona test facility on April 23 in Berlin Germany.

Crew on the the Ruby Princess wave with a cartoon-sized hand and head as the ship departs from Port Kembla in Wollongong, Australia, on April 23. The ocean liner — notorious as Australia’s largest single source of coronavirus infections and at the center of a criminal investigation over the sickness’ spread — set off a month after it was ordered by police to leave.

Turkey celebrates the National Sovereignty and Children’s Day, as well as the 100th anniversary of the foundation of the parliament, on April 23 in Ankara, Turkey.

Paramedics respond to a house call at the Vladivostok medical emergency service during the ongoing coronavirus pandemic on April 23 in Vladivostok, Russia.

A village resident, left, is helped by Georgia Riches, landlady of the Bull Inn public house in Bethersden, England. The pub has opened a not-for-profit community shop in its car park, as England continues to employ a lockdown to help curb the spread of the coronavirus.

A woman wears a face mask and plastic gloves as she shops in Jakarta, Indonesia on April 23.

A health worker collects a sample for coronavirus testing on April 23, in Kuala Lumpur, Malaysia.

Visitors stand with their cars in the drive-in cinema in Chemnitz, Germany, on April 22. Up to 230 vehicles can park on the square in front of the 200 square meter screen or the 50 square meters LED wall. Until 25 June, there will be a children’s and family film every day at 5 pm and the evening program at 8 pm. On Fridays and Saturdays, there will be a midnight film from 23:00. 

A municipal worker is sanitized after he cremated the body of a man, who died due to coronavirus disease (COVID-19), at a crematorium in Ahmedabad, India, on April 22.

Local residents, watch celebrations ahead of the National Sovereignty and Children’s Day, in Istanbul, Turkey, on April 22. Turkey will mark its 100th anniversary of the foundation of its parliament on April 23.

Medical personnel jump in the COVID-19 unit at the CHR Centre Hospitalier Regional de la Citadelle Hospital, in Liege, Belgium, on April 22.

The karate coach of Khaled Sheikh el Eid, and his sons and daughters, train together on the roof of their family house, at Rafah refugee camp, southern Gaza Strip, on April 22.

Groupama-FDJ’s Kilian Frankiny of Switzerland warming up for the Digital Swiss 5 virtual cycling pro race that replaces the Tour de Suisse, which was canceled due to the coronavirus disease (COVID-19) outbreak, in Naters, Switzerland, on April 22.

Fox cubs venture out from their den under a popular boardwalk alongside Lake Ontario in Toronto, Canada, on April 22.

Teacher Sergio Ferraro gives a lesson to his students at Escuela 30, a rural school that has resumed classes after a month off, in San Jose, Uruguay, on April 22.

A cashier jokes with French President Emmanuel Macron as he visits a Super U supermarket about the partnership with local producers in Saint-Pol-de-Leon during a day trip centered on agriculture amid the coronavirus disease (COVID-19) outbreak in Brittany, France on April 22.

Residents buy food items at a store ahead of Ramadan during a government-imposed nationwide lockdown as a preventive measure against the (COVID-19) corona virus on April 22.

Passengers wearing protective masks disembark the cruise ship Costa Deliziosa, which had been on a 15-week round-the-world trip when the coronavirus disease (COVID-19) hit the world, in port of Genoa, Italy on April 22.

Medical staff evacuate an elderly woman from a nursing home after multiple residents of the facility tested positive for the new coronavirus, in Buenos Aires, Argentina, on April 22.

Members of the audience sit at socially-distant intervals due to the coronavirus disease (COVID-19) outbreak as U.S. President Donald Trump and first lady Melania Trump hold a tree-planting ceremony outside the Oval Office on the 50th anniversary of Earth Day in Washington, on April 22.

Brazilian national volleyball team player Isac Viana Santos controls a ball next to his golden retriever as he exercises at his home, amid the coronavirus disease (COVID-19) outbreak, in Belo Horizonte, Brazil on April 22.

A man pushes a cart while passing a closed market amid the spread of the coronavirus disease (COVID-19), in Mexico City, Mexico on April 22.

A security forces officer tells a man to wear a face mask as the spread of the coronavirus disease (COVID-19) continues, in Abidjan, Ivory Coast on April 22.

Brunie Vega, left, and coworkers review applications for election ballots at the Cuyahoga County Board of Elections, on April 22, in Cleveland. Voter participation in Ohio’s coronavirus-delayed primary election is on a slow pace with less than week to go. Numbers released Tuesday by the state’s election chief, Republican Frank LaRose, show that 1.67 million people, fewer than a fourth of registered voters, had requested an absentee ballot by the end of last week. There will be in-person voting on April 28 that is restricted to disabled voters and homeless people.

Thai children line up for free food distribution in Bangkok, Thailand on April 22.

A man prepares allotments of free food donated by the Kabul Chamber of Industries and Mines for distribution to needy people, in Kabul, Afghanistan on April 22.

Members of the Environmental Health Citizens’ Association of Korea wearing masks representing the virus perform during an event to celebrate the 50th anniversary of Earth Day, at Gwanghwamun Square, in Seoul, South Korea on April 22.

Indian workers unload saline bottles from a truck at the Directorate of Medical and Health office, in Hyderabad, India on April 22.

People walk through China Town, in Yokohama, near Tokyo on April 22.

A soldier of the German army Bundeswehr wearing a gas mask and protective suit handles canisters with chemicals at a mobile disinfectant production line on the premises of the Bundeswehr university, in Neubiberg near Munich, Germany on April 22.

Joint officers conduct a raid on the streets for residents not wearing face masks while entering the town of Lhokseumawe, Indonesia on April 22.

Victor Vazquez works on a balloon depicting the coronavirus at a store in Cuautlancingo, Mexico on April 21.

A Palestinian man hangs decorations for the upcoming holy month of Ramadan, in Jerusalem, Israel on April 21.

A pedestrian wears a protective mask while walking past a post showing portraits of medical workers who have been fighting COVID-19 in Wuhan, on April 21 in Shanghai, China.

Alexis, and his sister Catalina train Karate while quarantining at home, in Santiago, Chile, on April 21.

Migrants line up to receive sanitisers outside a hotel used as a refugee shelter, after authorities found several cases of the novel coronavirus and put the area under quarantine, following the outbreak of the coronavirus disease (COVID-19), in Kranidi, Greece on April 21.

Members of the contemporary circus company Cirk La Putyka perform in front of sculpture of Franz Kafka’s head to entertain local residents in Prague, Czech Republic, on April 21. 

Brothers of Italy party members attend a session of the lower house of parliament on the coronavirus disease (COVID-19), in Rome, Italy on April 21.

NHS superhero street art by Lionel Stanhope, is pictured in South London on April 21.

Vehicles queue in a long traffic jam at Delhi-Ghaziabad border after local authorities stopped vehicular movement except for essential services during an extended lockdown to slow the spreading of the coronavirus disease (COVID-19) in New Delhi, India, on April 21.

People queue in their cars at a coronavirus test centre in Mane Garrincha Stadium parking lot, amid the coronavirus disease (COVID-19) outbreak, in Brasilia, Brazil, on April 21.

French firefighters Romain and Karrinne Mussault perform for the residents of “La Residence des Anciens Combattants” retirement home (Ehpad – Housing Establishment for Dependant Elderly People) as a lockdown is imposed to slow the rate of the coronavirus disease (COVID-19) in Nice, France on April 21.

Workers wearing protective suits clean the windows outside the coronavirus disease ward at Kuala Lumpur Hospital, in Malaysia on April 21. 

Gene Campbell, 89, who contracted coronavirus disease at Life Care Center of Kirkland in early March, leaves Swedish Medical Center Edmonds with sons Todd Campbell (Center) and Charlie Campbell after spending six weeks in the hospital in Edmonds, Wash. on April 20. 

King Willem Alexander and Queen Maxima (pictured) work from home in The Hague, Netherlands on April 20. 

Healthcare workers at the Brooklyn Hospital Center react as residents and members of the New York City Fire Department (FDNY) cheer in New York City, New York on April 20.

A woman wearing a mask to prevent the spread of coronavirus walks past an electronic stock board showing Japan’s Nikkei 225 and New York Dow index at a securities firm in Tokyo, Japan on April 21.

Volunteers of the French Red Cross deliver food to homeless people in Paris, France on April 20.

A policeman asks for documents in a checkpoint during a police and army joint operation as part of security measures in San Salvador, El Salvador on April 20. This is done to keep people out of city downtown markets during a quarantine throughout the country to curb the spread of the coronavirus disease.

50/50 SLIDES

Slideshow by photo services

On Wednesday the US secretary of state, Mike Pompeo, said the US believed that China’s ruling Communist party failed to report the outbreak of the new coronavirus in a timely manner.

The US and Australia have called for an international investigation into the handling of the outbreak.

On Wednesday China’s ambassador to the US, Cui Tiankai said there needed to be “a serious rethink of the foundations of this important relationship” between the two countries. He also criticized US politicians for being “preoccupied in their efforts for stigmatization and groundless accusation”, instead of listening to scientists.

The US, mainly via president Donald Trump, has amplified theories that the virus escaped from a Chinese lab, without evidence.

On Wednesday evening, Trump rebuked a state governor and Republican ally over his decision to reopen bowling alleys, hair salons and other businesses on Friday “in violation” of the phased federal guidelines.

Despite having voiced support for US citizens protesting against lockdowns, Trump said of Georgia governor Brian Kemp: “I want him to do what he thinks is right, but I disagree with him on what he’s doing.”

The US’s top infectious diseases expert, Dr Anthony Fauci, also urged against Kemp’s decision.

At the same press conference however there was complete contradiction between Trump and his experts over the risk of a virus resurgence later in the year.

Trump said the director of the Centers for Disease Control and Prevention, Dr Robert Redfield, had been “totally misquoted” in an article about the dangers of the virus during flu season. Redfield, standing by Trump at the podium, told reporters: “I’m accurately quoted in the Washington Post”.

Fauci said he was “convinced” of the risk of resurgence, adding: “We will have coronavirus in the fall.”

Other developments include:

The world is on track for a recession of “unprecedented depth in the post-war period”, ratings agency Fitch said in a note issued on Thursday. The agency now expected world gross domestic product to tumble by 3.9% in 2020.

Asian stock markets rose on Thursday as the combination of a rebound in crude prices from historic lows and the promise of more US government aid to cushion the coronavirus-ravaged economy helped calm nervous markets.

South Korea’s economy, the world’s 12th largest, saw its worst performance in more than a decade in the first quarter of this year, the central bank said Thursday, with officials warning of a bigger impact still to come.

Two pet cats in New York state have tested positive for the coronavirus, marking the first confirmed cases in companion animals in the US, federal officials said Wednesday.

Missing Wuhan citizen journalist Li Zehua has reappeared. He went missing for almost two months after posting videos from Wuhan during the coronavirus outbreak but has turned up, saying he was detained by police and forcibly quarantined.

The director general of the World Health Organization, Tedros Adhanom Ghebreyesus, has said that there is still “a long way to go” in tackling the coronavirus crisis around the world.

The first case has been recorded among Palestinian refugees in Lebanon. The outbreak of the virus at crowded camps has been feared since the start of the crisis.

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