Excess mortality in Wuhan city and other parts of China during the three months of the covid-19 outbreak: findings from nationwide mortality registries

Abstract

Objective To assess excess all cause and cause specific mortality during the three months (1 January to 31 March 2020) of the coronavirus disease 2019 (covid-19) outbreak in Wuhan city and other parts of China. Design Nationwide mortality registries. Setting 605 urban districts and rural counties in China’s nationally representative Disease Surveillance Point (DSP) system. Participants More than 300 million people of all ages. Main outcome measures Observed overall and weekly mortality rates from all cause and cause specific diseases for three months (1 January to 31 March 2020) of the covid-19 outbreak compared with the predicted (or mean rates for 2015-19) in different areas to yield rate ratio. Results The DSP system recorded 580 819 deaths from January to March 2020. In Wuhan DSP districts (n=3), the observed total mortality rate was 56% (rate ratio 1.56, 95% confidence interval 1.33 to 1.87) higher than the predicted rate (1147 v 735 per 100 000), chiefly as a result of an eightfold increase in deaths from pneumonia (n=1682; 275 v 33 per 100 000; 8.32, 5.19 to 17.02), mainly covid-19 related, but a more modest increase in deaths from certain other diseases, including cardiovascular disease (n=2347; 408 v 316 per 100 000; 1.29, 1.05 to 1.65) and diabetes (n=262; 46 v 25 per 100 000; 1.83, 1.08 to 4.37). In Wuhan city (n=13 districts), 5954 additional (4573 pneumonia) deaths occurred in 2020 compared with 2019, with excess risks greater in central than in suburban districts (50% v 15%). In other parts of Hubei province (n=19 DSP areas), the observed mortality rates from pneumonia and chronic respiratory diseases were non-significantly 28% and 23% lower than the predicted rates, despite excess deaths from covid-19 related pneumonia. Outside Hubei (n=583 DSP areas), the observed total mortality rate was non-significantly lower than the predicted rate (675 v 715 per 100 000), with significantly lower death rates from pneumonia (0.53, 0.46 to 0.63), chronic respiratory diseases (0.82, 0.71 to 0.96), and road traffic incidents (0.77, 0.68 to 0.88). Conclusions Except in Wuhan, no increase in overall mortality was found during the three months of the covid-19 outbreak in other parts of China. The lower death rates from certain non-covid-19 related diseases might be attributable to the associated behaviour changes during lockdown.

The changing pattern of enteric pathogen infections in China during the COVID-19 pandemic: a nation-wide observational study

“…China was among the countries that had applied nationwide NPIs at the early epidemic. Since the fourth week of January, 2020, accompanying the block of Wuhan city [ 14 , 15 ], massive interventions including the isolation of the confirmed/suspected cases and quarantine of close contacts, even the strict and unprecedented measures like closure of school and entertainment venues, banning of mass gathering activities, have been implemented across China to contain the spread of COVID-19 [16] . At the individual level, the use of facemasks and hand washing at public areas had been encouraged widely in China.…”

Covid-19, non-Covid-19 and excess mortality rates not comparable across countries

“…Wuhan where the pandemic is assumed to have originated, had a very high RMR and an eight-fold increase in pneumonia mortality in the first three months of the pandemic suggested that Covid-19 went largely underreported. Interestingly, mortality from non-communicable diseases also increased by 20% [ 21 ].…”

The Interferon-Induced Transmembrane Protein 3 -rs12252 Allele May Predict COVID-19 Severity Among Ethnic Minorities

“…An example of this is the lower morbidity and mortality from COVID-19 seen in China. Despite a high allele frequency of 0.50 of the at-risk IFITM3-rs-12252 allele among the Chinese population, the mortality and morbidity were low in China in the first 3 months of the outbreak excluding Wuhan (Liu et al, 2021 ). The lead author of the study attributes the low mortality in China to the lockdown and associate behavioral changes like facemasks, increased hygiene, social distancing and travel restrictions.…”