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A new study involving researchers from Oxford University and the Chinese Center for Disease Control and Prevention (China CDC) looked at the change in general and cause-specific death rates during the three months of the COVID-19 outbreak in early 2020 The The results will be published today in the BMJ.

In China, the occurrence of COVID-19 was first reported in mid-December 2019 in the city of Wuhan, Hubei province. At the same time as the Chinese New Year celebrations in January 2020, the virus spread rapidly across China. This resulted in a national lockdown on January 23, 2020 that lasted until early April.

The study analyzed data from official Chinese death registers for the period from January 1 to March 31, 2020 and compared them with the same period over the past five years. The researchers conducted separate analyzes for the city of Wuhan, the epicenter of the pandemic, and elsewhere in China.

The main results were:

  • The overall death rate in Wuhan City was 56% higher than normally expected (1147 v 735 per 100,000). This was mainly due to a eight-fold increase in deaths from pneumonia, most of which were COVID-19 related.
  • Deaths from certain other diseases also increased slightly in Wuhan City, including cardiovascular disease (29% increase: 408 v 316 per 100,000) and diabetes (83% increase: 46 v 25 per 100,000).
  • Overall, there were about 6,000 additional deaths (4,573 from pneumonia) in Wuhan city from January to March 2020, compared to the expected rate over the past five years. Excessive deaths were significantly higher in central counties (compared to suburban counties) in adults over the age of 70 and higher in men than women.
  • Outside of Wuhan City, the overall death rate did not rise and was even slightly lower than expected (675 versus 715 per 100,000). This was due to fewer deaths from non-COVID-19 pneumonia (47% reduction), chronic respiratory disease (18% reduction) and traffic accidents (23% reduction), all of which coincided closely with the lockdown.

Dr. Jiangmei Liu, a study author from China’s CDC, said, “This was the first nationwide study in China to systematically examine excessive mortality during the COVID-19 outbreak, not only from pneumonia but also from a number of other conditions in different countries regions of China. ‘

The researchers used official records from the nationally representative Disease Surveillance Point (DSP) system of the Chinese CDC. It includes more than 300 million people from 605 municipalities and counties, which is more than 20% of the total population in China.

Professor Maigeng Zhou, lead author of the study at China’s CDC, said, “The data showed that the first three months of the COVID-19 outbreak existed in completely different situations in the city of Wuhan and the rest of China. Within the city of Wuhan, there were also wide variations in the severity of the outbreak between central and suburban districts. ‘

In Wuhan City, there have been about 1,400 additional deaths from multiple chronic diseases in addition to excessive deaths from pneumonia (mostly related to COVID-19). When examining the location of these deaths, the data found that in-hospital deaths decreased significantly while out-of-hospital deaths increased. This suggests that difficulties in accessing hospital services or reluctance to get medical care during the outbreak may have been a key factor in the increased deaths from non-pneumonia diseases.

Outside of Wuhan City, the small increase in deaths from COVID-19-related pneumonia has been more than offset by a decrease in deaths from other types of pneumonia, chronic respiratory disease and traffic accidents. This reflected the success of rapidly controlling the spread of SARS-CoV-2, as well as maintaining adequate health systems maintenance during the nationwide lockdown.

Zhengming Chen, professor of epidemiology at Oxford University’s Nuffield Department of Population Health and lead author on the study, said, “It appears that lockdown and associated behavioral changes – such as wearing face masks, increased hygiene, social distancing and restricted travel – Actually had unintended additional health benefits beyond reducing the spread of SARS-CoV-2. “

Apart from the cause-specific mortality, the study did not directly assess the effects of the COVID-19 outbreak on hospital admissions, routine clinical examinations (e.g. for cancer diagnosis), and the mortality rate after infection with SARS-CoV-2.

Yet this large study provides important evidence of the need for rapid, drastic, and coordinated action in major infectious disease outbreaks to contain, suppress, and eradicate transmission and minimize harmful effects on human health.

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More information:
BMJ (2021). Provided by the University of Oxford

Quote: During the first COVID-19 outbreak (2021, February 23), accessed from on February 23, 2021, deaths did NOT increase in most parts of China

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