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Reported Corona Virus Cases in China Massively Under Counted Due to Shortage of Diagnostic Kits and Layers of Bureaucracy

Posted on 26 January 2020

The official numbers from China for cases of 2019 Novel Coronavirus (2019-nCoV) are massively under counted due to a shortage of diagnostic kits because of overwhelming demand and a multi-layered bureaucracy that takes days or weeks to designate each case. The official count reported Sunday in China is 1975 cases with 56 deaths. A video by a nurse posted two days ago claimed 90,000 cases in Hubei Province, its Wuhan city and China.

This video of another nurse is unconfirmed, however it tracks with other reporting:

A report by Renwu, a Chinese publication, published January 23 details the shortages and bureaucracy that help explain the disparity between official numbers and the videos of death and emotional breakdowns in Wuhan hospitals and the extraordinary actions by the Chinese government.

Provinces are being locked down, roads are blocked with berms and large concrete blocks, travel being restricted and pop-up hospitals are being constructed.

https://twitter.com/IsChinar/status/1220901405743034368

Several of the hospital videos have been confirmed by reporters as authentic.

Renwu excerpt (via translation):

…Patients in Wuhan are in a difficult situation because of the lack of kits, which cannot be diagnosed and treated. Similar situations have occurred in not only Guangji Tongji Hospital, but also designated hospitals in Wuhan, such as Tongji Hospital Headquarters, Wuhan First Hospital, Sixth Hospital, Wuhan Red Cross Hospital, Wuhan Pulmonary Hospital and other popular hospitals. The patients who were lucky enough to use the kit were called “winning the lottery” by other patients.

In the Wuhan area, kits are also in short supply. The National Health and Medical Commission issued a notice on January 19 stating that “a new coronavirus nucleic acid detection kit has been issued, and all regions are required to strengthen the detection. ” Only the first batch of kits was received at the designated hospital for viral pneumonia this time, and the number was very small, “less than one-tenth of the number of people the hospital wants to check. ” A hospital in Huanggang just got it on the 22nd. Kit. According to medical staff from a hospital in Xianning, Hubei, they have not yet received the kit.

Prior to this, on December 26, the Shanghai Public Health Clinical Center collected a patient specimen from Wuhan. Ten days later, a SARS-like coronavirus was detected from the specimen, and the entire genome sequence of the virus was obtained. The virus isolation, sequencing and other steps were completed at a fairly fast speed, and test reagents were quickly developed. A few days ago it was also reported in the media that the test agent has now achieved 24-hour full coverage in major cities without panic.

But in fact, according to the information disclosed by three companies that have passed the certification of the National Centers for Disease Control, kit production is still tight and capacity is still insufficient. The three companies are Shanghai Pfizer, Shanghai Jeno Bio and Shanghai Berger.

On January 23, People reporters called the three companies, and they were all quite busy. Zhang Zhihua, an employee of Shanghai Jeno Bio, said that the production of kits is not as easy and fast as outsiders say. “Since receiving the order, we have been working overtime. ” Employees of Pfizer, another company In an interview a few days ago, they said that their company employees only slept two or three hours a day these days. According to previous interface news reports, Pfizer has supplied kits for 50,000 to 60,000 servings to various regions, and Jeno has produced kits for 75,000 servings on January 16. The two together can test more than 100,000 people.

But it is confusing that the kit is still in short supply. An employee of Shanghai Berger said that these days they keep receiving calls from hospitals and disease control centers around the world, and they can only reply to each other: to ensure full production, adequate stocking, and strive to ensure supply. Near the end of the year, their biggest pressure comes from the companies on the upstream and downstream sides of the relevant supply chain have begun to take vacations, “there is greater pressure on procurement and transportation.”

On top of the shortage of diagnostic kits is the multi-layered government bureaucracy that delays reporting confirmed cases for days or weeks:

When kits are shipped everywhere, the first place they arrive will be the disease control centers of the provinces and cities. Up to now, the CDC is still the most important institution for the use of control kits.

A female patient in Wuhan in her 20s told People. In the early morning of January 21, because of a fever, she was examined at Wuhan Pulmonary Hospital, one of the three designated hospitals in Wuhan at that time. The examination process she went through was a blood test. , CT and nucleic acid tests, costing nearly 1800 yuan. The doctor identified her lung infection and helped her rule out the possibility of flu, H7N9 and other viruses one by one, but only to the extent that it was impossible to find out whether the infection was caused by a new type without a kit Caused by coronavirus.

When she asked if the kit could be tested, the doctor replied that the kit was “extremely scarce” and that only those hospitalized or highly suspected cases would be sent for testing. Patients with such a mild condition are mainly treated at home and reviewed, and follow-up treatment is determined based on the progress of the condition.

Which hospital can use the kit, how much can be used, you need to apply and coordinate. A person familiar with the disease control system in Wuhan told People that the detection process was mainly performed by the disease control center. At present, all the disease control and inspection departments in Wuhan have sent all personnel to the hospitals to take samples and send samples of suspected cases. All the samples are sent to the laboratory of Hubei Provincial Center for Disease Control and Prevention for nucleic acid testing. And the experimenters are also running at overload. “

According to a report by Sanlian Life Weekly on January 23, a Wuhan-based respiratory doctor said that the power to test in the past two days has also been delegated to the top three hospitals. The top three hospitals are indeed capable of completing such tests. A former RT-PCR diagnostic kit manufacturer employee told “People” that nucleic acid testing requires a special PCR laboratory, but this laboratory is not very demanding, the equipment is not complicated, and strict partitioning can be enough. . “Hepatitis B HBV, Hepatitis C HCV, and AIDS HIV all use PCR testing, so in theory, hospitals with these detection methods can complete PCR testing independently. “

However, due to the limited manpower and material resources of the top three hospitals, only part of the burden can be assumed, and considering the possibility of leakage of the new coronavirus, the current head of detection is still at the Hubei Provincial CDC.

After the kit diagnosis, the confirmation process is still long. Huanggang is one of the closest cities to Wuhan. A person from the government department of the city revealed that the counties and cities around Wuhan were relatively cautious about the first case diagnosis (that is, the “first diagnosis”). Even if the kit is received in the county and the result is confirmed to be positive, it cannot be published. It needs to be reported to Hubei Province, reviewed, and then released.

This can also explain why the previous Caixin report stated that the county mayor of Hunchun County, Huanggang City, stated at a county-wide viral pneumonia prevention and control conference on January 20 that Huanggang City’s viral pneumonia cases had already There were 109 cases, but there was no confirmed patient in Huanggang at that time-because Huanggang did not have a kit at that time, even if there was, Huanggang had no local authority to confirm the diagnosis.

According to the newly revised “Procedure for Confirmation of the First Case of New Coronavirus Infected Pneumonia in the Provinces (Regions, Cities) of the Country” newly revised by the Health and Medical Commission on January 18, for other provinces and cities except Wuhan, the review must not only go through the provincial level, It must be reported to the country and evaluated by an expert team, and confirmed in all three rounds before the diagnosis can be confirmed. This was the first case of new pneumonia announced in Jiangsu on the 22nd. According to a report from Jiangsu Province, the 37-year-old male patient was quarantined and treated on January 10. The specimen was tested by the laboratory of the Jiangsu Provincial Center for Disease Control and Detection and showed a new type of coronavirus-positive nucleic acid, which was reviewed by the Chinese Center for Disease Control and Prevention. It was evaluated by the expert team on January 22, and the diagnosis was finally confirmed. From admission to diagnosis and announcement, there are layers of checks, which last up to 12 days…

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