China’s official COVID-19 death toll stands at roughly 87,500 as of March 2023, but independent estimates suggest the true number is far higher, likely around 1.5 million deaths. The enormous gap between these figures comes down to how China defined a COVID death, when it stopped counting, and what proxy data like cremation records reveal.
What China Officially Reported
As of March 16, 2023, Chinese government statistics listed 87,475 deaths from or with COVID-19, mostly in patients with other health conditions. After February 24, 2023, China reported zero COVID deaths for weeks, effectively signaling that its counting had stopped. The country also stopped providing daily case briefings in late 2022, right as infections were surging nationwide.
For most of the pandemic, China only counted symptomatic cases, contrary to World Health Organization recommendations and the practice of most other countries. This meant that mild and asymptomatic infections, which made up a large share of cases, were never recorded at all.
Why the Official Count Is So Low
In December 2022, just as China was abandoning its strict Zero-COVID policy and cases were exploding, the government adopted an unusually narrow definition of what counts as a COVID death. Under this new standard, only patients who tested positive and died specifically from pneumonia or respiratory failure caused by the virus were counted. Deaths from cardiovascular disease, strokes, heart attacks, or any other condition in COVID-positive patients were excluded.
Wang Guiqiang, an infectious disease expert advising the Chinese government, said the new criteria would “scientifically and objectively reflect deaths.” But the practical effect was dramatic: respiratory failure directly caused by the virus alone is relatively rare. Most people who die during a severe COVID infection die because the virus worsens pre-existing conditions like heart disease, kidney failure, or diabetes. By excluding those deaths, China’s official tally captured only a fraction of the real toll. Most other countries counted any death in a person with a confirmed or probable COVID infection, which is why their numbers look so different.
What Independent Estimates Show
With official data unreliable, researchers turned to indirect methods to estimate how many people actually died. One study published in JAMA Network Open used obituary data from three Chinese universities and tracked search engine activity on Baidu (China’s dominant search engine) for terms like “cremation,” “funeral parlour,” and “burial” across all of mainland China from 2016 through January 2023. By comparing the expected number of searches to the spike that occurred after Zero-COVID ended, researchers could estimate excess deaths, meaning the number of people who died above what would normally be expected.
Ben Cowling, who leads the epidemiology division at the University of Hong Kong, reviewed multiple data sources and told The BMJ that the evidence pointed to roughly 90% or more of China’s population being infected in December 2022 and January 2023, resulting in approximately 1.5 million deaths during that exit wave alone.
Cremation Data and Local Reports
Some of the most telling evidence came from local-level data that was briefly made public before being removed. News reports from Chinese cities in December 2022 showed crematoriums overwhelmed, with staff reporting double or triple their normal workload. When provinces released health reports for the fourth quarter of 2022, the period when infections surged, cremation figures were conspicuously missing from every province. Data from particularly hard-hit cities had already begun disappearing from official records earlier that year.
Zhejiang province accidentally published cremation data that was quickly taken down but not before international researchers cached it. The numbers supported the larger mortality estimates. On-the-ground accounts painted a similar picture. A healthcare worker in Jiangsu province told Radio Free Asia that cities that normally saw 100 deaths per month were recording 300 to 500. In Wuhan’s Huangpi district, home to 900,000 people, a source close to the local civil affairs department reported more than 5,000 deaths in a single month, several times the usual rate.
Another indirect signal came from household registration cancellations, a bureaucratic step required after someone dies in China. Several provinces reported sharp spikes in these cancellations during January 2023, consistent with a massive wave of deaths that was not reflected in official COVID statistics.
How This Compares Globally
If the estimate of around 1.5 million deaths is accurate, China’s per-capita death rate would still be lower than that of the United States or many European countries over the full course of the pandemic. Zero-COVID did delay most deaths until late 2022, when much of the population was infected within weeks. But it also meant that when the wave hit, it hit a population with relatively little natural immunity from prior infection, and it hit all at once, overwhelming hospitals and crematoriums simultaneously.
China’s official figure of 87,475 remains one of the lowest reported death tolls of any major country relative to population size. The gap between that number and independent estimates of 1.5 million or more reflects not just differences in counting methodology but active decisions to narrow the definition, stop reporting, and remove data from public access.