Doctors in China say they are discouraged from writing COVID-19 as the cause of death on death certificates

• Doctors in China are being urged not to write COVID-19 on death certificates, Reuters reported.
• If the patient had underlying diseases, doctors have been told to write that as the cause of death.

If a person who has COVID-19 dies in China, chances are their death certificate won't mention the virus.

Six doctors in public hospitals across China say they have been instructed to not attribute deaths to COVID-19 if the patient had any underlying health diseases, Reuters reported. Instead, those health conditions should be listed as the main cause of death on the deceased's death certificate.

A physician at a private hospital in Beijing told Reuters about a printed notice in the hospital's emergency department, which said doctors should "try not to" write COVID-induced respiratory failure as the cause of death on death certificates.

If the person who died did not have any underlying health conditions, doctors must report it to superiors, who go through two rounds of "expert consultations" before classifying it as a COVID death, the notice said. A copy of the notice was seen by Reuters.

Patients have also said they were not tested for the virus, even though they arrived at the hospitals with respiratory symptoms akin to those of COVID-19.

"We have stopped classifying COVID deaths since the reopening in December," a doctor at one of Shanghai's public hospitals told Reuters. "It is pointless to do that because almost everyone is positive."

Public health experts, including some from the World Health Organization, have criticized China for underreporting its COVID-19 deaths.

China relaxed most of its COVID-19 restrictions in early December after protests erupted across the country over the government's prolonged restrictions. The country's COVID cases spiked after it reopened, with hospitals, morgues, and crematoriums all overwhelmed by demand.

Even after China abandoned its zero-COVID policy, the Chinese Center for Disease Control and Prevention was recording daily COVID deaths in the single digits.

On January 14, China's National Health Commission revised its official statistics and said that almost 60,000 people died from COVID in China from December 8, 2022, to January 12, 2023, a figure the World Health Organization welcomed.