China is likely seeing 2.42 million daily infections and 15,850 deaths a day to the virus, the company said in an updated report on Thursday. It estimates 192,400 cumulative deaths in the country since December 1, in what is the latest private sector attempt to gauge developments in China in the absence of comprehensive data out of Beijing.

In America, COVID fatalities peaked at 23,387 for the week of January 13, 2021, or an average of 3,341 per day, CDC figures show. Based on Airfinity’s model, China’s current daily deaths are 4.74 times higher in a population 4.25 times larger than that of the U.S.—1.41 billion vs. 331.9 million, as per the World Bank’s latest records.

Airfinity forecasts China’s nationwide wave will reach its first high point on January 13, with deaths likely to peak 10 days later at 25,000 a day, or 7.48 times that of the U.S. peak, for a total of 584,000 since early December.

The group predicts a second peak on March 3, when infections could hit 4.2 million a day. “We predict 1.7 million deaths across China by the end of April 2023,” it said.

Anecdotal accounts from crowded hospitals and at-capacity crematoriums suggest the country’s COVID death toll is rising despite official figures showing a vaccination rate of over 90 percent.

China’s National Health Commission, which published the data in late November, revealed immunity gaps that included an estimated 37 million over-60s, roughly one-third of the age group, who had yet to accept a booster dose, and 28 million over-60s who hadn’t been vaccinated at all.

The numbers were equally worrying for Chinese senior citizens over the age of 80, only around 40 percent of whom were boosted.

The World Health Organization says the inactivated virus vaccines like those approved for use in China are effective at preventing severe disease and hospitalization at higher doses. More than a year ago, the U.N. health agency advised immunocompromised people or those receiving an inactivated COVID vaccine to accept a booster to protect against waning immunity.

By comparison, less than 10 percent of the U.S. population was vaccinated when cases and deaths were at their highest in January 2021. The CDC said more than 80 percent of eligible Americans had been boosted, including 95 percent of over-65s, as of late last month.

“While China has vaccinated their population, their vaccine campaigns were well over a year ago and boosters were almost a year ago, with the elderly, high-risk getting their boosters about 12 months ago,” said Matt Linley, analytics director at Airfinity.

“We have extensive data showing the waning immunity of the vaccines, particularly the less effective Chinese vaccines. While the data is less clear around long-term protection against death, China had very low uptake in the very high-risk groups that are most likely to die from COVID, for example 40 percent booster uptake in over 80-year-olds, around one year ago,” Linley told Newsweek.

“We therefore believe protection levels in China are extremely low and are comparable to a naive population,” he said, referring to people who have not previously come into contact with the virus. “Furthermore, the wave China is experiencing now is with a far more transmissible variant than the U.S. experienced then,” he added.

With more than 100 million positive cases and over 1 million deaths recorded in the U.S. as of Wednesday, the pandemic, now in its fourth year, has killed at least 3,237 people for every 1 million Americans.

Without comparable methodologies for counting infections and deaths, however, China’s per million death toll is difficult to calculate. Before swiftly dismantling its zero-COVID policy last month, Beijing still considered symptomatic positive cases separate from asymptomatic infections, before it ceased publication of both statistics on December 14 and 25, respectively.

Since scrapping lockdowns, mass testing and contact tracing, Chinese health officials have also revised the criteria for COVID-related deaths, which now exclude patients who die with preexisting conditions. The WHO believes China’s definition is too narrow and contributing to undercounting, the health body’s emergencies director Mike Ryan said on Wednesday.

Beijing has reported around two dozen deaths from the virus since December, including one for January 4 for a pandemic total of 5,259, very low by global standards.

“We believe that the current numbers being published from China underrepresent the true impact of the disease in terms of hospital admissions, in terms of ICU admissions, and particularly in terms of deaths. And we would like to see more data on a more geographic basis across China,” Ryan said.

The WHO acknowledges that Beijing may simply be struggling to accurately track what could be the world’s largest COVID outbreak. Models like the one produced by Airfinity have therefore become a consistent way to assess the spread of the virus in China, where current and former health officials say tracking the outbreak amounts to a guessing game.

The WHO’s weekly report on Thursday said China had reported 218,019 weekly COVID cases as of January 1. Zeng Guang, one of China’s chief epidemiologists, estimated in late December that some 80 percent of Beijing’s 22 million people may have already been infected.

“While the lack of credible data coming out of China makes forecasting what will happen more difficult, our team has a great deal of data about outbreaks in other countries, including those which also abandoned zero-COVID policies,” Linley said.

“Examining what we know about China and using data from previous surges around the world can help us make predictions about what’s likely to be happening in China. We also extensively track data on mobility, local media and anecdotal reports to see if that corroborates our estimates in real-time,” he said.

The WHO, whose advice to phase out zero COVID was rejected by Beijing last spring, has turned to frank public messaging to encourage more transparency from China, whose scientists have also been invited to present data in the past week.

“We continue to ask China for more rapid, regular, reliable data on hospitalizations and deaths, as well as more comprehensive real-time viral sequencing,” said Tedros Adhanom Ghebreyesus, the WHO’s director-general, who noted the agency is “concerned about the risk to life” in the country.

Beijing has hit out at suggestions it hasn’t been open about its COVID situation, which is “under control,” said Mao Ning, China’s Foreign Ministry spokesperson. “It is hoped that the WHO secretariat will take a science-based, objective and just position and play a positive role in addressing the pandemic globally,” she said.

A day earlier, Mao criticized the U.S. and other governments for imposing soft restrictions on travelers from China by requiring negative PCR tests. President Joe Biden told reporters the same day that China is “very sensitive…when we suggest they haven’t been that forthcoming.”

The WHO, however, has defended the travel protocols required by the U.S. and others.

“With circulation in China so high, and comprehensive data not forthcoming, as I said last week, it’s understandable that some countries are taking steps they believe will protect their own citizens,” Tedros said.

“The requirement for testing is not in itself a restriction of travel. It’s important to note that the vast majority of countries who’ve implemented measures are just requiring testing,” Ryan said.

“It’s not an excessive measure based on any individual country’s risk assessment,” he said. “You can remember over the last three years, China has had very strict testing requirements for entering China, so the reality for China now is that many countries have felt that they don’t have enough information to base their risk assessment, so they’re taking a cautionary approach, they’re applying a cautionary principle, and requiring testing.”

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