# Ireland surpassed China in confirmed COVID-19 deaths — how on Earth did that happen?

Johns Hopkins ranks Ireland as No. 40 in the world on a list of COVID-19–related deaths per capita by country: 98 per 100,000, with a case-fatality rate of 2%. By comparison, China is ranked No. 160, with 0.35 death per 100,000 people and a case-fatality rate of 4.7%.

Some 146 million people have been infected worldwide by the novel coronavirus first identified in Wuhan, China, in late 2019, according to Johns Hopkins. Worldwide, more than 3 million people have died from the disease. In the U.S., more than 32 million people have been infected, and 571,964 have died.

An article in the Lancet medical journal cited China’s centralized response. The U.S., on the other hand, is subject to a variety of approaches, some more successful than others in containing the virus, at the state level. “Most Chinese adults remember SARS-CoV and the high mortality rate that was associated with it,” Talha Burki wrote.

“Ageing parents tend to live with their children, or alone but nearby. Only 3% of China’s elderly population live in care homes, whereas in several western countries, such facilities have been major sources of infection.”

“Wuhan was placed under a strict lockdown that lasted 76 days,” she added. “Public transport was suspended. Soon afterwards, similar measures were implemented in every city in Hubei province. Across the country, 14,000 health checkpoints were established at public-transport hubs. School re-openings after the winter vacation were delayed and population movements were severely curtailed.”

“Dozens of cities implemented family outdoor restrictions, which typically meant that only one member of each household was permitted to leave the home every couple of days to collect necessary supplies,” . Within weeks, China had managed to test 9 million people for SARS-CoV-2 in Wuhan. It set up an effective national system of contact tracing.”

Others are more skeptical of China’s official figures. “China is underreporting their cases, but we don’t know how much,” said Derek Scissors, a resident scholar at the American Enterprise Institute and chief economist of the China Beige Book. “Chinese vaccination is proceeding so much slower than it should.”

Vaccinations have been slow in China. The country’s National Health Commission told news media this week that 65 million people there had been vaccinated, but that has since risen to over 216 million by the weekend, according to The New York Times vaccine tracker.

About 15% of China’s population has been vaccinated against COVID-19, as of Sunday. The country plans to vaccinate 40% of its population by the end of June, a goal that would require a significant increase in the vaccination rate. China has five COVID-19 vaccines available, the first of which was reportedly made available for emergency use in the summer of 2020.

“They started distributing emergency doses last summer? And here we are in April, and they’re behind the United States in dose administration,” Scissors said. “If there was a new variant that came out of China, we wouldn’t hear about it until it’s too late.”

The Chinese government was slow to report the initial outbreak in Wuhan at the end of 2019, and 2021 is no different, Scissors said. “Xi Jinping is not allowed to fail at anything. Therefore, the problem is solved. This is now a national political issue for them, and it’s a public health issue way down in priority.”

China did not appear to take preemptive actions in the early days of the pandemic, and was reluctant to tell its citizens about the suspected viral outbreak. The first known person was reported to have contracted the virus on Dec. 1 in China, according to an article in the Lancet.

In December 2019, Yaxue Cao, a political activist, wrote on Twitter
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 that a Wuhan doctor said in a WeChat group that there were seven cases of SARS connected to the Wuhan food market, being he was forced to retract that by the party disciplinary office. The doctor later contracted SARS-CoV-2, as the new coronavirus came to be identified, and died.

Amid the fear and confusion of the initial days of the viral outbreak in China, some families voiced concern and frustration that their relatives’ causes of death were being recorded as “severe pneumonia” or “viral pneumonia” on their death certificates, the Wall Street Journal reported.

“We don’t have a way to find out what current spread is like,” Scissors said. “It’s very suspicious that we have new variants that seem to be more infectious [but] seem to have had no effect in China.”

“It wouldn’t be surprising if they were hiding local outbreaks,” he added. “I read the Chinese press every day, and it’s like the new variants don’t exist. There are massive variations across countries. Even if they are doing well nationally, it’s unlikely they’re not having local outbreaks.”

Last March, journalists from the Wall Street Journal, the New York Times and the Washington Post were banished from China, including the semiautonomous states of Hong Kong and Macau.

“The pandemic continues everywhere in the world, including Ireland and the United States, but not in China, if you believe the reporting,” Dr. Daniel Lucey, senior scholar at the O’Neill Institute for National and Global Health Law at Georgetown University, and fellow at the Infectious Diseases Society of America.

Still, he gives China the benefit of the doubt, “I do believe there’s been no major outbreak in China.”

Also read:‘Asian-American businesses are dealing with two viruses’: Reeling from racist incidents, many are hurting financially during COVID-19

“Hong Kong is still very transparent,” Lucey said. “We know what’s going on in Hong Kong and Taiwan, but in the mainland I am more skeptical,” he said. “There have been four outbreaks in markets in China, but there have been no major outbreaks in China since the spring of last year. There are strict rules for travelers, and the South China Morning Post has integrity and independence.”

Lucey said the rate of fatalities related to COVID-19 does “sound unbelievable,” and the media there is also very reliant on official data from state sources. What’s more, the small percentage of people vaccinated on the mainland means that the population is “still very vulnerable to infection, particularly variants,” he added.

The Chinese Embassy in Washington, D.C., did not immediately respond to a request for comment. This week, however, state media reported that the vaccine supply was “relatively tight” but did not specify where the problem was most pronounced or how long people would have to wait.

Ireland’s road to recovery, meanwhile, has not been a straight line. The rollout of vaccinations there, as in much of Europe, has been slow compared with that of the U.S. Mask-wearing policies have been haphazard, and compliance has been uneven, particularly in the early days of the pandemic.

The recent Johnson & Johnson
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 blood-clot issue in the U.S., believed to have affected 15 women and be related to three deaths, is similar to one that prompted many European countries to restrict use of the AstraZeneca
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vaccine developed with Oxford University, also an adenoviral vector-based vaccine.

In addition to AstraZeneca,
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the vaccines made by Pfizer
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and its German partner, BioNTech SE
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and by Moderna
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are also available in Ireland. Authorities there have decided to limit availability of the AstraZeneca vaccine to people over age 60 due to the concern over blood clots.

The country has had three separate lockdowns, which were restrictive by international standards: one in the initial surge last year, another in the fall and a third lockdown after Christmas, when people went shopping and many gathered in homes to celebrate the holidays.

The lockdowns have been described locally as brutal. Visiting people other than for outdoor exercise was banned, and people cannot travel beyond 5 kilometers from home. Those who leave the country for a nonessential reason can be fined €2,000 ($2,407).

People arriving in Ireland who have not been vaccinated are required to stay in a hotel for 10 days at their own expense. Several people attempted to flee; two Irish women who went to Dubai for cosmetic procedures refused to enter a hotel and, as a result, were arrested at the Dublin airport.

Under an agreement reached in June 2020, Fianna Fáil leader Micheál Martin took the reins as taoiseach, or prime minister, from Fine Gael leader Leo Varadkar until 2022. It is a polite, if imperfect, game of musical chairs to maintain stability.

This time last year, the nation’s lawmakers were — perhaps more so than usual — eager not to upset this delicate balance of power or upset the public by making any drastic or sudden moves or, indeed, missteps as the nation reeled from the economic effects of the pandemic.

Case in point: The government only advised people to wear masks in June 2020. In August, masks were mandatory in supermarkets and other indoor public spaces such as hairdressers and museums. In January 2021, the rule was extended to banks, post offices and credit unions.

A growing body of research suggests that face coverings help stop the transmission of COVID-19 through respiratory droplets, and may also encourage people to adopt other behaviors recommended by health professionals, including practicing social distancing and avoiding touching their faces.

Ireland today is a long way from those earlier laissez-faire policies. This month, the European Commission urged the country to ease some of its public health measures. Spokesman Christian Wigand expressed concerns under EU law on the principles of proportionality and nondiscrimination.

“The commission believes that the objective pursued by Ireland, which is the protection of public health during the pandemic, could be achieved by less restrictive measures,” Wigand said. He also called out Austria, Belgium, France, Italy and Luxembourg over their mandatory hotel quarantines.

Ireland’s government said Wednesday that it hopes to reopen the economy as much as possible by May and June, given the current rates of vaccinations and new infections. But it’s not clear whether the country will reach its goal of vaccinating 82% of adults by the end of June.

Aside from their difficulties in rolling out their respective vaccination programs and the official COVID-related fatalities, there is one other thing Ireland and China have in common: that their battles against COVID-19, as in much of the world, are far from over.

“This pandemic isn’t going to end with a bang,” Ireland’s Varadkar told Today FM radio station on Wednesday. “We will probably have to get through another winter to know for sure if it really is behind us.”