Taiwanese artist Big S (Dee Hsu) passed away in Japan due to complications from the flu, at the age of 48, sparking public concern over the flu epidemic. According to academic data, in recent years, the flu has caused an annual excess death toll of nearly 100,000 on the mainland. However, the Chinese official annual reports on flu-related cases and deaths are criticized for underestimating the actual number of flu-related deaths.
The so-called “excess death toll” refers to the difference between the number of deaths within a certain period and the expected number of deaths, which can be used to estimate the direct or indirect impact of different crises on the number of deaths or mortality rates.
This winter, China is once again in the seasonal flu epidemic period, with an increase in flu virus activity. According to monitoring data released by the Chinese Center for Disease Control and Prevention, as of week 52 in 2024 (December 23 to December 29), the flu virus positivity rate for flu-like cases in emergency departments nationwide increased by 6.2% compared to the previous week, indicating enhanced flu virus activity.
In addition, there has been an increase in cases of human metapneumovirus (HMPV) infections recently. HMPV is a common respiratory virus with symptoms similar to the flu, including fever, cough, and nasal congestion. Northern areas of China reported an increasing trend in HMPV infections, raising public concern.
The latest official data shows an increase in flu virus positivity rate in the first week of 2025.
According to the “China Influenza Surveillance Weekly Report” released by the Chinese Center for Disease Control and Prevention in week 4 of 2025, the main virus strain circulating in southern and northern provinces is A (H1N1) pdm09 subtype.
Overall, the respiratory infectious disease activity level in China is on the rise, mainly dominated by flu and HMPV infections.
Feng Zijian, former deputy director of the Chinese Center for Disease Control and Prevention, stated in 2019 that no country has accurate statistical data on flu cases, and all published figures are estimates of cases and deaths.
In March 2021, a research team from Fudan University published a study on the burden of flu diseases from 2006 to 2019 in the “Chinese Medical Journal,” estimating an average of 3.05 million excess emergency room visits due to flu in mainland China each year, and an average of 92,000 excess respiratory system disease deaths.
Furthermore, in September 2019, a research team from Fudan University, the Chinese Center for Disease Control and Prevention, and the University of Hong Kong published a paper in “The Lancet Public Health” analyzing flu mortality rates in mainland China from 2010 to 2015.
The research showed that during the period from 2010 to 2015, there were an average of 88,000 flu-related excess respiratory system disease deaths per year in China, accounting for 8.2% of respiratory system disease deaths; flu-related excess deaths among people over 60 accounted for 80% of the total population, with a significantly higher excess death rate than those under 60.
According to reports in mainland Chinese media, the dangers of the flu are significant compared to common colds. In 2009, the novel H1N1 flu broke out in many provinces and cities in China, with a global death toll exceeding 18,000. In 2013, China saw an outbreak of H7N9 avian flu infections in humans, with a national critical case mortality rate close to 40%. From 2016 to 2018, Chinese and Japanese hospitals accumulated 574 cases of hospitalized adult flu patients, with Beijing having the highest rate, and a hospitalization mortality rate of 9.8%.
It is important to note that there are discrepancies between official Chinese reports on flu-related deaths and research estimates. For example, in 2018, the official report stated a total of 768,291 cases of flu infection and 144 flu-related deaths for the year. However, research estimates suggest a far higher death toll than this figure.
Academic research indicates that the actual flu-related death toll is underestimated. The public should take flu prevention and control seriously, especially for high-risk groups such as the elderly.