China Outbreak

A doctor checks the conditions of a patient in Jinyintan Hospital, designated for critical COVID-19 patients, in Wuhan in central China’s Hubei province Thursday.

BEIJING — China on Thursday reported a sharp spike in deaths and infections from a new virus after the hardest-hit province of Hubei applied a new classification system that broadens the scope of diagnoses for the outbreak, which has spread to more than 20 countries.

Japan reported its first death, a woman in her 80s who had been hospitalized since early February. She is the third confirmed fatality outside of mainland China, after deaths in the Philippines and Hong Kong.

The new diagnostic approach came on the same day that Hubei and its stricken capital, Wuhan, replaced their top officials in an apparent response to public criticism of how authorities have handled the epidemic.

The death toll in China reached 1,367, up 254 from the previous day. The number of confirmed cases jumped 15,152 to 59,804. The unusually large increases were due to the change in Hubei’s approach.

The total now includes more than 13,000 cases of “clinical diagnosis” in Hubei, which appears to include those based on a doctors’ analysis combined with lung imaging, as opposed to waiting for laboratory test results.

In breaking down the large number of new cases in China, National Health Commission spokesman Mi Feng said Hubei had adopted a revised diagnosis and treatment plan aimed at accelerating the identification and treatment of patients.

That adds a “clinical diagnosis case” classification to identify suspected cases who appear to have pneumonia so that patients can be accepted as soon as possible and treated as confirmed cases, Mi said, adding that should “reduce severe illness and mortality.”

One expert said the changed case definition in Hubei likely speaks to the crush of patients the health system is experiencing and the backlog of untested samples.

“Clearly in Wuhan, the health system is under extreme pressure and so the first priority has to be the patient,” said Mark Woolhouse, a professor of infectious disease epidemiology at the University of Edinburgh.

He said it wasn’t unprecedented for case definitions to rely on doctors’ diagnoses rather than wait for laboratory confirmation, and that these kinds of changes usually happen when there are simply too many patients to process in a fast-moving outbreak.

Many countries have implemented travel restrictions on recent visitors to China, which has more than 99% of the world’s reported infections.

An advance team of WHO experts has been in China since Monday. The team is here to “discuss specific arrangements for the China-WHO joint mission with the Chinese side,” Chinese foreign ministry spokesman Geng Shuang said at a daily online briefing.

“The purpose of the joint mission is that experts of both sides can have in-depth communication on the situation and efforts of prevention and control, and come up with advice for China and other affected countries,” Geng said.

In Vietnam, official media reported that a village of 10,000 northwest of the capital, Hanoi, was put in lockdown due to a cluster of cases there.

The online newspaper VN Express cited a senior official of Vinh Phuc province as reporting an increase in cases in Son Loi. Vietnam has confirmed 16 cases, most of them in the province.