China said Wednesday that no one had died of Covid-19 the previous day, after changing the criteria such that most virus deaths are no longer counted, as the World Health Organization said it was "very concerned" about the new wave of cases.

Hospitals are struggling, pharmacy shelves have been stripped bare and many crematoriums are overwhelmed in the wake of the Chinese government's sudden decision to lift years of lockdowns, quarantines and mass testing.

China had recorded a total of seven deaths -- all in Beijing -- since its decision to lift its zero-Covid policy, but removed one death from its official tally Wednesday.

The removal followed a government announcement that only those who had directly died of respiratory failure caused by the virus would be counted under Covid death statistics.

Previously, people who died of an illness while infected with the virus were counted as a Covid death. This way of recording Covid deaths accounts for huge numbers of fatalities in other countries.

"At present after being infected with the Omicron variant, the main cause of death remains underlying diseases," Wang Guiqiang of Peking University First Hospital told a press conference of the National Health Commission (NHC) on Tuesday.

"Old people have other underlying conditions, only a very small number die directly of respiratory failure caused by infection with Covid," he said.

In Geneva, World Health Organization chief Tedros Adhanom Ghebreyesus said he was "very concerned over the evolving situation in China", and appealed for specific data on disease severity, hospital admissions and intensive care requirements.

"We continue to hold out hope that China will share the data and conduct the studies we have requested," Tedros told a weekly news conference.

- New data 'reversal' of norm -

One expert told AFP that because the prevalent Omicron variant does not affect the lungs as much as other strains of Covid-19, the changing definition will mean a great many more cases will now go unrecorded.

"The definition that focuses on respiratory failure (which develops when the lungs can't get enough oxygen into the blood) will miss a large number of Covid deaths," said Yanzhong Huang, a senior fellow for global health at the New York-based Council on Foreign Relations.

"The new definition is a reversal of the international norm adopted since mid-April during the Shanghai outbreak, which counts a Covid death as anyone who died with Covid," he added.

And Singapore-based infectious disease expert Leong Hoe Nam said the new definition meant "many, many deaths will go unreported".

"Massaged low death rates... add shine to (China's) healthcare system and policies," he added, saying they "will validate their retreat from zero-Covid".

- 'Particularly busy' -

From the country's northeast to its southwest, crematorium workers have told AFP they are struggling to keep up with a surge in deaths.

Beijing last week admitted the scale of the outbreak has become "impossible" to track following the end of mandatory mass testing.

But authorities are determined to push ahead with re-opening, with the central city of Xi'an on Tuesday joining several other major population centres in calling for infected people with no symptoms to go to work as normal.

Crematoriums in multiple Chinese cities declined AFP interview requests on Wednesday, with one in Xi'an saying they were "particularly busy".

In the central city of Changsha, two companies specialising in burial clothing said they had seen an uptick in customers.

One proprietor said a Covid outbreak was having "a slight effect" on his business, adding that he had been taking more orders for deceased "older people" than normal.

Others presented a more varied picture, with a staff member at a funeral services firm in the southern city of Guangzhou telling AFP that the number of customers "was always a little higher in winter".

And some were cagey when asked about the impact of Covid, with another such employee in the megacity of Chongqing saying it was "not easy to talk too much about this" at present.

- 'We must act quickly' -

A leading Chinese health expert warned Tuesday that the capital will face a surge in cases over the next two weeks, which will continue until the end of January.

"We must act quickly and prepare fever clinics, emergency and severe treatment resources," Wang Guangfa, a respiratory expert from Peking University First Hospital, told the state-run Global Times.

Earlier this week, the United States said the surge of infections in China had become a matter of international concern, and offered to share vaccines to stem the soaring Covid cases.

"We know that any time the virus is spreading, that it is in the wild, that it has the potential to mutate and to pose a threat to people everywhere," State Department spokesman Ned Price said Monday.

Beijing has rebuffed the offer, insisting that the virus is under control and that "China is continuously optimizing its prevention and control measures".

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