China could have had more than 230,000 cases of coronavirus, almost five times the official figures, a study has revealed.
The report, by the Hong Kong University's school of public health and published in the British medical journal The Lancet, looked at World Health Organisation's evidence from China.
It revealed the true number of those infected would have been far greater if the definition of a Covid-19 case, that was later used as the standard across the world, had been applied from the outset.
China recorded 55,000 cases as of February 20, and that has now risen to 83,000 to date.
The country’s national health commission issued seven versions of a case definition for covid-19 between January 15 and March 3.
The Hong Kong study found these changes had a “substantial effect” on how many infections which were detected as cases.
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Experts analysed data up to February 20, taken from the WHO's mission to Wuhan.
It estimated that each of the first four changes increased the proportion of cases detected and counted by between 2.8 and 7.1 times.
The study reads: “If the fifth version of the case definition had been applied throughout the outbreak with sufficient testing capacity, we estimated that by February 20, 2020, there would have been 232,000 … confirmed cases in China as opposed to the 55,508 confirmed cases reported."
As scientific knowledge evolved, the definition of a confirmed case has widened to include cases with milder symptoms, or without epidemiological links to Wuhan.
The report said these changes should be taken into account.
There are currently 2.5million covid-19 cases worldwide and 176,786 deaths have been reported.
In the UK 18,094 have died of the virus.
The USA and Australia have called for an international investigation into the handling of the outbreak.
Mike Pompeo, US secretary of state, said the USA believed that China’s ruling Communist party failed to report the outbreak of the new coronavirus in a timely manner.
