Infectious diseases experts are losing confidence in the accuracy of China’s count of cases of the novel coronavirus, pointing toward health officials’ shifting definition of cases over time.

Confusion over how China is counting cases of infections is making it harder to know how coronavirus is spreading, even as China is officially reporting that the numbers of new cases reported in recent days have fallen sharply. Many suspect the decline may be attributed in part to shifting case definitions. Earlier this month, China broadened the criteria for newly diagnosed cases in Hubei province, the epicenter of the outbreak, then reversed itself.

“Every time you change the case definition, that then means you have a reset in terms of what you’re actually looking at,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Diseases Research and Policy. “I think between the inability to determine the actual number of people infected and how cases are now being called a case means at best you can get trend data, possibly, but not more than that.”

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