China defended on Thursday its handling of its raging Covid-19 outbreak after US President Joe Biden voiced concern and the World Health Organisation (WHO) said Beijing was under-reporting virus deaths.

The WHO’s emergencies director, Mike Ryan, said on Wednesday in some of the U.N. health agency’s most critical remarks to date, that Chinese officials were under-representing data on several fronts.

China scrapped its stringent Covid controls last month after protests against them, abandoning a policy that had shielded its 1.4 billion population from the virus for three years.

China’s foreign ministry spokesperson Mao Ning told a regular press briefing in Beijing that China had transparently and quickly shared Covid data with the WHO.

Mao said that China’s ‘epidemic situation is controllable’ and that it hoped the WHO would ‘uphold a scientific, objective, and impartial position’. Facts have proved that China has always, in accordance with the principles of legality, timeliness, openness and transparency, maintained close communication and shared relevant information and data with the WHO in a timely manner,’ Mao said.

China reported one new Covid death in the mainland for Wednesday, compared with five a day earlier, bringing its official death toll to 5,259.

Ryan said on Wednesday the numbers China was publishing under-represented hospital admissions, intensive care unit patients and deaths. Hours later, US President Joe Biden also raised concern about China’s handling of a Covid outbreak that is filling hospitals and overwhelming some funeral homes.

‘They’re very sensitive … when we suggest they haven’t been that forthcoming,’ Biden told reporters while on a visit to Kentucky.

The French health minister voiced similar fears while German Health Minister Karl Lauterbach voiced concern about a new Covid subvariant linked to growing hospitalisations in the northeastern United States.

Crowded hospital

The United States is one of more than a dozen countries that have imposed restrictions on travellers from China, while Lauterbach also announced on Thursday tighter rules for entry to Germany.

China has criticised such border controls as unreasonable and unscientific and the government said on Thursday that its border with its special administrative region of Hong Kong would also reopen on Sunday, for the first time in three years.

Hong Kong carrier Cathay Pacific Airways (0293.HK) said on Thursday that it welcomed quarantine-free travel and would more than double flights to the mainland Chinese cities.

Millions of people will be travelling within China later this month for the Lunar New Year holiday.

China’s government has played down the severity of the situation in recent days and the state-run Global Times said in an article on Wednesday that Covid had peaked in several cities including the capital, Beijing, citing interviews with doctors.

But at a hospital in Shanghai’s suburban Qingpu district, patients on beds lined the corridors of the emergency treatment area and main lobby on Thursday, most of them elderly and several breathing with oxygen tanks, a Reuters witness said.

A notice on a board advised that patients would have to wait an average of five hours to be seen.

Staff declared one elderly patient dead and pinned a note to the body on the floor stating the cause of death ‘respiratory failure’.

Police patrolled outside a nearby crematorium, where a stream of mourners carried wreathes and waited to collect the ashes of loved ones.

Data gaps

With one of the lowest official Covid death tolls in the world, China has been routinely accused of under-reporting for political reasons.

In December last year, the WHO said it had received no data from China on new Covid hospitalisations since Beijing lifted its zero-Covid policy.

In its latest weekly report, the WHO said China reported 218,019 new weekly Covid cases as of Jan. 1, adding that gaps in data might be due to authorities simply struggling to tally cases.

The methods for counting Covid deaths have varied across countries since the pandemic first erupted in the central Chinese city of Wuhan in late 2019.

Chinese health officials have said only deaths caused by pneumonia and respiratory failure in patients who had the virus are classified as Covid deaths.

But disease experts outside China have said its approach would miss several other widely recognised types of fatal Covid complications, from blood clots to heart attacks as well as sepsis and kidney failure.

International health experts predict at least 1 million Covid-related deaths in China this year without urgent action. British-based health data firm Airfinity has estimated about 9,000 people in China are probably dying each day from Covid.

Surging Covid infections are hurting demand in China’s $17 trillion economy, with a private-sector survey on Thursday showing services activity shrank in December.

But investors remain optimistic that China’s dismantling of Covid controls will eventually help revive growth that has slid to its lowest rate in nearly half a century. Those hopes were seen lifting Asian equity markets (.MIAPJ0000PUS) on Thursday.

“China reopening has a big impact ... worldwide,” said Joanne Goh, an investment strategist at DBS Bank in Singapore, adding the move would spur tourism and consumption and ease supply-chain crunches seen last year.

An end to China’s travel curbs this month is expected to revive demand in the global luxury retail market, but many consumers now see more reasons to do their high-end shopping locally.