During a busy shift at the height of Beijing's COVID-19 wave, a physician at a private hospital saw a printed notice in the emergency department: Doctors should "try not to” write COVID-induced respiratory failure on death certificates.

Instead, if the deceased had an underlying disease, that should be named as the main cause of death, according to the notice, a copy of which was seen by Reuters.

If doctors believe that the death was caused solely by COVID-19 pneumonia, they must report to their superiors, who will arrange for two levels of "expert consultations" before a COVID-19 death is confirmed, it said.