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China on Thursday reported 254 new deaths and a spike in virus cases of 15,152, after the hardest-hit province of Hubei applied a new classification system that broadens the scope of diagnoses for the outbreak, which has spread to more than 20 countries.

Japan also reported its first death, a woman in her 80s who had been hospitalized since early February. Two other places outside mainland China — Hong Kong and the Philippines — have previously confirmed one death each.

The new diagnostic approach came on the same day that Hubei and its stricken capital, Wuhan, replaced their top officials in an apparent response to public criticism of local authorities’ handling of the epidemic.

The total deaths in mainland China since the outbreak began in December stood at 1,367, with the total number of confirmed cases mounting to 52,526. This figure now includes more than 13,000 cases of “clinical diagnosis” in Hubei, which appears to include those based on a doctors’ analysis combined with lung imaging, as opposed to waiting for laboratory test results.

In breaking down the large number of new cases in China, National Health Commission spokesman Mi Feng said Hubei had adopted a revised diagnosis and treatment plan aimed at accelerating the identification and treatment of patients.

That adds a “clinical diagnosis case” classification to identify suspected cases who appear to have pneumonia so that patients can be accepted as soon as possible and treated as confirmed cases, Mi said, adding that should “reduce severe illness and mortality.”

China also appointed new high-level officials in Hubei and Wuhan.

Former Shanghai Mayor Ying Yong succeeded Jiang Chaoliang as the ruling Communist Party chief in the beleaguered province, the Xinhua state news agency reported, while Wang Zhonglin took over from Ma Guoqiang as the party secretary in Wuhan.

The appointments follow the sacking earlier this week of two leaders of the provincial health commission. State media also reported that a slew of others were expelled from the party for transgressions related to the epidemic.

The public has widely criticized local officials for failing to respond quickly and decisively to the new virus. Authorities initially assured people that there was little to no risk of human-to-human transmission, a statement that was later retracted. Wuhan residents said hospitals were overcrowded and lacked sufficient medical supplies. Doctors who tried to share information early on were reprimanded by police for “spreading rumors.”

Many countries have implemented travel restrictions on recent visitors to China, which has more than 99% of the world’s reported infections.

In an unprecedented measure to contain the disease, recently named COVID-19, the Chinese government has placed the hardest-hit cities — home to more than 60 million — under lockdown.

World Health Organization spokesman Tarik Jasarevic said the agency is seeking more clarity from China on the updates to its case definition and reporting protocol.

“It is our current understanding that the new case definition widens the net, and includes not only lab-confirmed cases but also clinically diagnosed cases based on symptoms and exposure,” Jasarevic said in an email to The Associated Press.

“The jump in cases today reflects the broader definition,” he said.

An advance team of WHO experts has been in China since Monday. The team is here to “discuss specific arrangements for the China-WHO joint mission with the Chinese side,” Chinese foreign ministry spokesman Geng Shuang said at a daily online briefing.

“The purpose of the joint mission is that experts of both sides can have in-depth communication on the situation and efforts of prevention and control, and come up with advice for China and other affected countries,” Geng said.

In Vietnam, official media reported that a village of 10,000 northwest of the capital, Hanoi, was put in lockdown due to a cluster of cases there.

The online newspaper VN Express cited a senior official of Vinh Phuc province as reporting an increase in cases in Son Loi. Vietnam has confirmed 16 cases, most of them in the province.

Japan’s Health Ministry announced Thursday that 44 more people on a cruise ship quarantined in the port of Yokohama, near Tokyo, have tested positive for COVID-19. The ship has 218 infections among its 3,700 passengers and crew.

Health Minister Katsunobu Kato told reporters five of the patients who were already sent to hospitals for isolation and treatment have severe symptoms and are on artificial respirators or under intensive care.

Another cruise ship, the Westerdam, finally docked Thursday in Cambodia after being turned away by several Asian and Pacific governments. No cases of the viral illness have been confirmed among its 1,455 passengers and 802 crew members, according to operator Holland America Line.

Thailand refused to allow the Westerdam to dock this week after it had already been turned away by the Philippines, Taiwan, Japan and Guam over virus concerns.

The Westerdam began its cruise in Singapore last month and its last stop before it was refused further landings was in Hong Kong, where 51 cases of the viral disease have been confirmed.