What we know about respiratory illness outbreak ‘overwhelming’ China’s hospitals

Scientists urge people to not panic as thousands of children complain of pneumonia-like symptoms in China

China’s hospitals have been flooded with cases of respiratory illnesses and sick children complaining of pneumonia-like symptoms, leading to increased scrutiny from the World Health Organisation (WHO).

The respiratory illness is caused by known pathogens and there is no sign of new infectious diseases, the Chinese health ministry said on Saturday, as the country braced for its first winter after lifting the Covid-19 restrictions.

There has been a rise in cases linked to viruses such as influenza, rhinoviruses, the respiratory syncytial virus, or RSV, the adenovirus, as well as bacteria such as mycoplasma pneumoniae, the ministry said in a statement.

Mi Feng, an official with China‘s national health commission, said in a press conference that authorities will open more paediatric outpatient clinics, seek to ensure more elderly people and children receive flu vaccines while encouraging people to wear masks.

The rise in pneumonia-like cases in China has become a global issue in the last two weeks. Several South Asian countries, such as India, Taiwan, Singapore, and others, have raised surveillance levels and ramped up measures.

It has also prompted several Republican senators in the US to urge Joe Biden to impose travel restrictions with China.

The spike in cases appeared to be driven by children contracting pathogens that two years of Covid-19 restrictions kept them away from, said Maria Van Kerkhove, the acting director of WHO’s department of epidemic and pandemic preparedness and prevention.

“This is not an indication of a novel pathogen. This is expected. This is what most countries dealt with a year or two ago,” Ms Van Kerkhove told health news outlet STAT.

Mycoplasma pneumoniae infections were mostly seen in children aged five to 14, said Wang Huaqing, the chief immunisation planning expert for China Centre for Disease and Protection (CDC).

“Since China experienced a far longer and harsher lockdown than essentially any other country on Earth, it was anticipated that those ‘lockdown exit’ waves could be substantial in China,” Francois Balloux of University College London, told AFP.

The Chinese health ministry has asked local authorities to increase the number of fever clinics and urged people to wear masks in order to stop the illnesses from spreading.

A Beijing children’s hospital earlier told state media CCTV that at least 7,000 patients were being admitted daily to the institution, far exceeding its capacity.

Last week, the largest paediatric hospital in nearby Tianjin reportedly received more than 13,000 children at its outpatient and emergency departments. Liaoning province, about 690km northeast of the capital, is also grappling with high case numbers.

The increasing number of cases prompted the WHO on Wednesday to issue a formal request for disease data on respiratory illnesses and reported clusters of pneumonia in children.

Chinese health authorities responded by saying they found no “unusual or novel diseases”. The officials claimed the high number of patients had not overwhelmed the country’s hospitals contrary to the local media reports.

China's National Health Commission has also warned that the spread of several pathogens could converge into a major outbreak between this winter and next spring.

The global health body also said on Wednesday that any link between clusters of undiagnosed pneumonia and a rise in respiratory infections is unclear as of now.

What has happened so far?

Northern China has reported an increase in “influenza-like illnesses” since mid-October, compared to the same period in the previous three years, according to the WHO.

On 21 November, public disease surveillance system ProMED had issued a notification about reports of “undiagnosed pneumonia”. ProMED, whih is run by health experts, had earlier in 2019 raised the alarm over the virus that causes Covid-19.

“With the outbreak of pneumonia in China, children’s hospitals in Beijing, Liaoning and other places were overwhelmed with sick children, and schools and classes were on the verge of suspension,” ProMED said while citing a report by FTV News.

“It is not at all clear when this outbreak started as it would be unusual for so many children to be affected so quickly.

“This report suggests a widespread outbreak of an undiagnosed respiratory illness in several areas in China as Beijing and Liaoning are almost 800 km apart.

“The report does not say that any adults were affected suggesting some exposure at the schools.”

Some parents in Shanghai on Friday said they were not overly concerned about the wave of sickness.

“Colds happen all over the world,” said Emily Wu outside a children’s hospital. “I hope that people will not be biased because of the pandemic... but look at this from a scientific perspective.”

What are the symptoms?

According to Chinese health authorities, the outbreak could be linked to mycoplasma pneumoniae, also known as “walking pneumonia”, a common bacterial infection typically affecting children that has been circulating since May.

Symptoms of walking pneumonia include a sore throat, fatigue and a lingering cough that can last for weeks or months. In severe cases, this can eventually deteriorate into pneumonia.

A Beijing citizen, identified only as Wei, told FTV News that infected children “don’t cough and have no symptoms. They just have a high temperature (fever) and many develop pulmonary nodules.”

Health data analytics firm Airfinity noted that atypical symptoms have also been reported at a Sichuan province hospital.

"The fact that only children are affected suggests this is most likely to be an existing pathogen," Jin Dong-yan, a professor at the University of Hong Kong told Bloomberg.

"If it's a new pathogen it should mostly hit adults. It looks like it's something adults have got accustomed to."

However, Mycoplasma has previously triggered epidemics in China every two to four years, with the latest positivity rate in Beijing being 40 per cent — about 1.3 times higher than its 2019 peak.

How infectious is the disease?

Bruce Thompson, head of the Melbourne School of Health Sciences at the University of Melbourne, told Reuters very preliminary data suggested there was nothing out of the ordinary.

“At this stage, there is nothing to suggest that it may be a new variant of Covid,” he said.

“One thing to note is that we can be reassured that the surveillance processes are working, which is a very good thing.”

The WHO suggested people in China get vaccinated, isolate if they are feeling ill, wear masks if necessary and get medical care as needed.

“While WHO seeks this additional information, we recommend that people in China follow measures to reduce the risk of respiratory illness,” the agency said.

What are scientists saying?

Marion Koopmans, a Dutch virologist who advised the WHO on Covid, said there needs to be “more information, particularly diagnostic information”.

“We have to be careful.”

“The challenge is to discern the outbreaks and determine the cause,” said David Heymann of the London School of Hygiene and Tropical Medicine.

He pointed out that there was a likely background of seasonal respiratory infections.

“I am not going to push the pandemic panic button on the basis of what we know so far, but I will be very keen to see the response to WHO from China and see the WHO’s assessment following that,” said Brian McCloskey, a public health expert who also advised the WHO on the pandemic.

“What we are seeing is WHO’s International Health Regulations system in action”, he said, referring to the rules governing how countries work with the WHO on potential outbreaks.

Virologist Tom Peacock from Imperial College London said it was unlikely the increasing infections happened under the radar as there are tools now to “pretty rapidly” pick up emerging influenza or coronaviruses.

“(I) suspect it may end up being something more mundane or a combination of things – say Covid, flu, RSV [respiratory syncytial virus] – but hopefully we’ll know more soon,” he said.

Countries raising alerts

Despite China’s continued assurances, countries in Asia including India, Taiwan, Thailand and Nepal are on alert or ramping up surveillance in preparation for a possible rise in respiratory diseases in people.

Five US Republican senators led by Marco Rubio have also asked the Biden administration to ban travel with China.

“We should immediately restrict travel between the United States and (China) until we know more about the dangers posed by this new illness,” said the letter signed by Mr Rubio, the top Republican on the Senate intelligence committee.

A Biden administration official has said that the US was closely monitoring the uptick in respiratory illnesses in China but added that “we are seeing seasonal trends. Nothing is appearing out of the ordinary”.

“At this time, there is no indication that there is a link between the people who are seeking care in US emergency departments and the outbreak of respiratory illness in China,” the official added.

US health officials are closely observing a pneumonia outbreak affecting children in an Ohio county, emphasising that the outbreak seems to be caused by well-known pathogens and is not linked to pneumonia clusters reported in China and parts of Europe.