Infection
Reports of a mystery virus in China might bring back bad memories. But here’s what appears to be going on
Nov
A recent spike in respiratory illnesses in China and a request from the World Health Organization (WHO) for more information may give some people an uneasy sense of deja vu.
Almost four years ago, undiagnosed clusters of respiratory illness were one of the earliest signs of what would become an unprecedented global pandemic that shuttered economies and devastated health systems.
Fast forward to last week, the WHO said it was aware of media reports of cases of undiagnosed pneumonia in children’s hospitals in Beijing and other areas of the country.
It cited a warning from ProMed, a global outbreak surveillance system, that included some haunting similarities to one of the first notices it ever sent about SARS-COV-2.
“Undiagnosed pneumonia — China: (Beijing, Lainong) children, reported epidemic, request for information,” ProMED said on November 22.
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Vision on state run news inside China has shown hundreds of people seated in the waiting room of a hospital in Nanjing, in China’s eastern Jiangsu province, with IV drips hanging from the ceiling.
In another story, director of the outpatient department of Beijing Children’s Hospital Li Yuchuan is quoted as saying the internal medicine department was receiving 7,000 patients a day, far beyond hospital capacity.
After monitoring media reports, the WHO requested more information to identify “whether these were separate events, or part of the known general increase in respiratory illnesses in the community”.
WHO’s query and the public nature of the request was “a little unusual”, but “not surprising”, according to Christine Jenkins, a professor of medicine at the University of New South Wales.
“When infections like these, such as [when the] first SARS occurred and subsequently when [SARS-CoV-2] occurred in China, initially it was exceptionally difficult to get information,” she said.
“I think the WHO is taking a much more proactive approach to surveillance.”
China had 24 hours to respond. Health authorities from the Chinese Center for Disease Control and Prevention (CDC) and the Beijing Children’s Hospital provided WHO with data indicating there “has been no detection of any unusual or novel pathogens or unusual clinical presentations”.
A mysterious respiratory illness does not appear to be spreading around China, but a combination of pathogens, the lifting of restrictions and the onset of winter may all be fuelling a surge in sickness.
Scientists say the situation warrants close monitoring and are “alert, but not alarmed”.
China says multiple pathogens are circulating
A post by the Beijing Friendship Hospital service earlier this month said the number of children attending the hospital was rising, reaching up to 1,800 daily outpatient and emergency patients across two districts.
WHO said it had been advised by Chinese authorities that “the rise in respiratory illness has not resulted in patient loads exceeding hospital capacities”.
As part of its response to the WHO, Chinese officials provided data, which included laboratory results from infected children, that indicated the clusters were due to multiple known pathogens.
These included the flu, adenovirus, RSV and mycoplasma pneumoniae, a common bacterium that usually causes mild illness.
Outpatient consultations and hospital admissions for children with mycoplasma pneumoniae had increased in China since May, according to the data provided to WHO.
Known viruses such as RSV and the flu had begun circulating in October.
Mycoplasma pneumonia and RSV are both known to affect children more than adults, which may explain the spike in younger patients.
An explanation on the clusters provided to China’s government-run news outlet, The Global Times by Zhang Wenhong — a Shanghai infectious diseases doctor who is sometimes referred to as China’s Anthony Fauci — indicated the rise in infections was due to a reduction in public safety measures post-COVID-19.
“Zhang explained the reason for prevalent respiratory illness infection is because various protective measures such as wearing masks and staying at home in the past years have greatly reduced the incidence of diseases,” the paper reported.
The article went on to detail how the low incidence of diseases has “led to a decrease in the body’s pre-existing antibodies”.
“The doctor noted that this winter, the incidence of respiratory infectious diseases will increase, but China still has the right tools to combat the rise in cases,” it said.
Zhang also said the country had “sufficient technical expertise [and] public health resources” to deal with the current outbreak.
In an effort to keep track of spreading cases, China’s National Health Commission spokesperson Mi Feng has called on local authorities to expand the number of relevant clinics and extend opening hours.
Since mid-October, Chinese authorities have stressed the need to strengthen the capacity of the health system to manage patients, according to WHO, in addition to enhancing disease surveillance in health care facilities and community settings.
“WHO is closely monitoring the situation and is in close contact with national authorities in China,” WHO said.
Health experts are ‘alert but not alarmed’
Since the global pandemic sparked an increase in public health messaging designed to keep people safe, citizens around the world are on higher alert to the spread of viruses and illnesses.
Increased hospital admissions and requests for more information can be alarming, but are an important part of keeping people alert and informed.
“There’s just a huge potential increased risk if there is a serious pathogen that we don’t understand and don’t know how to treat,” Professor Jenkins said.
“So I think transparency, openness, rapid communication and very rapid scientific response and medical response is what’s required.”
China has pointed to the lifting of restrictions as one factor behind the rise in infections, a post-pandemic experience replicated in other countries around the world last year once governments began unwinding public health measures.
In one Australian study, scientists noted how non-pharmaceutical interventions and travel restrictions for controlling COVID-19 had “impacted the circulation of most respiratory viruses, including RSV globally, particularly in Australia”.
Their findings highlighted the need for “continued surveillance and sequencing of RSV and other respiratory viruses … as mitigation measures may disrupt seasonal patterns, causing larger or more severe outbreaks”.
Australia opened its borders to vaccinated travellers in February 2022, almost a full year before China did the same.
This will be China’s first winter with its borders fully open and COVID-19 restrictions lifted.
“They’re in a position where lockdown has now ceased and, of course in China, the lockdown was for a much longer period,” says Karl Minge, from the University of New Haven’s department of population health and leadership.
“So they’re dealing with what most countries dealt with a year or two ago with regard to this uptick in respiratory virus.”
But there are a couple of unusual things about the rise in respiratory infections in China that need to be taken very seriously, according to Professor Jenkins.
One is the fact that this is not just an upper respiratory tract infection, but pneumonia, which is “a very serious illness”, she says.
“Pneumonia is a much more serious illness than most of the common respiratory pathogens that affect people and give them the common cold and similar syndromes in winter,” Professor Jenkins said.
The other cause for concern is the rise in younger patients given little children are “very, very much at risk”, Professor Jenkins adds.
“There are very few treatments that you can give them to open up their airways and perform physiotherapy on them as easily ,” she said.
“[So there are] a range of reasons why pneumonia is very problematic for very little children, say, under the age of two.”
Dr Minges says he isn’t “hugely concerned” given there’s no indication of any new pathogen at this stage.
Professor Jenkins said she was “alert but not alarmed”, noting one of the biggest lessons learned from the COVID pandemic was the importance of early detection.
“I’d say, wait, let’s find out more,” she said.
Can we trust the information coming from China?
Importantly, Chinese health authorities — including representatives from the Chinese CDC and the Beijing Children’s Hospital — held a teleconference with WHO the day after their request for more information was made.
WHO says that data was provided, and while some of these clusters of infections are happening earlier than usual, they were not unexpected given the lifting of COVID restrictions earlier this year.
Chinese authorities have advised WHO there was nothing unusual about how the illnesses were presenting, and most significantly there were no unknown germs or viruses detected.
Dr Minges says while it’s fair to question China’s level of transparency following criticism levelled at Beijing over the origins of COVID-19, China’s conduct so far doesn’t suggest anything untoward.
“The information that they’re providing WHO has been detailed,” he told the ABC.
“I think China is aware that the world’s watching given naturally what happened in 2019 with COVID.
“So there’s no reason to think that anything’s being hidden and most diseases that we’re seeing are similar to influenzas, pneumonias, things that are pretty common after a period of of extreme isolation.”
He says he will be keeping an eye out though for any indication of a mutation — but so far, the path China is currently on resembles the experience of other countries in the year after they lifted restrictions.
“China extended their [COVID-19 policies] far beyond any other country and so for that reason immune systems are suppressed,” Dr Minges said.
“This is what the world went through last year at this exact time.
“An important data point to note is that in 2018/2019, before COVID, the infection rates that [autumn] were very much on par in China with where they are now — in fact, they were even a little higher, and that was pre-COVID.”
Based on the information disclosed to the WHO, its latest advice is for people to continue to do the things we have all become familiar with over the last few years.
That includes maintaining good hygiene practices such as regular handwashing as well as getting vaccinated and staying home when sick.
