Chinese authorities say they have no evidence that “unusual or new” pathogens are causing a surge in childhood pneumonias in the country.
Health records provided on Thursday at the request of the World Health Organization showed that Chinese hospitals first recorded a rise in cases of respiratory disease in children in May, five months before China reported the increase.
Doctors in a number of cities, including Beijing, have recently reported an influx of children sick with an “undiagnosed” respiratory illness according to ProMed, a public surveillance system that monitors global disease outbreaks.
China’s Center for Disease Control and Prevention on Thursday denied reports that hospitals were overwhelmed.
Doctors and health authorities in China believe that RSV, influenza and mycoplasma pneumoniae, a common bacterial disease also known as ‘walking pneumonia’, are responsible for the surge.
These pathogens, they say, are returning in China’s first post-lockdown winter, part of a trend seen in other countries where strict pandemic restrictions led to weakened population immunity.
But internationally, some have raised doubts about China’s transparency amid concerns that an unknown pathogen is responsible for the illnesses.
After issuing an “official request” for more information, the WHO said Thursday it was holding a teleconference with officials from the Chinese Center for Disease Control and Prevention and Beijing Children’s Hospital.
The data provided indicated an increase in the number of cases of Mycoplasma pneumoniae pneumonia since May, and of RSV, adenovirus and influenza virus since October.
“Some of these increases are occurring earlier in the season than historically, but are not unexpected given the lifting of COVID-19 restrictions, as is the case in other countries,” the WHO said in a statement.
“No changes in disease presentation were reported by Chinese health authorities.
“Chinese authorities have said that no unusual or novel pathogens or unusual clinical presentations have been detected.”
The statement noted: “They further stated that the increase in respiratory diseases has not caused the patient load to exceed hospital capacity.”
Videos show overcrowded hospitals
Weibo, a Chinese social media site, is full of video clips reminiscent of the early days of the Covid-19 pandemic.
In one video, a busy line of parents holding intravenous drips above their children’s heads weaves through a waiting room in Xi’an, a major city in central China.
Another clip shows hundreds of people wearing face masks queuing outside Beijing Children’s Hospital, while a photo warns that more than 700 people are already queuing to see a doctor.
“Dear parents, many children are suffering right now,” reads the bulletin from a regional hospital. “It takes about 13 hours to wait for treatment.”
Concerns were initially raised in an alert from ProMed, which first alerted the world to a mysterious virus later named Sars-Cov-2 in December 2019.
The notice suggested that the reported symptoms were not consistent with common pathogens seen in winter, such as RSV, indicating that an “undiagnosed respiratory disease” may be spreading.
“This report suggests a widespread outbreak of an undiagnosed respiratory disease… It is not at all clear when this outbreak began as it would be unusual for so many children to be affected so quickly,” an editor said.
For many people, the warning brought back memories of 2019.
“The last time I saw reports of an outbreak of undiagnosed pneumonia in China [I] thought, naa… no problem. That won’t amount to much,” Dr. Neil Stone, an infectious disease specialist at University College Hospital in London, wrote on X, formerly known as Twitter.
“That was in December 2019. Don’t make that same mistake again.”
But others say ProMed has drawn hasty conclusions, possibly reflecting internal changes.
In the summer, the International Society for Infectious Diseases – which runs the 30-year-old system – announced it planned to switch to a subscription-based model amid financial problems. In protest, at least 21 of the 38 paid contributors went on strike.
“ProMed has been struggling to stay on top of things since they annoyed all their free contributors by charging subscription fees,” Prof. Ben Cowling, an epidemiologist at the University of Hong Kong, told the Telegraph. “Many of their top contributors left in protest.”
He added that the warning “does not appear to be new news,” referring to a report in China Daily about a rise in cases of mycoplasma pneumoniae last month.
“I’m pretty sure it’s the same story… it seems [to be] mycoplasma pneumonia plus a general winter surge of all respiratory viruses,” Prof Cowling said, adding that Hong Kong could see a similar rise in acute respiratory infections over the next two to three months.
In China – where clips of children hooked up to IVs and doing their homework in waiting rooms have gone viral – this is the explanation given by doctors and health authorities.
It is a trend that has also been observed in countries such as Britain and the US, as other pathogens have rebounded due to weakened population immunity after years of suppressed transmission.
Recently, local media have reported a steady rise in infections linked to mycoplasma pneumoniae – a bacteria that usually causes mild colds in older children and adults but can cause pneumonia in younger ones. The symptoms can last for weeks.
Tong Zhaohui, vice dean of Beijing Chaoyang Hospital, China’s top medical center for respiratory diseases, said last week that the mycoplasma positivity rate among children has risen to 40 percent, compared with just six percent among adults, according to Bloomberg. He added that the disease causes major outbreaks every three to seven years.
On Wednesday, Wang Quanyi, deputy director and chief epidemiological expert at the Beijing Center for Disease Control and Prevention, added that the city has “entered a season with high incidence of respiratory infectious diseases” in an interview with state-owned Beijing News. There is a “trend of multiple pathogens coexisting,” he said.
“It is important to consider that there is probably a background of seasonal respiratory infections,” David Heymann, professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine and former director of the WHO, told the Telegraph.
“[The] The challenge is to distinguish the outbreaks and determine the cause. There are many different known viruses that could be the cause and these should all be examined during testing. At the same time, isolation and sequencing will also provide answers.”
However, on Thursday morning, after adding commentary highlighting media reports of the Mycoplasma outbreak, ProMed reiterated its concern that the symptoms described in the media reports are not consistent with Mycoplasma.
As the world waits for answers, the WHO has urged China to “follow measures to reduce the risk of respiratory diseases”.
“I was very concerned when the first reports of the alert came in at the end of 2019 and I am concerned now,” wrote Dr. Krutika Kuppalli, an infectious disease expert and member of the WHO health emergencies team , on X.
“This is China’s first winter without it [a] strict lockdown and they would have a [increase] in respiratory infections, as other countries did when they came out of lockdown. This could be anything – let’s get more information.”
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