by Chinese authorities say they have no evidence that “unusual or novel” pathogens are causing a wave of childhood pneumonia infections in the country.
Health records handed over on Thursday after claims from the World Health Organization showed that Chinese hospitals recorded a rise in children’s cases of the respiratory illness in May, five months before China reported the outbreak.
Doctors in several cities, including Beijing, recently reported an influx of sick children with “undiagnosed” respiratory illnesses, according to ProMed, a public surveillance system that monitors global disease outbreaks.
China’s Centers for Disease Control and Prevention on Thursday denied reports that hospitals were overcrowded.
Doctors and health agencies in China believe that RSV, influenza and mycoplasma pneumoniae, a common bacterial disease known as “walking pneumonia,” are responsible for the rise.
These pathogens, they say, are bouncing back in China’s first post-lockdown winter as part of a trend seen in other countries where population immunity has declined due to strict pandemic restrictions.
But internationally, some have expressed doubts about China’s transparency, amid concerns that an unknown pathogen is responsible for the illnesses.
After issuing an “official request” for more information, WHO said on Thursday it was holding a teleconference with officials from the China Center for Disease Control and Prevention and Beijing Children’s Hospital.
The data provided showed an increase in cases of Mycoplasma pneumoniae pneumonia since May, and RSV, adenovirus and influenza since October.
“Some of these increases are earlier in the season than historically, but not unexpected given the lifting of COVID-19 restrictions, as has happened in other countries,” the WHO said in a statement.
“The Chinese health authorities have not reported any changes in the presentation of the disease.
“The Chinese authorities indicated that no unusual or novel pathogens or unusual clinical presentations were detected.”
The statement noted: “They also said that the increase in respiratory illness has not resulted in the number of patients exceeding hospital capacity.”
Videos show crowded hospitals
Weibo, a Chinese social media site, is abuzz with video clips reminiscent of the early days of the Covid-19 pandemic.
In one video, a large number of parents with intravenous drips above their children’s heads pass through a waiting room in Xi’an, a large city in central China.
Another clip shows hundreds of people queuing in front of Beijing Children’s Hospital, while one photo warns that more than 700 are already arriving to see a doctor.
“Parents, many children are suffering right now,” says the bulletin at a regional hospital. “It takes about 13 hours to wait for treatment.”
Concerns were first raised in an alert from ProMed, which first alerted the world to a mystery virus called Sars-Cov-2 later in December 2019.
The notice indicated that the symptoms reported were not consistent with common pathogens seen in winter, such as RSV, suggesting that an “undiagnosed respiratory illness” may be spreading.
“This report indicates a widespread outbreak of undiagnosed respiratory illness … It is not at all clear when this outbreak began as it would be unusual for so many children to be affected so quickly,” a said a note from the editor.
For many, the alert brought back memories of 2019.
“Last time I saw reports of an outbreak of undiagnosed pneumonia in China [I] think, naa … not much. There won’t be much interest,” 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. Not to make that same mistake again.”
But others say ProMed has reached conclusions, which could be an indication of internal changes.
Over the summer, the International Society for Infectious Diseases – which operates the 30-year-old system – announced plans to move to a subscription-based model amid financial woes. In protest, at least 21 out of 38 paid contributors went on strike.
“ProMed has been struggling to stay current since they screwed all their participants for free by charging a subscription fee,” Professor Ben Cowling, an epidemiologist at the University of Hong Kong, told the Telegraph. “Many of their best contributors left in protest.”
He added that the alert does not appear to be new news, referring to a report in the China Daily about a rise in mycoplasma pneumoniae cases last month.
“I’m pretty sure it’s the same story … it seems [to be] mycoplasma pneumonia plus a general winter surge in all respiratory viruses,” Professor Cowling said, adding that Hong Kong could see a similar rise in acute respiratory infections in the next two to three months.
Inside China – where clips of children connected to an IV drip doing their homework in waiting rooms have gone viral – this is the explanation given by doctors and health authorities.
It’s a trend also seen in countries including the UK and US, as other pathogens have made a comeback due to weakened population immunity after years of suppressed transmission.
Recently, local media have reported a steady increase in infections related to mycoplasma pneumoniae – a bacterium that generally causes mild colds in older children and adults, but triggers pneumonia in younger children. Symptoms can last weeks.
Tong Zhaohui, vice dean of Beijing Chaoyang Hospital, China’s leading medical center for respiratory diseases, said last week that the mycoplasma positivity rate among children has risen to 40 percent, compared to six percent among adults, according to Bloomberg. He added that the germ tends to cause major outbreaks every three to seven years.
On Wednesday, Wang Quanyi, deputy director and chief epidemiology expert at the Beijing Center for Disease Control and Prevention, said in an interview with the outlet run by the Beijing News state. “The multi-pathogen trend is converging”, 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 WHO executive, told the Telegraph.
“[The] The challenge is to identify the outbreaks and determine the cause – there are many different known viruses that can cause them and all of these need to be looked for during testing. At the same time isolation and sequencing will also provide answers.”
However, on Thursday morning, after comments highlighting media reports about the Mycoplasma outbreak, ProMed repeated concerns that the symptoms described in media reports are not consistent with Mycoplasma.
As the world waits for answers, the WHO has urged China to “pursue measures to reduce the risk of respiratory illness”.
“I was very worried when the first reports of the alert came at the end of 2019 and I’m worried now,” Dr. Krutika Kuppalli, an expert in infectious diseases and member of the WHO’s health emergencies team, wrote on X.
“This is the first winter without China [a] strict locking and may be the [increase] in respiratory infections as other countries have done in getting out of lockdown. This could be anything – let’s find out more.”
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