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

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).

A Beijing children’s hospital 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 the respiratory illnesses and reported clusters of pneumonia in children.

It is rare for the UN health agency to publicly seek more detailed information from countries, as such requests are typically made internally. The agency’s China office said this was a “routine” request.

Chinese health authorities later said they found no “unusual or novel diseases”.

They said the rising infections are a mix of already known viruses and are linked to the country’s first full cold season after strict Covid restrictions were lifted last December.

The lifting of the curbs, along with the circulation of known pathogens like mycoplasma pneumoniae, may have contributed to increasing cases of such illnesses, suggested the authorities.

The WHO 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, that is run by health experts, had earlier in 2019 raised the alarm over the virus that causes Covid.

“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.”

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.