How Worrisome is the Surge in Respiratory Illnesses in China?

There has been a significant increase in the number of children with respiratory illnesses, such as pneumonia, in hospitals in northern China and Beijing. The World Health Organization has requested more information from China regarding these cases. How serious are these cases? What could be causing the surge in respiratory illnesses? Should travelers reconsider their plans to visit China? What additional measures should be taken by governments, health systems, and individuals?

I consulted Dr. Leana Wen, a medical expert in wellness from CNN, to gain insight into the situation. Dr. Wen, an emergency physician and professor at the George Washington University, previously held the position of Baltimore's health commissioner. CNN: How worried should we be about the increase in respiratory illnesses in China?

Dr. Leana Wen explains that the increased respiratory illnesses do not seem to be a cause for global concern, based on information from the WHO. She notes that the most worrisome scenario would be the emergence of a new pathogen, similar to what happened with Covid-19 in 2019. However, current data from Chinese health authorities suggests that the rise in respiratory illnesses is due to known pathogens like Mycoplasma pneumoniae, influenza, adenovirus, and respiratory syncytial virus (RSV). WHO attributes these spikes to the lifting of Covid-19 restrictions, which has been observed in other countries as well.

There have been no new pathogen detections and no unusual clinical presentations, with children not appearing any sicker than usual. CNN questions why China is experiencing a sudden surge.

Sick children, accompanied by their parents, receive infusion treatment at the People's Hospital in Fuyang, China, on November 28, 2023.

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Wen emphasized the importance of independent verification of these data points by WHO and other international medical community members, particularly due to the delay in alerting the global community about Covid-19 by Chinese authorities. However, the situation in China is reflective of what occurred in the United States and numerous other countries last year.

During the winter of 2022, children's hospitals in the US were overwhelmed with cases of Covid-19, flu, RSV, and other common viruses. The increase in illness was linked to the relaxation of Covid-19 mitigation measures. At the height of the pandemic, instances of respiratory illnesses significantly decreased, sparing many children from the regular yearly infections. However, when the mitigation measures were lifted, contagious illnesses spread rapidly through schools and daycares, resulting in a spike in childhood infections and hospitalizations.

China implemented its mitigation measures later than the US and many other countries. Therefore, it is logical that they would see an increase in respiratory illnesses during their first full winter since ending the "zero Covid" policy, similar to the experience of much of the world. According to CNN, Chinese health authorities are linking the rise in pediatric pneumonia cases to Mycoplasma pneumoniae.

Pneumonia is a lung infection that can be caused by bacteria, viruses, and fungi. Mycoplasma pneumoniae is a common type of bacterial pneumonia. It is estimated that around 1% of the population in the US is infected with Mycoplasma every year. Only 5% to 10% of those infected with Mycoplasma will develop pneumonia.

A pharmacy in New York City offers vaccines for COVID-19, flu, shingles and pneumonia on December 6, 2021.

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Pneumonia caused by Mycoplasma is known as "atypical" pneumonia. Symptoms usually start slowly, with patients experiencing non-specific symptoms such as mild fever, fatigue, and headaches. Some individuals may also have a persistent cough or chest discomfort from coughing. Sore throat, runny nose, and ear pain are also possible, and in rare cases, a rash, joint pain, and gastrointestinal symptoms could develop.

The US Centers for Disease Control and Prevention states that Mycoplasma pneumoniae infections are prevalent among young adults and school-age children, especially those in crowded settings like schools. While most patients can be treated with outpatient antibiotics and do not require hospitalization, the very young, elderly, immunocompromised individuals, and those with severe underlying medical conditions are at higher risk for severe illness.

CNN: Is it possible that pneumonia cases are caused by other organisms?

Wen: Yes, pneumonia can also be caused by the bacteria Streptococcus. Additionally, viruses such as RSV and Covid-19 can also lead to pneumonia. Health care facilities typically try to diagnose the cause of pneumonia and determine whether it is bacterial or viral, but diagnostic capabilities may be limited in some areas. It can also be difficult to attribute pneumonia to a single organism, especially if a person has multiple infections at once.

CNN: Should people avoid travel to China at this point?

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According to the WHO, imposing travel or trade restrictions based on the current situation is not recommended. While no specific preventive measures for travelers to China are advised, people in China are encouraged to take actions to minimize the spread of respiratory illness. This includes staying home when sick, maintaining good ventilation, practicing frequent handwashing, and using masks when necessary.

What additional precautions should governments and health systems take, especially those in the rest of China and neighboring countries? I believe these measures are reasonable, and I would also suggest that individuals at high risk for severe respiratory illness consider taking extra safety measures, such as wearing an N95 mask or a similar equivalent when in crowded indoor spaces.

I concur with the WHO's stance that imposing restrictions on travel and trade is not warranted at this time. However, it is important for the WHO to continue urging China to provide timely and accurate data disclosures.

In the interim, governments and hospitals should strengthen their own infrastructure. They should remain vigilant for an increase in cases of influenza-like illnesses and pneumonia and ensure prompt testing.

Health systems must also guarantee their ability to care for patients requiring hospitalization. There is a high likelihood that regions, particularly those with previously stringent virus containment policies, will experience an increase in respiratory illnesses this coming winter. Health systems should ready themselves for a potential surge in patients, similar to what occurred during the height of the Covid-19 pandemic.