What’s the mystery pneumonia making children sick in China? Should the world worry?

China is infamous for giving the world COVID-19. It kept the virus which reportedly originated in Wuhan under wraps and what followed was a pandemic that brought countries to a standstill. Now once again, the Communist nation is under the scanner for another illness: A pneumonia outbreak has escalated in Chinese cities, including the capital Beijing, and hospitals are “overwhelmed with sick children”, according to reports in the media.

It sounds like a story we have heard before. How bad is China’s pneumonia up-surge? Is another pandemic in the making? We explain.

What do we know about pneumonia cases in China?

Like in the case of COVID-19, scientists have once again raised alarm. ProMED, a publicly available surveillance system that monitors disease outbreaks worldwide, issued a public notification on Tuesday reporting an “undiagnosed pneumonia” in children in China. This is the same body that drew the attention of the World Health Organization (WHO) toward a mystery virus in the country in December 2019 – it turned out to be Sars-Cov-2 (the novel coronavirus).

Its latest post is based on a report by Taiwanese news website FTV News, which said that children were flooding hospitals in Beijing and Liaoning, a coastal province in northeast China, with symptoms of high fever and inflammation of the lungs but no cough. Hospitals, the post said, were struggling to cope with the influx of children suffering from pneumonia.

Beijing Children’s Hospital was overcrowded with parents and children seeking treatment, ProMED said in its note.

Wei, a Beijing citizen, told FTV News, “Many, many are hospitalised… They don’t cough and have no symptoms. They just have a high temperature (fever) and many develop pulmonary nodules.”

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“You are not allowed to report to school. If you have symptoms such as fever, cold, cough and then you are hospitalized you can ask for leave,” he added.

Watching this one closely...

Link: https://t.co/gxRuLe4y50 pic.twitter.com/WSm4W2wV1q

— Isaac Bogoch (@BogochIsaac) November 22, 2023

“The situation in Liaoning province is also serious. The lobby of Dalian Children’s Hospital is full of sick children receiving intravenous drips. There are also queues of patients at the traditional Chinese medicine hospitals and the central hospitals,” it added.

ProMed quotes a staff member of Dalian Central Hospital as saying, “Patients have to wait in line for two hours, and we are all in the emergency department and there are no general outpatient clinics.”

Classes in some schools have been cancelled. It’s not only the students who are sick but also the teachers, according to the ProMed statement.

Epidemiologist Eric-Feigl-Dingh shared videos, which he claims are from hospitals in China along with messages from residents in a long thread on X. In the post, he says that the illness started surging in October. “The pneumonia started surging in October… doctors noted also that: “Compared to previous years, we found more patients with mixed infections, **drug resistance**,” he wrote on X.

⚠️UNDIAGNOSED PNEUMONIA OUTBREAK—An emerging large outbreak of pneumonia in China, with pediatric hospitals in Beijing, Liaoning overwhelmed with sick children, & many schools suspended. Beijing Children's Hospital overflowing. 🧵on what we know so far:pic.twitter.com/hmgsQO4NEZ

— Eric Feigl-Ding (@DrEricDing) November 22, 2023

In the editor’s note, ProMed concluded, “This report suggests a widespread outbreak of an undiagnosed respiratory illness … It is not at all clear when this outbreak started as it would be unusual for so many children to be affected so quickly.”

“It is too early to project whether this could be another pandemic…” it added.

What has China said so far?

The state-run China Daily reported a month ago that hospitals were seeing a surge in infections of “mycoplasma pneumoniae”, a pathogen that commonly causes respiratory illnesses among young children.

“Experts have said that the outbreak will likely remain at a peak for another month and suggested families not panic but take necessary precautions such as wearing masks and seeking treatment promptly,” the report said. “The symptoms of the disease usually include a sore throat, fatigue, fever and a lingering cough that can last for months, and the infection is most commonly treated with antibiotics.”

Zhou Huixia, director of the children’s medical centre at the Seventh Medical Center of the Chinese PLA General Hospital, was quoted as saying by China Daily that the number of infections resulting in hospital visits has been rising since May and increased rapidly since August. “The wave has appeared particularly ferocious since the National Day holiday in early October… Compared to previous years, we found more patients with mixed infections, drug resistance and lobar pneumonia.”

“This wave is intense, and we are expecting to experience the peak of the outbreak throughout the next month,” she added.

Beijing’s National Health Commission told reporters last week that the respiratory illness spike was due to the lifting of COVID-19 restrictions and the circulation of known pathogens, including influenza and common bacterial infections that affect children.

China’s capital has “entered a high incidence season of respiratory infectious diseases”, Wang Quanyi, deputy director and chief epidemiological expert at the Beijing Center for Disease Control and Prevention, told state-run outlet Beijing News on Wednesday, according to AFP.

Beijing “is currently showing a trend of multiple pathogens coexisting”, he added.

What has the WHO said?

The World Health Organization (WHO) has asked China for more data on the respiratory illness.

Northern China has reported an increase in “influenza-like illness” since mid-October when compared to the same period in the previous three years, according to the WHO. “WHO has made an official request to China for detailed information on an increase in respiratory illnesses and reported clusters of pneumonia in children,” the UN health body said in a statement on Wednesday.

Meanwhile, WHO has recommended that Chinese residents reduce the risk of respiratory illness, which includes recommended vaccination. Keeping distance from people who are ill, staying at home when ill, getting tested, wearing masks and washing hands regularly are part of the guidelines.

Are there reasons to worry?

Mycoplasma pneumoniae is also known as “walking pneumonia” and it generally affects children. In severe cases, it can deteriorate into pneumonia, according to a report in The Telegraph, UK.

The recent surge has raised concerns about antibiotic resistance, as the bacteria are increasingly sidestepping macrolides, a preferred class of drug. China, the report says, has the world’s highest rate of resistance.

The Telegraph article points to a study from February 2022 that macrolide resistance was identified in more than 80 per cent of mycoplasma pneumoniae in children in China who were hospitalised with the infection.

However, experts say that few children have died from the disease yet. “There is a steady number of patients developing severe cases, but there are very few critical cases, and there are no related deaths so far,” Hua Shaodong, a paediatrician at the Beijing Children’s Hospital, was quoted as saying by China Daily.

With inputs from agencies