Such accounts elicit shudders among many who experienced the trauma of the covid-19 pandemic. After all, it was just four years ago that a mysterious respiratory illness started to spread in China, and a lack of transparency by government officials cost other countries precious time to respond to it.
Though the sense of déjà vu is understandable and caution is certainly warranted, I do not believe the situation is a repeat of 2019. There is a far more likely explanation than yet another novel pathogen threatening to upend global health.
After reviewing data provided by Chinese health authorities, the WHO stated that the rise in respiratory infections is consistent with increased spread of existing bacteria and viruses. For months, there has been an uptick in a common bacteria pneumonia caused by the organism Mycoplasma pneumoniae. This has been compounded by a more recent rise in respiratory syncytial virus (RSV), influenza, adenovirus and other common viruses.
The WHO says such increases are “not unexpected given the lifting of covid-19 restrictions, as similarly experienced in other countries.” This sentence, I think, encapsulates what is happening in China.
Throughout the coronavirus pandemic, China had the most restrictive virus-mitigation protocols in the world. Horror stories abounded of residents being barricaded into their apartments and not allowed to leave, even during deadly fires or for medical emergencies. Few other countries pursued a zero-covid policy like this; most abandoned strict mitigation measures by 2021 or early 2022.
China only emerged from lockdowns last December. That means this will be its first full winter since ending “zero covid,” so it shouldn’t be surprising that the country is now experiencing a jump in respiratory illnesses.
Recall that this is what the United States experienced last winter. At the time, the heads of the American Academy of Pediatrics and the Children’s Hospital Association wrote an urgent plea to President Biden to declare a state of emergency because pediatric hospital beds were so limited. The tripledemic of flu, covid and RSV and the reemergence of other common viruses were sickening children in alarming numbers. In some states, more than 90 percent of pediatric beds were full, and desperate families waited in emergency rooms for many hours.
Experts believe that surge was a result of reduced immunity resulting from earlier mitigation measures that protected not only against the coronavirus but also other pathogens. Children who would have been exposed to these illnesses were not because of remote learning and distancing. So once those restrictions were lifted, it was not uncommon for a child to test positive for multiple viruses and bacterial illnesses at once. While most children recovered quickly, an abnormally high number became seriously ill, straining health systems.
This pattern was seen around the world. In Canada, as documented in a JAMA Network Open study, the average number of RSV-associated hospitalizations before covid was about 2,500. There were just 58 hospitalizations in the first full winter of the pandemic. Then there was a rebound effect, with 3,170 hospitalizations in the 2021-2022 winter season.
China is likely experiencing a similar rebound effect now, a year or two after other countries. Its uptick in cases is probably not because of a new pathogen, but rather a resurgence of existing ones. While Chinese social media reports of overcrowded ERs are harrowing, they are also reassuring because of what they have not documented: strange or new symptoms or larger numbers of children requiring intensive care or dying.
There is another social and cultural factor that the international community must consider as it processes the increase in Chinese patients seeking medical care: China has limited primary-care infrastructure. Many residents believe their local clinic is insufficient and that they need to go to the ER if they become ill. It’s also common practice to seek intravenous infusions and in-hospital care for ailments that Americans would treat at home with oral medications. This is another reason why recent clusters of cases have not been deemed unusually severe.
None of this is meant to downplay the seriousness of a potential new global health threat, which could arise at any moment. The WHO must continue to monitor the situation in China, including to assess whether it could be related to the newly reported spike in pediatric pneumonia cases in the Netherlands. I also think it’s important to approach anything the Chinese government says with a healthy dose of skepticism.
But based on the facts we know now, China’s surge in pediatric respiratory illnesses mirrors what other countries have seen in past seasons and should prompt attention and vigilance — not panic and alarm.
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