Some scary news has emerged from China in the past few weeks: on November 23, the World Health Organisation (WHO) issued a statement about an increase in respiratory symptoms in various hospitals across the northern part of the country.
The statement was backed up by alarming pictures of overcrowded hospitals full of children with oxygen masks and getting intravenous fluid, and details that the Beijing Children’s Hospital was receiving more than 9,000 new patients a day.
Reading these reports sent shivers down my spine. It was a replay of similar stories back in late December 2019, when news of what turned out to be Covid first hit.
I’ll be honest, back then I initially dismissed those stories, thinking that this was a contained outbreak involving a relatively small number of patients, served up with a significant dose of alarmist hype.
I very quickly realised how wrong I was.
Children receive a drip at a children hospital in Beijing on November 23, the same day the World Health Organization issued a statement about an increase in respiratory symptoms in the country
So this time when reading the reports from China, knowing I’d been mistaken in my previous initial pandemic predictions, I looked at the story with a much more critical eye to the detail. The question is: should we in the UK be worried?
The first details were published by the International Society for Infectious Diseases in their Promed (Programme for Monitoring Emerging Diseases) report of November 21, showing there were clusters of new infections occurring at various sites across northern China.
The next day, the WHO had a teleconference with the Chinese health authorities to ascertain what was happening. They in turn provided data which could explain what was going on and that there was no need for panic. This data revealed there’d been a significant rise in the amount of winter viruses circulating in the population since October.
These viruses included RSV — respiratory syncytial virus — adenovirus and influenza. These viruses most often affect children, because they’ve not been exposed to them before, or those most vulnerable to infections, such as the elderly.
An increase in cases is to be expected every winter — but I believe that this spike is so much larger because of the way China managed its Covid response; severe lockdown and then its sudden opening up of society.
This means that many children were not exposed to these viruses and there was no build-up of immunity, leading to the sudden explosion of cases.
A similar thing (but to a lesser extent) happened this year in early January in the UK, when paediatric wards and A&E departments (where I work) were full of children with respiratory infections. However, as predicted, the numbers fell as quickly as they dramatically rose. But this couldn’t explain the whole picture of what’s going on in China.
The data showed there was also an increase in infections with a bacterium called Mycoplasma pneumoniae, which can cause a nasty pneumonia.
The number of children infected with this had been rising since May; then there were rising cases of co-infections — where the children got the bacterial and viral infections simultaneously — thanks to the increasing amounts of viruses circulating in the population (blame winter weather and people spending more time indoors in close proximity).
Although pneumonia caused by the bacterium is usually treated with a specific type of antibiotics called macrolides (e.g. clarithromycin and erythromycin), excessive use of these drugs has led to the strain of bacteria that’s dominant in Beijing being antibiotic resistant. Indeed over the past 15 years in Beijing, 70-90 per cent of cases of infection with Mycoplasma pneumoniae were due to strains resistant to these antibiotics. But what’s really significant is that the cases in China have been linked to a known cause — unlike with Covid-19 initially, where we had no idea what was driving it.
This would also explain why this time it’s children suffering the most — adults have been exposed to these infections before and so have a built-up immunity and aren’t getting as sick.
A woman receives a dose of the Moderna coronavirus disease (COVID-19) vaccine at a vaccination site in New York in 2021
Another possible explanation for the rise in cases is that, as a reult of Covid, the population has a reduced ability to fight infection. While for most people, the immune system is restored to normal after a simple bout of Covid, those who had a severe episode and/or developed long Covid are at risk of having an altered immune response. But again, severe Covid is so rare in children that it cannot be a contributor to the rise in cases of respiratory symptoms seen in China.
And then there are those pictures on TV of the children in China in the wards. They have oxygen and intravenous fluids — things we would only give very sick patients, but they are sitting up looking quite well and doing homework.
This is not something that I have seen in the hospitals I have worked in. Maybe some of the numbers in hospital are a reflection of different medical ways of caring for patients, rather than the start of a new pandemic. So I am as confident as you can be that what we’re seeing in China is a rise in usual respiratory infections following the sudden changes in lockdown rules.
I don’t believe it’s due to past Covid infections, nor is it a new virus about to start a worldwide pandemic worse than Covid.
Once again, I believe that this is a relatively small number of patients but in a contained outbreak, served with a significant dose of hype.
My assessment is based on an interpretation of the data and science. I’m conscious, though, that any thinking can be influenced by a phenomenon known as optimism bias: an unconscious bias which influences how we think so we come to the conclusion we want to happen. And I definitely don’t want to experience another pandemic.
And of course, my opinion is based on the facts we have now and on the caveat that the information we have is true.
As new information becomes available, my opinion will change with the new evidence — just as it did when the extent of the Covid outbreak became apparent.
But it’s not just me who is thinking like this about the recent outbreak in China: Benjamin Cowling, an epidemiologist at the University of Hong Kong and a leading expert on transmission of infections, said in an interview after the data from China was released that this ‘is a typical winter surge’ in acute respiratory infections.
‘It is happening slightly earlier this year, perhaps because of increased population susceptibility to respiratory infections resulting from three years of Covid measures,’ he said.
PROFESSOR ROB GALLOWAY: As new information becomes available, my opinion will change with the new evidence — just as it did when the extent of the Covid outbreak became apparent
Meanwhile, Francois Balloux, a computational biologist at University College London, stated: ‘Since China experienced a far longer and harsher lockdown than essentially any other country on Earth, it was anticipated that those ‘lockdown exit’ waves could be substantial there.’
Zania Stamataki, one of the UK’s leading experts in this field, works as an associate professor in viral immunology at Birmingham University — she told the BMJ on November 23: ‘There is currently no evidence that the increase in paediatric pneumonia cases in China may be due to a new virus.’
All reassuring words from world-renowned experts. So don’t panic about what’s happening in China.
But there’s no doubt that we’ll face a new pandemic at some point and what I can predict with confidence is that the time bomb of the next pandemic is ticking.
The problem is that we do not know when this bomb will explode — it could be next year, it could be in 100 years.
All we can do is plan; learn the lessons from Covid-19, invest in the systems needed to get early detection of the start of pandemics and increase the resilience of the health service so that it can cope better when the next pandemic really does hit.
@drrobgalloway
