How the New Outbreak in China Is Affecting the US and Other Regions

The social media images from China are a heart-rending déjà vu with photos of young children connected to intravenous lines receiving fluids from overcrowded hospital waiting rooms.

For a world still reeling from the recent coronavirus pandemic, news from China about a sudden rise in respiratory ailments has prompted understandable concern.

Just 4 years ago, a mysterious respiratory illness started to spread in China (SARS-CoV-2), and a lack of transparency by government officials cost other countries needed time to prepare.

In Beijing, worried parents seeking help for their children are having to wait at least a day, even for emergency care. The Chinese Center for Disease Control and Prevention reported more than 3500 cases of respiratory infection admitted to the Children’s Hospital.

In Liaoning Province, almost 500 miles away from Beijing, there are more reports of sick children overwhelming hospitals.

Chinese media blame the outbreak on mycoplasma pneumonia, sometimes called walking pneumonia, which is a bacterial infection that usually causes upper respiratory tract symptoms but can also prompt more serious lung issues and pneumonia.

In the United States, the weekly percent of emergency department visits for children with diagnosed pneumonia was about 2% as of the latest Centers for Disease Control and Prevention (CDC) report November 25, 2023, which is average for this time of year, although the agency is already reporting a slight increase above typical levels for children aged 5-17 years.

Sick Children

Chinese authorities from the National Health Commission held a news conference on November 13, 2023 to talk about the new rise in respiratory illnesses. Colder weather paired with China lifting stringent COVID restrictions has authorities attributing the latest wave of illness to what is sometimes called an immunity gap with an anticipated surge of circulating known pathogens.

But troublingly, a Program for Monitoring Emerging Diseases (ProMed) report noted that many of the children in China were not coughing and didn’t really have other symptoms other than a high fever. Some children developed pulmonary nodules.

This has prompted specialists to question whether these new clusters could be evidence of undiagnosed pneumonia caused by a novel pathogen.

Since mid-October 2023, the World Health Organization has monitored data from Chinese surveillance systems showing increases in respiratory illnesses. And on November 22, the United Nations health agency asked China to provide more epidemiologic and clinical information and lab results from these reported cases as well as data about recent trends in circulating respiratory pathogens.

By November 24, China reported no unusual or novel pathogens in the clusters of pneumonia cases.

The CDC has a small office in China that is working with local scientists. Reassuring, perhaps, is the fact that cases are predominantly in children, which seems to point away from this being a novel pathogen. Something new like a never-before encountered pandemic-spurring disease would leave everybody susceptible so cases might cut across age groups more than what we are seeing from these first reports from China.

“We are in touch with our counterparts in China and we believe there is no new or novel pathogen,” Mandy Cohen, MD, director of the CDC told the House Committee on Energy and Commerce. “These are related to existing pathogens: COVID, flu, [respiratory syncytial virus (RSV)], and mycoplasma.”

Cohen said that her team was able to corroborate this information across other sources, including European Union partners.

Cases in Europe

In Denmark, mycoplasma pneumonia activity is rising across the country, with 541 cases reported last week: triple that of the middle of October 2023.

A common bacterial cause of pneumonia is mycoplasma pneumonia, the so-called white lung, being talked about in China. White lung refers to the patches that light up on chest radiographs of those affected by the illness. Another bacterial cause is streptococcus pneumonia and viral causes of pneumonia are very common too, coming from circulating flu viruses, RSV, and SARS-CoV-2, the virus that causes COVID.

Other countries already saw increases in respiratory illnesses after easing pandemic measures like China has now. And in the US, a tripledemic of the flu, RSV, and COVID filled hospitals in multiple states. Today, “COVID is still the primary cause of new respiratory hospitalizations and deaths in the US,” Cohen said, “with about 15,000 hospitalizations and 1000 deaths every week.”

Macrolides, tetracyclines like doxycycline, and fluoroquinolones are typically the antimicrobials of choice for mycoplasma pneumonia. However, macrolide resistance has been reported worldwide, especially in Asia, where resistance rates of over 90% have been reported in China.

“We’re following up through our clinical networks and working with clinicians in China to better understand resistance to antibiotics,” Maria Van Kerkhove, PhD, COVID-19 Technical Lead at the World Health Organization told reporters. “It’s a problem across the world but is a particular problem in the Western Pacific and Southeast Asia region,” she said.

Syra Madad, DHSC, MSc, MCP, CHEP, an infectious disease epidemiologist at Harvard’s Belfer Center for Science and International Affairs and the New York City Hospital System, commented that we live in a new world where close monitoring of threats to human health is “essential.”

Hospital care to seek treatment is really the last line of very costly defense, she told Medscape Medical News. “Where parents like me and like you have to put our attention is on prevention to make sure we’re protecting our children.”

We have the tools, she said, “on the front end, we have vaccines and therapeutics, but we have so much more work to do in public health and how we communicate with people so they know how to keep themselves and their loved ones safe.”