Scientists expected a surge in respiratory disease, but what is happening in China is unusual
China is grappling with a surge in respiratory illnesses, including pneumonia, in children. The World Health Organization (WHO) said last week that common winter infections — rather than any new pathogens — are behind the spike in hospitalizations. A surge of infections was expected in the country this winter, China’s first without COVID-19 restrictions since the pandemic began in 2020. What is unusual, say epidemiologists, is the high prevalence of pneumonia in China. When COVID-19 restrictions were eased in other countries, influenza and respiratory syncytial virus (RSV) drove most spikes in illness.
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The rebound in common respiratory diseases during the first winter after the loosening of pandemic measures — such as mask-wearing and travel restrictions — has been a familiar pattern in other countries. In November 2022, the number of people hospitalized with flu in the United States was the highest it had been for that time of year since 2010.
Nationwide lockdowns and other measures implemented to slow the spread of COVID-19 prevented seasonal pathogens from circulating, giving people less opportunity to build up immunity against these microorganisms, a phenomenon known as ‘immunity debt’, said Francois Balloux, a computational biologist at University College London, in a statement to the UK Science Media Centre. “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 in China,” said Balloux.
However, the Chinese wave of illness differs from that seen in other countries. Some nations grappled with flu and RSV infections during their post-COVID winter surges, but in China, M. pneumoniae infections have been common. This is surprising because bacterial infections are often opportunistic and take hold after viral infections, says Cowling.
Although pneumonia caused by the bacterium is usually treated with antibiotics known as macrolides, an overreliance on these drugs has led to the pathogen developing resistance. Studies show that resistance rates of M. pneumoniae to macrolides in Beijing are between 70% and 90%1. This resistance might be contributing to this year’s high levels of hospitalization from M. pneumoniae, because it can hinder treatment and slow recovery from bacterial pneumonia infections, says Cowling.
Winter surges are always a challenge, but health-care systems in China are better placed to mitigate them now than they were before the pandemic, says Christine Jenkins, a respiratory physician at the UNSW Sydney in Australia. She says that better national disease-monitoring systems, diagnostic tests and measures for impeding transmission and preventing deaths are now in place.
Jenkins adds that even if the infections are caused by known pathogens, it’s important to track them closely to minimize the risk of a serious outbreak of disease. “We are in a very different situation [to COVID-19], but I don’t think we can be complacent,” she says.
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Chinese Hospitals Are Housing Another Deadly Outbreak
Authorities are covering up the spread of antibiotic-resistant pneumonia
In Beijing and other megacities in China, hospitals are overflowing with children suffering pneumonia or similar severe ailments. However, the Chinese government claims that no new pathogen has been found and that the surge in chest infections is due simply to the usual winter coughs and colds, aggravated by the lifting of stringent COVID-19 restrictions in December 2022. The World Health Organization (WHO) has dutifully repeated this reassurance, as if it learned nothing from Beijing’s disastrous cover-up of the COVID-19 outbreak.
There is an element of truth in Beijing’s assertion, but it is only part of the story. The general acceptance that China is not covering up a novel pathogen this time appears reassuring. In fact, however, China could be incubating an even greater threat: the cultivation of antibiotic-resistant strains of a common, and potentially deadly, bacteria.
Fears of another novel respiratory pathogen emerging from China are understandable after the SARS and COVID-19 pandemics, both of which Beijing covered up. Concerns are amplified by Beijing’s ongoing obstruction of any independent investigation into the origins of SARS-CoV-2, the virus that causes COVID-19—whether it accidentally leaked from the Wuhan lab performing dangerous gain-of-function research or derived from the illegal trade in racoon dogs and other wildlife at the now-infamous Wuhan wet-market.
Four years ago, during the early weeks of the COVID-19 outbreak, Beijing failed to report the new virus and then denied airborne spread. At pains to maintain their fiction, Chinese authorities punished doctors who raised concerns and prohibited doctors from speaking even to Chinese colleagues, let alone international counterparts. Chinese medical statistics remain deeply unreliable; the country still claims that total COVID-19 deaths sit at just over 120,000, whereas independent estimates suggest the number may have been over 2 million in just the initial outbreak alone. Now, Chinese doctors are once again being silenced and not communicating with their counterparts abroad, which suggests another potentially dangerous cover-up may be underway.
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Most disturbing, and a fact being downplayed by Beijing, is that M. pneumoniae in China has mutated to a strain resistant to macrolides, the only class of antibiotics that are safe for children less than eight years of age. Beyond discouraging parents to start ad hoc treatment with azithromycin, the most common macrolide and the usual first-line antibiotic for MPP, Beijing has barely mentioned this fact. Even more worrying is that WHO has assessed the risk of the current outbreak as low on the basis that MPP is readily treated with antibiotics. Broader azithromycin resistance in MPP is common across the world, and China’s resistant strain rates in particular are exceptionally high. Beijing’s Centers for Disease Control and Prevention reported macrolide resistance rates for MPP in the Beijing population between 90 and 98.4 percent from 2009 to 2012. This means there is no treatment for MPP in children under age eight.
Fears over a novel pathogen are already abating. After all, MPP is rarely lethal. But antimicrobial resistance (AMR) is. Responsible for 1.3 million deaths a year, AMR kills more people than COVID-19. No country is immune to this growing threat. Since China, where antibiotics are regularly available over the counter, leads the world in AMR, it is inconceivable that this issue hasn’t yet come up, particularly during WHO’s World AMR Awareness week, from Nov. 18 to Nov. 24.
Any infectious disease physician would want to know: Did WHO asked China the obvious question—what is the level of azithromycin resistance of M. pneumonia in the current outbreak—and include the answer in its risk assessment? Or did it ask about resistance to doxycycline and quinolones, antibiotics that can be used to treat MPP in adults? Even if WHO did ask, China isn’t telling, and WHO isn’t talking.
China’s silence isn’t surprising. Its antibiotic consumption per person is ten times that of the United States, and policies for AMR stewardship are predominantly cosmetic. While surveillance is China’s strong point, reporting is not.
Despite Spring Festival, the Chinese celebration of the Lunar New Year and another peak travel period, approaching in February 2024, WHO hasn’t advised any travel restrictions. It should have learned the danger of accepting Beijing’s statements at face value. Four years ago, Beijing’s delay enabled more than 200 million people to travel from and through Wuhan for Spring Festival. That helped COVID-19 go global. Since China’s AMR rates are already so high, importing AMR from other countries isn’t a major concern for China. Export is the issue, and China’s track record in protecting other countries is abysmal.
Rather than repeating the self-serving whitewashing coming from Beijing, WHO should be publicly pressing China about the threat of mutant microbes. Halting AMR is essential. Before antisepsis and antibiotics, surgery was a treatment of last resort. Without antibiotics, we lose 150 years of clinical and surgical advances. Within ten years, we are at risk of few antibiotics being effective. It may not be the novel virus that people were expecting, but the next pandemic is already here.
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US Senators Urge Biden to Ban Travel from China Amid Mysterious Pneumonia Outbreak
A coalition of United States Senators, including Rick Scott (R-FL), Marco Rubio (R-FL), Tommy Tuberville (R-AL), Mike Braun (R-IN), and J.D. Vance (R-OH), have sent a compelling letter to President Joe Biden, urging an immediate travel ban from China in response to a recent outbreak of a mysterious pneumonia-like illness.
“In light of an unknown respiratory illness spreading throughout the People’s Republic of China (PRC), we call on you to immediately restrict travel between the United States and the PRC,” the Senators wrote in their letter.
The Senators expressed concerns about the disease’s unknown nature and the Chinese Communist Party’s (CCP) history of misinformation, particularly referencing the initial handling of the COVID-19 pandemic.
They noted that similar action was taken by President Trump on January 31, 2020, during the early stages of COVID-19, which they argue was a necessary measure despite criticism at the time.
“On January 31, 2020, President Trump issued an order to restrict travel from the PRC into the United States to protect the American people and counter the spread of COVID-19. Many officials and commentators—including you—criticized his decision as being influenced by “xenophobia.” But history and common sense show his decision was the right one,” the Senators added.
China has seen the emergence of several significant viruses in recent history, raising concerns about public health and highlighting the need for enhanced surveillance and prevention efforts. Here’s a look at some of the most notable outbreaks:
1957-1958: The Asian Flu (H2N2), a pandemic responsible for the deaths of an estimated 1 million people worldwide. While the exact origin is debated, it’s believed to have originated in China.
1968-1969: The Hong Kong Flu (H3N2) pandemic, which killed an estimated 1 million people, also likely originated in China.
1997-2004: The H5N1 (bird flu) virus, which continues to cause sporadic outbreaks in humans, first emerged in China in 1996.
2002-2003: SARS (Severe Acute Respiratory Syndrome), caused by the SARS-CoV coronavirus, emerged in Guangdong province and spread to 26 countries, infecting over 8,000 people and causing over 770 deaths.
2009: The Swine Flu (H1N1) pandemic, originating in North America, spread globally, with China experiencing its own outbreak.
2013: Porcine Pestivirus, a virus affecting pigs, emerged in China and raised concerns for potential zoonotic transmission.
2019-present: COVID-19 (SARS-CoV-2), another coronavirus, emerged in Wuhan, China, and quickly spread worldwide, causing a global pandemic.
Amidst reports of this unidentified disease, which has overwhelmed hospitals in northern China, particularly affecting children, the Senators are calling for proactive measures.
The WHO has requested detailed data from China, but the Senators remain skeptical of the transparency and cooperation of the Chinese Communist Party (CCP), citing historical precedents.
“The World Health Organization (WHO) says it is unclear if the disease is due to an overall increase in respiratory infections or separate events. If history is any indication, we have cause to be concerned,” the Senators noted.
“The WHO has requested that the CCP share “detailed information” about the mystery illness. However, CCP has an incentive to lie, just as they did throughout the COVID-19 pandemic and any new pathogen could derail its efforts to stimulate its economy.”
“Besides, we should not wait for the WHO to take action given its track record of slavish deference to the CCP. We must take the necessary steps to protect the health of Americans, and our economy. That means we should immediately restrict travel between the United States and the PRC until we know more about the dangers posed by this new illness. A ban on travel now could save our country from death, lockdowns, mandates, and further outbreaks later.”
Senator Marco Rubio emphasized the urgency of the situation: “[W]e should not wait for the WHO to take action given its track record of slavish deference to the [Chinese Communist Party]. We must take the necessary steps to protect the health of Americans, and our economy.”
“That means we should immediately restrict travel between the United States and the [People’s Republic of China] until we know more about the dangers posed by this new illness. A ban on travel now could save our country from death, lockdowns, mandates, and further outbreaks later.”
The mysterious illness, predominantly affecting school-aged children in China, is causing alarm due to its swift escalation and atypical symptoms. Reports from the Daily Mail indicate children are being hospitalized in large numbers, with alarming symptoms of high fevers and lung inflammation, but without the typical respiratory symptoms such as coughing, leading to the term “undiagnosed pneumonia.”
Similar cases have now emerged in the United States, with physicians in Ohio and Western Massachusetts reporting an “extremely high” number of children diagnosed with a strain of pneumonia that has been nicknamed “white lung syndrome” due to its distinctive radiological appearance.
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House panel on China says CDC failed to test viruses from Reedley lab. What went wrong?
Illegal lab in California warehouse
A congressional committee investigating Chinese communist influence blames gaps in the U.S. regulatory framework for allowing a “wanted fugitive” to set up a clandestine biological laboratory in Reedley last year. The U.S. Centers for Disease Control was also faulted by the House Select Committee on the Chinese Communist Party for its “baffling” and “unacceptable” response to Reedley city officials who sought the agency’s help identifying thousands of vials of suspected contagions inside the warehouse.
The committee’s conclusions were included in a 41-page report released Wednesday in Washington, D.C. The report specifically criticizes the Centers for Disease Control for refusing to test the biological material found in refrigerators and freezers at the Reedley site, instead relying on labels on containers to determine that the lab contained samples of various infectious viruses, bacteria and parasites that include chlamydia, streptococcus, hepatitis B and C, HIV, rubella, malaria and COVID-19. The report states that “CDC’s refusal to test left local officials unable to assess the danger to the … Reedley community or inform the community about what steps, if any, it should take to protect public safety.”
The report is based on evidence obtained through a subpoena served on the city of Reedley in September and subsequent interviews by investigators. It amounts to thousands of pages of documents seized from the warehouse where Universal Meditech Inc. set up shop on I Street in downtown Reedley, hundreds of photographs taken inside the warehouse, and hours of video. “This evidence, alongside interviews of local officials and other investigative steps, revealed troubling gaps in federal pathogen safeguards,” the report states. “Those gaps allowed a wanted fugitive from Canada, who is a (People’s Republic of China) national who had previously stolen millions of dollars of American intellectual property, to operate an illegal facility” in Reedley.
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