In recent weeks, pediatric hospitals across China have been inundated with patients suffering from a variety of respiratory illnesses, causing growing alarm across the country and internationally.

The public health crisis in China began in mid-October and has only worsened. On October 23, a social media post from a parent in the Pediatrics Department at Tianjin Medical University General Hospital noted that there were 100 people in line, and they had to wait for three hours for their child to be seen by a doctor. A comment replying to the post stated that more than 900 patients were in line at the door of Tianjian’s Children’s Hospital, while another noted that more than 2,000 children were then on intravenous therapy at Beijing Children’s Hospital roughly 85 miles away.

A man comforts a child at a children's hospital in Beijing. [AP Photo/Dake Kang]

By mid-November, there were growing reports of schools being forced to close due to the spread of disease. Under a November 13 social media post on schools closing in Shenzhen, numerous comments were left sharing similar experiences from Yunnan, Shandong, Beijing, Guangdong, Jilin and Hebei.

Over the past week, reports have indicated a further deterioration of the situation.

On November 19, officials at the China-Japan Friendship Hospital in Beijing announced, “The number of patients waiting to be seen in pediatrics now exceeds 400, and the wait time is estimated to be over 6 hours. We suggest going to nearby pediatric clinics to help reduce the pressure here.” Similar wait times and experiences were reported at Capital Institute of Pediatrics in Beijing, as well as other hospitals throughout the country.

It is not yet clear what pathogen or pathogens are responsible for the deluge of child hospitalizations, but government reports are stating that the primary infection spreading has been mycoplasma pneumoniae, as well as influenza, adenovirus, respiratory syncytial virus (RSV), and SARS-CoV-2, the virus that causes COVID-19.

There is also speculation that the spike in hospitalizations could be attributable to the fact that mycoplasma pneumoniae is acquiring resistance to the macrolides class of antibiotics. In recent years, China has experienced a greater degree of antibiotic resistance than most countries, with reports that Zithromax, the most widely prescribed macrolide in the country, is now ineffective in up to 80 percent of children.

Finally, there are also concerns that a dangerous novel pathogen or influenza, A/H9N2 (bird flu), could unknowingly be spreading due to inadequate public health surveillance in China. The possibility of H9N2 circulating was raised by Epiwatch, an Australia-based artificial intelligence-driven pandemic early warning system, which detected reports of possible H9N2 infections.

On Tuesday, the Program for Monitoring Emerging Diseases (ProMED), one of the largest publicly available emerging diseases and outbreak reporting systems in the world, published an abridged version of a report on the crisis from Taiwan-based media outlet FTV News, with commentary from ProMED Rapporteur Dan Silver.

The FTV News report described the growing crisis in Beijing and Liaoning, which are separated by 800 kilometers, stating, “With the outbreak of pneumonia in China, children’s hospitals in Beijing, Liaoning and other places were overwhelmed with sick children, and schools and classes were on the verge of suspension. Parents questioned whether the authorities were covering up the epidemic.”

The article quoted a Beijing citizen who stated, “Many, many are hospitalized. They don’t cough and have no symptoms. They just have a high temperature (fever), and many develop pulmonary nodules.”

The report went on to note, “Some school classes have even been canceled completely. Not only are all students sick, but teachers are also infected with pneumonia.”

Commenting on this report, Silver wrote:

This report suggests a widespread outbreak of an undiagnosed respiratory illness in several areas in China as Beijing and Liaoning are almost 800 km apart. It is not at all clear when this outbreak started as it would be unusual for so many children to be affected so quickly. The report does not say that any adults were affected suggesting some exposure at the schools. ProMED awaits more definitive information about the etiology and scope of this concerning illness in China.

It is too early to project whether this could be another pandemic but as a wise influenza virologist once said to me “The pandemic clock is ticking, we just do not know what time it is.”

In response to this report and the lack of adequate data from Chinese officials, on Wednesday the World Health Organization (WHO) submitted “an official request to China for detailed information on an increase in respiratory illnesses and reported clusters of pneumonia in children,” as documented in a WHO press release the same day.



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