Features
A winter surge of Respiratory Infections sweeps across China
MBBS(Cey), DCH(Cey), DCH(Eng), MD(Paed), MRCP(UK), FRCP(Edin), FRCP(Lond),
FRCPCH(UK), FSLCPaed, FCCP, Hony. FRCPCH(UK), Hony. FCGP(SL)
Specialist Consultant Paediatrician and Honorary Senior Fellow, Postgraduate Institute of Medicine, University of Colombo, Sri Lanka.
Joint Editor, Sri Lanka Journal of Child Health
Section Editor, Ceylon Medical Journal
Past President, Sri Lanka Medical Association (2013).
Founder President, Sri Lanka College of Paediatricians (1996-97)
There is considerable global concern regarding the current escalation of respiratory infections in China. Of course, the main reason for worldwide apprehension on the present situation is linked to the everlasting memory of COVID-19 pandemic that was claimed to have originated in China and caused havoc and mayhem right across the globe. The memories of the dire effects of that miserable virus are quite fresh in the mind of the entire planetary population.
This time however, as winter gripped China, that entire nation is made to grapple with a surge in respiratory infections, a confluence of viruses and bacteria overwhelming their healthcare systems. It is reported that all health services in China are tried to the extreme maximum and stretched to the limit. While COVID-19 still remains quite a concern in China, it is now joined by a formidable cast of microorganisms or bugs, including influenza, respiratory syncytial virus (RSV), adenovirus, rhinovirus, human metapneumovirus (HMPV), and Mycoplasma pneumoniae. The last-mentioned mycoplasma organism is a somewhat strange bacterium that is known to cause significant lung infections, especially in children and the elderly. However, it is the only one out of that entire lot against which there are effective antibacterial therapies.
In the face of evolving information about human infections being caused by this plethora of different organisms, the present situation in China, aptly described as a huge storm of many types of respiratory infections, has now sparked fears of a widespread health crisis in that country. That would concomitantly lead to shivers down the spines of inhabitants of many other countries, especially in view of the memories of the terrible consequences that followed COVID-19.
The present wave of chest infections in China is a stark reminder of the ever-evolving nature of respiratory illnesses. While COVID-19 dominated headlines for quite a few years, the recent easing of restrictions has also allowed other viruses and bacteria to resurge. The current respiratory infection surge in China is a complex phenomenon driven by multiple pathogens.
Of all these bugs that are causing havoc in China, influenza is well-known to be perennial winter threat, and remains as a very significant player. Both influenza A and B strains are circulating, causing fever, cough, sore throat, and muscle aches. In severe cases, influenza can lead to pneumonia and even death, particularly among the elderly and those with underlying health conditions. Respiratory Syncytial Virus, primarily affects young children, has the potential to cause mild cold-like symptoms to severe bronchiolitis and pneumonia. Its resurgence has overwhelmed paediatric wards in many parts of China. Adenoviruses are also known to cause problems in children, leading to a range of illnesses, from mild respiratory infections to severe pneumonia as well as eye involvement in the form of conjunctivitis. Rhinovirus, the most common cause of the common cold, can contribute to the overall burden of respiratory infections. There are major concerns regarding the Human Metapneumovirus. Often overlooked, HMPV can cause symptoms similar to the flu, including fever, cough, and difficulty breathing. However, it poses a particular risk to infants, young children, and the elderly, in whom it could go on to a life-threatening illness. Mycoplasma pneumoniae can cause a type of pneumonia known as “walking pneumonia,” characterized by a persistent cough and mild fever but we cannot forget that in some cases the illness becomes quite severe.
The timing of this surge coincides with the onset of winter in China, a period when respiratory infections are typically more prevalent. Cold weather can weaken the immune system, making individuals more susceptible to infection. In the Western countries that have winter weather, respiratory infections are quite common but has not assumed the proportions that are presently seen in China. Additionally, in many countries, including China, the prolonged period of COVID-19 restrictions may have weakened population immunity to other respiratory pathogens as well, contributing to the severity of the current wave in China.
As indicated above, certain groups are particularly vulnerable to severe illness from these infections. In young children the immune systems are still developing, making them more susceptible to severe infections from all kinds of viruses. The elderly have already weakened immune systems as well as other underlying health conditions that put them at increased risk of severe illness and complications. Individuals with chronic health conditions, including young and the middle-aged who are afflicted by asthma, diabetes, and heart disease are more likely to experience severe complications from respiratory infections. Pregnancy too can weaken the immune system, making pregnant women more susceptible to severe illness.
The relentless surge in sheer numbers of affected people has put a significant strain on China’s healthcare system. Hospitals are overflowing with patients, and medical staff are working tirelessly to provide care. This has led to concerns about the quality of care and the potential for further strain on the system. The current situation in China serves as a stark reminder of the importance of preparedness for epidemics of respiratory infections. It highlights the need for robust surveillance systems, access to vaccines and antiviral medications, and strong public health measures to mitigate the impact of these infections.
All these causative organisms spread to humans through the nose and the respiratory tract and the majority of them are exquisitely infectious, thereby leading to rapid spread of the diseases caused by them. One cannot help but reiterate the mantra of the usefulness of wearing masks, avoiding crowded places, maintaining reasonable distances from others and scrupulous washing of hands as time-tested means of preventing respiratory infections. Preparedness and proactive public health measures are crucial to mitigate the impact of future respiratory infection outbreaks. This aspect is particularly important for countries like Sri Lanka as the modern-day fast air travel could make it not too difficult for these infections to come into the country. It calls for cat-like vigilance on the part of our health authorities to enable them to act decisively when the occasion demands it.
As winter progresses, it remains crucial to monitor the situation closely and implement measures to protect vulnerable populations. By staying informed and taking precautions, we can help mitigate the impact of this ongoing health challenge. There is no cause for alarm as yet for us in this Pearl of the Indian Ocean but we need to follow the adage that “a stitch in time saves nine.”