China: Rise in respiratory illnesses concerns 0:53

(CNN) -- Hospitals in Beijing and northern China are grappling with a surge of children with respiratory illnesses as the country enters its first winter since strict Covid-19 controls were relaxed nearly a year ago.

Wait times to see doctors stretch for hours, with hundreds of patients queuing at some children's hospitals in major cities in northern China, CNN and Chinese state media and social media reported.

An official at Beijing Children's Hospital told state media on Tuesday that the current average of more than 7,000 patients a day "far exceeds the hospital's capacity." The largest pediatric hospital in nearby Tianjin broke a record on Saturday, receiving more than 13,000 children in its outpatient and emergency services, according to local state media.

When CNN called Thursday to inquire about appointments at Beijing Friendship Hospital, a staff member said it could take all day to see a pediatrician.

"We have a lot of kids here right now. Those who booked an emergency appointment yesterday still haven't been able to see the doctor this morning," the staff member said.


Health authorities in Beijing and other major cities in northern China have said seasonal illnesses such as flu and respiratory syncytial virus (RSV), as well as mycoplasma pneumonia — a bacterial infection that usually causes mild infections and commonly affects children — were the main causes.

The surge in cases in northern China comes amid a surge in seasonal respiratory infections across the Northern Hemisphere, including the United States, where RSV is spreading at "unprecedented" levels among children.

But the situation in China sparked concern around the world after the World Health Organization (WHO) on Wednesday asked China for more information on rising respiratory illnesses and "reported outbreaks of undiagnosed pneumonia in children," citing a message from the open-source surveillance system ProMED.

  • China responds that the increase in respiratory illnesses in children is due to seasonal germs and not "unusual or new pathogens," according to the WHO

However, after speaking with Chinese health and hospital officials on Thursday, the WHO said data indicated an increase in outpatient visits and hospital admissions of children due to mycoplasma pneumonia in May and common seasonal illnesses RSV, adenovirus and influenza viruses since October.

"Some of these increases occur earlier in the season than has been experienced historically, but are not unexpected given the lifting of Covid-19 restrictions, as has been similarly experienced in other countries," the WHO said.

The agency added that Chinese authorities said there had been "no detection of unusual or novel pathogens or unusual clinical presentations."

Outside experts monitoring the situation also noted that there was no evidence of the presence of a new pathogen, but called on China to share more information about the situation with the public.

"We don't think there's an unknown pathogen hiding somewhere," Jin Dongyan, a virologist at the University of Hong Kong's School of Biomedical Sciences, told CNN. "There's no evidence of that."

Catherine Bennett, an epidemiologist at Australia's Deakin University, said the main concern is whether the rise in childhood pneumonia will indicate a new pathogen, or new levels of disease severity.

"So far we haven't heard of either," Bennett said, adding that it was important to monitor sources of infection to rule out such concerns.

  • WHO asks China for more information on rise in paediatric respiratory illnesses such as pneumonia

Children receive intravenous drips at a children's hospital in Beijing on Nov. 23, 2023. (Credit: Jade Gao/AFP/Getty Images)

Overcrowded hospitals in China

In recent weeks, Chinese parents have complained on social media about the overcrowded situation in hospitals, where it takes hours for children to be seen by a doctor before having to wait longer for a blood test or an IV drip.

Given China's relatively underdeveloped primary health care system, patients often turn to hospitals or emergency departments as the first point of contact. These facilities can become overcrowded during peak seasons.

On Chinese social media platform Weibo, a widely shared photo showed a hospital screen notifying patients that the queue exceeded 700 people, with an estimated wait time of 13 hours.

At a pediatric hospital affiliated with the Beijing Capital Institute of Pediatrics, the hallways were so crowded that some children with IV drips sat on the laps of their parents, who lined the aisles on folding stools, videos showed on social media.

China's national health authorities and hospital officials have repeatedly urged parents not to take children directly to large pediatric centers, but to take them to other health centers that offer primary care or general services.

The National Health Commission (NHC) on Thursday warned parents that large hospitals could have "long wait times and a high risk of cross-infection," and directed them to other types of facilities for triage.

In a statement, the NHC said it had directed "all localities" to strengthen their case management and treatment systems, including identifying severe cases among the influx of patients.

Meanwhile, Beijing's municipal government republished an article in state media that featured a doctor telling parents they didn't need to ask for intravenous fluids "as soon as a child has a fever."

The WHO said Thursday that Chinese authorities reported that "the increase in respiratory illnesses has not caused the patient load to exceed the capacity of hospitals."

  • FDA Approves First Vaccine to Protect Newborns from Respiratory Syncytial Virus

Uptick in post-covid illnesses

The increase in hospital visits coincides with China's first full winter without its "zero-covid" controls, in which people maintained strict social distancing and wore masks.

Controls were abruptly relaxed last December, after rare protests erupted against pandemic measures, which included strict lockdowns.

It is unclear whether there has been an increase in respiratory illnesses or severe cases among children relative to pre-pandemic years, due to the limited public data released by China.

"During the zero-Covid period, these (common respiratory) diseases were underestimated (as people avoided hospitals), and because everyone practiced some social distancing the incidence was low," said Jin, a virologist at the University of Hong Kong.

"It's absolutely normal that this year, compared to last year, there will be a big increase. But whether it's a big increase compared to 2018, 2019, that's still to be determined," he said.

Jin added that social factors could play a role in the current situation, as parents could also be more concerned about their children's health in the wake of the pandemic, leading more of them to seek medical help.

More attention is being paid to disease outbreaks following the emergence of the pandemic coronavirus in late 2019. There are also calls for more transparency, including from China, which has been accused of hampering research into the origins of the virus and hiding initial information about its spread.

Christine Jenkins, Professor of Respiratory Medicine at UNSW Sydney, said an increase in viral respiratory tract infections in children at this time of year is not unexpected and is a phenomenon that has been observed for many decades around the world at the start of winter.

"However, in the context of the pandemic due to a relatively new virus such as (COVID-19) and the potential for other new viruses or mutations to cause respiratory tract illness, rapid notification and follow-up is essential," he said.

Respiratory diseases