A surge in respiratory illness in China

Sam Hawley: Hi, I’m Sam Hawley, coming to you from Gadigal land. This is ABC News Daily. When the World Health Organisation demanded China pass over detailed information on an outbreak of respiratory illnesses last month, there was an uncomfortable sense of deja vu. Local media had been reporting hospitals were being overwhelmed with sick children with undiagnosed pneumonia, and the WHO wanted to know what was going on. It’s clear now it’s a winter surge in illness rather than a new pathogen. But are we really prepared for the next pandemic? Today, professor of global biosecurity, Raina MacIntyre, on whether we are and what it might look like. Raina, you oversee a system called EPIWATCH, an early warning system for epidemics or the rapid spread of disease. And you’ve been watching closely this respiratory illness sweeping through China. When did you first start noticing this?

Raina MacIntyre: Well, we started seeing reports of mycoplasma pneumonia, which is one of the causes of this situation, back in June, July this year. And we’ve been watching several reports of mycoplasma pneumonia outbreak since then.

Sam Hawley: The images coming out of China were initially pretty concerning. Hospitals were packed with people. There were lots of children on I.V. drips in waiting rooms. And for a while, you know, it looked very much like what we saw when Covid first appeared. It was a little worrying.

Raina MacIntyre: It was, and I think it appears to be a coalescence of multiple factors and multiple different viruses and mycoplasma. So their winter has just started. So it was getting cold in November. And of course when the cold weather comes the risk of viral respiratory infections increases. And we know now that they’ve identified a range of different viruses: influenza, covid, adenovirus and RSV, as well as mycoplasma. Mycoplasma is a bacteria that causes pneumonia. The combination of all of these things happening at the same time appears to have overwhelmed the hospitals. We can’t exclude that there’s something undiagnosed, that’s a new pathogen. But they’re telling us, and the WHO is reporting that they know the cause of of the illnesses that are presenting, and it’s a mixed picture. So definitely, there’s something unusual happening in China right now. But I should say there are reports now coming out of other countries showing a similar picture. So the Netherlands, Denmark, Ireland, I think probably also what’s happened in China and the media coverage has heightened the awareness globally. But there does seem to be a rise in particularly mycoplasma pneumonia. But a mixed picture with mycoplasma, influenza, RSV, adenovirus in multiple countries.

Sam Hawley: Right. And is that spreading from China to those countries?

Raina MacIntyre: No, no. Most of those things circulate normally in all countries. And this is being seen in all countries in winter now in the northern hemisphere. I think it’s a combination of a few factors. One is that this bacteria, mycoplasma, normally causes a pneumonia that we call community acquired pneumonia. It usually doesn’t need hospitalisation because it can be treated easily with antibiotics, and it’s not that severe. But we do know that there are reports of very high rates of antibiotic resistance to this bacteria with the usual antibiotics we use, so that could partially explain why people are going to hospital. The second is the effect of Covid itself. So there’s been mass transmission of SARS-CoV-2, the virus that causes Covid, in China for over a year now since they dropped their Zero Covid policy. And we know now from multiple studies from all over the world that SARS-CoV-2 causes a range of impacts on the immune system. So it causes immune dysfunction, where your immune system isn’t quite able to handle things as it normally does. So this could be explaining an increase in all kinds of infections. We’ve actually noticed all over the world, there’s been an increase in what’s called group A streptococcus, another bacteria, also increases in infections like tuberculosis. So it’s a mixed picture right? Going into winter; antibiotic resistance; some degree of population immune dysfunction due to mass SARS-CoV-2 infection. All of that’s contributing.

Sam Hawley: Right. Okay. So it could be in part because of Covid, or SARS-CoV-2, and the result of having Covid, that there’s an immune dysfunction of some sort.

Raina MacIntyre: Yes, yes, yes, I believe so. There’s now an enormous number of studies showing the impact of SARS-CoV-2 on the immune system. I mean, I follow all the literature. Anyone who follows the medical literature knows that this is true. There’s one very good study that’s been published, quite a large case series of mycoplasma pneumonia, showing that something like a half of the patients that came in with mycoplasma pneumonia were co-infected with SARS-CoV-2. So I think co-infections are also playing a part in this, where people have more than one infection at the same time.

Sam Hawley: Raina, let’s have a look now at how China has actually responded to the spread of this illness. The World Health Organisation, it says it’s been monitoring it for a while. And on November the 22nd, it made an official request for China for more information and lab results. And China gave those over within 24 hours. That sounds pretty positive.

Raina MacIntyre: It does. Yeah, I think WHO is very much on the front foot and prepared. As soon as there were these unconfirmed reports coming, they asked China for information and the information was provided.

Sam Hawley: But can we trust what China is saying here? That there’s nothing to worry about, that it’s being completely transparent.

Raina MacIntyre: Look, I can’t comment on that, but you can never say never. We are going into winter, so definitely there are people with these different viruses and bacteria affecting them right now, not just in China, but in many other countries that are going into winter. You have to you have to have good testing systems so that when you’ve got patients coming in with pneumonia, you test them. And generally if you don’t find a positive test for the things you know cause pneumonia, whether it’s bacteria or viruses, that’s when you should be worried. So what you’re looking for is evidence that there’s good testing being done and that the testing is coming up negative for every known pathogen.

Sam Hawley: Yeah. All right. Well, this is clearly not another pandemic, but I guess a lot of people would question how quickly we would recognise the start of the next pandemic, given the world responded quite slowly, of course, when it came to Covid.

Raina MacIntyre: Look, I think that is the one big gap in terms of pandemic preparedness, and that’s what we’re doing with EPIWATCH. We’re trying to get early warning signals by tapping into open source data, using artificial intelligence to get valid signals that will be obtained before anyone in the health department knows there’s anything unusual going on. At the moment we rely on formal reporting, which is very important and necessary, but it’s quite delayed. And what we’re doing is the earliest possible warning you could get. And I think that is what’s missing. There were a couple of systems like that, including one that WHO has, but if they did pick up any signal early that no one knew about it.

Sam Hawley: If another pandemic is inevitable, what do you think it’s likely to look like?

Raina MacIntyre: The pandemic I’m most worried about now – and of course, it could be anything – is influenza. You know, we’ve seen a very concerning spread of a very novel avian influenza, H5N1 type, really increasing and spreading from the historical epicentre, that was always Asia for the last 25 years, to Europe, North America and Africa. And it’s now everywhere. And it’s now infecting mammals, which means it’s adapting to transmit in mammalian species. And huge amounts of mammals are being infected around the world. And the symptoms and the presentation is very concerning. So it’s more than just the pneumonia we’re seeing seizures, encephalitis, you know, very prominent neurological presentations in the animals and the birds who are getting infected with this. Now it’s caused about, I think 12 or 13 human cases so far. But if we start seeing widespread transmission in humans, I think it could be quite a deadly pathogen.

Sam Hawley: Gosh. All right. And do you think we’re prepared for what might lie ahead?

Raina MacIntyre: You know, the world is has always prepared for influenza pandemics. So there are the problem is you need a vaccine that’s exactly matched to the exact virus that’s causing it. But you can give some partial protection by doing these vaccines that just target one part of the virus. And we do have seasonal influenza vaccines. So I think we’d be in a slightly better position in those initial stages if it was an influenza pandemic. I think one of the things that Covid taught us was how quickly the whole international scientific community could galvanise. It was quite phenomenal, really, that in less than a year after Covid started, we had a vaccine. I think that was a very good learning experience, and the world has had that experience now of being able to collaborate and come together to find treatments and vaccines. But it’s the early detection prevention bit that’s still a bit of a gap.

Sam Hawley: And even if we are ready, politicians and citizens would need to play a role, wouldn’t they, in stopping the spread. Do you think there’d be the will to do that, to go through things like shutdowns again, given what we saw with Covid?

Raina MacIntyre: It just depends on how severe it is, right? If you had something like smallpox, you’d see 30% plus of people dying, which is a huge increase compared to Covid. If it was the kind of pandemic influenza we’re talking about at the moment with the human cases, avian flu is like a 50 plus percent mortality rate. So I can tell you if 50% of people are dying, people are going to stay inside. So it’s really a function of risk perception. When people perceive the risk to be high and can see the evidence for it themselves, they will, you know, because people don’t want to die being exposed to a highly contagious pathogen.

Sam Hawley: Raina McIntyre is from the Kirby Institute at the University of New South Wales. This episode was produced by Nell Whitehead, Bridget Fitzgerald, Anna John and Sam Dunn, who also did the mix. Our supervising producer is David Coady. Over the weekend, look for the If You’re Listening podcast with Matt Bevan. He’s looking at China’s panda diplomacy. Find it on the ABC listen app. I’m Sam Hawley. ABC News Daily will be back again on Monday. Thanks for listening.