This article highlights WHO setup recommendations and discusses China's pneumonia rise after COVID-19, which is linked to common infections that coincide with winter.

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A surge in respiratory ailments is observed in China as it enters its first complete winter season since COVID-19 restrictions were lifted in December, triggering sentiments of déjà vu among individuals worldwide. Has a new infection emerged? Who is impacted? Why is this spread happening now? First and foremost, should we be concerned?

What precisely is transpiring?

In China, the number of cases of respiratory ailments recorded has increased. The ailments, which were first announced at a press conference by China's National Health Commission on November 13, have increased hospital admissions, with many institutions issuing wait times.

This week, the WHO requested more information from China on undetected pneumonia cases in children, citing a study from the Programme for Monitoring Emerging Diseases (ProMED).

Where is this peak taking place?

China's northeastern areas have seen a surge of infections, with Beijing and Liaoning, which are 800 km apart, serving as two of the main centres. According to a prominent hospital in Beijing, over 1,200 individuals visit its emergency department each day on average.

Among whom has the outbreak had the greatest impact?

A significant fraction of hospitalised patients are children, and the number of cases among them is particularly high. Beijing's schools are reporting significant absence rates; in extreme cases, lessons may be cancelled for as least a week in the event that some kids are absent.

Certain authorities have observed that the elevated prevalence among children may have a positive connotation, suggesting that older people possess a certain degree of immunity to the pathogens that are thriving.

This would thus imply that people are likely to benefit from the current vaccinations in terms of illness prevention. But in addition to kids, pregnant women and the elderly could also be at risk.

Does this mean the start of a new disease like COVID-19?

Chinese authorities have linked the spread of recognised diseases such mycoplasma pneumoniae, influenza, respiratory syncytial virus (RSV), and SARS-CoV-2 (the virus that causes COVID-19) to the rise in the occurrence of respiratory disorders. Although China has been ordered to provide additional disease data by the World Health Organisation, no new illnesses have been discovered to yet.

The majority of patients under the age of 18 are probably suffering from mycoplasma pneumoniae, a common bacterial illness that usually affects younger children, according to WHO.

Risk assessment by WHO

1. As of right now, Chinese surveillance and hospital systems state that the clinical manifestations of the current respiratory illness epidemic are caused by recognised pathogens in circulation. The reported symptoms are similar to various respiratory disorders. Antibiotics are an easy way to treat Mycoplasma pneumoniae, a common respiratory infection that often causes pneumonia in children.
2. China maintains a sentinel monitoring system for severe acute respiratory infections (SARI) and influenza-like illness (ILI). China has been using improved respiratory disease monitoring systems, which include Mycoplasma pneumoniae, since mid-October. These systems include a wide range of respiratory viruses and bacteria.
3. To completely describe the total risk of these reported instances of paediatric respiratory disease, there is not enough precise information at this time. The co-circulation of respiratory viruses may raise the load on healthcare facilities, but the onset of winter is predicted to bring with it a rise in respiratory infections.
4. ILI was above normal for this time of year and rising in the northern regions, according to monitoring data released by the National Influenza Centre in China and submitted to WHO's FluNet. The most common influenza viruses found were those of the A(H3N2) and B/Victoria lineages.

What has sparked this breakout?

The outbreak has been ascribed by Chinese officials and several international health experts to the relaxation of COVID-19 regulations, like to the "lockdown exit waves" seen in other nations.

Some experts believe that China may be paying back a "immunity debt" as a result of their stringent and protracted lockdown, which must have significantly curtailed the spread of respiratory infections and, therefore, immunity to endemic infections. In addition, the arrival of winter is also a contributing factor.

Concerned about the Indian outbreak?

First off, for the time being, the spread of the disease is still mostly limited. Even without a complete shutdown, China has increased testing and monitoring. Authorities are probably being extra careful, especially after the epidemic a few years ago.

Second, based on what we currently know about the pandemic, we probably have the vaccinations and medications needed to combat it, even if it extends outside of China. For example, azithromycin is an antibiotic that may be used to treat mycoplasma pneumonia.

Compared to 2019–20, the globe is a radically different place. Worldwide fear of the "next COVID-19" is still stoked by the horrific experience of the pandemic. However, because of the same experience, we are in a far better position internationally now to cope with such infectious illnesses.

Suggestions from WHO

WHO advises people in China to take precautions against respiratory illnesses based on information currently available.

These precautions include:

• Getting recommended vaccinations against influenza, COVID-19, and other respiratory pathogens as needed
• Avoiding sick people
• Staying at home when sick
• Getting tested and receiving medical attention when necessary
• Wearing masks when appropriate
• Making sure there is adequate ventilation
• Regularly washing your hands

The WHO does not advise any particular precautions for visitors visiting China. If a person has symptoms that might indicate a respiratory infection, they should generally avoid travelling. If symptoms arise during or after travel, they should contact a doctor and let them know about their past travels.

Based on the most recent information on this occurrence, WHO recommends against applying any travel or trade restrictions.

The Indian Health Ministry has said that there isn't now a reason for concern and is actively monitoring the issue. But the Health Ministry has recommended us to assess and strengthen our readiness to handle any eventuality as a precaution. The following actions are suggested:

1. Hospital capacity: Review the availability of hospital beds, ensuring that we are adequately prepared for a potential increase in patients.
2. Medications and vaccines: Ensure an ample supply of drugs and vaccines for influenza.
3. Medical oxygen: Confirm the availability and functionality of medical oxygen systems.
4. Antibiotics: Stock an adequate supply of antibiotics.
5. Personal Protective Equipment (PPE): Ensure an ample stock of PPE for healthcare workers.
6. Testing kits and reagents: Confirm the availability of testing kits and reagents for prompt diagnosis.
7. Functionality of oxygen plants and ventilators: Regularly assess and maintain the functionality of oxygen plants and ventilators.
8. Infection control practices: Reinforce infection control practices within the hospital.

Everyone must adhere to personal preventative measures in addition to these readiness steps:

• Remain apart from sick individuals
• Maintain your vaccination
• Remain at home if you're sick
• Obtain testing and, if necessary, medical attention
• Use masks as necessary
• Make sure every location has enough airflow
• Make frequent hand washing a habit

Moreover, the "Operational Guidelines for Revised Surveillance Strategy in the context of COVID-19," which is attached to this email for your information, has been recommended for implementation by the Health Ministry.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.
About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.