Children and their parents wait at an outpatient area at a children hospital in Beijing on November 23, 2023.

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Hong Kong 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 relaxing stringent Covid-19 controls nearly one year ago.

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

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

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

“Right now, we have a lot of kids here. Those who booked an emergency appointment yesterday still weren’t able to see the doctor this morning,” the staff member said.

Health officials in Beijing and other major cities in northern China have said typical seasonal illnesses, including influenza and respiratory syncytial virus (RSV), as well as mycoplasma pneumonia – a bacterial infection that typically causes mild infection and commonly affects children – were driving causes.

The surge in cases across northern China comes amid a rise in seasonal respiratory infections around the northern hemisphere, including in the United States, where RSV is spreading at “unprecedented” levels among children.

But the situation in China raised global concern after the World Health Organization (WHO) on Wednesday asked China to provide more information on an increase in respiratory illnesses and “reported clusters of undiagnosed pneumonia in children,” citing a post from open-source surveillance system ProMED.

After speaking with Chinese health and hospital officials Thursday, however, the WHO said the data indicated an increase in outpatient consultations and hospital admissions of children due to mycoplasma pneumonia in May and common seasonal illnesses RSV, adenovirus and influenza virus since October.

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

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

Outside experts monitoring the situation also noted there was no evidence of a novel pathogen at work, but called for China to share more information about the situation with the public.

“We don’t think there is an unknown pathogen hidden somewhere,” Jin Dongyan, a virologist at the University of Hong Kong’s School of Biomedical Sciences, told CNN. “There’s no evidence for that.”

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

“So far we have not heard reports of either,” Bennett said, adding that it was important to monitor sources of infection to rule out such concerns.

Children receive a drip at a children hospital in Beijing on November 23, 2023.

Crowded hospitals

Over recent weeks, Chinese parents have complained on social media about the crowded situation at hospitals, where it takes hours for children to see a doctor before more lengthy waits to get a blood test or intravenous drip.

Given China’s relatively underdeveloped primary care system, sick people typically head to hospitals or emergency rooms as a first point of contact. Those facilities can become overcrowded during peak seasons.

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

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

China’s national health authorities and hospital officials have repeatedly urged parents not to rush children directly to large pediatric facilities, instead calling for them to take kids to be diagnosed at other health centers offering primary care or general services.

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

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

Beijing’s municipal government meanwhile republished a state media article featuring a doctor telling parents that they didn’t need to ask for intravenous fluids “as soon as a child has a fever.”

The WHO on Thursday said Chinese officials reported that “the rise in respiratory illness has not resulted in patient loads exceeding hospital capacities.”

Post-Covid surge

The surge in hospital visits coincides with China’s first full winter without its “zero-Covid” controls, which saw people maintain strict social distancing and wear face masks.

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

It’s unclear if there’s been an increase in respiratory illnesses or severe cases among children relative to pre-pandemic years because of limited public data released by China.

“During zero-Covid, these (common respiratory) diseases would be under-estimated (as people avoided hospitals), and because everyone was practicing some social distancing the incidence was low,” said Jin, the virologist at Hong Kong University.

“It’s absolutely normal that this year compared to last year would be a big increase. But whether it’s a big surge compared to 2018, 2019, that’s still to be determined.” he said.

Social factors could be at play in the current situation, Jin added, as parents may also be more concerned about their child’s health following the pandemic, prompting more 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 hindering investigation in the origins of the virus and obscuring early information about its spread.

Christine Jenkins, a professor of respiratory medicine at UNSW Sydney, said a rise in viral respiratory tract infections in children at this time of year is not unexpected and is a phenomenon that has been observed over many decades worldwide at the onset of winter.

“However, in the context of the pandemic due to a relatively new virus such as (the novel coronavirus) and the potential for other new viruses or mutations to cause respiratory tract illness, prompt reporting and monitoring are essential,” she said.