It was just a few days after new year’s celebrations when news of a surge in the number of people infected with a new kind of virus began to emerge. A respiratory disease causing flu or cold-like symptoms had begun spiking across northern Chinese provinces, building over the course of the winter, especially among children under four years old.
There were reports of overcrowded hospitals, overwhelmed intensive care units (ICUs) and new monitoring measures. Concerns were further raised when signs that the outbreak had spread began to appear.
More cases have been detected in India; Malaysia and Kazakhstan have also begun reporting patients who have contracted the disease. By Tuesday 6 January, some reports claimed that cases in the US had doubled to 300. In the UK, a particularly severe strain of the flu and other respiratory illnesses seem to be everywhere. There’s not an office, nor a family home that doesn’t seem to have had a significant brush with something quite debilitating.
On the surface, it has uncomfortable echoes of five years ago, when in January 2020, there was a whisper of a killer virus outbreak in China. As pictures started to emerge of overflowing hospitals and emergency pop-up medical facilities to cope with the sick and dying, it would still be a month until the World Health Organisation (WHO) declared the strain’s official name: Covid-19.
Back then, the flu wasn’t something we worried about. We all know what happened next. A few weeks later, we were all familiar with its name, with cases breaking out across Europe. A short time later the world was in lockdown.
Five years on, we are more alert to what can happen when we ignore the signs. Which is probably why, when headlines about a virus “surging” in China appeared this week, many sat up and took note.
Countries and authorities are diligently keeping track, and there is already wild speculation and misinformation circulating on social media. Official bodies are starting to call for more transparency from China, who initially appeared to play down the severity of the Covid-19 pandemic, saying that Beijing needs to be more open with whatever data they have.
But how worried should we really be?
First things first: unlike Covid-19, what is happening in China is not a new virus, it is human metapneumovirus (HMPV), an “old” virus that was discovered in the Netherlands in 2001. In fact, most people will contract it before they reach five years of age – researchers estimate that around 10-12 per cent of respiratory illnesses in children are caused by HMPV. It’s also not as infectious as coronavirus (its incubation period is three to six days) nor, despite the images that are coming out from China, as severe.
Mortality rates are much lower and symptoms are primarily a cough, fever, nasal congestion and fatigue. However, while most cases are mild, it can sometimes cause lower respiratory infections like pneumonia and, more commonly, agitate a flare-up in conditions like asthma or chronic obstructive pulmonary disease (COPD) – and there is currently no vaccine or antiviral treatment for HMPV.
Unsurprisingly, cases of HMPV rise more rapidly in the winter and spring each year – which experts are keenly emphasising. In the UK, it’s not hard to notice that even the hardiest among us seem to be falling prey to “whatever is doing the rounds”.
And it really has been a particularly harsh and sickly winter so far. Although the latest government statistics show that last week the hospital admission rate for Covid-19 was the lowest of the same period for any winter post-pandemic, there has been a rapid onset of other viral illnesses, namely influenza (flu), respiratory syncytial virus (RSV), diarrhoea and vomiting and norovirus.
The first week of reporting (in mid-December) showed a 352 per cent increase in general and acute hospital beds occupied by patients with flu. The prevalence of HMPV is reported as “slightly increasing” with a “medium” level of activity. During the Covid pandemic, rates of viral infection were partially monitored by the government using sewage waste, which can reveal trends in novel viruses.
While this initial HMPV data “showed clear signs of high demand driven by winter illnesses”, it also noted that “it is unclear whether this is the worst winter yet for pressures arising from flu”. However, the number of beds occupied by patients with flu in the second week of winter is the highest “since the first publication of the measure” in 2020-21.
“The total number of people in hospital with flu and other viruses is much higher than this time last year and NHS services have been under relentless pressure,” Saffron Cordery, interim chief executive of NHS Providers, explains, adding that with children going back to school and offices being populated again, it’s looking like “things will get worse before they get better”.
HMPV in the UK is also slightly increasing week by week. Again, experts are keen to allay any fear that this could be history repeating itself. The fact is that in the five years that have passed since Covid-19 arrived, our attitudes towards viral illness have changed tremendously. Back in 2018, you’d be hard-pressed to find friends or colleagues mentioning a rise in flu cases anywhere in the world – now, there’s been a shift in our collective consciousness.
“I think part of what’s playing into this worry is the recency bias is Covid-19 having started in China – people are looking and seeing what is potentially discrimination, or potentially this fear of the unknown again; of something that feels as though it could spiral and become another pandemic,” says Dr Simon Williams, a behavioural scientist, public health researcher and lecturer in psychology at Swansea University, who has also worked as a consultant for WHO.
He explains that there have been many other potential pandemics – bird flu in the US, for example, has a much higher risk than HMPV currently poses; in the last few weeks, a “mystery” new virus that stoked similar fear in the Democratic Republic of the Congo turned out to be malaria. Caution and additional information are necessary before speculation, he says.
“What we need to defer to is data being fed into the global level so that people around the world know what the risk level is, and those official risk levels are key for public communication. Sadly, just because we’ve had and technically still are in a pandemic, albeit at the tail end of it, that doesn’t mean another one is not going to be in our lifetimes. We need good data to deal with that.”
It was this – clear communication of fact, or lack thereof – that became the unfortunate legacy of the Covid-19 pandemic. Back then, right from the beginning, speculation over the origins of the virus in China – the most vital information in our reach for preventing another from spreading – was rife.
Both Chinese governance (notoriously secretive to outside sources) and the WHO in their own investigation were publicly scrutinised by The New York Times; questions as to how Covid-19 jumped from animals to humans and why China failed to contain the virus were left largely unanswered. As the months ticked by, misinformation and conspiracy found a captive audience.
Though we’re five years on, it’s this, says Williams, that could make a contribution to an increased risk of another outbreak. In the UK, vaccine uptake is curiously low – lower than last year, even among NHS staff – which he attributes to both complacency and hesitancy borne from the pandemic.
“On the one hand we have HMPV this week, where there’s a kind of premature fear over the next pandemic – the early reports that have imaginations wondering,” he says. “But then on the other hand we have seasonal and continual threats from flu and Covid-19 where, in some cases people are looking at it with too little concern. That could be why we’re seeing a low uptake of the vaccine [leaving us more at risk], or why people aren’t taking a few days off if they’re feeling sick. There’s an attitude reemerging where [when we’re ill] we just get on with things like we did back in 2019.
“There’s probably a bit of a happy medium somewhere in between the two, where we’re not living in fear of the next outbreak or the next pandemic, but we’re also not completely throwing the baby out of the bathwater and saying ‘let’s not worry’.”
As reports of HMPV continue to emerge, then, perhaps it can be a reminder that a pandemic could happen again – we might be concerned about what’s happening overseas, but we could still be more vigilant at home. If we’ve learned anything from 2020, it’s that we need to take threats seriously wherever they come from and whatever they look like.
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