World Health Organization Coronavirus Press Conference Transcript May 8

Tarik: (00:00) On the anniversary of smallpox eradication we had to change this for different reasons, and I'm sure Dr. Tedros will mention this event and this anniversary in his opening remarks, so I will give the floor to Dr. Tedros. Dr. Tedros: (00:20) Thank you. Thank you. Tarik. Good morning, good afternoon and good evening. Exactly 40 years ago today, on the 8th of May, 1980, the World Health Assembly officially declared that the world and all its peoples have won freedom from smallpox. Smallpox is the first, and to date, the only human disease to be eradicated globally. Until it was wiped out, smallpox had plagued humanity for at least 3,000 years, killing 300 million people in the 20th century alone. It's eradication stands at the greatest public health triumph in history. As the world confronts the COVID-19 pandemic, humanity's victory over smallpox is a reminder of what's possible when nations come together to fight a common health threat. Many of the basic public health tools that were used successfully then, are the same tools that have been used to respond to Ebola and to COVID, there's surveillance, case finding, contact tracing, and mass communication campaigns to inform affected populations. Dr. Tedros: (01:53) The smallpox eradication campaign had one crucial tool that we don't have for COVID-19 yet, a vaccine, in fact, the world's first vaccine. As you know, WHO is now working with many partners to accelerate the development of a vaccine for COVID-19, which will be an essential tool for controlling transmission of the virus. But although a vaccine was crucial for ending smallpox, it was not enough on its own, after all, the vaccine was first developed by Edward Jenner in 1796. It took another 184 years for smallpox to be eradicated. The decisive factor in the victory over smallpox was global solidarity. At the height of the Cold War, the Soviet Union and the United States of America joined forces to conquer a common enemy. They recognized that viruses do not respect nations or ideologies. That same solidarity built on national unity is needed now more than ever to the feet COVID-19. Stories like the eradication of smallpox have incredible power to inspire, but there are many more untold stories about health around the world. Dr. Tedros: (03:27) Next Tuesday, the 12th of May, WHO will announce the 5 winners of our inaugural Health For All Film Festival. The winning films were chosen by a distinguished panel of jurors from almost 1,300 entries from 110 countries. The shortlisted films can be seen on WHO's YouTube channel and we invite everyone to join us on our social media channels next Tuesday for the announcement of the winners. Yesterday, I announced the resources WHO estimates it needs to deliver our updated strategic preparedness and response plan for COVID-19. The updated plan estimates that WHO requires 1.7 billion U.S. dollars to respond to COVID-19, across the three levels of the organization, between now and then of 2020. This estimate includes the funds that WHO has already received to date, leaving WHO's COVID-19 response with a funding gap of 1.3 billion U.S. dollars for 2020. To be clear, this estimate only covers WHO's needs, not the entire global need. Dr. Tedros: (04:52) WHO is deeply grateful to the countries and donors who responded to WHO's initial strategic preparedness and response plan. And to the hundreds of thousands of individuals, corporations and foundations, who have contributed to the COVID-19 solidarity response fund. And we thank you so much for your commitment and support. Our updated strategic plan takes into account the lessons we have learned so far, strengthening WHO's role in global and regional coordination. It's built on 5 strategic objectives. First, to mobilize all sectors and communities. Second, to control the sporadic cases and clusters by rapidly finding and isolating all cases. Third, to suppress community transmission through infection prevention and control and physical distancing. Fourth, to reduce mortality through appropriate care. And fifth, to develop safe and effective vaccines and therapeutics. Dr. Tedros: (06:05) To support these objectives WHO will continue to provide technical, operational and logistic support to countries, and we will continue to update and adapt our guidance according to local needs. In certain fragile settings and countries with weaker health systems, WHO will continue its operational work as a provider of essential health services. As we reflect today on the eradication of smallpox, we are reminded of what is possible when nations come together to confront a common foe, to confront a common enemy. The legacy of smallpox was not only the eradication of one disease, it was the demonstration that when the world unites, anything is possible. If there is a will, there is a way. It gave us the confidence to pursue the eradication of other diseases like polio and guinea worm. Dr. Tedros: (07:08) Like smallpox, COVID-19 is a defining challenge for public health. Like smallpox, it's a test of global solidarity. Like smallpox, COVID-19 is giving us an opportunity not only to fight a single disease, but to change the trajectory of global health and to build a healthier, safer, fairer world for everyone. To achieve universal health coverage. To achieve our dream from the establishment of WHO in 1940s, health for all. And I thank you, but before we move on to questions, Tarik, I would like to mention one small way we are commemorating the eradication of smallpox. When WHO's smallpox eradication campaign was launched in 1967, one of the ways countries raised awareness about smallpox was through postage stamps, when social media, Twitter, Facebook was not even in the horizon. To commemorate the 40th anniversary of smallpox eradication, the United Nations Postal Administration and WHO are releasing a commemorative postage stamp to recognize global solidarity in fighting smallpox. I especially want to thank my friend, Mr. Atul Khare, the United Nations Under Secretary General for Operational Support, for making this commemorative stamp a possible. Thank you again, Tarik, and back to you. Tarik: (08:51) Thank you very much Dr. Tedros for these opening remarks on this very remarkable anniversary day. I forgot to introduce our speakers today, but I think you know them already, it's Dr. Mike Ryan And Dr. Maria Van Kerkhove, and we have Mr. Steve Solomon, who is WHO Principle Legal Officer. We would also like to thank interpreters who are with us today helping, that journalists can ask questions in their language. So we will start with questions now. Please be short, concise, one question per person, and we will start with [Dutcher Bella 00:09:31] and we have George. George, can you hear us? George: (09:38) Yes sir, I can hear you. Tarik: (09:41) Yes. George: (09:42) And may I ask, French scientists have found that cigarette smokers are less likely to be hospitalized with COVID-19, what do you make of these findings? Tarik: (09:54) Thank you very much George for this question. Dr. Maria Van Kerkhove: (09:59) Thank you very much for the question. So, we know the harms of tobacco are well known, and we know that millions of people die every year from the use of tobacco. COVID-19 is a respiratory illness and smoking causes damage to the lungs, and there are a number of studies out there that have been published that have found that smoking leads to more severe disease, the development of severe disease, and puts people at higher risk for being put on a ventilator, being in ICU, and for dying. There are some studies, there are some media reports of some studies, two studies in particular, that have not been peer-reviewed, that have looked at the prevalence of smoking and people who've been hospitalized and not. These studies did not evaluate, they were not designed to evaluate, whether smoking was protective or not, or in any shape or form. And they do not say that smoking is protective. We do know, I will repeat, that we know the harms of smoking and we know that smokers, if they do get infected with COVID-19, have a higher risk of severe disease and death. Tarik: (11:12) Thank you very much, Dr Van Kerkhove. Next question comes from Guatemala. Guatemala [foreign language 00:00:11:18], and we have [Gresha 00:11:20] on phone. [ [Gresha 00:11:25], if you could just unmute yourself. Hello? Gresha: (11:44) [foreign language 00:11:32]. Tarik: (11:44) You want to repeat? [Gresha 00:11:59], can you just please repeat the question, because we are not sure we understood it. Gresha: (12:03) [foreign language 00:12:09]. Tarik: (12:26) Thank you very much. I think we understood it now. Dr. Maria Van Kerkhove: (12:35) I can start and perhaps Mike would like to supplement. So, we're just beginning to see now a number of countries that are opening up their economies after having shown that they are able to suppress transmission. The countries that are further along in this, are countries across Asia. And we do see that countries like China, Japan, Korea, Singapore, have lifted some of these public health and social measures in a slow and a controlled way. In some countries, they have seen a resurgence in cases, meaning that they've seen some outbreaks. And in Japan and in Singapore for example, they've seen outbreaks that are taking place in certain situations. Singapore right now is dealing with outbreaks in expat dormitories, dormitories where people live in close proximity to one another. And they just shared a presentation with us earlier today demonstrating how they are going into exquisite detail, in terms of trying to find all of those cases and suppress transmission even in these close settings. Dr. Maria Van Kerkhove: (13:40) What we are learning from those countries who are slowly opening up their economies again, and we've talked about this before, once these measures are lifted, they need to be lifted in a very slow and controlled way because it's possible for the virus to take off again. Countries are improving their systems to identify the virus, identify people who are infected with that virus through increasing their testing capacity, through increasing their ability to do contact tracing, where they're making sure that the beds in the hospitals are free so that they can care for patients depending on the severity of their systems. So what we're seeing is even though they are lifting some of these measures, they are quickly working to find cases, if those cases do resurge, so that they can try to suppress transmission again. I think we're going to be in a situation where we may need to lift some of these measures, but be ready to quickly identify those cases. There may be sort of a push and pull for some time as we try to really work and suppress this virus across the globe. Tarik: (14:50) Thank very much. Next question is from our friend, Geneva based journalist, Peter Kenny representing South Africa media. Peter, can you hear us? Peter, can you unmute yourself please? Do we have a Peter Kenny? You really need to unmute yourself, otherwise we then go, we will try to come back to Peter maybe later. Yes, so let's try with Bianca Garcia from Global Brazilian media. Bianca. Bianca: (15:30) Hi Tarik, can you hear me? Tarik: (15:32) Yes, please go ahead. Bianca: (15:34) Thanks a lot. So my question's about Brazil, I'll make it in Portuguese. [foreign language 00:15:40] Thanks. Dr. Michael Ryan: (16:38) That's about five questions in one, so I think it's going to be difficult to address. WHO always responses to request for assistance for our member states. I think it's important to clarify here, that the WHO is an agency made up of its member states and we respond to any requests for assistance from those members states. We're not entitled or empowered to come into any country- Dr. Michael Ryan: (17:03) Member states. We're not entitled or empowered to come into any country, provide any specific standards or guidance, or to deliver any particular material unless we're invited to do so by the government of that country. I'm sure that the government in Brazil is working closely with our colleagues in our American regional office, the Pan American Health Organization. We will respond promptly to any request for materials, supplies, technical assistance, or strategic guidance regarding the nature of mass gatherings or any other control measure that Brazil wishes us to do so. Speaker 1: (17:45) Thank you very much. Yes. Please, if we can have one question for journalist that would be really a good next question... is coming from Greece. That's Kostas from ERT Television. Kostas, please unmute yourself, and we will be able to hear you. Kostas: (18:05) Hello to everybody. Thanks for taking my question. Since the beginning of the pandemic, states have been called upon to identify cases in past citizens, PCR and antibody tests that are already in use. Lately, we have been observing groups of researchers analyzing city wastewaters to determine the degree of contamination of areas by coronavirus. Can this [inaudible 00:18:34] to give us a faster and more realistic picture of the pandemic versus the usual test? Thank you. Speaker 1: (18:46) Kostas, if we can just repeat the question. The question is about the new tests, antibody tests, or? Kostas: (18:52) No, no. It's a question about analyzing city's wastewaters to determine the degree of contamination of areas. Speaker 1: (19:03) Oh okay. Kostas: (19:03) Can this give a faster and more realistic picture of the pandemic? Speaker 1: (19:09) Thank you very much for that. Dr. Maria Van Kerkhove: (19:11) I could start, but maybe Mike will want to add. Yes. Sorry, I didn't hear the question before. There's numbers of ways in which we are looking to evaluate how the virus is circulating globally. You mentioned two of those, the use of molecular tests, or PCR tests, which are measuring active infection in people. There's the use of the antibody tests, which are also testing people, but that's testing past infection. We have a unit here that's looking at wastewater that is looking at if the virus, live virus or fragments of the virus, are found in wastewater. We do understand that there are fragments of virus, this is not live virus or infectious virus, that can be found in wastewater, so it's possible that that might be something that could be used to look at where the virus may be. Dr. Maria Van Kerkhove: (19:58) It's important that we focus our attention on looking for the virus in people. If you aggressively look for cases, human cases, and find those individuals, isolate those individuals, care for them depending on the severity of their illness in a healthcare facility or at home, if that can't be done, and identify all of their contacts and quarantine those contacts, we know that that works. That can stop transmission. Dr. Michael Ryan: (20:30) If we could maybe just emphasize that point... I think we've said this a couple of times. I mean, science and discovery is very important. Looking for the virus in different samples have been able to find different ways to monitor the presence of the virus, be it in environmental samples, very important, in antibody tests, in recovered patients. Very important... They all have an importance. They're all very important for understanding the long-term trajectory of the pandemic. We seem, also, to be avoiding the uncomfortable reality that we need to get back to public health surveillance. We need to go back where we should have been months ago: finding cases, tracking cases, testing cases, isolating people who are tested positive, doing quarantine for contacts. We have seen time and time again, in countries that have contained this virus and brought it under control without the need for massive lockdowns, have done it through the application of principled, human rights-driven, but sometimes quite aggressive public health surveillance. Dr. Michael Ryan: (21:40) I think this is something we do in society. We sometimes look for the answers where they are not. We need to go back to the basic principles of how we control this disease: a comprehensive strategy that matches basic public health surveillance, community education, knowledge, and empowerment with a strengthened healthcare capacity to treat cases. We are able to pull those three things together and develop a vaccine in the medium to long-term. That's the core. There's a lot of other information and science that needs to be discovered around that. We need to stick to the core strategy or else, we really will risk looking for answers where the answers are not. Or, the answers to the questions we're asking are not going to solve the problem we have. We know the problem we have. Speaker 1: (22:34) Thank you very much, Dr. Ryan and Dr. Van Kerkhove. Now we will go to Logan Sierra from Swiss News. Logan, can you please unmute yourself? Yes, please, go ahead. Logan SIerra: (22:48) Yes, thank you for having my question. Since you raised the question of the sera tests the last time that the Swiss pharmaceutical group rushed, got the approval from FDA, and they pretend to other product which is trustful than 99% and more efficient. At the same time, there was a study by the University of Zurich published in the land sets that tend to show that COCVID-19 is not only a pneumonia but also systemic vascular inflammation. What does these two components tell us? What might that change in terms of response? Thank you. Dr. Maria Van Kerkhove: (23:28) I'll start with the first part of that question. There are hundreds of tests that are available. A number of them are serologic tests, which are measuring the amount of antibodies in an individual. Some of these are undergoing different forms of validation, which is very important. This means that each of the tests that are developed are assessed and evaluated for how well they work. You use a known quantity of sera, of biological material, to look and see how well the test performed. Do they actually measure what they're supposed to measure? That's important. Dr. Maria Van Kerkhove: (24:06) We are working with a number of labs and also find to help do validation of molecular tests as well as serologic tests. As those validation results come available, then we will have more and more confidence in each of these tests that are out there. There are more than 90 countries that are currently conducting sera-epidemiologic studies. We've mentioned that previously. This is an important part of understanding the extent of infection in a population, in a country, and across the world. Dr. Michael Ryan: (24:41) On the issue of the clinical syndromes associated with COVID-19... I think this is an important issue because I think we've very often seen with new emerging diseases that they don't always have just one target organ. They tend to cause a much more disseminated disease. They may affect multiple organs. It is sometimes only over time, many, many generations of transmission, sometimes decades, sometimes hundreds of years where some diseases establish what looks like a preferred organ or it becomes an endemic disease with one organ that's affected more than any other organ in the body. We tend to often call those diseases after the organ they affect. We often call the hepatitis viruses because they cause hepatitis inflammation of the liver, but there are many different types of virus that cause that same problem. Dr. Michael Ryan: (25:34) However, there are diseases like measles. We often think of measles as a disease, a fever with a rash, a mild self-limiting illness in children. I can tell you that measles in an unvaccinated child who's undernourished and living in a refugee camp is a serious disease that can affect their lungs, their eyes, their brain. It can cause so many different organs to fail. It's quite frightening. I think when we look at COVID-19, we need to see that as a disease that obviously is a respiratory disease. It's spread by a respiratory route. It causes a respiratory syndrome. It is clear that in a proportion of patients, it is causing a broader inflammatory response either within the vascular or... That's the blood carrying system. Or in other parts of the body. Dr. Michael Ryan: (26:23) We've also seen reports of encephalitis, or swelling, or inflammation of the brain. We've seen other reports of other effects of the disease. That's why it's so important, as Maria has said previously, that we continue to collect clinical data from across the world on all of these different impacts of the virus. It's still primarily causing a respiratory syndrome. You see that, unfortunately and tragically, repeated day after day in intensive care units around the world, patients struggling to breathe with their oxygen levels falling and having demonstrable damage by CAT scan and x-ray to their lung tissue. That is a major part of the syndrome, but clearly, the vascular effects, or the effects on the blood-carrying system, or the cardiovascular system are there. They're real, and they need to be studied further. Speaker 1: (27:16) Thank you. Next question is from David Andelman from CNN. David, you have the floor. David Andelman: (27:26) Yes, thank you. Can you hear me? Speaker 1: (27:29) Yes. David Andelman: (27:29) Great. Can you suggest why Russia's infection rate has been rising so dramatically, and whether the WHO figures really reflect the totality of Russia rather than largely Moscow, and whether Russia is following WHO guidelines for containment as Dr. Tedros has just outlined? Speaker 1: (27:49) Thank you, David. Dr. Michael Ryan: (27:52) I think Russia is probably experiencing a delayed epidemic. We've seen this in many contexts. We've seen how Italy was one of the first countries in Europe to experience a large-scale epidemic. It was followed by Spain, followed by the UK and others. We believe that in that sense, Russia has experienced a delayed beginning to the epidemic and is now seeing that increase in cases. Russia has also increased its testing, both in the urban areas and outside of it. The increased numbers may reflect partly that. There's also been an increase in deaths, which means the disease is clearly having an impact. Dr. Michael Ryan: (28:36) I think the government has really shifted its response into a much more aggressive mode over the last week or so because I think there's a growing realization that this disease is requiring a scaled-up response. In terms of the strategies been implemented, Russia has implemented very large-scale public health and social distancing measures. It is increasing its lab testing across the country. I think where all countries have struggled, quite frankly, is with systematic contact tracing, particularly when numbers begin to rise very quickly. I think this has happened. Dr. Michael Ryan: (29:15) If you remember, we spoke about the four Cs before where you have cases, and you have clusters, and then you have this widespread community transmission. I think when you have cases and clusters of cases, it's quite straightforward with some targeted investment in public health services to do the kind of contaminant activities we've spoken about before. Once you reach intense community transmission, it becomes very, very difficult at that point to do systematic and comprehensive surveillance. I think the exception to that are countries like Korea that managed to do incredible contact tracing in the middle of a very intense community outbreak. It is possible to do, but it requires a very coherent, very well-resourced, a very well-trained public health workforce with a lot of resources, and the support of government and of the community to achieve that. Dr. Michael Ryan: (30:12) I think that's maybe for Russia, for other countries in Europe. Once you get behind the curve and once the disease has spread at community level, the only options that have remained open to countries in those situations have been pretty severe public health and social distancing measures. Those measures have had an impact. They have suppressed infection. Dr. Michael Ryan: (30:35) As those numbers have fallen and restrictions are lifted, the danger is always, as Maria has said before, of a jump back. That disease will probably jump back unless you continue suppressing the virus by those public health measures, by those cluster investigations, by that contact tracing, that testing, and by continuing to support the community to maintain physical distance and appropriate measures, if not a total lockdown. With the case of Russia, I think Russia is just in a different phase of the pandemic and can learn some of the lessons that have been learned at great cost in Asia, in North America, and in Western Europe. Speaker 1: (31:23) Thank you, Dr. Ryan. Next question coming from Maya Plans from the Shifter. Maya, you need to unmute yourself, please. Maya Plans: (31:36) Yes. Thank you very much for taking my question. My question is still regarding the current vascular issues that have been reported. If you could elaborate a bit more on, how are you looking at these issues of patients' report, how does the WHO reports on this and collect data on this, kind of. because I heard that some people came to hospitals, not with respiratory problems, with cardiovascular problems. Then they went back home, and later they were found out that that was part of the symptoms that they exhibited by having cardiovascular issues. Dr. Maria Van Kerkhove: (32:25) Thank you for the question. It's a really important question. As Mike has just said, as we learn more and more about this virus, I have to remind myself that we're in month five of this pandemic. Although it has seemed like an incredibly long time, we're at the very, very early stages of our understanding of how this virus affects the body, how disease progresses, what diseases that this infection causes. We have a global clinical network that we've brought together. We bring this same group of clinicians across the globe together for other diseases. We activated this group very early in January to bring together clinicians who have experience with treating COVID-19 patients. Dr. Maria Van Kerkhove: (33:14) The value in doing that, as you're putting clinicians, talking to clinicians with firsthand experience of what they're actually seeing in terms of the patients, in terms of what those patients are dealing with and what those doctors, and nurses, and medical professionals are doing to try to save their lives, and to try to prevent them from progressing to severe disease... The way in which we gather information about symptoms or disease is through a standardized set of data that needs to be collected from patients. It's very difficult to collect a standardized set of data from patients when you're in the middle of a very intense outbreak, and you're just trying to save as many lives as you can. In some countries and in many countries that don't see intense transmission right now, and especially in the beginning, what we did is we set up a clinical case... Dr. Maria Van Kerkhove: (34:03) In the beginning. What we did is we set up a clinical case report form, which is something that was developed with WHO and ISARIC, which is the International Severe Acute Respiratory Infection Consortium, and many partners, many clinicians and nurses and medical practitioners across the globe, to set up a case report form that collected a set amount of data from each patient. And in doing so, that helps us gather information so that we can analyze it and say, is this common, is that not common? Is it associated with COVID-19 infection? What does the presence of smoking or an underlying condition have to make that condition worse? Dr. Maria Van Kerkhove: (34:42) So we set up this case report form, it is being used now. It took some time to get going. And there's more than 10,000 case records in this, and we are hoping that more and more case records can be obtained so that we could better understand this. Dr. Maria Van Kerkhove: (34:58) In addition, we're working with a number of countries who are conducting their own studies in their hospitals. Some of these are coming out through peer-reviewed publications, but those are done by individual hospitals. And that information is really critical for us to gather an evidence base to really understand what's happening. Dr. Maria Van Kerkhove: (35:17) But with these syndromes, with these new syndromes that we hear about, those are identified by astute clinicians, astute nurses, astute medical professionals, and it's important that that's characterized. You've heard of this hyperinflammatory syndrome in children. That is something that is now being looked at by clinicians. This is among children, a very rare condition that seems to be among children. This is being looked at globally now, and there will be a case report form specifically for that so that we can collect standardized information and be able to understand this disease further. Speaker 2: (35:55) Thank you Dr. Van Kerkhove. Next question is from [inaudible 00:00:36:00]. We have online [inaudible 00:02:06]. Can you hear us? Speaker 3: (36:08) Yes, I can hear you. Can you hear me? Speaker 2: (36:10) Please go ahead. Yes. Speaker 3: (36:12) Okay, so [inaudible 00:36:15] about any promising cure or vaccine, especially that we heard reports about having negative side effects on patients who will use hydroxychloroquine. And now eyes are on remdesivir. So any updates concerning that. Dr. Maria Van Kerkhove: (36:36) So I can start on this. And Mike or GG may want to supplement. So there are hundreds of clinical trials that are currently underway looking at different therapeutics, different drugs that could be used for COVID-19. What is important is that any of these potential therapeutics need to be evaluated properly through what are called randomized clinical trials, to ensure that whatever agent is used, provides safe and effective treatment. You mentioned side effects. So it's not only important to look at how well this works against maybe preventing infection or helping someone progress to more severe disease or preventing death, it's also very important that it doesn't have side effects. Dr. Maria Van Kerkhove: (37:23) So there are a number of clinical trials underway. We have initiated with partners, the Solidarity Trial, which is a clinical trial that is evaluating a number of therapeutics, including remdesivir, including chloroquine. And there are more than 2,500 patients that have been enrolled in this clinical trial from, I think 15 countries so far. But there are more than a hundred countries that are willing to participate in this clinical trial. Dr. Maria Van Kerkhove: (37:52) And the beauty of this is that by doing a clinical trial across multiple countries and across multiple hospitals is that we can have enough patients to be able to evaluate the answer to which drugs are safe and effective, quicker. Dr. Maria Van Kerkhove: (38:07) And so as of right now we don't have any drugs that have fulfilled all of the criteria through these randomized controlled trials, but it is incredible that there are so many that are underway, and we look forward in the coming months to finding out more about which drugs are safe and effective for COVID-19. Speaker 2: (38:29) Next question is for Antonio from EFE News Agency, Spanish speaking news agency. Antonio, can you please unmute? Let's try one more time with Antonio. Antonio: (38:50) Si, gracias. [Spanish 00:38:53] Dr. Michael Ryan: (38:53) Yeah. I think that you reflect our fervent desire of all human beings to reconnect with each other, and we share that sentiment here. We haven't shaken hands or hugged our friends in 18 weeks either, or seen our family, some of us, and therefore it's really important that we work hard to get back there. But also, we need to be careful. We've seen what this virus can do in situations where the virus has spread unstopped. Dr. Michael Ryan: (39:56) So yes, I think there is a pathway out and I think many countries are taking a very careful stepwise approach relying on the patience and perseverance of their citizens to continue to suffer what is a difficult process both socially, psychologically and economically for many people. But I think everyone is doing that because we want to protect those we love, and we want to ensure that we end this as quickly as possible. Dr. Michael Ryan: (40:25) So we're going to have to monitor this very carefully. We are and as WHO we are monitoring, and it's very difficult, but we've tried to work out with the whole selection of measures that have been put in place by countries. And as those measures are lifted we're looking at which countries are taking away which, and we will monitor the epidemiology in those countries. And with them, we will look at and examine if certain measures, as they're lifted, may cause a jump in cases. We'll have to think about that again. One being the schools is a very good example as people return to work. I think the thing, and I think we're seeing is that a careful and measured return to those kinds of normal activities of work and school, especially if they're done with density reduction, physical distancing and hygiene in place seem to be very prudent and practical. Dr. Michael Ryan: (41:19) Where we're going to maybe have to accept a little bit more time, is going to be around mass gatherings, things like large scale gatherings, concerts. We're coming into the summertime in Europe and North America and other places in Asia, and this is the time when people gather on mass. We go to big events and it's going to be much more difficult to make those perfectly safe. Dr. Michael Ryan: (41:44) And life is life. There's no zero risk. We do it every day. We manage the risks in our lives and what we need to do collectively is reduce the risks associated with COVID transmission to an absolute minimum, and then recognize what risk is left and be able to mitigate that risk. And we would, at this point, in countries where we see downward trends in disease, where we see a strong public health surveillance in place, where we see a healthcare system that's capable of treating cases, where we see a committed community willing to continue with personal and community measures, I believe there's a path out. But it may involve schools or partial school opening, partial workplace opening, those working from home that can, those that need to go to work, being properly protected in place. And especially those people who have to work in high density conditions, we have to make special provision for their occupational health and safety. Dr. Michael Ryan: (42:52) Then we have to look very carefully at events that bring people together on mass, and see how best we can bring. For example, we spoke to the last day about football and other spectator sports. Maybe the sports can start again, but the spectators may have to stay away for a little bit longer. And I think everyone has a stake in this. This isn't just the purview of scientists. This is a dialogue with communities. This isn't just science spitting out orders that then are implemented by people. Community activities and social life is a dynamic process, and there needs to be a good dialogue, and we need to have that at national level, we need to have that at provincial level of it, needs to be had at a local level. Dr. Michael Ryan: (43:36) Communities are very often best placed to look at what's important and look at what's relevant for them, but always with risk in mind, and listening to the science, and listening to the public health advice. So yes, I'm sorry, bit long-winded in my response, because I think the issue is so important. Dr. Michael Ryan: (43:54) There is a path out, but we must remain ever vigilant. And we may have to have a significant alteration to our lifestyles until we get to a point where we have an effective vaccine and effective treatments. But that doesn't mean it's all bad. I mean, we've seen some benefits to our environment. We've seen some benefits to our connectedness. Strangely enough, even though we've been disconnected physically, I think many of us have recognized how important those connections are. So I think we need to move forward recognizing that it's been, and is and will be for many populations and countries, what we call systems. Still, this is a big challenge, and we're not through it yet in many countries. And as some countries come out of lockdown and come out of these measures, they can offer hope to communities who are entering into epidemic situations, learn lessons from what everyone has done, transfer resources, and help other countries to fight the fight they have to fight. And in the end of this as Dr. Tedros says again and again, true solidarity, we will win the fight and nobody is safe until everybody's safe. Speaker 2: (45:16) Thank you, Dr. Ryan. We can take a couple of more questions maybe before we conclude. Now we go to India, United News of India with Ajit. Ajit: (45:30) Yeah. Thank you. Thank you so much. My question [inaudible 00:45:34] that? Is there any study, any experiment or any elaborate research, that what is the temperature range that this virus can survive within the human body as well as in the open environment? Dr. Maria Van Kerkhove: (45:54) That is a very good question and a very specific question, and I don't have the data in front of me. There are studies that have evaluated virus survival on different types of surfaces; on wood, on steel, on fabric; that have found that the virus can survive hours to days depending on the temperature and the humidity. I don't have the details of the temperature and humidity off the top of my head, so I will be very happy to provide that answer if you get the name and the contact information. Dr. Maria Van Kerkhove: (46:26) But what we do know is that the virus, if it is on a surface, can be inactivated, can be killed with disinfectants in a matter of minutes. And that is important, and it is important that people know that because if they do touch a surface that is contaminated, they can wash their hands or use an alcohol-based rub and protect themselves, or they can clean their surfaces regularly. So it's important that surfaces are cleaned regularly and that you wash your hands. But I'll have to get back to you on the specifics of the temperature and humidity. Dr. Michael Ryan: (46:58) And just, I think one important point, because you mentioned two things, one about environmental situations and you also mentioned body temperature. Body temperature, this is important for people because I've heard various stories about people saying that it's important to be very hot or be very cold. This has no impact on the virus. Dr. Michael Ryan: (47:22) Viruses and infectious diseases cause people to have fevers and very often it's the breakdown products of the virus or the immune response that trick the body into being hot. And having a temperature in itself is not necessarily a bad thing, but also, that temperature has to be carefully monitored, especially in children. So the idea that one should have a very high temperature and that's helping to get rid of the virus is not true. The body is responding to the virus's presence. Dr. Michael Ryan: (47:54) Equally, the idea that you will try to cool someone down to get rid of the virus is not true. But there are certain situations where there is a high temperature and it's important for doctors and nurses to get the temperature down, because very high temperatures, I mean very high temperatures can be associated with convulsions and other effects. Dr. Michael Ryan: (48:12) So the monitoring and the management of temperature in a person who's got an illness, it's very important, and it's very important that clinicians can manage a very high temperature. But the idea that temperature itself is affecting the way the virus will behave in the body is not true, so people managing themselves by trying to make themselves very cold or make themselves very hot will not affect the process of the virus in your body. But managing the temperature is very important for the outcome for the patients. Speaker 2: (48:47) Thank you. Maybe we go to the last question. That would be a Politico, and it's Carlo who is with us tonight. Carlo? Carlo: (48:58) Yes. Hello. Thank you for taking my question. I had a question about the different rates of the virus geographically. For example, even in Europe, you see very different rates in Eastern Europe versus Western Europe, and sometimes even within the same country. For example, the North of Italy versus the South of Italy. Do we have any idea of what's causing this extreme variability even in small geographies? Dr. Michael Ryan: (49:32) If that was the last question, we could be here all night, because it is, and it's an important question, but it's not one that one can answer in a single sentence or in a number of sentences. But it does go to the heart of some of the issues associated with the transmission of this virus. Dr. Michael Ryan: (49:50) I mean, obviously the virus transmits in different situations with different degrees of intensity. And what we've seen in mass gatherings or situations where people have been pulled together in large groups, we can see an amplification of disease that can seed disease in a community very quickly, therefore generating a very large wave of infection. Dr. Michael Ryan: (50:10) And in some situations, we have very small waves and the number of infected builds up more slowly. And that can occur because of a particular type of event that sort of triggers the transmission and a large number of people in the community at one time. But it can also happen because of the conditions that a community live in. The number of people who live in a household can often affect that. The transmission of, for example, disease in somewhere like Sweden versus somewhere like Italy may just as much be affected by the fact that 50% of Swedish people live alone in apartments or live in apartments of less than two people, whereas many people initially socially live in much larger households. I'm not saying that's the reason, but you have to look at population density, you have to look at the way people live, you have to look at the way they interact. And- Dr. Michael Ryan: (51:02) At the way they interact. And that may be affecting the way disease is transmitted, in many countries. You have to look at the way in which people use public transport, and use transit. If the large proportion of people are using overcrowded transit, in the middle of a respiratory epidemic, you will see more transmission. So, you could look at any number of factors, population mobility between areas. In some countries, mobility between areas is not very high. In other countries, mobility, long range commuting, has become very common in Europe, for example. It's not unusual to find people commuting between countries, to go to work. So, social, economic, behavioral patterns, can affect the way in which disease spread, population density, population behavior, social norms, and the way we live our lives in general. And there are differences right now as I said before, between Western Europe, which has been through that first big wave, and Eastern Europe, particularly the Russian Federation, that is now experiencing higher numbers of disease. Dr. Michael Ryan: (52:11) And I was answering the question previously about Russia. I'd forgotten to say that there'd nearly been, about 450,000 tests, carried out in Russia, which, when you do it for the number of tests per million population, is around 30,000 per million. Which of the 57 countries in the European region of WHO, puts Russia about the 10th highest of all the rates of testing. The positivity rate is about 3.6%, which again, is quite low, compared to the positivity rates and other countries. So in that sense, just to follow up on the previous question, the number of deaths also remains very low as a proportion of the overall cases for the Russian Federation. But you see that you can clearly see that the number of cases, as recently as somewhere like Russia, what we have to be very careful of is that the death toll doesn't rise with those cases. Dr. Michael Ryan: (53:13) The other factors around the world, I was speaking in a European context, there are so many other factors driving the risk of transmission, in countries. The degree of compliance with public health and social measures. The availability of effective public health response, like contact tracing. We've seen countries who've been very systematic with a very comprehensive strategy. I think of countries like New Zealand, who've really done the last and they've gone from public health measures, to a very graded response, to very systematic case-finding and contact tracing, to a high rate of testing. When all of those factors have been put together, the disease tends to be more controllable. So, disease epidemiology is driven by the natural history of the virus. It's driven by human behavior, and it's obviously affected, by the public health or the health response to the virus. So it's very hard to, make hard and fast rules for what happens in any individual country. Maria. Dr. Maria Van Kerkhove: (54:14) Thanks, I just want to touch upon on one aspect of this. The virus is transmitted through the respiratory route. It's transmitted through infectious droplets, from an infected person, to another individual, who's in close proximity to that person, without wearing protective gear, or, through contaminated surfaces, where you touch a contaminated surface, and you inoculate yourself, through touching of your eyes, or your nose, or your mouth. The parameter that we look at to really evaluate how fast and how quickly this virus could spread is called the reproduction number. And that number is the average number, one infected person, individual will infect. If that number is above one, then the virus can take off and you can have an epidemic. If the reproduction number is below one, it will die out. And so what we're looking at in a number of countries is that they're constantly evaluating is, what is the reproduction number? And they call that the time varying reproduction number. Dr. Maria Van Kerkhove: (55:11) That number, is contact-specific, as Mike was saying. If you prevent people from coming in contact with one another. If you isolate known contacts, so that they don't have the opportunity to be in contact with someone else. If you find the contacts, and you quarantine those contacts, and they do become cases, they don't have the opportunity to infect other people. You actually break the chain of transmission, and the virus has nowhere to go. The virus needs a person, to be able to transmit to another person. If we are able to break those chains of transmission, we can bring that reproduction number under one. And it's very contact-specific. I brought up Singapore before, but even thinking of what's happening in Singapore, they were able to bring their outbreak under control, until the virus had an opportunity to start in a closed setting. Where you have people who are living in close contact with one another. Dr. Maria Van Kerkhove: (56:12) These types of close settings, exist in all countries. In longterm care living facilities, in institutions, in prisons. And we need to find ways in which we can prevent the virus from transmitting from one person to another. And that way we can bring that reproduction number under one, and we can break those chains of transmission. This is the first pandemic in history, that we can control. By doing these measures, find, isolate, test, treat. Find all of the contacts, quarantine those contexts, engage your populations, have them know what they can do to protect themselves, and protect others. Tariq: (56:54) Thank you very much. So, we will conclude. And I apologize to journalists whose questions have not been answered this time, but obviously, we will have other opportunities. The audio file will be sent, in the next hour or two, and transcript will be available tomorrow. I wish you a very nice weekend to all. Dr. Tedros: (57:17) Yeah, thank you. Thank you, Tariq. Thank you for joining us, all online and, have a nice weekend. (Silence)