World Health Organization Coronavirus Update March 6, 2020

Tariq: (00:03) Good afternoon. Good afternoon everyone. Thank you very much for joining for this Friday press briefing on COVID 19. Welcome to all people watching us on WHO Twitter account. Journalists who are dialing in through mobile phones, you will need, as any other day, to press star nine to ask questions. And those who are watching us through Zoom online, to click raise hand. Today, we have as most of the days Dr. Tedros, Dr. Maria Van Kerkhove and Dr. Mike Ryan. We also have couple of colleagues sitting in the back, Dr. Adriana Velasquez, Dr. [inaudible 00:00:59] Dr. Anamaria Janel, Dr. [inaudible 00:01:03] and Dr. Sumia Swaminathan, who may also be asked to answer some of the questions. As always, we will have an audio file and transcript for this press conference. And I will just really remind everyone if it's possible to ask one question please so we let all colleagues to ask their questions, so please let's try to respect that. Dr. Tedros, please. Dr. Tedros: (01:30) Thank you. Thank you Tariq. And good afternoon, and thank you once again for joining us in person and online. And I would like to start by acknowledging International Women's Day this Sunday. This is a moment to remember that around the world, many women cannot access essential health services and continue to suffer disproportionately from preventable and treatable diseases. But International Women's Day is an opportunity not only to promote and protect the health of women, but to highlight the vital role they play in promoting and protecting the health of all people. Dr. Tedros: (02:25) Globally, women make up 70% of the global health workforce but hold only 25% of senior roles. WHO is committed to promoting gender equality everywhere and especially in the health workforce. We're proud that we have achieved gender equality in our senior leadership team at WHO headquarters, although we know we still have to work to do in other parts of the organization. Women are also playing a vital role in the response to COVID-19, and we're proud to have many amazing woman leading our response in WHO, including Maria, Sylvie, Somia and Anamaria, Maria-Angela, Mary Pierre, Adrianna, Gabby, Nika, and many others. In the past 24 hours, 2,736 cases of COVID-19 were reported from 47 countries and territories. There is now a total of 98,023 reported cases of COVID-19 globally and 3,380 deaths. We're now on the verge of reaching 100,000 confirmed cases. As cases increase, we're continuing to recommend that all countries make containment their highest priority. We continue to call on countries to find, test, isolate and care for every case and to trace every contact. Slowing down the epidemic saves lives and buys time for preparedness and for research and development. Every day we can slow the epidemic is another day hospitals can prepare themselves for cases. Every day we slow down the epidemic is another day governments can prepare their health workers to detect, test, treat and care for patients. Every day we slow down the epidemic is another day closer to having vaccines and therapeutics, which can in turn prevent infections and save lives. Dr. Tedros: (05:10) As you know, last month WHO convened a meeting of more than 400 scientists to identify research priorities. Hundreds of ideas were discussed and debated, and today we're publishing an R&D roadmap which distills those ideas into a core group of priorities in nine key areas. This includes the natural history of the virus, epidemiology, vaccines, diagnostics, therapeutics, clinical management, ethical considerations, social sciences, and more. The R&D roadmap focuses on research that can save lives now, as well as longer term research priorities for vaccines and therapeutics. It's vital to coordinate research so that different groups around the world complement each other, so WHO can give better advice and countries can take evidence based decisions that save lives. That's why WHO has developed a set of core protocols that outline standards of how studies should be done, and to collect critical data so we can compare apples with apples and pull data from multiple studies. Dr. Tedros: (06:42) France and South Africa have already indicated they will use these protocols for clinical trials, and we encourage other countries to do the same. We are also developing research protocols to assess interventions for disenfranchised communities such as refugees and internally displaced persons. We're very encouraged by the level of interest around the world in accelerating research as part of the response. So far WHO has received applications for review and approval of 40 diagnostic tests. 20 vaccines are in development, and many clinical trials of therapeutics are underway. Even as we test therapeutics, we need to ensure that supplies of those medicines are available should they prove effective. WHO has been monitoring the potential risk of a disruption to medicine supplies as a result of the COVID-19 epidemic. China, as you know, is a major producer of active pharmaceutical ingredients and the intermediate products that are used to produce medicines in other countries. WHO has focused on the most essential medicines that are critical for primary healthcare and emergencies, including antibiotics, pain killers and treatments for diabetes, hypertension, HIV, tuberculosis, and malaria. Dr. Tedros: (08:28) WHO is working closely with industry associations, regulators, and other partners to monitor this risk. And so far, we have not identified any imminent specific shortages. Many manufacturers either have alternative sources of ingredients or had stocks to draw on. Manufacturing has now resumed in most places in China, although some challenges remain. Separately, WHO has developed a list of more than 20 essential medical devices that countries need to manage patients, including ventilators and oxygen supply systems. Access to medical oxygen could be the difference between life and death for some patients, but there is already a shortage in many countries which could be exacerbated by this epidemic. WHO has an existing working group with the Gates Foundation, the Clinton Health Access Initiative and Path, and we are building on that partnership to increase access to oxygen. We encourage every country to review WHO's disease commodity package for COVID-19 to ensure it has the supplies it needs, including protective equipment and medical devices. Dr. Tedros: (10:02) All of this requires the involvement of the private sector to ensure countries can access lifesaving products. You have heard me talk about the market failure for personal protective equipment. You heard me talk about the need for a whole of government approach. And you have heard me talk about what individuals can do to protect themselves and others. We look forward to businesses to step up and play their part. We need you. WHO is working with the World Economic Forum to engage companies around the world. And earlier this week, I spoke to more than 200 CEOs about how they can protect their staff and customers, ensure business continuity and contribute to the response. As I keep saying, we are all in this together, and we all have a role to play. Facts, not fear. Reasons, not rumors. Solidarity, not stigma. I thank you. Tariq: (11:16) Thank you very much Dr. Tedros for these opening remarks. We will start with the questions here from room. I will start with Chan, then Madea, and then we will have a question here. Yes, we don't use the microphone. If you can just switch it off and talk a little bit louder. Chan: (11:34) Chan from the [inaudible 00:11:35] agency. The epicenter of the epidemic is in China. Fox News posted, demanding a formal apology from Chinese for the outbreak of coronavirus. So what's the comment from WHO towards the remark? Thank you. Dr. Michal Ryan: (12:04) I'm not aware of the comment, but I think we've said numerous times in previous conferences that diseases can emerge anywhere on the planet and have proven to do so. Ebola emerges very often in Africa. The last pandemic emerged in North America of H1N1. And coronavirus has in this case emerged in China. So I think you should know, as the DG has just said, can we avoid blame culture and can we move on to do the things we need to do to save lives? Tariq: (12:46) Madea please, and then we'll go to you. Madea: (12:49) Official reports in Iran shows a huge spike in identified cases of COVID-19. A spokesperson of [inaudible 00:12:58] today said that we have now identified more than 500 for past 24 hours. Can you categorize or assess the way outbreak is managed in Iran, especially when we have our [inaudible 00:13:14]? Dr. Michal Ryan: (13:16) It's very important in epidemic response to understand your problem because without understanding your problem, it's very difficult to fix it. So we've seen this. China's numbers went up very, very quickly because they started to look for cases. The same happened in Korea when Korea started to do active surveillance. And then you can turn a corner. So I think we need to look at these data in terms of yes, natural epidemiology. But also I think because the Iranian system is switching on, we're seeing a much more out all of government approach as the DG called for yesterday. There's a national action plan now. There's 100,000 workers committed to this plan. And we are going to see, any country in the face of an epidemic, when it looks for cases, will find them. And if we call that a bad thing, it is. It's a sad thing for the people who have the disease. But it's much better that we understand the extent of the problem. So we commend the move towards more aggressive targeted surveillance and we hope that that will lead to the kind of control measures that can help push this virus back. Tariq: (14:25) We have one question here. Then we will move online. One question please. Ken: (14:29) Hi, my name is Ken. I'm from the Japanese [inaudible 00:14:34]. I'd like to ask about Japan and Korea, its travel restrictions. And so both nations have been implementing travel policies against each other, and in Japan part of the Korean measures are taken to be retaliatory, and so can you tell us about to what extent these travel restrictions are meaningful? And do you have any concerns on the countries countering and escalating against each other? Dr. Michal Ryan: (15:05) I think we've been pretty clear on the issue of travel restrictions for a very long time. They should be very carefully considered. They should be public health evidence driven. They should be of short duration, and they should never be carried out in the absence of a comprehensive set of measures to contain or control the disease. There is a long history unfortunately of countries sometimes with tit for tat travel restrictions, and that has happened in the past. Since the advent of the HIR, in fact we've seen a huge improvement in that and in transparency between countries because we challenged countries who put in place travel restrictions, and we challenge them to provide the public health evidence. Dr. Michal Ryan: (15:50) Again, I think Japan and Korea are both doing a fine job in the face of this epidemic. They've both scaled up their public health operations. They're saving lives. And I think we should focus on that and not necessarily on political spats over travel restrictions. It's very, very important that people understand that these types of restrictions are not helping, and in that sense to over emphasize them is to hurt the response. But we do commend both governments for making significant progress in fighting this disease. Dr. Maria Van Kerkhove: (16:23) If I could just say something to the contrary to that in the sense that what we are seeing and what the stories need to be focusing in is how countries are helping each other, and we see a lot of examples of this. The DG mentioned this research meeting that took place on the 11th and 12th. We've been talking since the beginning of scientists communicating with each other, clinicians talking to each other on the phone, sharing experiences. When the world didn't have experience with COVID-19, we had MERS scientists teaching each other about what they did to help patients with MERS, patients with SARS. And I think there's a lot of very positive stories here where countries are helping each other. We have a Chinese delegation in Iran right now. We have people participating in sharing, and I think that there's a lot of lessons to be learned in that. This is not the first outbreak where this has happened before. WHO brings together scientists all over the world, public health professionals, women on the front lines. And I think those are stories that also need to make the headlines as well. Dr. Tedros: (17:27) I would like to add to that. In a globalized world, the only option is to stand together. And all countries should really make sure that we stand together. And in addition to that, as you know, COVID-19 is a common enemy, and the only way we can beat this virus is when we stand together. And that has been the message from WHO all along. And it is, and it will be. So... Dr. Tedros: (18:03) ... along and it is and it will be. So we call on all countries to stand in unison, because it's the united force that can help us to beat this virus as soon as possible. Tariq: (18:14) Thank you very much. We will now go to some journalists who are online. And I'll remind everyone, it's *9 if you are dialing in, and clicking raise hand if you are on Zoom. We will start with Romania. We have [inaudible 00:18:32]. Tariq: (18:32) Adrian, can you hear us? Dr. Tedros: (18:33) Yeah. Hello? I am from [inaudible 00:18:37] Romania. So speaking about Europe, from your estimation, do you think that during the summer the spread of COVID-19 will decrease? And another thing I want to know, if World Health Organization experts sends to all the countries [inaudible 00:18:45] persons because we have some problems here in Romania. And all of the criteria you said when you consider a person suspected of being infected with the coronavirus are the standard procedures? Tariq: (18:44) We lost you in the middle. Can you please repeat the question? Sorry for that. Dr. Tedros: (18:44) Speaking about Europe from your estimation, do you think that during the summer the spread of COVID-19 will decrease? And another thing I want to know if World Health Organization experts sent all the countries some procedures how to test a person. And what are the criteria you set when you consider a person suspected of being infected with coronavirus? Dr. Michal Ryan: (19:45) I think Maria can take the question on seasonality. I think our original director ... we've had multiple, multiple meetings with the European countries across our whole region plus at the European union level with the European Center for Disease Control. Our regional director has been, again in meetings today with European Health Administers coordinating actions between countries and ... We do not know yet, what the activity or the behavior of this virus will be in different climatic conditions. Dr. Michal Ryan: (20:16) We have to assume that the virus will continue to have the capacity to spread and it's a false hope to say yes, it will just disappear in the summertime like influenza virus. We hope it does. That would be a godsend. But we can't make that assumption. And there is no evidence right now to suggest that that will happen. Dr. Michal Ryan: (20:36) So we need to fight the virus now, not live in hope that the virus may disappear on its own. And on the issue of definition, there are very specific case definitions that have been released and updated on a regular basis by WHO, Maria may want to go into the detail on the criteria. Dr. Maria Van Kerkhove: (20:54) So we do publish surveillance guidance on our website as we do with all of our technical guidance and we are constantly looking at the evolving situation to update those. Our case definitions are focusing on people of interest, who should be tested. And it's a combination of factors. It has to do with where a person is, where they are living, where they have traveled. It has to do with if they have symptoms or not and what level of symptoms that they have. So our latest guidance is on the WHO website and there's a very detailed description of who should be tested. Dr. Michal Ryan: (21:30) Again to be clear, when there is a high index of suspicion from a clinician, that the clinical syndrome is consistent, the clinician is in a position to request a test. The test is not restrictive, the criteria are not restrictive. We have to be careful with is that if every single person with a sniffle is to be tested, then we will run out of the capacity to test. So there are major criteria, but that final decision is very much left in the hand of the attending physician based on their instinctive or clinical judgment. And if there are symptoms highly consistent with the COVID infection, that physician may request that test or that is at least WHO's advice. Dr. Maria Van Kerkhove: (22:13) Yes, and context. So that's the other one is not just in that that index of suspicion, but also if you have a confirmed case and you're looking at the context of those cases, they need to be tested as well. Tariq: (22:26) Thank you very much. Next question came through message because there was Steve from Uganda from MBSTV in Uganda is asking what measures have been put in place to contain the virus in Uganda? He says Uganda being a poor country. Dr. Michal Ryan: (22:45) I think Uganda has proven its capacities over the last year and a half. And Uganda has invested heavily in this preparedness for Ebola and important unfortunately Ebola twice from Congo and contain that disease without any further cases. Uganda has a lot of capacity and history in dealing with severe emerging disease that spread from person to person and require the isolation of cases and the followup of contacts. And as the director general has been saying for years now, this is about preparedness. Dr. Michal Ryan: (23:22) You prepare for one disease, you prepare for all diseases. Preparing for Ebola gives you capacities against COVID. Preparing for flu gives you capacities against other diseases. And what we hope is that these investments that are being made by countries like Uganda and that we want to make under the new emergency preparedness division here at WHO it's really important that we focus on that. Dr. Michal Ryan: (23:47) Other countries, Uganda's a strong system, but we are concerned that there are countries who have much weaker surveillance, much weaker health systems. And we need to continue to support all countries in getting ready. [inaudible 00:24:01] may have a comment on this. Dr. Tedros: (24:04) That's enough. Thank you. Tariq: (24:05) Thank you very much. This was answer to question from Steve from Uganda and MBSTV. If Chris is fine, we can go to one more question or two more questions from online. Elaine Fletcher from Health Policy Watch. [Banjo 00:24:24] [Inaudible 00:24:24] from Down To Earth, India. Banjo, can you hear us? Banjo: (24:27) Yes, I can hear you. Can you hear me? Tariq: (24:32) Please go ahead. Banjo: (24:34) My question is to Dr. Maria. Maria, We had only five cases three days ago, but now we are up 30, 31 cases, but the distinct criteria in our country is limited to suspected cases or to the ones who have been in contact with the confirmed cases. Do you recommend that, as Dr. Mike was saying, that we should now expand our criteria and the clinician if he finds that it is necessary we allow to recommend the test, an investigation test. Dr. Maria Van Kerkhove: (25:04) Well, thank you. Thank you for the question. So we put out recommendations of what we feel is most appropriate for testing and it is important that that countries look at these and they make an assessment of what is best for their country. Our guidance is out there to be aggressive at finding all cases among people of suspicion and ensuring that the contacts of those cases are also tested so that we can prevent onward transmission. Decisions need to be made based on capacity, based on many different factors. But it really is important, especially early on as you said, you have some cases in your country. It's very important that there's an aggressive approach in the beginning that you look for all of those cases. Because as case numbers increase, systems become overwhelmed and so as much as can be done in the early stages of this, the better chance you have to delay and to reduce and suppress transmission. Tariq: (25:59) Thank you very much. We will now go to Elaine Fletcher from Health Policy. Watch Elaine, please go ahead. I'm sorry for the confusion. Elaine Fletcher: (26:06) Well thank you. Hi, thanks for taking my question. The World Bank announced recently that will put it's spring meeting on a virtual format and that move was applauded in many quarters as something that would also save carbon emissions and travel costs, which are significant for global organizations. And many private companies meanwhile have also begun to encourage teleworking as a preemptive move to reduce infection risks. What's your message on these topics and is WHO making contingency plans for a virtual World Health Assembly? Dr. Michal Ryan: (26:38) Yeah. Did you need to comment on the World Health Assembly? I think we advise a risk management approach to all of these different gatherings and meetings. And I think we are entering a new era on this planet in terms of our movement and how we engage and how we interact with each other. Dr. Michal Ryan: (27:07) And it's wonderful to see that we have alternatives now to necessarily having to meet face to face all the time. And if there is a benefit to the planet then that is great. But we would obviously rather not have COVID-19 and the fear, and the disruption that it's causing. But life has to go on. Our economies, our societies, our communities have to continue to work, to live, to educate. But I think we also need to innovate. And it's wonderful to see the innovation in education, the innovations in communications, the innovations in our capacity to continue doing the things we do. But maybe using alternative ways of achieving the same ends. Dr. Michal Ryan: (27:49) And if there are benefits to our planet for that and to our society in general, that's great. But I think we'd like to get rid of COVID-19 too. Dr. Tedros: (28:01) Yeah. Maybe to add to that, I know we will have this COVID-19 behind us. And virtual meetings should actually be considered, not because of COVID now, but when there is no COVID. We have to challenge all our meetings, whether we really need to meet in person. So that's our advice. Dr. Tedros: (28:34) But in the middle of the COVID-19 now as Mike said, we have to do the assessment, risk assessment and make our decisions based on that. But the virtual meetings, teleworking should actually be an issue even when we don't have COVID around. Dr. Tedros: (28:56) As you said, one added advantage is minimizing the carbon footprint, but there will be other advantages too. Dr. Michal Ryan: (29:04) Let's go back to- Chan: (29:08) [crosstalk 00:29:08] Assembly? Dr. Tedros: (29:11) On assembly, we still have time. So we will assess the situation. It's what we said based on the risk we will decide. We will let you know. Tariq: (29:28) Thank you very much. We will go back here but we will take one or two from the room because we want to go back to online. You really remember yesterday we had issues and we didn't take questions from our colleagues. Yes, please show [inaudible 00:29:42] and then Jamie and then we'll go back online. Speaker 1: (29:49) [inaudible 00:29:49] you just mentioned that the number of confirmed cases is not reaching more than 1,000 and it's spread to [inaudible 00:12:01]. Do you consider it as a new phase or how do you characterize this situation? Dr. Tedros: (30:09) I said it yesterday that it's geographically expanding and it's deeply concerning. But at the same time the most concerning is out of the 88 countries, we're saying more countries affected from the low income with weaker health systems. And that's the most concerning. And we're working with all countries to tailor the response they should take based on their situation. Dr. Tedros: (30:48) And our focus will be to support countries with weaker health systems. There was a question from Uganda earlier. I fully agree with what our general said on Uganda. It's preparedness level has increased significantly, especially after Ebola [inaudible 00:31:07] and we have seen how it has been responding. But still we will continue to support especially the countries with weaker health systems to help them to better respond. That will be our focus. Dr. Tedros: (31:29) And that's why we had a meeting with all AU administers couple of weeks ago to discuss about continental strategy for preparedness and also national strategy for preparedness. Tariq: (31:43) Jamie, short question please. Chan: (31:46) Hi Jamie. This is [inaudible 00:31:47]. I'd like to go back to behavioral things that people can do because I think there's still a lot of confusion out there about what people can do. You mentioned sort of needing to cough in your arm, et cetera, but what about in terms of their households? I mean, are there things that they can do, should they be being buying bleach? Should they be wiping their faces, touching their faces with Kleenexes? What kind of things can people do to make themselves live by greater sanitation to be able to prevent the spread? Dr. Maria Van Kerkhove: (32:22) I'll start with this and you may want to supplement. So it's very important that everyone knows that there are many things that they can do to protect themselves and to protect their families against COVID-19 and to protect against any infectious threats. Dr. Maria Van Kerkhove: (32:38) The first is washing your hands. You've heard us say this many times and it's absolutely critical that people wash their hands. And there's a process for doing so and using soap and water and/or using an alcohol rub. That's the first thing. Dr. Maria Van Kerkhove: (32:52) The second thing is respiratory etiquette. We see many people not practicing respiratory etiquette. And this is really important. This is very simple. You and your family and everyone you know can do this. It's sneezing into your elbow. It's sneezing into a tissue and throwing this into a closed bin and then washing your hands. Dr. Maria Van Kerkhove: (33:09) Making sure that you are well informed. You all know this very well in this room, but this situation is evolving quickly. We're learning new information every single day and we're trying to communicate that information to you as quickly as possible. Making sure that the information is accurate. There's a lot of false information out there. There's a lot of myths that are out there that are not only confusing, but sometimes could be damaging. Dr. Maria Van Kerkhove: (33:33) So that's important. You can get your families ready, you can talk to your children, you can talk to your parents, you can talk to older people. If you have neighbors that don't live with other people, talk to them. Find out what do they need to know? What are their fears? As the DG has said, many times facts, not fears. Let's address these fears and turn this fear into some positive action. You can talk to your employers, you can talk to your government. Dr. Maria Van Kerkhove: (34:01) What are you doing to get ready? How are we getting ready? What's the plan? So there's a lot of things that you can do to get yourselves ready so that you can anticipate what may come. We've said this before, that there is no eventuality here. We are working with governments, with individuals to make sure that everything is done to drive this down to slow transmission, to stop transmission. Dr. Maria Van Kerkhove: (34:21) So that is possible and we're seeing that in many countries. But it all depends on the actions that we take now. The situation could get worse, the situation could get better. We need to prepare for different, different situations. Tariq: (34:36) Thank you very much. Gabriela, you are next to me. Please go ahead. Gabriela: (34:41) Thank you so much. Thank you very much. Sorry, can you Dr. [inaudible 00:34:42], could you say something about Switzerland. We are here. So if you can talk about this and measures that they have taken. What is your opinion on that? Dr. Tedros: (35:02) [inaudible 00:35:02] likes to ask me [inaudible 00:17:12]. I have a general here. Dr. Michal Ryan: (35:19) Well, first of all, we express our gratitude to the government in Switzerland for their cooperation with us and all of the other UN agencies in terms of our own business continuity planning and other things there. Dr. Michal Ryan: (35:31) There's a big international community here in Geneva, and we've been working closely with them on how we deal with business continuity going forward. You can imagine we have our own concerns too, to be able to continue to run our operations in WHO, not only for our normal health programs, but to be able to continue running a global operation here at Global Neuro Center. So we thank the Swiss authorities for their continued cooperation. I believe the Swiss authorities are implementing measures from their pre-plans- Dr. Michal Ryan: (36:03) I believe the Swiss authorities are implementing measures from their pre-plans, preparedness plans and are engaging very closely with other countries in trying to coordinate activity across many countries. I think that's been the challenge for everyone in Europe right now is coordinating activities across all of the nations of Europe with such open borders, and many having slightly different policies regarding mass gathering, slightly different criteria regarding testing. And I think that's caused a lot of people to question why there isn't one standard approach in every country. But that's impossible to achieve. Dr. Michal Ryan: (36:34) But we need each country is making its own risk assessments based on the risks it perceives, its openness, its exposure and its own vulnerabilities. And we continue to say this, and what we will do, as always when asked and sometimes even when not asked, offer advice to countries regarding the approaches they're taking to risk management. Dr. Michal Ryan: (36:54) So I don't know any specific comments to make on the source response unless there's some specific issue you have a concern with, because it's a good public health system responding to the issues that it faces. Tariq: (37:07) Thank you very much. Let's try to take a couple of more questions from online to make up for yesterday. Marian Benitez from Hong Kong. Marian, can you hear us? Marian Benitez: (37:19) Yeah, yeah. Can you hear me? Thanks for taking my call. This afternoon, the University of Hong Kong and their Wuhan counterparts released a study showing that the mortality rate from COVID-19 is much lower than the one the WHO has said of three or four percent. [inaudible 00:01:44]. And it could be lower. But is mortality rate really important, and what's the implication of that? What does the WHO think about studying the mortality rate at this stage when there are so many unknowns. Tariq: (38:00) [ inaudible 00:00:38:01]. We understood the question. Dr. Maria Van Kerkhove: (38:05) Studying mortality is very important in any infectious disease, in any disease period. And from the beginning, our biggest concerns, our biggest questions were around the transmissibility of this virus and the severity of this virus. We have been up here talking to you about the difficulties in calculating a mortality rate and what that actually means, especially early on in an outbreak. And there are many studies that describe why this is very difficult. Dr. Maria Van Kerkhove: (38:31) So there could be simple arithmetic in terms of what we say, but the study that you're referring to is a modeling study. And we work very closely with the university of Hong Kong. They're a collaborating center, a WHO collaborating center. And there are many studies that have tried to estimate what mortality would look like if we consider everyone that may be infected with this virus. Dr. Maria Van Kerkhove: (38:55) You've heard us talk about CIRO surveys and making sure that there's certain population- based CIRO surveys that are conducted, and those are critical so that we really understand the extent of infection in the general population. We've mentioned those studies are underway, but it will take some time to get those results. Dr. Maria Van Kerkhove: (39:11) In the meantime, we work with many different modeling groups that helped us to try to use mathematical models to estimate what population infection may look like. And so what that study is, in fact, is a modeling study that's looking and making an estimate of a mortality rate, which I think is about one percent in that study. So we've said before that the true mortality rate, we don't know at this time. What we can say is how many people have died up to this date. But we do look to our partners to estimate mortality. If we take into consideration the estimated number of people that may be infected, the mortality rate will go down. So it will take some time before we actually get a true value. Dr. Maria Van Kerkhove: (39:55) But it is a very important value for us. Any death is significant. And as we've mentioned, the steps that need to be taken to make sure we slow down this virus will save lives. All of the efforts towards containment will save lives. Dr. Michal Ryan: (40:15) Maybe I could add to that. Obviously a lot of their speculations and modeling and the attempt to understand this, why so few people under 40 have been clinically unwell. Most of the people who are really sick are between the ages of 40 and 90. And therefore when we look to calculate a case fatality, yes we could add in a whole bunch of young people and children who may be getting infected and are not getting sick, and that's important, and the overall case fatality will drop. That may not necessarily affect the experience of older people. Dr. Michal Ryan: (40:49) And remember within this, if you look at the data from China, based on the numbers reported, the actual case fatality for people in the older age group goes up with age and goes up significantly with the presence of underlying conditions. So the actual age-specific or condition-specific mortality could be much higher than those numbers. So the numbers could be higher for individuals who have underlying conditions. It could be higher for ... And equally, we have an assumption that children are maybe getting infected and are having mild infections. Dr. Michal Ryan: (41:28) I personally have experienced in the past, influenza epidemics amongst children with low nutrition, children in compromised refugee type settings and their mortality can be much higher. They're much more vulnerable. They're living in much more exposed conditions. We've seen what normal respiratory infection can do in refugee camps, and anyone who's worked in a refugee camp knows how devastating viral disease can be in those situations. Dr. Michal Ryan: (41:54) So while we can make some assumptions and we hope for the best, I hope fervently that we find that there are millions of people who've been infected asymptomatically and the overall mortality is lower. That's not something we hope for. But we have to look to those, and the DG keeps speaking about this, look to those around you who are most vulnerable. Look to the people who are older. Look to people with underlying conditions, look to our refugee populations, look to the undernourished, look to people who may have other longterm infectious conditions. And that's what we need to do in order that we put in place the necessary services to protect and save their lives. And that's the approach. But we do hope over time that as we do the serology, we find that the overall fatality is lower. Tariq: (42:45) Thank you very much. Let's try to take two more questions. We have BuzzFeed. If I'm not wrong, it's Zara Hijri, but please correct me. Can you hear us? Zara: (42:57) Hi, thank you. Yes, it's Zara here, Jay. And I've been seeing some mixed reporting out of China about whether people can get reinfected versus being released from hospitals prematurely. Can you provide clarity on what is actually known at this point about the potential for reinfection? Dr. Maria Van Kerkhove: (43:19) We know is there's certain discharge criteria that are used in China and in many countries. And in fact our recommendation is that an individual needs to have two negative PCR tests, 24 hours apart. What we've seen from China, there's some case reports of individuals who will test negative and be clinically recovered, but after some days may test positive again. Dr. Maria Van Kerkhove: (43:46) And what we need to understand is in those situations, in each of those situations, is the individual, is it a matter of the way that the test was done and perhaps how the sample was collected, the performance of the PCR test, and if the individual just is sort of borderline positive negative, or whether they were reinfected. From the evidence we have, it doesn't indicate that they've been reinfected. It's likely that there's been some virus persistence. Dr. Maria Van Kerkhove: (44:16) What we need to also understand is just because people are PCR positive, if they've tested negative and then test positive again, we need to understand if that's infectious. And so we need prospective studies of individuals who have recovered over time and following them after their recovery, to take repeated samples to understand if they're still shedding and if they are infectious. Dr. Tedros: (44:44) While agreeing with what Maria said, even in other countries, there is one concern we have. Hospitals have been running very lean and mean, especially in high income countries, creating a lot of efficiency. And when I say lean and mean, making it very close to what they need during normal times, the number of beds they need and so on. And that's why we see some surprise in high income countries. And when emergencies actually arrive, then tree gutting or expanding that lean and mean system becomes a bit difficult and time taking. And that may even force some countries to discharge patients early because the system is adapted to lean and mean approach. Dr. Tedros: (45:47) So I think this is a question for even the long term. Okay, running hospitals in a lean and mean fashion could be okay during regular times, but how can we expand the capacity in few hours when the need comes? It's not COVID only by the way. It could be earthquake or it could be tsunami. It could be another, what do you call it, disaster, whether it's manmade or natural. Dr. Tedros: (46:21) So I think we have to check that approach we have, especially in many countries, running hospitals in a very lean and mean way. And I know some countries couldn't even have isolation facilities that can accommodate even 10 or 20. And it shows how vulnerable we are. And the discharging and so on, could happen because of that. Tariq: (46:52) Let's try to take Thomas from Bloomberg who was not able to ask questions a couple of days in a row. So Thomas, if you hear us, please go ahead. Helen Brownsville: (47:34) Hi. I've been unmuted. I'm not Thomas from Bloomberg. It's Helen Brownsville from STAT. Sorry for the delay. Just realized I was unmuted. My question is about the clinical trials in China for the therapeutics. Are you getting any word yet about how those are turning out? Is there any chance of data soon? Dr. Maria Van Kerkhove: (48:01) I will turn to my colleagues to finish that. So as you know Helen, there are many clinical trials that are currently underway in China. There are more than 200 registered on the clinical trials list, and we know that they're actively underway, looking at different therapeutics, looking at traditional Chinese medicine. And Maria do you want to comment on more detail on that piece? Maria: (48:25) Thank you very much. So just we have a very good collaboration with researchers in China. In fact, they even shared with us the preliminary information as they move forward with the analysis. They are planning to soon start releasing and publishing some of the results. Maria: (48:41) I just want to say that they have done great work in publications. We have counted that about 180 publications internationally have been released, and the information is available to the public. And there are over 50 publications in Chinese language that had been made available. Where we are engaging with them now is in the translation of this information, in seeing what the new [inaudible 00:49:04] that were conducted. Mean in terms of public health and whether or not we need to adjust our ideas for clinical trials elsewhere, and also how can we learn from the implementation of these trials because there is a great expertise now in China that we would like to build upon. So yes, we are working with them very closely and they are very forthcoming in studying with us. Dr. Michal Ryan: (49:27) I'm working, just to supplement because there's more to be done than just China. We have issued master protocols for clinical trials, for serology studies, for others. And working under the leadership of Anna Maria Marie Pierre, [Brazi 00:49:46] and our chief scientist Sumia. We need to bring all of that data together. We're pulling together a data monitoring board, an independent board of experts who will monitor and analyze that data with us because we need to ensure that all of the available information regarding clinical trials is pulled together so we have the best possible assessment of all of the data. Dr. Michal Ryan: (50:11) So we commend the researchers for all of the work they're doing independently and with us. We commend those who are willing to work on implementing this more standardized approach. And we believe by doing that we will get to answers more quickly. And the evidence for these products will be much more solid and much more reliable. Dr. Michal Ryan: (50:31) And we thank all of those around the world at the research level and governments and others for that form of collaboration. It is through this kind of innovation and sharing that we will get the answers more quickly than we would otherwise. Dr. Michal Ryan: (50:43) We also have to look beyond the issue of efficacy. Having an effective drug, and we hope these are effective, we also have to ensure that those who most need those drugs get them. And that is not the same as drug efficacy. We have to absolutely focus now on equity and access. We cannot have a situation where people who need the drug don't get it and people who don't need the drug do. We must find ways to ensure we can scale up production of any drugs that prove effective. And we can ensure adores drugs are distributed on the basis of need and the basis of benefits. And WHO is already working on mechanisms by which we can achieve that, working with our partners both in the north and the South. Tariq: (51:29) Thank you very much. Anna Maria, and [inaudible 00:51:33] who is a unit head, a research and development blueprint with our emergency program. Let's try, Chris one more time, Thomas from Bloomberg, before we finish for today. Thomas, can you hear us? Tariq: (51:45) We'll have to leave it then for tomorrow. We will conclude for today. Thanks everyone for watching us. We will have audio file and transcript and maybe Dr. Tedros will tell us when do we see each other again. Dr. Tedros: (52:07) See you on Monday, bon weekend. Dr. Tedros: (52:14) (silence)