World Health Organization COVID-19 Briefing Transcript March 30

Tariq: (00:06) Hello to everyone from Geneva from WHO Headquarters. This is Tariq again. Happy to be back here with you. Will have our regular press conference on COVID-19. And usual, the last journalists who are on Zoom to quickly raise hands to be put in to cue. I understand there are not many journalists calling on the phone, but if there is someone, you would need to press *9. Tariq: (00:40) Today, we have Director General Dr. Tedros, Dr. Maria Van Kerkhove, and Dr. Mike Ryan as usual. We will have an audio file immediately available and transcript a little bit later in the evening, or tomorrow. We give floor to Dr. Tedros for opening remarks. Dr. Tedros, please. Dr. Tedros: (01:09) Thank you, Tariq. Good morning, good afternoon and good evening, wherever you are. The COVID-19 pandemic is straining health systems in many countries. The rapidly increasing demand on health facilities and health workers threatens to leave some health systems overstressed and unable to operate effectively. Previous outbreaks have demonstrated that when health systems are overwhelmed, those due to vaccine preventable and treatable conditions increase dramatically. Even though we are in the midst of a crisis, essential health services must continue. Babies are still being born; vaccines must still be delivered; and people still need lifesaving treatments for the range of other diseases. Dr. Tedros: (02:15) WHO has published guidelines to help countries balance the demands of responding directly to COVID-19 while maintaining essential health services. This includes a set of target immediate actions to reorganize and maintain access to high quality essential services, including routine vaccination, care during pregnancy and childbirth, treatment for infectious and noncommunicable diseases, and mental health conditions, blood services and more. That includes ensuring an adequate health workforce to deal with the many health needs other than COVID-19. Dr. Tedros: (03:06) For example, we're pleased by the 20,000 health workers in the UK who have offered to return to work, and that other countries, such as Russian Federation, are involving medical students and trainees in the response. To help countries manage the surge in COVID-19 cases while maintaining essential services, WHO has also published a detailed practical manual on how to set up and manage treatment centers for COVID-19. The manual covers three major interventions. Dr. Tedros: (03:46) First, how to set up screening and triage at health facilities using a repurposed building or a tent. Second, how to set up community facilities to care for mild patients. And third, how to set up a treatment center by repurposing hospital wards or entire hospitals, or by setting up a new hospital in a tent. The manual covers structural design, infection prevention and control measures, and ventilation systems. This is a lifesaving instruction manual to deal with the surge of cases that some countries are facing right now. Dr. Tedros: (04:34) These facilities will also have longer term benefits for health systems once the current crisis is over. In addition to having facilities for patients, it's also vital that countries have sufficient supplies of diagnostics, protective equipment and other medical supplies. Ensuring free movement of essential health products is vital for saving lives, and curbing the social and economic impacts of the pandemic. Earlier today, I spoke to three ministers from the G20 countries about ways to address the chronic shortage of personal protective equipment and other essential medical supplies. We call on countries to work with companies to increase production, to ensure the free movement of essential products, and to ensure an equitable distribution of those products based on need. Dr. Tedros: (05:38) Specification should be given to low and middle income countries in Africa, Asia and Latin America. In addition, WHO is working intensively with several partners to massively increase access to lifesaving products, including diagnostics, PPE, medical oxygen, ventilators, and more. We understand that many countries are implementing measures that restrict the movement of people. In implementing these measures, it's vital to respect the dignity and welfare of all people. It's also important that governments keep their people informed about the intended duration of measures, and to support for older people, refugees and other vulnerable groups. Dr. Tedros: (06:34) Governments need to ensure the welfare of people who have lost their income and are in desperate need of food, sanitation, and other essential services. Countries should work hand-in-hand with communities to build trust and support resilience and mental health. Two months ago, WHO published the Strategic Preparedness and Response Plan, with an initial ask of $675 million US dollars to support countries to prepare for and respond to COVID-19. We're very grateful to the many countries and foundations who have contributed more than $622 million US dollars have been received so far. I'd like to use this opportunity to thank King Salman Center of the Kingdom of Saudi Arabia for the monetary relief for this contribution of $10 million US dollars. Dr. Tedros: (07:40) We continued to be encouraged by the signs of global solidarity to comfort and overcome this common threat. The commitment of G20 countries, to work together to improve the production and equitable supply of essential products shows that the world is coming together, and coming together is the only option we have. Unity is the only option we have to defeat this virus. Yesterday, I sent a tweet with a single word: humility. Some people asked me, "Why? Why I sent a single word on Twitter saying humility?" COVID-19 is reminding us how vulnerable we are, how connected we are, and how dependent we are on each other. In the eye of a storm like COVID, scientific and public health tools are essential. But so are humility and kindness. With solidarity, humility, and assuming the best of each other, we can and we will overcome this together. I thank you. Dr. Michael Ryan: (09:10) Thank you very much, Dr. Tedros. We will start with questions, as we remind journalists that we can take only one question per person so we can advance as much as possible. So, we will start with the Lusa News Agency. That's a Portuguese-speaking agency. Can you hear us? Antonio: (09:40) Yes, can you hear me? Dr. Michael Ryan: (09:41) Yes, is it Antonio? Antonio: (09:43) Yes, this is Antonio. Thank you. Dr. Michael Ryan: (09:44) Please go ahead. Antonio: (09:46) I would like to ask a question on the issues of birth and newborn care and breastfeeding. Does the WHO recommend any restrictions on breastfeeding, presence of partners in delivery rooms, and skin-on-skin contact between mother and child because of the pandemic? Because health authorities in country like my own, Portugal, have banned these practices for women who are infected. Thank you. Dr. Maria Van Kerkhove: (10:16) Thank you for the question. So, we have recently published some guidance on clinical management on individuals who have COVID-19, which includes pregnant women and lactating women, breastfeeding women. It is very important that women are able to breastfeed their children when they are born. There are certain precautions that need to be taken place, in terms of contact precautions. But we've outlined the ways in which that could be done safely. Dr. Tedros: (10:48) Thank you very much, Dr. Van Kerkhove. I hope this answers the question. I just been told there was a little problem at the beginning of the ordeal for people who were on the Zoom, so please listen to the audio file that we will send immediately after if you have missed those few first seconds. We go to next question. Do we have Al Jazeera online? Speaker 1: (11:16) Yes, Al Jazeera. I'm here. Dr. Tedros: (11:19) And if you can just speak a little bit louder. Please go ahead. Speaker 1: (11:22) Yes, thank you. I'm [inaudible 00:11:26] with Al Jazeera. So, I'd like to ask you with regard to the coronavirus pandemic in Indonesia because, as of today, there have been more than 1400 confirmed cases and 122 deaths in Indonesia, which has the most of any country in Southeast Asia. What needs to be done more by the Indonesian authorities in this case? Thank you. Dr. Michael Ryan: (11:58) I'll have a go at the question, and maybe the Director General will supplement. While the pandemic is very well developed and escalating in many parts of the world, particularly in Europe and North America, there are countries who are still in the earlier parts of the pandemic. It remains to be seen how the pandemic will develop in those countries. But countries with relatively known numbers of cases, and I would count Indonesia in that, have the opportunity to implement comprehensive strategy focused on containment and suppression of spread, and on strengthening the health system for a likely increase on demand. Regardless of the scenario, it is likely that the number of cases will rise, and therefore, that the demands on the health system will grow. Therefore, it's really important that the health system is prepared for any increase in cases. Dr. Michael Ryan: (12:59) At the same time, you have to put pressure on the virus. You have to go after the virus. Like other countries in the region have shown in Southeast Asia, going after the virus, detecting all cases, testing all suspect cases, isolating cases and identifying contacts, following them and putting them into quarantine or home isolation is the way to go. And matching that with the strong community education and engagement approach, and this needs to be built from the communities up. So, in all of society, all of community approach focused on both containing the virus where you have clusters in small numbers of cases, and where you have efficient or widespread community transmission to be sure that the health systems in those areas are prepared to deal with what will be a large influx of cases. We believe that that is what Indonesia is attempting and we will do everything to support the government there in doing that. Dr. Tedros: (14:05) Thank you very much, Dr. Ryan. Speaker 2: (14:09) [inaudible 00:14:09]. Dr. Tedros: (14:09) Thank you, thank you so much. I just wanted to add to what Mike said. We're working very closely with Indonesia. We had a discussion with the foreign aid minister and then followed with His Excellency, the president. We're aligned with what the response- Speaker 3: (14:31) ... And does the World Health Organization recommend [inaudible 00:14:35] to other governments? Thank you. Dr. Michael Ryan: (14:39) I will begin and Maria will give some more technical detail. So that we're clear, there is no proven effective therapeutic or drug against COVID-19. However, there are a number of drugs that have shown promise, either in previous treatment of coronaviruses like [inaudible 00:15:00] in the fight against HIV or in other situations. There is some preliminary data from non-randomized studies, observational studies, that indicate that some drugs and some drug cocktails may have an impact. Some of those drugs may impact the length of disease. Some may impact the severity of disease. And the dosages of those drugs, when they're given to what patient at what stage of the disease, has not been standardized. We've never had a comparison group where we've had a randomized approach to treatment with the drug or not treatment with the drug. Dr. Michael Ryan: (15:38) It is very important that we continue to accelerate the implementation of the randomized control trial set. We've already begun all over the world, including the WHO Coordinated Solidarity One Trial. But there are other large scale trials underway in various parts of the world. It's also very important that those drugs are very, very needed for the treatment- Dr. Michael J. Ryan: (16:03) ...of other diseases and that we don't see a situation where people who need those drugs for the treatment of other diseases cannot access them because people are just buying them up and using them. Some countries may introduce compassionate use rules which allow physicians to use those drugs in certain situations off-label. That is a matter for national regulatory authorities. We don't encourage that if it leads to widespread use because it will, in effect, divert drugs away from the diseases that these drugs are used for and we really want to accelerate the trials that will give us the actual answers that we need. We also need to look at how to scale up the production of those drugs that will prove effective in the clinical trials. For you. Dr. Tedros: (16:54) Thank you very much, Dr. Ryan. I will read one question that's from Today News Africa, and the question is that WHO Africa office acknowledged last week that the African continent does not have the capacity to produce respirators and ventilators at the moment. What type of support can WHO provide to African countries to quickly get the material that is needed? Dr. Michael J. Ryan: (17:21) As the DG indicated, we've already sent large numbers of protective equipment and diagnostic tests to Africa. All countries in Africa can now make the diagnosis of COVID with support from ourselves, from Africa, CDC, and from others. We've been working with the World Food Program, the Jack Ma Foundation and Africa CDC to bring PPE into Africa as well as supplies from our own stockpile, which is based in Dubai. It is not enough, and you're correct, the issue of ventilators is a very difficult issue. One, because ventilators are technologically sophisticated, expensive, difficult to produce and distribute, and require very high levels of training in order to use them properly. Dr. Michael J. Ryan: (18:13) There are lots of innovation at the moment in how we can scale up the production of ventilators and even use the ventilators that don't require a patient to be intubated. In other words, how can you support ventilation in a conscious patient, and there are all kinds of interesting solutions emerging on that front, the issue is getting those solutions to scale. But the one thing I will say from the perspective of supporting severely ill patients, oxygen is something we need to discuss because everybody's talking about ventilators, and that's important. A critically ill person struggling to breathe, a ventilator can be lifesaving. But before that happens, what truly is lifesaving is the ability of a patient to be given supplemental oxygen in order that the concentration of oxygen in their blood can be kept at a high level, because that's what patients suffer when they can't breathe properly. Dr. Michael J. Ryan: (19:11) The level of oxygen in their blood drops, and you'll hear people talking about oxygen saturation, it means how much oxygen is getting into someone's blood from their lungs. When someone has COVID-19, your lungs struggle to put enough oxygen into your blood. By increasing the concentration of oxygen in the air that someone breathes, you allow more oxygen to reach the blood. Every country in Africa has oxygen and we need also to focus on getting a better distribution of medical oxygen so patients with moderate to severe disease can benefit from that. Dr. Michael J. Ryan: (19:46) We will work and we are working with the World Food Program. We're working with the UN in New York, and the DG has spoken to the efforts we're making to not only scale up the distribution of such equipment and supplies, but to coordinate that in a way that countries can expect a more smooth service in accessing those vital supplies. Dr. Maria Van Kerkhove: (20:06) If I could just add something very briefly. This is a very good opportunity to bring more clinicians and medical professionals on board with us who are into our clinical networks so that they can learn from and share experiences of dealing with COVID-19 patients. Not all countries are overwhelmed right now with patients, some have very few patients and it's time right now where we can be sharing experiences. We could be doing trainings that actually look at how patients are treated and what type of care patients who develop either moderate, severe, or critical disease could be cared for. So we could bring them on board and join our teleconferences that happen regularly with clinicians all over the world. Dr. Tedros: (20:54) Thank you very much, Maria. The next question is Christiane Oelrich from DPA German News Agency. Christiane, can you hear me? Christiane Oelrich: (21:02) Hello. Can you hear me? Dr. Tedros: (21:06) Yes. Please go ahead. Christiane Oelrich: (21:10) Yes. This is a question on Austria. The Austrian government has decided to make everyone wear a mask who is going into the shops. I understood from our previous briefings with you that the general public should not wear masks because they are in short supply. What do you say about the new Austrian measures? Dr. Michael J. Ryan: (21:35) Thank you. I'm not specifically aware of that measure in Austria. I would assume that it's aimed at people who potentially have the disease not passing it to others. In general, WHO recommends that the wearing of a mask by a member of the public is to prevent that individual giving the disease to somebody else. We don't generally recommend the wearing of masks in public by otherwise well individuals because it has not been up to now associated with any particular benefit. It does have benefits psychologically, socially, and there are social norms around that, and we don't criticize the wearing of masks and have not done so. But there is no specific evidence to suggest that the wearing of masks by the mass population has any particular benefit. In fact, there's some evidence to suggest the opposite in the misuse or wearing a mask properly or fitting it property or taking it off and all the other risks that are otherwise associated with that. Dr. Michael J. Ryan: (22:36) And there also is the issue that we have a massive global shortage and where should these masks be and where are the best benefit? Because one can argue that there's a benefit of anything, but where does a given tool have its most benefit? And right now the people most at risk from this virus are frontline health workers who are exposed to the virus every second of every day. The thought of them not having masks is horrific so we have to be very careful on supply, but that is not the primary reason why WHO has advised against using masks at a mass population level, but I'll pass to Maria on the technical side, you may have something to add. Dr. Maria Van Kerkhove: (23:17) Thanks. No, only to reinforce what Mike has said, that our recommendations are for in the community we don't recommend the use of wearing masks unless you yourself are sick, and as a measure to prevent onward spread from you if you are ill. The masks that we recommend are for people who are at home and who are sick and for those individuals who are caring for those people who are home that are sick. But as Mike has said, it's important that our frontline workers who we recommend standard and droplet precautions have adequate use of PPE and so that we make sure that we prioritize the use of masks for those who need it most. Dr. Tedros: (23:54) Thank you very much. Next question from India from Banjot Kaur, Down to Earth. Banjot, can you hear us? Banjot Kaur: (24:04) Hi. Can you hear me? Dr. Tedros: (24:05) Yes. Please go ahead. Banjot Kaur: (24:09) Dr. Ryan, you must be aware that India, as part of its lockdown, is witnessing unprecedented humanitarian crisis in the form of movement of migrants from one part of the country to other. I do understand that you do not like commenting on individual countries, but this is an unprecedented humanitarian crisis. What will be your advice to our government? And second question, it's not a question it's just a clarification. None of the situation reports given by WHO says community transmission is happening in any of the countries, while we do know it is happening. Could you please clarify on that. Dr. Tedros: (24:47) Can you just repeat the second part of your question. Banjot Kaur: (24:52) I said, the situation reports which WHO gives us every day, there are countries and the state of transmission mentioned against those countries. Against none of the country there is mention of community transmission when we do know that some countries are witnessing community transmission. Could you please clarify on that. Dr. Michael J. Ryan: (25:16) Yeah. I think we will go back and look at our websites and see the situation there. I don't believe we've indicated that there is no community transmission in somewhere like India, but we will definitely check that. But going back to I think what is the more important part of your question, which is the impact of lockdowns. Movement restrictions in any situation are very ... Number one, need to be taken very carefully. And two, obviously, regardless of their intent, are very difficult to accept by communities and by others because people need to move and want to move for family reasons, for economic reasons, and for many other reasons. And it's important that governments communicate openly and transparently with their people as to the reasons why lockdowns or shutdowns or movement restrictions are occurring because they do impinge on people's freedom of movement and if people in communities are to offer up that freedom of movement, they do need to understand why that's happening. Dr. Michael J. Ryan: (26:28) It's also ... And those movement restrictions are regrettable in all situations, nobody wants to see those happen. But in situations where you have a very, very intense epidemic in one part of a country and another part of a country it's not so intense, you may have to implement some measure to at least encourage. Sometimes it's advice, sometimes it's strong advice, and sometimes it's a restriction where transport is stopped. Each government has to choose the balance between what is advice to communities and what is in some senses an enforced lockdown. Whatever is chosen, it's really important that communication and acceptance by the community is at the center of the concern of the government. It is impossible to have an effective restriction of movement without a community on board with that restriction of movement at all levels. And as the DG said in his speech, when such measures are put in place it's exceptionally important that those measures are carried out with not only the acceptance but with the human rights and dignity of the people affected at the center. Dr. Michael J. Ryan: (27:45) Now that is not always easy, but that is what should be as part at the center of the objective of the process. And I'm not here speaking specifically about India, I'm speaking about this in general terms, but I think what it does speak to is that these society-wide measures are difficult. They are not easy and they are hurting people, but the alternative is even worse. And countries, if they're going to be able to move away from this approach of having to lock down and shut down, if we're going to move away from that approach as a means of suppressing the virus, we have got to put in place the public health surveillance, the isolation, the quarantine, the case-finding, the detection. We have got to be able to show that we can go after the virus because lockdowns alone will not work. But unfortunately in some situations right now they're the only measure that governments can actually take to slow down this virus and that's unfortunate, but that is the reality and we need to continually explain the reasons for this to our communities. Dr. Tedros: (29:03) Thank you. This is a very important question. Maybe on the first one, based on the transmission in countries WHO has categorized actually countries into four. There are countries with no cases, what we call the four C's. No cases, your group of countries, and then the second is countries with sporadic cases. The third is countries with clusters of cases. And the fourth is community transmission. And we have now a number of countries with community transmission and that's why we have developed a guideline that's tailored to these four situations. And please check our website and you will find the four C's and the four categories and what should be done based on this. But we have community transmission in many countries and we have said it many times. Dr. Tedros: (30:16) And then on the issue of so-called lockdown, maybe some countries have already taken measures for physical distancing, closing schools and preventing gatherings and so on. That can buy time, but at the same time each and every country actually differs. Some countries have strong social welfare system and some countries don't. And I'm from Africa, as you know, and I know many people actually have to work every single day to win their daily bread. And governments should take this population into account, okay? If we are closing or if we are limiting movement, what is going to happen to those people who have to work on a daily basis and have to earn their bread on a daily basis? Dr. Tedros: (31:32) So each and every country based on its situation should answer this question. We're not seeing it as an economic impact on a country as an average of GDP loss or the economic repercussions. We have to also see what it means to the individual in the street. And maybe I have said it many times, I come from a poor family ... Dr. Tedros Ghebreyesus: (32:03) ... and I know what it means to always worry about your daily bread. That has to be taken into account, because each and every individual matters, and how each and every individual is affected by our actions has to be considered. That's we're saying. It's about any country. It's not about India. It's about any country on earth. Even the wildest country on earth can have people who need to work for their daily bread. No country's immune. Each and every country has to really make sure that this is taken into account. Speaker 5: (33:04) Thank you very much. Next question. Associated Press, Jamie. Speaker 4: (33:08) Hi, can you hear me? Speaker 5: (33:14) Yes. Speaker 4: (33:17) Great. Good afternoon. My question has to do with the situation of some European countries. We've seen some signs that countries like Italy and Spain may be I'm sensing that they are reaching the peak, and I believe the UK also mentioned some experts there, one expert there mentioned that they may be nearing a peak. I'm just wondering if you have any estimates. I know that, Mike, you said on Friday that there's no way to sort of see the end of this, but what about peaking? Do you see any signs of peaking within Europe? Thanks. Dr. Michael Ryan: (33:59) If you just look at the extent of transmission in those three countries you mentioned there, we wouldn't compare them to Korea or to Japan or to Singapore in terms of the situation. They have much more extensive problems. Then if you compare them to what happened in China and specifically in Wuhan, which was the most intense epidemic, we did see, rather than basing it on some modeling, let's base it experience, right? We saw what happened in Wuhan after the lockdown, and not only did they do that physical distancing and put people in their homes, but they continued to look for cases. That's the essential difference. They continued to detect cases and isolate all cases including mild cases away from their families, but let's assume they've done that. What we saw over a period of days, and I think you were one of the people who asked the question during the one event, do you think this is stabilizing? Is it going down? Dr. Michael Ryan: (35:03) For a number of days, we said, "Well, we can't tell," and it went up and down and up and down. What we're likely to see, if you imagine the lockdowns and the stringent measures that were put in place are now in place between two and three weeks in Italy at different levels and different places, we should start to see a stabilization, because the cases we see today really reflect exposures two weeks ago. The cases you see today are almost historical, in the same way, when we're told that we're looking at galaxies through a telescope that we're seeing light from a billion years ago. We're seeing a reality that existed before. When you count your cases on a daily basis in an epidemic, it reflects a reality of transmission and risk two weeks before at least, so [inaudible 00:00:35:51]. Dr. Michael Ryan: (36:19) ... has dropped from the 20s to 15 to 12 to 10 to eight to four, which means less people have been exposed to that case than would have been two weeks ago, which shows people are distancing. For whatever reason, they're distancing, so there are less people at risk for many individual case. Out of the community quickly, they'll expose even less people. That's how you get ahead of an epidemic. So do we hope that Italy and Spain are nearly there on that? Yes, but the way you stabilize and then move to zero, and I think everyone's talked about the curve up, and everyone talks about the stabilization. The question is how do you go down? Going down isn't just about a lockdown and let go. To get down from the numbers, not just stabilize, requires a redoubling of public health efforts to push down. It won't go down by itself. It will be pushed down, and that's what we need countries to focus on. Dr. Michael Ryan: (37:24) What is the strategy now to put in place, the public health measures that will push down the virus after those measures may be released, and then how do we take care of people better in a clinical environment to save more lives? So, yes, potentially stabilizing, and it is our fervent hope that that is the case, but we have to now push the virus down, and that will not happen by itself. Dr. Maria Van Kerkhove: (37:53) If I could just add to that, what I was going to say, which Mike has just said, is we need to focus on the now. We need to focus on what must be done now to get us out of this. There is this, I understand completely the desire to want to know when we will reach the peak and when we will start seeing that decline, but that will not happen on its own. These physical distancing measures, these stay at home measures have bought us a little bit of time, a little window of time, and that short window has to be used appropriately so that we get systems in place to look for this virus aggressively through testing, through isolation, through finding contacts, through quarantining those contacts, through caring for further patients, because we will still see patients, and many patients are still going to require need, to support other countries that are going to go through this. Dr. Maria Van Kerkhove: (38:48) The focusing on what we do now is absolutely critical to make sure we use that time wisely, we use that time actively so once we do reach that peak, that we continue to push and suppress that virus down as quickly as possible, but still be ready to find additional cases should they show up. What we've seen in a number of countries in Asia where they've brought this virus down, they've brought transmission down, they're now seeing repeat introductions from outside of their countries. They have not let their guard down. They are still aggressively looking for those cases as they come in and suppressing it so that it doesn't start again. We need to focus on the now. We need to use our time wisely, and that is to aggressively find this virus and care for our patients. Speaker 5: (39:38) Thank you very much. Next question is from a Nippon TV. Atsuko? Atsuko, can you hear us? Can we try one more time with the Nippon TV? Okay. That's okay. Let's go to Jim from a Westwood One. Jim, can you hear us? Jim: (40:12) Yes. Thank you very much. Very good afternoon to you. I would like to clarify a little bit on the chloroquine issue in the U.S., and it should be important to point out that the FDA hasn't approved it for wide prescription by doctors but only in a hospital setting, and the doctors there can only get it from the national stockpile. But my question is what exactly was observed with chloroquine or hydroxychloroquine that could lead to the possibility of it being used to treat COVID-19 in a hospital setting, and what do you mean exactly by randomized testing as opposed to a non-random randomized testing? If you can answer those, I'd appreciate that. Thank you. Dr. Michael Ryan: (40:57) Maria will supplement. I mean, there were somewhat people will describe as in vitro evidence, evidence in the lab that the drug was active against the virus, but any number of things are active against viruses. Chlorine is active against viruses, but other things are active against viruses. The question is whether they're safe and effective to put in the human body and whether they will be absorbed and processed in a way that the virus can be attacked and not the body. From the perspective of chloroquine, there were also some small observational studies, one in France that followed a small number of patients where there was no randomization of those patients and looked at their outcomes. Patients were admitted at different stages of illness, and the outcomes that we're really focused on was the length of illness. The observation that was made was that peoples' length of illness or length of hospitalization or length of significant symptoms was reduced. Dr. Michael Ryan: (42:00) No one here is talking about cure. No one here is talking about taking a magic pill, and all of a sudden you recover from COVID. Everyone's looking for therapies that will shorten the disease illness, will prevent people going from moderate to severe, and will prevent those that are critical dying. Drugs act in different ways. Some drugs may actually prevent the virus replicating early in the disease and therefore shorten the length of the illness and reduce the progression to severe disease. Once the disease is very well established and in a later stage of the disease, a lot of the damage that's been caused by the virus has not necessarily been caused by the virus itself, but all of the secondary effects, the inflammation, the organ failure and other things that happen. A lot of antiviral therapies are focused on getting a person with the disease treated at an earlier stage of disease. If you look at a lot of the anti-flu medications like Tamiflu and others, their main benefit that has been found for those again has been shortening the course of illness. Dr. Michael Ryan: (43:11) With regards to randomized control trials, the importance of having a control group is to have a comparison and then be able to stratify your patients. Because if I have a drug and I treat a very severe patient who's of an older age with the drug and that person dies, does it mean that that drug didn't work? If I treat a really healthy young person who's got a moderate disease and they recover, does that mean the drug worked? I don't think any of us need to be rocket scientists to work out that there are many factors that predict recovery or predict death. What we have to separate and we have to distill out is what is the effect of the drug itself, not the age of the patient, not the condition of the patient and so many other factors that can affect survival. Dr. Michael Ryan: (44:05) We've all been through infectious diseases ourselves and we recover. Is that because we get out of one side of the bed or the other? No, we wouldn't assume that that was affecting the outcome of the illness. There are many natural things affecting illness outcome, including the hard work of doctors and nurses in supporting the patient and preventing organ failure and ventilating the patient. The difficult thing at this moment is distilling out the specific effect of a drug in a complex illness, and that's what we're trying to do with the randomized control trials. That's why we need so many patients in those trials across many countries, many age groups, genders, many phases of the disease and many levels of severity. Then we can break out what is the actual effect of the drug on the outcome of the disease. Dr. Maria Van Kerkhove: (44:58) Only to add that there are a number of clinical trials that are ongoing, like, as described, the French study that I'm aware of as well. But there are a number of clinical trials that are ongoing that look at chloroquine, that look at a number of other therapeutics. On the one hand, it's incredible to see this acceleration of research and development and this focus on the evaluation of therapeutics for COVID-19 patients, which is building upon a history of other respiratory pathogens that have plagued us. But the challenge is that many of these clinical trials are small in size, which makes it very difficult to draw any conclusions, which is why it is very important that we have these larger trials, these multi-site trials, the solidarity trial that WHO is running to be able to have enough cases to be able to get an answer to which drugs work safely. Speaker 5: (45:52) Thank you very much. We have time for one or two more questions, so I'll try with Bloomberg and Naomi. Naomi, can you hear us? Naomi: (46:01) Hi. Yes, I can. Thanks for taking my question. I wanted to ask, we've seen some different approaches to quarantine in China and in European countries with group quarantine used to good effect in China. Do you think that home quarantine will be as effective anywhere for people who are positive, or would central quarantine be needed in order to have the same success that China had? Dr. Michael Ryan: (46:28) Hi. Yeah, just so we get our terms right and we can explain ourselves properly, we tend to use the word isolation for someone who is a case confirmed. We tend to use the word quarantine for someone who's at risk of being a case, usually a contact. On that basis, we advise that all suspect cases are tested and all suspect cases are isolated in an appropriate medical facility. I think nobody disagrees with that where the capacity exists. When we come to contacts, it very much depends on the context and the intensity of the epidemic at any given moment. In low incidence areas where there are sporadic cases or clusters, we advise that all contacts should be quarantined. Dr. Michael Ryan: (47:16) Ideally, that quarantine should occur in a place other than the home. For this reason, one, because if that person gets sick, they may already have infected their family. But that's not always possible, so at least quarantining contacts at home with good health advice that would not transmitting a disease if they've become sick and with regular monitoring of that individual is an option for countries. It is difficult to do that in the middle of intense transmission where you might have hundreds of thousands of contacts, because you're having tokens of cases a day. It is difficult to deal with that, so home quarantine of contacts is acceptable with appropriate information ... Dr. Michael J. Ryan: (48:03) ... acceptable with appropriate information education; and more importantly, a very rapid system of getting those people out of their homes if they become sick. Dr. Michael J. Ryan: (48:12) I listened to the president of Singapore this morning and he had a conference call with the director general; and the clarity of that in Singapore, that ability not only to isolate cases but to rapidly detect illness in the contacts and remove those contacts should they become sick, was a central part of that. And as he said, they're using apps now to do that. They're testing apps, but that they didn't do it with apps Singapore. They did that with community workers, with public health workers visiting the houses, checking on people, checking their health status every day and saying, "How are you? Have you got a fever? Have you got a cough?" And if a contact is developed a cough or a fever, they were taken immediately for testing. Dr. Michael J. Ryan: (48:59) So yes, we need the information technology tools. They help. They are not the solution. Right now, we don't have an alternative to what we would've considered in the old days. boot-leather epidemiology. Public health practitioners, doctors, nurses, community workers, working with communities to detect cases at community level. And the most likely person to become a case is someone who's been a significant contact of another case. Dr. Michael J. Ryan: (49:27) And at the moment, in most parts of the world, due to lockdown, most of the transmission that's actually happening in many countries now is happening in the household at family level. In some senses, transmission has been taken off the streets and pushed back into family units. Now, we need to go and look in families to find those people who may be sick and remove them and isolate them in a safe and dignified manner. Dr. Michael J. Ryan: (49:55) That's what I was saying previously about the, the, the transition from movement restrictions and shutdowns and stay-at-home orders can only be made if we have in place the means to be able to detect suspect cases, isolate confirmed cases, track contacts, and follow up on the context health at all times, and then isolate any of those people who become sick themselves. Speaker 6: (50:26) Thank you very much, John. As we try to have a variety of different outlets being able to ask questions, we don't have quite often sports outlets, So I will call on [Diane 00:50:36] from soccer.com. Diane, can you hear us? Diane: (50:40) Yes, I can hear you. Can you hear me? Speaker 6: (50:43) Yes, please. Go ahead. Diane: (50:47) Hello? Speaker 6: (50:49) Yes, please go ahead with your question. Speaker 7: (50:56) We may have lost her. Try again. Speaker 6: (50:59) Diane, let's try one more time. Can you hear us? We were hearing you very well. Diane: (51:06) Yes. I'm sorry, I'm having my phone... Hello? Can you hear me now? Speaker 6: (51:10) Yes, please go ahead. Diane: (51:12) There is such a discrepancy of information regarding the validity of masks and I know that you have addressed this and there's a great deal of fear regarding medical professionals have access to it, but is there any type of qualitative research that can confirm that wearing a mask prevents the spread for normal transmission in going to the supermarket, in day-to-day activity? Dr. Maria Van Kerkhove: (51:44) I can start, and perhaps Mike or the DG would like to supplement. This is an area of very active research. There's a lot of use of masks globally for different diseases, for influenza, for other coronaviruses, for this particular outbreak; but, there isn't a lot of quantitative analysis of this. And what we know works, we know that people who are sick and they stay home, that works because that prevents them from spreading the disease to someone else. We know that washing your hands works or using an alcohol-base. rub because that will remove the virus from your hands. We know that physical distancing works because that removes the opportunity to spread that virus from one person to another. Dr. Maria Van Kerkhove: (52:33) We are working with a large group of people across the globe and our IPC specialist networks to look at the use of masks in various- Speaker 6: (52:40) And I will take one more question because I've been getting messages, and obviously we apologize to all those that will not be able to ask their question today, but we will have opportunity to this week. I'll call on Gabriela Sotomayor to ask her question. Gabriela, please. Gabriela Sotomayor: (53:43) Ah, thank you very much. Thank you very much, [inaudible 00:05:45], taking my question. Dr. Tedros on testing, there are some countries that, I think, that they are not listening exactly. I mean, the message, they are not receiving the message. Just to clarify because some countries are saying that it's useless to test. In a country, for example, in a country when you have 1000 confirmed cases and 2,500 suspected cases, how many tests do you have to do? I mean, just to have a number or something, an estimate. Thank you very much. Dr. Michael J. Ryan: (54:28) The positivity rates on tested... The DG may wish to comment as to whether people are listening or not. But on the specific issue of tests, the positivity of tests or the number of tests, in general, where testing has been done fairly extensively, we've seen somewhere between three and 12% of tests being positive. If you get to a point where a tiny percentage of tests are positive, then the danger is you're either looking in the wrong place... It's reassuring, or you have to be very careful to ensure you can keep up that level of testing. Dr. Michael J. Ryan: (55:04) It's an issue of balancing the use of your test against their value. And again, it's like any detector system testing. Testing is a detector system. You can turn up and down the sensitivity of that system as long as the batteries last. That's the issue. How long will your tests... The available tests, if you know I've got X number of tests available to me over the next month then how am I going to use those tests over the next month? Countries have been limited by the number of available tests and that's important. Countries have also had to ration tests according to the intensity of the disease in different parts of the country; therefore, the return or the return rate or the percentage of confirmed tests will vary. But we would certainly like to see countries testing at the level of 10 negative tests to one positive, as a general benchmark of a system that's doing enough testing to pick up all cases. Now, it can be more or it can be less depending on the circumstance. It's not an objective, but you really do want to see a lot more... You know you're missing a lot of cases if 80 or 90% of the people you test are positive. You are probably missing a lot of cases. Dr. Maria Van Kerkhove: (56:18) And if I could just add to that to say that a lot of the challenges that countries are facing, a lot of the argument that comes back is just, "Well, we just don't have enough." And so just to say what WHO is doing and what countries are doing is they're trying to find tailored diagnostic solutions to their needs, to meet their needs of their countries and the outbreaks that are happening in their countries; and that includes a variety of things that we are doing and countries are doing. Dr. Maria Van Kerkhove: (56:47) The first is to increase the capacity of the lab. The number of labs that can actually conduct that testing. Whether these are national labs or academic or private labs, but increasing that number of labs. Increasing the number of people that can actually run those tests. Finding individuals that can run those tests. Dr. Maria Van Kerkhove: (57:04) The second is increasing the production and availability of tests. There's a huge number of tests that are on the market right now thanks to the rapid sharing of sequences, full genome sequencing of this virus in early January. Dr. Maria Van Kerkhove: (57:17) And then the third we are working very hard to have a tailored support to country based on their need, based on what they have in their individual countries, whether these are bench-top or manual PCR kits or whether these are automated PCRs or whether these are high throughput machines. There's not one single solution to increase your ability to test, but it is important that you continue to do so, so that you know where the virus is. Dr. Tedros: (57:42) Yeah. I think it has been said, just wanted to add, testing is very, very important. I cannot even emphasize it more. Dr. Tedros: (57:54) There was a meeting of ministers. This was last Thursday, I think, and we had some of the practices from four countries actually, what they have done. The common factor in all four countries was the testing. Testing is important to understand the status of an individual, but testing is also important to see what the situation looks like. Dr. Tedros: (58:34) For instance, from the presentations of the four ministers, we saw that when they test, they go back and check those positives, how they got the infection. Some of them could be from a church gathering or a religious event, or others could be in a bar or a restaurant, or others could be in a social gathering for some some purpose. And then the testing is not about that individual. It becomes about the event that happened and how to really address such events. The testing doesn't tell you just a story about one person. It's a story about what happened when that person actually acquired the infection, and that helps you to trigger your public health interventions. Dr. Tedros: (59:33) Take Korea. When it started the community transmission, it was actually in a religious event and thousands of people ended up being infected in one gathering. Another important event... Another important lead was in a hospital. One was the religious event and the other one was a hospital where they saw very intensive transmission and how then they mobilized their public health intervention to address not only that but also other clusters. Dr. Tedros: (01:00:21) So without knowing, without testing, it's like moving blindfolded. Testing can help us not only to know the status of individual persons, but to know also what's behind it and take public health measures. And that's why you were saying testing is very important, and from testing you can do the contact tracing. From there you can also do the isolation. But we fully understand when there is community transmission, the health system could be overwhelmed. Even the public health interventions could be very, very, very heavy, but there are ways to tailor our public health interventions even in such situations. And the isolation may not necessarily be in a hospital or health facility. It could be in a community facility. Many countries have very innovative ways of isolating because their health system was overwhelmed and they had to actually look for community facilities. And then the last resort is when they couldn't do that and when they have a number of cases and when there is coming to transmission, then some of them resorted into isolation in their home and separating their bedrooms and separating the utensils they use. Dr. Tedros: (01:01:56) But then let's be practical. Okay, you can have your own bedroom or you can have your own this or that to isolate yourself and to take all the precautions you need, but if it's in a developing country... For instance, where I grew up, if it's a one room where there is a big family, like five or seven people in one room, how do you implement that? And then that's why we say we don't have a one-size-fits-all solution. And the solution should really be tailored to the situation of each and every country. How do you implement isolation in a situation where a single family, a big family is living in one room or two rooms and isolation is not possible at all? That's why we say one-size-fits-all solution cannot happen. Dr. Tedros: (01:02:50) And each and every country knows its situation in terms of COVID situation. It knows its own social and other factors, and it knows what solutions it has at hand to have successful public solutions. That's what we are saying. And of course, necessity is the mother of invention and we expect a solution in every situation from the communities that-