World Health Organization (WHO) Coronavirus Press Conference June 17

Tarik: (00:00) Your settings on Zoom. You can also ask your questions in six different languages and Portuguese. Today, our press conference will be a little bit shorter than usual. We have to finish by 6:00 Geneva time, so we will try to be concise in answering and also asking questions. Now I will give a floor to Dr. Tedros. Dr. Tedros: (00:23) Thank you. Thank you Tarik. Good morning, good afternoon, and good evening. The world has now recorded more than eight million cases of COVID-19. In the past first two months, 85,000 cases were reported, but in the past two months, six million cases have been reported. There have been more than 435,000 deaths in the Americas, Africa, and South Asia. Cases are still rapidly arising. However, there are green shoots of hope, which show that together sort of global solidarity, humanity can overcome this pandemic. We now have examples of many countries, good examples that have shown how to effectively suppress the virus with a combination of testing, tracing, and quarantining patients, and caring for those that get sick. Lab capacity has been dramatically enhanced across the world to boost COVID-19 testing, which is critical for identifying where the virus is and informing government actions. New mega hubs have been established that are now key to the distribution of personal protective equipment, which includes millions of masks, goggles, aprons, and gloves, as well as other medical supplies. Dr. Tedros: (01:55) Tech companies have developed applications that can assist with the critical task of contact tracing. And there has been an enormous effort to accelerate the science around the pandemic. Early on in the outbreak on 11th February, WHO convened a research and innovation forum on COVID-19 where hundreds of researchers came together from across the world with the aim of quickly developing quality diagnostics, therapeutics, and vaccines. One of the key priorities identified was for the world to focus on accelerating research around treating patients with COVID 19. Specifically, researchers agreed to investigate existing drugs with potential, including steroids. WHO also developed a core protocol, which has been adapted and used by researchers around the world. And yesterday there was the welcomed news of positive initial results from the recovery trial in the United Kingdom. Dexamethasone, a common steroid, has been shown to have a beneficial effect on those patients severely ill with COVID 19. According to early findings shared with WHO, for patients on oxygen alone, the treatment was shown to reduce mortality by about one-fifth. Dr. Tedros: (03:23) And for patients requiring a ventilator, mortality was reduced by about one-third. However, dexamethasone was shown to not have a beneficial effect for those with milder disease who did not need respiratory support. This is very welcomed news for those patients with severe illness. This drugs should only be used under close clinical supervision. We need more therapeutics that can be used to tackle the virus, including those with milder symptoms. WHO has now started to coordinate a meta analysis pulling data from several clinical trials to increase our overall understanding of this intervention, and we will update it our clinical guidance to reflect how and when dexamethasone should be used to treat COVID-19. I want to thank the United Kingdom government, the University of Oxford, and the many hospitals, researchers, patients, and families who have contributed to this scientific breakthrough. WHO will continue to work with all partners to develop other therapeutics and vaccines for COVID-19, including through the access to COVID-19 tools accelerator. Over the coming weeks and months, we hope there will be more treatments that improve patient outcomes and save lives. Dr. Tedros: (04:51) While we are searching for COVID-19 treatments, we must continue strong efforts to prevent as many infections as possible by finding, isolating, testing and caring for every case, and tracing and quarantining every contact. COVID-19 is affecting the whole world, but it's important to remember that for the most vulnerable communities, this is just one of many threats they face. We have consistently stressed the importance of ensuring essential service to continue, including routine vaccination and services for malaria, TB, and HIV. Today, I want to touch on neglected tropical diseases. This is an issue I care deeply about, and it is at a group of 20 diseases, including elephantiasis, sleeping sickness, leprosy, Tacoma, and intestinal worms that collectively wreak havoc on the poorest and most marginalized communities. These diseases disfigure, disable, and can kill. And they strike hardest in places of poverty and in remote areas where access to quality health services is extremely limited. WHO and partners have developed a new roadmap, which moves away from single disease programs to integrated approaches to the prevention, diagnosis, and treatment of neglected tropical diseases as part of an overall movement toward the universal health coverage. Dr. Tedros: (06:32) The NTD roadmap puts greater ownership on national and local governments to drive action. Like with COVID-19, it calls for greater collaboration between governments, academia, civil society, and the private sector in order to boost innovation and access to health technologies. I have seen firsthand the courage of people who are living with entities, which is why I call on countries not to forget about the most vulnerable. Together we can achieve anything and I'm encouraged by progress in tackling the Ebola outbreak in the East of the Democratic Republic of Congo. If there are no more cases in the next seven days, the government of DRC will be able to declare the outbreak over. The lessons learned and experience gained by Congolese health workers are now being applied to inform the Ebola outbreak response in the West of the DRC, as well as broader lessons on testing and contact tracing, which are directly transferable for tackling COVID-19. I thank you. Tarik: (07:57) Many thanks to Dr. Tedrus and just to remind you that we have our director of neglected tropical diseases here, Dr. Maria Van Kerkhove, who can talk more about the roadmap that Dr. Tedrus just mentioned. We will start with the questions. Please be concise and one question per person. We will start with FN News Agency and we have Antonio Bratu. Antonio, can you unmute please? Antonio: (08:25) [Spanish 00:08:33]? Tarik: (08:25) [Spanish 00:08:33]. Antonio: (08:47) [ Spanish 00:08:35]. Dr. Michael Ryan: (08:58) Yes, absolutely. And I'm very, very glad you asked this question. And Johnathan and Maria may wish to supplement. It's exceptionally important that this drug is used under medical supervision. This is not for mild cases, this is not for prophylaxis. This is a very, very powerful antiinflammatory drug. It can rescue patients who are in very serious condition where their lungs and their cardiovascular system around their lungs may be very inflamed. So this allows possibly the patients are able to continue getting oxygen into their blood from their lungs for a very critical period by rapidly reducing inflammation at a critical period in their illness. It is not a treatment for the virus itself. It is not a prevention for the virus. In fact, steroids, particularly powerful steroids, can be associated with a viral replication. Dr. Michael Ryan: (09:53) In other words, they can actually facilitate the division and replication of viruses in human bodies. So it's exceptionally important in this case that this drug is reserved for use in severely ill and critical patients who can benefit from this drug clearly. And as the Director General said, this is great news, but it is part of the answer we need on the clinical site. Oxygen, ventilation, the use of antivirals, the use of steroids, and finding a combination of therapies that allows us to save as many patients as possible. Janet? Dr. Janet Diaz: (10:35) Thank you. So now I just have to echo the benefit we've seen in patients who are on oxygen therapy, so who had already lung injury, or those patients that were on ventilation. So there was no benefit seen in the patients that had mild disease. And this study was not for prophylaxis. So I think that is the take home message as you've described, Mike. Tarik: (11:01) Many thanks. So next question, we'll go to Jason from NPR. Jason Bobian? Jason, can you just press unmute please? Jason, can you press unmute so we get to you? Jason Bobian: (11:31) Sorry. Can you hear me now? Tarik: (11:33) Now it's fine. Jason Bobian: (11:34) My apologies on that. I was just wondering if you could just talk any more about the continued work with the United States in terms of ongoing programs. Are things most things continuing to go forward in terms of work with the United States? Dr. Maria Van Kerkhove: (11:54) I can start and then others might want to supplement. I can speak to the work that we do with the United States for COVID-19 and other programs. So yes, of course. We work with scientists all over the world, including American scientists, and public health professionals, and medical professionals mainly in our day to day work through collaborative international networks. So we have established international networks of experts for clinical management, for vaccine development in therapeutics, for mathematical modeling, for infection prevention and control, for risk communication, for many different areas of work. And those include scientists from the United States, from U.S. CDC, from NIH, and many academic groups. And so that will continue. We also work of course, with scientists from many countries all over the world. And I think that's one of the strengths that we have as an organization, to bring people together, to share firsthand experience, firsthand practical experience, with patients in health facilities, in communities, to be able to exchange. And we will continue to learn from one another. Dr. Michael Ryan: (13:00) I fully agree with Maria and beyond COVID, we have many, many collaborating centers all over the United States. Hugely important contributions that they individually and collectively make to global health. And I think the issue here is that these institutions and individuals are contributing to global health. We all work on global health together. We all work together to ensure that we improve the health experience, the health outcomes, and the survival of all people on this planet. And we really do recognize and thank the power of U.S. scientists and U.S. scientists and public health professionals. In fact, today we have Maria from the East coast of United States, Janet from the West coast of the United States. And the Americas is equally further represented by Anna Maria, Anna from the country of Columbia. So the most represented group at this table right now is the Americas and the United States of America from the perspective of how U.S. citizens around the world contribute not only to the health and welfare of Americans, but to the health and welfare of the world. Tarik: (14:23) Thank you very much, Dr. Diaz and Dr. Ryan and Maria on these. So we will go to Yahoo Finance, and we have Angelie online. Angelie? Hello? Can you unmute yourself, Angelie, if possible? If it's not working, we will try to go to Siddhant Manthani from India TV. Siddhant, can you hear us? Siddhant Manthani: (15:01) Hello? Tarik: (15:02) Yes, please. Siddhant Manthani: (15:03) Yeah. Tarik: (15:03) Can you hear us? Speaker 1: (15:03) Hello? Tarik: (15:03) Yes, please. Speaker 1: (15:03) Yeah. So, my question is also about the dexamethasone drug trials. Have there been any talks of initiating the trials on a much wider scale? And would you say that this drug would stand... I mean, the drug could be used as a drug that is both feasible in efficiently providing it to patients all across the world and also effective against coronavirus? Thank you. Dr. Michael Ryan: (15:26) Thank you. Let me just restate that this drug we have, first of all, with great congratulations to my colleague, Peter Horby and all of the great researchers in the U.K. and, as director general said, to the doctors, the nurses, the patients, their families who have participated in this. It is one of the many breakthroughs we're going to need in order to effectively deal with COVID-19. And, as such, we should celebrate that today. But it's still just preliminary data. It's from one study. It's very significant, but we also have to see the real data, the full data. And we thank our colleagues in the U.K. for briefing us. But we still, obviously, and they will be working very hard over the coming days to release detailed data to get this published in peer reviewed journals so everybody can see what the results are. Dr. Michael Ryan: (16:19) From that, at the same time, Janet and her team will be doing some work on more systematic reviews around other data that may be available around the world. And, on that basis, we will pull together the necessary expert group to look at all of that, both on the research and the clinical side, and come to a conclusion around our clinical advice to countries. And it's important that each country takes that measured approach as well. This is not the time to rush, to change clinical practice in too rushed a fashion. People need training. We need to understand what doses to be used, how patients are going to be clinically assessed. We need to make sure there are supplies of the drug. We need to look at a lot of things. So, while we're very pleased today, we still need to see the final data. We need to adjust the clinical guidelines that will be needed. And we need to support countries to both access and utilize this drug in the most appropriate way possible. Dr. Michael Ryan: (17:19) And let me state again, it cannot be said strongly enough, this drug is purely for use under close clinical supervision. It is meant and has only been shown so far to be useful in the treatment of severely ill people with COVID-19. Those people on oxygen, those people who are ventilated. And, while we're very pleased to see a life saving intervention emerge, please, please let us use it and take forward the use of this drug for what it has shown to be beneficial in doing. Janet? Dr. Janet Diaz: (18:00) There we go. Just to echo that, it's really important to see the full data, the full report from the manuscript in a peer reviewed journal. So, we look forward to that. Currently, we know there are other ongoing randomized controlled trials testing steroids for COVID-19. And we are assembling and coordinating to aggregate data from those trials in a meta analysis to give us a bigger perspective, a wider perspective of the studies that are ongoing. Dr. Janet Diaz: (18:28) And then, at the same time, putting into place the mechanisms in order to update our guidance in a transparent and trustworthy way with global experts representing all regions of the world in the very near future. So, all that's going on in place. And again, just to echo, this is something that should be used in hospital for severe patients, for those that are critically ill, but not for mild patients. And we hope in the very near future to have our recommendations more clear, the practice protocols adjusted accordingly, and other tools to assist frontline clinicians and member states to make the appropriate adjustments to their national guidelines. Tarik: (19:14) Many thanks. The next question comes from CCTV. We have Shane with us. Shane? Shane? Just a second. Go ahead, please. Shane: (19:31) Yeah. Can you hear me? Tarik: (19:32) Yes. Now it's fine. Shane: (19:33) Okay. Thank you, [inaudible 00:19:34]. Question to Dr. Tedros. Dr. Tedros, you have attended the extraordinary China, Africa summit on solidarity against COVID-19 today. And what do you think about the meaning of the summit? And what do think about China's support for the African countries in the fight against COVID-19? Thank you. Dr. Tedros: (19:57) Yeah, thank you. So, the China Africa Summit, FOCAC, is one of the platforms where China and Africa partner. And, during this COVID situation, a special session was organized by China, South Africa, and Senegal. The three leaders have co-hosted this meeting and with a specific agenda of fighting COVID- 19 together. Dr. Tedros: (20:32) So, as you know, since the pandemic started, China has been supporting Africa. And many countries have already outlined the kind of support they have been getting, especially in sending experts in sharing information, in addition to that, in providing supporting with supplies, test kits. It's not only the health part. They have also raised the issue of economic recovery and debt relief that China is willing to support with. So, these were the areas of cooperation that were stressed or outlined. Dr. Tedros: (21:24) And, since the pandemic is still not over, and although the number of cases in Africa is the lowest compared to other regions, but it's also at the same time accelerating, appreciating the support that has already been given. But I think they have agreed to give more support because the pandemic is accelerating. So, this is what I would like to say in a brief. Dr. Tedros: (21:58) But, as I always say, this pandemic is... or this virus is a very dangerous virus. And it has two dangerous combinations. It moves fast and it's a killer. And it surprised many countries, including developing nations. And the answer is to fight in unison. Unity and solidarity are very important to defeat this virus. When unity and solidarity is lacking, when there is a crack between us, the virus exploits that crack between us, the differences between us. And that's why national unity and global solidarity is important. Dr. Tedros: (22:57) And platforms like this will be important in strengthening, like the China Africa, in strengthening solidarity across the globe. And this should really be followed by global solidarity to help speed up the defeat of this virus. So, I'd like to use this opportunity to call on unity and solidarity of the whole world. Dr. Tedros: (23:33) In my speech. I compared actually, in the first two months, it was 85,000 cases. And more than 90% of them, by the way, were in China. But, if you take the last two months, this is from April, mid April, up to now mid June, in just two months six million cases. From this, you can see how the virus is accelerating and moving really fast. We can move faster because it's only by moving faster that we can defeat it. And, to move faster, the most important element is unity and solidarity, which is political. And that's what we should really strengthen, national unity and global solidarity. Thank you. Tarik: (24:36) Next question is coming from New York Times. We have David Waldstein with us. David, if you unmute yourself, we will hear you. David Waldstein: (24:47) Hi. Sorry about that. On Monday, Dr. Ryan, you mentioned that you might have some kind of a decision on hydroxychloroquine. Anything new on that? Dr. Michael Ryan: (25:02) One should never promise what one doesn't deliver. Yes. We've been discussing with, and again, because of the independent nature of the solidarity trial and the fact that it has its own executive committee and its own the data safety monitoring board, we've been discussing with the executive group that oversees the trial. The process now for looking at the data, Ana Maria can confirm, but the executive committee now and the DSMV are looking at the data across a number of... yeah. And she will just outline the process for that. But, as of today, we're awaiting the decision and analysis of the steering committee for the group and the analysis of the DSMB. Maria? Ana Maria? Anna Maria Henao: (25:56) Is this on? Yes. Thank you, Mike. So, as Mike reported, NTG reported a few weeks ago. We took three actions. The first action was to conduct the systematic review of the evidence that was conducted by the Cochrane collaboration, one of our work collaborators. The second is we looked into the safety of hydroxychloroquine among the patients vaccinated who were treated in the solidarity trial and in the discovery trial in France, our sister companion trial. And the third thing that we promised is that we will look into the evidence through our data safety monitoring committee. Anna Maria Henao: (26:33) After completing these three steps, we have communication with our executive group that is formed by the representatives of seven of the member states who are participating in the trial. And today, just five minutes ago, we finalized a call with all the investigators in the trial. On the basis of the evidence that is available to the investigators, to the secretariat, to the accepted group, and to the DSMC, the decision was made to stop the randomization with the hydroxychloroquine trial on the basis of two pieces of information. The first, the data that was published by the U.K. trial, and second, the data that was available to us from the solidarity trial. I will stop here. Tarik: (27:24) Thank you, Dr. Henao, who is, just to remind everyone, the head of our research and development blueprint unit at WHO. I understand that we have a question on NTDs and tropical diseases. Our friend Simon Ateba is online and would like to ask that. Simon? Simon Ateba: (27:46) Yeah. Thank you for taking my question. My name is Simon. I came from Today News Africa in Washington, D.C. And I would like the expert... I'm sorry. I can see the name very well from where I am. But I would like the African expert on the panel to tell us about all those neglected diseases in Africa and how COVID-19 is affecting them. Thank you. Dr. Mwelecele Malecela: (28:14) Thank you very much for that question. It's without a doubt that COVID-19 has wreaked havoc in the world. And one of the things that has been severely affected is our neglected tropical disease programs worldwide, and particularly in Africa. As part of the focus on social distancing, we've had to stop most of the mass drug administration programs in Africa. And so, the idea is now to think about when we go back post COVID, how are we going to do our programs? What is the way that we're going to do our programs better? Are there innovative ways that we can actually carry out these programs where people can be treated safely and not necessarily through mass drug administration, but making sure the safety of the people being treated and the safety of the community health workers who are treating them? Dr. Mwelecele Malecela: (29:12) So, that is the discussion that is ongoing. But we have still, as WHO issued guidance, that all programs that involve any kind of mass drug administration should be halted. And, as a followup to that, there are diseases which require treatment, immediate treatment, diseases like leishmaniasis, which are also part of the neglected tropical disease group. And those diseases, people are still required to go to health facilities and get the requisite treatment. Thank you. Tarik: (29:51) Many thanks, Dr. Malecela. So, for Simon, if you can't see it. But we will send you, it's a Dr. Mwelecele Malecela of WHO program for neglected tropical diseases. We will go now- Tarik: (30:03) For Neglected Tropical Diseases, we will go now to Global Brazil, Bianca [inaudible 00:00:06]. Bianca: (30:08) Hi Tariq, can you hear me? Tarik: (30:10) Yes. Very well. Bianca: (30:12) Thanks a lot. My question is to Dr. Mike Ryan. How do you see the situation in Brazil now? Do you think the number of deaths has stabilized? Do you see any sign of stabilization? And if so, what does it mean exactly? What signs it can give us? Thanks. Dr. Michael Ryan: (30:37) Yeah. Dr. Michael Ryan: (30:45) Is this not working? It's working now. Okay. Yeah. I think the epidemic is still quite severe in Brazil. I believe health workers are as we said before, working extremely hard and under pressure to be able to deal with the number of cases that they see on a daily basis. But certainly the rise is not as exponential as it was previously. So there are some signs that the situation is stabilizing, but we've seen this before in other epidemics and other countries. You can see a sign of stabilization for a day or a few days, and then the disease can take off again. So what I would say is it's a moment of extreme caution in Brazil. There needs to be a focus on physical distancing, on hygiene, on reduced crowding, and being able to support populations, particularly populations from ethnic minorities, for people living in difficult conditions in urban environments and poor conditions. Dr. Michael Ryan: (31:48) It's difficult for people to do social distancing. It's difficult for people to maintain personal hygiene, and we have to try and support them in that. So it is, I think from the perspective of Brazil, a moment now to really double down, to really focus on the public health and social measures, to focus on supporting communities who find this both difficult to sustain that, and also have a greater impact in terms of health, to ensure that the hospital system continues to function and is able to cope with the severely ill patients. If all of that is done, then we would expect that Brazil has historically, as I said previously, a proud history of containing and suppressing infectious diseases. And I have no doubt that if the full scale commitment ingenuity of the Brazilian state, of the provinces, of the people is leveraged in a united, sustained, and combined way, that Brazil will bring this disease under control and will succeed in emerging from this as quickly as possible. Tarik: (32:54) Thank you Dr. Ryan. Next question is from Mexico. We have Paulina [inaudible 00:33:01] from Cancun. Paulina, if you unmute yourself we will hear you. Paulina: (33:27) [foreign language 00:03: 10] Tarik: (33:31) [foreign language 00:03:13]. Paulina: (33:37) [foreign language 00:03:15] Dr. Maria Van Kerkhove: (33:48) Oh I can start and then others can supplement. So that's a very good question and it highlights the need to ensure that we have surveillance systems in place for not only COVID-19, but for other pathogens that are circulating. And in fact, this morning I had a call with teams across NTD and my own team looking at Arborviruses and looking at Dengue and Yellow Fever and Chikungunya and Zika. And how do we accelerate the arbovirus work across the globe in COVID-19? How do we ensure that countries are continuing to fight against other pathogens that exist, that are common in many parts of the world, so that not only can we detect cases, but then we can distinguish between who is infected with which pathogens? How does this affect the clinical pathway in terms of what patients need in terms of clinical care and how we can protect onward transmission within families, within communities? Dr. Maria Van Kerkhove: (34:45) And so this is something that is very important to all of us. We work through our regions. We work through our country offices. We work with the national ministries of health and across different sectors to ensure that these systems continue, that these surveillance systems and that the medications are in countries that need to be in countries. So I'm not sure if you want to supplement. Dr. Mwelecele Malecela: (35:06) I just like to add the importance of vector control and how we are actually focusing also on encouraging the personal surrounding vector control that can be done easily with social distancing to continue. So in our guidance, we've also issued that the vector control to particularly deal with the Aedes mosquito which a lot of the time is around the house in little flower pots et cetera, should be continued and should be encouraged. Thank you. Dr. Michael Ryan: (35:40) Maybe I can just add on this that while Dengue, Chikungunya, and COVID-19 are very different diseases and have different pathways for which they're caused, they're very much fused in one way and that is that they can attack vulnerable communities. They're very specific to context, to the context of water, sanitation, overcrowding, poverty, the lack of appropriate management of wastewater, lack of access to healthcare for what can be life-saving interventions. There are so many similarities when a new or an old disease emerges in a community that is not well served by health care, that has underlying issues, both social, and healthcare issues. These diseases exploit all of those as the Director General has said many times, the cracks, that exist in our societies in terms of social justice, in terms of access to health care. Dr. Michael Ryan: (36:36) Dengue is a very, very good example of that. And I think while they may not be very similar diseases, they exploit very similar weaknesses in our societies and in our health systems. And if we work towards universal health coverage, if we work towards strengthening core health systems, if we work as you are working so well on integrated approaches and primary health care delivered close and within communities for multiple diseases, both in prevention and control, and we move away from over-verticalized approaches and we focus on communities and their capacity to deal with the diseases that threaten them, then I think we will be doing better in the long run. We have to deal with COVID now as a singular problem, as the DG said it's a very dangerous disease, but we need solutions in the long run that deal in a more integrated fashion and strengthened resilient health systems, empowered, educated communities that can access the tools that they need to be able to control disease within their own communities. Tarik: (37:38) Many thanks. So now we will go to Jim from Westwood One. Jim, hello, do we have Jim? We don't it seems so. We will go to Jamil. Jamil Chade working for Brazilian Media based here in Geneva. Jamil. Jamil: (38:02) Thank you Tariq. It's just a clarification. What is the current status of hydrochloroquine? If Mike Ryan or your guests could clarify that to us, many of us are having this question during this press conference. Thank you very much. Dr. Michael Ryan: (38:29) Yeah. But I know Maria can clarify. I think there's some confusion as to whether the hydroxychloroquine [inaudible 00:38:31] Anna Maria Henao: (38:33) I apologize. I apologize for the confusion. So I will repeat again. We promise that on the basis of the recommendation of our accepted group for the trial, we will do three things. Number one, to review the evidence and we post that in the website of WHO. A review of the evidence by the Cochrane Collaboration that suggested, the review suggested that there was no apparent beneficial effect of hydroxychloroquine. Two, there was an press release by the UK Recovery Trial on the findings of hydroxychloroquine that suggested that there was no beneficial effect on mortality, on the duration of hospital stay, and on the need for ventilation. So we say we were going to look into our own data to see if there was evidence that is suggested beneficial effect. Anna Maria Henao: (39:25) So we have completed these three since, we have a discussion with our executive group and all the PIs or the principal investigators of the trial that finished just 10 minutes ago. And on the basis of this evidence, we are going to proceed, is not automatic. We are going to proceed to consider the modifications on the protocol for the WHO Solidarity Trial. And apologies I was not clear the first time. Tarik: (39:55) Thank you very much for this clarification doctor. And now we will go to Business Insider. We have Anna with us. Anna. Anna: (40:10) Hi, can you hear me? Tarik: (40:10) Yes. Very well. Anna: (40:12) Great. I just would like some insight on second lockdowns. We're seeing, I know you don't necessarily want to call it a lockdown, however you term it, we're seeing spikes in cases across the US and places around the world and some of the strategies are to go back into lockdown, or some of the threats have been that. I would like to hear kind of your thoughts on how that works as a public health strategy the second time around. Thank you. Dr. Maria Van Kerkhove: (40:45) So thanks for the question. It's an important one. I think we've been trying to articulate that the approach and the interventions that need to be taken by countries will depend on the situation that they're in. It will depend on how the virus is circulating, how efficiently it is, the intensity of it, and what are the systems in place to be able to detect the cases, to isolate cases, to care for those cases, depending on their severity, to quarantine contacts, to empower the communities, and have an all of government approach. And in many situations we have seen countries have success in suppressing transmission, where we've seen their epi curves go down and transmission go to a low level or even stop in some cases. But there is always the possibility that the virus can resurge and there are opportunities for the virus to be able to take off again. Dr. Maria Van Kerkhove: (41:41) And if there is a situation where the virus does resurge, then certain interventions may need to be put in place. What we're hopeful for though is, the decisions that are taken to adjust these measures, whether to lift them or whether to put them in place again, is done in a data-driven way and it's done in a way that meets the needs to suppress transmission. It doesn't have to be all or nothing. And in fact shouldn't be. It should look at which are the measures that need to be in place and where? And in a temporary nature. So the fundamental things of hand hygiene, and respiratory etiquette, physical distancing, using a mask when you're in community transmission and you can't adhere to physical distancing, all of these measures continually need to be put in place in addition to active case-finding, caring for cases, and contact tracing. Dr. Maria Van Kerkhove: (42:32) So it's a long answer because it depends on the situation. Governments need to look at the data that they have. They need to look at which measures can be implemented where. And do that in a slow and in a staggered way depending on where the need is. But it is certainly possible that countries will need to implement measures again, as we've seen in a number of countries now, but we are hopeful that those could be temporary. Dr. Michael Ryan: (43:00) And if I could add. If we look at the experience of countries that have avoided so-called lockdowns or stay at home orders, travel restrictions, extreme public health social measures, can be varied in the footprint, in the duration, and in their intensity. The type, how long, and where these things are implemented. And governments have choices. The less sensitive your surveillance system is, the more blunt your response measures have to be. If you can't see very well in the dark, then you don't know where to apply the measure against the virus if you can't see it. And I'm sorry for being so simplistic, but governments need to be working under surveillance. They need to know where the virus is. If you know where the virus is, if you know who's getting it, if you know the situations in which it's been transmitted, if you do case and cluster investigations, and you can understand in your communities and societies, what are the specific situations and contexts in which the disease is amplifying and spreading, then you can apply measures that are much more sophisticated. Dr. Michael Ryan: (44:14) You can apply them at a lower geographic level. You don't have to do the measures everywhere. You can do them in one county or one community. You don't have to do them forever because you can raise those measures relatively quickly, because you have a surveillance system to see if something is going wrong. So I do think we need to move towards a more sophisticated analysis of, is it no lockdown, lockdown? We need to move into a more smooth, more modulated approach where our surveillance should drive the measures that we take and public health and science should be able to advise competent authorities to modulate the measures that need to be taken at any given time. None of that is possible if you don't have surveillance, tracing, testing, and the ability to know where the virus is. Dr. Michael Ryan: (45:03) Surveillance tracing, testing and the ability to know where the virus is within your community, or society at a given moment. If you don't have those answers, then your responses necessarily become more and more blunt, less and less precise. And that's when we see large scale lockdowns that have such an impact on social and economic life. Tarik: (45:24) Many thanks Dr. Ryan. Now we will try to go back to Jim if we have Jim. Jim? Jim: (45:34) Yes, I'm very sorry [crosstalk 00:00:45:36]. Tarik: (45:37) No, that's okay. Please go ahead. Jim: (45:38) I was just wondering if there is any new science, or any new information on the behavior of the virus that causes COVID-19. Have we seen any advances in knowing how it spreads, the super spreading events that it seems to have? Is there any new signs on the behavior, but to help us get around the ability to rein this thing in? Dr. Maria Van Kerkhove: (46:06) Thanks, Jim. That's a great question. We're learning about this virus every day. We're learning about how this virus behaves and its characteristics. And there are really incredible studies that are being published every day. Really grateful for these detailed epidemiologic investigations, household transmission studies, cluster investigations, studies in health care facilities. I could go on and on. And these, unfortunate in a pandemic like this, there are these opportunities to learn about how these viruses behave. And we have really good researchers all over the world that are communicating with us directly and are publishing these results. Dr. Maria Van Kerkhove: (46:46) We have scientists that are following the virus itself. And so there are full genome sequences that are being made available publicly. There's more than 40,000 viruses, 40,000 full genome sequences that are available in which we are looking to see if there are any changes in the virus. We do see normal changes, which is expected with an RNA virus. And this unprecedented reporting of these viruses, is allowing us to look at these viruses in real time. Dr. Maria Van Kerkhove: (47:15) Secondly, we're seeing very detailed cluster investigations, as you've heard Mike say, where there are outbreak investigations in either ex-pat dormitories, or in gyms and facilities, or in wherever we are seeing these super spreading events. And indeed, we are seeing super spreading events in places of worship, in gyms, in longterm living facilities. And these places where the virus can transmit, we can learn a lot from. Who is it transmitting to? In which departments, for example, in a healthcare facility? And that helps us refine our guidance. It helps us refine our ability to break the chains of transmission, to prevent infections and to work to save lives. Dr. Maria Van Kerkhove: (48:04) The virus, in terms of what we know about its behavior and how it transmits, is very similar from day one, in terms of its respiratory nature and spreading through respiratory droplets. But the super spreading events are worrying, because these are opportunities that we can actually work to prevent happening. If we know that they can happen, we can ensure that in facilities where people are in close quarters, we put measures in place to break those chains of transmission before they even have a chance to start. Dr. Maria Van Kerkhove: (48:31) Thanks for that question. We encourage research to continue. We encourage collaborative nature and research and open findings. And having researchers communicate with one another and with us, and we know we will learn even more every day. Tarik: (48:47) Many thanks. I have received a couple of texts from journalists who just want to clarify with Ana Maria about hydroxychloroquine, Dr. Heanao. Anna Maria Henao: (48:59) Yes. Thank you Tarik. I'll try once for time. They turned in evidence from the Solidarity discovery trial, the external evidence from the recovery trial and they combine evidence from these large randomized trials, bring together, suggests that a hydroxychloroquine, compared with the standard of care in the treatment of hospitalized COVID patients, does not result in the reduction of the mortality of those patients. Based on this analysis and on the review of the published evidence, the executive group of the Solidarity/recovery trial has made in two occasions. And today we met with all the PIs. After deliberation, they have concluded that they have concluded that the hydroxychloroquine will be stopped from the Solidarity trial. But I want to emphasize that this does not constitute the WHO policy, that this is not a WHO policy recommendation. This is the results from trials, and that this does not apply to the use of all the evaluation of hydroxychloroquine as prophylaxis in patients exposed to COVID. That's a different scene. Anna Maria Henao: (50:17) This is focused on what we are doing on the Solidarity trial, on randomization for COVID patients, but does not apply outside of that. And it doesn't constitute WHO policy. WHO has different processes for developing of guidelines. Tarik: (50:37) Thank you very much, Dr. Heanao. We hope now this question has been clarified and we will take one last question. And then we will conclude this briefing and we will speak to our friend Gabriela Sotomayor from Mexico and [inaudible 00:05:56]. Gabriela? Gabriela: (50:58) Yes. [foreign language 00:05:59]. Tarik: (51:19) [foreign language 00:06:01]. Gabriela: (51:23) [foreign language 00:06: 02] Dr. Michael Ryan: (51:55) I can begin, did you may wish to supplement. First and foremost, it is entirely unacceptable that access to healthcare anywhere in the world would be effected, or influenced by race. Access to healthcare should be absolutely based on clinical need, never on any other factor for a patient's care. However, there are clearly, and this is important, there are lots of ongoing research as to whether there are genetic and other backgrounds that would lead to more severe outcome in certain ethnic groups. That work is underway and has not enough proven as such yet. Dr. Michael Ryan: (52:42) What is clear is that many ethnic minorities and countries are very often underserved, have very often had a a more difficult health experience and have higher risk factors in earlier paths of life. And carry with them conditions that are associated with poor outcomes for COVID-19. That in itself is a tragedy. And it is sad that that is the situation. But what that does allow clinicians and hospitals and public health authorities to recognize, is that if we have people of ethnic minorities who are likely to suffer worse outcomes, then we need to double our intent. We need to be even more alert to that fact. Dr. Michael Ryan: (53:23) And in fact, it should be in some senses the other way around. We should be prioritizing people from certain backgrounds who may have worse outcomes and ensuring that they get access to care. But it should always be based on underlying conditions. It should be based on age. It should be based on people's potential to recover and benefit from clinical care. But I think it's important to state that nowhere in the world, it doesn't matter where you are, access to healthcare, access to lifesaving care should never, ever be based on race or ethnicity. Tarik: (53:59) Thank you very much, Dr. Ryan for answering this question. We will conclude this press briefing at this stage. I would like to thank, especially our guests, Dr. [inaudible 00:09:07], Dr. Diaz and Dr. Heanao for their participation today. Tarik: (54:13) The audio file will be sent to you shortly, as well as a transcript that will be posted tomorrow. We will keep sending you information from WHO offices, from around the world, on our activities on COVID-19. And from my side, I wish you a very nice evening. Dr. Tedros: (54:32) And finally, before we close, thank you Tarik. Before we close, I want to acknowledge journalists on this call and around the world. As you know, according to UNESCO, which has been working with the Swiss-based nongovernmental organization, press emblem campaign between March 1st and 31st, May, 127 journalists were killed in 31 countries. Dr. Tedros: (55:04) Other journalists have been harassed and detained while reporting this pandemic. Journalists are critical to holding decision makers to account and communicating lifesaving public health messages to the general public. They should never be a target for violence. They should be protected so that they can continue to do their critical work. Again, my respect, all journalists who are at risk, reporting and telling the truth. And we value your contribution. And thank you again for joining us today. And thank you so much and see you during our next program on Friday. Thank you.