World Health Organization (WHO) Coronavirus Press Conference June 19

Tarik: (00:02) We will have some other guests that will be announced, as we start with opening remarks. I will just remind the journalists who are watching this on Zoom, that you can listen simultaneous interpretation in six UN languages, plus Portuguese, plus Hindi. This is thanks to our interpreters who are here with us and we would like to thank them as well for being here. I will give the floor now to Dr. Tedros for his opening remarks. Dr. Tedros: (00:35) Thank you. Thank you Tarik, Thank you! Good morning, good afternoon, good evening. The pandemic is accelerating more than 150,000 new cases of COVID-19 were reported to WHO yesterday, the most in a single day so far. Almost half of those cases were reported from the Americas, with large numbers also being reported from South Asia and in the Middle East. The world is in a new and dangerous phase. Many people are understandably fed up with being at home. Countries are understandably eager to open up their societies and economies, but the virus is still spreading fast. It is still deadly and most people are still susceptible. We call on all countries and all people to exercise extreme vigilance, continue maintaining your distance from others, stay home if you feel sick, keep covering your nose and mouth when you cough. Dr. Tedros: (01:54) Wear a mask when appropriate, keep cleaning your hands. We continue to call on all countries to focus on the basics. Find, isolate, test and care for every case, trace and quarantine every contact. As the pandemic gathers pace, it's the most vulnerable who will suffer the most. All countries, rich and poor, have populations who are vulnerable to a higher risk of disease and death. Dr. Tedros: (02:33) Tomorrow is World Refugee Day, an important moment to highlight the risks of COVID-19 for some of the world's most vulnerable people. Refugees are particularly at risk of COVID-19, because they often have limited access to adequate shelter, water, nutrition, sanitation, and health services. Over 80% of the world's refugees and nearly all the world's internally displaced people are hosted in low and middle income countries. WHO is deeply concerned about the very real and present danger of wide spread transmission of COVID-19 in refugee camps. Beyond the health threat posted by the virus, COVID-19 is also exposing many refugees to even more severe hardship. A report published today by the International Red Cross and Red Crescent Movement shows that about 70% of refugees surveyed in Turkey reported having lost their jobs since the start of the pandemic. Dr. Tedros: (03:48) We have a shared duty to do everything we can to prevent, detect and respond to transmission of COVID-19 among refugee population. Public health measures that reduce transmission of COVID-19 requires strict and sustained implementation. This is difficult to achieve in refugee camp where the public health situation is weak. It's an honor to be here today with my brother, Mr. Filippo Grandi, the United Nations High Commissioner for Refugees, UNHCR's primary purpose is to safeguard the rights and wellbeing of refugees. WHO's mission is to promote health, keep the world safe and serve the vulnerable. Our organizations are a natural fit and every day WHO and UNHCR work to strengthen the collaboration between our two agencies. Dr. Tedros: (04:52) Last month, our two organization signed a new agreement to strengthen and advance public health service for the millions of forcibly displaced people around the world. COVID-19 has demonstrated that no one is safe until we are all safe. Only by putting politics aside and working in true collaboration can we make a difference. We're most vulnerable when we are divided, but with solidarity and cooperation, we will overcome this pandemic and be better prepared for the crisis of the future. It's now my great honor and pleasure to invite my brother, the United Nations High Commissioner for Refugees, Mr. Filippo Grandi to say a few words. Please Filippo. Filippo Grandi: (05:53) Thank you. Sorry. Thank you very much Director General. Thank you Tedros. I'm really very honored and pleased to share this press conference today, because of all the reasons that you have just explained, I do appreciate very much WHO's focus on the most vulnerable, including the refugees, displaced stateless people that my organization deals with. It's also very significant, I think that we have decided to speak together to the media today, the day before World Refugee Day, which is observed tomorrow, and which in this context, this year, takes particular significance. Filippo Grandi: (06:56) It is also significant that we do this the day after we issued our yearly report on forced displacement figures. They refer to 2019 and as you mentioned, they're very dramatic. I've already spoken to the press about this, but let me repeat what I guess most of you know already. We reported a dramatic increase in displacement figures last year, compared to the year before. We're close to 80 million people that are either refugees or displaced in their own country. This means, in simple terms, that 1% of humanity lives today in situations of forced exile. Filippo Grandi: (07:47) You also already mentioned, Tedros, a very important and insignificant statistic, 80, in fact, sometimes we could even say almost 85% of the refugees and practically all the displaced people, the internally displaced people live in countries that contrary to the political rhetoric are usually countries that are either poor or middle income country, not countries with a lot of resources. Filippo Grandi: (08:19) This means since I'm speaking from WHO headquarters, countries that not only have fragile institutions, fragile economies, but also often fragile health systems. This is something that we need to reflect on. I would also add another couple of statistics. One is that over 40% of the people we're talking about are people below 18 years of age. So a very big prevalence of young people, children, or very young, and of course, a very big prevalence of women over men, because many of the refugees are in fact that, women. Often women that are also breadwinners and have children in their responsibility. Filippo Grandi: (09:09) It's also interesting that two thirds of the figure is not refugees that have crossed borders, but refugees in their own countries, internally displaced people. These people are people that are more difficult often to access for all of us in the humanitarian community. Why? Because, they are in the middle of conflict. These are the places where, as we know very well, and you have spoken about this very clearly over the past few months, and I'm very grateful for that. Places like Yemen, places like certain parts of Syria, places like Libya, are the places where doing work, health work also for the vulnerable is extremely, extremely difficult. Filippo Grandi: (09:51) Finally, one more telling statistic, the figure we reported yesterday is about double the same figure 10 years ago. So in 10 years, the figure of forced displacement has doubled. What does this mean? This means that the space, the opportunities for solving forced displacement are receding. We calculate that, we estimate that in the '90s about one and a half million refugees and displaced went back every year in operations of voluntary repatriation. We're down to less than 400,000 a year that avail themselves of these opportunities. This means that, as I've said many, many times, and yesterday I was invited also to brief the Security Council on this. We are living in a world in which making peace is becoming very difficult. New conflict emerge and add themselves to old conflicts like in Afghanistan, like to an extent in Somalia, despite improvements and other places where conflicts continue to displace people and inflict suffering on civics. Filippo Grandi: (11:10) If a few more words, just to say that on this situation, we now have the additional complication of the pandemic. So I won't speak about the pandemic, because of course the experts are here in WHO, but I would like to add a few points to what you already said. Though we have not seen or not seen yet, I should say, major outbreaks where we feared the most, in large concentration, in refugee camps, traditionally, like in Bangladesh, for example. We've seen cases, we've seen some small outbreaks, but not the catastrophic outbreaks that we were fearing at the beginning, because of the lack of social distancing, the lack of water and sanitation facilities and so forth. I think this is also due to the fact that in many of these situations, we had time to prepare. There is where our cooperation with WHO has been invaluable, because it is WHO and I want to stress it and many of my humanitarian colleagues can say the same, that has provided us throughout these difficult months with leadership and technical guidance, without which we would not have been able to achieve whatever we have been able to achieve. Filippo Grandi: (12:32) So it's, for me, also an opportunity to thank the Director General and to thank WHO staff worldwide for the support that you have provided to us in this very, very difficult months. But of course, we hear what WHO keeps telling us. We need to maintain that vigilance high in those situation, and remember the majority of refugees and displaced are actually not in refugee camps, they are in communities. Those communities in some places have been devastated already by the pandemic. I'm thinking of Latin America where 17, 18 countries host more than four million Venezuelans on the move. I'm thinking of many urban centers in Africa that are hosts to large refugee populations. I'm thinking of Africans in Pakistan and Iran that live, share facilities and accommodation with communities that have been impacted very severely by COVID. Filippo Grandi: (13:36) Throughout the situations what worries us, and perhaps at this point, from our perspective, even more than the health impact is the impact on livelihoods. Refugees and migrants depend essentially on daily wages, on very fragile income, on that informal economy, which lock downs eliminate very quickly. So a lot of the jobs of the very thin livelihoods on which refugees depend have already disappeared, and this is causing enormous vulnerability on people that depend on these incomes. Vulnerabilities that translate also into health vulnerabilities, because in many places to access health facilities cost money, which is not there anymore. I would like to make a final comment. The key issue that we have been impressing on governments is that refugees, displaced people, other people on the move, must be included in national health responses. This is again, an area in which we have cooperated very well with WHO. Filippo Grandi: (14:49) I have to say that in most countries, this has happened. There was a clear understanding that if you excluded this population, it would be actually a liability for the rest of the population as well. So I want to thank all governments for having done this. The next campaign for inclusion will be tougher, and it is inclusion in social and economic responses. That will be more difficult to include refugees and displaced people. It will be more difficult economically because it costs a lot of money. It will be difficult politically in many countries, but I want to use this forum to appeal to States, to think of that. Filippo Grandi: (15:31) I've reached out already, we've reached out to the World Bank, to the International Monetary Fund, which are putting in place rescue packages for fragile economies, to tell them, "Take it into account when you plan this with governments, that some of those States have the additional responsibility of hosting large refugee populations." I have to say that both the IMF and the World Bank have been very responsive on that. So thank you very much. I can only conclude by echoing what the Director General said. I hope as has- Filippo Grandi: (16:03) The Director General said. I hope, as has been said many times, that the pandemic will be an opportunity for all of us to reflect on the need to move away from the rhetoric of "me first, my country first," and to work together in a unanimous manner. Filippo Grandi: (16:19) Yesterday, I briefed the security council, as I said. And this was my main message. Please put aside your divisions. As the DG said, let's depoliticize these issues. This is valid for the pandemic, and this is valid also in dealing with refugee and migration issues. Thank you very much, Dr. Tedros. Dr. Tedros: (16:44) Thank you, thank you, thank you, Filippo. That was really, really great and speaking from your heart. I really enjoyed your speech and your passion. Thank you so much. And today we're also honored to be joined online by two WHO colleagues who are working with refugees. First, I would like to introduce Dr. Iman Shankiti, WHO's representative in Lebanon. Dr. Tedros: (17:15) As you know, Lebanon is a country of 6 million people of which 1.5 million are refugees, mainly Syrian and Palestinian. There are also more than half a million migrant workers. Dr. Iman is currently leading the overall response to COVID-19 in Lebanon. Dr. Iman, you have the floor and [foreign language 00:01:43] to you. Iman Shankiti: (17:46) Thank you so much for giving us the chance to brief you on Lebanon. Thank you, Mr. Tedros also. So as you said, DG, Lebanon is hosting more than one and a half million refugees and half a million migrant workers, which is around 30% of the total population. This is one of the highest percentages in the world. The outbreak in Lebanon, we can still say that it is. so far under control. We still have cluster of transmissions. We do not have wide community transmission. Iman Shankiti: (18:15) The COVID-19 outfit had really coincided with a very difficult period for Lebanon. We have a severe unprecedented financial crisis. And also this has been topped up by political insecurity, civil unrest, which has started in October 2019. This has all resulted in a competition for the very scarce resources and employment, which is quite fierce. And also there has been a rise in collective anxiety in Lebanon. The threat of COVID-19 and the lockdown measures all are favoring inequities in access to health. Iman Shankiti: (18:50) The fact that WHO and partners has been working diligently together UNHCR, UNRWA, UNICEF, we have all try through the intensive social mobilization and large scale awareness interventions to address this very early in the outbreak. Looking at some of the alarming figures that the refugees are facing due to the impact of the civil unrest and the COVID-19, there has been a sharp drop in access to vaccination, which is estimated around 50%. This is due to financial hardship, but also due to the lockdown. Iman Shankiti: (19:28) There has been an overall drop in the utilization of primary health care services, which amounts around to 47%. The admissions to hospitals also decreased by 30%. There has been an increase, a significant increase, in the child labor estimates, and some of the recent figures or reported estimates that the caregivers, 63% of the caregivers, have reported that they didn't have enough food for the last two weeks. Iman Shankiti: (20:03) The rise of domestic violence, and this is something that we have been monitoring on the ground together with UN Women, UNFPN, national commission for Lebanese women. We are looking at monitoring trends around gender based violence among the host community and also among refugees. We can see that there's a sharp rise in this. We have been confined in this on a monthly basis, sending out gender alerts. This was used to brief governments, UN, and also to impact the advocacy for programming for the refugees. Iman Shankiti: (20:35) WHO, UNHCR, UNDP, UNICEF, UNRWA, IUM, civil society organization, and others, we're all aware of the triple crisis given that Lebanon is facing. That's why when we started the planning the response, we planned it across the eight global pillars. The support had short and medium and longer term interventions. It was geared towards reinforcing the country health system resilience, but also supporting access or continuing care, and also access to COVID-19. There was a special emphasis on access to care for vulnerable populations, specifically the refugee. Iman Shankiti: (21:12) For example, to ensure equity, we kept saying that what applies to Lebanese applies to the whole population in Lebanon. So this is something that was quite important for us, that we adopted a one national health preparedness and response plan. This was developed and it's in implementation right now. The same standards, the same rules applies to all, whether a refugee, immigrant, or a Lebanese. Iman Shankiti: (21:40) Also, I would like to highlight a success story, which was started two weeks ago when we started testing of refugees. We developed a national testing strategy and the testing strategy was, there was a sample that was specified for the refugees are in their informal tented settlements, but also for the refugees that are living within the population, I mean among the population. The testing has started and almost 50% of the samples in the camps have been reached. Iman Shankiti: (22:13) The same will be applied for the Palestinian refugees very soon. Now, due to the fragile context in the country, the efforts are also made by all partners to minimize tension between the refugees and host communities and to avoid stigma and discrimination, which has been happening a lot. [inaudible 00:22:32] together with UNICEF, UNDP are collaborating with ministry of information to counter rumors and misinformation. At this critical juncture, I can only say that I am urging all partners, stakeholders, private sector, to work together, to work with us, to continue working with us to ensure that no one is left behind. Thank you. Filippo Grandi: (22:54) Thank you. [foreign language 00:06:56], Iman. Now I would like to invite Mr. Tulle Polk Joke. Mr. Joke is currently leading the COVID-19 response in The Gambella region in Ethiopia. Ethiopia hosts more than 700,000 refugees in eight different regions. More than 40% of the refugee population is hosted in seven camps in the Gambella region. Mr. Joke, you have the floor. Please go ahead. Can you please unmute, probably? Tulle Polk Joke: (23:44) Thank you. Thank you. Thanks you for me to join this ... Okay. Do you hear me now? Filippo Grandi: (23:51) Yes. Yes, we can hear you. Please proceed. Tulle Polk Joke: (23:55) Okay, thank you. Thank you for introduction, Dr. Tedros. I think it's a very good time for me to meet you today. I wish I could check out with you as we have had almost many years back. Coming to the issues, Ethiopia is a population of more than 100 millions and as Dr. Tedros said, it hosts more than 750,000 refugee in different camp, in different regions. Tulle Polk Joke: (24:31) Gambella hosts almost half of the refugee in Ethiopia. Gambella has a population of half million that hosts more than 300,000 refugee in seven refugee camp. At the moment, we have almost 8,000 refugee in the border waiting for these attendments. So we can see that, you can imagine that is a huge effort for the COVID-19 response planning. In Gambella, we have five hospitals and 28 health centers serving those communities and 14 health facility that are all seeing the refugee camp. We can see that we don't have capacity to manage the cases COVID-19 continue to treating across the regions. Yes. Do you hear me? Tulle Polk Joke: (25:50) So currently we have five confirmed cases in the regions that we may see as [inaudible 00:26:04] number of people, but we are really worried of the treat of disease in the camp, because [inaudible 00:26:11] condition where people are living in a crowd conditions and that really actually lack of water to wash. And you know that there are illegal crowd water of people coming from South Sudan to the camp, which is really worrisome for the treat of the disease. So currently WHO is working with [inaudible 00:10:33], the Ethiopian government refugee agency together with UNHCR and other agencies and partners trying to prevent the spread, or trying to prevent the return of the COVID-19 to the camps. [inaudible 00:26:59] is training and checking, I mean is training the [inaudible 00:27:06] system in the refugee camp to find the cases. So currently we are really working hard with all the partner government agencies to tackle all the problem in the camps. And together with UNHCR and other agencies, we are trying to response the COVID-19 pandemic, especially for the vulnerable communities. Tulle Polk Joke: (27:38) Taking this into account, we are really preparing for the kids in the camp. We put in place the isolation that may take care for those women who require immediate treatment. So we are really working hard. Very, very, very big tasks for the partner. And although I can really call upon all the partner to really work, to tackle this problem for the [inaudible 00:28:22] community, including refugee and IDPs in the countries. Tulle Polk Joke: (28:27) Saying this, I really thanks you to invite me today to join this press conference, to address really the refugee situation in the region. We are really working together with all the partners. And personally, I would like to say refugee are really our brothers, our peoples where we can work to see the problem and we can be with them together in this COVID-19 response. Thank you. Filippo Grandi: (29:03) Thank you, thank you, Tulle. Thank you so much, indeed. And I can understand in what situation you're serving and thank you so much for your commitment in a place where we need committed people like you. So our appreciation and respect to you and your colleagues. You are helping the most vulnerable and you should be proud of that. And we're proud of you too. Tarek, with that, please back to you. Tarek: (29:34) Thank you, and we all join, I think, our thanks to Mr. Joke and Dr. Iman for their work they're doing. Also, thanks to Mr. Grandy for his opening remarks on this very important topic. We will now open the floor for questions. I'll remind you that you can ask questions in six different languages plus Portuguese, and that we will try to be concise and take one question per person. And we will start with the Gunilla Van Hall, who is our Geneva based colleague here working for Swedish media, Gunilla. Gunilla: (30:11) Yes, can you hear me? Tarek: (30:12) Very well. Gunilla: (30:13) Good. Well, look, I have a question on what you all talk about, the second way that we seem to be seeing now in China. What is the WHO's definition of a second wave? Are we talking about when we have 10 cases, or a hundred cases, where we have a cluster, where we have several countries? And what you recommend countries to do if we have this second wave? I'm thinking especially about Europe where we had strict lock downs and they feel like we cannot afford to go back to that kind of situation. What kind of recommendation would you give to European countries if they have what we call second wave? Thanks. Dr. Michael Ryan: (30:58) Thank you. That's a lot of questions inside a question, important issues at hand. I think there is no specific definition of a second wave, but let me explain it like this. What we will see sometimes with viral diseases is they pass through a community, like a wave passing through. And it passes through and so you end up with a number of cases rises and it falls down to a very low or undetectable level. And there's a period of time in which there's very low or no activity. And then the disease returns in a large wave. And that's what we see with seasonal influenza every year. There is a different concept when many countries are facing now, when they've come off the peak of the first wave, but they haven't reduced the disease down and they're in a steady state where they're struggling to reduce the incidence of the disease. And then they get a second peak. In other words, community transmission continues to occur, but at a lower level, which you do not get down to the very ... Dr. Michael Ryan: (32:03) Even at a lower level, which you do not get to the very low levels. And then you experienced the second peak within that first wave. So you can see a situation in some countries where they could get a second peak now because the disease has not been brought under control. The disease will then go away, reduced to a low level and they could then get a second wave again in the off or in later in the year. So you may have a second peak within your first wave, and then you may have a second wave. It's not either or. The second peak depends on how good, how strong and how effective the control you have over the disease at this present moment. Dr. Michael Ryan: (32:44) If you start to experience a second peak, then the chances are that the disease is spreading in a way that you have not got full control over that. Dr. Michael Ryan: (32:53) Now, there is a phenomenon and we've seen this phenomenon in many countries that as countries have got better at testing, sometimes the number of cases being detected goes up, and then it's difficult to determine is an increased number of cases due to more testing or more disease? And it's very important at that time to look at things like hospitalizations and deaths. If you start to see your hospitalizations going up, that's not because of testing. If you start to see the number of people dying, going up unexpectedly, that's not because of testing. Dr. Michael Ryan: (33:28) So I do think it's important to look at increased numbers, to examine where are those increased numbers happening? Who are those increased numbers happening to? Can it be explained by increased testing? Is the health system starting to come under pressure? And if it is, you need to act, to protect the health system and to suppress infection because nobody wants to go back in the epidemic to a situation where people can't access healthcare. Dr. Michael Ryan: (33:57) Now, there are many countries potentially in that situation, and that's why the director general has been very careful, Maria and many of us at WHO to advise our member States that exiting lockdowns must be done carefully, it must be done in a stepwise manner and it must be done and driven by the data. If you don't know where the virus is, the chances are that the virus will surprise you. Maria, do you have anything further? Dr. Maria Van Kerkhove: (34:21) Yeah, just to supplement that, that as Mike has said, many countries are in different situations. And as the director general has said in his speech today, this pandemic is accelerating in many parts of the world. And so while we have seen countries have some success in suppressing transmission and bringing transmission down to a low level, every country must remain ready. And if countries are seeing some success and are considering lifting the lockdowns, we need to ensure that we are all using this time wisely to ensure that our systems are in place, to be at the ready to detect any cases, any resurgence in cases, ensure that our workforce is in place, not only our healthcare professionals who are on the front lines caring for patients, but those who can carry out contact tracing, those who can actively find cases and support the ability to rapidly identify cases, make sure that your supplies are in order. Make sure not only that your hospitals are ready, but that you have the supplies to be able to deal with any resurgence in cases, and make sure that your essential medical services that may have not been able to be activated or be used at the full potential, that they should be, make sure that they are up and running and that people receive the medical services that they need. Dr. Maria Van Kerkhove: (35:46) We should not be surprised if there are resurgence in cases, because we know that a large proportion of the population remains susceptible, which means that if the virus has an opportunity to enter into the population again, and if we do not have physical distancing and handwashing and all of the other measures in place to be able to detect isolate, care contact trace, it will take off. So it's about being able to not only lift these measures carefully, but be able to activate them rapidly when they need to be activated again. Dr. Michael Ryan: (36:22) Sorry, just in terms of a complete answer and I think it's important for precision. Having a cluster of cases does not mean a second wave. So if we take an example of our colleagues or friends in Germany... Sorry, if I pronounce this incorrectly, but in [inaudible 00:04:39], there has been a cluster of cases that's involved a number of positive individuals. One third of those tests has been positive. 7,000 contacts identified and in quarantine. Schools and the childcare in the area have been closed. But in doing all of that, the German authorities hoped to avoid a larger lockdown. So what German authorities are doing is a targeted intensification of testing. They're doing smaller measures aimed at suppressing infection. They're trying to limit that geographically and in terms of its impact, and then wait and see does that work. And if that works, then keep doing that. Dr. Michael Ryan: (37:17) And they may have to add more measures. They may be able to take some of those measures away. So I think what we really want to see is that agility, that ability to use data, to use investigation, to use testing, to use physical and social measures in an agile, adapted, in a sensitive empathic way where you're doing the absolute minimum you need to do to suppress the infection or the maximum you need to do with the minimum disruption of society. And I think there are good examples like that. I think our colleagues in Beijing as well are mounting a very large scale response in Beijing in an attempt to prevent that getting out of hand. And we've seen the same in Korea, we've seen the same in Japan and approach to rapid detection, description, investigation, and suppression of clusters, because that's what you get at the end of your wave. You get a few cases occurring and then a super spreading event or something happening where there's a large amplification of disease. And when that happens, you want to avoid that first amplification turning back into community transmission. Dr. Michael Ryan: (38:27) And what we've seen in the pattern, and we've said it before, we have sporadic cases here and there, they lead to clusters of infection. Sometimes within those clusters, super spreading events because of indoor gatherings or because of some special risk factor. And then those specific clusters have been associated then with receiving at community level and then more intense community transmission picking up. Dr. Michael Ryan: (38:52) There is a sort of sequence of events here. So when you start to see a cluster now in the absence of disease, when you're down to a very low level of disease and you see a cluster, you have to jump on the cluster, you have to take the cluster seriously because you want to avoid that second peak, you want to avoid going back into community transmission. So using our tools in a more precise and agile way is what we need to do if we want to avoid the blunt instrument of lockdown, which we all need to avoid, if we can, because of the deleterious, social and economic consequences. But if you have full blown community transmission and your hospitals are overwhelmed, then you have no option again. So we need to give ourselves options. We need to give ourselves choices. And the only way we give ourselves choice is to react quickly, react quickly to the clusters, investigate, suppress infection, limit the measures, and then avoid going back into the more destructive measures as a last gasp attempt to shut down community transmission. Dr. Tedros: (39:55) Many Dr. Ryan, Dr. Kerkhove for this detailed answer. So we will try now to go to India where we have Nitty from India TV. You would need to unmute yourself Nitty. Nitty: (40:12) Hi. Can you hear me? Dr. Tedros: (40:13) Yes. Now it's fine. Nitty: (40:16) The number of patients who recovered from coronavirus in India has crossed about [inaudible 00:40:21] and the recovery rate in the country stands up 64%. Recently, the recoveries moved past active cases as well. How do you read these recovery numbers in India? What do these tell you? Dr. Michael Ryan: (40:39) Maria can give you some specific, it's always great news when we see people recovering from COVID-19. The recovery numbers tend to lag behind because they're very often not reported officially and it takes time for us to catch up. What we do in those numbers is a group of patients who are very lucky in many ways to have got through the disease, some people who've been critically ill. But also people who need continued support, people who need potentially, some who've been critically ill need follow up. At the critical stage, this disease takes an awful lot of people. They need follow up, medical care. They may need life support, income support and certainly the last thing they need a stigma. And we've seen situations where again, patients finding it hard to reintegrate because of stigmatization. Dr. Michael Ryan: (41:31) So it's very important that we see the survivors of COVID as people who've been through a lot, people who've suffered and people who deserve the care and acceptance of communities as they return. COVID survivors are a symbol of hope for all our communities, and we hope that in India, that they will provide that symbol for further efforts to control the disease. Dr. Michael Ryan: (41:55) We're also obviously seeing some interesting and useful therapies emerging and trying to ensure that patients who needed to get medical oxygen, get access to the drugs and standards of care that they deserve. So, yes, it's, it's good to see that. Dr. Michael Ryan: (42:09) There's nothing particular you can read into recovery rates, but I'll asked Maria to maybe speak about that in terms of epidemiologically, what it means. Dr. Maria Van Kerkhove: (42:18) Thanks, Mike. Yes. So we are seeing a large number of recoveries, and we expect to continue to see that. If we look at the breakdown of severity, that many, many countries are seeing amongst the reported cases, there will be recoveries, but what we're trying to do through our clinical networks and through our collaborations with clinicians and medical professionals all over the world is really to understand what recovery looks like. So even in mild patients who didn't necessarily require hospitalization for care, they are still seeing some lingering effects. And we're really learning what those lingering effects look like. We're hearing people feel quite tired for quite some time, still feeling a little bit of out of breath if they need to walk upstairs or walk up hills. And so we need to better understand that so that we know what kind of longterm care are required. Dr. Maria Van Kerkhove: (43:10) Those individuals who have had severe disease, who've been either intubated or on ventilation and required more advanced care, they may have some longer or more severe effects going forward, we're working with the clinicians to find out what does rehabilitation look like amongst those that have recovered. But as Mike has said, the fact that we're seeing so many recoveries is a sign of hope. We want to ensure that anyone who is infected with COVID-19 receives the care that they need to prevent them from advancing to severe disease, but no matter what level of disease they have, to ensure that they're cared for, even after they recover and they leave hospital. Dr. Tedros: (43:55) The next question comes from National Geographic. We have Gabriela DiBella with us. Gabriela. Can you unmute yourself, please? Gabriella: (44:15) Hello? Dr. Tedros: (44:15) Yes, we can hear you now. Gabriella: (44:18) Hi, can you hear me now? Dr. Tedros: (44:20) Yes, now it's fine. Gabriella: (44:22) Well, first I'd like to thank you for all your work and in Brazil, we also are seeing a really big explosion of cases of severe respiratory syndrome. And I'd like to how the WHO is looking at this picture or if you are evaluating these numbers too, when you look to the country? And if this is happening too in other countries. Thank you. Dr. Michael Ryan: (45:00) I think I've said this before, our team in our American regional office, the Panamerican health organization have working very, very closely with the countries in Brazil of both federal and at state level. Dr. Michael Ryan: (45:16) I think in the last 24 hours, we've had again over 22,000 cases from Brazil and over 1,230 additional death covering all of the federal units in Brazil. The highest reporting federal units are still Sao Paulo, Rio de Janeiro, Rio Grande Do Norte [inaudible 00:13:40]. Dr. Michael Ryan: (45:44) The situation across the country varies. And I think that's an important issue in any large country and federated state. The situation and the epidemic situation in each state is very different. And we've seen a flattening of cases in some areas, but a continued raising of cases in others. I've spoken previously about the health workers in Brazil who've bravely stood in the front lines. We've seen about 15,000 cases of COVID-19 amongst physicians, but 12% of the total in healthcare workers, about nearly 19,000 cases amongst nurses, and also amongst other technicians who work in the hospital space, I think over 40,000 infections. Healthcare workers represent over 12% of all COVID cases in Brazil. So these are a very brave courageous group of people who've stood on the front line and served the people of Brazil with great courage and professionalism over the last number of weeks. Dr. Michael Ryan: (46:53) The intensive care capacity around the country continues to cope. I've said previously that some intensive care units in some areas have come under pressure, but the system continues overall to be coping. But it's difficult for any system to sustain this persistent increase in cases, the persistent pressure on the system. And as I've said previously, this requires all of government, all of society approach with federal and state based systems, working seamlessly together in the service of the citizens of Brazil. We will continue to work and support the government of Brazil, the States and the citizens in any way we can to both suppress the infection and save lives. Dr. Maria Van Kerkhove: (47:40) I just want to add in general what we're doing to support as it relates to dealing with patients in clinical care in all countries. And we work through our regional offices and our country offices to ensure that not only do we provide guidance in terms of what do medical professionals need to do, how can they best care for patients? Which we of course learned through our collaborations internationally, we provide trainings, whether... Dr. Maria Van Kerkhove: (48:03) ... collaborations internationally. We provide trainings, whether these are through our open WHO platform or virtual trainings, where we try to have these one-on-one discussions with healthcare facilities and with healthcare professionals. We provide support in looking at surge capacity. What does the workforce need to look like? What do the number of beds need to look like? And in what type of area within the hospital, whether for mild patients or for more severe patients. Ensuring that the clinical pathway is appropriate, whatever that medical facility looks like. Making sure that there's infection prevention and control measures within the health facility, whether that's a community care center or whether that's a tertiary hospital, or whether that's a built, a purpose-built severe acute respiratory infection treatment center to ensure that healthcare workers are protected, that they have appropriate PPE. Dr. Maria Van Kerkhove: (48:51) We're also working to ensure that there's adequate oxygen supply in country so that patients that need respiratory support and need oxygen will have access to that within the country and within the healthcare facilities that are there. But the support is through our regional offices, is through our country offices, it's through our partners with our EMTs and it's based on need and it's based on risk. And that is something that we as WHO, with our partners are working to provide all countries everywhere based on what they need and when they need it and how it needs to be implemented. Dr. Tedros: (49:31) Thank you. Next question comes from Italy. [Magilla Buccellati 00:49:37] from Business Insider Italy. Magilla? Magilla Buccellati: (49:45) Can you hear me? Dr. Tedros: (49:46) Yes. Now we can. Magilla Buccellati: (49:48) Okay. Thank you. I just would like to know the technical details on the measure you are adopting inside the refugee camps to keep the COVID lower. Thank you. Filippo Grandi: (50:11) Thank you. The most important measure that we demand, that we request, actually, to governments, is to ensure that whatever measures are taken for the national population include also refugees. And this is where we work very closely with WHO because WHO has access to ministries of health and this is where our partnership is particularly valuable. Filippo Grandi: (50:44) Now, many governments, most governments, have done this already, as I said earlier. But many governments require additional assistance, in particular when population are additional to national population. And this is where we have mobilized again, with WHO's support and assistance, medical supplies, PPEs, whatever is needed to help governments set up those responses. Filippo Grandi: (51:13) In particular, where there are large refugee camps and you do have to set up say, for example, quarantine or isolation facilities in a refugee camp. Clearly we have then worked specifically with governments to do that in those situations. Filippo Grandi: (51:31) We have worked very much in other areas as well, especially again, when there are large refugee concentrations. For example, in improving water supplies, which are so crucial, in improving sanitation systems to ensure that there is better hygiene. Often, these are very overcrowded situations. We have worked, extremely important as well, on another track, again, with WHO, public information. I think we have all learned, all of us including people like me who are not experts like those people with whom I'm sharing this table, we have all been listening every day to the advice provided by the health authorities or by WHO and how to try to prevent the spread of the pandemic. Washing hands, keeping social distancing, not congregating in large clusters, referring to doctors when we have symptoms, et cetera, et cetera. Filippo Grandi: (52:34) So all of this was necessary also for refugee communities often in different languages because they don't speak the language of the national population, of the nationals. So this is another area in which we have been working very hard. So these are really the main areas in which we have been cooperating with WHO, but very importantly, with governments that are hosting those populations. Dr. Michael Ryan: (53:01) May I supplement Filippo again with huge thanks to HCR, to colleagues in UNICEF, Red Cross, and local NGOs. We use just a particular example where we've all had concerns and worked together very effectively. We have the Rohingya refugee situation in Bangladesh with approaching a million people there over a long period of time. First of all, with great thanks to the government of Bangladesh. Again, the host government is a hugely important factor in the success in caring for refugees. And we've worked very closely with the Institute of Epidemiology and Disease Control to establish laboratories and Cox's Bazar, not just for the refugee population, but to support the local population as well. And very often supporting the host population is very important, as well as supporting the population who's been hosted as refugees. Dr. Michael Ryan: (53:50) Since the start of April, we've supported over 11,000 tests been conducted in the camps. That's a daily sampling rate of about 500 samples per day. I know it doesn't sound like much, but doing that in a camp situation has its own challenges. We've supported 1,080 bed capacity in 12 isolation centers for severe acute respiratory illness, so that people who do fall sick can, as Filippo said, be treated safely and not infect other patients. And they're being run by partners in the camps. And part of this process is transferring knowledge to local actors, local Bangladeshi actors, to Rohingya themselves who many of them have professional backgrounds. We've established a referral pathway, so we can identify and pick patients out who have respiratory illness and we've trained more than 200 staff in the camps on clinical management. Dr. Michael Ryan: (54:43) In addition, we've trained over 800 staff in infection prevention and control, not just in the camp facilities, but in the surrounding facilities within the host community. So working across the health sector, indeed, we've also had to update the operational plans for the cyclone season, because if people have to shelter, they may have to shelter in conditions in which they can physically distance or are much more crowded together. So we've had to update those guidance according to that. Dr. Michael Ryan: (55:12) But doing that while also protecting the immunization program, continuing to routine immunization and all of the other health services that are needed. So providing healthcare to refugee populations is pretty much the same as providing us to any population which are very often doing it in extreme environments, in situations of overcrowding, where resources are limited, where you have a host government that's supportive and providing and facilitating that process it makes it a lot easier. Or you have partners as wonderful as UNHCR and the leadership that they show, then the job is much more straightforward. So we very much appreciate, and we would like to achieve that kind of action in every refugee camp in every country. Sadly, that is not the case yet, but that is the standard to which we wish to aspire. Dr. Tedros: (56:06) We will go now to Sara Jerving from Devex. Sara. Hello? Can you unmute yourself please? Sara Jerving: (56:15) Yep. Sorry about that. Thanks for taking my question. Because vaccine development is at an accelerated unprecedented rate, are there any concerns that longterm health impacts of a vaccine might not be detected? Are there any concerns about safety when the development process is at an accelerated pace? Dr. Michael Ryan: (56:38) Yeah, I think when we talk about accelerated vaccine development, what we hope is that we're talking about more efficient, faster, but still extremely safe. Well planned, well managed. So what trying to do with many partners around the world, and there are many initiatives which are trying to accelerate the development of a vaccine, but not cutting any steps, no shortcuts, no issues that can be shortcut in this. But there are things that have been done to speed up the process of that development. And it's been unprecedented, the cooperation, the collaboration since many months ago, since the Director General hosted the meeting here of the research and development experts from all over the world in February and subsequently in April brought partners together here to initiate the access for a COVID tools initiative. Both have driven that process, but there are no shortcuts in the science and safety is a most. Dr. Michael Ryan: (57:38) The trials that are underway now are safety trials and efficacy trials will begin. Those first efficacy trials will need to be as large as possible for two reasons. One, so we can get an early signal of clinical efficacy, but also because if we move from vaccinating small numbers of people to vaccinating very large numbers of people too quickly, we may see effects that would not be detected in a small group. Rare side effects can be detected only when you have a large group of people tested. Dr. Michael Ryan: (58:14) So we would like, and that's why we've been working with partners all around the world, to ensure that the clinical trials that we carried out together are done on as large a scale as possible in order to be able to detect any rarer symptoms or side effects that may come from the vaccine. And it's an important question and something that needs to be closely monitored. That is often why even when vaccines are introduced for the first time, they're associated with what they call post marketing surveillance. There's a much higher need to do surveillance when you introduce a new vaccine, even when it's approved, because there's always a chance of a very rare side effect, you need to be able to pick that up and manage it. Dr. Michael Ryan: (58:54) So yes, there will have to be great care taken and we have to balance the benefit of a vaccine that can save lives and we have to manage the risks that are associated. Immunization has proven over the last 50 to 70 years, to be the single most effective health intervention and the single most effective life saving intervention for children all over the world. And we hope as we go through this process, that we will together find a safe, effective, and affordable vaccine that will save lives in the coming years.