World Health Organization Coronavirus Press Conference Transcript April 29

Tarik: (00:00) Hello to everyone from WHO Headquarters here in Geneva. My name is Tarik [inaudible 00:00:12]. And we welcome you for our regular press briefing on COVID-19. Today, as we have previous days, we have simultaneous interpretation to six UN languages, plus Portuguese. And I would like to take this opportunity to thank interpreters who are here with us. And who will help have the information interpreted in those languages. We also have sent a number of documents from our regional offices, as well as invitation to press briefings from our regional colleagues that you may wish to follow. Tarik: (00:55) Today, we have Dr. Tedros Adhanom Ghebreyesus, Dr. Maria Van Kerkhove, and Dr. Mike Ryan with us. And I will give the floor immediately to Dr. Tedros before we open the floor for questions. Dr. Tedros, please. Dr. Tedros: (01:14) Thank you. Thank you, Tarik. Good morning. Good afternoon. And good evening. As of tomorrow, it will be three months since I declared the public health emergency of international concern over the outbreak of Novel Coronavirus. Today, I would like to take a few moments to look back at the period proceeding that announcement to be clear about what WHO knew and what we did, which could help the country to understand the three months. On the 31st of December, WHO's Epidemic Intelligence System picked up a report about a cluster of cases of pneumonia of unknown causes in Wuhan, China. The following day, New Years Day, WHO asked China for more information under the international health regulations, and activated our incident management support team to coordinate the response across headquarters, and our regional and country offices. Dr. Tedros: (02:25) On the 2nd of January, WHO informed the global outbreak alert and response network, called GOURN. Which includes more than 260 institutions in more than 70 countries. Yesterday was GOURN's 20th birthday, and I would like to use this opportunity to say, happy birthday to GOURN, and thank you, and congratulations to every single GOURN member for their commitment to responding to the COVID-19 pandemic. And many other emergencies. We're really proud to work with you. On the 3rd of January, China provided information to WHO through a face-to-face meeting in Beijing, and through WHO's Event Information System, established under the international health regulations. On the 4th of January, WHO reported that cluster of cases on Twitter. At that stage, notice were reported. Dr. Tedros: (03:24) On the 5th of January, WHO shared detailed technical information through its Event Information System. This included advice to all member States in IHR contact points to take precautions to reduce the risk of acute respiratory infections. Providing guidance on the basis that there could be human-to-human transmission. On the same day, WHO also issued its first public disease outbreak news. Publishing technical information for the scientific and public health communities. As well as the worlds media. On the 10th and 11th of January, WHO published a comprehensive package of guidance on how to detect, test for, and manage cases, and protect health workers from potential human-to-human transmissions. Based on our previous experience with coronaviruses. We also published- Dr. Tedros: (04:35) (Silence) Dr. Tedros: (06:56) ... report. We post country supports as is. However, earlier the same day WHO held a press briefing at which we said that based on our past experiences with coronaviruses, human-to-human transmission was likely. And our senior experts participated in that press conference. And that news was carried by mainstream media. On the 20th and 21st of January, WHO staff visited Wuhan. And on the 22nd, reported that the evidence suggested human-to-human transmission was occurring. On the 22nd and 23rd of January, I convened the Emergency Committee consisting of 15 independent experts from around the world. At the time, 581 cases had been reported, and only 10 cases outside China. The Emergency Committee was divided in its opinion. And did not advise that I declare a public health emergency of international concern. The committee asked to reconvene in 10 days or less to allow time for more information and evidence to be collected and considered. On the 27th of January, I traveled to Beijing with WHO's Chief of Emergencies, Dr. Mike Ryan, and other Senior WHO staff and met with President Xi Jinping and other leaders to learn more about the response and offer WHO's assistance. We discussed the seriousness of the situation and agreed that an international team of scientists should travel to China to look into the outbreak and their response, including experts from China, Germany, Japan, the Republic of Korea, Nigeria, the Russian Federation, Singapore, and the United States America. Dr. Tedros: (08:46) On the 30th of January, I reconvened the Emergency Committee. And after receiving their advice, because of the new information they gathered, they had a consensus, I declared a global public health emergency. WHO's highest level of alarm. At the time, as you may remember, there were less than 100 cases and no deaths outside of China. To be specific, we had 82 cases outside China and no death when we declared the highest level of global emergency. From the beginning, WHO has acted quickly and decisively to respond and to warn the world. We sounded the alarm early. And we sounded it often. We said repeatedly that the world had a window of opportunity to prepare and to prevent widespread community transmission. Dr. Tedros: (09:34) We started out early, press conference. People were saying the world would be tired of you if you're making a press conference every day. But, we didn't mind. We wanted to make sure that the world understands what we're saying. WHO is committed to transparency and accountability. In accordance with the International Health Regulations, I will reconvene the Emergency Committee tomorrow, because it's almost three months since we declared the highest emergency. And that was what was suggested by the Emergency Committee to reconvene three months after the declaration to evaluate the evolution of the pandemic and advice on updated recommendations. In the three months since the Emergency Committee last met, WHO has worked day in, day out, to sound the alarm, support countries, and save lives. Dr. Tedros: (10:56) We have worked with countries to help them prepare and respond. We have brought countries together to share experiences and lessons learned. We have brought together thousands of experts to analyze the evolving evidence and distill it into guidance. We have convened researchers to identify priorities from all over the world. We have launched a large international trial to find answered fast about which drugs are the most effective. We have brought together a consortium of countries and partners to accelerate the development and equitable distribution of vaccines, diagnostics, and therapeutics. We have shipped millions of test kits and tons of protective gear all around the world, focusing on those countries who need our support most. We have trained more than two million health workers, to be exact, 2. 3 million health workers around the world. We don't think that's enough. We will continue to train more. Dr. Tedros: (12:21) We have worked with tech companies to fight the infodemic. We have kept the world informed in multiple ways. Including these regular press conferences, answering your questions. We have brought together entertainers to provide music and laughter even in these dark times. Using this opportunity to thank, Hugh Evans, my friend from Global Citizen. And Lady Gaga for bringing the whole world together. And we have watched with admiration as the world has come together in solidarity to fight this common enemy. Dr. Tedros: (13:05) We share the grief and pain of so many people around the world. And we share the hope that we will overcome this pandemic together. There is one thing we haven't done. We haven't given up and we will not give up. We won't. Our commitment remains to serving all the people of the world with signs, solidarity and solutions. But above all, with humility and respect to all people and nations. WHO is now working to provide the critical strategies, solutions, and supplies that countries will need in the coming weeks and months. One thing that we would ask is unity at the national level and solidarity at the global level. More than ever, the human race, humanity should stand together to defeat this virus. I have said it before. This virus can wreak havoc. It's more than any terrorist attack. I said it before. It can bring political, economic and social upheavals. But the choice is ours. And the choice should be unity at national level. The choice should be global solidarity. Standing in unison. The choice should be humanity against this virus. I thank you. Tarik: (15:07) Thank you very much, Dr. Tedros, for his opening remarks. Before we open the floor for questions, just to remind everyone that we have simultaneous interpretation into six UN languages. And that's Russian, English, French, Spanish, Chinese, Arabic. And we also have Portuguese. For journalists who are watching us on Zoom, you have to click on interpretation. And then there is just one little thing that Arabic is under Korean. So I don't know really why is that. But, if you want to listen in Arabic, you have to click on Korean. So, if that's okay. We will ask everyone to be very short and have one question. So we try to take as many as possible. So, if we may start. Also, just to remind you that we cannot unmute you. So if we call on you, please unmute yourself and you will be able to ask question. So we will start with Kazakhstan, with [inaudible 00:16:10] from TV channel, [foreign language 00:16:16]. Janet, can you hear us? Janet: (16:12) Yes. Good evening. My name is Janet [inaudible 00:16:24]. My question is, in the framework of regional cooperation, Kazakhstan has provided humanitarian assistance in the fight against the coronavirus pandemic to Kurdistan and Tajikistan. Several countries provided such assistance to Kazakhstan. How such a partnership building in other regions of the world, and how does this correlate with WHO's work in this direction? Thank you. Dr. Michael Ryan: (16:59) Thank you for the question. And again, I thank you to Kazakhstan for the help you're providing in the region. And the assistance you're getting from others. I think we've seen in this pandemic that very often it doesn't matter what level you're at. The most effective and welcome assistance comes from your neighbors. And that may be the house next door, but sometimes it's the country next door. Neighboring countries share a common, very often common people's, common languages, common cultures, a common approach to the world. And have deep, usually have very deep rooted connections between countries. Dr. Michael Ryan: (17:42) And those trusting relationships in situations like this can be relied upon to allow for assistance, support, and solidarity to move between countries. I also believe it's a pathway through this pandemic. As countries who are close to each other, have those historical links, can begin to open, and trade, and work with each other in a careful and- Dr. Michael Ryan: (18:03) ... can begin to open, and trade, and work with each other in a careful and stepwise manner, so having good neighbors is always a very positive thing. Also, I believe across the whole sub region, from Turkey all the way through to Kazakhstan, Tajikistan, the Turkish-speaking nations have worked together very effectively in providing mutual support. Subregional and regional collaboration and coordination is very important. The Director General, Dr. Tedros, has worked with our regional directors and so many of the regional collections of ministers and governments with ASEAN, with the African Union, with the CARICOM, with so many other regional integration organizations, which provide a basis for cooperation and support between countries. Dr. Michael Ryan: (18:54) So, yes. I do think that the local support in sub-regions, regional coordination, both in terms of aligning response strategies, aligning exit strategies from lockdown, aligning innovation strategies, and working our way through this pandemic to reach a point where we have enough control to be able to resume our social and economic lives. Tarik: (19:22) Thank you very much, Dr. Ryan, for this answer for Khabar TV news channel from Kazakhstan. Next question comes from Globo Brazil. It's a Bianca Rothier. Bianca, can you hear us, please? Bianca Rothier: (19:38) Yes. Tarik, Can you hear me? Tarik: (19:40) Yes. Please go ahead. Bianca Rothier: (19:41) Thanks a lot. My question is about Brazil, and so I will ask in Portuguese. [Portuguese 00:19:58] So what [Portuguese 00:20:02]. Tarik: (20:27) Bianca, can you please repeat the question? Because Dr. Tedros was not able to hear everything. Can you just repeat slowly please? Bianca Rothier: (20:36) Do you prefer in English? Tarik: (20:41) No, Dr. Tedros, It's number two channel. Okay. Please just repeat in Portuguese. It's okay. Thank you. Bianca Rothier: (20:49) Okay. [Portuguese 00:20:58] Dr. Tedros Adha...: (21:19) Yeah, very much. Thank you. There was a question asked from Brazil, when was it? Last Monday. And I was informed that the newspapers in Brazil actually carried something I never said, maybe out of ... what do you call it? Out of perspective. Dr. Tedros Adha...: (21:50) The response I had was a response, how all countries should actually do. And to be honest, even now from the information you're giving me, I would not comment on what the President said without checking what he really said. That's what I would like to say. And we're talking to Brazil on a regular basis, so if they have questions or if they have issues they can talk to us, and if there is any comment that's made, we would like to hear it directly. Thank you. Tarik: (22:31) Thank you very much, Dr. Tedros. Now we will go to a Simon Ateba from Today TV news channel Africa. Simon, can you hear us? Simon Ateba: (22:44) Yes, I can hear you. Can you hear me? Tarik: (22:47) Yes, please go ahead. Simon Ateba: (22:50) Thank you for taking my question. My name is Simon Ateba from Today News Africa in Washington DC. My question is on testing in Africa. Dr. Tedros, as you know in most part of Africa testings remain extremely inadequate in most part of Africa. For instance, in Nigeria has almost 200 million people, but only 11,000 tests have been done so far. And the trend seems to be the same in other countries in Africa. I was wondering if you could expand again on all the ongoing effort the WHO is doing to expand testing in Africa. And if I may add quickly to Dr. Maria, I know that [inaudible 00:23:41] mentioned recently that you were having a partnership with tech companies. I was wondering if you could clarify in detail what type of personal, private health information you are giving tech company, and how long can they store that private personal information? Thank you. Dr. Michael Ryan: (24:08) [inaudible 00:24:08], you may want to respond on the broader capacities in Africa, but in terms of laboratory testing capacity, I think led by the Institute Pasteur in Senegal, the National Institute for Communicable Diseases in South Africa, and working with ourselves and the African Union and the Africa CDC, the capacity for both the laboratory technicians to do the testing and the distribution of test has occurred across Africa. I do agree with you, Simon, that the availability of tests is still a critical issue, as it is in many parts of the world, and I can assure you that we have recently affected deliveries of personal protective equipment and more testing and test kits to 51 countries on the African continent. Those flights were just completed this week, but over the coming a few weeks there will be a huge scale up in terms of automated tests, manual tests, swabs, media, and all of the other material needed for testing right across low, middle income countries and within about 140 priority countries. Dr. Michael Ryan: (25:21) And in fact, I think all countries in sub Saharan Africa are included as part of that priority list, and we will be procuring and shipping over 5 million manual tests kits for those countries. So there will be ... and this is under the supply chain task force that the director general kicked off in the last number of weeks with the UN secretary general, and we've been working on supply chain management now for months, but bringing together the architecture of identifying supplies in the global supply chain that's essentially broken, validating those tests kits that were available, scaling up the production of those test kits at the manufacturers, procuring those kits and arranging for them to be transported to two countries along with PPE, along with the other supplies, along with the swabs and the media has been a challenge. Dr. Michael Ryan: (26:17) And we'd like to thank our partners out there, those who worked with us on procurement like UNICEF, like The Global Fund like UNITAID, many, many others, the Gates foundation, and those partners who are working with us on allocation and distribution like the World Food Program. And I forgot to mention our colleagues at the Clinton Health Access Initiative as well. So we've seen a coming together of a global consortium of institutions and organizations who are fundamentally focused on ensuring that we fill the gaps in the supply chain, especially in low and middle income countries, and especially in countries affected by fragility and conflict. We intend to fill a significant proportion of that gap in the coming weeks and months and be a reliable source of PPE, of testing capacity and equipment and supplies as well as other medical supplies of ventilators to countries and populations all over the world. We are doing and striving our best to identify the funding and the transport mechanisms and the way to guarantee those suppliers. Dr. Michael Ryan: (27:23) But might I say, in the context of a very, very broken global supply chain where production, procurement, and distribution is extremely difficult. And again, we'd like to thank our partners for that. With regard to ... we have a lot of collaboration with the private sector and with the IT sector on our work, both to protect our systems here in Geneva and around the world, but also on developing solutions for the field and developing solutions for public health. I can reassure you that there is no personal data being held by private sector companies on any of the elements to do with Covid-19, or anything else for that matter. So just to reassure you that we are not passing personal data to private companies of any kind, and especially to IT companies on this issue, and all of our data sharing is within our data protection and ethical considerations that pertains. So just to reassure you on that. Dr. Tedros Adha...: (28:31) Yeah. So on our partnership with tech companies, the partnership we started is mainly to fight epidemics, so if it's because of the recent discussions and agreements we had with them, it's about fighting epidemics and it's not about sharing data, but as Mike said, we take private information very seriously. But the agreement we had recently is not about that. It's about fighting epidemics together. And rooting, all those will have questions about a Coronavirus to the right site or to the right agency meaning to WHO and other reliable agencies, and they are doing that. Facebook is doing that, Google is doing that, and other tech industries are doing that and directing any questions to the right institutions. But at the same time, when there is misinformation or fake news they remove it immediately. So that's where we're focused now in our partnership with them. Tarik: (29:56) Thank you very much for this. Now we will go to NHK Japanese news agency. [inaudible 00:30:05] can you hear us please? Speaker 1: (30:07) [inaudible 00:30:07] Can you hear me? Tarik: (30:08) Yes, please go ahead. Speaker 1: (30:09) Okay, thank you for taking my question. So some countries are reporting a possible link between Covid-19 and Kawasaki Disease. What's the position of WHO on this issue? Thank you. Dr. Michael Ryan: (30:24) Maria, you may supplement. Do you want to go? Yeah, please. Sorry, I thought you were just ... Dr. Maria Van Kerkhove: (30:31) No, no. So yes, I'll start and maybe Mike would like to supplement. So yes, we are aware of this report which came out of the United Kingdom about a small number of cases amongst children with its inflammatory response. We're looking at this with our clinical network, and in fact our clinical network had a teleconference yesterday which discussed this. And if I can remind you that we have a global network of clinicians that are dealing directly with Covid-19 patients across the globe, and they meet one at least once a week, if not more, to exchange information. What they're doing is trying to better understand how this infection affects the body and the disease that it causes. Dr. Maria Van Kerkhove: (31:15) So we do know so far with regards to children that continuing in our understanding of this, that data from this disease in children, they tend to have less severe disease so they tend to have overwhelmingly mild disease. But there are some children who have developed severe disease and some children who have died. There are some recent rare descriptions of children in some European countries that have had this inflammatory syndrome, which is similar to the Kawasaki's syndrome, but it seems to be very rare. What we've asked for is for the global network of clinicians to be on alert for this and to ensure that they capture information on children's systematically so that we could better understand what is occurring in children and so that we could better improve our understanding and guide treatment, but it seems to be very rare and only in maybe one or two countries so far and in a number of additional countries they have not reported this yet, but this is something that the clinical network is looking into specifically. Dr. Michael Ryan: (32:22) I just may supplement and emphasize for all parents out there that the vast, vast majority of children who get Covid-19 will have a mild infection and recover completely. Kawasaki syndrome is a syndrome that's been around for a long time. It's a rare condition that happens. It's usually resolves itself and it is associated with inflammatory processes in the blood vessels and something that we're very grateful to the clinicians who've observed this in children, but they have said this is an atypical Kawasaki syndrome. They're describing something they have seen in children. It's a very important observation and it may reflect too as we've seen in adults the fact that the SARS-CoV-2 virus causing Covid-19 obviously is causing inflammation and attacks tissue other than lung tissue and we are in a situation where clinicians are looking at what those other effects of having this Coronavirus infection are. Dr. Michael Ryan: (33:31) And we've seen this in the past with many emerging diseases. They don't necessarily only attack one type of tissue. There can be multiple organs affected, and many of you have seen the reports of other organs that have been affected with this disease. So it's really important that this information is shared around the world. It's really important that pediatricians and clinicians get time to collect information and share that. But again, just to reassure parents out there, this is a rare complication and one should always be watchful in children who are experiencing an infectious disease for any deterioration in their condition, but I think it's important that parents out there are reassured. Tarik: (34:15) Thank you for this. Now we will go to Reuters and Stephanie. Stephanie, can you hear us? One more time, Stephanie from Reuters, can you hear us? You need to unmute yourself. Stephanie: (34:32) Yep. Thank you. Sorry. Yes, I wondered if perhaps Mike could comment on some of these reports on Remdesivir that have come out, there's some indications in The Lancet that it's not been that effective. The company is saying that it's helped improve outcomes for patients and given some data that they say is encouraging. I wonder if you could help us on that. It's still all coming out, of course. Dr. Michael Ryan: (35:05) Yeah. Thanks, Stephanie. No, I wouldn't like to make any specific comment on that because I haven't read those publications in detail and it's always very important that we consider all the publications related to that, and it can sometime take a number of publications to determine what the ultimate impact of a drug is. And clearly we have the randomized control trials that are underway, both in the UK and the US and on the solidarity trial with WHO. Remdesivir I think is one of the drugs under observation in many of those trials. Dr. Michael Ryan: (35:38) So I think a lot more data will come out. We are all hoping, fervently hoping that one or more of the treatments currently under observation and under trial will result in altering clinical outcomes or improving clinical outcomes and ensuring that less people die or that less people have a severe course of illness. But I wouldn't like to make any ... Dr. Michael Ryan: (36:03) As people have a severe course of illness. But I wouldn't like to make any comment. Maria, you may have read the papers, or we like to look at papers, not just as one paper. We like to look at a group of publications and then be able to compare and use our clinical networks in order to do a proper review. We have a scientific review process in house, where we do systematic reviews at various times on different aspects of the response, especially on drug efficacy and the efficacy of other interventions. We would like to look at that in the context of a broader look at the overall data regarding to Remdesivir. But we are hopeful that this drug and others may prove to be helpful in treating COVID-19. Maria? Dr. Maria Van Kerkhove: (36:45) Yeah. Thanks Mike. So it's a great question and it's a good opportunity to explain a little bit about how we actually evaluate the evidence. So there are studies that are coming out, particularly on therapeutics, but in all aspects of this novel coronavirus, in this new coronavirus, causing this pandemic. It's something within the scientific community. What we try to do when we evaluate the evidence is we look at what we call the weight of the evidence, where we pull together all available evidence, all available studies on any particular topic. Whether these studies are conducted in a laboratory through experimental conditions, whether they're done in observational studies or epidemiologic studies in people, whether these are done through clinical trials. What we do is we pull together every shred of evidence, every piece of evidence we can get our hands on and we review it and we critique it. Dr. Maria Van Kerkhove: (37:43) In this particular pandemic, we have a large volume of papers that are being shared with us prior to publication. These are the pre-publication materials. And this is amazing. This is such a positive aspect of this pandemic. And we thank all researchers who are willing to do that with us. But it is an important process for papers to go through what we call the peer-review process, which means they submit a paper to a journal and then they have top experts in that field really go through in detail and review that article, and then it goes back to the authors and they modify it and then they resubmit. So oftentimes when you submit a paper, by the time it goes through the peer-reviewed process, it actually looks a lot different when it actually gets published in a journal. Dr. Maria Van Kerkhove: (38:26) For us, we're trying to digest all of the information that comes to us that are pre-publication and also the ones that are coming out in peer-reviewed journals. Once we do that, we look at all of the studies and we judge them in the sense of, "This is a better study. This is more robust. And this study has some significant limitations." Once we are able to take that collectively, we can come away with some kind of a conclusion of, "Yes, we see an effect. No we don't. Yes we know more about this disease in children or something about transmission," or whatever the topic may be. Dr. Maria Van Kerkhove: (38:59) Then we go one step beyond that. Then we debate these results with our global expert networks and this is a healthy debate. It's a constructive debate where we actually look again and we say, "What does this tell us and what does this mean in terms of our guidance to our member states, to all people all over the world?" And that's a really important process to go through. That can be sped up, especially in emergencies when we need to do this very quickly. But it doesn't change our willingness and our desire to do this very comprehensively. Dr. Maria Van Kerkhove: (39:29) Right now what we are doing at WHO is we're working with our science division and we're working with partners at GOARN who are conducting living reviews for us. So every day we are looking at the publications that come out in the peer-reviewed journals and the publications that are being sent to us before they reach the journals. And we're conducting living reviews on about 30 topics right now so that we can stay in tune with what is coming out. Dr. Maria Van Kerkhove: (39:57) So typically you don't have one study that will come out that will be a game changer. There could be, if it's a very well designed study, if there's enough cases and controls, it could really change our understanding. If that happens, we will adjust our guidance. But there is a process for this to take place and we're really grateful for all of the scientists and experts that work with us to help us develop this guidance and understand all of this research that's coming out. Speaker 2: (40:26) Thank you very much, Dr. Van Kerkhove. Next question is for [Gunhilde Vandhall 00:04:34] from Swedish media. Gunhilde, can you hear us? Gunhilde Vandhall: (40:39) Yes. Can you hear me? Speaker 2: (40:40) Yes, please go ahead. Gunhilde Vandhall: (40:42) Thank you. My question is on Sweden. It's a country that chose a different road and strategy, basically no lock down and an open society through the crisis. Could this mean that the population of Sweden, and maybe other countries that are not hard, strict lockdowns, have a chance to be better protected in case of a second wave, as they have been more exposed and have had a chance to develop a possible herd immunity? Thank you. Dr. Michael Ryan: (41:16) Thank you. I think two things here. I think there's a perception out there that Sweden has not put in place control measures and has just allowed the disease to spread. Nothing could be further from the truth. Sweden has put in place a very strong public health policy around physical distancing, around caring and protecting for people in long-term facilities and many of the things. What it has done differently is that it's very much relied on its relationship with its citizenry, and the ability and willingness of citizens to implement physical distancing and to self regulate, if you want to use that word. In that sense, they've implemented public policy through that partnership with the population. Dr. Michael Ryan: (42:04) They've been doing the testing, they've ramped up their capacity to do intensive care quite significantly and their health system has always remained within its capacity to respond to the number of cases that they've been experiencing. Dr. Michael Ryan: (42:19) Like many other countries in Europe, Sweden has experienced some many, many clusters of disease in long-term care facilities, but that's unfortunately and tragically not a unique event in Europe. Many countries across Europe have experienced the same tragedies over the last number of months. That's something that really needs to be looked at very carefully all over Europe. Even as the numbers go down, our elderly or older citizens are still dying in large numbers in many nursing homes and longterm care facilities. More needs to be done to protect and stop those clusters and prevent disease spread in those settings. With regard to this concept of herd immunity, I think we will wait. I believe sero prevalence studies are underway in Sweden as well as many, many other countries. Maria can speak to that because WHO, with our partners, have done a large review of all of the seroepidemiologic studies that are underway and some of the results that are available. But I will say that the general outcome, even in areas of fairly intense transmission, the proportion of people who have seroconverted or who have antibodies in their blood is actually quite low, which is a concern because it does mean the vast majority of people remain susceptible. So the chances of disease rebounding or returning is quite high, especially if control measures or lock-down type measures are released too quickly, without being replaced by case finding, contact tracing, testing and strong community compliance. Dr. Michael Ryan: (43:56) I think if we are to reach a new normal, I think in many ways Sweden represents a future model of if we wish to get back to a society in which we don't have lock downs, then society may need to adapt for a medium or potentially a longer period of time, in which our physical and social relationships with each other will have to be modulated by the presence of the virus. Dr. Michael Ryan: (44:24) We will have to be aware the virus is present and we will have to, as individuals and families and communities, do everything possible on a day-to-day basis to reduce the transmission of that virus. That may mean adjusting the way we live our lives. I think maybe in Sweden they're looking at how that is done in real time. So I think there may be lessons to be learned from our colleagues in Sweden. Dr. Michael Ryan: (44:52) But again, I wanted just to emphasize, Sweden has not avoided controlling COVID-19. It's taken a very strong, strategic approach to controlling COVID-19 across all of the elements of society. What it has done differently is it really, really has trusted its own communities to implement that physical distancing. That is something that remains to be seen whether that will be fully successful or not. Dr. Tedros: (45:20) It could be a coincidence, but I actually received a letter from His Excellency, the Prime Minister Stefan Löfven today. He shared with me the strong measures they're taking and [foreign language 00:09:41], Your Excellency. Dr. Maria Van Kerkhove: (45:41) To supplement what Mike said around the herd immunity, right now we're tracking over 90 seroepidemiologic studies that are in various stages of development, whether the countries are just starting the process to implement or whether they're implementing them now. There are some papers, pre- publication papers, that have come out that have suggested low seroprevalence, so low percentage of the people that they tested that actually have antibodies, indicating if the tests that they have used are reliable, indicates that a large proportion of the population remains susceptible to COVID-19. Dr. Maria Van Kerkhove: (46:19) That means the virus has more room to move. So it is important that these measures, that we continue to adhere to these public-health measures. I think we need to wait some time to have a better understanding of how well the serologic tests that are available work. For the studies that we are working with, for the countries that we are working with on seroepidemiology, we've advised them to store their samples in minus-20 freezers right now until we can give a better indication of which tests are performing well, which serologic tests are performing well. But we do hope that we will have more information about the extent of infection in a number of countries across the globe, so we can really understand how far and wide this virus has spread. Speaker 2: (47:07) Thank you very much. We will now go to Morocco, where we have Abdullah [inaudible 00:47:13] media. Abdullah, can you hear us? Please go ahead. Abdullah: (47:16) [foreign language 00:00:47:22] Speaker 2: (47:16) Yes, please go ahead. Abdullah: (47:16) [foreign language 00:47:24] Speaker 3: (47:16) [inaudible 00:47:42]. Abdullah: (47:29) [foreign language 00:11: 50] Dr. Tedros: (47:50) Thank you, Abdullah. Yep. [foreign language 00:47:56] Abdullah, [foreign language 00:12:00]. Vaccine development is one of the areas we have been actually following from the start. From the projections we have, it could take 12 to 18 months. This was said actually two months ago, so it means 10 to 16 months from now. Dr. Tedros: (48:26) But as you also know, we have launched a new initiative last Friday, last week. The purpose of that initiative is to accelerate the development of vaccines, so to have it even earlier than the projected dates, but at the same time ensure access to the vaccine all over the world. So it has a combination of two objectives. One is accelerating development and the second is ensuring access, so that everybody has access, the haves and the have nots. Dr. Tedros: (49:07) As you may remember, governments and the private sector, all agencies, relevant agencies participated in that launching. There is a strong commitment from everybody to push this forward, to accelerate the development, and also break the barriers to access and ensure access. I hope and WHO hopes that the two objectives will be met. But I know it will be very difficult. As WHO, we know that it will be difficult but we don't believe that it's impossible. Dr. Tedros: (49:49) One of the important things we need to do to accelerate the development and ensure access is the financing part. As you may know, the European Union, the European Commission is hosting a pledging conference on May four. I would like to use this opportunity, actually, to do two things. One, to invite everybody to join in that pledging conference, because we need funding to accelerate and ensure access. But at the same time, I would like to use this opportunity to thank the European Commission in general and all its member states. But at the same time, and specifically, to thank my sister, Dr. Ursula Van Der Leyen for her leaderships in the pledging conference. Dr. Tedros: (50:45) I hope to see as many countries as possible, as many donors possible, as many private sectors as possible, as many citizens as possible, to support the European commission's initiative that will help the whole world. That is being done based on the principle of solidarity that we have been talking about. I'm glad that European commission is delivering based on the principle of solidarity. Thank you. Speaker 2: (51:20) Thank you very much. We have a time for one or two questions. Next one is Ajit from United News of India. Ajit, can you hear us? Ajit: (51:32) Yes. Can you hear me? Speaker 2: (51:33) Yes, please. Go ahead. Ajit: (51:36) Thanks for taking my question. I just wanted to know what is WHO's view regarding India's testing? Some people say that testings are below the level what it should be. So what's WHO's view? Dr. Maria Van Kerkhove: (51:57) I can start and perhaps Mike or DG would like to supplement. I mean I think the question is specifically on India, but I think we need to make very clear what our goal is for testing globally. Our goal for testing is to find the virus and it's to find people who have been infected with the virus, and through the active case finding, so aggressively looking for people who are suspected to have COVID-19. We have case definitions that describe who those people might be. If we test those individuals and know if they have the virus, then they can be isolated and cared for depending on the severity of the disease that they have. And that's very important that we have early clinical care and we have early isolation of those individuals so that we prevent the onward. Transmission. Dr. Maria Van Kerkhove: (52:45) Testing also helps us to identify those cases and then their contacts. So if we find contacts of the confirmed cases, then we can quarantine them. We can isolate them as well, away from individuals and prevent them from passing it to someone else. These are critical to the goal of suppressing transmission. There's been some confusion that we, when we have said test test, test, that that means to test everyone in the population. That's never what that meant. That meant to have aggressive case finding, test all suspect cases, and test the contacts who develop symptoms. That's really important. Dr. Maria Van Kerkhove: (53:23) we get a lot of questions and saying, "What does that mean? How many should we actually test?" It's difficult to say based on the population. It's based on the transmission scenario that a country is in. What we've tried to do to support countries is to provide a testing strategy and to help you, depending on where you are. If you have clusters of cases or community transmission, how can you prioritize your testing, should you have a limit in the number of tests you have or the supplies necessary to carry out that testing. So just to be clear, we recommend that all countries test suspect cases and test the contacts who develop symptoms. Again, that will depend on what's- Dr. Maria Van Kerkhove: (54:03) ...catch the contacts Who develop symptoms. And again, that will depend on what's happening in your country, depend on the transmission scenario that's you're in at the lowest administrative level. Dr. Tedros: (54:12) Thank you. Let's go now to Jim Roope from Westwood One. Jim, can you hear us? Jim, can you unmute yourself so then we will be able to hear you? Jim Roope / Westwood One: (54:28) Yes, there we go. I apologize, Terry. Dr. Tedros: (54:30) No problems. Please go ahead. Jim Roope / Westwood One: (54:32) Thank you all very much. You guys are rock stars. Not just you three, but I mean Eric and Chris too, awesome for bringing this to us, thank you very much. My question comes in recovery numbers. We don't seem to get those, and it's my understanding that if someone is considered no longer infectious, they must have had a test. So are not those who were positive now negative, aren't those numbers collected so that we know the legitimate number of recovered people? Dr. Maria Van Kerkhove: (55:07) I'll start with it. Jim, thank you for thanking others. I think you see the three of us up here every day, but we represent a huge number of people, and thanks for saying that publicly, because we are very grateful for everybody at WHO and beyond that is working on this pandemic. Dr. Maria Van Kerkhove: (55:23) With regards to recoveries. This is a very, very important question. It is important, I'm surprised more people don't actually ask us about the recoveries, because there are a large number of people who have recovered from this. I don't know the exact numbers, but it's in the hundreds of thousands of people, if not over a million people so far that have recovered from infection. When someone is discharged from hospital or discharged from home isolation, typically there's different ways that that's done depending on the country. Our recommendation is that somebody has two negative PCR tests at least 24 hours apart, and that they've clinically clinically recovered. They have no more symptoms. Dr. Maria Van Kerkhove: (56:04) In situations where testing is limited, what we recommend is that individuals who are either suspected to have it or who have tested positive at least once, that they recover in terms of their clinical symptoms and they stay home an additional two weeks. What we're working on with our clinical network is following those individuals who have recovered, to trace them over time and see how they're doing and see if there's any longterm effects from infection. And I think this is a really important aspect as we go through this pandemic. Just because you've had the disease and you've recovered, most people will recover and be totally fine, but some people will have some lingering effects. And it's important for us to document this very carefully. Dr. Maria Van Kerkhove: (56:47) We're also following people over time to really understand the level of protection that they have from another infection. And we've talked about this at other press conferences before, but that will take some time, because we need to follow individuals over weeks and months to measure the level of antibodies. And this is the part of the immune response that the body has after infection. And that will take us some time to really understand if they have protection, how strong that protection is, and for how long that protection will last. Dr. Tedros: (57:24) Thank you very much and thank you Jim for nice words. Maybe the last question for tonight. Imogen from BBC. Imogen, can you hear us? Imogen / BBC: (57:32) Yes, yes I can. I hope you can hear me. Dr. Tedros: (57:34) Yes, please go ahead. Imogen / BBC: (57:35) Yeah, it's again, it's coming back to the question of children and whether they can actually infect other people, because we heard here in Switzerland and I'm getting a lot of questions from people all over the world that grandparents were advised this week, actually it's okay, you can hug your grandchildren if you want to. I just wonder, could you clarify the evidence about children being able to spread or not the virus. Dr. Maria Van Kerkhove: (58:05) So thanks for that question. I'm sure many grandparents around the world are dying to hug their children, grandchildren. This is one of the living reviews that we're currently working on. We're tracking all studies that are evaluating this infection in children. Consistently, what we're seeing across countries that are dealing with COVID-19, is that children seem to be less affected. And as Mike said earlier, overwhelmingly a majority of children who are infected and detected through surveillance systems have mild disease and recover. And that's important. We do know from some household transmission studies, where you follow household members very carefully over a period of time and you test them, that we've seen transmission from adults to children, and we have also seen transmission to a much lesser extent from children to adults. Dr. Maria Van Kerkhove: (58:57) There's no reason to think that children are less susceptible to infection if they're exposed and that they can transmit. So it's certainly possible, but we're really not seeing this in the epidemiology. We need a lot more research and very detailed studies. It can't come from individual case reports. It has to come from studies that follow people over time to really better understand what role children are playing. We will also learn from the seroepidemiology studies, which include children, if they are infected and they're not developing disease. And so that's something that we don't know yet, but we are in those 90 studies that I mentioned, many of those will be looking at zero prevalence in children. Dr. Michael Ryan: (59:49) Sorry. Just add to that and I think Maria spot-on there. And I think we also need to look with children and if children are getting infected without developing clinical disease, they may also be less infectious if they're not coughing and hacking and sneezing. And part of this may also, we need to look across this whole epidemic at infectious dose, and we need to look at how people are infected. Because we're sometimes making assumptions that because someone is asymptomatic, they're probably spreading all of the disease. Well, it may not be the case. We need to look at how people are symptomatic through the course of the disease and how much virus they're potentially expelling through coughings, through sneezing, through contaminating their hands, the environment and other issues. We also need to look at severity of disease in relation to the exposure dose. Was the type of exposure or the dose of exposure, does that relate to severity of disease? So there's a lot of issues that are going to have to be worked out as we continue to learn more about this virus. Dr. Tedros: (01:00:54) Thank you very much. Before we conclude this, I think Dr. Ryan would like to have a few words. Dr. Michael Ryan: (01:01:00) Yeah. I just want to, before we finish, say happy birthday to the Global Outbreak Alert and Response Network to GOARN. I wear two lanyards every day of my working life, which seems to be every day now. My WHO one and my GOARN in one, and that's to say to our colleagues in GOARN, like you, I am GOARN. A group that came together 20 years ago in this room and agreed that no one institution in the world has all of the capacity to deal with epidemics, that we were stronger together, and we could find solutions together. Dr. Michael Ryan: (01:01:38) GOARN was set up on 12 guiding principles, has never had a bureaucracy, a theocracy, a constitution, or law to underpin it. What it has had is a tribe of committed, very different organizations. Our colleagues at CDC in Atlanta, our colleagues at MSF, our colleagues at UNICEF, our colleagues in small and large scientific institutions, the Robert Koch Institute, Singapore, Korea, China. So many institutions from around the world, and with one thing in mind, to come together to serve humanity, to serve those communities who are facing the terror of epidemics. And so many people in this network have put their own lives on the line again and again in the service of humanity. So happy birthday GOARN and proud to be GOARN. Dr. Tedros: (01:02:29) Yeah, I'd like to join Mike in a saying happy birthday to GOARN and appreciation to all what you're doing, all members of GOARN. And my special thanks especially to its chair, Dr. Dale Fisher from Singapore and all members of the committee and also all the members of GOARN. And look forward to fighting this pandemic, to continue the fight together and bring it to an end. Thank you, and happy birthday GOARN. Speaker 4: (01:03:12) Thank you very much everyone. Dr. Tedros: (01:03:14) Okay, so see you on a Friday. Thank you. Thank you for joining. Speaker 4: (01:03:20) Thank you [inaudible 00:09:22], and we will have a audio file being sent to you soon and transcripts will be available tomorrow. Wish you a very nice evening. Everyone from Geneva.