World Health Organization (WHO) Coronavirus Press Conference May 25

Dr. Tedros: (00:00) Infectious diseases like polio, measles, Ebola, yellow fever, influenza, and many more. Africa's knowledge and experience of suppressing infectious diseases has been critical to rapidly scaling up an agile response to COVID-19. There has been solidarity across the continent labs in Senegal, in South Africa, were some of the first in the world to implement COVID-19 diagnostic testing. And beyond that, they work together with Africa, CDC, and WHO to extend training for lab technicians, for detection of COVID-19 and to build up the national capacity across the region. Furthermore, health clinicians, scientists, researchers, and academics from across Africa are collectively contributing to the worldwide understanding of COVID-19 disease. Dr. Tedros: (00:58) For many years, and from the outset of this pandemic, WHO has been working throughout our country offices to support nations in health emergency preparedness and developing comprehensive national action plans to prevent, detect, and respond to the virus. Dr. Tedros: (01:18) With WHO support, many African countries have made good progress in preparedness. All countries in Africa now have a preparedness and response plan in place compared with less than a dozen in the first few weeks of the pandemic. 48 countries in the region have a community engagement plan in place compared with only 25 countries 10 weeks ago, and 51 have lab testing capacity for COVID-19 compared with 40 countries 10 weeks ago. WHO Continues to support Africa with other lifesaving supplies, and as of last week, we have shipped millions of personal protective equipment and lab tests to 52 African countries. In the coming weeks, we plan further shipment of PPE, oxygen concentrators and lab tests. However, we still see gaps and vulnerabilities. Only 19% of countries in the region have an infection prevention and control program and the standards for water sanitation and hygiene in health facilities, and disruption to essentially the services such as vaccination campaigns and care for malaria, HIV and other diseases, pose a huge risk. Dr. Tedros: (02:34) I now want to introduce my sister, Dr. Moeti, who is the Regional Director of the Afro region. Dr Moeti, you have the floor. Dr. Moeti: (02:59) Thank you very much, Dr. Tedros. I'm very pleased to join this celebration of Africa day today, and especially pleased to be in the company of Professor Sam Basso and Dr. John [inaudible 00:03:16] who are special envoys on COVID-19 in Africa. Thank you so much for having joined us, Sam Basso and John. Dr. Moeti: (03:24) As Dr. Tedros says, this is the 57th anniversary of the creation of the OAU, which later became the African union. And I would like to join him in commending the leadership of the African union and the actions of African political leaders in response to this pandemic. Not only have they rallied strongly and created at the country level, all of government and all of society structures and mechanisms, but we've also seen the mobilization of the African private sector, both those who are in Africa and those who are working in the diaspora. Dr. Moeti: (04:02) I'd like to also add my thanks to our fellow countrymen in the African diaspora, in the US, in the UK and other European countries, who have joined our work, our virtual work in training, sharing their knowledge and skills in proposing innovations to contribute to the response to the pandemic in Africa and in mobilizing their networks and their resources and in stating that determination in continuing to support their families from wherever they are. Dr. Moeti: (04:33) Dr. Tedros has highlighted some of the progress that's been made in recent months. And these achievements have built on years of work led by governments with the support of WHO and our partners like the Africa CDC to prepare for and respond to severe and widespread epidemics, and also to work on strengthening and making more resilient the health systems in our countries. Dr. Moeti: (04:57) In our efforts towards eradicating polio, for example, we have used geographic information system technologies, and we have engaged communities who are able to alert the authorities when they start to see cases in their midst. I'd like him to pay special tributes to African communities. It was said by doctor Tedros that our leaders have put in place some measures to control the pandemic. We have seen African countries take very tough decisions to put in place some of the control measures that are aimed at physical and social distancing. And this has been at a high cost. They have recognized and acknowledged on the economic level in countries, but also very much at the level of individuals and households. In a survey that we carried out, we are in partnership with the Africa CDC and the Resolve foundation. Dr. Moeti: (05:57) We've found on interviewing people in African cities, in 28 African cities that they accepted the need for some of these measures, although many of them recognize that they would be very tough on them in their households, particularly if you take into account the proportion of African people that work in the informal sector, where you need to be out earning your money in order to be able to put food on the table. But they have stated that they understood the need and were ready to comply with some of these measures, which are very challenging. I'd like to very much commend and thank them for that because we think that it's thanks to these measures that we have started to see, not the kind of evolution on the pandemic in Africa that we were projecting in some of our projection tools. Dr. Moeti: (06:46) We are working with our partners, and I'd like to thank our humanitarian and United nations partners for the joint work that we are doing in the 13 African countries that are affected by conflict and insecurity. Just to remind that the theme of Africa day this year is Silencing the Guns in the Context of COVID-19, which reminds us that we have in this disease, a common enemy, and while one country is vulnerable, all at risk. And it reminds us again to continue to work towards having peace so that the kind of risks that people encounter in insecure areas towards their health can be reduced. So I'd like to thank very much those partners that are working to support the most vulnerable African communities in very difficult, sometimes conflict affected regions and say that we are there, we are committed to work with you. Dr. Moeti: (07:42) I will end by wishing all of Africa's people, whether we are in Africa or elsewhere, a happy Africa day, and let us continue with an amazing solidarity that has seen us progressed thus far in our response to the pandemic. Thank you very much Tedros. Dr. Tedros: (08:00) Thank you. Thank you, Cindy. Thank you so much for joining us on this very, very special day. So please stay with us for some question and answers if you have time. Dr. Tedros: (08:17) I want to introduce professor Sam Basso, Director General of the Center for Vaccine Development in Mali and former minister of health of Mali, and my special envoy with a particular focus on supporting the Francophonie African countries. Professor Sam Basso, please. Sam Basso: (08:44) Thank you very much. I would like to thank WHO and all the partners and colleagues here, yourself, [inaudible 00:08:53] and Dr. CD and my colleague, special envoy, John DG of the CDC Africa. And thank you to your communication team. It was very difficult to reach me out. I am so far away, not in Bamako, in a very remote area right now. I would like to really especially thank them for trying so hard. Sam Basso: (09:19) I only would like to share a few points with you on this very special day, which is Africa Day and which is so normal, thank you so much. This is such a great idea for WHO to arrange such a press conference. So my first point right now for Africa, my concern is that there is a lack of testing, leading to a silent epidemic in Africa, so we must continue to push leaders to prioritize testing, to prioritize tracing, to prioritize treatment and to prioritize prevention. So such a day is a good day to echo that. And the second point is a health systems in Africa can be weak and easily overwhelmed leads to COVID-19 deaths, but may well also leads to a raise in maternal mortality, infant, and child mortality. And so we must work to strengthen the health system. The impact of COVID is being seen in African health system and is being seen in many over domain, such as schools and social and economy, but health system is number one. Sam Basso: (10:42) So Africa must be, my third point, at the forefront of vaccines and treatment research, but it must be conducted ethically and with country ownership and to ensure the trust of population. So I have to say solidarity organized by WHO and co-sponsored by WHO and countries, country members, is a very good example, but we need more communication, even with just that solidarity trial. Sometime we are having such a difficulty, such a trouble at the government level, sometime there's less communication, and right now in Africa, we are seeing lots of anti COVID research treatment or vaccine treatment, or even survey group that are bringing bad rumors against those kinds of great actions. We don't want to hear again, there is no data from Africa, no data from Africa. We have to generate, locally generated data from Africa, by Africa, in Africa, for Africa, that's what we need to do. Sam Basso: (11:57) So then communication is my fourth point. We need to communicate with communities. When I say communities, not only capital city, not big cities, communities, very far remote areas. So it's so important in this very politicized time, we have to be very careful, we are all being politicized somehow at this very moment. Sam Basso: (12:21) So my last point is that it is important regarding the support, we support the call, support the call for people vaccine, and the call from war leaders on a COVID vaccine and the demand for all vaccine treatment and test be patent free, mass produced, distributed fairly and made available to all people in all country free of charge. Sam Basso: (12:57) I will stop here and thank you very much for inviting me. Dr. Tedros: (13:07) Thank you, thank you, professor Sam. Thank you so much indeed. And now I will move to the rest of what I would like to say for today. Dr. Tedros: (13:19) As part of our continued response to the pandemic globally, WHO continues to work aggressively on research and development. As you know, more than two months ago, we initiated the solidarity trial to evaluate the safety and efficacy of four drugs and drug combinations against COVID-19. Over 400 hospitals in 35 countries are actively recruiting patients and nearly 3,500 patients have been enrolled from 17 countries. Dr. Tedros: (13:57) On Friday, The Lancet as you know, published an observational study on hydroxychloroquine and chloroquine and its effects on COVID-19 patients that have been hospitalized. The authors reported that among patients receiving the drug, when used alone or with a macrolead, they estimated a higher mortality rate. The executive group of the solidarity trial representing 10 of the participating countries met on Saturday and has agreed to review a comprehensive analysis and critical appraisal of all evidence available globally. The review will consider data collected so far in the solidarity trial and in particular robust randomized available data to adequately evaluate the potential benefits and harms from this trial. Dr. Tedros: (14:59) The executive group has implemented a temporary pause of the hydroxychloroquine arm within the solidarity trial, while the data, the safety data is reviewed by the data safety monitoring board. The other arms of the trial are continuing. Dr. Tedros: (15:20) This concern relates to the use of hydroxychloroquine and chloroquine in COVID-19. I wish to reiterate that these drugs are accepted as generally safe for use in patients with autoimmune disease or malaria. WHO Will provide further updates as we know more, and we will continue to work night and day for solutions, signs and solidarity. I thank you. Dr. Tedros: (15:52) Margaret, back to you for the question. Margaret: (15:57) Thank you Dr. Tedros. Margaret: (15:58) So now as Dr. Tedros said, we will have the questions from the media. I should let you know that with Dr. Tedros is Dr. Mike Ryan, Dr. Maria Van Kerkhove, Dr. Sumia Swaminathan and Paul Malinarow. So we have a rich range of expertise here to answer your questions. Margaret: (16:19) Use the icon to raise your hand to ask your question, and please, because there are so many of you and so many questions, please, one question put journalist. Margaret: (16:34) Now, because it's Africa Day, I will give the first question to Simon Ateba from Today News Africa. Simon: (16:44) Thank you for taking my question. Can you hear me? Margaret: (16:49) Yes. We hear you very well. Please go ahead, Simon. Simon: (16:52) Okay. Thank you. This is Simon Ateba from Today News Africa in Washington, DC. My question goes to Dr. Tedros and all the panelists from Africa. Africa has last seen the type of spike that we've seen in other countries around the world. We've seen countries that recorded like hundred thousand cases in one day. But right now in Africa, we have only about a hundred thousand cases for all the countries in sub Saharan Africa. I was wondering, does this have to do with the experiences that African countries have had in treating other infectious diseases? Or does it have to do with malaria? Because most people in sub Saharan Africa that I know have at least beaten malaria for many times in their life. Thank you. Dr. Maria Van Kerkhove: (18:00) Dr. Tedros? Dr. Moeti. Dr. Moeti: (18:08) Thank you for that question. This is a question that has been asked over many months, in fact, right from the beginning, when there were very few cases in Africa throughout the month of January, even into the beginning until the middle of February. Dr. Moeti: (18:28) I can say that it's very unlikely that this has anything to do with malaria, first of all. And then secondly, that by the time we started getting importation of cases into Africa countries, it started first in Egypt and then in Algeria and eventually in some West and other countries, of course, in South Africa. It was sometime into the experience of the rest of the world. And very soon after countries started seeing cases, they put in place some of the measures, starting with abolishing flights from... Speaker 2: (19:03) ... just starting with abolishing flights from so-called hotspots of the time, and therefore reducing some of the traffic of people who might have been infected. In addition to that, relatively soon after they started seeing community transmission, and in many cases before they started seeing community transmission in some of the Eastern Southern African countries, countries put in place even more radical measures of physical and social distancing. So stopping social gatherings, mass gatherings, closing schools, and eventually asking people to limit their movements. At the same time they have scaled up, and they did a very good job at the beginning of point of entry screening, meaning at the borders. And this had been built from the experience with Ebola, for example. So they started screening people traveling in, and were able to, if not catch somebody with a [inaudible 00:00:54], track them down and their contacts. Speaker 2: (19:57) So we think it's a combination of these measures. The physical distancing measures, as well as the public health contact tracing isolation measures that countries are put in place that we are seeing slower picture in Africa. It's true that, and it was stated by Professor Samba so that there have been challenges with testing in some of the African countries, especially with access to the testing kits that are very difficult to find on the international market. We have seen some countries ramp up their testing, like Ghana and Senegal, but in those countries we are not seeing then a similar huge increase in positive cases. So we think there may be some underestimation, but we don't think there's a huge underestimation of the cases in Africa, and using also our influenza surveillance network to monitor on the syndromic level what sort of cases might be being underrepresented as COVID in countries. So we think it's the measures put in place, and the fact that the virus arrived later in Africa when there was already some experience in other regions. Thank you. Margaret: (21:09) Thank you very much, Dr. [Moetti 00:21:10]. I now have a question from the Spanish radio network, Victoria Garcia. Victoria Garcia, you're on the line. She's not? Could you unmute yourself please, victoria Garcia? We'll move to the next question. That will be Ankit from India today. Ankit: (21:49) Hello? Margaret: (21:50) Yes, please go ahead, Ankit. Ankit: (21:52) Yeah. My question is on air travel, India resumed its domestic yet traveled today. There is quite a debate going on if the middle row of the airplane should be left empty. Based on what we know so far, what is your advice on this. Does leaving the seats empty have any benefits? Does it actually help? Thank you. Dr. Maria Van Kerkhove: (22:16) Thank you for the question. And it's great to see that there's a slow approach to initiating travel again. I know many people are trying to ensure safe travel as we resume economic activity. What we know about COVID-19, and what we've been talking about up here for many weeks now from the beginning, is that this comprehensive approach, comprehensive package of activities is really important to be able to stop transmission between people. And the virus transmits between an infected person through respiratory droplets when they're in close contact with one another. Our recommendations are of one meter or more distance between individuals. We recently had a systematic review that's been conducted to look at influenza, influenza-like illness, Coronaviruses, and COVID-19, and has found a strong, protective effect of a distance of one meter or more. And so that's important. If someone is ill, as you know, we recommend the use of medical masks in that context, and for people who are caring for somebody who is ill. But the distance that note we know can be protective is one meter or more. Margaret: (23:42) Thank you. Thank you very much, Dr. Van Kerkhove. The next question is from [Kyle Koup-Fishmet 00:04:48] Kyle, are you on the line? Speaker 3: (23:53) Yes. Margaret: (23:53) Please go. Speaker 3: (23:54) Yes, thank you very much for taking my question. I wanted to ask about what you just said about the chloroquine hydroxychloroquine arm of the solidarity trial being paused. I know it's supposed to be one question, but just so that I understand that this applies to both the chloroquine and the hydroxychloroquine, I expect. And could you say a little bit more about, what exactly the executive board based its decision on? You mentioned the Lancet paper, was that the main reason, or does the DSMB have beta from the solidarity trial itself that concerns them just to understand a little bit better what the decision was based on? Soumya Swaminathan: (24:38) Thank you for that question, Kyle. And I'll start. Mike may wish to add. So as you know, the solidarity trial has an oversight mechanism, an independent steer executive group that's made up of members from the participating countries, very senior experts. It has a representative of the data safety monitoring board, the trial statistician. So there's an independent data safety monitoring board. And then there's a larger steering group. That's composed of two senior representatives of each of the participating countries. Now, when we saw the publication in The Lancet, while it's still an observational reporting of observational data, but from multiple registries, and quite a large number 96,000 patients of whom about 14,000 or so had treatment with chloroquine with or without a macrolide or hydroxychloroquine with or without a macrolide, there was also a lot of questions coming from our own principal investigators in countries. And we knew that the regulatory agencies in many countries were also discussing these data. Soumya Swaminathan: (25:49) So the steering committee met over the weekend and decided that in the light of this uncertainty, that we should be proactive, err on the side of caution, and suspend enrollment temporarily into the hydroxychloroquine arm. And to answer your other question, we only have the hydroxychloroquine in this trial. We're not using chloroquine. The plan is now to look at data from the solidarity trial. As the DG mentioned, we have about 3,500 patients randomized. Of course not all of them have outcomes. We will also be writing to the principal investigators of all the other trials that are ongoing. We're aware of at least seven other trials, including the UK's recovery trial that are using hydroxychloroquine. And we will look at all the published evidence so far. We know there are very few and very small randomized trials. And that's why it's so important to continue to gather evidence on both the efficacy and the safety of hydroxychloroquine, because we know that the evidence from observational studies, however large they may be, are still subject and inherent to bias. Soumya Swaminathan: (27:05) And therefore it's really important to have well conducted RCT is done in large enough numbers in order to definitely answer this question. Because we want to use hydroxychloroquine if it is safe and efficacious, if it reduces mortality reduces the length of hospitalization without increasing the adverse events. So this is a temporary measure that's been taken by the steering committee. The data safety monitoring board we'll meet again, as soon as we've collected all the data from both published and unpublished studies that are ongoing, and then we will review the decision again during the course of the next week or two. Thanks. Margaret: (27:49) Thank you very much, Dr. Swaminathan. Dr. Ryan's going to add a few more- Dr. Michael Ryan: (27:55) Just possibly add to clarify for everybody, the steering committee and others who are over the trial including WHO, we don't see the data. That's the purpose of the trial is that nobody gets to see the data or interfere with the process. The Data Safety Monitoring Board, though, will be looking at the data and then will inform if there are any issues. And that the caution that Soumya refers to is purely to await a rapid analysis by the Data Safety Monitoring Board. And we would expect that if no signal is found of any problems, then we would continue to randomize and to use the drug. This has purely been done as a precaution in order to be able to have that data reviewed and have the proper process. This process has been carefully put together, and other trials that are currently underway have very similar processes associated with them. So this is a standard practice in order to be able to ensure that we're using the processes as designed with the partners in the trials and under regulatory guidance. Margaret: (29:09) Thank you very much, Dr. Ryan. We'll give Victoria Garcia from Spanish Kadena network another opportunity to ask her question. Victoria Garcia, can you unmute yourself and please go ahead with your question? Victoria Garcia: (29:26) I have some problems with the mic. Can you hear me right now? Margaret: (29:29) Yes, we can go. Ahead. Victoria Garcia: (29:31) Okay. I sent you the question in writing, but I do it again. Here is much better. My question is for Dr. Ryan, in which scenarios are you working right now is still there the possibility of a important second wave for infectious or you discard more and more the possibility of that important second wave, especially in countries like mine, Spain, with severe confinement measures in place right now? Dr. Michael Ryan: (30:03) Thank you. I think it depends where you are in the world. Right now, we're not in the second wave. We're right in the middle of the first wave globally. And if we look at the data from South America, as was spoken about, for Africa, for South Asia, and for many other countries, we're still very much in a phase where the disease is actually on the way up. We congratulate countries like Spain, who've managed to contain and suppress the disease transmission. But as we've seen in the zero prevalence studies, and Maria wish to speak to this, the actual number of people who've been infected in each country remains relatively low. So when we speak about a second way classically, what we often mean is that there'll be a first wave, the disease by itself effectively goes to a very low level, and then occurs a number of months later. What we're concerned about right now... Dr. Michael Ryan: (31:04) That may be a reality for many countries in a number of months time, but we need to be also cognizant of the fact that the disease can jump up at any time. We cannot make assumptions that just because the disease is on the way down now that it's going to keep going down, and then we're going to get a number of months to get ready for a second wave. We may get a second peak in this wave. This happened during pandemics in the past. It certainly happened in the pandemic of 1919 in the Spanish flu. We got a second peak, not necessarily a second wave. Dr. Michael Ryan: (31:40) And therefore, I think right now, countries in Europe, countries in North America, many other countries around the world in Southeast Asia have to continue to put in place the public health and social measures, the surveillance measures, the public health measures, the testing measures, and a comprehensive strategy to ensure that we continue on a downward trajectory and that we don't have an immediate second peak. We will then have to look later in the year whether or not there's a possibility of a second wave of infections coming. And that's particularly of concern when we look at the possibility of having a second wave of infections that may be also associated with influenza season, which will greatly complicate things for disease control. Dr. Maria Van Kerkhove: (32:34) So if I may add, yes, I mean, let us be perfectly clear. All countries need to remain on high alert here. All countries need to be ready to rapidly detect cases. Even countries that have had success in suppression, as Mike has said. Even countries that have seen a decline in cases must remain ready. The zero prevalence studies that we have seen... There are two published studies. There are an additional approximately 20 studies that are either in pre-print, which means they haven't been published in a peer review journal or have made results available through press release, indicate that a large proportion of the population remained susceptible. That means that this virus, if it finds an opportunity, will start an outbreak. And we need to be very clear on that and need to remain strong, remain vigilant, have our systems in place to readily detect those cases, to care for those cases, to find and trace and quarantine contacts. Dr. Maria Van Kerkhove: (33:37) This virus, as I said, at my first press conference on this, on the 14th of January, a hallmark of Coronaviruses is its ability to amplify in certain settings, its ability to cause a transmission or super spreading events. And we are seeing in a number of situation in these closed settings, when the virus has an opportunity, it can transmit readily. We're seeing it in longterm care facilities. We've seen it in some hospitals. That means that the virus will take that opportunity to amplify if it can. But the good news is that we have the steps, the tools in our toolbox, to be able to suppress transmission. And these are the fundamentals of public health that Dr. Tedros, Dr. Moetti has talked about. It's about having that public health workforce in place, having the ability to test for cases, to care for those cases, depending on the severity of their symptoms. To find those contacts, to quarantine those contacts. To keep our people, to keep all people fully empowered, engaged, and informed about what the situation is in their setting. And these are the tools that we can use to suppress transmission. Dr. Tedros Adhanom Ghebreyesus: (34:53) I will add to that. Today, as you may know, Japan prime minister Abe had announced the lifting of the emergency declaration that was imposed actually more than six weeks ago. And if you see the number of cases at its peak, it was more than 700 per day. Now it's down to around 40 cases per day. And the number of deceases is also kept at minimum. So we can see also the success of Japan, but at the same time, as Maria said, they will continue to do the case identification, the tracing, the proper care, isolation. That will still be there. So lifting some of the serious measures doesn't mean that the basics will not be done. It should actually be strings, and that's why we say the social distancing should help to prepare for testing, tracing, and the rest. Dr. Tedros Adhanom Ghebreyesus: (36:06) So we see it in many countries, including Japan's lifting of the... Declaration today. And we remind all countries who are lifting the serious measures they had to make sure that the public health measures, the comprehensive approach, is in place, and the right instruments are actually continuing to be implemented. Thank you. I think Dr. John, the director of CDC, is online and would be happy to give him the floor to make his speech. And then if we continue the question and answer after that, and he can join us on that too. Margaret, if you agree. Margaret: (36:55) That would be great. Dr. John, I hope you can hear us, and please go ahead. We're looking forward to hearing from you. Dr. John: (37:04) Good evening from Addis Ababa, and greetings from the African Union Commission, where we are celebrating the Africa Day under the banner of solidarity. So I think there couldn't have been a better moment for choosing that word solidarity than today, where we need solidarity to fight and win this battle against COVID-19, especially for our continent, where we continue to see a progression in the numbers of infections occurring every day on our continent, and it's extremely concerning. I would echo what Dr. Tedros just mentioned, where our greatest chance... I've been speaking the entire day at the EU. I'm advocating for the need to enforce public health measures, and all that critical activities that allow us to win this battle against COVID-19 on the continent. A battle that we must win to solve ... Dr. John: (38:03) Against COVID-19 on the continent, a battle that we must win to survive for our own existence as a continent. Which means we have to intensify our ability to test, our ability to trace, our ability to track and our ability to treat as a continent. And I'm very pleased that the leadership of the continent has rallied behind that, the chairperson of the African union chairperson Moussa Faki under the guidance and leadership of president Ramaphosa as the chair of the AU, have all endorsed this approach and they're rallying behind. So I'm particularly pleased to work side by side WHO to continue to benefit from the support, extraordinary support from both my friend Dr [inaudible 00:38:46] and Dr. Tedros to continue to join forces in the fight against COVID on the continent. A fight which as I said we must win to survive. And as a continent I'm really happy that we are aligning ourselves with the values and principles of what WHO is putting forward. Thank you. I will participate for about another 15 minutes, then run over to take part in my own webinar which is going on. Thank you so much. Dr. Tedros: (39:13) Thank you. Thank you John, for joining us. So if you can stay for questions we would appreciate it. Otherwise please feel free. Thank you, Margaret please. Margaret: (39:26) So now we'll resume the question and answers with Helen Branswell from STAT news, Helen please go ahead. Helen Branswell: (39:35) Hi. Thanks for taking my question. I just wanted to follow up on Ki's question just to be a hundred percent clear. The pausing of the hydroxychloroquine arm of the solidarity trial is not related to any signals that the data safety monitoring board has seen? Dr. Michael Ryan: (40:01) No Hellen no, not at all. That data that's what we're posing to analyze that data, not us but the DSMB and the statisticians will analyze that data and inform us accordingly. So as such, it is not related to any problem. There is no problem at all right now within the solidarity trial. There's no issue, there is no signal. We're just acting on an abundance of caution based on the recent results of other studies to ensure that we can continue safely with that arm of the trial. Margaret: (40:38) Thank you Dr. Ryan. The next question comes from Brazil, from Ana Pinto from Folha de Sao Paulo. Ana, please go ahead. Ana Pinto: (40:47) Hi, thank you for taking my question. As of today Brazil has the second highest number of infections in the world. Over 350,000 with over 22,000 deaths. And their reproduction number that has been over one for several weeks. And in many cities, the ICU patient rate is over 90%. in such a scenario is it possible to prevent a public health collapse without restriction measures such as the stay at home orders? If it's possible, what are the alternatives to control the pandemic in Brazil given its current epidemiological numbers? Thank you. Dr. Michael Ryan: (41:37) The transmission in Brazil at this moment is quite intense, but also we've seen increasing transmission in countries like Chile, in Peru and a number of South American countries. With regard to suppressing infection when there's widespread community transmission and we've said this way back since February, you must continue to do everything you can. And there's a perception that you can only suppress transmission through very extreme public health and social measures. Certainly in very high transmission it's a very effective means of asking people to stay home in order to reduce the flames of the epidemic. But then that you need to do case finding, you need to investigate clusters, you need to isolate cases. In a sense extreme measures are very often used as an alternative. What we do is we make everybody stay at home while we try and sort out what to do next. Dr. Michael Ryan: (42:41) And that's essentially what many countries ended up doing. What we really would like is to be in a position where we can identify cases and contacts, and those cases can be isolated and their contacts can be quarantined. It is a much more effective strategy to do that. And effectively only isolate or quarantine a small proportion of the population, as opposed to having to isolate or effectively have the whole population in a stay at home mode. We all know the downsides of doing that economically and socially. However, in these kinds of circumstances, there may be no alternative because if you do not have the capacity to do the kind of tracing, the kind of detection, the testing that's needed, it's very, very demanding. And sometimes countries have understandably not been able to do that work while they try to suppress. What countries have done in implementing these public health and social measures, widely and lock downs what they're known as they've put in place the measures to be able to investigate disease, investigate clusters. Dr. Michael Ryan: (43:43) They've increased their public health workforce, they've increased their testing capacity. So then as the numbers drop, they get control of the situation again. So yes, at this moment in countries with high levels of transmission, unless they've got tremendous capacities to investigate cases and isolate cases and quarantine contacts and do widespread testing at this point, it is very difficult to see how countries with very intense transmission can suppress the infection without some level of public health and social measures being put in place. The extent of those and some countries have demonstrated that it is possible to suppress the disease without full-scale lock downs. Certainly countries in Southeast Asia have demonstrated that, but that has only been in situations where they were able to put in place extensive other measures like case finding and surveillance and contact tracing and testing and quarantine. Dr. Michael Ryan: (44:39) It's never been a situation where a country's had intense transmission and it just goes away by itself. That has not happened as yet. Countries with intense transmission have all had to implement some level of public health and social measures. In Brazil many of the states are trying to implement such measures. And certainly it's not that the state level in Brazil is not implementing measures they are. I think there is a variation in the measures been implemented and there needs to be a whole of government, all of society approach to that. But certainly there are many countries now in central and South America dealing with intense transmission. And again, as the director general has said over and over again, we need a comprehensive approach. It's not just public health and social measures or lock downs. It's not just tracing and case identification. It's not just testing. It's not just quarantine. It's all of these things done together. If countries do that then easing restrictions can be done much faster and much more safely. Dr. Tedros: (45:40) Maybe I could add to that. If you don't take the serious social misery measures like social distancing and so on. As you rightly said the speed of the virus will continue to be high. In order to beat the virus you need to have a speed which is faster than the virus itself. Meaning you have to take this measures to slow it and then prepare the public health approach that Mike said and then you will be ahead of the virus. So that's the whole idea. While the virus has all the spaces and moving everywhere as it can with the speed it can really use you can't beat it. So that's why it's like a roadblock. You have the social distancing measures and other social measures to slow that and during that measure, when you do the lockdown or whatever, that's when you develop also your testing, your contact tracing, you increase your surge of personnel who will do the contact tracing and other measures. Dr. Tedros: (47:07) Then that will give you to be ahead of the virus, you slow and then ahead of it. So that's the whole idea otherwise if you let it go, if it has all the spaces to move as it wishes, if you don't increase your speed by slowing the virus' speed, it will be very difficult to control it. So I think that's why we need the so-called lock downs or social distancing measures to really prepare ourselves and move faster than the virus itself. And we said it many times this virus is very, very dangerous. It has two combinations, two dangerous combinations, one, it can move faster, very fast. And at the same time it's a killer. And that's why you can see what you can see 5 million cases, more than 5 million and more than 300,000 deaths. In many countries it has shown that after a certain number of cases, after a certain threshold, it moves like a bushfire exponential. It did it in China, in Wuhan. It did it in many European countries, and it's doing it now as you said in Brazil. It really moves fast that's why we need to do everything to slow it. And the slowing is mainly in the social measures, social distancing measures that we take. And they have to be as really aggressive as possible to give us the time to be ahead of the virus. It's a matter of speed and we should control it's speed using different methods. Thank you. Margaret: (49:01) Thank you Dr. Tedros. We're now moving to Morocco for a question that will be asked in Arabic. And this will be asked by Abdallah [inaudible 00:49:12] from Morocco Media News. Abdallah please go ahead. Abdallah: (49:17) [foreign language 00:11:20]. Dr. Maria Van Kerkhove: (50:08) Thanks. I heard the question yeah. The question was about the use of detergents and disinfectants. And the question was if it was safe sometimes and not safe other times. So the use of detergents and disinfectants for the cleaning of surfaces is very important for a virus like COVID-19. So when people infected individuals who transmit the virus they transmit through these infectious droplets, and sometimes those droplets can fall onto the surfaces around them and in the environment that's around them whether that's at home or whether that's in a healthcare facility. So the virus can survive for a small amount of time. But if you use a disinfectant, it can deactivate, it can kill the virus within minutes. So the use of the disinfectants there is very important. And that's where disinfectants are safe. In no other situation is the use of disinfectants for COVID-19 safe and certainly not people using disinfectants. Dr. Michael Ryan: (51:07) Yeah. And if I could just add as well that the widespread use of disinfectants at the community level, and we've all seen the images of large amounts of disinfectants being sprayed in the air and whatever. These disinfectants can cause irritation to the skin, they can cause irritation to the eyes. So again, we're focused here on surfaces that people will potentially touch and doing that carefully. There are some disinfectants for example that are currently being used on airlines, which are sprayed in the airplane when there are no passengers. Those sprays are electrostatically charged. What they're aimed at doing is they will attach themselves to surfaces and then disinfect the surface. But we need to be very careful in using sprayed disinfectants in areas where there are large numbers of people. So the large scale sort of spraying of environments in which there are large numbers of people is not necessarily effective. And therefore we should focus on disinfecting surfaces that people will touch and doing this properly and avoiding flooding disinfectants into the environment and potentially causing skin and eye irritation particularly in children. Margaret: (52:25) Thank you Dr. Ryan. Now the next question is from John Cohen from Science. John, please go ahead. John Cohen could you unmute yourself and ask your question. There you are. John Cohen: (52:41) Thank you for taking my question. I'm curious about the seasonality relationship to a second wave. when we talk about second waves, I think we're largely looking at influenza, which has a seasonality pattern. And are you thinking of a second wave based on there being the assumption of seasonality? And if there is no seasonality, what determines the second wave [inaudible 00:15:08]? Dr. Maria Van Kerkhove: (53:11) John, thanks for that question, you've reminded me that I meant to add an additional point to the last question. The use of the word waves, the use of the word seasonality implies that indeed we have some information about how this virus will behave over years and over many, many months. And most people think when they hear seasonality, they think influenza and they think Northern hemisphere winter season, Southern hemisphere winter season, and it may get bad. We are five months into this pandemic. We have five months worth of data on COVID-19. We do have some experience with SARS, we do have some experience with Merz, we do have some experience with other human corona viruses, but there is nothing right now to indicate that this virus will resurge in winter months. What we know is that from the Sierra epidemiology studies is that many people remain susceptible. Dr. Maria Van Kerkhove: (54:07) And that means if the virus is there, regardless of the temperature, regardless of the month, that virus can infect people. And if people are in close contact with one another, it can resurge. The complication becomes if we think of waves, if we think of winter months, if we think of flu is when we have a co-infection or co-circulation of influenza and COVID- 19 as we are seeing in the Southern hemisphere, that could complicate our understanding. Because if we don't have testing in place, we don't know what people are infected with. And so it could potentially flood the system, it could potentially overwhelm the system. But specifically to your question about waves and about seasonality, we don't have enough information right now to know how this virus will behave over many years. What we know and what we need to prepare for is that the virus can resurge if we give it an opportunity. We don't need the winter months to be able to do that in the Northern hemisphere, we are seeing increases in a number of countries. And as I've said previously, all countries need to remain on high alert in terms of their ability to detect cases and have this comprehensive package and this approach of finding, isolating, testing, caring for cases, tracing contacts, quarantining those contacts, caring for individuals, empowering the population, making sure that we have all of our public health infrastructure in place to deal with COVID-19 and deal with all of the other diseases that are affecting our countries. Dr. Michael Ryan: (55:39) And if I could just add John, that's why I used the word second peak, because we would tend to talk about waves of infection in terms of the natural history of a disease in the absence of control measures. The natural phenomenon of waves of disease, which maybe reflect a seasonality. They may reflect the population behavior during different seasons the amount to which people mix or are indoors. So there are factors that may drive the natural transmission dynamics during different seasons. It's not that the season itself, the temperature may affect the disease, but in many cases it's not necessarily the temperature. It may be the fact that in wintertime people are indoors more, they are in much more contact with each other. So there are the natural phenomenon. Dr. Michael Ryan: (56:26) I think many countries have paid a heavy price in doing the measures that have needed to be done to suppress the transmission of this disease. And they deserve credit and the communities deserve credit for the efforts and the sacrifices they've made to break chains of transmission. And that has driven down and suppressed virus transmission. It would be I think at this point a little bit worrisome if people assume that the downward trend in disease has occurred naturally. I don't think any of us believe that that has occurred naturally, that has occurred because of very- Dr. Michael Ryan: (57:03) Many of us believe that has occurred naturally. That has occurred because of very, very, very tough public health measures that have been tough on the population. And, if we assume that, if we take that to be true, if we take the fact that we've pressured the virus, we've pressured transmission, and we've driven transmission down, then the opposite is true, that if we take the pressure off the virus, then the virus can bounce back. That's where we are right now. Dr. Michael Ryan: (57:26) What's happened in many countries is that countries that have managed to keep transmission low, or have managed to suppress transmission down to a low level, have then found it relatively straightforward to contain the disease after that. They found the level of disease at which their public health system, their testing, their tracing, their contact tracing, their isolation, their quarantine, their healthcare system, can maintain a status quo. It reaches a steady state. We hope we can retain and maintain low levels or no transmission over time. And then, we'll see what happens with the second wave concept later on. That may still be an issue. Dr. Michael Ryan: (58:01) My concern right now is that people may be assuming that the current drop in infections represents a natural seasonality. I think that's a dangerous assumption. I think a huge effort has been made to suppress transmission of this virus, and to remove pressure from the virus at this point, making an assumption that it's on a downward trajectory and the real next danger point is some time in October or November, I think that will be a dangerous assumption. Dr. Michael Ryan: (58:27) I think this virus is under pressure because communities, public health authorities around the world, are putting the virus under pressure by reducing the opportunity for the virus to transmit. If we give too much of an opportunity back to the virus to transmit, as the DG said, if we let the virus get ahead of us again and we don't have the systems in place to be faster than the virus, the danger is we could rapidly get back to a second peak, and in fact, may be just experiencing the first step on an ever-increasing trend. Speaker 6: (59:01) Thank you, Doctor Ryan. We've gone well over the hour, so we're giving the last question to Nina at AFP. Nina, are you on the line? Please go ahead. Nina: (59:13) Yes. Hi. Can you hear me? Speaker 6: (59:15) Very well. Please go ahead. Nina: (59:16) Okay. Thank you. Thank you, everyone, for taking my question. Nina: (59:20) I had a question on China's foreign minister, who yesterday said that the country was open to international cooperation on identifying the source of the novel coronavirus, and suggested that WHO probably should lead that investigation. I was just wondering, has the WHO now been invited to China to take part in such a probe, and if so, when would you expect such an investigation to start? Thank you very much. Dr. Michael Ryan: (59:53) Maria may wish to add. We've been in discussions day-to-day with our colleagues in China about putting together the necessary scientific inquiries into the origin of the virus. I think the authorities in China, governments around the world, and ourselves, are very keen to understand the animal origin of the virus itself. And, I'm very pleased to hear a very consistent message coming from China, which is one of openness to such an approach. Dr. Michael Ryan: (01:00:25) Again, pleas that we've seen ... for example, the publication of the first peer-reviewed journal publications of the vaccine studies from China. And, again, I think in terms of the number of scientific publications that have come from China over the last number of months is very good. And, the number of scientific collaborations between Chinese institutions and institutions all over the world is also a very positive sign. Dr. Michael Ryan: (01:00:56) So, I think we will be very pleased to continue those discussions. I don't believe, Maria, there's a date yet for a scientific mission, but we will be looking forward to doing that as soon as possible and with the right mix of scientific experts from a multinational perspective to join such a team. Maria Van Kerkhove: (01:01:18) Yes. Only to add that, yes, we have been in regular contact with our colleagues in China, and they have all the expertise in the country to be able to do this. We welcome the opportunity to work with them and with the international community, to really understand the virus origins and the animal-human interface, because of the public health importance of this. SARS-CoV-2 virus, that causes COVID-19, is a zoonotic pathogen, and it's important for us to understand the intermediary hosts of this particular virus so that we can work towards preventing something like this happening again. Maria Van Kerkhove: (01:01:53) As we all know, as you all know now, most of these emerging pathogens do come from animals, so it's important that we have a strong system in place. We're working with our partners at FAO and OIE, our sister agencies, to be able to work towards surveillance in animals and at the animal-human interface. So, we welcome this opportunity to go forward. Maria Van Kerkhove: (01:02:14) I do want to make one other point from the last question, and I don't know if DG would like to comment on this as well ... the idea of complacency. One of the things I've been asked recently, what worries me the most, and it is complacency. It relates to the last question, in terms of what are our expectations are of this, and waves, and what might happen. Maria Van Kerkhove: (01:02:34) We here at WHO, and with our regional offices and country offices, are planning for any scenarios. There's a certain predictability of this virus, but any time you become complacent and you think you know, it will surprise. This virus has an opportunity, and it will take every advantage that it can to resurge, to transmit. Maria Van Kerkhove: (01:02:55) And so, I understand very well, and I am in the same boat as you. We all want this to be over, but we have a long way to go. We're at the beginning of this. We must continue to really stay strong and not become complacent. I know that is very hard, so it's something that we are conscious of. We are ensuring that we are working with you to support you through this, but it is important that we don't become complacent. Tedros Adhanom: (01:03:23) Thank you. I would like to add to the first one. As you know, with China, we have agreed on two issues, and the study of the origin of the virus is not actually new. We have agreed on having international experts to visit the country, which was done in February. And, this was also agreed during that time, on the origins, also. So, it has been there on the table. It's a matter of continuing and doing it. Tedros Adhanom: (01:04:03) But, all the stakeholders understand the importance of studying the origin because it's by studying the origin that we can prevent it from happening in the future. So, this is not a new thing, as Mike and Maria said. It's something that has been already going on. The discussion has been going on and something that was already agreement. Thank you. Dr. Michael Ryan: (01:04:37) Margaret, just before you finish ... I know the DG has very much recognized our colleagues on the African continent, but just from a personal perspective, to say thank you to GD and our team in Africa, to John and his teams in Addis Ababa. Dr. Michael Ryan: (01:04:56) These teams have not only been fighting COVID, but have been 500% committed to so many epidemics in Africa, particularly the Ebola outbreak in DR Congo over the last year and a half. I think African clinicians, epidemiologists, nurses, public health physicians ... So many others in Africa have sacrificed so much over the years to protect populations in Africa, but also populations around the world. And, they've done that with limited resources, with limited investment, but with huge professionalism, huge courage. I just wanted to, on this Africa Day, just say thank you from the world to our African colleagues, for all they do to protect the world from emerging and infectious diseases. Speaker 7: (01:05:49) I'd also like to ask Doctor Moeti if she's got any closing remarks. Also Doctor [Soh 01:05:55] ... Speaker 7: (01:05:55) Doctor Moeti, would you like to say a few words? Dr. Moeti: (01:06:03) Yes. Thank you. I think what I'd like to say is very much to support and echo your comments of we are not complacent. So, these apparently low numbers in Africa, the low proportion of cases of the global cases that Africa represents, I think, is in the context of very challenged systems, where we see a big wave of cases coming in the region. So, for me, this emphasizes the need for governments to continue, expand. Dr. Moeti: (01:06:36) We're advising them very strongly to [inaudible 01:06:38] the capacity, both for the public health actions or organized our capacity to provide care and treatment while we continue to ensure the availability of essential services for populations. So, it's just to say we encourage continuing. Dr. Moeti: (01:06:56) We will not also let down our guard at all, and we are absolutely determined to work with our partners, with the African Union, with professionals in Africa, with civil society, and very importantly, with communities and people where it's our duty to help people understand and to help them feel empowered and enabled to take the actions that they need to take, because they are not the subjects of government interventions. Things work best if people themselves understand and take actions that are needed. Dr. Moeti: (01:07:26) So, again, a shout-out for African people. I thank them so much for the courage that they've shown, the forbearance under sometimes difficult circumstances, and we are committed to continue in this fight with them. Thank you. Speaker 7: (01:07:40) Thank you, Doctor Moeti. Professor Soh, have you got any final remarks you'd like to make? Speaker 7: (01:07:49) We can't ... Professor Soh, would you like to unmute yourself? Professor Soh: (01:07:55) Thank you. So, I say okay here? Okay. Yes, thank you very much. Just to really thank again WHO for organizing this, and thanks to CDC Africa for joining. I would like just to echo a few things. Doctor Moeti said exactly what I wanted to say. Having few cases or small number of African cases compared to Europe and Asia ... very small ... It doesn't mean that there is no cases. It doesn't mean that the problem cannot be big one day in the near future. Professor Soh: (01:08:34) We just have to continue to be careful and to maintain and to strengthen our entire community system, strengthen our entire public health system. I fully agree with Doctor Moeti there because if we don't be careful, what can happen in Africa ... We'll continue to be at this plateau level for a long, long time, and that could be a big problem. Professor Soh: (01:09:01) We are already seeing small other epidemics coming in. Mike just mentioned ... It's not only Ebola. We are seeing measles epidemics in some places, and so on and so on. We don't want to be overwhelmed in places where the health system is already very weak. Professor Soh: (01:09:17) Lastly, I would like to add one last point onto the use of antiseptics for hands and for surfaces. In many places like Africa, it will be difficult to get those things. If one doesn't be careful, people can in fact bring bad products and say that they are good antiseptics. Professor Soh: (01:09:39) So, we strongly recommend hand washing, soap and water. Soap and water is very, very good compared to this very modern product that can, one, harm you, hurt you, break your skin, your eyes, et cetera. But, second, soap and water is really heavily, highly, highly recommended also, as far as I can measure. Professor Soh: (01:10:06) I would like to finish by thanking WHO for its leadership. In many ways, not only communication, not only disease control, but many other ways WHO is doing a fantastic job around the world, and I would like to thank them all for that. Thank you for helping not only Africa, the entire world, but especially African countries, to promote many of this research operations that are ongoing. Solidarity surveys, solidarity trials, solidarity [inaudible 01:10:44] trials, vaccine trials ... These are all great, great ideas. Professor Soh: (01:10:48) So, we hope that Africa will be really ... As Moeti said, we will try to stop this really quickly in Africa, and start to save lives very quickly in Africa, in collaboration with African countries. Thank you very much. Speaker 7: (01:11:09) Thank you, Professor Soh. We'll conclude this press conference with final remarks by Doctor Tedros. Tedros Adhanom: (01:11:16) Thank you. Thank you, CD, for joining. Thank you, John, and thank you, [Samba 01:11:23]. Thank you to all for joining and the journalists and others also have joined us today. And, Happy Africa Day. Thank you so much.