World Health Organization COVID-19 Press Conference Transcript October 12

Fadela: (00:00) ... Dr. Tedros are Dr. Mike Ryan, Executive Director Health Emergencies. Dr Maria Van Kerkhove, Technical Lead COVID-19. Present also in the room, Dr. Soumya Swaminathan, Chief Scientist, Dr. Mariângela Simão, Assistant Director General, Access to Medicines and Health Products. Dr Bruce Aylward will be joining very shortly. The press briefing is being translated simultaneously into the six official UN languages plus Portuguese and Hindi. Now, without further ado, I will hand over to Dr. Tedros for his opening remarks. Dr. Tedros, please. You have the floor. Dr. Tedros Adhanom Ghebreyesus: (00:53) Thank you. Thank you Fadela. Good morning, good afternoon and good evening. Around the world we are now seeing an increase in the number of reported cases of COVID-19, especially in Europe and the Americas. Each of the last four days has been the highest number of cases reported so far. Many cities and countries are also reporting an increase in hospitalizations and intensive care bed occupancy. At the same time, we must remember that this is an uneven pandemic. Countries have responded differently and countries have been affected differently. Almost 70% of all cases reported globally last week were from 10 countries and almost half of all cases were from just three countries. For every country that's experiencing an increase, there are many others that have successfully prevented or controlled widespread transmission with proven measures. Those measures continue to be our best defense against COVID-19. There has been some discussion recently about the concept of reaching so-called herd immunity by letting the virus spread. Dr. Tedros Adhanom Ghebreyesus: (02:29) Herd immunity is a concept used for vaccination in which a population can be protected from a certain virus if a threshold of vaccination is reached. For example, herd immunity against measles requires about 95% of the population to be vaccinated. The remaining 5% will be protected by the fact that measles will not spread among those who are vaccinated. For polio the threshold is about 80%. In other words, herd immunity is achieved by protecting people from a virus, not by exposing them to it. Never in the history of public health has herd immunity been used as a strategy for responding to an outbreak, let alone a pandemic. It's scientifically and ethically problematic. First, we don't know enough about immunity to COVID-19. Most people who are infected with the virus that causes COVID-19 develop an immune response within the first few weeks, but we don't know how strong or lasting that immune response is or how it differs for different people. Dr. Tedros Adhanom Ghebreyesus: (03:52) We have some clues, but we don't have the complete picture. There have also been some examples of people infected with COVID-19 being infected for a second time. Second, the vast majority of people in most countries remain susceptible to this virus. Several prevalent surveys suggest that in most countries, less than 10% of the population have been infected with the COVID-19 virus. Letting the virus circulate unchecked therefore means allowing unnecessary infections, suffering, and death. And although older people and those with underlying conditions are most at risk of severe disease and death, they're not the only ones at risk. People of all ages have died. Third, we're only beginning to understand the long-term health impacts among people with COVID- 19. I have met with patient group suffering with what is now being described as long COVID to understand their suffering and needs so we can advance research and rehabilitation. Dr. Tedros Adhanom Ghebreyesus: (05:18) Allowing a dangerous virus that we don't fully understand to run free is simply unethical. It's not an option. But we do have many options. There are many things that countries can do and are doing to control transmission and save lives. It's not a choice between letting the virus run free and shutting down our societies. This virus transmits mainly between close contacts and [inaudible 00:05:50] outbreaks that can be controlled by implementing targets measures; prevent amplifying events, protect the vulnerable, empower, educate, and engage communities and persist with the same tools that we have been advocating since day one; find, isolate, test and care for cases and trace and quarantine their contacts. This is what countries are proving works every day. Digital technologies are helping to make this tried and tested public health tools even more effective, such as mobile applications to support contact tracing efforts. Dr. Tedros Adhanom Ghebreyesus: (06:38) Germany's Corona-Warn-App has been used to transmit 1.2 million test results from labs to users in its first 100 days. The Aarogya setup from India has been downloaded by 150 million users and has helped city public health departments to identify areas where clusters could be anticipated and expand testing in a targeted way. In Denmark, more than 2,700 people have been tested for COVID-19 as a result of notifications received through a mobile application. And the United Kingdom has rolled out a new version of its NHS COVID-19 app, which had more than 10 million downloads within the first week. As well as alerting users that they may have been exposed to a positive COVID-19 case, the app allows users to book a test and receive results, keep track of the places they have visited and receive the latest advice on local restrictions. WHO is working with the European Centre for Disease Prevention and Control to help countries evaluate the effectiveness of their digital contact tracing applications. Dr. Tedros Adhanom Ghebreyesus: (08:07) This is just one example of the innovative measures countries are taking to control COVID-19. There are many tools at our disposal. WHO recommends case finding, isolation, testing, compassionate care, contact tracing, quarantine, physical distancing, hand hygiene, masks, respiratory etiquette, ventilation, avoiding crowds, and more. We recognize that at certain points, some countries have had no choice but to issue stay at home orders and other measures to buy time. Many countries have used that time to develop plans, train health workers, put supplies in place, increase testing capacity, reduce testing time and improve care for patients. WHO is hopeful that countries will use targeted interventions where and when needed based on the local situation. We will understand the frustration that many people, communities and governments are feeling as the pandemic drags on and as cases rise again. There are no shortcuts and no silver bullets. The answer is a comprehensive approach using every tool in the toolbox. This is not theory, countries have done it and are doing it today successfully. My message to every country now weighing up its options is you can do it too. I thank you. Fadela: (09:57) Thank you, Dr. Tedros. We will now open the floor to question from journalists. I remind you that you need to raise your hand. Use the raise your hand icon in order to get in the queue to ask questions. I would like also to remind journalists to ask, please, only one question to allow for more journalists to intervene. Let's start the first question with Kai Kupferschmidt from Science. Kai, can you hear me? Kai Kupferschmidt: (10:39) Yes. Thank you very much Fadela. This is probably for Bruce Aylward. I'm not sure whether he's joined already. I just wanted to ask whether you could give a quick update on where the COVAX facility stands, both in terms of who has signed the commitment and in terms of the vaccine contracts that have been signed? Fadela: (11:00) Thank you Kai. Can we come back to you later on? Bruce is in a meeting, but maybe Dr. Soumya Swaminathan can take this question. Dr. Soumya Swaminathan: (11:13) Yes. Thank you. Kai. The COVAX facility is going from strength to strength. October 9th was another deadline for countries to make commitments. And over the weekend, we have over 180 countries that have committed. These include the self financing countries and the latest one to join and make a public announcement was China. And then you have the 92 AMC countries, which will be eligible for Gavi support for the vaccines. So actually when you add up all of these countries together, they represent 90% of the world's population. So it looks like the COVAX facility is really brought countries and people together, and it sets a good example for believing in and trying to achieve equitable access of vaccines. The second part of your question was about investment in vaccines, I think. Now, the facility we'll be looking at the broad range of vaccines that are out there, all of those that are being developed, particularly those in the late stages of clinical trials. As you know, CEPI has nine candidate vaccines in the portfolio that they have supported the R&D for. Three of those are in phase three clinical trials. But the COVAX facility will be looking at a number of other candidates, as well as the data comes out of the trials. And then they will be making decisions on advanced market commitments for several of those vaccines. And again, there'll be an external advisory committee that is going to advise the COVAX facility to make those investments. So at the moment, it's looking good. On the funding side, there's still a shortfall. We need to get $2 billion, excuse me, by the end of this year and another 5 billion next year to supply just the AMC 92 countries which we'll be able to provide them for up to about 16, 17% of their population. So there's still a bit of fundraising to be done, but I think the commitment seems to be there. Thanks. Fadela: (13:43) Thank you, Dr. Swaminathan. I would like now to invite Bianca Rothier from Globo for the next question. Bianca, can you hear me? Bianca Rothier: (13:57) Hi, Fadela. Can you hear me? Fadela: (13:59) Very well. Go ahead please. Bianca Rothier: (14:03) Thanks a lot. Despite the fact that Brazil has rated two thirds and very symbolic milestones in the last days, more than 5 million cases and 150,000 deaths, the numbers are clearly declining. Can Dr. Michael now comfortably say that the pandemic in Brazil has already reached its peak? And what lessons can Brazil learn from what we are experiencing now here in Europe with record numbers only months after the reopening? Thanks a lot. Fadela: (14:41) Thank you, Bianca. I would like to involve Dr. Ryan to take this question. Dr. Michael Ryan: (14:50) Yes. Well, we are pleased to see the numbers stabilizing and going down in Brazil. But remember, they're stabilizing and going down from some very, very high numbers and there are still many people getting COVID-19- Dr. Michael Ryan: (15:03) ...High numbers. And there are still many people getting COVID-19 in Brazil and across the Americas. And so while there has been an overall downward trend in Central and South America, there are a number of countries in which that trend is still upwards. Again, we congratulate the frontline health workers in Brazil for what has been a very, very long and continues to be a very long fight. And also the communities in Brazil for continuing to work, to try and reduce the spread of this disease. But as we've all learned at the school of hard knocks over the last number of months is the fact that disease is on the way down, does not mean the disease will not pick up again. And very, very quickly in certain circumstances. So we need to remain vigilant in all countries, and there needs to be a high, high index of suspicion as numbers go down to make sure that you detect areas in which the numbers may be going up. Brazil is very, very large country. Dr. Michael Ryan: (16:03) It's almost the size of half a continent. So saying that the disease is on the way down in Brazil is a positive thing, but that does not mean in other certain areas that the disease is not on the way up. And therefore local authority, state authorities will have to remain vigilant over time. So yes, we're always glad when a country like Brazil that has so many people and contribute so much to the global economy and global culture is gaining some success. But no country is out of the woods yet. And everyone needs to remain vigilant. Fadela: (16:35) I think that a Dr Van Kerkhove would like to add something. Dr. Maria Van Kerkhove: (16:38) Yeah, just very briefly, not specific to Brazil, but specific to all countries in that where we are in this pandemic right now and what we have learned, and Brazil is no different, is we're so far advanced in terms of our knowledge about how to deal with this virus. And as you stated, there is a decline that we are seeing across, in Brazil and in a number of countries while in others, that we are seeing a resurgence. I think the knowledge that we've all gained on, not just what to do, but how to implement this is just as important. And so this feedback mechanism about looking at how all of these interventions have been applied in each country at the sub national level and how those measures were put in place, how the measures are being adjusted as we go through this calibration period of opening up societies while keeping transmission at a low level, while applying the tools we have for active surveillance and in case finding is really quite critical. Dr. Maria Van Kerkhove: (17:35) And that feedback loop, that learning loop needs to be constant. And I think all of us remain humble to this virus and the fact that we don't know everything, but we know a heck of a lot more than we did a few months ago. And I think that motivation of getting us to take that knowledge and be empowered by that to say, "What we are doing is having an effect, what we are doing is saving lives." And I think mechanism by which a country, a sub national level can use that to drive yourself forward needs to be used. Because there are so many tools that you all have, that we all have that are working. And I think finding what works and how it works at that most localized level is really what is critical right now. But as Mike has said we need to remain ready. Dr. Maria Van Kerkhove: (18:23) We need to not become complacent. We need to be ready to quickly find as many cases as we can. And especially those clusters, because this virus likes to transmit between people in close contact with one another. It likes to cause outbreaks. And if we know where those outbreaks are going to happen, and we have clues on this because these outbreaks happen in an enclosed settings, they happen where people spend prolonged periods of time together, often time where there's poor ventilation, if we could prevent that from happening, we can get ahead of this virus. And we can prevent even clusters of cases becoming community transmission again. So well done to all of the countries that are working so incredibly hard and who are continuing to fight against this and to bring transmission under control. Fadela: (19:11) Thank you. I would like now to give the floor to [inaudible 00:19:15] from [inaudible 00:19:18] press. [inaudible 00:19:18] can you hear me? Speaker 1: (19:23) Yes. Good evening everybody. Fadela: (19:25) Hi [inaudible 00:19:26] go ahead. Speaker 1: (19:27) Good evening. Fadela: (19:28) Hello. Speaker 1: (19:29) So this is a question to Dr. Ryan, last week, Dr. Ryan announced that... It was last Monday, that 10% of the world's population might be infected by the COVID. So the first question would be, how do you get to that figure? And with so many people infected, this suppose the fatality rate is much lower than what we think about before and similar to the flu fatality rates. So the question is, can we still say that COVID is more worrying than the flu? Dr. Michael Ryan: (20:06) Hi, thanks for your question. Fadela: (20:06) Thank you. Dr. Michael Ryan: (20:07) I made my remarks, right. I believe at executive board meeting with a member States were what I was actually trying to communicate was that the vast majority of human beings on this planet remain susceptible to the virus. And I believe what I said was that approximately 10% of people are... Many studies have demonstrated that 10% or less of people had been infected. Although that was very variable with some slum areas, high risk populations, like health workers being much higher. So I was using that 90/10 as an illustration of the fact that most people in the world were susceptible. In fact, in many countries that serial prevalence is very low. But again, what you have to remember is some of those seroprevalence studies were done a number of months ago. What we currently have is a lot of work going on to summarize all of the serologic studies that have been done. Dr. Michael Ryan: (20:59) We also have a series of a Unity Studies, which are longitudinal studies, which are studying seroprevalence around the world or the number of people who've been infected much more systematically. So from that perspective, you can say that 10%... If you look on average at some of these studies, on average 10% are less, in some is much less. And in some studies as much more. So my point was illustrative, and we will be coming out with much more detailed data as we make our estimates more accurate. I don't know, Maria, if you want to speak to that issue of how we're looking at the data right now. Dr. Maria Van Kerkhove: (21:37) Thanks Mike. Yes. So as you've heard us speak many times before, we're looking at these sero-epidemiology studies that are occurring globally. We are looking at a number of ways. First of which, we're looking at the publications that are coming out. These are peer reviewed publications, preprints, government reports. And to date there's more than 150 published results from such studies that Mike has just referred to. These are done various ways using various methodologies. Some are looking at populations, some are looking at stored clinical samples from people who have shown up at hospitals. Some are from blood donors and other studies are done in specific types of populations among health workers, for example, in specific areas where there was high transmission in slums or in some cities and towns where there was really intense outbreaks. And the results indicate across all of these 150 studies that as Mike has said, that the vast majority are below 10% with the exception of some high incidents areas that are above 20, 25%. In some even higher. Dr. Maria Van Kerkhove: (22:38) And so the point is that these studies continue to tell us that the vast majority of the world's population remains susceptible. The way in which we're trying to get a more standardized approach to look at studies and be able to pull these results and combine these results, if you will, is through what we call the Unity Studies. And this is a series of six protocols that WHO has developed with many, many partners. And in fact, over the last 11 years, because this work began with influenza, because we knew the importance of really trying to understand the extent of infection as measured through these sero-epidemiology studies and the need to standardize this approach, use the same approach across multiple countries so that we can better compare what is happening in one country and another. And so WHO with our partners has developed six protocol templates for different types of populations. Dr. Maria Van Kerkhove: (23:33) And we were working with more than 50 countries right now to implement these studies. Where we are providing technical support on the adaptation of the protocol for the local context. We're providing support and working with the countries who are running these studies themselves to carry them out. And many of these are underway. With the use of a standardized protocol, what we can do when these results are finished and with the permission of the principal investigators of those, is to be able to compare those and pool those. And this will help us get a good global estimate of what is happening in different populations. You also mentioned the infection fatality ratio. So in addition to this, there are a number of statistical groups, mathematical modeling groups that are looking at the infection fatality ratio, which is the number of deaths, divided by the number of estimated infections. Dr. Maria Van Kerkhove: (24:26) And there are several papers that have come out that are looking at this. Several of these analysis have used published or pre-print sero-epidemiology study results. And they all converge around a point estimate of around 0.6%. Now, that may not sound like a lot, but that is a lot higher than influenza. And the infection fatality ratio increases dramatically with age. So we can provide you with these papers. These papers are published, but there is a big increase in the infection fatality ratio by age. But overall these converge around the 0.6%. Fadela: (25:05) Thank you. I would like now to invite Bloomberg Reporter for the next question, Tim [inaudible 00:25:16] from Bloomberg. Can you hear me Tim? Tim: (25:20) Yes. And can you hear me? Fadela: (25:22) Yes, very well. Go ahead please. Tim: (25:24) All right. Thank you. Yeah. So my question has to do with the recent upsurge in Europe right now, even in countries like Spain, where the current wave of infections is hitting especially hard, hospitalizations due to the virus are still far lower than they were at the peak of the first wave. I'm just looking for an update on your current thinking as to why this is and what risk factors might cause this trend to worsen in the coming weeks or months. Fadela: (25:56) Thank you, Tim. Dr. Ryan, Dr. Michael Ryan: (25:57) I'll start. Maria will likely add. Well, clearly as we've seen in all cases of raising incidents so far in this pandemic, that incidents of hospitalization and deaths lags behind the incidents of cases themselves. And it takes a number of weeks, usually for those numbers to feed through into the system. But I do also, we also recognize that within that lag has been over a longer period of time, and it may reflect a shift in the age distribution of cases, or at least of tested cases with more disease in younger age groups who don't tend to be hospitalized or don't tend to have fatal outcomes. It's certainly a factor, but what we are beginning to see worryingly in places like France, like the UK, Ireland and other countries is hospitalization rates increasing, ICU occupancy rising. And it's really important that health systems are able to cope with what will be an increasing number of cases in hospital and ICUs over the coming weeks. Dr. Michael Ryan: (27:07) The question remains as to how many of those daily incident cases convert into hospitalizations and then into very seriously ill patients. And we don't know that. We don't know that for sure. If this trend continues, yes, it could be down to the age base. In terms of people going into ICU or even being hospitalized, again, Maria may speak to this, but we've learnt a lot about how to recognize early symptoms of the disease, how to ensure the patients who are vulnerable are better protected, and those that are vulnerable, get access to early treatment. I think a lot of this is making sure that those people, most likely, to fare badly are in a clinical pathway that gets them into intensive care or supportive care much more quickly. We also in back in March and April people on hospital trolleys, great difficulties and triaging patients, patients who probably needed immediate care and not getting immediate care. Dr. Michael Ryan: (28:02) And therefore the streamlining and efficiency of the system is very, very important. That efficiency drops as the system comes under pressure. And it's a great testament to the emergency... Particularly people working in emergency rooms, in the front end of our systems have really improved the way in which we streamlined the clinical pathways in the hospital to ensure that the sickest patients are those most likely to become sicker, are getting access to care quickly. We then add in the advent of therapeutics like Dexamethasone and the use of high flow oxygen, oxygen concentrator, so many other things that have come on stream. So I think overall clinical care is improving, which won't reduce hospitalization rate per se, but certainly will reduce death rates. So a number of factors in that. It may also be, and this is something that remains to be explored, whether or not the very fact that people have been more socially distanced. Dr. Michael Ryan: (28:59) The very fact that people are taking more care with hygiene, whether or not people are being exposed to a lower infectious dose. And that is something that's still very, very speculative. Something that will be explored and is being explored as we speak. But the reality is that we may not be perfectly effective at reducing transmission between people, but there is a link between the infectious dose, the amount of virus you're exposed to and the severity of your illness or your likelihood to become sick. Again, a lot of work going on in that. And I believe in the end, it will turn out to be multifactorial. There'll have been many reasons, but I think we need to be really careful right now, not to make an assumption that the current disconnect between the rising number of cases and deaths that could reconnect very, very badly and very catastrophically, unless we're very, very careful. Dr. Maria Van Kerkhove: (29:53) Thanks, Mike. I mean, I think you described it perfectly, but as you said, it's a combination of factors that we're seeing this happening across Europe. And in fact, a number of countries where we're seeing a lower... Dr. Maria Van Kerkhove: (30:03) It's happening across Europe and in fact, a number of countries where we're seeing a lower mortality rate compared to the beginning of this pandemic. Part of it is due to surveillance because we are able to test more. We are able to expand our surveillance beyond just severe patients, beyond just individuals who show up at healthcare. This is a hallmark of outbreaks and pandemics. In the beginning, you tend to focus on those severe patients because that is what your system can cope with. As surveillance expands, we are able to test more. We are able to do contact tracing. We tend to find more individuals who are on the more mild end of the spectrum. That's one. Second, through these second peaks that we are seeing in a number of countries, there is an age shift in the average age of cases that we are detecting. Dr. Maria Van Kerkhove: (30:48) Part of that is because as societies are opening up, individuals are coming away from those stay-at-home measures. They're going back to work. There's a lot of socializing that is happening. Unfortunately, in some of those situations, the virus really, really likes this type of setting. It can spread. We have seen quite a few outbreaks in a number of countries across entertainment-type settings, across religious settings, across sporting events. That will drive the age down. We know that younger individuals tend to have less underlying conditions and they don't develop as much severe disease as someone who is older, but also, we are getting better at preventing outbreaks happening in vulnerable populations. The long-term living facilities, for example, in some countries were incredibly devastating in the beginning and unfortunately, are still happening in some countries. If we could prevent the virus from entering a long-term living facility, for example, we could prevent amplification. We could prevent severe disease and death. Dr. Maria Van Kerkhove: (31:53) The other side of this coin is that we are getting much better at dealing with patients. Clinicians, nurses, frontline workers have experience with COVID-19 now. They're better trained, they're better experienced. We know, and they know from the hard work that they have dealt with to save lives. Earlier testing means earlier access to clinical care. It means checking that oxygen level in that individual quicker, it means providing oxygen quicker when needed. It means providing ventilatory support, if necessary, providing dexamethasone for people who are severe and who are critical and all of that saves lives. We're getting much better at actually dealing with patients and treating patients and caring for them, which are leading to more positive outcomes. The one thing we worry about, and I know we've said this many times, one of the things that we worry about, it's not just numbers of cases. It's not just hospitalizations and deaths. It's about all of the long-term impacts that we are starting to see in individuals who have even had a mild infection, a mild disease. Dr. Maria Van Kerkhove: (32:59) We are only now starting to really learn of the long-term impacts on the heart, on the brain, on the lungs, on mental health, on people's ability to recover from COVID infection. Not only do we need to work very hard at reducing mortality, and we are seeing the benefits of that, we still need to reduce the numbers of infections that we are seeing. Again, we come back to all of the tools that are in place to be able to do this. We can do it all. We can do this all together because we are all in this together. It's about individual measures that we take to protect ourselves and having the enabled environment for us to take those, to protect ourselves and our loved ones. Fadela: (33:40) Thank you. I would like now to invite a reporter from The Independent. No, I think we will come back to [inaudible 00:33:55] from The Independent later on, if he's still online. I would like now to invite Stephanie [inaudible 00:34:03] from Writers. Stephanie, can you hear me? Stephanie: (34:07) Yes. Thank you for taking our question. I wondered whether as you probably know, Australian researchers today said in a study that was published earlier today that the SARS-CoV-2 virus can survive on bank notes and glass and stainless steel for up to 28 days, which is of course, quite a bit longer than the flu virus. What can WHO say about the transmissibility from such surfaces, please, over such long periods of time. Do you have any increased concerns or new advice following this study that was published today? Thank you. Fadela: (34:48) Thank you, Stephanie, and we'd like to invite Dr. Van Kerkhove to take this question. Dr. Van Kerkhove, you have the floor. Dr. Maria Van Kerkhove: (34:55) Thanks. Fidela thanks, Stephanie, for this question. Yes. We're aware of this study that was published. This was an experimental study that was looking at the SARS-CoV-2 virus. It looked at samples that had very high viral loads. There are other studies that have been done under experimental conditions. Of course, we look at those studies to look at our advice and look at how we make recommendations for disinfectants, and what the study found it was done under experimental conditions. Not real-world conditions, it was done in the dark, which means it didn't have any UV lights of what you would see under normal, real-world type situations. It found that the virus could remain viable for 28 days at 20 degrees Celsius and 24 hours at 40 degrees Celsius. It looked at different types of surfaces, like glass and stainless steel and paper and polymer bank notes. Dr. Maria Van Kerkhove: (35:48) We use this information to look at our disinfectants. The good news is that this virus can be disinfected with disinfectants, with chlorine, with different types of very, very quickly. We know that fomites or touching of contaminated surface is one of the ways this virus can transmit. What we worry about is if someone is infected and they release the virus and it falls onto a surface, if it isn't disinfected and someone touches that surface, and if they don't wash their hands or use an alcohol-based rub, if they touch their eyes or their nose or their mouth, they can infect themselves that way. Dr. Maria Van Kerkhove: (36:24) We continue to recommend these basics. We continue to recommend that there's environmental cleaning that is happening in areas where there's known patients, of course, in hospitals and in homes where people are being cared for, but also making sure that we disinfect surfaces regularly. Again, there's good news that disinfectants like bleach work very well at removing the virus. They're very highly effective of killing this virus. The measures remain in place, hand hygiene, carry your alcohol-based rub, make sure that you use it because that will clean your hands and remove the virus from your hands before you can infect yourself. Dr. Michael Ryan: (37:09) Just on that, the very basis of hand hygiene, and I go back to the old soap and water argument as well. Soap and water is probably one of the most effective public health interventions that's ever been invented because it does everything from getting rid of all kinds of bacteria, all kinds of viruses on your hands and prevents the spread of any number of diseases from cholera to Corona viruses. I think the having access to soap and water, having access to hand sanitizer and coming back to those basic messages that we've been speaking about for months since the very beginning about hand hygiene and not to forget hand hygiene, and I've seen this myself and I personally witnessed it, and I'm very, very pleased to see the adherence to masks and to physical distancing. Then I've witnessed many times, people have access to hand hygiene stations going in and out of shops or public transport, and they don't tend to use it because they've made an association that in some way this disease is only spread through droplets or only spread through another means. Dr. Michael Ryan: (38:17) In fact, this disease can be spread through contamination of surfaces however long those surfaces are contaminated for. It's very, very important that we continue. Again, Digi has spoken about this many times, do it all. That includes hand hygiene, that includes washing your hands regularly, as regularly as you can, not so easy for many people in the world who don't have access even to soap and water to be able to do that. That is a huge injustice in the world. Not only for the case of coronavirus, but for so many other diseases. I would just say to everybody, hand hygiene is a major part of coronavirus control. This study only reinforces that. We'll see, as Maria says in the long-term, the implications of this and other studies are, but the message is wash your hands often with soap and water or use de-sanitizer or sanitizer when you can. Fadela: (39:15) Thank you very much. I would like now to invite Sophie from SABC, South Africa, Broadcasting Company. Sophie, can you hear me? Sophie: (39:26) Yes. I can hear you. My question is directed to Dr. Ryan and Dr. Tedros. We have a situation where most countries are currently going to elections. For example, on the continent, you have Ivory Coast, you have Tanzania in two weeks time, you also have the United States of America. There you look at what leaders are doing in terms of their rallies and their campaigns. They have these large numbers. Are you not worried that this will lead to [inaudible 00:40:01] outbreaks? Dr. Michael Ryan: (40:07) Elections do many things. They're an essential part of our lives, and they are absolutely central to how many societies live, survive, and thrive. They're very important parts of the cycle of life. However, they do tend to bring people together. We've seen many examples over the last nine months where elections have actually been held very safely and with appropriate measures and have been straightforward enough to manage and implement. It takes effort. We've worked very closely in the past in the same way we've done for all types of mass gatherings. We've worked on a risk management approach. You cannot reduce the risk to zero, but what you can do is identify and manage those risks, especially where in-person voting is the choice of the country. We don't specify to any country what the proper choice is for the type of election they need to run, that is based on their own risk assessment. Dr. Michael Ryan: (40:59) We do offer them advice on how to reduce those risks if in-person elections are the way forward. In fact, we're working right now and finalizing specific guidance for countries who choose in-person elections, learning from the last eight, nine months as to what has worked in those circumstances. We'll be issuing that guidance in the coming days. It's a very important question, but like any form of gathering, any form of social process at society level, it is possible to manage them and reduce risks to an absolute minimum if everybody participates and if everybody adheres to what is an agreed method and agreed practice. The problem very often is when those practices are ignored and that's essentially something that can't be legislated for, but it is possible to hold safe elections if the proper measures are put in place. Fadela: (41:55) Thank you, Dr. Ryan, I would like now to invite Simon Atiba, Africa News Today to ask the next question, Simon, can you hear me? Simon Atiba: (42:08) Yes. I can hear you. Thank you for taking my question. [inaudible 00:42:11] from Today News Africa in Washington DC. I know it's really hard for WHO to talk about specific members, especially the US, and especially President Trump and especially 22 days to an election, but on Thursday last week, 11 days ago, he tested positive for coronavirus. He's gone back on the campaign trail. I was wondering first, how long is, according to WHO guideline, how long does the virus stay in the system? When does he know there is no more a risk to other people, especially because he has not done a second test that has proven that he's tested negative? I was also wondering if, what is the best way to go back on the campaign trail after testing positive for coronavirus? Thank you. Dr. Michael Ryan: (43:07) Well, I mean, that's a lot of questions and there's certainly not the personal physicians to anyone in the world and not like to make a comment on specific individuals. What we can say is that the US Public Health Services have very clear criteria in place for what represents the release of an individual from what might be isolation due to being infected and the criteria in the US, Maria Mayo [inaudible 00:43:39] very clear. From WHO's perspective, we allow both testing and duration of number of days since the onset of symptoms. Both approaches are used by WHO are offered to our member states as mechanisms. I believe Maria, it's 10 days from the onset of symptoms and plus three days from the onset of the last or the cessation of the last symptoms. Again, all countries have adapted that according to their national protocols. Therefore, we wouldn't comment on whether any specific individual meets the requirements of their national protocol. Maria. Dr. Maria Van Kerkhove: (44:16) Thanks. Yes, so I can tell you yes, exactly what Mike has said. For symptomatic individuals, it's it's 10 days from the time of symptom onset, plus the three days of symptom resolution, meaning no fever, no respiratory symptoms. We also have criteria for asymptomatic individuals, but what we do is we work with countries all over the world. We work with labs all over the world to look at when people test positive using PCR testing, but also looking at virus isolation from those individuals. There are a handful of studies that have been underway. We've outlined our understanding of the science in a scientific brief on this, which is on our website. We are continuing to work with labs who are following patients and individuals over time. This is a body of work that is very important for us. We work with the ... Dr. Maria Van Kerkhove: (45:03) ... and so this is a body of work that is very important for us. We worked with our counterparts in the US as well. Fadela: (45:09) Thank you so much. I would like now to invite Bayram Altug from Anadolu News Agency for the next question. Bayram, can you hear me? Bayram Altug: (45:19) Yes, I can hear you. Thank you, Fadela, for taking my question. And good evening to everyone. [foreign language 00:45:27] good news from WHO about the COVID- 19 vaccine. From WHO perspective, where do we stand with the vaccine development as number of countries says they are on the cusp of having successful vaccine like China, Russia, USA, UK, and today Turkey? So when will we get a safe and effective vaccine at the earliest? What is your latest update on this? Do you have any good news for us today? Thank you. Fadela: (45:53) Thank you, Bayram. I would like to invite Dr. Swaminathan to answer this question. Dr. Soumya Swaminathan: (46:00) Yes. Thank you for that question. And we've of course continued to track the development of vaccines, and it's really very encouraging to see the progress in the clinical trials happening all around the world. As you know, we have about 40 vaccine candidates now in some stage of clinical trials and 10 of them are in the phase three trials, which are the late stage clinical trials, which will tell us about both the efficacy and the safety. So the best that we could make a guess or predict looking at when a trial started and when it is likely to have enough data to submit to the regulators, the earliest is starting from December of 2020 into the early part of 2021. We expect a number of clinical trials to start providing data for regulators to look at. And this is going to be a lot of data for regulators and also the WHO. Dr. Simão's here. She may want to add. But we also put out a call for expressions of interest from vaccine developers to submit whatever data they have to us. And so have a rolling submission and update us, but unless we see results from phase three trials. So as I said, the majority of the ones which are currently in phase three trials will be reporting in the early part of 2021 and beyond. It will continue because many others are going to enter into phase three over the next few months. So the good thing is we'll have a number of different vaccine trial results that we will be looking at over a period of the next, I think, six to 12 months, and then both regulatory agencies and the WHO will have to make decisions on either emergency use authorization or on regular licensing of the vaccines depending on the data set that they're able to provide. So I think in the first quarter of 2021 is when we are going to see most of the data coming in. Thanks. Fadela: (48:07) Thank you, Dr. Swaminathan. I think Dr. Simão would like to add some information. Dr. Mariângela Simão: (48:13) Yes. Thank you Fadela. And thank you for the question. I think there are other issues that will come into play as well. Dr. Swaminathan referred to the regulators part. Once you finalize a phase three trial, this vaccine will need to be licensed if it proves positive both on the safety side and the efficacy side. This vaccine will have to be licensed in the country where it's been experimented, where the trial took place. And we also have the manufacturing capacity. It will need to be available to be used at country level. So there are many, many steps that need to be taken after the phase three trial actually ends. WHO is working very closely with the national regulatory authorities like Dr. Swaminathan referred to. Dr. Mariângela Simão: (49:15) We issued an expression of interest for the emergency use listing of a vaccine. And we are accepting any producer, any candidate vaccine that's in phase 2B, or phase three. And we expect this will help to move the process faster as we get the doses and we start to analyze not only the efficacy and safety, but we work at the same time with a good manufacturing capacity at each of this vaccine producers, right? So that when the vaccine is finally concluded the trials, we do have a clear vision of the quality assurance of the product that will come to the market. So I think that we will be ready when we are ready, but we are getting there. Thank you. Fadela: (50:10) Thank you, Dr. Simão. I would like now to invite Gabriela Sotomayor from El Proceso to ask the next question. Gabriela, are you online? Gabriela Sotomayor: (50:21) Yes. [foreign language 00:50:23]. Thank you very much for taking my question. I would like to know about the forecast in Mexico. The first wave is not over yet. The cases are still in the rise. Few tests are done. There are more than 80,000 deaths, but it's possible that there are three times more death. So Mexico is one of those 10 countries that Dr. Tedros just mentioned. So I would like to know what recommendations do you have? And there is also another serious problem because about 1000 children with cancer have died due to the lack of treatment. A problem that began to appear in public hospitals before the pandemic. So that is the situation. I would like to know what is your recommendation and your forecast for the country? Thank you. Dr. Michael Ryan: (51:19) Hi, thanks. The situation in Mexico obviously remains difficult. Until October the 10th, we're over 814,000 cases and over 83,600 deaths from COVID. Again, I think putting it in context, I think nearly half of all the confirmed cases have come from Mexico City and the State of Mexico, Nuevo León, Guanajuato and Sonora. So in that sense, there's been a big impact in certain areas. About a quarter of the patients reported to us have required hospitalizations. And there's been a preponderance of males over females, about 52% to 48%, but not such a great preponderance. Again, many people like we've seen all over the world have had underlying conditions, including hypertension, diabetes, obesity, were the main associated conditions there. Dr. Michael Ryan: (52:26) And Mexico has been running this traffic light system, a three level traffic light system. And interestingly, many other countries have adopted similar traffic light systems in the last number of months. Mexico was one of the first countries in the Americas to introduce that traffic light system. And we would support Mexico in continuing to do that. Health personnel have been very much affected in Mexico. And again, predominantly 60% reported in females, which probably represents the fact that health workers in Mexico are predominantly female themselves. 48% of the cases in nurses, about a quarter of the cases in doctors and another quarter in other health professionals in Mexico. Clearly, protecting those health workers is very important and our power office have obviously continued to recommend to Mexico to continue the training, protection and provision of equipment to frontline health workers in Mexico. Again, the same issues arise in terms of that shift of disease into younger populations. There have been issues in the past on the testing strategy and the amount of testing done. But I'd also like to commend Mexico. It's had a large bump in cases over the weekend, just before the weekend, because it's actually changed a lot of its definition of cases, not to reduce the of cases, but to actually capture more cases, particularly those who weren't tested. So Mexico now considered cases who are epidemiologically associated with the confirmed case to be cases and the same with deaths which actually puts Mexico in a situation where it will tend to report more cases than elsewhere. And it is to be commended for its transparency on that. So I would say yes. Dr. Michael Ryan: (54:19) And no more than many other countries in North, Central and South America, no country is out of the woods. Mexico continues to be in difficulty. And it is very tragic to hear you're reporting on cancer patients. And we've seen this impact around the world on oncology services around the world, outpatient services and others for essential care. In many ways and I think the DV has said this many times before, COVID, to an extent, has caused some of these problems, but it's also revealed huge inequities in the system. As you said, many of these issues may have been present before. So Mexico, no more than every country in the world has serious inequities in the way healthcare is delivered and the way healthcare is paid for. And it is tragic to hear in any country that children would die unnecessarily from treatable cancers. Fadela: (55:13) Thank you, Dr. Ryan. We are up to the hour now. I would like to invite Dr. Tedros for final comments. Over to you, Dr. Tedros. Dr. Tedros Adhanom Ghebreyesus: (55:24) Thank you. No, thank you. Thanks Fadela and thanks also to all who have joined today and see you in our next presser. Thank you. Fadela: (55:36) Thank you, Dr. Tedros. Just reminding journalists that we will be sending the audio file and Dr. Tedros remarks right after the press conference. The full transcript will be posted on the WHO website tomorrow morning. Sorry for journalist I wasn't able to take question from for time constraints. Don't hesitate to contact us. Thank you so much and see you soon.