World Health Organization (WHO) Coronavirus Press Conference July 10

Margaret Harris: (00:31) Hello everybody. This is Margaret Harris welcoming you to a WHO press briefing from Geneva. Thanks for your patience on this Friday, July 10. Today we want to tell you about something really exciting, a new and exciting initiative called the Access Initiative For Quitting Tobacco, to help over one billion tobacco users quit and reduce the risk of COVID-19. Margaret Harris: (00:57) The lineup, will be led by, of course, the WHO Director General, Dr. Tedros Adhanom Ghebreyesus, followed by Her Royal Highness Princess Dina Mired of Jordan, the President for the Union for International Cancer Control and a global advocate for tobacco control. She'll be followed by Mr. Thibaut Mongon, Executive Vice President, Consumer Health, for Johnson & Johnson. Margaret Harris: (01:29) Then after hearing about this new initiative, we'll move to our regular COVID 19 press briefing, so without further ado for us to begin proceedings, Dr. Tedros, you have the [inaudible 00:01:43]. Dr. Tedros: (01:43) Thank you, Margaret. Good morning, good afternoon, and good evening. Today WHO is launching the Access Initiative For Quitting Tobacco, which aims to help the world's 1.3 billion tobacco users quit during the pandemic. This initiative will help people freely access the resources they need to quit tobacco, like nicotine replacement therapy and access to a digital health worker for advice. Dr. Tedros: (02:16) Smoking kills eight million people a year, but if users need more motivation to kick the habit, the pandemic provides the right incentives. Evidence reveals that smokers are more vulnerable than nonsmokers to developing a severe case of COVID-19. The project is led by WHO together with the UN Interagency Task Force on Noncommunicable Diseases, and brings together the tech industry, pharmaceutical, and NGO partners, like PATH and the Coalition for Access to NCD Medicines & Products. We thank our first manufacturing partners, Johnson & Johnson Consumer Health, who donated nearly 40,000 [inaudible 00:03:06]. Dr. Tedros: (03:06) We are also pleased to introduce Florence, the world and [inaudible 00:03:13] first ever digital health worker [inaudible 00:03:19] intelligence. Dispels myths around COVID-19 and helps people personalize [inaudible 00:03:31]. Florence is available 24/7 via video streaming or texts to help people access reliable information. Florence was created with technology, developed by San Francisco and New Zealand-based company, Sol Machines, with support from Amazon Web Services and Google Cloud. Dr. Tedros: (03:52) WHO is in the final stages of adding more partners and encourages pharmaceutical tech companies to join this initiative, which will help people reduce their risk of COVID-19 and lead healthier lives. We will first launch the initiative in Jordan, and then roll it out globally over the coming months. Dr. Tedros: (04:19) To tell you more about this initiative, I would like to introduce my sister, Her Royal Highness Princess Dina of Jordan. Princess Dina is a longtime friend, the President of the Union for International Cancer Control, and a lifelong advocate for global tobacco control. You have the floor, Princess. Princess Dina Mired: (04:43) Can you hear me? Thank you Dr. Tedros for this innovative and lifesaving initiative. COVID-19 has required us all to don masks. And yet at the same time it has unmasked [inaudible 00:05:08] truths. One of those glaring truths is that smoking tobacco in all of its forms, electronic and non-electronic, has shown us no benefits whatsoever to its users. It depletes one's health, one's heart, and puts the user in the highest risk group for not only contracting COVID-19, but also in spreading it, as well as not being able potentially to fight and survive the virus due to higher vulnerability to severe complications. Princess Dina Mired: (05:44) I thank you, Dr. Tedros, from the bottom of my heart for your leadership for not only facing off with the coronavirus, which is a Herculean task to say the least, but also in not neglecting the so-called underlying conditions, noncommunicable diseases, NCDs, such as heart disease, cancer, lung disease, and diabetes. The epidemics that remain the major causes of preventable deaths in the world totalling over 40 million in 2016. Princess Dina Mired: (06:17) On the contrary, Dr. Tedros, you are maintaining and doubling down on our work to prevent and control those epidemics and the risk factors that cause them, starting with tobacco that is set to kill a billion this century if we don't do something about it. Jordan, my beloved country, has unfortunately been one of the many countries on the target list of the global tobacco industry, the latter which lost its markets in developed countries and now are doubling their efforts in ensnaring and owning the lungs of our youth to consume their deadly product. Princess Dina Mired: (06:57) According to a national survey in 2019, this has resulted in the deadly statistic of 80 [inaudible 00:07:04] percent of our men over 18 smoke tobacco or e-cigarettes. One of the highest in the world. 60% of our [inaudible 00:07:18] ages of 13 to 15 are addicted. Not only does this impact families, it costs the country a great deal of money. In 2015, smoking cost Jordan 1.6 billion Jordanian dinars, including money spent on tobacco and smoking-related diseases, and other NCDs. Princess Dina Mired: (07:42) That is why I am beyond pleased that Jordan will be the first country to launch the Access Initiative For Quitting Tobacco. This emphasizes the fact that smoking addiction is a disease that needs to be treated, thus de-stigmatizing smokers who often feel blamed and shunned for their own addiction despite the fact that we all know that most users are victims of the tobacco industry's well-known tactics to trap the youth before they reach maturity and adulthood. This initiative would also have Jordanian's access the information and tools they need to quit. I hope Florence speaks Arabic, by the way, but also offers them the nicotine replacement therapies and medications necessary to aid them in their journey of quitting and starting to lead healthy lives. Princess Dina Mired: (08:36) Jordan is a proud party of the framework convention on tobacco control and has a strong group of grassroots NGOs fighting for tobacco control. I might say most of them are women, just an FYI, that is shaking the [inaudible 00:08:53] and improving step by step the enforcement of the [inaudible 00:08:58]. Just last week the government of Jordan adopted the ban of smoking indoors in public places. The link between smoking [inaudible 00:09:05] is essential for governments to pass [inaudible 00:09:08] laws that will protect the health of their people [inaudible 00:09:13] and beyond. We must do [inaudible 00:09:18] ... the government can show that Jordan is investing in tobacco control measures and saving lives. [inaudible 00:09:25] based on FCTC and WHO's empowered, like banning tobacco use in public spaces. Princess Dina Mired: (09:33) I would like to thank WHO again, and for you Dr. Tedros personally, for leading this innovative initiative, and all of our partners for their support, including Johnson & Johnson for the significant donation of nicotine patches. This will help thousands of people overcome their addiction to nicotine and support them in their journey to a healthy life free of addiction. Thank you, Dr. Tedros again, for your leadership. We are so proud of you and we are thinking of you day in, day out, for all your efforts on fighting the COVID-19, and on making sure that we don't lose ground all the gains we did in public health. Thank you for everything. Yes, I feel so honored that you also call me your sister and a friend, and I feel the same. Thank you for Johnson & Johnson. Thank you. Margaret Harris: (10:31) Thank you so much, Princess Dina, for those really powerful words and the great news about the actions being taken in Jordan on tobacco control, and also for your support for the work against COVID-19. Margaret Harris: (10:46) I'd like to introduce Mr. Thibaut Mongon, the executive vice president [inaudible 00:10:49], chairman, consumer health, for Johnson & Johnson. Mr. Mongon, you have the floor. Thibaut Mongon: (10:49) Hi everyone. We are very, very pleased [inaudible 00:11:09] today for this important event. At Johnson & Johnson we are committed to change the trajectory of health or humanity, as we all are today. In this initiative, we really help people quit smoking. This is a very important public health milestone. It was made possible through the close collaboration between public and private partners. This is, I believe, what makes its potential to succeed even greater. When we hear Princess Dina, when we hear Dr. Tedros' and WHO's commitments, I have no doubt that this program is going to be very successful, starting with Jordan, but expanding well beyond Jordan in the future months. Thibaut Mongon: (12:02) As we all know, good health is impossible without access to the right tools, we just heard about AI, and the right products. In terms of smoking cessation, we know that one simple patch of nicotine replacement therapy can change the trajectory of the health of a smoker. This is what we're talking about here. One smoker at a time that with a commitment to a large scale impact, allowing smoker to change the trajectory of their own health. This is what all of us at Johnson & Johnson are very excited about, this program's ability to make a difference. It will require, as always, a commitment from all of us, many different place, the [inaudible 00:12:53] WHO, government, NGOs, industries, but now, with COVID, we really need to rally behind this to change the trajectory of the health of people around the world. Thibaut Mongon: (13:14) With this objective in mind, Johnson & Johnson Consumer Health is proud to build upon changes, longstanding collaboration with the WHO, and participate to the program with a donation of free products for smokers in need. We are really committed to continuing to provide access to Nicorette nicotine replacement therapy around the world, because we know that so many people around the world need our help to quit smoking and get access to better health, a better life, and a better future. Thank you to all participants, and thank you for your unwavering commitment to this very, very important initiative. We are counting on all of you to make it very successful. Margaret Harris: (14:05) Thank you so much, Mr. Mongon, for all that you're doing to help smokers beat this terrible addiction. Now, I don't know if you're as curious as me, but I'd like to know who this Florence is, and we now have a video, which I'd like to entitle The Unmasking of Florence. Video: (14:22) Does nicotine help protect you from COVID-19? Video: (14:25) There is currently insufficient information to confirm any link between tobacco or nicotine in the prevention or treatment of COVID-19. Nicotine replacement therapies, such as nicotine gum and patches, are designed to help smokers quit tobacco. Would you like to hear another COVID-19 myth buster? Video: (14:41) Sure. Dr. Tedros: (14:41) Yeah. Thank you, Margaret. That's our first ever digital health worker, which will give all the support people need. She is available 24/7. Thank you so much, my sister, Princess Dina, and also thank you to Dr. Mongon. We really appreciate it. Thank you for joining us. Dr. Tedros: (15:25) Now back to COVID-19. Today the world recorded 12 million cases. In the last six weeks, cases have more than doubled across all walks of life. We're all being tested to the limit. For those in poverty, with little or no access to quality health services, it's not only COVID-19 that threatens lives and livelihoods. Other diseases, like measles, polio, and malaria, all thrive when immunization is paused and supply chains for medical supplies are interrupted. WHO continues to work with partners to ensure that the poorest and most marginalized are prioritized. That means we're starting routine immunization and ensuring that medical supplies each health worker across the world. Dr. Tedros: (16:27) There's a lot of work still to be done. From countries where there is exponential [inaudible 00:16:33] to places that are [inaudible 00:16:34], and now we see cases rise We need community participation and collective [inaudible 00:16:44]. Only aggressive action combined with unity and solidarity [inaudible 00:16:56]. There are many from around the world that have shown that even if the outbreak is very intense, it can still be brought back under control. Some of these examples are Italy, Spain, South Korea, and even in Dharavi, a densely pocket area in the mega city of Mumbai. Dr. Tedros: (17:22) A strong focus on community engagement and the basics of testing, tracing, isolating, and treating all that are sick is key to breaking the chains of transmission and suppressing the virus. As we continue to tackle the pandemic, we're also looking into the origins of the virus. Two WHO experts are currently en route to China to meet with fellow scientists and learn about the progress made in understanding the animal reservoir for COVID-19 and how the disease jumped between animals and humans. Dr. Tedros: (18:05) This will help lay the groundwork for the WHO-led international mission into the origins. For all the challenges that COVID-19 has posed, it has also shown the way forward for other challenges that threaten humanity. The paces of growing microbial resistance is slow motion [inaudible 00:18:32], but despite the rise in resistant infections and development of new antibiotics. Unless we take quick and [inaudible 00:18:46], we risk a doomsday [inaudible 00:18:50] common injuries. Illnesses return to become major killers. Dr. Tedros: (18:54) The AMR action fund aims to tackle this by strengthening and accelerating the research and development of antibiotics through game-changing investments into biotechnology companies around the world, whether it's COVID-19 or AMR, the best shot we have is to work together in national unity and global solidarity. I thank you. Margaret Harris: (19:25) Thank you so much, Dr. Tedros. I'll now open the floor to questions. Do remember, as usual, we will be providing simultaneous translation in all six UN languages, and also Portuguese. If you prefer to ask your questions in any of those languages, please do. You may also listen in Hindi, but you cannot ask your questions. Note, owing to the way this room is set up, you will need to go to the button marked Korean to access Arabic. Margaret Harris: (19:54) With Dr. Tedros, we have our usual experts, Dr. Maria Van Kerkhove, Technical Lead for COVID; Dr. Mike Ryan, Executive Director Emergencies; and joining them is also Dr. Rita Director of Health Promotion, who can answer your questions about the Access Initiative For Quitting Tobacco. Without further ado, I will go to the first question, and that is for Sarah Wheaton from Politico. Sarah, please unmute yourself. Go ahead. Sarah Wheaton: (20:25) Yes, thank you very much for taking my question. It's about the timing of the independent review panel that you've announced. When we've asked about the World Health Assembly, Dr. Tedros you said you would initiate the review when all the conditions we meet are actually met, and Dr. Ryan, you needed that these are [inaudible 00:20:48] over. Furthermore, the independent oversight and advisory committee for the WHO emergencies program said in their interim report, that while they recommended a review, they said, and I'm quoting, conducting such review during the heat of the response, even in a limited manner, could disrupt the WHO's ability to respond effectively. Dr. Tedros, what conditions that you said needed to be met have now been met, and Dr. Ryan and Dr. Tedros, are you concerned about the effect on the response of the review happening? Thank you. Dr. Michael J. Ryan: (21:29) Yes, I can begin. Well, first of all, we're very used to in certainly the Emergencies Program in WHO of a constant process of operational review, both during and after events, and that's reviewing how our operations are running so we can improve those operations. That's a very important part of our DNA in terms of optimizing the impact that we have at country level. Dr. Michael J. Ryan: (21:55) The Independent Oversight and Advisory Committee also reports to our governing bodies, as you know, to the executive board and to the World Health Assembly on a six-monthly basis, and, again, reviews all of our operations on the ground. This evaluation that has been mandated by World Health [inaudible 00:22:18], asking the Director General to carry out an independent evaluation, that is the will of the member states of WHO. We believe that he has been constructed in good faith to learn the lessons [inaudible 00:22:33] it is presented as both [inaudible 00:22:37] interim linked from the response of [inaudible 00:22:42]; therefore, the first part of the review is to [inaudible 00:22:46] about the response, how we have all performed in this at global and national level, and how we can learn to optimize the response going forward. However, obviously a review of this nature and with the seniority of the panel members, or the panel chairs, we'll work with the member states- Dr. Michael J. Ryan: (23:03) ... Panel members or the panel chairs will work with the member states now to identify further panel members to join that panel. And it will be they that will set the pace for that review, and they will consult with the member states. Again, they will consult and work with the director general to ensure that the pace and nature of the evaluation does not interfere with the day to day response. And I trust, given the seniority of the two wonderful leaders that have been chosen, I believe that they and the panel members, the member states, and the director general of WHO will find the appropriate pace and the appropriate approach that will allow us both to learn the lessons of this response at all levels, but at the same time, not to interrupt or disrupt what is a very important pandemic response right now. Interpreter: (23:50) [foreign language 00:00:52]. Dr. Tedros: (23:53) Thank you. Thank you. I think Mike had already said it all. The decision in the resolution by the assembly was at ... Earliest appropriate time, and it gives the responsibility actually to me, which is very important so that we can have a balancing act. So ... evaluation then affect ... The response, and that's why the members ... very specific. They say at the appropriate ... And we felt that starting it now ... We help us to understand ... How the whole response is happening. And as Mike said, we will continue to make sure that the evaluation actually doesn't affect the response, and we will balance as much as possible. Dr. Tedros: (25:06) So it's a matter of a balancing act, and we have very able two co-chairs now, and then the panel members also, we expect them to be the best people we can really have. And all member states will be involved in contributing to the panel members and candidates. Of course, it will be up to the co-chairs in consultation with me to select the members, and I think that will also hopefully help us in balancing the capacity of the panel itself. And there will be an independent secretariat. We're not going to use a WHO secretariat for the panel. Meaning, we will have additional member that will work on this, not only the panel, but the independent secretariat too. So we will do everything to balance it, but as the independent oversight committee said, it's also our concern that ... We meet the evaluation ... Would have some effect, but we will do everything ... In order to learn as we go. Interpreter: (26:27) [foreign language 00:03: 30]. Margaret: (26:31) Thank you, doctor. Our next question comes from Antonio ... EFE, the Spanish news wire. Antonio, and please, you're welcome to ask in Spanish if you prefer. Please unmute yourself and go ahead. Antonio: (26:47) Good afternoon. Can you hear me? Interpreter: (26:48) [foreign language 00:03:50]. Margaret: (26:52) Very well, please go ahead. Antonio: (26:54) Okay. Yes, I will make my question in English, if I may. [foreign language 00:26:59]. Interpreter: (27:23) [foreign language 00:27:26]. Dr. Michael J. Ryan: (27:30) I think that's a fundamentally important observation actually, and I think that it was to be expected. And I think we, and many other scientists around the world have said that once lock downs were ended, that there was always the risk that the disease could bounce back. Because if the virus is present, it will potentially take all opportunities to transmit. Our advice has been, I think, quite consistent in advi' ... Countries, number one, to open up slowly in a stepwise fashion, to wait between different phases of reopening, to ensure that the data on the virus is clean, and clear, and tells you where your problems are ... To be ready to move backwards, forwards depending on what ... And to accept the fact that ... Situation. Dr. Michael J. Ryan: (28:26) It is unlikely that we can ... Eliminate this ... They are very particular environments ... Island states, other places. But even they risk re-importation, and we've seen countries who have managed to get to zero or almost zero, re-import virus from outside. So there's always a risk, either from within or from bringing disease back in. And therefore, it is a given that there was always a risk of further cases. The transmission that occurs in that situation can be singled sporadic cases, which can be relatively easily isolated and quarantined. A more worrying pattern is large clusters of cases that could occur in association with super spreading events, events in which there are large crowds gathered, the virus is present and you get a small explosion of cases, which can very quickly mushroom into a much larger case. It's very analogous to a forest fire, a small fire. It's hard to see, but it's easy to put out. A large fire is easy to see, but very difficult to put out. So you really need a system where you can detect the small flames, the small embers that may be there. You can detect a small fire and put that out by good surveillance, by good detection, by aggressive testing, and then by isolating cases, quarantining cases. Dr. Michael J. Ryan: (29:47) Throughout all of this, and I think this is probably a very central message, that when the virus is present, there is a risk of spread. The authorities can have surveillance in place. The authorities need to ... Isolation, quarantine, all of those others which isn't testing ... It comes down to communities and individuals, and how we protect others. When the virus is in your ... It is quite clear that there are things ... Do to reduce the risk of those infections, and it ... Powered, that they have the knowledge to be able ... Pretty strong partnership, a trusting partnership between communities and authorities. A trusting partnership based on honesty, based on transparency, based on regular information that everybody can trust, and based on a sustained effort by everybody. Dr. Michael J. Ryan: (30:43) It is very tough right now. It is very tough for everyone to maintain the kind of vigilance that people are being asked to maintain. It is tough. It's not easy, but we have to be able to sustain that. So, if we want to avoid, after lockdown, having major epidemics, we need to watch out for the small clusters and we need to extinguish those clusters quickly. We all need to remain vigilant. We need to remain vigilant with our physical distancing, with our hygiene, with mask wearing in the appropriate settings. Dr. Michael J. Ryan: (31:15) In that situation, we can potentially avoid the worst of having second peaks, and having to have to move backwards in terms of lockdown. It is also, and you've seen this in a number of countries, are managing to deal with clusters and with flare ups by having limited geographic lock downs. Locking down small areas in order to ... The disease. And I think it is a matter of scale. Countries can and should be able to contain the disease through those measures. Dr. Michael J. Ryan: (31:45) We all want to avoid whole countries going back into total lockdown. That is not a desire that anybody has ... There may be situations in which that is the only option ... This is a fundamental question right now for everyone, for every ... It is going to require ... It's going to require a lot of trust. It's going to require clear messaging. It's going to require a huge investment of ... Public health effort, and a massive investment in community empowerment, and the capacity of us as individuals in our community, is to act and to stay safe ... Maria, you may want to add. Interpreter: (32:23) [foreign language 00:32:26]. Dr. Maria Van Kerkhove: (32:29) Thank you Mike, yes. So ... I think this is something we all need to anticipate ... There could be a resurgence. There could be small outbreaks ... Have been advising is, in these situation ... Fast, to act comprehensively. Use the public health infrastructure that you have in place. Many countries have worked incredibly hard to improve the infrastructure that's in place, to be able to find cases, test cases, isolate cases, very quickly. And if they have symptoms, if they develop disease, to ensure that they are cared for appropriately, in the appropriate facilities, to put contact tracing to the test, carry out contact tracing as comprehensively as possible. Quarantine the contacts so that you break those chains of transmission and inform, inform the communities often, regularly, honestly, thoroughly, because the situation is evolving and we know how quickly these embers can really turn into these forest fires. Dr. Maria Van Kerkhove: (33:29) And with that hope, that if restrictions need to be put in place, they're put in place temporarily, they're put in place in a limited geographic region, only to help, and that they're not put in place for long periods of time. But it is possible that these small outbreaks, that these small clusters can be prevented into being turned into large outbreaks. And we've seen this time and time again. So it is possible. And as Mike has said, and as we have said, be part of the response. Everyone has a role to play. If you're asked to stay home and you can stay home, please do. If you're feeling ... Well, stay home. Call your healthcare provider to find out, call the hotline ... The next steps that you need to take, because everybody ... Play a part in this, and it will take some time while we take some ... How to get through this together, but it is ... But we have tools ... Place, and governments have ... Communities have worked very hard. Individuals have worked ... Need to put those tools in use again ... Margaret: (34:34) Thank you Dr. Ryan and Dr. Van Kerkhove. The next question comes from [Ben Chen 00:00:34:39] from Shanghai Media Group. Been, if you wish to speak, ask your question in Chinese, we've got the translation service. So, please do. Interpreter: (34:48) [foreign language 00:11:49]. Ben Chen: (34:50) Hi. Thank you. I think I will continue to ask my question in English. Thank you for taking my question. So my question is a followup regarding the independent panel. We currently know that the panels two chairs are selected, and they could choose other panel members. So I would like to ask, how many more panel members will be selected, and experts in which areas are the panel and the WHO exactly looking for? For example, policymakers, medical professionals, or specialists in public health. Thank you. Interpreter: (35:19) [foreign language 00:12:20]. Dr. Tedros: (35:22) Yeah, thank you. So the number of the size of the panel, there was some discussion of course, but not yet decided. And the co-chairs will decide finally, as they see fit. And then the panel members, of course, will be a mix of professionals. And again, this will be up to the co-chairs after developing the ... Reference, based on the terms of reference to select people ... Fit into the term of reference ... Start out going to be, and one ... Start actually working ... This assignment. Interpreter: (36:17) Merci. Margaret: (36:19) Thank you Dr. Tedros ... Comes from Jacqueline Howard from ... Jacqueline please unmute self and go ahead. Interpreter: (36:27) CNN. Jacqueline Howard: (36:29) Yes, thank you for taking my question ... We've noticed reports circulating about a pneumonia in Kazakhstan that may be, "Deadlier than COVID." That's what some of these reports are saying. So I wanted to ask if this is something that WHO is investigating, or can there be any more information shared about whether these reports are accurate, or whether this is something on your radar? Thank you. Dr. Michael J. Ryan: (37:00) Yes, this is certainly on our radar and we've been tracking COVID-19 across all of Europe, and particularly in the Central Asian republics, including Kazakhstan. On July the fifth, Kazakhstan went back into a lockdown as COVID-19 cases have actually spiked. So the first lock down was from March 16th until May the 11th. The second lockdown is expected to last two weeks. As of July the seventh, we have just under 50,000 cases reported of Kazakhstan, with 264 deaths. Dr. Michael J. Ryan: (37:37) There are a number of explanations that can explain the reported rise in the number of pneumonias in Kazakhstan, and we're working with the authorities there to investigate. More than 10,000 barratry confirmed cases of COVID-19 have been reported by national authorities over the last ... The big surge in actual COVID cases itself ... We're looking at the actual testing and the quality of the ... But there haven't been false negative tests for some of those other pneumonia ... Tested negative, and that's likely to be ... In many ways the ... Cases, males ... Will also be COVID-19, they just have not been diagnosed correctly. Dr. Michael J. Ryan: (38:31) But again, that remains to be seen and we're also working with the authorities there to look at X-rays and review X-rays, and look at the patterns of the pneumonias to make sure that they're consistent with COVID-19. So, while we believe that many of these cases will be diagnosed as COVID-19, we keep an open mind. We're working very closely with authorities. Our team on the ground is working very closely with the authorities there to track this, and ensure that, that is the case. Dr. Michael J. Ryan: (38:59) There are clusters of atypical pneumonia. It can occur anywhere in the world at any time. It can be caused by diseases as wide ranging as Legionella, chlamydia, influenza, and other things. So there are all those other potential causes for clusters of atypical pneumonia, and we always keep an open mind until we have definitive diagnosis. But the upward trajectory of COVID-19 cases in the country, would suggest that many of these cases are in fact, undiagnosed cases of COVID-19. But as I said, we keep an open mind until we have an absolute confirmation of the diagnosis of these clusters. [crosstalk 00:39:38]. Interpreter: (39:38) [foreign language 00:16:39]. Margaret: (39:41) Thank you Dr. Ryan, and now we have a question from Helen Branswell from STAT News. Helen, could you unmute yourself and please go ahead? Interpreter: (39:48) [foreign language 00:39:49]. Helen Branswell: (39:50) Hi, thanks very much for taking my question. I think ... Mike, could you give us an update on the ... Outbreak in Equateur Province in DRC. Thank you. Interpreter: (39:59) [foreign language 00: 17:02]. Dr. Michael J. Ryan: (40:06) Yes Helen, I will and what we'll do ... Another question and I'll come back on that ... You some numbers. You're a numbers person. So I can give you the ... Give you maybe a more specific numbers driven answer in a few minutes. So if you could take the next question, and I'll just pull out the numbers for Helen. Margaret: (40:30) Thanks. Helen, so I'll put you at the end of the queue, but you will definitely come back to you. Okay, so now we have a question from Shoko Koyama from NHK, Japan. So Shoko, could you unmute yourself and go ahead? Shoko Koyama: (40:45) Hi [Margaret 00:17:45], can you hear me? Margaret: (40:47) Very well. Please, go ahead. Shoko Koyama: (40:49) Okay, thank you for taking my question. So my question is regarding the airborne transmission. According to the scientific brief released yesterday, airborne transmission of the virus can occur in health care settings, and some [inaudible 00:41:06] related to indoor crowded spaces, have suggested the possibility of aerosol transmission. Based on the evidence you have so far, do you recognize the airborne transmission as a realistic danger in our daily lives? And what's your recommendation to the general public? Thank you. Interpreter: (41:26) [foreign language 00:41:27]. Dr. Maria Van Kerkhove: (41:29) So thanks for the question. And yes ... So you've highlighted a scientific brief that we published yesterday on ... Transmission of COVID-19 and the SARS-COv-2 ... That causes COVID-19, and in the scientific brief, it's not a guidance document. It's a brief, which summarizes all of ... Literature and evidence that we have about how the virus ... Transmitted, when the virus transmits between ... At least for their infection, and what's means in terms of ... We look at droplet, we look at aero' ... We look at fecal-oral. We look at lots of different modes ... To do this, is consolidate everything that we know about this virus. It's not a systematic review, and there's new literature being published and being released every single day. So this is a living review. We call this a living review, which means it will be updated regularly. Dr. Maria Van Kerkhove: (42:24) Within the brief we talk about droplet and we talk about aerosol. Your specific question is about aerosol transmission, and aerosol transmission is one of the modes of transmission that we have been concerned about since the beginning, particularly in healthcare settings, where there are known to be these medical procedures called aerosol generating procedures, where we know that these droplets can be aerosol-ized. Which means that the particles could stay suspended in the air for longer periods of time. In those situations where the health worker is actually carrying out those procedures, and for people working in those areas, we recommend airborne precautions, which is a certain type of personal protective equipment for health workers. Dr. Maria Van Kerkhove: (43:03) Outside of healthcare settings, there is the possibility that there could be aerosol-ized particles in specific settings, like indoor settings, where there are crowded conditions, where there's poor ventilation, and where people are spending prolonged periods of time. And so what we've seen, is that there are some outbreaks that have been reported in these closed, indoor settings with poor ventilation, which include what you had mentioned, the nightclubs, which have included ... Fitness centers, where airborne transmission cannot be ruled out. Dr. Maria Van Kerkhove: (43:37) In those outbreaks there could also be ... Droplet transmission and full might, with the contaminate surface transmissions ... We are calling for is more systematic research to be done in these types of settings. So it's not just how when ... The settings in which they happen. So we need a much ... These particular settings and the outbreaks that are happening ... So transmission is happening. In terms of everyday life, we recommend a comprehensive set of packages which include physical distancing, which does include hand hygiene and respiratory etiquette, which includes the use of fabric masks when you cannot do physical distancing, and to ensure that when you have these close settings, that you have good ventilation. Dr. Maria Van Kerkhove: (44:23) So it's a combination of packages, but the dominant routes of transmission from all of the available evidence, and our understanding in working with large groups of different disciplines collectively, is droplet and contact. Although, there may be other modes of transmission, which we don't rule out. So we have requested, and we will be through our R&D blueprints, which we began working on since February, is to accelerate research in this area, to make sure that we have well conducted studies, so that we could better determine the different roles of transmission, different modes of transmission, and so that all of the advice that we give is as up to date as possible. Interpreter: (45:05) [foreign language 00:22:06]. Margaret: (45:08) Thank you very much, Dr. Van Kerkhove. Now I have a question from Simon Ateba from Today News Africa, who I understand has a burning question about smoking and COVID. Simon, please go ahead. Simon Ateba: (45:22) Thank you for taking my question. This is Simon Ateba from Today News Africa in Washington DC. My first question is on pregnant women and it goes to Dr. Maria. I was wondering if WHO knows how the virus affect pregnant women and how it ... Affect their babies. If you allow me, I also would like ... How if there is a correlation between COVID and smoking, and if smoking makes things ... Thank you. Interpreter: (45:57) [foreign language 00:45:58]. Dr. Ruediger Krech: (46:01) Yes, perhaps I can start talking ... Dr. Ruediger Krech: (46:03) Yes, perhaps I can start smoking. We know that if you're a smoker [inaudible 00:46:10] of developing more severe symptoms for COVID are higher. We know that the way you can attract COVID is not yet established whether there is a combination with smoking at all. So what you can say is, if you're a smoker, you should stop smoking straight away because of the likelihood of having more severe symptoms. Dr. Van Kerkhove: (46:42) Do we take the second question? Okay. You snuck a second question in there. Yeah. So thank you for your question about COVID-19 and pregnant women. Of course, we are always concerned about COVID-19 in any population, and of course, in particular pregnant women. What we understand from the studies, this is something our clinical management team looks very closely at, and within our clinical guidance, we have specific recommendations for pregnant women. Dr. Van Kerkhove: (47:11) We understand that among women who are pregnant, they don't seem to develop a different type of disease than women of the same age who are not pregnant. However, there are some studies that have come out recently that have looked at pregnant women with underlying conditions. And if there are women with underlying conditions, they are at a higher risk of developing more severe disease. And so, this is something to ensure that we keep a close eye on and ensure that pregnant women have the right care throughout their pregnancies. Margaret: (47:41) Thank you very much, Dr. Van Kerkhove. So now we have a qu- [inaudible 00:01:45]. Jameel, please go ahead with your question. Jameel: (47:50) Yes. Can you hear me, Margaret? Margaret: (47:53) Please go ahead. Jameel: (47:54) Very good. Thank you very much for... We have seen in the last couple of days President Bolsonaro taking proudly his chloroquine. My question to you, did anything change in terms of studies? Or are you still sticking to the point that actually this drug, at least so far, has not shown any kind of evidence in terms of science? What is your position in terms of taking chloroquine, not to reduce medical hospitalized days, but as for example, President Bolsonaro's taking at the moment? Thank you very much. Dr. Michael J. Ryan: (48:45) It's difficult to comment on any specific individual use of hydroxychloroquine. And we have said many times previously that hydroxychloroquine should be used in the context of COVID only under strict medical supervision. And we would assume that that is the case in this case. Dr. Michael J. Ryan: (49:05) The findings regarding hydroxychloroquine for hospitalized patients do not demonstrate differences in mortality, although there are lots of different studies out there. And at present, WHO does not advise its use in hospitalized patients on the basis that the drug has not clearly demonstrated the benefits to those who take it. But that is then for [inaudible 00:49:37] to make determinations regarding the use of the [inaudible 00:49:42] on an off-label basis. [inaudible 00:49:46] see from our randomized control trials and other observational studies. And in the end, it is for national authorities to determine what the use of the drug is in their context. And it is then obviously for individual clinicians to [inaudible 00:50:01] use that knowledge in the treatment of their patients. Dr. Van Kerkhove: (50:05) Thank you very [inaudible 00:50:09] And, now I have a question, Gabriela. Gabriela, please unmute yourself and go ahead. Gabriela: (50:15) [foreign language 00:04:23] Dr. Michael J. Ryan: (51:07) I think it's difficult to predict the trajectory of any epidemic in countries at the moment. But certainly Mexico now has, I think the fifth highest COVID-19 death toll and has had record breaking days in the last week recording nearly 7,000 cases on a single day, with it's total cases now passing a quarter of a million. Mexico at the same time is in the process of reopening. And in that period, the number of cases has increased significantly. And again, this is a pattern we've seen in many [inaudible 00:05:53] opening economies [inaudible 00:00:51:58] community transmission and lead to an [inaudible 00:52:03] that is not unique at all to the [inaudible 00:52:06] . And Mexico, like other countries is balancing [inaudible 00:00:52:10] demands immunities to get back to work and [inaudible 00:52:14] with the significant risks of increased and intensified and accelerated COVID transmission. Dr. Michael J. Ryan: (52:27) So I think from the perspective of Mexico, Mexico and other countries in this situation, may face increase and a continued increase in cases over time. Because as I said in previous intervention today, if the virus is present, if the virus is transmitting efficiently at community level and communities continue to mix and engage in normal activity and public health surveillance is weak, in that situation. And there's not the ability to identify cases quickly as Maria has said, investigate quickly. If these two things don't work together in concert. And if you reach a point where the number of cases exceeds the capacity of the public health system, to chase down the context in cases, exceeds the capacity of the health system to cope with the number of severe cases, then we're right back where we started in February and March with systems effectively failing in the face of the pressure of the number of infected. Dr. Michael J. Ryan: (53:24) We need to try and avoid that. And again, the question in a country [inaudible 00:53:29] that is Mexico and many other countries like, is to really look this on a national level, see where the virus is under control and where [inaudible 00:53:36] continued reopening [inaudible 00:53:38] continue to understand where your hot spots are, where you may have to slow down or reverse path to that reopen by public health surveillance, intensify communications [inaudible 00:53:49]. And again, it comes down to a certain extent, [inaudible 00:53:53] be consistent and clear messaging [inaudible 00:53:58] authorities from those and others. Dr. Michael J. Ryan: (53:59) We must be honest with our communities about the spread of the disease in our communities. We must communicate that risk appropriately, and we must give people the information they need to maintain proper social distance, to engage in proper personal hygiene, to wear masks were appropriate. And we must support our communities in doing that and consistently message that in an inappropriate way. Dr. Michael J. Ryan: (54:24) Again, it is difficult for countries, especially when the individual economic consequences to individual families are negative. If you cannot go to work and you cannot earn money and you cannot feed your family, there is a huge consequence from that. And we fully understand the pressures that people themselves are under. And we fully understand from that the pressures that governments are under. But we have to find a way to balance these two most important issues. We have to find a way to balance the COVID-19 acceleration against the economic reopening. Because it's very, very clear from a look from a number of countries that opening in a situation where you have intense community transmission and weak public health response leads to a difficult situation that may push the whole country back in terms of the progress that it makes. And that is not inconsequential and blind, reopening, not associated with [inaudible 00:55:25] process based on data, based on the local community, may not lead to where everybody wishes to go and that's Mexico included. Margaret: (55:37) Thank you, Dr. Ryan. The next question is on COVID [inaudible 00:55:39] This one comes from Jim [inaudible 00:09:43]. Jim from [inaudible 00:55:45] Radio News. Jim, please go ahead. Jim: (55:50) [inaudible 00:55:50] his question though, that I typed to you, that I was happy if you would just pass it along to yourself, that would have been fine, but I appreciate this. I realize this is one of those stupid questions because I think the answer is obvious. But I'll ask it anyway. The question was, with COVID-19 and smoking, her Royal Highness said that people who smoke are more likely to contract the virus and also more likely to spread it. So my question was what's the spreading aspect of it? Is it because the virus can linger in smoke? Is it because of exhale factors? Is it because when you smoke you don't wear a mask? And I realize it's probably all of the above. But if I'm wrong, you can answer it. If not, then I guess Dr. [inaudible 00:56:32] can answer the Ebola [inaudible 00:56:33] question. Thank you. Dr. Ruediger Krech: (56:38) I can take you there. As I said, it leads to more severe disease and that is the main cause. And that's why, at the moment we know that 618 million people want to quit smoking. And we know that about 400 million, that's our latest estimate, will try to stop smoking. And that's the good news. So that with today's initiative, we hope that we will be successful in really helping [inaudible 00:57:13] to succeed in this. So that's actually the [inaudible 00:57:17] that we have. Margaret: (57:26) Thank you very much Dr. Krech. I have a question from Kai [inaudible 00:57:30] and then we'll [inaudible 00:57:33] questions. Kai, please go ahead. Kai: (57:38) Thanks. Actually, my question has already been asked, so let me use the chance to just ask about how the way forward is looking in terms of treatments. I mean we obviously have some negative results on some experimental treatments. Is it becoming clearer what the next ones are that need to be tested because I think we're kind of getting to that second phase? Dr. Van Kerkhove: (58:08) I can start and perhaps Mike would like to supplement on this one because that's a big question that you asked and it's a good one. What I can say is with our clinical management network and also know within the R&D blueprint, we know that there's a number of therapeutics and drugs that are currently under evaluation. And those clinical trials are underway. There's a lot of small trials and of course we have the solidarity trial that is underway. What the clinical network is doing and with R&D partners is, working with those that are carrying out those clinical trials to follow them in real time. Because many of them are small, there are possibilities that we could try to combine the data coming in from some of those studies so that [inaudible 00:58:51] a quicker answer to these questions. I don't have any specifics on which one is the next one because that's the trillion dollar question here. Dr. Van Kerkhove: (59:01) But I think there are a number of therapeutics that will cover different aspects of the disease. Whether they are the prevention of developing [inaudible 00:59:24] or preventing people from dying, but there are a lot that are [inaudible 00:59:24] There are a huge number of clinical trial. Mike do you [inaudible 00:59:24] Dr. Michael J. Ryan: (59:25) Thank you. You said it all. I think the [inaudible 00:59:30] who came together last [inaudible 00:59:31] essentially that same view. There are lots of existing therapies. We're seeing even more today more data suggesting that some existing therapies for other diseases may have some impact. I think this is important. We continue to find potential treatments in the drugs we already have. And being able to pick the best of those candidates and bring them into the solidarity of other trials is very important. And that's why the solidarity, recovery and discovery trials were designed as multi arms. They allow us and other partners in the UK, France and other places, across many, many countries, to bring in new drugs into that armory of potential drugs. Dr. Michael J. Ryan: (01:00:10) The bigger question is new molecules and new drugs that are being discovered because they obviously have a much longer pathway to be used in humans. The advantage we have with existing drugs is that many of them have strong safety profiles and are already approved for use in other diseases. And they can be relatively easily introduced in randomized control trials against COVID because we already have a strong clinical and safety profile for those drugs. Dr. Michael J. Ryan: (01:00:39) Other drugs, new molecules that are developed have to go through the whole rigor of the scientific, the safety, the discovery process. And it takes much longer to bring those drugs into randomized control trials because they have to go through primary safety studies first. And that does slow down the process as those molecules become available. But like I said there are many, many, many of those molecules currently in development. Dr. Michael J. Ryan: (01:01:09) And there are other treatments like [inaudible 01:01:11] already being used in trial [inaudible 01:01:18] antibodies that I think show [inaudible 01:01:18] used molecule antibodies to very, very good effect in Ebola in Congo. And I think they've been ground breaking in reducing mortality, both [inaudible 01:01:28] antibodies have been highly successful in reducing fatality and have transformed the way we manage Ebola as a disease in the field. So I do think there are some potential platforms, types of drugs out there that may result in a much faster cycle to get those diseases to all people who need them. Dr. Michael J. Ryan: (01:01:49) But again, it's a complex area and what we're really, really pleased with is the level of collaboration between institutes, between clinicians, between hospitals, between every different kind of physician, doctor, nursing organization out there. We've seen today, fantastic information summarized on the neurologic impacts of these disease. We've seen other fantastic summaries of the cardiovascular impacts. And what we're seeing, I think, is one of the fastest accelerations of knowledge of the pathophysiology and the impact of this disease. And that in itself is providing very interesting insights for what we're treating. Dr. Michael J. Ryan: (01:02:38) So when we look at a drug like Dexamethasone currently in trials, we can attack this virus in two ways. We can attack the virus by treating the virus. In that sense trying to use drugs that will impede the virus' capacity [inaudible 01:02:42]. But we also have [inaudible 01:02:45] the impact of the virus by [inaudible 01:02:47] the immune response to the virus in certain stages which prevents our systems overreacting and dampening down inflammation. We also [inaudible 01:02:57] various interventions underway using some other drugs that may prevent some of the blood thinning impacts. So we [inaudible 01:03:06] itself or treat virus itself or [inaudible 01:03:10] a tremendous amount of good work. We understand the disease and its impact and where we can [inaudible 00:17:18] not just to be used in future. Dr. Michael J. Ryan: (01:03:22) So I'm very hopeful in terms of the levels of collaboration, the levels of innovation that are underway. And I'm very confident that we will find therapies over time. And I think it bodes well for the future of emerging diseases in general, in general for our ability to collectively deal with pandemics. One of the most important things in dealing with a new disease is to gain an understanding of how that virus or how that disease operates in the human body. And understand how it impacts human organs, how it spreads, and how it affects the immune system. The more we understand that and the more rapidly we understand that, the more we create the space for the innovators in the pharmaceutical and the pharmacology side of things to develop the counter measures that we need. Dr. Michael J. Ryan: (01:04:02) So I'm actually, while we're desperately needing more therapies. I believe the world probably, at this point could not be doing more collectively in order to develop those counter measures that we need. Dr. Van Kerkhove: (01:04:19) Sorry, to give a specific example of this science solutions and solidarity, one of the things that we're looking into, and Dr. Janet Diaz mentioned this the other day, is actually trying to operate a new model of working together. And we've reached out to a number of PI's that are working on a specific therapeutic, for example. So that they can work with us on a prospective meta analysis where they agree to share data on their individual trials. And we can actually pool [inaudible 01:04:45] and we do these analysis as the trials are still going, so that we are learning and that we are able to understand how these therapeutics work. So that when we need to adapt our guidance, if we need to adapt our guidance, that could be done in real time. And that's a new model of working. As Michael said, this is incredible [inaudible 01:05:06] be able to agree to hare this. [inaudible 01:05:09] So it's something that we are trying. It's something we are working very hard [inaudible 01:05:13] and we're very grateful to PIs that have agreed to do this with [inaudible 00:19:18]. Margaret: (01:05:18) Thank you Dr. Van Kerkhove. So we're well over the hour. And I'd like to update the numbers for [inaudible 01:05:25] offline, if that's okay Helen. I'll be in contact with you. I'll just hand over to Dr. Tedras for any final words. Dr. Tedros: (01:05:39) Thank you, thank you Margaret and thank you to all for joining. And see you on Monday. Thank you. Speaker 1: (01:09:00)