World Health Organization (WHO) Coronavirus Press Conference June 1

Dr. Tedros: (00:00) ... in public health all around the world. It is WHO's wish for this collaboration to continue. I thank you. Tarik: (00:13) Thank you very much, Dr. Tedros, for these remarks. We will now go for session of questions and answers. I will remind journalists to be concise, to ask only one question so we can take as many as possible. I would also like to acknowledge and thank interpreters who here with us and who will make sure that a journalist can answer their questions in six UN languages plus Portuguese, and also listen to answers in those languages. So if we are technically fine with starting with questions, I will call on Helen Brownsville first from Stat News. Helen? Helen Brownsville: (00:52) Hi, thanks very much for taking my question. Dr. Tedros, can you please tell us what the process is for a country to withdraw from the WHO? I don't believe there's anything in the constitution that spells out a mechanism for withdrawal. Can you please explain? Dr. Tedros: (01:16) Thank you. I think for the moment, what I have said in my speech would be enough. And for the process, if you need additional information, we can do it some other time. Thank you. Tarik: (01:34) Thank you very much for that. We will go now to Cameron Cosimo from Azerbaijan. Cameron, do you hear us? Cameron Cosimo: (01:46) Do you hear me? Tarik: (01:48) Yes, Cameron. Cameron Cosimo: (01:49) Hello. Greetings from Azerbaijan, from LTV. My question to Dr. Tedros, because he claimed about that. We got information one hour ago, a record number of countries are now monitoring and reporting on antibiotic resistance marking major step forward in the global fight against drug resistance, but that [inaudible 00:02:13] provide reveals that the warring number of bacterial infections are increasingly resistance to the medicines at hand to save them because as [inaudible 00:02:22] Republic, Azerbaijan, we need more information about that, Dr. Tedros, please. Dr. Tedros: (02:30) Thank you, maybe- Cameron Cosimo: (02:30) Dr Tedros, please. Dr. Tedros: (02:34) Thank you, Cameron. I think Professor Balkhy may add here. Professor Hanan H. Balkhy: (02:39) Thank you very much for the question. And I'd like to also refer to Dr. Tedros is a summary also few minutes ago about the problem with antimicrobial resistance. I think it is one of those entities that are extremely difficult to identify, and we're very happy that we've at least have started the first steps in releasing the glass report, the third edition of the glass report, where 66 countries from 22 countries in 2018 have provided data on the amount and types of resistance they have to certain antibiotics to certain pathogens. And I think that step is extremely important. So we can look into the magnitude of the problem within the different countries, and we hope that more will engage. But I do want to emphasize that the problem with AMR or antimicrobial resistance is that it's very unlike many of the other entities. Professor Hanan H. Balkhy: (03:38) It's a mechanism that can be applied in many different pathogens. So we would not be able to strictly identify it in every single pathogen, although we hope to reach that point. The solutions for antimicrobial resistance, as you might want to understand, for each country, it's going to be very different. It's one of those problems that have been tackling high, mid, and low income countries, and the stimulators for resistance in each of these countries is very different. And that's why the WHO has taken a big step in trying to address this issue in a customized fashion, in a multi-sectoral fashion in each country, where we would support with technical advice for the countries on how to mitigate those issues, whether it's over use in the human world, through misusing patients, or in the agriculture side. And also to try to understand how to improve the issues of hygiene so that we do not replace good hygiene, whether it's infection prevention control in the human side or hygiene in the animal side, by the excessive use of antimicrobials. So the problem is very complex and we will be working with the countries on trying to find ways of improving it in each specific country as needed. Thank you. Tarik: (05:05) Thank you very much. This was Professor Hanan Balkhy, who is our Assistant Director General for Antimicrobial Resistance. Now we will go to Antonio from [inaudible 00:05:16] News Agency. Antonio, can you hear us? Antonio: (05:20) Yes. I can hear you. Thank you for taking my question. I would like to ask about what we know already about the lasting effects of COVID-19 on people, namely those who have been hospitalized and put in ICUs, and how should health authorities keep following these people in the intervening months? Thank you. Dr. Maria Van Kerkhove: (05:42) So thank you for this very important question. Yes. As you know, millions of people now have recovered from COVID-19 infection and we are starting to follow them more systematically. As we've outlined in our update to the management guidance that we published last week, we now have a section specifically on the rehabilitation for patients with COVID-19. What we know from those that are infected so far globally is that the vast majority of people who have had COVID-19 infection will recover without problem. There will be some individuals who have had severe disease or more severe disease or critical disease that have been in hospital for prolonged periods of time. They may have had intubation, they've had severe pneumonia. They may have had toxic shock. They may have had quite some serious, serious disease, and these individuals may have a longer effect. Dr. Maria Van Kerkhove: (06:36) And so what we need to do is follow them over time to understand how they recover and what longterm care, if any, they need. So we're just starting to learn from this, from the patients who have recovered, and we hope to be able to have a more systematic way we could provide care for those that leave hospital. Tarik: (06:59) Thank you very much Dr. Van Kerkhove for this answer. Now we will go to Kai [inaudible 00:07:05] from Science. Kai? Kai: (07:09) Hey Derek, thank you very much for taking my question. I just wondered whether one of you, maybe Dr. Tedros, might want to address some of what we're seeing in the US. So obviously, these street protests have raised the fear that they could lead to more spread. At the same time, people have pointed out that the systemic racism that is being protested here is in itself a public health crisis. And I wonder whether you have any comments on how to balance these things. Dr. Maria Van Kerkhove: (07:45) So Kai, thank you for this important question. I won't speak specifically about any particular events, but what we can say and what has been highlighted in the DG speech today about mass gatherings in particular is that with increasing social mixing and people coming together, particularly in areas if the virus is not under control, that close contact between people can pose a risk. And at the heart of our guidance that we've published recently on mass gatherings are supporting the people who are organizing those, whether these are mass gatherings for sport or for religious events, for any other reason, to ensure that those who plan those undertake a very serious rigorous risk assessment, which looks at the local context, which looks at the transmission intensity in that area. What we know about the virus, where it's circulating, and about the potential activity that would take place during that event. Whether it's a number of people or the proximity of people together, to make sure that the system is in place to keep people separated. Dr. Maria Van Kerkhove: (08:50) Physical distancing remains a very important aspect to control and suppression of transmission of COVID-19. This is not over yet. And we need to ensure that in locations that are considering these events, mass gathering events, that you have a system in place to prevent and detect and respond to any such cases. And so we are here to support those who are planning mass gatherings events, and to ensure that that planning takes place in a rigorous way. Tarik: (09:24) Maria, thanks for this. Next question goes to South Africa Broadcasting, and we have a Sophie with us, Sophie McKenna. Sophie, can you hear us please? Sophie McKenna: (09:37) Can you hear me? Tarik: (09:38) Yes, please. Go ahead. Sophie McKenna: (09:40) Yes. I want to ask a Dr. Tedros. Dr. Tedros, currently we see African countries beginning to ease the measures that they took earlier on to fight this COVID-19, the issue of lock down, Africa in particular today, starting with level three, having children going out some of them to schools, even though that decision has been [inaudible 00:10:10]. What is your advice to African countries who have started with process of easing down the lock down in particular when you look at the sub Sahara region? Dr. Michael Ryan: (10:26) I can begin and possibly Dr. Tedros will supplement. I think that the advice is pretty much the same as we have given across the whole pandemic for countries. In exiting lockdown, and we understand the countries in exiting lockdown are trying to put economies back on track, trying to bring social cohesion and social interaction back. And that's laudable. What we've asked for as a careful stepwise approach that each move is measured. And the impact of the release of measures is measured in a way that we can see any increase in cases. And if necessary, reapply measures. We've also said that you have to replace lockdown with something else. And we've said consistently, I think, and Dr. Tedros has said this on many occasions, we need to have a strong, empowered community who are educated and participating in the response willingly and are able to sustain a new normal, able to sustain the new behaviors, the new behaviors around physical distancing, hygiene, and other things. Dr. Michael Ryan: (11:36) We have to have a strong public health response. And I would South Africa in the way in which it's energized and mobilized its community health workers for both community education on surveillance, the way that the capacity to detect, test, and trace has increased across South Africa through the use of mobile clinics and mobile teams. And that measured approach allows countries to come out of the so-called lockdowns and replace lock downs with a more comprehensive set of public health and social interventions that will allow us to live in a more sustainable way with this virus until we reach a point where we have vaccines or other interventions that may eventually allow us to eliminate the virus. Dr. Michael Ryan: (12:20) That though being said is a difficult challenge for many countries, particularly in the South where the concepts of social distancing, of hygiene, of surveillance are difficult to achieve, especially when many people live in poverty and overcrowded conditions where those objectives are hard to reach. So we need the external world, other countries need to provide all support possible, particularly to countries in Africa to achieve those goals in terms of being able to support communities, support surveillance, and support the health system to cope. But we believe progress has been made in Africa. In general, we've seen a stabilization of the situation. However, in some countries the disease continues to be on the rise and therefore we have to be very, very careful and ever vigilant over the coming weeks and months. Dr. Tedros: (13:22) Yeah. Thank you. Thank you, Sophie. And nice to hear your voice. I just would like to add, of course, Mike had covered your question. But just to add, first of all, one thing, which was very important that Africa did, was the meeting in February that helped of the Ministers of Health that helped develop the continental strategy. And aligning national plans and strategies with the continental strategy. And then, the other important development was- Dr. Tedros: (14:03) TG. And then the other important development was the creation of the coalition of leaders by President Ramaphosa who is the current African Union Chairperson, and also the leadership by the African Union Commission Chairperson, Dr. Moussa Faki. And then the other important step was the social distancing in Africa, the social distancing measures actually started while the number of cases where were low. So it was done as early as possible. I think that helped in slowing the epidemic. Now, the issue is Africa is again starting to open up. So when it opens up, the recommendation from WHO is, it has to be a phased approach, and South Africa is doing that and many countries are doing that. It has to be a phased approach. And at the same time, we need to continue to strengthen especially the case identification, tracing and other public health measures, especially the involvement of the community and mobilizing community health workers to be involved as Mike said, which is happening in South Africa and in other countries, and really strengthening that part and following the development seriously and strictly. Dr. Tedros: (15:52) So based on changing situations to take measures, for instance, some of the measures which are taken in opening up can be reversed if there are challenges. For instance, South Korea did that when it opened up and then started to see some clusters of cases, then started to take action, social distancing, which is tailored to that. So the vigilance and the strict follow up will be very important. But of course, as Mike said, I understand and I'm from Africa, how difficult it is to implement some of the social distancing measures. But based on the situation, adapting to the situation, taking the maximum measures you can take, will be very, very important. So thank you again, Sophia, and look forward to continue to talking to you. Speaker 2: (16:53) Many thanks Dr. Tedros and Dr. Ryan. Next question comes from BBC. We have Naomi online. Naomi please go ahead. Hello, can we hear Naomi from BBC? Can you unmute yourself please? Naomi- BBC: (17:15) Hello. Sorry. I would like to ask about these reports from Italy, that doctors there have suggested coronavirus is somehow losing potency. What do the panel make of that? Dr. Maria Van Kerkhove: (17:33) So thank you for the question. I'll begin and perhaps others would like to supplement. So what we are learning about this virus in terms of its transmissibility and in terms of its severity. These are the two major features we've been talking about since the beginning. In terms of its transmissibility, the thing we measure is the reproduction number. How many cases, secondary cases can one case infect. And that reproduction number naturally is above two, which means it has an epidemic potential to take off if we allow it to. What we've seen across a number of countries is that that remains true. But, there is the ability for this virus to cause what the DG mentioned today, are these super spreading events, which take place in closed facilities or in situations where you have very close contact with people. And that we've seen across a number of countries and I would argue in all countries. The other thing we look at when we think of potency and we think of is the severity that this disease causes. And consistently, this virus CoV-2 virus, the virus that causes COVID-19, causes a range of illness in people that it infects consistently across the globe. Where the majority of people have a more mild infection, some have a moderate infection with pneumonia, and then about 20% of individuals will have a severe disease. That is consistent. So in terms of the transmissibility, that has not changed. In terms of the severity, that has not changed. But what I think is important and what these scientists may be talking about, because I haven't seen that particular report, is that there are measures that we can put in place to reduce transmission, to suppress transmission. And this includes finding, testing, isolating, caring for all cases, tracing and quarantining all contacts, ensuring that we have a mobilized and engaged public, ensuring that we have an all of society, all of government approach. Dr. Maria Van Kerkhove: (19:31) These fundamentals that we've talked about from the beginning remain consistent, remain the plan. And we know that early treatment, early identification, early oxygen support when needed can save lives. And so these are the things that I think can reduce the potency, that can reduce the power of this virus. But if we let the virus go, it will transmit. If we let the virus go, it will infect people and it will cause severe illness in and about 20% of the people. So the important message is that there are things that we can do to suppress transmission and to save lives. Dr. Michael Ryan: (20:07) Just supplemental. I think we've said this many times. All new observations are very important and should stimulate further inquiry. New viruses in human populations can do one of two things. They can evolve and become less pathogenic, or sometimes they can become even more pathogenic. It is not in the interest of obviously of the virus to kill everybody that it infects because the virus can survive better if it can transmit from person to person. And we see this with many of the illnesses, the childhood illnesses we have. Well, we need to be careful. This is still a killer virus and there are still thousands of people everyday dying from this virus. So, we need to be exceptionally careful not to create a sense that all of a sudden the virus by its own volition has now decided to be less pathogenic. That is not the case at all. Dr. Michael Ryan: (21:03) We also need to respect the fact that many people have fought very hard at community level, health workers and others to suppress this virus. And it may be, and we have to look at this, and look at the various hypothesis for what our colleagues in Italy are observing. But it may, in some ways have something to do with the dose and length and intensity of exposure. Because we do know with other viruses and other diseases that the dose and length and intensity of exposure can affect the severity of an illness. In other words, the absolute amount of virus you're exposed to can determine how severe ultimately your illness can be. And that has been proven with other diseases. We don't know that that's the case in the case of COVID-19, but it may not be that the virus itself is becoming less potent. It may be that we are as a community and as a globe successfully reducing the number, intensity and frequency of exposure to that virus, which on the face of it, the virus then looks weaker, but it may be weaker because we're doing better not because the virus itself is weakening. Dr. Michael Ryan: (22:11) I hope the virus is weakening. We all hope that. But we cannot at this point, take that chance. And we have to continue to do the things we're doing. But we will speak to our colleagues in Italy and in other places. It is always important to take any observation on this virus seriously, to inquire, to create a scientific dialogue, and certainly not to be negative about any hopeful message, but at the same time, we need to be realistic and be driven by facts. Dr. Soumya: (22:42) And just to add to that. There is a huge global collaboration of scientists that share the genomes of this virus from around the world and currently in this publicly available database called [inaudible 00:08:57]. We have over 32,000 whole genome sequences of this virus from all parts of the world and scientists are regularly updating their knowledge on the mutations that are happening, and we expect mutations to occur because this is a virus and all RNA viruses, there are constantly some mutations happening. So scientists are tracking what these mutations mean. And so far there's been no correlation with either transmissibility, or with potency, or in fact with any mutations that are interfering with either diagnostic tests or with vaccines that are being developed targeted to the spike protein. So I think this kind of a global database that scientists from around the world can access, can collaborate on, is very, very important and useful for us to study the changes in the virus and then correlate it with some of these clinical and epidemiological questions. Thank you. Speaker 2: (24:01) Many thanks Dr. Swaminathan, Dr. Ryan and Dr. Van Kerkhove. We'll go to our next question. It's NHK Japanese broadcaster. We have [inaudible 00:24:10] with us. [inaudible 00:24:11] Speaker 3: (24:12) Can you hear me? Yes. Thank you for taking my question. So regarding the announcement by the United States Dr. Tedros, when were you officially informed by the United States of their intention of [inaudible 00:10:26]. Thank you Speaker 2: (24:32) I think this question has been dealt with [inaudible 00:24:34]. I don't know if Dr. Tedros wants it? Dr. Tedros: (24:38) I think we have answered the question already. And the announcement was last Friday as we all heard from the media. And the only communication we have or announcement was actually that Friday's media announcement from the US. Speaker 2: (25:00) Many tanks. So I think this question has been answered. So let's try to get Antonio from FA, Spanish news agency. Antonio I think just to let everyone know that we have a little issue on streaming on our social media platforms. While it still goes on on the Zoom, if I understand correctly. So for all those who are watching us on LinkedIn, Facebook, Twitter, hopefully we will get back soon. But in the meantime, we will continue with the press conference and those who are on Zoom and who are still with us. So let's try to get Antonio from FA. Antonio. Antonio: (25:53) [foreign language 00:11:55] Dr. Soumya: (26:22) So maybe I can start. So the WHO's Solidarity Trial has four treatment arms compared to the standard of care and one of them is hydroxychloroquine. So the week before last, there was a publication that came out, which was an observational study in a large number of patients, that concluded that the risk of death is higher among COVID-19 patients who received hydroxychloroquine or chloroquine either alone or in combination with a macrolide antibiotic compared to those who did not. As you know, the Solidarity Trial is governed by a steering group. And the executive committee met urgently to consider the implications and decided that while the bata safety monitoring board is looking at the data from the trial, that it was safer to protect patients from any possible harm, to actually temporarily suspend enrollment into the hydroxychloroquine arm of the Solidarity Trial. Dr. Soumya: (27:29) So it was a temporary suspension. The data safety monitoring board is looking at our own data, and we should have that information within the next 24 hours or so to make a decision. Meanwhile, we do know that there's another large trial going on in the UK called the RECOVERY Trial, which has enrolled more than 11,000 patients. Their data safety monitoring board looked at the hydroxychloroquine arm versus the standard arm, and did not find anything to concern them. And they are actually continuing with their enrollment. So- Dr Swaminathan: (28:02) ... with their enrollment. So to answer the other question of countries using hydroxychloroquine, we have always believed that it's important to generate data on safety and efficacy of any of these treatments. Because this is a new disease, we do not have the evidence. We want to try, of course, treatments as quickly as possible, but the best way, and the only really robust way of generating evidence is to do well designed randomized trials, which enroll enough patients to make a definite of conclusion on safety and efficacy. Hydroxychloroquine has been proposed both for the treatment and for the prevention of COVID-19, but really we need to wait for results from the randomized trials to know whether it's effective in either or both situations. Until then, doctors who are prescribing it do so basically under a sort of a compassionate use protocol, which needs to abide with the laws and regulations of the country concerned. But we hope that the trials that have already started will continue to enroll and we'll be able to answer these questions definitely because that's going to be really, really important. Thank you. Dr. Maria Van Kerkhove: (29:25) If I could just add something, not specifically on the hydroxychloroquine. I just want to point out that while the world is looking for therapies, looking for antivirals and other therapies specific for Covid-19, there is supportive treatment that is available for patients, and I think that's an important message that we need to continue to push out. Because people with pneumonia, people with severe pneumonia, people with acute respiratory distress syndrome, people with septic shock, people who need oxygen and respiratory support, we have guidance that's out to work with clinicians where we've learned from frontline clinicians who are dealing with Covid-19 patients and how they're dealing with patients now before we have that treatment. We want the treatment. We want a safe and effective treatment and these clinical trials are underway. But until we have that, there is some supportive care that is out there and that clinicians can use. Dr. Maria Van Kerkhove: (30:19) In addition to that, we are working with, ensuring that healthcare facilities and health facilities have the right equipment to be able to care for patients depending on the severity of their system, to build treatment centers in areas that don't have treatment centers. And so there's a large amount of work with huge teams that are trying to build treatment centers in countries that don't have those so that they can be used for Covid-19 patients and any patients that need care. We're working to supply oxygen to ensure that oxygen can be available to people who need it across different countries. So I just wanted to add that, to say that while we are working hard to accelerate the knowledge around safe and effective treatments, there are supportive treatments that are out there, and we're working with clinicians worldwide, listening to them, learning from them, putting out guidance, doing training so that there is care that's out there in the meantime. Tarek: (31:16) Many thanks, Dr. Swaminathan and Dr. Van Kerkove. It seems we are back on our social media platforms, so those who were watching us on those channels may have opportunity to see those few minutes that were missing on our footage that will be available afterwards. I understand that on Zoom, where we have our journalists, everything was functioning normally. We have time for one or two more questions, so let's go to Jamil [inaudible 00:03:46], Geneva based correspondent for Brazilian media. Jamil... Hello, Jamil? Jamil: (31:56) Yes. Thank you, Tarek. Thank you to all of you. Mr. Ryan, last week you spoke about Brazil and how the situation was still very intense. A week later, we have an even more difficult situation in Brazil. Is the worse still to come? How do you see the [inaudible 00:32:18] of the case in Brazil? Dr. Michael Ryan: (32:23) It's difficult to predict, but if we look at the different hemispheres, I mean, five of the 10 countries worldwide are reporting the highest new number of cases in the past 24 hours are in the Americas, Brazil, USA, Peru, Chile, and Mexico, and that covers a vast stretch. The countries though reporting the biggest increases are Brazil, Colombia, Chile, Peru, Mexico, Haiti, Argentina, Bolivia. While the numbers are not exponential in some countries, we are seeing a progressive increase in cases on a daily basis. It's across a range of different countries and countries are having to work very, very hard to both understand the scale of infection, but also health systems are beginning to come under pressure across the region. We're particularly concerned about places like Haiti because of the inherent weakness in the system. Dr. Michael Ryan: (33:27) There are other countries in the Americas in which health systems are also weak. There are different responses by different countries in the region. We see very good examples of countries who have an all of government, all of society, inclusive, scientific driven approach, and I think we're seeing in other situations an absence and weakness in that. I think we now absolutely need to focus on supporting particularly Central and so the South America in their response. The DG has said many times, no one is safe until everyone is safe. And many, many weeks ago, the world was extremely concerned about what was going to happen in potentially South Asia or in Africa. And to a certain extent, the situation in those two settings is still difficult, but it's stable. Clearly the situation in many South American countries is far from stable. There's been a rapid increase in cases, and those systems are coming under increasing pressure and they need our support, they need our solidarity. Dr. Michael Ryan: (34:37) And the complexities of the population structure, the number of people living in urban settings, the urban poor, there are so many factors that drive an increase, the intensity of transmission, but I would certainly characterize that Central and South America in particular have very much become the intense zones of transmission for this virus as we speak, and I don't believe that we have reached the peak in that transmission. And at this point I cannot predict when we will, but what we do need to do is to show solidarity to the countries of Central and South America. We need to stand with them. We need to provide the support that we can to help them overcome this virus, as we have done collectively for countries in other regions. This is a time to stand together and leave no one behind. Tarek: (35:31) Thank you, Dr. Ryan. So maybe the last question for today's press conference, we will go to India, India TV, and we have with us [inaudible 00:35:41] can we hear us? Speaker 4: (35:43) [inaudible 00:07:44]. Tarek: (35:44) Yes, we can hear you. Speaker 4: (35:46) Thank you for taking my question. So my question basically follows up on what Sophie had to say. The general consensus in India is that the lock down was imposed in the country at a very early stage when the cases were fairly low. The fourth phase of lock down came to an end yesterday and a partial unlocking of services began today. So at the same time, the number of cases in the country are touching 200,000 now. So do you think there's a relation between these partial opening of services and the rising number of cases? And if so, then how do we balance the resumption of economic activities and at the same time control the coronavirus lockdown? Thank you. Dr. Michael Ryan: (36:27) I think you've sort of answered your own question there quite well in the sense that it's exactly that question. How do you balance the needs of the economy and society against the needs to control this disease? And that certainly cannot be done from a place like Geneva. That can only be done by national governments who are working locally to understand the local situation, understand the local context and absorb the guidance and the global scientific consensus that's building. And we've had many, many countries over the last number of weeks and months after our weekly briefings with all our member states and missions, and it's been striking to me the success that countries have had and I've been trying, to be honest, to understand what has been the magical formula for success in this response. And to me, what I'm seeing beyond the epidemiology and beyond the virus is that countries that have taken real ownership of the problem politically, and pulled in the maximum amount of information from outside, and then adapted and driven a local response, which communities on board have done well. Dr. Michael Ryan: (37:43) This has not been about global knowledge, just stopping the virus. There is an essential second step, and that has been responsible, open governments looking and seeking for that scientific information within the country and from outside and translating that into actions and into programs that communities understand and accept and support. Where governments have taken that all of society, all of government approach, where they've been open to the global and local science, where they've been sensitive and empathic to local population needs, they have found that balance, but that balance and that point of balance cannot be set externally. That is primarily the responsibility of national government. That is what government is there for. So in that sense, WHO will continue to drive the gathering of global science, global knowledge, global epidemiology, continue to do our best to synthesize that into the best guidance we can, to work through our country offices with each government to try and find that balance. Dr. Michael Ryan: (38:54) But ultimately that balance comes from a responsible government, listening to science, listening to the population and balancing these very difficult questions in a way that people can look at and see that a transparent job is being done to protect them, the economy, their society. Not easy, not easy to achieve, but I think governments who have done that seem to have had success, and we wish India every success in that. India's one of the largest countries in the world, a center of science, a center of public health, as I've said many times in the past. It did implement measures early and has a huge capacity to continue doing the surveillance and the community engagement that it's so much demonstrated in the past. But also, India has one of the densest populations in the world, has pockets of real poverty and underprivileged. And we really do have to ensure that those populations are protected and that India remains vigilant, ever vigilant moving forward, as it takes slow steps towards a fully opening its society. Dr Soumya, you may have a comment on this, given that India is your home country. Dr Swaminathan: (40:08) No, I think you put it well, Mike. I think there are big challenges. And one of the unique challenges, I think, is the density of population, particularly in the urban areas. And what I've seen of the data from India is 70% of cases and deaths are in 13 cities, the most populated cities. So that's where really there's a need to focus attention. And even within those cities, there are areas that are micro clusters of disease. And of course, those people are also probably in the weakest, most vulnerable living conditions as well. And so I think this is a challenge, but needs a strategy to address those specific challenges that exist. And I think it's a combination of what you were saying, Mike. It's a combination of involving the local community, developing a plan that is bottom up, that is participatory. Dr Swaminathan: (41:01) It should be based on real data, a lot of testing and contact tracing needs to be done, and there needs to be constant monitoring and a constant, perhaps reorientation of the plans as the data emerges. There's also the issue of protecting the frontline workers, whether they're policemen or whether they're drivers, bus drivers, ambulance drivers, nurses, and doctors. I think we must not forget that these people are at very high risk when they go into these densely populated and high incident settings. But there are good models within India that have shown that it is possible to do, and so I think we have to remain optimistic. Dr. Maria Van Kerkhove: (41:53) If I could just briefly add. So going beyond India, I think the responses so far, specific to the context of India, are critical. But I just want to take it a little bit beyond- Dr. Maria Van Kerkhove: (42:03) To the context of India are critical, but I just want to take it a little bit beyond that, to say that there are a lot of countries right now that are lifting lockdown, so-called lockdowns. And a lot of them are doing it in a slow way. And as Mike and as Sumia has said, it needs to be done very, it's very context specific. And so not everything can be lifted all at once. This virus isn't homogenous, it doesn't spread evenly. It likes to exploit the vulnerabilities. It likes to exploit close contact. And so it's important to have these lifting of these measures done in a data driven way and to have the systems in place to have that. But the one point I wanted to make is that in a number of countries that we're seeing, the slow lifting, the slow lifting, we are starting to see in some countries, some increase in case numbers. Dr. Maria Van Kerkhove: (42:47) And that delay is about a two to three week delay from the time that the lifting of the lockdown starts. And that's important because we know the incubation period, which is the time from when someone is exposed to the time they develop symptoms is on average five, six days. Which means that between five, six days, and then another five, six days, you may see more and more cases. And so to have the system in place, the public health infrastructure in place to capture that data means you need to track these individuals over time. So while some countries are starting to see an increase again, with the lifting of those lockdowns, that is not necessarily a negative thing. We don't want to see any more cases. We want to see transmission suppressed, but it is important that countries are monitoring this, report those increasing in cases and more importantly, take the measures to stamp it out, take the measures to suppress transmission again, because we all must remain on high alert for this and ready to detect cases and apply all of these measures that we know can suppress transmission. Tarik: (43:52) Thanks everyone for these answers, we will conclude this press briefing here. You will have the audio file available shortly and transcript will be posted tomorrow. We thank our interpreters once again for being with us today, as well as all speakers and all journalists who were with us online, as well as those who were watching us on social media platform. There were a few minutes that we lost the signal. The full video will be available on our YouTube channels and on our social media platforms as well. We will continue sending you news from headquarters, from our regional and from our country offices about what WHO is doing. I wish everyone a very nice evening. Dr. Tedros: (44:39) Thank you also to you Derek and to all who have joined us today. Thank you, have a good evening. Dr. Tedros: (44:44) (silence).