World Health Organization (WHO) Coronavirus Press Conference Transcript July 23

Margaret Harris: (00:11) Hello everybody. This is Margaret Harris at the WHO headquarters in Geneva. Welcome to our COVID-19 press briefing today, this Thursday, July 23. Director General Dr. Tedros will open the briefing with some remarks, then we will open the floor to questions as normal. Joining Dr. Tedros today we have our regular experts, Dr. Mike Ryan, Executive Director of Emergencies, and Dr. Maria Van Kerkhove, but also Mr. David Clarke, Team Leader for Universal Health Coverage and Health Systems Law. As usual, we'll be providing the simultaneous translation in all six languages, all six UN languages, plus Portuguese. And if you prefer to ask your questions in any of those languages, please, please do. You may also listen in Hindi, but you cannot ask your question in Hindi. And now I will hand over to Dr. Tedros. Dr. Tedros, you have the floor. Dr. Tedros Adhanom: (01:08) Thank you. Thank you, Margaret. Good morning, good afternoon, and good evening. More than 15 million cases of COVID-19 have now been reported to WHO, and almost 620,000 deaths. Although all countries have been affected, we continue to see intense transmission in a relatively small group of countries. Almost 10 million cases or two thirds of all cases globally are from 10 countries, and almost half of all cases reported so far are from just three countries. As we have said previously, political leadership and community engagement are the two vital pillars of the response. One of the tools governments can use is the law not to coerce, but to protect health while protecting human rights. Dr. Tedros Adhanom: (02:10) Yesterday, WHO, the United Nations Development Program, UNDP, and Georgetown University launched the COVID-19 Law Lab, a database of laws that countries have implemented in response to the pandemic. It includes state of emergency declarations, quarantine measures, disease surveillance, legal measures relating to mask wearing, physical distancing and access to medication and vaccines. Well designed laws can help to build strong health systems, evaluate and approve safe and effective drugs and vaccines, and enforce actions to create healthier and safer public spaces and workplaces. Dr. Tedros Adhanom: (03:03) However, laws that are poorly designed, implemented, or enforced can harm marginalized populations, entrench stigma and discrimination, and hinder efforts to end the pandemic. The database will continue to grow as more countries and themes are added. But even more powerful than the law, is giving people the information they need to protect themselves and others. The best way to suppress transmission and save lives is by engaging individuals and communities to manage their own risk and take evidence based decisions to protect their own health and that of those around them. Dr. Tedros Adhanom: (03:57) The pandemic has disrupted the lives of billions of people. Many have been at home for months. It's completely understandable that people want to get on with their lives, but we will not be going back to the old normal. The pandemic has already changed the way we live our lives. Part of adjusting the new normal is finding ways to live our lives safely. It can be done, but how to do it will depend on where you live and your circumstances. It's all about making good choices. We're asking everyone to treat the decisions about where they go, what they do and who they meet with as life and death decisions, because they are. It may not be your life, but your choices could be the difference between life and death for someone you love, or for a complete stranger. Dr. Tedros Adhanom: (05:09) In recent weeks, we have seen outbreaks associated with nightclubs and other social gatherings, even in places where transmission had been suppressed. We must remember that most people are still susceptible to this virus. As long as it's circulating, everyone is at risk. Just because cases might be at a low level where you live, that doesn't make it safe to let down your guard. Don't expect someone else to keep you safe. We all have a part to play in protecting ourselves and one another. Dr. Tedros Adhanom: (05:50) First, know your situation. Do you know how many cases were reported you live yesterday? Do you know where to find that information? Second, do you know how to minimize your exposure? Are you being careful to keep at least one meter from others? Are you still cleaning your hands regularly? Are you following the advice of your local authorities? No matter where you live or how old you are, you can be a leader in your community, not just to defeat the pandemic, but to build back better. In recent years, we have seen young people leading grassroots movements for climate change and racial equality. Now we need young people to start a global movement for health, for a world in which health is a human right, not a privilege. I thank you. Margaret Harris: (07:01) Thank you, Dr. Tedros. I will now open the floor for questions. I will remind you that as usual, please, just one question per person, as we have huge numbers of journalists and limited time. Most of you know this already, but those here for the first time, please use the raise your hand icon to ask a question. Now I will go to the many people lining up for questions. The first one is from Jamey Keaton, Associated Press. Jamey, please unmute yourself and ask your question. Jamey Keaton: (07:37) Good afternoon. Thank you very much. Actually, my question ties into what Dr. Tedros had just mentioned about governments and laws and whatnot. My question has to do with how worried you are about the mixed messages that we're getting from governments about mandatory, but ultimately voluntary quarantines, and how important is it that people respect them? Is there any evidence that people ignoring these quarantines has increased case counts? And just as a final on that, if I understand correctly, your last recommendations on quarantines date from March 19th. I'm just wondering if you're planning on updating those at all soon. Thanks. Dr. Michael Ryan: (08:23) You know, the issues I'm Jamey, I'm going to assume you're referring to quarantine measures in relation to context. There are different interpretations because in some cases, people talk about quarantine measures in relation to travelers arriving from another country who are not necessarily contact of a case, and then there's quarantine for people who are documented contacts of cases. In the case of contacts of confirmed cases, WHO's recommendation is that all such contacts should be quarantined for a period of 14 days. That quarantine can occur in a facility or it can occur in the person's home as long as there's an appropriate way for that individual to isolate themselves from others who are not designated as contacts. Dr. Michael Ryan: (09:16) And we do believe, and Maria may speak to some of the evidence on this. In countries that have been successful at implementing that, have made a lot of progress, especially in shutting down. And you see as with shutting down of clusters in particular, it's not so obvious in the middle of a community transmission as it takes time for that impact to occur, but we've seen some pretty intense clusters of cases shut down fairly quickly when quarantine has been implemented successfully in contacts. The DG obviously spoke to the issue of public health law. Dr. Michael Ryan: (09:51) Quarantining oneself when you are a contact is an act of courage and it's an act of contribution to society. If you're a contact of a case, then you are much more likely than any other person around you to develop the disease and potentially transmit it to somebody else. It is much, much better if someone is ready, willing, and able to quarantine themselves on behalf of their community. But there are situations in which that is not the case. And some governments have public health law in place that allows them to make that a mandatory procedure. In other words, it's mandated by law. If it is such, and I think WHO's guidance is also clear, I don't think we do clearly state, that where such mandatory quarantine rules are in place, the state implementing that mandate most also respect the human rights of the individual. They must be in a position to provide an appropriate level of support and care to that individual that should not cost that individual in terms of extra out of pocket expenses for the purposes of staying in a hotel. We don't recommend that governments charge people for being quarantined. Dr. Michael Ryan: (11:07) So there's a whole load of issues that are associated with that issue. So sometimes a mandatory nature of quarantine allows a government in law to provide more support to people being quarantined. But we do and are against coercive procedures. And in our experience, yes, it may be that people may say making these things to be implemented coercively, it gets the job done. Well in our experience in WHO in dealing with communities, particularly marginalized and other communities, it can do exactly the opposite. It can shove the problem underground, and it can mean that people are unlikely to report their status in terms of either being a case or being a contact, if they feel they will be unfairly treated. So it is exceptionally important that we build strong community engagement, that people, individuals, and communities understand how the disease is spread, understand the role they- Dr. Michael Ryan: (12:03) ... understand how the disease is spread, understand the role they can play in the transmission of the disease and understand the role they can play in breaking those chains of transmission. In our experience, when people understand that fact, when they understand their own personal status and when they're supported in the process, most the vast majority of people will participate in the quarantine mechanism. And we would like to avoid coercive mechanisms to do that. Maria. Dr. Maria Van Kerkhove: (12:29) Thanks. Thank you for the question. Yes. I think indeed quarantine in the context of contact tracing is arguably one of the most important elements to breaking chains of transmission. Isolation of cases, known cases in facilities outside of the home in particular, if that can be done, and if inside the home it's among someone who is experiencing mild disease or no disease, or among an individual who does not have risk factors that would put them at a higher risk of developing severe disease or dying. But quarantining of contacts is incredibly important. Dr. Maria Van Kerkhove: (13:08) We will be updating our guidance. In fact, we're doing it now. It's almost as if you knew that Jamie, but we are updating it at the moment and it won't actually change that much. What we're changing in it is looking at, currently we require testing at the end of the quarantine day period, and we will be removing that. But we're also going to add language in there to ensure that family units are taken care of. And so making sure that the language that's in there really focuses on children and isolation of and quarantining of children with family members and parents, so that they're not separated. Dr. Maria Van Kerkhove: (13:43) So that should be coming out hopefully in the next week or so. But it won't look that different to what the current version is online. And it does really remain an essential element to breaking chains of transmission. Margaret Harris: (13:59) Thank you, Dr. Van Kerkhove. Dr. Ryan, we now have a question from South Africa from Sophie, from the South African Broadcasting Commission. Sophie, could you please unmute yourself and ask your question? Sophie: (14:13) My question is directed to the Director General. Dr. Tedros, I saw on your Twitter account you spoke to the minister of health of South Africa. What was this all about? And the update on the China delegation of WHO is directed by the World Health Assembly to start the investigation, how far? Margaret Harris: (14:38) That's two questions. Dr. Michael Ryan: (14:41) With regard to South Africa, you will speak to this, but the situation in South Africa, as you know, the numbers have been increasing and the government are obviously looking at every possible measure to increase the intensity of the response there and support of their communities. And as part of that due diligence and reaching out for support and assistance and advice, the minister of health and his director general, as well as other staff in the ministry have been reaching out to our regional office in Africa, to our regional director, Tshidi Moeti, but also directly to the Director General. And our most recent conference call was a three-level conference call in which we were discussing the challenges that South Africa has faced, particularly the operational and technical challenges of scaling up the response at community level, scaling up surveillance, providing extra support to laboratory diagnostics, amongst other things. Dr. Michael Ryan: (15:42) WHO is working with South Africa to provide surge capacity in very specific technical areas. And we're also providing virtual support, and in fact, a virtual mission as well to support that. So a number of key individuals at global and at regional level will be both providing physical onsite support to the response, as well as virtual support in the coming days. South Africa has a tremendous internal capacity in public health. It has done a good job in responding to what has been an escalating situation. And it is only wise and smart that a responsible government will reach out for whatever assistance it feels that it needs to add to the quality and intensity of its response. And oh yeah, on the mission. Yeah, well, yes. I'm not quite sure if they're there yet, but our small team is hopefully on its way to Beijing or will be very, very soon. We've been engaged in a series of virtual consultations, again with scientific and other colleagues at the National Health Commission at the China CDC in looking at work already done, the preliminary or earlier investigations and scientific studies on the origin of the virus. Dr. Michael Ryan: (17:08) We continue to look at the opportunities for scientific collaboration and the terms of reference for an international mission. And we're already beginning to reach out to experts at the international level to see who will be available and most appropriate to be able to support an international mission in the coming weeks. Dr. Michael Ryan: (17:31) Again, as I said, previously, the logistics of that are not straightforward, I can assure you, but we are pleased that we now see the level of engagement that I think is important and will drive a successful mission. These are important questions. The answers are even more important. And I think everybody in the Chinese scientific community and the international scientific community is anxious to move forward with the appropriate studies to fully understand the animal origins of this virus. Yeah. Margaret Harris: (18:07) Thank you. Dr. Tedros, did you want to say anything more about South Africa or no? Dr. Tedros Adhanom: (18:13) You wanted me to say more. Okay. Sorry. No, thank you, Sophie. I think Mike had covered it very well. We had a very productive meeting with his excellency, Minister Zweli, my brother, and we have been interacting all along. This is a regular contact and we have agreed to boost our cooperation. And as Mike said, all levels participated from our country office, regional and headquarters, and we will increase the frequency of our engagement. And based on some of the requests that South Africa has already done. So we will intensify our cooperation and I hope to make progress in controlling the pandemic. Thank you. Margaret Harris: (19:22) Thank you, Dr. Tedros. The next question comes from Morocco from Monsieur, and I apologize if I get your name wrong, [inaudible 00:19:30] from MAP Morocco. Please unmute yourself and ask your question. Mr. [inaudible 00:19:47], can you hear us from Morocco? It sounds like we've lost him. So we'll go on. Margaret Harris: (19:57) We have a question from Spain, from Isabelle, from EFE, from the Spanish Newswire. Isabelle, could you unmute yourself and go ahead with your question. Isabelle: (20:06) Do you hear me? Margaret Harris: (20:18) Very well. Please proceed. Isabelle: (20:20) Hello? Margaret Harris: (20:32) Hello, Isabelle. We can hear you. Isabelle: (20:33) I don't hear anything. Sorry. I don't know if you are hearing. Margaret Harris: (20:39) We are hearing you. Can you hear us? It sounds like we've got some technical problems. We'll send Isabelle a message to tell her she can ask her question a little later. Margaret Harris: (20:54) We Imogen, Imogen Foulkes, BBC. Let's hope we do better with you. Imogen, can you unmute yourself and ask your question? Imogen Foulkes: (21:07) Hi, Margaret, yeah. I hope that I'm the exception to the rule if you can hear me. Margaret Harris: (21:10) Well done. Imogen Foulkes: (21:14) I just wonder, I know you have been very quiet on this, but we had these quite surprising comments from US Secretary of State Mike Pompeo in London on Tuesday. Do you have any response to that? Or could you give us an idea of how you think a big organization like the WHO can respond to that kind of comment? Dr. Tedros Adhanom: (21:45) Yeah, thank you. I think we haven't kept quiet actually. We released a statement. And as you know, the comments were done, I think on Tuesday, last Tuesday, and the comments are untrue and unacceptable, and without any foundation for that matter. Dr. Tedros Adhanom: (22:11) Our sole focus and the focus of the entire organization is on saving lives. If there is one thing that really matters to us and which should matter to the entire international community, it's saving lives, and WHO will not be distracted by these comments. And we don't want the international community also to be distracted. Dr. Tedros Adhanom: (22:44) As you know, one of the greatest threats we face continues to be the politicization of the pandemic. COVID-19 does not respect borders, ideologies, or political parties. And I have said it many times. COVID politics should be quarantined. And I'm appealing again to all nations to work together. Politics and partisanship have made things worse. So what is very important is sign solutions and solidarity. But I repeat, the allegations are untrue and without any foundation. Thank you. Dr. Maria Van Kerkhove: (23:36) If I might add? I feel the need to say something as an American, as a proud WHO employee. I have had the honor and privilege to sit next to Dr. Tedros and Dr. Mike Ryan for, I don't know how many days, since the beginning of this pandemic, and I have never been more proud to be WHO. I worked for this organization, with this organization for more than 10 years. We have dedicated ... Dr. Maria Van Kerkhove: (24:03) This organization, with this organization for more than 10 years, we have dedicated staff in all of our regions, and in countries working all over the world, we have partners that continue to work with us and engage with us. And I am particularly grateful for those that continue to show their support for us. But I see firsthand every day the work that Dr. Tedros does, that Mike does, that our teams do all over the world. We are firmly focused on saving lives, as Dr. Tedros has said, firmly focused. We will not be distracted and that is what we remain and we will continue to remain focused on. Dr. Michael Ryan: (24:44) And just on that, many of us have worked seven days a week, 20 hours a day for the last seven months. Everything we think, everything we do is focused on trying to save lives. And we send, and I've said for years, our people into harm's way every day. Many of them spent months and years on the frontline risking our lives and worrying our families for decades in this fight for social justice. It's really important that we try and maintain the morale of all frontline workers, be they WHO or the rest of the UN. And I can say too that none of us are perfect, but we all serve. We serve to save lives and we're here in the service of the vulnerable people of the world. Dr. Michael Ryan: (25:41) And again, I am proud to sit by the side of Dr. Tedros in doing that because our organization and his leadership are intertwined, and we have benefited from that leadership, from that direction, from a transformation in our organization. And I can say this as someone who's spent a quarter of a century associated with this organization, transformation that I taught might never come for an organization that truly needed to change the way it did business. I've seen that happen. We are committed to this. We are proud, proud to be WHO, and we will remain so, and we will serve the vulnerable people of the world, regardless of what is said about us. Margaret Harris: (26:28) Thank you so much, DG and Dr. Van Kerkhove and Dr. Ryan. I'm not meant to say anything, but proud to be WHO now more than ever. The next question goes to Chen Weihua from China Daily. Chen, could you unmute yourself and please go ahead? Chen Weihua: (26:52) Hi, Dr. Tedros, so you've just mentioned in the opening remarks that half of the cases came from three countries. We all know that's U.S., Brazil, India. So my question is, has WHO focused the special resources on these three countries to put them on the right trajectory? Because as Dr. Ryan mentioned about the coercive measures, I sort of find a confusing because some of us Congressman rejecting wearing marks because they say that I have a facial autonomy. So that sounds ridiculous to me, but I don't know. Is this coercive if I ask you to wear a mask? Thank you. Dr. Michael Ryan: (27:42) I think the three countries you mentioned are powerful, able, democratic countries who have tremendous internal capacities to deal with this disease. And there are many hundreds of thousands of brave frontline workers, doctors, nurses, hygienists, logisticians, and others who fight in the front lines, just like in every other country. It is a given, large countries can have large problems because by their very nature, they are large. They are populous, they are complex. And also, there are differences of opinion and differences between the federal and the state level in many countries in all over the world. It's one of the prices that countries pay for democracy in that context. Dr. Michael Ryan: (28:34) So we are always ready, and will always remain ready to provide advice, input, and service to any of our member states, wherever they are, and constantly offer advice and support to them. But these particularly, these three countries and many more, have tremendous internal capacities, and I believe can turn this around because of the nature of their public health or science and their innate capacities to fight this disease. And they trust that these three countries are doing that and will do that, and will escalate and upgrade the responses in order to bring this disease under control. Dr. David Clarke: (29:20) Just to add on the legal topic, one of the reasons that we've set up this new law lab is to help countries to better understand how they can legislate for their response. As Dr. Ryan said, it's a matter of balance between making sure that people voluntarily work with us to make sure that we save lives, but in cases where legislation is necessary, we're trying to provide countries with good advice about what good legislation looks like that will help those countries to deal with things like the compulsory wearing a mask in appropriate circumstances, and to deal with quarantine inappropriate circumstances. And that's where the legal lab comes in, to help countries to better understand what other countries are doing and sharing information about how they can make appropriate laws, which follow WHO guidelines and help save lives. Dr. Maria Van Kerkhove: (30:10) If I could just briefly add, to say that, to supplement to what Mike has said, that we stand ready to support all countries everywhere. I think many people, certainly in my friends and family, perhaps thought we were here really to support maybe lower income countries or lower resource countries, but we are here to help all countries. And we work through our regional offices and we work through our country offices to provide support to everyone everywhere. And I think just a message to say that even in those three countries that have the highest numbers of cases right now can be turned around. It can be turned around. And there are tools that all countries have that can do that. It takes tremendous will. It takes tremendous leadership and the work of all people to be part of the solution and to play their role. Dr. Maria Van Kerkhove: (31:03) And what Dr. Tedros was speaking about today in his speech, and what you've heard us say many times, is everyone has a role to play. And so, when you are thinking about the steps that you need to take to prevent yourself from getting infected, you're not only protecting yourself, you're protecting others that live around you, that you live with, that you socialize with. So continue to practice physical distancing, continue to clean your hands, continue to adhere to the recommendations that are put in place for your safety. Continue to know where that virus is and learn everything you can about this virus. Because as we do every day, we're learning something every day. And some of our guidance may be adapted. Some of the guidance and recommendations in your area may be adapted based on that current situation. So keep yourself well-informed about how you can protect yourself, your family and your community. Dr. Michael Ryan: (31:55) Margaret, I just may add to the, WHO's regional office for the Southeast Asia is based in Delhi, under the leadership of Dr. Poohnam Singh, who herself is Indian, and one of our largest country offices in the world is actually in India and works very closely with the Indian government. Similarly, one of our strongest offices in the Americas is in Brazil, and we work with both the federal and state level. They have worked together very successfully on the management of dengue, yellow fever and other diseases, so those countries are intertwined with us. Obviously the United States is not in need of our assistance most of the time, but certainly in the U.S., and I've said this before, the U.S. is deeply and its institutions, particularly at scientific institutions, are deeply entwined with global health and providing a strong, scientific and public health input to so many global health agendas over the last 10, 20 years. Dr. Michael Ryan: (32:52) So these countries are not only important in the COVID response, but each of them has a tremendous contribution to make at the global level. And it is a time when we do need global leadership. And large countries in regions very often set a standard for others. They set an example and other countries follow. And people look to India, people look to Brazil, people look to the United States for leadership, for examples, for ways of doing business. And they tend, when those are successful, to copy those strategies. So these countries are not only important in their own right, they're very important as regional and global beacons of doing the right thing. Margaret Harris: (33:39) Thank you for those comprehensive. So now we will go to Priti Patnaik, from here in Geneva, Geneva Health Files. Priti, please unmute yourself and ask your question. Priti Patnaik: (33:55) Hi, can you hear me? Margaret Harris: (33:57) Please, yes, yes. Very well. Priti Patnaik: (34:00) Yes. Yes, my question is basically I wanted to find out whether WHO is concerned about the lukewarm response it has received for the COVID-19 tech pool. Is it an update that you can share? We see that not as many countries have signed up as one hoped. And is it possible to share some details on what kind of technology you expect to be shared, and so on? Thanks for taking my question. Margaret Harris: (34:42) Ah, the Costa Rican initiative. Yes, yes. Dr. Michael Ryan: (34:48) We would have to get back to you on the details here. Your question as well asked, but I don't have the specific details on the number of countries and the technologies that are currently on the C-Tech platform. So what I propose we do is we gather that information, we send it through, Margaret, to you and maybe bring, on Monday we will also maybe give us a couple of minutes to give an update on C-Tech, if that's okay with you? Margaret Harris: (35:13) Excellent question. And just send it to me, harrism@who.int, and we'll make sure you get a good answer. Margaret Harris: (35:21) The next question is for Isabelle. Isabelle has reconnected, Isabelle from [inaudible 00:11:28]. So Isabelle, please unmute yourself and ask your question. Isabelle: (35:33) Yes. Do you hear me. Margaret Harris: (35:35) Very well. Please ask your question. Isabelle: (35:38) Thank you. Thank you very much for trying again. Thank you. My question is, as you know, there are several outbreaks in Spain and most of them, even if they are restricted to a few geographical zones. This is happening after you warned that we should have been very careful after the confinement. Isabelle: (36:02) ... very careful after the confinement. And I would like to hear from you, what is the lesson we have to learn in Spain and in other countries. In this context, a quite important proportion of these contaminations happen in nightclubs, as you mentioned. Do you think that is most reasonable to close these sites until the situation is under control? Dr. Michael Ryan: (36:33) I think we have to be careful here that when we see clusters of cases, or arising cases after lockdowns are lifted that in some way that that is projected as a fault or a failing, it happens. The minute you raise the pressure on the virus and the virus as a community level, you will see sporadic or clusters of cases. Dr. Michael Ryan: (36:55) The question you should ask is what is the reaction to that? What we've seen is in areas that have lifted restrictions very early, without having control on the virus have seen a very fast jump back up. But in other countries, even in countries that have brought the disease under extreme control, like Germany and Spain and others, where the numbers have been suppressed to very low levels, that when you open up, there's always a chance that the disease can be imported or the disease can spread from unseen clusters. Dr. Michael Ryan: (37:23) And the real, I suppose, test of community and government is how quickly can you get those under control? How quickly can you detect the cluster? How quickly can you test the people in that cluster? How quickly can you get the results from that? How quickly can you identify the contacts? How quickly can you identify the risk factors? Was the risk factor a nightclub? Was the risk factor a mass gathering? Dr. Michael Ryan: (37:45) What do you need to do at the community level to prevent that happening again? Do you need to implement some local movement restrictions? Where we're really trying to get here is move from, as I've said before, using a very big hammer to trying to be more precise in what we're doing. Instead of restricting everyone, we try and go after the virus and we try and identify where the virus is, and then specifically, and surgically in a sense, excise the virus from the community by minimizing the impact on the lives and livelihoods of the community by focusing in on cases, on contacts, on investigation. Dr. Michael Ryan: (38:21) So countries coming out of lockdown, even countries with low levels of disease, will experience potential cases and clusters of disease. And I believe in this case, Spain, like many other countries have reacted quickly. They've reacted well, and the incidence of disease is stable. And yet we still have to deal with a few of these clusters that have emerged in a number of countries. And that is really how we get to what the DG spoke about. Dr. Michael Ryan: (38:56) We have to learn to live with this virus. We will not be able to eliminate or eradicate this virus in the foreseeable future. And we have to learn to find a way to get back to our lives, to get back to some kind of normality, to do that with, as David's spoken about, with respect to human rights. With respect to the use of law. With using every single tool that we have as a society, to suppress this virus in a sustainable way, to make maximum disruption to the virus and minimum disruption to ourselves. Dr. Michael Ryan: (39:28) Now, how do we go about doing that? And we need everybody on board. The DG's spoken, it's not just the authorities on board. It's not just the responsibility of the authorities, it's also of communities and people within those communities. And more and more of the youth and not just the older ones, the old fogies like myself and others. Youth culture can break this. Dr. Michael Ryan: (39:52) Youth culture can help drive this pandemic or youth activism can help break the back on this virus. And going to the issue then of closing sites. Everything about gathering is related to the background incidents of the disease and the community. If there is no disease in the community, then it's safe to reengage in normal activities. If disease is in the community, and if you have intense community transmission, then any activity that brings people together in crowds, especially indoors will lead to further transmission of the disease. Dr. Michael Ryan: (40:29) Because if you don't know where the virus is, but you do know the virus is spread in your community and you bring people together in large groups, you're going to get transmission. And in that sense, governments are going to have to make decisions, based on the local epidemiology as to whether things like bars and clubs, in particular circumstances, need to be closed or have restricted numbers or whatever it is they need to do to reduce the chance of person to person transmission. Maria? Dr. Maria Van Kerkhove: (40:59) Thanks. I really appreciate the question because I think so many people are dealing specifically with this question of what are the lessons that can be learned? Once you've been successful at suppressing transmission, what about these sporadic cases and clusters that are starting to appear? I think the lesson is that we should expect this. We should be ready for this to happen. And with all of the systems that are in place now, which countries have worked so hard to put in place, they need to be used fast. They need to be used aggressively and robustly and with no regrets. With the exception of ensuring that when these interventions are put back in place again, where you may shut down something temporarily, it's done for a temporary amount of time, and it's done in the lowest or smallest geographic region as possible. Dr. Maria Van Kerkhove: (41:51) I think everyone wants to avoid these huge so-called lockdown measures again, we do too. We hope that we don't need to see these again. But if these outbreaks are dealt with swiftly, if the test, treat, contact, trace, care for, if all of that is put in place and done really quickly, you have an opportunity to really put that fire out quickly. And we are seeing countries do that. I think it's important to know, as Mike has said, where these outbreaks are occurring. Dr. Maria Van Kerkhove: (42:21) Is it in a particular entertainment sector? Is it in a longterm living facility? Is it in another closed settings? And if you, as an individual have an opportunity to avoid going to a nightclub, maybe it's worth avoiding that nightclub for a little while. I don't think we've talked so much about nightclubs in recent days, in recent weeks because these tend to be the hotspots right now. Dr. Maria Van Kerkhove: (42:46) But I think having a blanket of closing all nightclubs is not the solution either. I think we need to have a data driven approach. Where is the virus? Where are the opportunities for the virus to transmit? If it happens to be in a certain area then yes, perhaps maybe they need to be closed for a little while. But again, you have a choice yourself to make and say, "Do I do this? Do I go to this?" Dr. Maria Van Kerkhove: (43:08) I said the other day, there's a lot of things that people want to be doing. I do too, we all do here. But there's not necessarily things we need to do. The things we need to do to keep our families safe and alive. And we need to perhaps, make some sacrifices ourselves, so that essential workers and frontline workers, who are putting themselves at risk every day to keep businesses going, to serve us food. For health care workers who are out there, who are caring for patients, they need to go to work and they choose to go to work proudly. And we are very grateful for that. So again, we all have a role to play and we really do need to make decisions based on risk to keep ourselves safe and keep our families safe. Margaret Harris: (43:55) Thank you very much, Dr. Van Kerkhove. The next question, we are going to try to go back to Morocco, and I believe that Mr. El Bactoui has reconnected. So Mr. El Bactoui, please unmute yourself and ask your question. Margaret Harris: (44:20) Looks like we're out of luck today. We have come up to six o'clock, we've come up to the end of the hour. So I'll close this press conference, but of course I will hand it over to the director general for final words. Dr. Tedros Adhanom: (44:37) Thank you. Thank you, Margaret. Thank you to all who have joined us today and see you on Monday in our next presser. So thank you again.