WHO Coronavirus Update Transcript March 3, 2020

Reporter: (00:00) CNN Opinion. Thank you for taking my question. I was wondering, early on you said that a lot of countries should resist imposing trade and travel restrictions, and I remember Dr. Ryan also saying that we can't close down the world. But I think a lot of what we see around the world happening is the exact opposite, is actually trade and travel restrictions are being imposed. More difficult for people to get around, and some nationalities are being banned. So, I'm wondering how do you feel about this, and do you think that it might kind of chip away at your authority if countries continue to do this? Thank you. Dr. Michael J Ryan: (00:42) [inaudible 00:00:42]. Dr. Tedros Adhanom Ghebreyesus: (00:42) Hmm? Dr. Michael J Ryan: (00:43) [inaudible 00:00:43]. Dr. Tedros Adhanom Ghebreyesus: (00:44) As you wish. You want to [inaudible 00:00:46]? Dr. Michael J Ryan: (00:50) Yeah. I think what we've seen with travel restrictions, we've always maintained that these should be a very limited part of any set of public health measures taken by countries. WHO doesn't have the authority to... Other than recommend public health measures. But what we do have the authority is to challenge countries when they implement restrictions that we believe exceed our advice, and we've been doing that systematically. Dr. Michael J Ryan: (01:20) What we have noticed, though, is that countries that have relied purely on travel measures as the only public health intervention have not done so well, because when they've imported cases, they've subsequently been caught off guard. So, any country that relies on travel measures or screening at airports as its only public health defense, that is a very weak defense. Where countries use travel measures and travel advice as part of a comprehensive public health strategy, where they implement measures that are time limited, that are evidence based and can be justified, and then I think those measures can be better understood. Dr. Michael J Ryan: (02:01) In terms of WHO's authority been eroded, WHO has no national authority in this area in legal terms. We don't have the right to punish member states for exceeding our travel advice. What we do have is scientific evidence. What we do have, if anything, is a moral authority to advise countries how to best use that evidence. If countries decide to exceed that evidence, there's not a whole lot we can do about that. We can only challenge them, and continue to challenge them on that. But clearly, travel measures by themselves do not represent an adequate response to the spread of any infectious disease, and that has increasingly been proven to be true in this event. Dr. Tedros Adhanom Ghebreyesus: (02:42) Yeah. So, the only thing I would like to add is it would be, at the end of the day, up to the countries to take measures, but our advice is to take proportional measures, measures that are proportional to the public at risks, based on their own assessment. Speaker 4: (03:06) Thank you very much. The next question comes from Sara from Telegraph. Sara, can you hear us? Reporter: (03:11) Yes. Can you hear me? Speaker 4: (03:15) Yes. Go ahead, please. Reporter: (03:16) Brilliant. Thank you. There's been some reports today that India have restricted the export of 26 pharmaceutical ingredients in medicines, because they haven't been able to get the ingredients from China. I just wondered how concerned you are, not only about restrictions on PPE, but also on labeled drug trade, and are we going to see medicines, medical shortages? Thank you very much. Speaker 4: (03:47) Thank you. Thank you, Sara, for that question. Paul Molinaro: (03:51) Yeah, thanks for the question. We're obviously concerned. We're seeing the first initial panic reaction around PPE, which we're still frantically trying to address. When it comes now to shortages, or potential shortages of medicines, whether it's through export restrictions or through China's manufacturing of API still trying to come back online after the disruption, which I'm sure it will, we are setting up a group now with industry to start looking at those further repercussions in the market. So, we'll examine that around a particular number of key medical products, around various different diseases, whether it's HIV, whether it's noncommunicable, whether it's maternal and child care. We've been looking at that, and performing some work to analyze that. So at the moment, it's not as restrictive as we see right now with PPE, but the fear is that the ripple effects of this will make shortages in those medicines, as well. Speaker 4: (05:06) Thank you very much. Badir, please. We'll go back to the room, and then we will maybe take one more from the online before we conclude. Speaker 7: (05:16) [inaudible 00:05:16], Dr. Tedros. [inaudible 00:05:19] International. Before WHO mission arrived to Tehran, a mission delegation from China landed in Tehran, to help rein in with the outbreak of Covid-19. Are they also working under supervision of WHO, and if so, are only the lessons learned from China's measures, which has been taken in China to tackle the outbreak of virus, could be implemented in Iran, would be sufficient to tackle the outbreak over there? Dr. Michael J Ryan: (05:53) [inaudible 00:05:53] taken the opportunity last night in the video conference. We have fully briefed our Iranian colleagues and our international team on the outcomes of the China mission, in extreme detail. We've also connected very closely with the China team that's on the ground. In fact, one of the reasons I'm not speaking to them now is that they're probably sitting together to discuss. So, the Iranian government are very keen that the Chinese expert team and the WHO GOARN team come together, as happened in China. And they will share experiences, they will double their impact, and their will be a joint approach to this. Dr. Michael J Ryan: (06:29) Again, we thank our colleagues for that. In fact, one of the Chinese colleagues has been deployed as part of the WHO GOARN team, because they come from a nongovernmental organization on the Chinese side. So, what we've done is helped him facilitate the arrival of the teams on both sides, so that the best people get to the ground, in the service of the people of Iran. So it's great to have a growing team on the ground, supporting the Iranian people. Dr Maria Van Kerkhove: (06:56) If I could just add to that, I think... I mean, we've said in this presser many times, the experience that China has had needs to be shared, and this is an excellent example of that in peer to peer, in sharing what has been done, what can be done in other countries. And having them as part of this mission, and having direct interaction with another country, sharing those experiences... Whether it's about case and contact finding, whether it's about the care and management of patients, whether it's about how they're readying hospitals and PPE and infection prevention and control... that direct interaction is what we want to see more and more happen. So, having China share their experiences with other countries is nothing short of excellent. Speaker 4: (07:43) Thank you very much. We have time for two more question. [Shen 00:07:47], if you want one- Speaker 9: (07:48) [inaudible 00:07:48]. Speaker 4: (07:48) Then it's fine. Then we go to [Kai Kuferschmitz 00:07:51] online for the last question for the day. Kai? Kai Kuferschmitz: (07:58) [inaudible 00:07:58] ask about something that you said at the start of the briefing. So, you make the point that one difference between the flu and Covid-19 is that Covid-19 does not seem to be spread mostly by [inaudible 00:08:12] cases. Now, the evidence on this seems to be so divergent, that I really wanted to understand a little bit better how big the uncertainty is around this, and the way you come down on it. I mean, on the one hand you say 1% of reported Covid-19 cases do not have symptoms. That's from China. Then on the other hand, we have studies like from the Princess Diamond, where suggestions are it's 30% or more. And the same goes with the mild cases. The joint mission report says there's no evidence of a lot of mild cases being missed, but we do have these mumblings that it's from early on, which used travelers to estimate that there were hundreds of thousands, potentially, of mild cases missed. So, just I realize that we need more data, but I'd really like to understand at this point in time how you kind of evaluate these different data sets, and the way you come down on it. Dr Maria Van Kerkhove: (09:01) Kai, thanks for that question. This is indeed a complex question. It's a complex topic. And as you say, we are learning more and more information about Covid-19 every day. What you have quoted, and what the DG quoted in his speech, the 1% of reported cases from China... These are reported cases from China that have been reported as asymptomatic. What we know from that 1% is that a large proportion of those, almost 75% of those, actually go on to develop systems. So, the truly asymptomatic is rare. You've mentioned presymptomatic. So, we do know that there are individuals that are being identified early because contact tracing is strong. Dr Maria Van Kerkhove: (09:44) So, you're finding contacts. You're look... Excuse me... You're finding cases, and then you're following all of their contacts. And because they're under observation, you're testing them early, and you're actually finding that they are presymptomatic. So you're capturing PCR positive individuals, who develop symptoms a few days later. There are many countries that are looking for mild cases, beyond cases in contacts, and the way that they're doing that is that they're utilizing other respiratory disease surveillance systems in their countries. We are advocating for this to be done across many countries. In fact, we have a pilot system right now in more than 25 countries, where countries are looking at their ILI and their SARI surveillance systems, and testing for Covid-19. So, SARI is on the more severe end of the disease, but influenza-like illness, people who are being detected through those respiratory disease symptoms, will be tested for Covid-19. Dr Maria Van Kerkhove: (10:44) You mentioned the modeling studies. Of course, we're working with a large number of modelers across the globe who are trying to make some estimates of how many cases may have occurred to date. These are really important estimates. This is a piece of information that we use to better assess what the extent of infection might look like. But we will not know what the extent of infection looks like until we have serologic surveys. The DG also mentioned this. These are studies that look for antibodies in people across the population, to determine how many people actually have been infected with this virus. Dr Maria Van Kerkhove: (11:20) And what WHO has done, and what many countries are doing right now, is they're initiating studies. We've developed a protocol which we would like countries to use to do these population-based sero surveys. Essentially what that is, is it's looking at a general population, different age groups, and testing for antibodies, to see how many people have been infected. Without those studies, we really can't say how many people have been infected so far. Dr Maria Van Kerkhove: (11:49) I'd like to remind you all again that we're eight weeks into this, and we have serologic essays. I think this is unprecedented. Someone needs to correct me if I'm wrong here, but this is unprecedented, to have a virus identified, a sequence shared a few days later, PCR assays to be ready a week or so later after that, and to have serologic assays in use eight weeks into an outbreak. So we are waited with baited breath, as you are, for these serologic studies to be done, and it's a matter of weeks before we start to see some of these results. Dr Maria Van Kerkhove: (12:23) But we encourage not just China, but countries all over who are interested to know how much of their population is infected, is to start testing. Test your individuals who have been identified through ILI and SARI surveillance systems, and conduct these seroepidemiologic studies in your general population. Speaker 4: (12:46) Thank you very much. [inaudible 00:12:47], we will conclude here for today. I thanks everyone for watching us on our Twitter account, dialing in by mobile, or watching us through internet. We will have a audio file, as always, in a half an hour or so, and a transcript will be posted tomorrow. We also try to send you on a regular basis Covid-19 related news from our region, so please try to read those as well. Have a nice evening, everyone. Dr. Tedros Adhanom Ghebreyesus: (13:16) Nice evening. And when do we admit them? After tomorrow. Thursday. Tomorrow we have a mission briefing, so we still have a media, but- Dr. Michael J Ryan: (13:29) [inaudible 00:13:29]? Dr. Tedros Adhanom Ghebreyesus: (13:30) No. No day off. Even-