World Health Organization April 1 Briefing on Coronavirus

Tarik: (00:00) We are here for the regular press briefing on COVID-19 with Dr. Tedros, Dr. Maria Van Kerkhove, and Dr. Mike Ryan. Before I give the floor to Dr. Ryan, just to remind you that we will have audio file for this press briefly immediately available with a couple of links to news that have been issued by different WHO offices, as well as advisories for media briefings that will be held by our regional offices. You will get that after the briefing. Now, I give the floor to Dr. Tedros. Dr. Tedros: (00:36) Thank you. Thank you, Tarik, and I would like to join Tarik in apologizing for the delay. Dr. Tedros: (00:44) Good morning, good afternoon, and good evening, wherever you are. As we enter the fourth month since the start of the COVID-19 pandemic, I'm deeply concerned about the rapid escalation and global spread of infection. Over the past five weeks we have witnessed a near exponential growth in the number of new cases, reaching almost every country, territory, and area. Dr. Tedros: (01:19) The number of deaths has more than doubled in the past week. In the next few days we will reach one million confirmed cases and 50,000 deaths. While relatively lower numbers of confirmed cases have been reported from Africa and from Central and South America, we realize the COVID-19 could have serious social, economic, and political consequences for these regions. It's critical that we ensure these countries are well-equipped to detect, test, isolate, and treat cases, and identify contacts. I'm encouraged to see that this is occurring in many countries despite limited resources. Dr. Tedros: (02:20) Many countries are asking people to stay at home and shutting down population movement, which can help to limit transmission of the virus, but can have unintended consequences for the poorest and most vulnerable people. I have called on governments to put in place social welfare measures to ensure vulnerable people have food and other life essentials during this crisis. Dr. Tedros: (02:51) In India, for example, Prime Minister Modi has announced a $24 billion U.S. dollars package including free food rations for 800 million disadvantaged people, cash transfers to 204 million poor women, and free cooking gas for 80 million households for the next three months. Dr. Tedros: (03:16) Many developing countries will struggle to implement social welfare programs of this nature. For those countries, debt relief is essential to enable them to take care of their people and avoid economy collapse. This is a call from the WHO, the World Bank, and IMF. Debt relief for developing countries. Dr. Tedros: (03:45) Three months ago we knew almost nothing about this virus. Collectively, we have learned an enormous amount and every day we learn more. WHO is committed to serving all people everywhere with the best evidence to protect their health. WHO develops guidance based on the totality of evidence collected from around the world. Every day our staff talk to thousands of experts around the world to collect and distill the evidence and experience. Dr. Tedros: (04:31) We constantly review and update our guidance as we learn more and we're working to adapt it for specific contexts. For example, we recommend hand washing and physical distancing, but we also recognize this can be a practical challenge for those who lack access to clean water or who live in cramped conditions. Together with UNICEF and the International Federation of the Red Cross, we have published new guidelines for improving access to hand washing. The guidance recommends that countries set up hand washing stations at the entrance to public buildings, offices, bus stops, and train stations, and many countries are doing it. Dr. Tedros: (05:24) We're also working hard with researchers all over the world to generate the evidence about which medicines are most effective for treating COVID-19. There has been an extraordinary response to our call for countries to join the Solidarity trial, which is comparing four drugs and drug combinations. So far, 74 countries have either joined the trial or are in the process of joining. As of this morning, more than 200 patients have been randomly assigned to one of the study arms. Each new patient who joins the trial gets us one step closer to knowing which drugs work. Dr. Tedros: (06:14) We're also continuing to study the evidence about the use of masks. WHO's priority is that frontline health workers are able to access essential personal protective equipment including medical masks and respirators. That's why we're continuing to work with governments and manufacturers to step up the production and distribution of personal protective equipment including masks. Dr. Tedros: (06:45) There is an ongoing debate about the use of masks at the community level. WHO recommends the use of medical mask for people who are sick and those caring for them. However, in these circumstances masks are only effective when combined with other protective measures. WHO continues to gather all available evidence and continues to evaluate the potential use of masks more broadly to control COVID-19 transmission at the community level. Dr. Tedros: (07:24) This is still a very new virus and we're learning all the time. As the pandemic evolves, so does the evidence and so does our advice, but what doesn't change is WHO's commitment to protecting the health of all people based on the best science without fear or favor. I thank you. Tarik: (07:51) Thank you very much Dr. Tedros. We will now open the floor for questions. I will just remind you that we will try to keep one question per person, so we try to get as many as possible. As we were late, we will not be able to stay very long, so let's start first from Italy. Tarik: (08:17) Dulio from RAI. Dulio, can you hear us? Tarik: (08:25) Can we try one more time? Italy, Dulio. Tarik: (08:34) Okay, we don't have a Dulio on line. We may try to come back to him. Let's try to Jamil from Brazilian Media. Jamil, can you hear us? Jamil: (08:45) Yes. Can you hear me, Tarik? Tarik: (08:46) Yes, Jamil. Please go ahead. Jamil: (08:48) Perfect. Dr. Tedros, thank you for taking my question. Yesterday especially, President Bolsonaro has misused your words to justify his policy in Brazil. My question to you, what is your message to the Brazilian people and to the Brazilian leadership? Thank you. Dr. Ryan: (09:17) I think the message the WHO is giving to all countries is that we need a comprehensive strategy to respond to this disease. We need, in addition to any measures around lockdown, we need to put in place a comprehensive strategy based on surveillance, on public health intervention, case detection, testing, isolation, quarantine, and strengthening our health systems to absorb the blow. The blow that many health systems around the world have had to bear over the last number of weeks, which has been a tragedy for all those caught up in it. Dr. Ryan: (09:55) It's really, really important that all countries take this seriously, get ready, prepare their health system, strengthen the public health architecture, engage their communities, educate communities, and bring communities onboard, and leave no one behind. This is advice we're giving to all countries, not just Brazil. Tarik: (10:17) Thank you very much Dr. Ryan. We will try one more time with Dulio from Italy. He was on mute apparently. Dulio, are you available now? Dulio [inaudible 00:10:35], can you unmute yourself? Tarik: (10:41) Apparently it is not working, so we will move on. We'll move to Stephanie from Reuters. Stephanie, can you hear me? Stephanie: (10:52) Thank you, yes. Can you hear me? Tarik: (10:53) Yes. Please go ahead. Stephanie: (10:55) Thank you very much. Perhaps a question, a data question perhaps for Mike. China has now disclosed that the number of asymptomatic cases and that they're not counting it in their statistics that they're reporting as confirmed cases. I wondered if you could comment for that for us please and put it in some context. Today, for example, they said there were about 130 asymptomatic cases which they're excluding from their figures. Can you help us understand that? South China Morning Post has said that according to classified data there's 43,000 cases, so how does that tally as a ratio with, you know, 80,000 confirmed cases? And, do you... Are you getting an accurate reading of the situation? Giving you an accurate picture? Thank you. Dr. Ryan: (11:52) Hi Stephanie. Great to hear your voice again. I'm going to pass to Maria on this because Maria has been tracking this one. Dr. Van Kerkhove: (12:01) Thanks Stephanie. So, with regards to the reporting of cases, our case definitions include laboratory confirmed cases regardless of the development of symptoms because we know that there are individuals who are followed up through contact tracing and they're identified very quickly. Some of those individuals who are identified have not yet developed symptoms, and so it's important for us to capture those individuals as part of case detection, as part of surveillance. Because, from data that we've seen from China, in particular, we know that individuals who are identified who are listed as asymptomatic, about 75% of those actually go on to develop symptoms. So, when we look at our language and we look at what proportion of the reported cases are asymptomatic, it's important to classify those as no symptoms and PCR positive and then do not go on to develop symptoms. Dr. Van Kerkhove: (12:57) Those individuals who are identified as asymptomatic at the time of reporting and go on to develop symptoms, so 75% of those, are actually pre-symptomatic. They're in that pre-symptomatic phase. And then, of course, most of the people that are identified are symptomatic. And, we know that through transmission, the transmission of this virus is driven by people who are asymptomatic. But, it is important for us to capture that full spectrum of illness, that full spectrum of detection through surveillance. Dr. Van Kerkhove: (13:27) So again, our case definition includes laboratory confirmed cases regardless of the development of symptoms. Tarik: (13:39) Thank you very much. We will go to Michael, contributor to CNN. Micheal, can you hear us? Michael: (13:47) I can hear you. Can you hear me? Tarik: (13:49) Yes. Please go ahead. Michael: (13:50) Okay. Thank you for taking my call. I'm dialing in from British Columbia today. In around three weeks from now the holy month of Ramadan will commence. Of course, hundreds of millions of faithful will be- Speaker 1: (14:03) Of course hundreds of millions of faithful will be partaking in this, breaking their fast, eating together, sharing food. There's the tradition, as you know, of Ramadan tents where large numbers gather. I know, Director General, as a former [inaudible 00:14:17] spokesperson in that region, it's very important to get unambiguous and clear public health messaging out early if behaviors are to be changed in any way, what would be your message right now to religious leaders, to governments in the region in order to prevent a further outbreak during this very special time of the year? Thank you. Dr. Ghebreyesus: (14:40) Yeah, thank you. Thank you so much. In this response and in the fight against this pandemic, the role of political leaders is central. The role of business leaders is very, very important and central, too. And the role of religious leaders and community leaders is very, very important. We're reaching out to government leaders, political leaders, business leaders, religious leaders, and community leaders and other influencers. It's through those leaders that we can reach out to all communities to take part in the fight. Then having said this, with regard to Ramadan, as you have been following, countries in the Middle East have been doing everything they can to limit the spread of the virus. And we will continue to engage them. And I know that we will have an amicable solution on this on, too. We're very close, and closely working, and our cooperation so far is very, very successful and we hope that we will continue in that spirit. Dr. Ghebreyesus: (16:08) By the way, not only something they're doing for their own region, we're getting a lot of financial support from the Middle East and from the Arab League members and I would like to use this opportunity, actually, to thank them, not only for taking serious measures in their respective countries, but for their solidarity to support countries who need support. And the recent pledge, as you remember, is from Saudi Arabia, which I have said a few days ago, and yesterday from Kuwait, big financial support. We will keep in touch. We will work with them closely and I know that they will continue to protect their own people but at the same time, support countries and communities who need their support. Speaker 2: (17:17) Thank you very much. [inaudible 00:17:18] We go to Guatemala now to Gracia Ortiz [inaudible 00:17:25]. Can you please ask your question? Guatemala: (17:28) Thank you so much. Can you hear me? Dr. Ghebreyesus: (17:30) Yes, please. Guatemala: (17:32) Thank you. How do you see the situation for COVID 19 in Central America and what are your recommendations for the governments? Speaker 2: (17:43) Thank you very much, Gracia. Dr. Ryan: (17:48) I think the countries of Central America are at the beginning or the upside of the epidemic. There are different capacities in different countries and different risks and different threats. There are lot of vulnerable people, migrants and others who are scattered throughout the sub region and there are many other communities who may be left behind as well so Central America is dealing with its own challenges. Certainly the small island nations of the Caribbean, equally, have different challenges. Dr. Ryan: (18:24) So each country has a different combination of economic challenge, social challenge, its vulnerable populations, its public health system, its healthcare system and how all this is put together. And it's really important that each country, and I am glad to report that almost every country in Central and South America now has a national action plan that is being supported by the international community, in many cases by humanitarian partners in the UN system and NGO partners. And some countries do need that external assistance. It's also important that countries in the Americas, in Central America and the Caribbean and South America are coordinating amongst each other to align their strategies and to align their policies so we don't see mass differentials in action and pushing people from one site to the other. We have people moving throughout the Americas and we need to be sensitive to those who have least and we need to be sensitive to those who are most vulnerable. Dr. Ryan: (19:25) But it is important that Central America, like all sub regions, scales up its public health response, scales up its community engagement, scales up its healthcare preparedness and has, as the Director General has said so many times, an all of government approach to this. This is serious. This is a deadly virus. People will get through it. Countries will get through it, but we must build the architecture of public health, the architecture of our health system if we're going to get out of an interminable cycle of economically punishing lockdowns and shutdowns. We must get back to be able to control this virus, live with this virus, develop the vaccines that we need to finally eradicate this virus. Dr. Ryan: (20:14) So, as I said, the message to Central America is very similar to that to the rest of the world. Dr. Van Kerkhove: (20:24) If I could just add, so we have within our guidance materials, what we've done is we've, in addition to putting out general guidance around infection prevention and control and clinical management, we've put out a series of guidance documents relating to the four Cs. No cases, clusters of cases, community transmission, so that there's specific actions associated with what needs to be done with whatever transmission scenario you're in, but also to prepare for other scenarios that you could eventually be in and get your systems ready. And just activate those systems now. We've seen how this virus behaves in a number of countries and we need to prepare for that. That may happen in your country. So there's some practical guidance that we have on our website related to clinical operations and getting your hospitals ready, finding locations where you can treat mild patients versus severe patients, readying your workforce so that you can have people who can identify cases and help with case finding and contact tracing, to help find where you can quarantine your contacts. So there's some practical information that's online that's there to help you tailor that approach and what Mike said around this comprehensive measures to get yourselves ready and activate those systems now. Speaker 2: (21:48) Thank you very much. We will try now to connect to Mr. [inaudible 00:21:57] from [inaudible 00:21:59], that's Kosovo based outlet. Mr. [inaudible 00:22:03] can you hear us? Kosovo: (22:07) Can you- Speaker 2: (22:09) Yes, please go ahead. Kosovo: (22:12) Thank you. From February 1 until today, over 20,000 people have entered Kosovo from abroad. Italy, Germany and Switzerland. The first case was confirmed on March 9. We are now in the fourth week of the epidemic with 112 cases. 1,300 people have been tested. What is the best recommendation for Kosovo considering this numbers do you recommend? Thank you so much. Dr. Ryan: (23:00) Kosovo is a country that has obviously emerged from very difficult time. It's had to rebuild its health service and [inaudible 00:23:09] to everybody in Kosovo. I spent many months in Kosovo helping to stabilize the health system in the aftermath of the great difficulties there. And I know deeply the vulnerabilities and the challenges the health system in Kosovo and the people of Kosovo have faced over the years. And the health system in Kosovo is still vulnerable. It has many excellent professionals within it. It's a hugely committed workforce, but we do need to ensure that we have in place good surveillance. Kosovo has had and built an early warning system that's syndromic. It needs to build on that. Kosovo needs to have an active system of detecting cases and we need to have the testing in place and we need to invest in building the community's response and having community based surveillance and strengthening the healthcare system so that you can deal with infected cases. Dr. Ryan: (24:09) Albania and Kosovo are only across the water from Italy. You are very, very close to some of the most intense epidemics in the world right now and this is really important to health systems in the Balkans in general, but in Kosovo specifically, need to be rapidly strengthened to be able to cope with this disease as it may accelerate. Dr. Ryan: (24:32) So, again, my warmest greetings to all my friends in Kosovo. Speaker 2: (24:40) Thank you very much. We have more questions from the Balkans. We may come back to them later. Let's go now to India. Do we have someone from India today? Mr. Kumar: (24:54) Hi. My name is [inaudible 00:24:56] Kumar. [inaudible 00:24:59] Speaker 2: (24:58) Yes, [inaudible 00:24:59] please go- Mr. Kumar: (24:59) My question is has the World Health Organization been tracking the [inaudible 00:25:07] in India, how would you comment on the progress made by India in the first week of lockdown and how do you assess that [inaudible 00:25:16] so far. Thank you. Dr. Ryan: (25:20) I think it's a little early to assess the results of the lockdown but I think we need to step back and assess the results of the response in general. Dr. Ryan: (25:28) Lockdowns and shutdowns should just be part of an overall comprehensive strategy. And what we need to be able to do as societies and with the leadership of an all of government approach is to be able to implement a consistent policy for a period of time and then see where that takes us and then measure and see what we need to do next. Dr. Ryan: (25:52) We need to be very careful not to knee jerk. We need to be very careful not to be changing policies every single day because people on the front line need certainty in their days. Communities need some certainty. So it's really important that we are very consistent in our communication with communities and our frontline workers about what we do and we need to give clear messages about what we do for the next week or the next two weeks and we need to then be clear when we're going to evaluate the impact of that period of intervention. Dr. Ryan: (26:23) Then if we have to change, we change. And we communicate that clearly. And then we do it again for another two or three weeks and then we see how that works. Then we gather the information. Then we consult with our frontline workers. Then if we have to adjust or change. This is about adapt, adjust, implement, measure, do it again. And you just have to keep doing that over and over and over again until you control the disease. Dr. Ryan: (26:46) I would love to say that there's an easy way to do this. I would love to say there's a way out of this without that kind of hard work, but there isn't. We have to be comprehensive. We have to measure everything we do. We have to measure it below the national level and then if we have to use lockdown, if we have to use shutdowns, we do them as part of an overall comprehensive strategy. Dr. Ryan: (27:11) I would say India, and as the Director General has said in his speech, has made a really huge attempt to limit the impact of the shutdowns on the people who are most at risk and people who are most vulnerable in India and that's a great thing to see. Dr. Ryan: (27:29) We see increase in testing. We're seeing an increase in surveillance, and we're seeing investment in the healthcare system to be able to deal with more cases. But it is certainly too early for anyone to determine the impact of the shutdown or lockdown measures on disease transmission at this point. Dr. Ghebreyesus: (27:55) Thank you, Mike. The health issues are very important as Mike said. I would like to add- Tedros Adhanom Ghebreysus: (28:03) ... Mike said. I would like to add the other side. As you know, this is the first ever coronavirus pandemic in the world. Meaning there are many unknowns. And whether we do shutdowns or take other measures, we have to understand that we're in a learning process. We have to constantly learn from our actions and adjust based on what we learn. But I would like to again underline this is the first ever coronavirus pandemic and its behavior is still unknown. And that's why we should always be in a learning mode. Tedros Adhanom Ghebreysus: (28:56) The other part is not only the public health measures during shutdown, but it should be the social and economy factors that we should consider. And what India is doing, as I said in my statement, is very, very important. During shutdowns there will be economy consequences on the country at large, but more importantly, individuals who live on daily subsistence who give their labor for their daily bread could be affected the most. Tedros Adhanom Ghebreysus: (29:40) And that's why India is taking measures like the 24 billion US dollars package. And not only that, this will cover 800 million individuals as food ration during the difficult times and cash transfers to 204 million woman. And of course 80 million households will also benefit for the next months from getting free cooking gas. That's the kind of support we said it should be given. Tedros Adhanom Ghebreysus: (30:33) So we should not see it from the public health part alone, but see it from the angle of what the consequences of this public health measures will be on the community and try to support our citizens. And this should be seen during this difficult times during the lockdown, as so-called, and that's how we can get the best impact. But at the same time cooperation from our communities too because if we understand and try to help them. Tedros Adhanom Ghebreysus: (31:14) But there was another important element I mentioned in my presser today. Because it's very important, I would repeat it. Many developing countries cannot really support their society, especially during lockdown, especially on those community members who work for their daily breads. And that's why we called on the international community to have a debt relief to support those countries. Tedros Adhanom Ghebreysus: (31:48) But as you also know, debt relief processes are actually lengthy, but what we are proposing, together with the World Bank and IMF, is an expedited process to support countries so their economy will not be getting into crisis and their communities will not be really getting into crisis. Tedros Adhanom Ghebreysus: (32:12) This is a time when we need solidarity not only for public health, but also to address the economic and social challenges that many countries are facing as we speak. Tedros Adhanom Ghebreysus: (32:28) I will repeat with what I started. This is a pandemic for the first time caused by a coronavirus and whose behavior is not really known and we have to stand in unison to fight this unknown and dangerous virus. Maria Van Kerkhove: (32:51) I just wanted to supplement with what Mike and Dr. Tedros has said, and one of the things that we are working very hard on is to systematically assess the response actions that are being taken by countries. As Dr. Tedros has just said, this is the first pandemic of a coronavirus. And it's important for us to critically look at what countries are doing so that we can assess these and see which actions have worked best and which combination of these have worked best. And there's a lot of factors that go into this that relate to this comprehensive approach that we've been talking about. Maria Van Kerkhove: (33:31) So for example, what are the testing strategies that countries are using and what is the percent positive that they're seeing in terms of the numbers of tests that they've done. What is their surveillance strategy? How are countries looking for cases? Are they looking at suspect cases and contacts? Are they trying to identify additional cases through existing respiratory disease surveillance systems, like their ILI or their SARI surveillance systems? How are public measures being applied and when and where? What movement restrictions are put in place when and where and for how long? How are our governments and leaders communicating with their populations, with their people? What type of support is being provided to communities? How are we innovating and how are we conducting research to learn and feed that back into the response? Maria Van Kerkhove: (34:22) All of those things need to be done at a national level and at sub national levels to look and see which actions are the most effective. We have evidence from Asia in terms of a number of countries now that have broken this down to sub national levels to look at what has been done where and what we've been saying about aggressively looking for cases, testing suspect cases, finding contacts, quarantining contacts, isolating patients and caring for them depending on their severity. Those work. Maria Van Kerkhove: (34:54) But we also need to continually assess what is being done as this pandemic moves across the globe so that we can build up that evidence base to show what works and to make sure that countries have a tailored approach to their response. Moderator : (35:11) Thank you very much. So from India we will move to Scotland. Anthony from [Degoudi 00:07:17]. Anthony, can you hear us? Anthony: (35:19) I can. Can you hear me? Moderator : (35:21) Yes. Please, go ahead. Anthony: (35:22) Great [inaudible 00:35:24] newspaper. Because of the pandemic, millions of students around the world have had to put their studies on hold. Could you elaborate on what the WHO and national governments can do to aid students at educational institutions a this very difficult time? Thank you. Michael J. Ryan: (35:47) Well, first of all, we thank all the medical, nursing, physiotherapy, and other educational institutions around the world who've done such a fine job turning out such wonderful professionals who can come and help on the frontline in so many countries. Clearly we thank them, those institutions and those individuals who are stepping forward to volunteer. Michael J. Ryan: (36:10) But we also have to be sure that those individuals are protected, that they're doing work that they're well trained and qualified to do, they're well supervised, and that they actually can assist and add to the value of the response. So we have a duty of care to them and a duty of care to the patients to ensure that we are giving the best possible care and we're using pre-qualified professionals in any part of the medical system or doing work that they're capable of doing and supervised in doing with we. Michael J. Ryan: (36:43) It's also obviously very important that at some point that these students, particularly the ones who are in their final exams have the opportunity to qualify and get into the system and I'm sure that national medical nursing and other educational policies are being adjusted and adapted to see how that can be achieved. Michael J. Ryan: (37:05) I will pass to Maria if she has any further points on this matter, but we will certainly be happy to work with national governments and with the national medical nursing and other educational institutes to see if we can come up with rational policies to guide the completion of education for many, particularly late stage, students in the medical professions. Moderator : (37:31) Thank you very much, Dr. Ryan. We will now go to Russia. Anna [inaudible 00:37:40] from Russia-24. Anna, can you hear us? Anna: (37:42) Yes, I can hear you. Can you hear me? Moderator : (37:44) Yes. Please, go ahead. Anna: (37:46) Yeah. Hi. Thank you very much for taking my question. Here in Russia, we're seeing a sharp rise in the local wholesale and retail prices of ginger. Could you please clarify whether ginger can really help to prevent or treat the new coronavirus or is it just a myth? Michael J. Ryan: (38:05) I think we have to be careful from what we would consider to be the traditional remedies that people use for making themselves feel better during common cold, or the flu, or any in this. We've all had illnesses and someone of us like to take a drink with honey. Some like to take ginger. Some of us take special herbal teas. Anything that makes one feel better, anything that provides that reassurance, and anything that you believe can help your health that's not dangerous certainly has a positive impact on your health. Michael J. Ryan: (38:37) But it's a different thing to say that something is effective in treating the disease. At this moment, there is no therapy that has been proven to be effective in the treatment of COVID-19. We've explained, and the DG has explained actually earlier, about the solidarity trials and many other trials that are testing many, many different compounds around the world, including the ones that are most promising. Michael J. Ryan: (38:59) So I would advise people that if you have your favorite remedy that you use, like honey, like lemon, like ginger, please continue to support yourself through the illness, but please let us avoid making assumptions without evidence that certain things can cure COVID-19. At the moment there is no proven therapy for COVID-19. Maria. Moderator : (39:27) Thank you very much. That was a Russia- 24. Now we will go to Karen Wolfson from World Health Alert Crisis. Karen was with us almost every press conference, so we are happy to hear from her now. Karen, please go ahead. Karen Wolfson: (39:44) Good afternoon, good morning, and good evening. I'd like to ask, how can individuals be [inaudible 00:39:54] that COVID-19 is a real threat and what each person does makes a difference? Some people still don't understand that if they fail to follow the physical distancing rules, they could be infecting other people that may lead to deaths further down the line. Or is it the case that some individuals need to be persuaded that what happens in their community as a whole is really important and that a greater sense of local community needs to be established in order for them to take on physical distancing? That's my question. Maria Van Kerkhove: (40:48) Thank you for that question. I think you almost answered the question in your question. In the sense that COVID-19 is a real threat. It is a real threat to everyone on the planet. It's a new virus, which means everyone is susceptible to infection. It is a virus that causes disease in people, which range from some individuals will have mild disease, and a large proportion, 15%, will have severe disease, another 5% will have critical disease, and some people will die. Maria Van Kerkhove: (41:24) Many individuals who will develop severe disease are older, but we have seen in a number of countries that younger people are dying. I'm looking at data from Italy here and we have individuals in their 30s who are dying. We have individuals in their 40s, in their 50s, who are dying. Maria Van Kerkhove: (41:42) This is a virus that can be very serious in individuals, and so it's a real threat. It not only has public health implications, but it has very strong social and economic implications, and everyone needs to understand that they have a role to play. Every person has a role to play in this... Dr. Maria Van Kerkhove: (42:03) You have a role to play. Every person has a role to play in this pandemic and a sense of duty to ensure that they take every precaution that they can to protect themselves from getting infected. And we've listed a number of ways in which people can protect themselves, through hand hygiene and respiratory etiquette, through physical distancing, by removing opportunities for yourself to get infected. Dr. Maria Van Kerkhove: (42:25) If you can prevent yourself from getting infected, you could prevent onward transmission to someone who may be more vulnerable, who could develop more severe disease and die. And that is a responsibility that you have to yourself to protect yourself, to protect your family, and to protect your community and your loved ones. And that is something that everybody needs to understand. Every person on the planet has a role to play here and they need to feel empowered to be able to do something about that to protect themselves. Speaker 4: (43:01) Thank you very much for that. We have time really for one or two more questions. So we will go to Nigeria now, to [inaudible 00:01:09], from Metro Star newspaper in Nigeria. [inaudible 00:43:14], can you hear us. Speaker 3: (43:14) I can hear you. Good evening, [inaudible 00:43:17]. Speaker 4: (43:18) Please go ahead. We can hear you. Speaker 3: (43:20) Okay. My question is this. We [inaudible 00:43:24] have about 500 ventilators in Lagos, in Nigeria, [inaudible 00:43:31]. And there's a lock down in Lagos, Abuja, and other states. Presently, the people in Lagos are feeling the impact of the lock down [inaudible 00:43:38] protest. What has WHO given to Nigerian work men as they guide them to manage the situation on the ground? Especially now that we have a lock down in Lagos, Abuja, and other states, knowing we have less ventilators in this country. Thank you. Speaker 4: (43:59) The line wasn't the best, but my understanding of the question is how WHO is helping Nigeria in terms of medical supplies. Dr. Michael J. Ryan: (44:11) We've been working very closely with Nigeria since the beginning and particularly with the Ministry of Health and Nigeria CDC. In fact, the director general and myself spoke with the director of Nigeria CDC latest was this morning with the [inaudible 00:02:27]. And actually, we were reviewing our support to Nigeria and what more we could do. We have been supporting lab diagnostics. We have been supporting with the creation of isolation facilities. We have actually been in Nigeria supporting [inaudible 00:44:42] and his teams in the Nigeria Ministry of Health for years on Lassa control, on monkeypox control, on cholera control. Dr. Michael J. Ryan: (44:52) We don't come to Nigeria, we don't arrive in Africa and on the continent. We are there. We are there every day of every week of every year working hand in hand with our colleagues at Ministry of Health and our other partners in the UN system. We've been beefing up our support, strengthening our country office. And again, supporting clinical, medical, and laboratory science. In fact, Nigeria has developed a very strong public health approach in the last number of years. First country in Africa to establish a full Center for Disease control, which has been inaugurated by the government only last year. Dr. Michael J. Ryan: (45:32) So yes, there are challenges and there are certainly challenges in a country as big as Nigeria with a diversity of climate, the diversity of population, the diversity of contexts from the Northern Nigeria, all the way through the tropical zones and South Nigeria, Southern Nigeria, to the massive cities of Lagos. So there are challenges, but there are great capacities in Nigeria. We will continue to scale up our support particularly on laboratory diagnosis and we spoke to Dr. [inaudible 00:46:05] about that this morning. We will continue to ramp up our support around medical protective gear and certainly was very clear on what he needed more from WHO and we are determined to deliver that in the interests of the people of Nigeria. Speaker 4: (46:24) Thank you very much. We will to the last question for tonight and I will apologize to all those who wanted to ask a question but we're not able. We are trying as you can see to get questions from as different places as different outlets as possible. So the last question, we go back here to Switzerland to Logan from RTS. Logan, can you hear us please? Logan: (46:48) Yes, I can hear you. Can you hear me? Speaker 4: (46:50) Yes, please. Go ahead. Logan: (46:52) Yes, thank you for taking my question. So we've learned that China is now counting asymptomatic cases. In this light, how can the public trust the previous numbers that have been given by China. And if the World Health Organization agrees that numbers are important in this fight against the pandemic, what can be done to keep countries like China accountable and transparent, lest there can be some perceptions by the public that the World Health Organization itself is being manipulated or taken for a ride in this crisis. Thank you. Dr. Michael J. Ryan: (47:31) I think Maria addressed the issue of asymptomatic infection before, so I hope you were able to listen to that answer. I won't dare to offer to repeat it. You can certainly listen to the transcript. With regard to the issues of transparency and working with countries, we work with all countries. And in fact if you look at the amount of data that's been put up by many countries and if you look at the number of peer review publications that have been made by colleagues from Korea, from Japan, from Singapore, from China, from other parts of China like Hong Kong, there's been a deluge of fantastic scientifically-based, evidence-based publications coming out on a daily basis from colleagues, in all of those situations. Dr. Michael J. Ryan: (48:17) There have been, I think we had 27 you were saying this morning, Maria, different teleconferences going on today with experts all over the world sharing real time information with each other and they all include colleagues from China and colleagues from Asia. So I think we need to be very careful also not to be profiling certain parts of the world as being uncooperative or non-transparent and we need to look at transparency across the board. We need to look at solidarity across the board. We need to look at contributions across the board. We need to compare apples with apples and oranges with oranges. We need to look at the epidemic and Switzerland as a population based epidemic and the population and the epidemic in, in Italy. We need to look at what our countries... And if one country is only sampling cases over a certain age and with certain symptoms. Are they being non transparent or are they're preserving maybe a very precious diagnostic resorts and they don't have the capacity to test. Dr. Michael J. Ryan: (49:18) So sometimes we attribute a lack of transparency to what our natural limitations and our response, or natural limitations and the lack of availability of information. Are we saying maybe that the lack of precise information from Italy on the condition of patients is because of lack of transparency or because we have a system overwhelmed with thousands of patients coming in every day and doctors and nurses struggling just to provide basic care? Are we saying they're lacking in transparency and not sending WHO all the data every day? No. We need to look at the context here and I think we need to show a little bit more balance. We need to be critical. And we will be and we will work with every single country to ensure that we're getting the best possible data from them. But at the same time, we need to be balanced in that and we need to recognize that systems under pressure find it hard to share everything on a minute to minute basis. And I hope I'm being too strong in my response, but frankly at times I think we get over focused on this issue. Dr. Maria Van Kerkhove: (50:19) Just want to add something that in this era of this new virus, there's so many unknowns. There's so many questions that we have which had been identified through our research and development meeting that we had in February. But there are a lot of questions that we still have and all of these teleconferences that we're having, people are sharing their experiences with not only WHO, but sharing their experiences with other countries. And as an evidence based organization, we rely on that data. We rely on that evidence. Dr. Maria Van Kerkhove: (50:49) And in countries that are overwhelmed right now, they may not be able, as Mike just said, they may not be able to capture that and report and conduct those studies that need to be done, but other countries that aren't as overwhelmed or that have higher levels of capacity, there's certain research that can be done right now that could answer critical questions around virus shedding, around modes of transmission, around many different things, natural history. And so it's almost like a call to action here in this solidarity that we have for this virus, is to try to better capture the data and the results from studies where we can so that it could feed and it can help other countries that may be overwhelmed at the present time. So we are seeing that. We are seeing countries that are doing studies, that are sharing results and we hope that that will continue. We know that that will continue and we're very happy to collaborate with a number large number of groups regularly through teleconferences and reading those papers. I have to say it's even hard for us to keep up with the papers, but we have large numbers of teams that are going through those publications and we thank groups that are sharing their publications, pre-publication materials with us, because it's all reviewed and it's all fed into our evidence. WHO Director-General: (52:04) We would like to add to that. I earlier said this is the first ever pandemic caused by a Coronavirus, but to that I will also add, it's a new virus too. So two things here. One, it's a new virus. And second, it's the first ever pandemic by a Coronavirus, two new things. Meaning, there are many unknowns and that's why some of the things we didn't know may come today as known, including the symptomatic cases that you said. So let's accept things with open mind and trust what's coming. But of course at the same time, ready to verify too. Dr. Michael J. Ryan: (52:59) Maybe I could just give a specific example because I've been sitting here all afternoon pouring over data with Maria and we were just looking at some of the viral shedding studies that are going on all over the world and the information that's been provided. We have information on viral shedding study in Germany, one Singapore, the United States one, and China four. That's what I was looking at this afternoon. We thank all of those countries for sharing that early data with us on viral shedding because this is helping us form policies on everything from the use of masks to the length of infection to many of the other risk factors with this disease. We thank all countries who are sharing this preliminary early information with us, but we also understand that some countries are in the middle of the fight of their lives and they can't necessarily collect this data at this moment in time. WHO Director-General: (53:50) And to add to that, actually we agree with many experts who are saying that there is better global cooperation now than previously because of the experience we had some epidemics and pandemics that [inaudible 00:54:07] before. So I think we should continue in that direction. Better global cooperation is needed. That's what we are seeing, but it's not enough. We need to continue to really do more in terms of cooperation, but we're at a better stage now in terms of cooperation. Speaker 4: (54:30) Thank you very much. I think this was a very important message to give to the world. We will conclude here. Audio file will be available very soon. Transcript as always, probably sometimes tomorrow. Tonight, we will send you a number of links of the documents produced by our regional or country offices that give some more detail about work the WHO is doing in different parts of the world. There will be also advisories for press conferences of our regional offices. So please have a look at that. I will wish you a very pleasant evening or day to everyone. WHO Director-General: (55:09) And do an addition to the three of us, on Friday, there will be a special guest, a surprise. So see you on Friday. Speaker 4: (55:18) See you on Friday. Speaker 4: (55:19) (Silence).