World Health Organization Briefing Update Transcript March 9

Tariq: (00:35) Good afternoon everyone, and apologies for this delay. We are just waiting for Dr. Mike Ryan to join us, and then we will start our press briefing on COVID-19. While we wait for Dr. Ryan, just let you know that we are planning to from now on have free press conferences per week, Monday, Wednesday and Friday so that would be a little change from what we have so far, but obviously we have to remain flexible, this can change again, but for the time being we are looking into Monday, Wednesday and Friday more or less the same time from here and I will give a floor immediately to Dr. Tedros for his opening remarks. Dr. Tedros Adhanom: (01:34) Thank you. Thank you Tariq and hope you had a very good weekend. Like to say, good afternoon. First of all, I would like to start with a brief update on the Ebola epidemic in DRC. As you know, we have two fronts. It's now three weeks since the last case was reported and a week since the last survivor left the treatment center. We're now in the countdown to end of the outbreak. We continue to investigate alerts and vaccinate contacts every day and the security situation in Northern Kivu remains fragile. In previous Ebola outbreaks, we have seen flare-ups even after the end of the outbreak, so we're continuing to provide followup care for more than 1,100 survivors and keeping teams on the ground to respond quickly to flare-ups if needed. The outbreak may ending, but our determination is not and nor is our commitment to combating the COVID-19 epidemic. Dr. Tedros Adhanom: (03:12) As you know, over the weekend we crossed 100,000 reported cases of COVID-19 in hundred cases. It's certainly troubling that so many people and countries have been affected so quickly. Now that the virus has a foothold in so many countries, the threat of a pandemic has become very real. But it would be the first pandemic in history that could be controlled. The bottom line is we're not at the mercy of the virus. The great advantage we have is that the decisions we all make as governments, businesses, communities, families, and individuals can influence the trajectory of this epidemic. We need to remember that with decisive early action we can slow down the virus and prevent infections among those who are infected, most will recover. Of the 80,000 reported cases in China, more than 70% have recovered and have been discharged. Dr. Tedros Adhanom: (04:46) It's also important to remember that looking only at the total number of reported cases and the total number of countries doesn't tell the full story except the potential the virus has. Of all the cases reported globally so far, 93% are from just four countries, this is uneven epidemic at the global level. Different countries are in different scenarios requiring a tailored response. It's not about containment or mitigation, which is a false dichotomy, it is about both. Both containment and mitigation. All countries must take a comprehensive blended strategy for controlling their epidemics and pushing this deadly virus back. Countries that continue finding and testing cases and tracing their contacts, not only protect their own people, they can also affect what happens in other countries and globally. Dr. Tedros Adhanom: (06:04) WHO has consolidated our guidance for countries in four categories. Those with no cases, those with sporadic cases, those with clusters and those with community transmission. For all countries, the aim is the same, stop transmission and prevent the spread of the virus. For the first three categories, countries must focus on finding, testing, treating and isolating individual cases and following their contacts. In areas with communities spread, testing every suspected case and tracing their contacts becomes more challenging. Action must be taken to prevent transmission at the community level to reduce the epidemic to manageable clusters. Depending on their context, countries with community transmission could consider closing schools, canceling mass gatherings and other measures to reduce exposure. The fundamental elements of the response are the same for all countries. Emergency response mechanisms, risk communications and public engagement, case finding and contact tracing. Public health measures such as hand hygiene, respiratory etiquette and social distancing, laboratory testing, treating patients and hospitals readiness, infection prevention and control, and an all of society, all of government approach. There are many examples of countries demonstrating that this measures work. China, Italy, Japan, the Republic of Korea, the United States of America and many others have activated emergency measures. Singapore is a good example of an all of government approach. Prime Minister, Lee Hsien Loong regular videos are helping to explain the risks and reassure people. Dr. Tedros Adhanom: (08:49) The Republic of Korea have increased efforts to identify all cases and contacts including drives through temperature testing to widen the net and catch cases that might otherwise be missed. Nigeria, Senegal and Ethiopia have strengthened surveillance and diagnostic capacity to find cases quickly. Further details on a specific actions countries should take in specific contexts are available on WHO's website. WHO is continuing to support countries in all four scenarios. We have shipped supplies of personal protective equipment to 57 countries, we're preparing to ship to a further 28, and we have shipped lab supplies to 120 countries. We are also working with our colleagues across the UN system to support countries to develop their preparedness and response plans according to the eight pillars. Dr. Tedros Adhanom: (10:16) We have set up a partners platform to match country needs with contributions from donors. As you know, more funds are being made available for the response and we're very grateful to all countries and partners who have contributed. Just since Friday, Azerbaijan, China, the Republic of Korea and the Kingdom of Saudi Arabia have announced contributions almost 300 million US dollars has now been pledged to WHO's strategic preparedness and response plan. We're encouraged by these signs of global solidarity and we continue to call on all countries to take early and aggressive action to protect their people and save lives. For the moment, only a handful of countries have signs of sustained community transmission. Most countries still have sporadic cases or defined clusters, we must all take heart from that. Dr. Tedros Adhanom: (11:37) As long as that's the case, those countries have the opportunity to break the chains of transmission, prevent community transmission and reduce the burden on their health systems. Of the four countries with the most cases, China is bringing its epidemic under control and there is now a decline in new cases being reported from the Republic of Korea. Both these countries demonstrate that it's never too late to turn back the tide on the virus. The rule of the game is, never give up. I'll repeat that. The rule of the game is, never give up. We're encouraged that Italy is taking aggressive measures to contain it's epidemic and we hope that those measures prove effective in the coming days. Let hope the antidote to fear, let... I'll repeat this, let hope be the antidote to fear, let solidarity be the antidote to blame, let our shared humanity be the antidote to our shared threat. I thank you. Tariq: (13:17) Thank you very much to Dr. Tedros. We will start with questions. I will repeat that to those who are dialing through mobile phones should type star nine and those who are watching us online should click raise hand and we will stress one more time that would be good to have only one question per person and we will start as always with a couple of questions from the room and then we will go to journalist watching us online. [inaudible 00:13:47], please can you start? Speaker 1: (13:50) Thank you Tariq for taking my question. Dr. Tedros, you just mentioned that the threat of a pandemic has become very real, but when you say pandemic, according to what criteria you say pandemic because I understand there's no criteria for the coronavirus. Thank you. Dr. Mike Ryan: (14:18) You're right. There is no accepted definition of pandemic of Coronavirus pandemics of anything really. I think the principle underlying pandemic is a principle that in some senses the disease has reached a point where it's further spread from country to country cannot be controlled. In other words, that there's, I said in the press conference here a number of weeks ago, if this was influenza, we would have called a pandemic ages ago because we know something inherently about the transmission dynamics of influenza. So it's not an avoidance of the word, but the word is important because in many situations the word involves country's moving purely to a mitigation approach. And what we've seen is that's moving to a purely mitigation approach is essentially seeing the disease will spread uncontrolled, in an uncontrolled fashion. Dr. Mike Ryan: (15:14) But we've seen other countries like Singapore, like China demonstrate real success in turning the disease around. So this controllability versus being controlled or uncontrolled. So from our perspective and as the director general has said, we are reaching that point and when you reach 100 countries and when you reach 100,000 cases, it is time to step back and think. Two weeks ago it was 30 or 40 countries. So now it's a hundred countries and that's not a quantitative measure, but it is a qualitative measure of what direction we're going and that's what the director general is saying. We're very close because at that point many more countries may become involved and at that point the virus will be everywhere. Dr. Mike Ryan: (16:02) The contradiction to that is unlike flu, we can still push this back, we can still significantly slow down this virus. So the word for us is not a problem, the issue is what the reaction to the word will be. Will the reaction to the word be, "Let's fight, let's push this disease back." Or will have reaction to the word be, "Let's give up." For me, I'm not worried about the word, I'm more concerned about what the world's reaction will be to that word. Will we use it as a call to action, will we use it to fight or will we use that word to give up? And I think that's what the DG has been saying right the way through his speech. Dr. Tedros Adhanom: (16:44) Thank you. As Mike said, whether it's pandemic or not, the rule of the game is the same, never give up please. Tariq: (17:01) Thank you very much. [inaudible 00:17:02] please. Speaker 2: (17:05) Yes. Good afternoon. [inaudible 00:17:07] this for France 24 in the [inaudible 00:17:09], Director-General you spoke eloquently about solidarity, but can you bring us up to speed how many countries have imposed export controls on personal protective equipment and if you could give us an update on how many hospitals have infections and how many health personnel are infected. Thank you. Dr. Mike Ryan: (17:32) On the export controls, we'll come back to you on that clearly a large number... Not a large number, a number of producing countries have imposed restrictions on export of material, protected material and we're currently tracking that and to ensure that essential supplies to WHO obviously are preserved for provision to those third countries that we were describing earlier. We've said consistently since the beginning of this, that hoarding, gouging, price manipulation and the requisition of material that doesn't allow that protective equipment to reach those who most need it is something we need to avoid. We can understand that governments have a primary responsibility to their own healthcare workers, but healthcare workers are a global resource. Dr. Mike Ryan: (18:25) Healthcare workers are a precious resource and the life of a health worker in one country is certainly as valued as the life of a health worker and another, so we would like to see that word again, solidarity, distribution of whatever the commodity is on the basis of need, on the basis of benefit and when we look at that, our most exposed workers in the world right now to this virus are frontline health workers and anything that blocks them getting the help they need, getting the assistance and protection they need is not good. So we do call on countries to re-examine their decisions to requisition and try and ensure that essential supplies of PPE are made available to health workers around the world. Dr Maria Van Kerkhove: (19:11) I can touch upon the second part of that question with regards to health care worker infections- Tariq: (19:16) So health facilities infected as well. Dr Maria Van Kerkhove: (19:19) Health facilities. As you are well aware one of the big concerns that we've had for any infectious disease and particularly for respiratory pathogens is the risk of transmission in healthcare facilities worried about there could potentially be amplifying events or super spreading events. We have not seen that be a hallmark of COVID-19 and so what we are doing in all countries is when cases are reported to us, we do follow up to find out if any of those infected individuals are healthcare workers. You are aware of the healthcare worker infections from China that we've heard about and what is very important for us to understand is where and how healthcare workers became infected. Was it through the treatment of patients, was it when they were wearing PPE, putting on PPE, taking off PPE was the right PPE used, for example. Dr Maria Van Kerkhove: (20:14) What we've learned from China is that many of the health care worker infection, some of them happened early on in the outbreak amongst doctors that hadn't had experience with COVID-19, experience with infectious diseases for that matter and that decline in health care worker infections over time has really shown that healthcare workers can be protected. But every healthcare worker infected is one too many. And it's very important as Mike talked about with the PPE and making sure that we prioritize the use of PPE for our frontline workers is really critical. But we are following up in every country where there are health care workers infections and where there is transmission taking place in a healthcare facility. But the transmission in healthcare facilities and among healthcare workers has not been a major driver- Dr Maria Van Kerkhove: (21:03) ... in healthcare facilities and among healthcare workers has not been a major driver of transmission for this particular pathogen, and I think there's a lot more research that needs to be done to really understand why. Dr. Mike Ryan: (21:13) Just to be direct in the question, we don't have comprehensive numbers on the number of health facilities globally that have been associated with the epidemics, because obviously when someone is in a health facility being managed for COVID-19, we don't consider that facility to be affected by COVID, as opposed to a facility that's received a case inadvertently and had an outbreak. Breaking out those numbers is important. Again, one of our frustrations has been that it has been difficult to get comprehensive data from all countries. We understand why; countries are under pressure, countries are struggling with getting the right information, but this week we're redesigning the data that we require from countries to ease the burden on them, but also to clarify exactly what data we need. Dr. Mike Ryan: (21:59) We certainly, within the aggregate data, we're going to be asking countries for in real time. The number of health workers as a proportion of their overall cases will obviously be a major factor in that, and we will track that more comprehensively going forward. But as I said, it's difficult to build a global picture in real time when you're not receiving real time data from everybody at all times. It's something we're going to have to address now, but more importantly into the future. Tariq: (22:31) Thank you very much. Jamie, and then we will go online. One question, Jamie. Thank you. Jamie: (22:36) Hi, I'm Jamie. Dr. Tedros, you mentioned the number of recovered in China. What is it elsewhere? What is the number elsewhere? Do you have any figures for that? You've oftentimes talked about how you want to reduce panic. Telling people the number of people that have recovered may could potentially be one way of helping people not panic, so why are you not saying that more often? Dr. Mike Ryan: (23:04) I think the difficulty in that is that China and other countries are quite systematic in announcing numbers of patients discharged from hospitals. In other systems, that's not announced, number one. It's not usually a reported number in all countries, so that's just a technical reason. Dr. Mike Ryan: (23:22) Secondly, you can see in China the number of recurrent has accelerated in the last couple of weeks, because that number lags even more than the death number. For example, many countries in Europe, people haven't had a chance to recover. Remember, it takes anything up to six weeks to recover from this disease, so it might be a quite misleading to say that in a country that has 500 cases, no one has recovered. It's not a good message either. It can be a hopeful message. It can also be a disheartening message. I think we need to look carefully at what recovered means in this case, but we haven't been systematically gathering the recovered numbers, other than when countries tell us they're gathering it when we do. That's why we report the recovered number from China. But it's a good point in terms of, and I take your point that as the epidemic goes on, maybe reflecting those numbers more systematically may be very hopeful, so we look at that. Speaker 3: (24:20) Can I just follow up? What is your definition of being recovered [inaudible 00:03:23]? Dr. Mike Ryan: (24:24) Maria will give you the technical definition, but it's usually I think a two negative PCR results within 24 hours means you're no longer carrying the virus. Recovered is a different issue, because that's a very relative term. People who've suffered very severe illness can take months to recover from the illness there, so there's a difference between recovering from the virus infection and your body fully recovering from the impact of what can be a very severe infection. There is no technical definition for being recovered. At some point in the course of your illness, you will feel recovered or your doctor will tell you you have recovered, but our definition I think is the technical one, right? Dr Maria Van Kerkhove: (25:04) Yeah, and it varies by ... When we get the number of recoveries, it depends on what the country is using as their definition of recovered. So it will be the two negative tests 24 hours apart, but it'll also be a clinical recovery where they have no more symptoms, respiratory symptoms. In China, I believe they're also using a clear CT scan. But I would like to give you that number from China, because it's more than 58,600 people who have recovered in China. The DG has said that's more than 70% of the cases reported to date. That is a very positive number, and I agree. We all agree those numbers should be reported, but it does take some time for people to get to that point. 80% of the people who are infected with this will recover, and that is also an important message. But those that are, that do develop severe disease, we need to make sure that they're cared for very carefully and make sure that their chances of recovery are as high as possible all over the world. Tariq: (26:03) Thank you very much. We will go now one line. We will start with NPR. Can you please introduce yourself? Speaker 3: (26:14) Hi, this is [inaudible 00:26:16] from NPR. Tariq: (26:16) We can hear you. Speaker 3: (26:19) Along those lines, I wanted to ask if you could elaborate a little bit on what the term mild to moderate means, because I've heard that it includes pneumonia, but I think that when people hear that 80% of people get mild to moderate disease, it seems like no big deal. Dr Maria Van Kerkhove: (26:34) That is a very good point. We do say that 80% of people ... Well, based on our information from China, let's stick with our facts here. 80% of the cases reported from China have had a mild or moderate infection, mild or moderate disease. The moderate part of that definition does include pneumonia, a "mild version of pneumonia." There are people that are developing disease, so we don't want to undermine that, but it is important to know that this mild infection starts normally with a fever. Although it may take a couple of days to get a fever, you will have some respiratory symptoms, you'll have some aches and pains, you'll have a dry cough. This is what the majority of individuals will have. Some of those individuals will go on to develop a mild form of pneumonia. Some of them will go on to develop a more severe version of pneumonia where they'll require oxygen, some will require ventilation, some will require ECMO, and unfortunately some people will die. But in the mild, moderate category, it does include a mild form of pneumonia for some individuals. Tariq: (27:38) Thank you very much. I will read the question from Bloomberg, because [inaudible 00:27:42] that from Friday. Corinne Gretler is asking, I think this is also for Maria. What have you learned about the death rates for the elderly versus other age groups? Can you give any details on the mortality rate for people above 60 or 70 versus people in their 30s and 40s? Dr Maria Van Kerkhove: (28:02) Yes, I can. We've talked a lot about mortality up here, and we talked about the difficulties in calculating mortality, but we do know that there are some underlying conditions, some medical conditions that will put people at a higher risk for death. Those include cardiovascular disease. They include chronic respiratory disease. They include cancer and they include diabetes. I can give you a breakdown of what that is in China, but of course this depends on the information that we receive. There are a lot of peer-reviewed publications that are coming out right now that do have details of the risk of death based on underlying conditions from a subset of patients, so this is information we're trying to gather to get a more comprehensive picture. Dr Maria Van Kerkhove: (28:50) What I can tell you from China, and this is not data as of today, but data from earlier, that mortality among people who are over 80 is highest amongst the age group, and the mortality is above 20%. there is higher mortality for people who have underlying conditions. For example, for those with cardiovascular disease around 13%. for those who have diabetes, around 9%. for those with chronic respiratory disease, around 8%, and for those with cancer around 7.5% percent. Now these numbers are based on a subset of the total cases that have been reported to date, and it is important that not only ... I mean we talk about this quite a lot and what our goals are is to reduce transmission. It's to reduce the number of people infected not only among younger people and healthier people, but among people who have these risk factors, so we can prevent infection and people who have these risk factors. We hope that we will receive more information about underlying conditions and the risk of death from a number of other countries, but that is some information that we need to see the consistency across countries. Dr. Mike Ryan: (30:05) I think those data that you presented, Maria, are publicly available data. Dr Maria Van Kerkhove: (30:10) They're all, yes. They're all in the report. Dr. Mike Ryan: (30:10) So this is not a surprise to countries. The countries making their pandemic plans are well aware of the numbers and estimates and China for many weeks now. I think it's very important when we make the sometimes brutal calculations of herd immunity and delaying a spread and achieving herd immunity and how maybe we should let the wave pass over us, and then more people will be immune and this will all go away. But there are many vulnerable people in our communities for which there's still will not go away, and turning to face that fire is very important. Our elderly, our people with underlying conditions, people with cancer on chemotherapy and others are our precious members of our society, and the arithmetic of epidemiology, as I said, for me in epidemiology, we talk about the N, the size of the population we're dealing with. We often say the N is the population of the country or the population of the world. So is N 7.8 billion? But for me as a medical professional, N equals one. Dr. Mike Ryan: (31:18) Every person matters. Every single person matters, and every community matters, every society matters, every country matters. I think we have to balance what are the epidemiologic calculations with what are the really tragic and and difficult scenes of family members worrying about particularly their elderly relatives or spouses worrying about their partners who have a cancer or are on chemotherapy. This is a very personal story, and it's very easy to wrap it up and numbers and graphs and trends, but in the end, there are many, many people around the world who were concerned. They're particularly concerned about those in their families and communities who are very vulnerable. It is the duty of us all, governments, communities alike, to do as much as we can to protect those communities, and particularly to protect those vulnerable people amongst us. N equals one. Dr Maria Van Kerkhove: (32:18) The numbers I quoted were in the China Mission Report, just for those of you that want to check. Sorry, DG. Dr. Tedros Adhanom: (32:24) No, I think this particular issue, especially about our senior citizens or the elderly is very, very important. If anything is going to hurt the world, it's a moral decay. Not taking the deaths of the elderly or the senior citizens as a serious issue is one of the moral decays, and Mike had said it. Any individual, whatever age, any human being matters. It pains us to see actually in some places when they want to move into mitigation, because the virus kills seniors or older people only. That's dangerous. Whether it kills a young person or on an older person or a senior citizen, any country has an obligation to save that person. That's why we are saying no white flag. We don't give up. We fight to protect our children, to protect our senior citizens. At the end of the day, it's a human life. Dr. Tedros Adhanom: (34:03) We cannot ... I have said this many times, by the way. We cannot say we care about millions when we don't care about an individual person who may be senior or junior, who may be young or old. That's what WHO is saying. For all countries, a comprehensive approach, a blended approach, an approach that can help contain this outbreak is very important, because the death rate from this outbreak is high. We shouldn't categorize it by young or senior. Of course, to understand the epidemiology it's fine to do that, but for action, I think every life matters. Every individual life matters. If we don't care about one individual, whether it's old or young, then we're not serious. That's why we're saying this is a moral decay if we try to categorize it that way, a moral decay of the society. Thank you. Tariq: (35:10) Thank you very much. This is a question from Corrine Gretler from Bloomberg, and I hope, Corrine, you got the answer. If Chris is okay, we can move to our next question from online, New Scientist. Adam? Adam Vaughn: (35:24) Yeah, hi. It's Adam Vaughn here from New Scientist. You said you welcome the aggressive measures on travel in Italy. I was interested in whether you think they will work to limit the spread of the virus and relieve the burden on the health care system? Dr. Mike Ryan: (35:47) I think two things. Obviously within the zone, they're going to help. There's two challenges here that Italy faces. One is dealing with the crisis within the zone in which disease is transmitting a community level, and clearly you've seen that the system there is under some pressure in terms of the health care provision system and others. Lombardy and others have got to face the difficulty now of dealing with quite an active epidemic in their zone. Restriction of movement in and out of those orders doesn't necessarily help. This is very much similar to the China experience. But reducing the floor of potential infections into other areas may offer those zones the opportunity to prepare and potentially have a different outcome. That's what we saw in China. We saw the provinces getting an earlier warning. They were able to prepare. The number of likely infected people going to other provinces was reduced. It wasn't entirely blocked and didn't stop it, but what it meant was the other provinces never reached the scale of transmission. Dr. Mike Ryan: (36:52) Can you imagine in China, in Wuhan, if every other province had become a Wuhan, China may not have coped. The reason China could cope was they only had one Wuhan, and they managed to keep each and every other province at not a minimum level, but at a manageable level. The question for Italy is can they launch a large scale epidemic response in the most effected areas, and can they limit the emergence of the epidemic in the other areas so they can focus on their intervention in the most effected zones? This is a tactical move. It's not going to stop disease necessarily moving out of those zones. It will delay and reduce that spread and hopefully allow authorities to focus their efforts in the most effective zones. That, to me, represents a reasonable tactical approach. It's not a guarantee, and certainly quarantine measures at a population level are never a guarantee of shutting down transmission a little result. Tariq: (37:51) Thank you very much. I looked around and we'll go to next question. It says John Cohen from Science. John, can you hear us? Hello? Do we have a John Cohen online? If not, we will go and see if there's any questions here in the room. Speaker 2: (38:16) [inaudible 00:38:19]. Tariq: (38:20) Can you please press the ... Yes. Speaker 2: (38:22) I'm [inaudible 00:38:22] International. It's regarding the WHO report. You said that you don't have comprehensive data regarding the death among them, but in Iran, so far the official report says that you know there are more than 10 health workers combating COVID-19 lost their lives. The question, as I said, might seem a bit redundant, but is there any action plan to support health workers, as you admire them, who are [inaudible 00:38:51] COVID-19 at the forefront, especially in countries that equipment like PPE is not available like in Iran, and do you support them more [inaudible 00:39:04]? Dr. Mike Ryan: (39:06) Yeah. Maria can add. There are two circumstances in which health workers are exposed to COVID-19. One is a an unsuspecting health worker in a facility where, if we imagine over the last few weeks, in an unaffected country who's treating patients normally and then inadvertently treat someone who has COVID. It's very hard to protect that worker, so training workers to have a high index of suspicion for a suspected case so that they don't expose themselves, and we've seen a number of nosocomial events or hospital transmissions in China and outside where that has happened. The disease has entered a healthcare facility and spread amongst patients or amongst healthcare workers who aren't in protective gear. They're just working in their normal situation. That's one way we need to avoid those epidemics. Dr. Mike Ryan: (39:57) The second way in which a health worker is potentially exposed is if they are working in a COVID-19 ward and they don't have appropriate protective gear, or they don't have the training to use that gear effectively, or that they're working such long shifts, long hours and under such stress that they're not able to maintain the performance or maintain their behavior to protect themselves. I think this is something that people need to consider. It's not just the equipment. I spent many hours and days and weeks in protective equipment. It is very difficult to wear. It is hot, it is restrictive. It cuts you off from the world. Your goggles fog up. Your hands just become totally unmanageable. It's very difficult. You've seen those workers in China having to do eight hour shifts without even been able to go to the toilet because they they had to work eight hour shifts straight through. I think in those circumstances, we owe a lot to those workers. Dr. Mike Ryan: (40:56) The very minimum we can give those frontline workers is the PPE and the training, and the management arrangements so we can manage their stress and their fatigue. I think most countries are moving to do that. That's why we spoke earlier about this issue of requisitioning of PPE. The real tragedy I think in the coming days and weeks will be the moral hazard and the dilemma that health workers may face if they've got COVID-19 patients in front of them who need help and they don't have the protective equipment to protect themselves. Would you like to be that health worker? Would you like to be a doctor or a nurse having to treat a patient knowing full well that you are not protected? That's an awful dilemma that no health worker in the world should have to face. It's a massive responsibility of government at national level and at international level to have the solidarity to fix that. But having the equipment doesn't solve the problem. You also need training, and training is just as important as PPE. Maria may want to comment on that. We have a lot of training ... Dr. Mike Ryan: (42:03) As important as PPE, and Maria may want to comment on that. We have a lot of training material online, and there's a lot of support for countries to do training. Dr Maria Van Kerkhove: (42:08) We do, we have a detailed package of trainings and guidance that are online for healthcare workers in different types of settings. Whether these are in clinics, or whether these are through ICU. Dr Maria Van Kerkhove: (42:20) And I think that, and reaching the right level, reaching the healthcare workers, making sure that that information gets to them in the appropriate way is really critical. So everything we have is online, they participate with us on teleconferences and whatnot. Dr Maria Van Kerkhove: (42:34) The only other thing to add from what Mike said is the support that we give healthcare workers at home. These are people, these are mothers, these are fathers, these are daughters, these are sons. And they have kids and they have parents. And unfortunately, what we've seen in many healthcare workers is that they weren't infected in the healthcare setting, they were infected at home or outside of the healthcare setting. Dr Maria Van Kerkhove: (42:57) And so what we've seen in some countries is that other members of the community have been helping healthcare workers with the rest of their lives. They've helped them do grocery shopping, they've helped them clean their homes, they've helped them look after their kids. Beyond the technical of what WHO can provide, there's a humanity element, there's a solidarity element here that our frontline workers are putting themselves at risk. They always do, and we are eternally grateful to them for that. Dr Maria Van Kerkhove: (43:27) But we can also help them at home. And so maybe not from a WHO technical guidance here, but this is something that we can all do in helping them out. Dr. Mike Ryan: (43:38) Thank you very much. Let's take a few more questions from journalists online. Do we have Jim Westwood? Jim Westwood: (43:46) Hi, it's Jim Westwood on news. Hi. Thank you very much. First of all, you have to know how much we appreciate how frustrating it must be for you to be in demand for answers about a virus you're learning about in real time. So please know that we really appreciate this. My question is really is there a light at the end of the tunnel here at all? Do we see an end to this thing? Even now? We know that the fundamental measures that are put in place seem to work in controlling the spread. But do we see a light at the end of the tunnel? Speaker 4: (44:20) Thank you Jim for that. Dr. Mike Ryan: (44:22) Maria may want to give a more technical answer than me. But right now I think we're still very much in the beginning or middle at the very maximum of this fight. The disease has not run its course by any means in most countries. In fact, most of the countries affected of the hundred have recently imported the disease. Dr. Mike Ryan: (44:45) The spread of the virus now and its impact are more in the hands of us and society than they are due to the virus itself. There's a lot, and Maria has spoken to this, the DGS spoken to this. There's a lot we can do to slow it down. There's a lot we can do to turn this virus around. And there are things that may happen with the temperature change. Not that the virus will change because of the temperature, but certainly human behavior changes according to seasons. And the way in which humans mix and distance socially changes with seasons. So we may see some natural changes in the incidence of the disease. Dr. Mike Ryan: (45:24) But as I've said many times in the past, a hope is not a strategy. And therefore when we look at this as being realistic, we're still very much in the up cycle of this epidemic. And there are still a number of miles to go. The hope, and to be quite frank, the way in which China, Singapore, Korea, and Japan are at various points of turning a corner gives me great hope. And in that sense, and as the Director General has spoken about, the very fact that there's an element of controllability, there's an element that this can be turned around and we need to seize that opportunity. In that sense that the Director General has been talking about the window of opportunity closing and the specter of a pandemic rising. Well, at the same time another window of opportunity may be opening. And that is the data and the experience in some Asian countries where there's clearly an indication that the application of measures across all of society, a systematic government led approach using all tactics and all elements available seems to be able to turn this disease around. Dr. Mike Ryan: (46:43) Maria, you may have a more precise definition of where you think we are epidemiologically. Dr Maria Van Kerkhove: (46:47) One thing we never want to do is predict what will actually happen. It is in our hands, it is in the hands of how every country deals with this. I think in many countries it will get worse before it gets better. But in many others they only have one or two cases or they haven't had cases yet. And that is an opportunity to stop something before it begins. We've talked a lot about the CS, the four CS, the no cases, cases, clusters, community transmission, when we think about transmission. And it's difficult to answer that question on a global scale. But to break it down country by country, I think that's really, really important and especially important for each country to do on its own. What is my risk? What is the risk of importation in my country? What is the risk of transmission in my country? What is our capacity to deal with this? Where do we have gaps? And how do we address those gaps? Those are really critical questions for every country to be asking themselves if they haven't already. Dr Maria Van Kerkhove: (47:48) And if we look at a country like China that's had more than 80,000 cases. Even within China, you break it down where you have Wuhan, you have what happened in Wuhan. You had what happened in Hubeo. You have what happened in all of the other provinces. And they have showed us that they've slowed this down tremendously and in some countries have stopped. In some provinces have stopped transmission and we really can't forget that. We've seen Singapore take drastic action and reduce their transmission. We've seen some countries not have any onward transmission. So in terms of what may happen in the light at the end of the tunnel, absolutely we can see a light at the end of the tunnel. Absolutely. But how quickly we get there depends on what countries do. Dr Maria Van Kerkhove: (48:31) The DG has been very consistent in his messaging. We've been very consistent in what we've been saying that the aggressive measures will depend on what happens, will dictate what happens in each country. But if we can see a country have more than 80,000 cases, now start to see a decline that is more than hope. That is evidence of showing that this can be done. And it's the fundamental public health measures that have been used across China and in many other countries that have shown that that transmission can be reduced. So it's a difficult question to answer. There isn't one global answer to that, but in each individual countries we should be asking that question. Dr. Tedros Adhanom: (49:17) Yeah. You know we can see the extent of the problem when we tried to see what the situation looks like by a group of countries. For instance, out of the more than 100 countries now. How many 110 countries will have reported? 43 countries have less than 10 cases. Dr. Tedros Adhanom: (49:51) So we're saying especially those countries, 43 countries with less than 10 cases, moving into cutting this from the bud and containing and blocking transmission or secondary transmission is possible. Dr. Tedros Adhanom: (50:15) Then if you take the additional set, six countries have 11 to 100 cases. The same, this could be they're in a better position again to follow the same strategy. So take those countries with less than 100 cases. These are 79 countries out of 110. That's why we're saying let's not to make a mistake by taking the more than 100,000 cases in more than 100 countries just as a lump sum without seeing what it looks like when you categorize it by country. Dr. Tedros Adhanom: (50:59) So mind you, 79 countries less than a hundred cases each. And a good number of them, 43 actually less than 10 cases. That's why each and every country has to assess its situation and do aggressive containment strategy to cut it from the bud. Dr. Tedros Adhanom: (51:26) Then take the countries we have, six countries more than 1000, this is including China. And even then when you have thousands of cases we have seen from China and Korea that you can actually make a dent and you can reverse that tide. Dr. Tedros Adhanom: (51:57) So this is what we are saying, less than hundred cases, 79 countries probably better suited to have a successful containment strategy and ultimately stop the transmission. But even those with higher number of cases, more one more than 1000, six countries still there is a possibility because countries are showing that. So we're being pragmatic, we're being realistic in proposing as WHO that whether we call it pandemic or not, we are really close now with a quality to qualitative change of spreading in 200 countries. Dr. Tedros Adhanom: (52:41) But still the comprehensive approach or the blended approach of using the containment strategy and other strategies, containment and mitigation all in one, is very important. So the message areas, even if we call it a pandemic, is still we can contain it and control it. That's what we are saying. It could be a matter of time, but if we give it our best, it could be the first pandemic. I say that earlier that we can make sure that we don't live with it. So pandemic doesn't mean that we say, "Okay, it's fine to live with it." We're saying, "It could be a pandemic but we shouldn't accept to live with it. We can contain it." Dr. Tedros Adhanom: (53:43) But there is pandemic like flu that we have agreed for several years now to live with it even when we have vaccines and so on. But on this one, it's very far down by the way. Even if it affects the elderly and we shouldn't choose to live with it. That's our message and we should give it our best and we can win this battle. That's what we are saying from WHO. Dr. Mike Ryan: (54:12) Thank you very much. We have a time for one last question because we promised it to John Cohen from science. John, can you hear us this time? John Cohen: (54:26) Yes, I hear you. Can you hear me? Speaker 4: (54:29) Yes, yes please go ahead this is a live session. John Cohen: (54:32) [crosstalk 00:54:32] I want to ask. Thank you so much. I want to ask a pragmatic, practical question about the elderly. Given that the mission report found 21.9% mortality in the over 80 group. My mother is 90 and I have a personal question that I think applies to a lot of people around the world. Should she stop the meeting with her friends now? She lives in California and there's virus spreading there and I think she should stop her card games and her Mahjong games and start the social distancing earlier. And I wonder why WHO and CDC in my country don't explicitly tell this to the over 80 population to start the social distancing early? What do you think? Speaker 4: (55:13) Thank you John for that question. Dr. Mike Ryan: (55:18) Thanks John. That was the easy questions. No. Your point is very well made. We issue risk management advice to countries and we obviously want to leave it to countries to make specific recommendations to specific risk groups or for specific age groups depending on the risk profiles in those. An 80 year old in one country is very often not the same as an 80 year old in another country. And depending on those population dynamics that can be different advice in different places. Dr. Mike Ryan: (55:58) But given the fact that our elderly are very vulnerable, I would definitely say that in terms of for example, visiting longterm care facilities and nursing homes. That nursing homes should be making a immediate arrangements to reduce the risk of introducing disease into those settings. Dr. Mike Ryan: (56:19) I think certainly more elderly members of our community, particularly those with underlying conditions should be, and I think already that advice is pretty much out there. The advice has been to all people and particularly to vulnerable people, to limit their contacts in crowded situations. To be exacting in their hand and other hygiene. But you are correct maybe we do need to push forward and be more precise in our advice to that group in terms attending gatherings. For example, travel and other things. We will definitely take a strong look at that in the coming days. Dr. Mike Ryan: (57:04) And again, we don't want to, as the DG has just said, there is this perception that a mitigation and as a measure is just about waiting for a longterm vaccine and trying to reduce mortality. While that happens and that mortality, what happened in elderly people, the DG has made it clear what his views are on that. We have to move towards a strategy of control. It's not about mitigating the worst impact. In a flu pandemic you are mitigating in the sense that you don't have an element of controlability. You can't stop the virus in any meaningful way. So you focus on reducing the impact of the virus. Dr. Mike Ryan: (57:43) A control strategy says you have an element of control. And what you do is both seek to control the virus and reduce its impact at the same time. And I think we've had this unfortunate emergence of camps around the containment camp, the mitigation camp and different groups presenting and championing their view of the world. And frankly speaking, it's not helpful. I think we need to now look at the last eight to 10 weeks. We need to look at what we've learned about this virus, both negatively in terms of its concerns and positively around what can be done about the virus. And we need to put our heads together and evolve our strategy. Not to live on strategies of the past and the past maybe years ago, but the past right now with this virus is eight weeks ago. Dr. Mike Ryan: (58:28) What have we learned? Has our strategy evolved? The DG has said a blended strategy that takes the learning of the previous eight to 10 weeks and puts that into an evolved approach that allows every country to design a strategy for controlling this virus that's best adapted to their circumstance and to the global needs. And I think within that, going back to your question John, we have to be within that very precise, maybe increasingly precise in our advice to high risk groups. Dr. Tedros Adhanom: (59:00) Yep. Nope. So much. By doing my statement today when I outlined the fundamental elements of the response, I said all of them actually the fundamental principles apply to all countries. And I have tried to outline them. And one of them is what you just said. I started with emergency response mechanisms, risk communications and public engagement, case finding and contact tracing. Then public health measures such as hand hygiene and social distancing. Dr. Tedros Adhanom: (59:39) But the social distancing is not just for the elderly only, it's for the others too. So where we should apply, especially in countries where we have community transmission, then it has to applied to all. So it will not be just for the elderly only. Dr. Tedros Adhanom: (59:59) So we need to have tailored interventions based on the four categories, which I have already announced in my statement. Dr. Mike Ryan: (01:00:13) Thank you very much. We will conclude with this for today. And I apologize to journalists online who were not able to ask questions such as Helen Braswell. Then we have a [Azaka 01:00:22] from Buzzfeed. We have Banjo from [Downturn 01:00:26] and the cops and others. We will have another opportunity on a Wednesday. So please stay with us. We are sending regularly news from our offices in other countries when we send audio files. So have a look for that. Thanks everyone and have a nice evening.