World Health Organization Coronavirus Press Conference Transcript May 13

Tarik: (00:34) Hello to everyone watching us on WHO social media platforms and welcome to all journalists who are joining us on Zoom. Welcome to this regular COVID-19 press conference. Today we have a number of guests. We have as usual, WHO Director General, Dr. Tedros, we have Dr. Mario Van Kirkoff, Dr. Mike Ryan. With us is also Mr. Steven Solomon, Principle Legal Officer in the legal office. And, we also have Dr. Samira Asma, who is the Assistant Director General in our Department for Data Analytics and Delivery for impact. Tarik: (01:15) Dr. Asma's team has been working on the World Health statistics that we have shared this morning with our media list. We will go to questions after the opening remarks from Dr. Tedros. I'll give a floor to Dr. Tedros now. Dr. Tedros: (01:36) Thank you. Thank you Tarik. Good morning, good afternoon and good evening. Yesterday was International Nurses Day and the moment to celebrate those critical frontline health workers saving the lives of people with COVID-19, Ebola and many other diseases. As the world celebrated nurses, I was shocked and appalled to hear of the attack on an MSF hospital in Afghanistan, which led to the deaths of nurses, mothers and babies. Dr. Tedros: (02:14) Civilians and health workers should never be a target. And, as my colleague and dear friend, Mike Graham said last week, "The weaponization of health is not helping anywhere." We need health and peace. We need peace for health and health for peace and we need it now. In the time of a global pandemic, I urge all the stakeholders to put aside politics and prioritize peace. A global ceasefire in ending this pandemic together. Every day without a ceasefire, more people are dying unnecessarily. Dr. Tedros: (03:03) Out of solidarity and respect for those killed and injured, as well as, all those nurses and health professionals working right now in some of the most difficult environments in the world, I would like to ask for the collective minute of silence to remember those that have been slain in their daily work to serve and save lives. Please join me. Thank you. Dr. Tedros: (04:04) Today the 2020 World Health statistics were published by WHO. There is good news that overall people around the world are living both longer and healthier lives. The biggest gains were reported in low income countries. Which so, life expectancy rise by more than a fifth since the turn of the millennium. Better maternal and child health care has led to having of a child mortality since the year 2000, an achievement for the world. Dr. Tedros: (04:48) Farther more, lower income countries dramatically scaled up access to services to prevent and treat HIV, malaria, tuberculosis, as well as a number of neglected tropical diseases such as Guinea worm. However, the report reflects that the rate of progress is too slow to meet the sustainable development goals and will be further thrown off track by COVID-19. Dr. Tedros: (05:17) The new statistics shine a light on one of the key drivers of this pandemic inequality. How is it that in 2020, approximately 1 billion people are spending at least 10% of their household budgets on healthcare? How is it that in 2020, over 55% of countries have fewer than 40 nursing and midwifery personnel per 10,000 people? How is it that in 2020, because of a failure to invest in preparedness, we now risk backsliding on child immunization, malaria, neglected tropical diseases and HIV. Dr. Tedros: (06:03) The answer is that, the world has not done enough to deliver on the promise of health for all. The COVID-19 pandemic is causing a significant loss of life, disrupting livelihoods and threatening to undo much of the progress we have made. While the coronavirus is an unprecedented shock to the world, through national unity and global solidarity, we can save both lives and livelihoods and insure that other health services for neglected diseases, child vaccination, HIV, TB and malaria continue to both function and improve. Dr. Tedros: (06:46) During the world health assembly next week, we will discuss with health leaders from across the world, not only how to defeat COVID-19, but also how we can build back stronger health systems everywhere. We have a once in a lifetime opportunity to prove that the world is more than just a collection of individual countries with colorful flags. We're one world that has more in common with each other than we would ever dare to believe. The pandemic has made it crystal clear that we are one world that has more in common with each other than we would ever dare to believe. Dr. Tedros: (07:32) The best defense against this outbreak and other health threats is preparedness, which includes investing in building strong health systems and primary health care. Health systems and health security are two sides of the same coin. If we don't invest in both, we will face not just health consequences but the social, economic and political fallout that we are already experiencing in this pandemic. Today I joined leaders from the Global Health Human Rights and Development Institutions to draw the attention of political leaders to the heightened vulnerability of prisoners during the COVID-19 pandemic. Dr. Tedros: (08:23) Along with WHO's own guidance on prisons, I urge political leaders to enhance all prevention and control measures, in respect to vulnerable populations in places of detention. Overcrowding in prisons, undermines hygiene. Health, safety and human dignity, a health response to COVID-19 in closed settings alone is insufficient. We urge political leaders to ensure that COVID-19 preparedness and responses in closed settings are identified and implemented in line with fundamental human rights and are guided by WHO guidance and recommendations to protect human health. Dr. Tedros: (09:14) Furthermore, today the WHO announced the launch of the WHO Academy application designed to support health workers and the WHO info app designed to inform the general public health public during COVID-19. The apps are available in all UN languages, Arabic, Chinese, English, French, Spanish and Russian. With this new mobile apps, the WHO is putting the power of learning and knowledge sharing directly into hundreds of health workers and people everywhere. The WHO Academy app provides health workers with mobile access to a wealth of COVID-19 resources developed by WHO that include up to the minute guidance, tools, training and virtual workshops, that will help them care for COVID-19 patients and protect themselves. Dr. Tedros: (10:18) Furthermore, in response to COVID-19 WHO has utilized our open WHO platform and translated guidance into training, including 68 online courses to improve the response to health emergencies. It now has more than 2.5 million enrollments and hosts three trainings on 10 different topics, across 22 languages, to support the coronavirus response including our first course in Swahili this week. Every day we learn more and more about COVID-19 and new apps and courses for health workers and the general public allow us to disseminate information quickly and effectively. Dr. Tedros: (11:10) Sharing experience and best practices is critical for strengthening our response to the pandemic. Learning together is key to building national unity and global solidarity, so that together we accelerate progress faster and build a better world for us all to live in. I thank you. Tarik: (11:39) Thank you very much, Dr. Tedros. We have shared, with journalists, several press releases on topics that have just been mentioned. Now, we will start with question as we had in previous weeks. You can ask question and listen to this press conference in six UN languages plus Portuguese plus Hindi. Our interpreters, that we would like to thank, are here to help with that. If we are okay, we will start with Jennifer Rigby from Telegraph. Jennifer? Jennifer Rigby: (12:15) Hello. Hi. Yep, Jen here from The Telegraph. I wanted to ask please, have you been tracking attacks on healthcare workers that are linked to the pandemic and how concerned are you about those attacks? Dr. Michael Ryan: (12:30) Thanks for the question. We have a system for tracking attacks on healthcare, which we've operated since 2017. As you can imagine, that system is very much focused in zones and countries of conflict around the world. And, that has heavily focused in those countries where we've seen horrific attacks on healthcare, like the most recent one in Afghanistan. And again, my personal condolences to the people affected and to our great colleagues in MSF, they've always been brave, courageous and in the frontline. Dr. Michael Ryan: (13:11) We are increasingly concerned about a whole range of attacks, not necessarily on healthcare facilities related to COVID, although there have been situations where isolation facilities have been in a sense, not attacked in the military sense of the world, where there've been public unrest around those facilities. And again, we would like to separate, here in our minds, what are the direct targeting of healthcare facilities and the healthcare workers for the prosecution of war or conflict. Which is, the most apparent weaponization of health that you can possibly imagine. Dr. Michael Ryan: (13:54) We need to separate that from what is, in this case, in COVID-19 very often uninformed, very often overreactions from individuals or communities who don't fully understand, they themselves are sometimes scared. And in that sense, I don't equate these two things together. It's very important. These aren't targeted perpetrators organized problems but it does, nonetheless, have a huge impact on individual health workers. Particularly, when we've seen assaults on health workers themselves because they're health workers dealing with COVID and are perceived to be bringing a risk back to their community. Dr. Michael Ryan: (14:39) We've seen some assaults on COVID patients themselves, equally seen as a potential risk in communities. And just in April alone, we've noted more than 35 incidents in over 11 countries that were more than... They were quite serious sort of events involving attacks on individuals or groups. And some of this again, we have to look at in terms of the way that the COVID-19, in a sense too, has a lot of other issues have arisen around human rights and on the profiling and targeting of ethnic groups or ethnic minorities. Dr. Michael Ryan: (15:23) We've seen similar issues arise around blame from settled communities versus communities that might be migratory. So I think in a sense, COVID-19 is bringing out the best in us but it's also bringing out some of the worst. It's bringing out reactionary groups, it's bringing out enhancing discrimination and it's in some way, we're seeing the facilitation of extreme responses, in which people are feeling empowered to take out their frustrations on individuals who are purely trying to help and help communities. Dr. Michael Ryan: (16:05) So I think we have to be sensitive to the fact that sometimes this happens because of misunderstanding and lack of information and education. And then, other times this is senseless acts of violence and discrimination, that must be resisted. And, we also need to be sure that our words, as leaders, are condemning and not facilitating and enabling such behaviors. Thank you. Tarik: (16:36) Thank you very much, Dr. Ryan. Next question is from Andrew Calbert from CBC News in Canada. Andrew? Andrew, do we have you? You need to unmute. Andrew Calbert: (16:49) [inaudible 00:16:51]. Tarik: (16:51) Yes, please. Go ahead. Andrew Calbert: (16:52) Thank you. On March 11, you rung the international bell that we had a pandemic. So I'm curious what conditions need to be in place for you to unring the bell, let's say, for there no longer to be a pandemic. Is that to do with the finding of an immunization or if you could just expand on what conditions and be specific? Thank you. Dr. Michael Ryan: (17:23) I can begin. I don't know if you were using the alarm bell analogy or the boxing analogy but there's a long, long way to go before there's going to be any bells unrung in this response. So I think, we need to be clear about that. Countries, as you've seen, are trying to find a path out and a path towards a new normal, as many people have quoted. And, we're going to be on that pathway for a long, long time. And, as we've seen in some countries, even a small recurrence of disease can cause the need for a serious response, in terms of the public. Dr. Michael Ryan: (18:03) ... disease can cause and the need for a serious response in terms of the public health response. So I think we're going to have to remain on alert, stay the course, and ensure that we're ready to respond. In terms of reducing the alert, I think one of the issues arises, the WHO has been given a binary system by our member states. It's not the choice of the secretary. Some member states decided we either have a global public health emergency or we do not. And in that sense, from an official perspective that is, they're the choices we have. We can obviously, as time moves on in our risk assessment, reduce the level of alert at national, regional, and global level through our systematic risk assessment process. At the moment, we obviously consider the risks to still be high at all national, all regional, and at global level. Dr. Michael Ryan: (19:00) But as time goes by, we will seek to adjust those risk assessments and move them down, but that is going to require us reaching a point of very significant control over the virus, very strong public health surveillance, and stronger health systems in place to cope with any recurrent cases. But there is no formal system of deescalating this other than for WHO to change its national, global and regional risk assessments. And obviously, as I said, the IHR only allows WHO two choices: There is either a global health public health emergency, or there is not. Speaker 2: (19:49) Thank you very much. Next question comes from Georgia. Konstantine- Dr. Tedros: (19:54) To what Mike said, with regard to the alarm, the highest level of alarm for WHO was actually raised on January 30, and this is when in the rest of the world, we had only 82 cases of COVID and zero deaths. So raising the alarm should be associated actually in the highest level, based on the IHR, with the January. Of course, many countries would like to get out of the different measures that are being taken by the country, by many countries, and that is rightly so, but our recommendation is still be alert. Any country should be at the highest level possible. And whatever measures we take should be very phased one that reflects the country's situation while investing in the comprehensive package that we have been advocating for. So while opening a country, still the alarm in each country can stay as high as possible, and we can do everything we can to control the epidemic, so the two can go together. Speaker 2: (21:49) So we will try Konstantine [inaudible 00:21:53] from Georgia. We tried to have you on Monday. Hope this time it will be better. Konstantine, can you hear us? We are trying to get in touch with Konstantine from Georgia. Konstantine: (22:14) Yeah, I am on. Speaker 2: (22:15) Okay. We can hear you. Konstantine: (22:17) Okay. Thank you. Thank you very much. I'm from a news agency [inaudible 00:22:22] from Georgia. Georgia is a nation with tight social contact. So they're motivated not only by tradition, but also by economic necessity to live in extended families without possibilities to distance or isolate. Our social behavior and welfare situation are very different to those of Sweden or Baltic countries. My question is in the future, will you issue countries specific guidelines, accommodating specific social and welfare contexts? How in this situation, where distancing is not an easy option, we can protect the most vulnerable groups? Thank you very much. Dr. Michael Ryan: (23:14) I could begin on Georgia. I think Maria will come in. And I think you make a very, very good point in the second part of your question around how can we ensure that these global guidance are adapted into local context, and it is important that they are. We have seen the impacts of lockdown measures in lower income settings, which are having a deep impact on people's lives. So we have to be very, very careful that we offer advice that can be adapted at national level. And we have issued subsequent advice for adapting our global guidance to refugee camps, to low income settings, to various other settings. And Maria can speak to that guidance. With specific respect to Georgia, I think Georgia has been in a very flat growth curve over the last couple of weeks and has obviously kept cases down to under 650, and has a doubling time of cases of weeks now. Dr. Michael Ryan: (24:15) So I think there's only been a 6% increase in cases in the last week. So I think Georgia itself is doing well. We do understand the context in Georgia and I was proud to serve on epidemic response in Georgia many years ago, and I've traveled throughout Georgia and understand the special social and cultural context. But I think Georgia also has very strong approach tradition in public health and science. And I'm sure, given the way the data looks, that Georgia will pull through, but I do respect the question that we must, and this is the job of national government. WHO can only create guidance at a global level aimed at giving governments the best possible scientific evidence and options. And very often you see with our documents, we call them considerations sometimes. We call them scientific technical advice, because what we really are conscious of is that what science may say is a fact at the global level must be adapted in terms of policy to local situations. Dr. Michael Ryan: (25:19) And the translation of scientific knowledge into policy and into action requires that this happen not only at national level, but very often at sub national level. And the context in some big countries is very different at sub national level. There are different groups, different ethnic groups, different populations, and therefore the constant capacity to be able to adapt guidance to the specific context in which our peoples live is extremely important and something that's overlooked in the process. We tend to focus on the generation of scientific evidence as the primary job. In my experience, that's very important, but the ability to adapt that evidence and make it practical and usable at more and more local levels, especially a community level, is a great gift. I think that's been under-recognized very often in this response and in many other public health endeavors in the past. Maria. Dr. Maria Van Kerkhove: (26:18) Thanks. Just to supplement that, to say, as Mike has just said, that we developed guidance at the global level. We work at the regional level through our regional offices where there are some adaptations that are made for the context of the region. We work through our country offices where the guidance is adapted further to the national context. And we work with ministries of health and other partners in countries to make sure that the guidance is adapted even further. So it takes into consideration the local situation, the capacity of the country, the economics of the country, the culture of the country, and as Mike has said, that adaptation is what makes this guidance useful. Having something on paper at a global level is not the same as taking it and putting it into a national action plan, resourcing that, ensuring that you have the right capacities in terms of people and products and testing and health workers and PPE to be able to implement that. Dr. Maria Van Kerkhove: (27:19) And that takes some work. And that's really important because that adaptation makes it worth its weight. One thing to note though is that the goals don't change when you adapt to different contexts. We don't change the goal or minimize our efforts to save lives, to prevent infections. That goal remains the same regardless of where the guidance is implemented. What we have to do is be practical. And we have to find those adaptations that make it work. You mentioned the multi-generation homes where people are living in close contact to one another. That is common in many parts of the world, and that needs to be taken into consideration, which is why it's so important that countries have the ability to rapidly detect cases and isolate those cases in health care facilities. Dr. Maria Van Kerkhove: (28:09) And if they can't be isolated in healthcare facilities, they're isolated in facilities that take them away from the home and care for them, depending on the severity of their symptoms. And that's important because then you remove the virus from that home, and further to that, find the contacts, quarantine the context in safe situations. So just to highlight that, we do acknowledge that what we put out at the global level may not be perfect for every situation and it certainly is not, but it's using the evidence that we have. And we are constantly looking at that evidence and we are constantly adapting our guidance and trying to make it as most useful for everyone across the world. Speaker 2: (28:49) The next question comes from the Independent. We have [inaudible 00:28:58] online. Do we have [inaudible 00:29:04] from the Independent? If possible, unmute please. Speaker 3: (29:12) Hi. Sorry about that. My question is regarding the reimpositions of lockdown measures in Algeria, Lebanon, Southwest Iran, a few other places in recent days, as well as plans to reimpose the lockdown in Saudi Arabia later this month. Of course, we had the situations in Seoul and Singapore earlier. Do you see these, I'm sorry if this is a rather basic question that I'm sure you've rehashed over the recent weeks, but do you see these as anticipated and normal? And given the trajectory of this and other pandemics, do these reimpositions suggest policy failures in any way? Are they cautionary tales or just understandable trial and error? Dr. Michael Ryan: (30:05) I think you answered your own question. So I think they're all of the above. Some are cautionary tales, and some represent actually the kind of things we expect. It's all about scale, and it's all about how much you understand the problem. I think if, there is no question, the reason why countries have gone into different forms of severe public health and social measures and lockdowns was to separate people so we could stop the virus jumping from person to person. If the virus is still present and you bring people closer together, you don't have to be an astrophysicist to work out that the disease will move more easily from person to person in that situation. So if you can get the day to day case number down to the lowest possible level and get as much virus out of the community as possible, then when you open, you will tend to have less transmission or much less risk. Dr. Michael Ryan: (31:12) If you reopen in the presence of a high degree of virus transmission, then that transmission may accelerate. If that virus transmission accelerates and you don't have the systems to detect it, it will be days or weeks before you know something's gone wrong. And by the time that happens, you're back into a situation where your only response is another lockdown. And I think this is what we all fear is a vicious cycle of public health disaster followed by economic disaster, followed by public health disaster, followed by economic disaster. And I think everyone, and sometimes there's a bit of a false equation here. I'm listening and involved in discussions all the time where people are asking me, so this is the economy or the health system? And it's not. Because I think very, very smart people are saying on the economic side, that the worst thing that can happen is if we go out of a lockdown and then we don't do the health part. Dr. Michael Ryan: (32:12) And we go back into a lock down, that that has more danger for the economic system than it actually has for the health system, in a sense. Because you can imagine that if the health system gets time to recover, then it can cope with another rise in cases. And the health system can probably do that a few times. I'm not sure how many times the economic system can do that. So I do think this isn't an either/or, and it's really important that we learn those lessons now. And I think you see in cases like, particularly in Korea, in China, in Germany, where there's been a jump in cases, the government's there have been alert to that happening, and have taken very immediate action to investigate. And I think that's what we need to see. When we see that kind of rapid action, then we're reassured, and I think populations are reassured. Dr. Michael Ryan: (33:04) But if we don't have those public health surveillance systems in place, and then we start to see the hospitals fill up again as the indicator, if we have to wait until our hospitals are overflowing before we recognize there's a problem, then I think you're not into trial and error. Then you're into what you call the cautionary tale. And we should not be waiting to see if opening of lockdowns has worked by counting the cases in the ICU or counting the bodies in the morgue. That is not the way to know something has gone wrong. The way to know that the disease is coming back is to have community-based surveillance, to be testing, and to know the problem is coming back and then be able to adjust your public health measures accordingly. Let us not go back to a situation where we don't know what's happening until our hospitals are overflowing. That is not a good way to do business. Dr. Maria Van Kerkhove: (34:01) I just want to comment on the use of the phrase lockdown. I think there's this misconception that a lockdown is one thing. It's not. It's a set of measures that countries have taken. They include individual and community level restrictions of movements, or some of them are called stay at home orders. They include closures of different types of facilities, whether these are schools or workplaces, partial closure or full closure. And we should say that not all countries did school closure, not all countries closed all their workplaces. They include closures of bars and nightclubs. They include restrictions or limiting of mass gatherings and sporting events. And so this use of the word lockdown, it makes it sound like an entire country has shut down overnight. And it's just not the case. So what we're seeing in a number of countries and where we're seeing more success in this, and we are constantly learning, we have to keep saying that, there is no one solution here that you must do this or you must do that. Dr. Maria Van Kerkhove: (35:04) It must be a comprehensive approach. And in some countries, they've looked at the virus, they looked at where's the intensity of transmission? Where do we need to impose some of these measures in terms of restricting people's movements and putting stay at home orders in? And where do we need to lift them when the situation changes? And I think we need to get into this mindset that it's going to take some time to come out of this pandemic, whatever that looks like, including the lifting of these measures in a slow, in a staggered way, which will differ based on the country itself. You may see a lifting in some parts of the country where it's staying in place and others. And as the virus is either controlled or it has found a place to take off and resurge, those measures may need to be put in place again. And I think that having the communities and having all of us understand... Dr. Maria Van Kerkhove: (36:02) And I think that having the communities, and having all of us understand that they may need to be lifted, they may need to be implemented again, I think we need to be ready for that. And it's important that countries have the systems in place to be able to rapidly detect cases and then take appropriate actions. So I just wanted to comment on the use of this word lockdown. because it isn't an all-or-nothing. And we need to find the new normal as we go forward in managing the risk of resurgence and protecting people's health while getting people back to living their daily lives. Tarik: (36:37) Thank you. A few of you were asking about a background noise. That was rain. It's just stopped now. But it can come again. So it's just rain. Next question is for Shane He Zhu from CCTV. Shane, can you hear us? Shane He Zhu: (36:58) Hi Terry. Thank you. Can you hear me? Tarik: (37:00) Yes. Shane He Zhu: (37:02) Thank you Terry. Shane from China Central Television, CCTV. In most states of United States, at least one surge of COVID-19 deaths are from the longterm care facilities. How could this happen? Or is it because of the idea of herd immunity that was discussed before in the previous briefing, or there's lack of the care for this vulnerable group? Thank you. Dr. Michael Ryan: (37:29) Yeah. I think the issue of deaths in COVID-19 in longterm care facilities is a phenomenon that's unfortunately happened all over the world. And many countries have been affected by this around the world. And in that sense, it is a tragedy. We spoken about that many times. there are many obviously factors driving this. The population of people who live in longterm care settings are very often older and have many health underlying conditions. So they're a very, very vulnerable community from that perspective. And the longterm care sector is not like the hospital sector. It's people are living in very many different types of settings. It's not around the world. It's not a standardized setting. And some longterm care facilities can have many residents who have been served by a relatively small number of staff who may or may not have lots and lots of training in healthcare provision, and infection prevention and control. And those standards would vary greatly from country to country. Dr. Michael Ryan: (38:40) But I think the one thing that most countries would accept is that we haven't managed to shield those centers from disease entering. And when the disease has entered those longterm care facilities, it has been extremely to prevent the spread in those facilities and the loss of our wisest people have died in that. And I think this is something that's going to have to be dealt with as countries now emerge from a high incidence phase. Because not only is it a tragedy that this disease is occurring and killing so many people in those facilities, if that disease remains in those facilities, it will come back out into communities, through the workers who work there, and families who visit. Dr. Michael Ryan: (39:31) The DG has said, no one is safe until everyone is safe. So we do have a duty of care, to care for and protect our most vulnerable, our wisest, our most cherished citizens. And we also need to take this on, because we want... Our communities will not be safe in many countries where over 50% of all the cases have been in longterm care facilities. And I can tell you, that's a long list of countries. If you measure how many countries in this response have more than 50% of their cases in longterm care facilities. Well, we also have longterm issues to face in terms of how we are providing care for our older citizens, and how that is delivered, and how that is paid for, and how safe, and how appropriate that is. That's a bigger discussion for another day, but it's one that will have to happen. Dr. Michael Ryan: (40:22) But for now we need to shield those very vulnerable people. And we need to be sure that we pick up these diseases. It's a bit... We were discussing earlier today with our colleagues who work in the NGO sector, about refugee camps. And we spoke historically how one case of measles or one case of meningitis in refugee camp is an emergency. Because the consequence of not reacting to that first case are so catastrophic. And we need to have that view when it comes to respiratory disease in longterm care facilities. And I think there may be a degree of complacency that there's someone has a respiratory disease in the longterm care facility, well, that person's just older, that may or may not be COVID. Dr. Michael Ryan: (41:01) But I think we have to have a high index of suspicion. And I think we need to be very reactive. And I think we need to provide support to those facilities. And I've seen some very good examples of local hospitals, training, and providing direct support to longterm care facilities, to support their infection prevention and control, to have more access to doctors and nurses to come and help them make diagnosis, to have more rapid testing available and prioritize for longterm care facilities. They're the things we can do immediately in order to address the immediate needs. But I do think in the longterm, we will have to look at how we provide care and support for our, as I said, our older and most cherished citizens Dr. Maria Van Kerkhove: (41:39) Yeah. To quickly add, we do have guidance out on longterm care facilities. But the critical factor is to prevent the virus from entering into a system, into this closed setting as they're known in the sense that people live in one building and facility. What the goal is, is to prevent the virus from entering in, and to help these facilities to have a risk assessment based approach to say, "What is our risk of having this virus introduced?" And if it is, what do we do? What is our plan to be able to protect the residents of these longterm facilities? How do we protect the workers who work there? And part of that is looking at infection prevention and control within that facility, ensuring that the workers who are there are trained, that the residents are familiar with what COVID is, and how they can protect themselves, and ensuring that the right prevention and control measures are in place. Dr. Maria Van Kerkhove: (42:36) As you've highlighted that this is a persistent problem in many countries, and is something that we really need to find ways to better support countries in this. But not only that. We need to also ensure that the people who are living in these facilities also have the right clinical care for their chronic conditions so that, that is maintained, so that they have the right psychosocial support as they're going through this. Some people who are living in longterm care facilities are at the end of life stage, and we need to make sure that they still have access to their families and their loved ones as they're going through that. And so there's a balance that needs to be taken into account. But we must protect people who are living in longterm care facilities. And we must make sure that the guidance that we do have is used, and to find ways to adapt that to the different settings so that we protect people who are living in these facilities. Tarik: (43:33) Next question is for FN News Agency, Isabel Sarko. Isabel? Isabel Sarko: (43:37) Yes. Hello. Can you hear me? Tarik: (43:40) Yes, please. Isabel Sarko: (43:44) Thank you. Thank you for taking my question. There are some countries that did not wait to have too many cases of COVID to look down. And I can take two examples [inaudible 00:44:00] one from the other. Russia has had six week of a lockdown. And Peru, eight weeks up to now. But in both countries, cases is still increasing. And Russia is now the second country with more cases in the world. My question to you is why these lockdowns, which were quite strict, didn't work for them? How much of the outcomes depend on government or state responsibility and how much on individual responsibility? Dr. Maria Van Kerkhove: (44:37) So I can start. I don't know the specifics about the implementation of public health and social measures in Russia, and Peru off the top of my head. But what we can say is the virus needs people to transmit between. If people are in close contact with one another, and you an infected person, it will transmit to another person through these respiratory droplets. And so everything that we can do to prevent that from happening where we know this virus is, we need to one, look for it so that we know where the measures need to be put in place. But if the virus is spreading when there are measures in place, then we need to assess that. And that needs to be... This is why we mentioned looking at a comprehensive approach, and taking a data driven approach. Dr. Maria Van Kerkhove: (45:25) Look at the epidemiology in the situation and in the geographic context of where it is. Break that down to the lowest administrative level as you can. Look at which interventions are being used, how they are being implemented, and see if there's any cracks there, if there's any ways in which that could be done better, or that could be done differently. And we need to learn from that. And I think that will help understand why is the virus taking off in certain situations, in certain contexts, and certain communities. Dr. Maria Van Kerkhove: (45:57) And because we... I say that because we know what has worked in some areas. We know what has worked, and that includes finding cases, isolating those cases, finding the context, quarantining the context. By doing that, you're actually breaking the chains of transmission. You're breaking the opportunity from an infected person to pass to another person. And so the interventions that are put in place, need to have that in mind. Dr. Michael Ryan: (46:29) May I just add. I did speak the other day about the rapid increase in the number of cases in Russian Federation. And obviously the situation there is developing equally with regard to Peru. There's been nearly a 50% increase in cases in the last week. And Peru is a relatively small country, is now up to nearly, I think it's 67 or 68000 cases there. And there've been quite a number of cases amongst health workers in Peru as well. I think 1600 health workers have been infected, and a lot of infections amongst police officers and others. And we've seen that in other countries how the first responders and the frontline workers are very often the ones exposed to the virus. Dr. Michael Ryan: (47:16) It's some of the success of implementing stay at home orders and movement restrictions have related to how quickly it was done or when it was not. And a difference of two weeks in those stay at home orders could make a big difference in the epidemiology. It also depends to what extent countries have good surveillance in place, and then added public health and social measures to that, as opposed to having very little in place in terms of public health surveillance, and then having to put the lockdowns in place to try and suppress the disease spread. There is some magical thinking going on, that's lockdowns work perfectly, and that unlocking lockdowns will go great. Both are fraught with dangers. Dr. Michael Ryan: (48:04) Just putting in place swinging lockdowns can do as much harm as good, if it's not done as Maria said, carefully. You choose the measures you want to put in place, that are adapted to your social and societal needs, that are adapted to stopping the virus most effectively. From what you understand as the transmission of virus in your community, what measures can you use that are adapted and acceptable and implementable and sustainable in communities in order to stop the virus? And then whatever risk is left, and there will be risks left, you manage with surveillance and response. That is a risk management approach. We've said it since the beginning. A comprehensive strategy based on measures to mitigate the spread and suppress the spread of the virus, and measures to pick up and respond to cases. The two together with the well empowered, involved, and educated community. Dr. Michael Ryan: (48:54) I think we've seen again and again, in a large number of countries they've made that work. Other countries haven't yet quite made that work. We all need to get on that journey. But I do think that when we say lockdowns didn't work, it may be a timing issue, it may be a fact that people were not on board with the processes, maybe the wrong measures were chosen and weren't adapted to the social context. So I think it's hard to say that. But I think we need to be very, very careful in also saying that if lockdowns didn't work, then taking away lockdowns will work. They're not the same. Tarik: (49:36) Next question is Stephen from a BBC World, Stephen Snyder if I'm not wrong. Steven, can you hear us? Stephen Snyder: (49:45) Yes, I can. Can you hear me? Tarik: (49:46) Yes. Stephen Snyder: (49:49) Very good. This is the question about the numbers of test kits in Yemen. On April 21st Reuters reported that the International Initiative on COVID-19 in Yemen was sending a shipment that contained tens of thousands of test kits. The article said that the IICY was working with the United Nations. This week I learned from a WHO staffer that there were 803 tests that have been conducted countrywide in Yemen so far. So my question is, why have so few coronavirus tests been completed in Yemen? Dr. Michael Ryan: (50:37) I have to get back to you on the number of test kits that have been shipped to Yemen. I don't have the data with me. I do know, as of the 9th of May, we have 35 lab confirmed cases and seven deaths in Yemen. And, we in the UN operating under the assumption that the virus is circulating widely and undetected in local communities. Since the 2nd of May, we've seen a five-fold increases. And while increasing from seven to 35 cases may not seem like much, we've seen that before. Very, very slow, low level incidents followed by a rapid escalation. Everyone starts at zero or one. It's where you go after that, that matters. And we do see worrying trends there. Dr. Michael Ryan: (51:24) We have not suspended in your operations at the moment. But we are greatly curtailed in our movements in the country for security reason. We're also trying to increase our footprint, but that also involves the rest of the UN decreasing footprint, because there are limitations on the number of UN staff that can be in country. So responding to COVID effectively means not responding to other things. And we thank our colleagues in the UN, and the leadership of Lisa Grande, the humanitarian coordinator there for facilitating and coordinating a process by which we can have more boots on the ground. We would like to see more testing. But to do more testing, you also have to have access to health care facilities. You have to have workers who can do that testing. You have to be able to train people to do that. You have to be able to do waste management. Dr. Michael Ryan: (52:18) It is exceptionally difficult to deliver services in the context of Yemen, the fractured state with multiple different warring parties. But as I say, I will come back to you on the number of tests shipped. I'm sorry. I don't have that information at hand. And with any further information on plans to scale up testing across the country. Tarik: (52:44) We'll take one or two more questions. Karen from ARD. Carla Wolfson. Hello Carla. Can you unmute yourself, please? Karen Wolfson: (53:00) Hello? Tarik: (53:01) Yes. Karen Wolfson: (53:01) Can you hear me? Tarik: (53:01) Yes. Karen Wolfson: (53:05) This is Karen Wolfson speaking from World Health Alert Crisis. Good afternoon. I'd like to ask you, what are the risks do you think, of the UK having eased lockdown with people going back to work, public transport quite crowded, and shops starting to open, before having implemented a full tracking and tracing system? Or do you think that they have already? Thank you. Tarik: (53:36) Thank you, Karen. And we'll try to go to Carly's last question. Sorry Carla, to you. Carla: (53:45) Okay. Thank you. Tarik: (53:46) Carla. Can we just respond to this question, and then we'll come to you? Carla: (53:49) Oh, okay. Thank you. I'm waiting. Sorry. Tarik: (53:53) Okay. DG says that Carla, go ahead. Ask you a question so we will then have two in a row. Carl, please go ahead. Carla: (53:59) Okay. I wonder if you can talk about that discussion, if Speaker 4: (54:02) I wonder if you can talk about the discussions, if closed borders had an effect on slowdown, spreading the virus, especially as states like Germany, Switzerland, Austria are now working to reopen. I wanted to know, are there any recommendations? What should states keep in mind when reopening borders, when reactivating traveling? Dr. Michael Ryan: (54:25) I think this was obviously a major consideration. I think it was two questions, one about the UK and one about the borders. I think the borders one has more general relevance. I'm going to answer that one first and then come back to the specific UK one. I think there are both land and air borders. Obviously, crossing a land border in itself doesn't present a tremendous amount of risk because the conveyancer is usually a car, so it's a person moving from one zone to the other. I think a lot of countries now are looking at risk and response equalization. They're looking at other countries and saying, "Is the risk of disease in your country similar to mine? Is your response comprehensive like mine?" If we exchange citizens or tourists, there's no real difference. If a person from a country that's managing risk well and managing response well can move between countries, then you're not adding any extra risks by moving your citizens between the countries. Dr. Michael Ryan: (55:22) In that sense, you see countries in the Baltic, like Latvia, Lithuania, looking at what they call "bubble" travel zones... I think Australia and New Zealand are doing the same. I think countries in the ASEAN are doing the same and looking at how... I think that's maybe how travel and trade will return. I'm not an economist. I'm not a futurist, but I think you're going to see countries in the same subregions or regions, particularly those with land borders, or strong, traditional trading, or historical links, are going to look for ways to equalize the risk, bring the responses into line so that they have the confidence of their communities that the risk in that country and the response in that country is very similar to what we have here. Therefore, we can move citizens between. That's going to take time, but I sense that's the way it's going to happen. Dr. Michael Ryan: (56:11) Air travel is a different challenge because air travel can bring people a very long way and around the world, literally, in half a day or a day. That's going to introduce more complexity for countries as regards to the rules they will have for arrivals from far away. That's going to involve much more sophisticated risk management and risk reduction measures, both in terms of which countries can travel to which and then how the airline process or the travel process is managed. I think a lot of airlines now, and we're working with IATA, we're working with [inaudible 00:02:48], on guidelines for how airlines can resume in a safe manner. That risk has to be managed right away through the airport process, the travel process, and then the immigration and arrival process, so it's not just being on the plane. It's a long procedure. Dr. Michael Ryan: (57:08) We are working to try and advise the travel industry how to do that as safely as possible. Again, this comes back to national policy, and obviously, nation states will decide who can travel to and from their countries. They will need to do that, both at their land borders and at their air borders. The arrangements made in those two situations may differ greatly. We may see a return of land-border travel, certainly, extensive cross-border travel, before we see extensive air travel, but that, again remains to be seen. Maybe the UK question. Dr. Maria Van Kerkhove: (57:46) Sure. I'll take the first question. The question was specifically about the UK, but I'm going to answer this question for all countries, because this is consistent for every country across the world. There are six criteria that countries need to take into account when they are considering adjusting their public health and social measures, or so-called lockdowns. We've already discussed that lockdowns can mean a number of different measures. The first criteria, and the DG has said this several times in his speeches, is that transmission is controlled. That means that the incidents of cases, the number of new cases that are happening, is reducing, and that is reducing over a period of time. Dr. Maria Van Kerkhove: (58:28) Second is that sufficient health systems and public health capacities are in place. That means that countries have the workforce and the ability to detect, to test, to isolate, to care for cases, making sure that the hospital facilities have enough beds to be able to care for patients depending on the severity of their symptoms, to have the right kinds of ICU facilities or advanced-care facilities, respiratory support, having healthcare workers that are in place that can actually care for patients, to ensure that they have ability to contact-trace the contacts of known cases, and they have the ability to quarantine those contacts in safe facilities. Dr. Maria Van Kerkhove: (59:10) The third is to make sure that the risks of outbreaks in high vulnerable settings are minimized. We've spoken about some of these today. The DG mentioned prisons and detention centers in his speech today. We've talked about long-term care facilities. It's very important that there are systems in place to protect vulnerable settings. Dr. Maria Van Kerkhove: (59:31) The fourth is that workplace preventive measures are established. We've also issued guidelines around workplace and the resumption of work in a safe way so that certain control and prevention measures are in place like physical distancing, for example, and that workplaces have plans to be able to rapidly identify cases and manage those cases. Dr. Maria Van Kerkhove: (59:55) Five... The risks of imported case are managed. Mike just described how with borders opening and people being able to move, and it could even be within a country, that we are able to find the virus so that the risk of the virus moving from one geographic area to another can be traced, can be tracked, and we can break those chains of transmission. Dr. Maria Van Kerkhove: (01:00:17) Lastly, that communities are fully engaged. These are informed, empowered, knowledgeable community members who understand how the lifting of these measures needs to take place in a control, in a slow way so that they understand that we may be able to lift them. We may need to impose them again, and that we are listening to our communities. We are working with our communities so that they know what role each individual has to play in controlling and suppressing this virus. Derek: (01:00:54) We will go to the last question for today. That's Emma Faris from Writers. Emma? Emma Faris: (01:01:03) Hey. Good afternoon. Another question on the potential longevity of the virus, please. I understand that Chief Scientist at WHO spoke today to the FT about us having to... It's going to take four to five years before the virus is under control. That seems, to me, like a sea change in people's expectations because I think most people think we'll muddle through until there's a vaccine, and that will take 12 months. Is this view of the Chief Scientist something held widely within the WHO? Thank you. Dr. Michael Ryan: (01:01:38) Yes. I would love to see what Soumya's commentary was, but I suspect it was an answer to probably a question about, how long could this last? as opposed to, how long do you predict it will last? We have a new virus entering the human population for the first time. Therefore, it is very hard to predict when we will prevail over it. What is clear, and I think maybe what Soumya may have been alluding to, is that the current zero prevalence or the current number of people in our population who've been infected is actually relatively low. If you're a scientist, and you project forward in the absence of a vaccine, and you try and calculate, how long is it going to take for enough people to become infected so that this disease settles into an endemic phase? Dr. Michael Ryan: (01:02:38) We may never. I think it's important to put this on the table. This virus may become just another endemic virus in our communities, and this virus may never go away. HIV has not gone away, but we've come to terms with the virus. We have found the therapies. We found the prevention methods. People don't feel as scared as they did before. We're offering life to people with HIV. Long, healthy lives to people with HIV. I'm not comparing the two diseases, but I think it is important that we're realistic. I don't think anyone can predict when or if this disease will disappear. We do have one great hope. If we do find a highly effective vaccine that we can distribute to everyone who needs it in the world, we may have a shot at eliminating this virus, but that vaccine will have to be available. It'll have to be highly effective. It will have to be made available to everyone, and we will have to use it. Dr. Michael Ryan: (01:03:39) Before we began responding to this event on the 31st of December, we were heavily involved and had teams in the Western Pacific, working on measles. At that time, every single ventilator... We've learned about ventilators, all of us around the world in the last... A lot of people talk about ventilators. I think there were 14 ventilators in Western Samoa at that time. All 14 were occupied by young children. They were occupied by young children who had a devastating disease. It was called measles. They weren't vaccinated against that disease. Forgive me if I'm cynical, but we have some perfectly effective vaccines on this planet that we have not used effectively for diseases we could eliminate and eradicate, and we haven't done it. We've lacked the will. We've lacked the determination to invest in health systems to deliver that. We've lacked the capacity to sustain primary health care at the front end. Therefore, science can come up with the vaccine, but someone's got to make it. We've got to make enough of it that everyone can get a dose of it. We've got to be able to deliver that. People have got to want to take that vaccine. Dr. Michael Ryan: (01:04:54) Every single one of those steps is fraught with challenges. It's a massive opportunity for the world. The idea that a new disease could emerge, cause a pandemic, and we could... Find a vaccine, and give that to everyone who needs it, and stop this disease in its tracks. We'll turn maybe what has been a tragic pandemic into a beacon of hope for the future or our planet in the way we care for our citizens and the way we work together to solve our problems through solidarity, through trust, through working together, and through a multilateral system that can actually benefit mankind. Dr. Michael Ryan: (01:05:38) I think there are no promises in this, and there are no dates. This disease may have settled into a long-term problem. It may not be. In some senses, we have control over that future, but it's going to take a massive effort to do it. The DG's been calling for it. He's been speaking, bringing leaders together, trying to drive the issue so that we have access to COVID tools. We believe we have a coalition that can deliver on that, but it's going to need the political, the financial, the operational, the technical, and the community support to be a success. Dr. Maria Van Kerkhove: (01:06:16) All right. I just wanted to add that I think many people are in a state of feeling quite some despair. They've been at home for quite some time. They're going through very difficult situation. They've had loved ones who have been infected or who have died. I just want to say that the trajectory of this pandemic, the trajectory of this outbreak, is in our hands. We have seen in a number of countries, without medical interventions... As Mike said, the global community has come together to work in solidarity to accelerate the development of a safe and effective vaccine and to come together to commit to have access to that safe and effective vaccine when it is available. Dr. Maria Van Kerkhove: (01:06:58) We have seen countries bring this virus under control. We have seen countries use public health measures, the fundamentals of public health, and epidemiology, and clinical care to bring the virus under control, and to suppress transmission to a low enough level where communities can get back to work and communities can open up again. We can't forget that. I mean, it will take some time before we have the information on these medical interventions. It's coming. People are working very hard on that. This is in our hand. We are seeing hope in a number of countries. I really don't want people to forget that. Derek: (01:07:40) Well, with these comments, we will conclude today's press conference. Thanks to everyone who was watching us on WHO social media platform. Also, to all journalists who were online... We will have audio file available for you in the next hour or two, and transcript tomorrow. I wish everyone a very nice evening. Dr. Tedros: (01:08:05) Thank you. Thank you. Thank you, Derek. As Maria said, I think that trajectory is in our hands. This is everybody's business. We should all contribute to stop this pandemic. Thank you for joining. See you on Friday.