World Health Organization Coronavirus Press Conference Transcript May 4

Tariq: (00:00) I give the floor to Dr. Tedros for his opening remarks. Just to remind you that we have been sending you press releases as well as invitation for press conferences of our regional offices and on activities from our different sections. So I'll give a floor to Dr. Tedros for his opening remarks. Dr. Tedros: (00:25) Thank you. Thank you, Tarek. Good morning, good afternoon, and good evening. 10 days ago, I joined President Emmanuel Macron, President Ursula von der Leyen, and Melinda Gates to launch the act accelerator to support the development, production, and equitable distribution of vaccines, diagnostics, and therapeutics against COVID-19. Today, leaders from 40 countries all over the world came together to support the act accelerator through the COVID-19 Global Response international pledging event hosted by the European Commission. During today's event, some 7.4 billion euros was pledged for research and development for vaccines, diagnostics, and therapeutics. This was a powerful and inspiring demonstration of global solidarity. Today, countries came together, not only to pledge their financial support, but to also pledge their commitment to ensuring all people can access lifesaving tools for COVID-19. Accelerating development of the products, but at the same time access to all. Dr. Tedros: (02:21) Recent advances in science are enabling the world to move at incredible speed to develop these tools. But the true measure of success will not only be how fast we can develop safe and effective tools, it will be how equally we can distribute them. None of us can accept a world in which some people are protected, while others are not. Everybody should be protected. None of us are safe until all of us are safe. The potential for continued waves of infection of COVID-19 across the globe demands that every single person on the planet be protected from this disease. WHO remains committed to working with all countries and partners to accelerate the development and production of vaccines, diagnostics, and therapeutics, and to ensure their equitable distribution. This is an opportunity for the world to come together to confront a common threat, but also to forge a common future, a future in which all people enjoy the right to the highest attainable standard of health and the products that deliver that right. Dr. Tedros: (03:56) That's what we mean by health for all. We have been saying it for the last more than 70 years since the WHO was created, but I think given the experience we have now and the difficulties we're going through, it's time to make it happen, health for all. But one of the best tools is also one of the most basic, clean hands. The simple act of cleaning hands can be the difference between life and death and remains one of the most important public health measures for protecting individuals, families and communities against COVID-19 and many other diseases. Tomorrow is Hand Hygiene Day, a reminder of the importance of clean hands for health workers and for all of us. At the same time, we must remember that millions of people around the world are not able to practice this most basic of precautions. Around the world, less than two thirds of health care facilities are equipped with hand hygiene stations, and 3 billion people lack soap and water at home. This is an old problem that requires new and vastly increased attention. If we are to stop COVID-19 or any other source of infection and keep health workers safe, we must dramatically increase investments in soap, access to water, and alcohol-based hand rubs. Tomorrow also marks the International Day of the Midwife. This is an opportunity to remember the vital role that midwives play all over the world in providing safe and effective care for women and newborns. Research shows that interventions delivered by midwives can avert over 80% of all maternal deaths, stillbirths, and neonatal deaths. The service of midwives is actually a lifeline for many. Childbirth can be one of the most precious moments in a woman's life, but it can also be one of the most dangerous, as you know. Midwives are essential for guiding and caring for women through their entire pregnancy and the critical moment of childbirth. But we need more midwives in all countries, especially low resource countries. Dr. Tedros: (07:14) To mark Hand Hygiene Day and the International Day of the Midwife, we're calling all people to stop what they're doing at noon tomorrow to clap for nurses and midwives and thank them for their role in delivering safe and effective care, especially during this pandemic. They're risking their life and to protect or to give life to others. Several countries are now starting to ease so-called lockdown and stay-at-home orders, but our common commitment to basic measures such as cleaning hands and physical distancing cannot be relaxed nor can the commitment to the tools that are the foundation of the response to find, isolate, test, and care for every case, and trace every contact. Then to ensure health systems have the capacity they need to provide safe and effective care for all. But just as the number of new cases and deaths is declining in some countries, it's mounting in others. That's why two days pledging even is so important. Dr. Tedros: (08:52) This virus will be with us for a long time, and we must come together to develop and share the tools to defeat it. But of course today's event only covers one part of the response for research and development in vaccines, diagnostics, and therapeutics. In the weeks and months ahead, we will need much more to meet the demand for personal protective equipment, medical oxygen, and other essential supplies. Later this week, WHO will launch its updated strategic preparedness and response plan, which will provide an update of the resources WHO needs to support the international response and international and national action plans to the end of 2020. Dr. Tedros: (09:54) WHO is grateful to the many countries and donors who supported the first strategic and response, preparedness and response plan. And we are also grateful to the more than 300,000 individuals, corporations, and foundations who have contributed to the Solidarity Response Fund, which has generated more than 210 million US dollars in just six weeks. As my friend Boris Johnson said during today's pledging event, "We're in this together, and together we will prevail." We will prevail through national unity and global solidarity. The antidotes to this virus are national unity and global solidarity. The antidote to this virus is the human spirit. Thank you. Tariq: (11:07) Thank you very much, Dr. Tedros, for these opening remarks. We will now open the floor for questions. I will remind journalists to be very brief and ask only one question so we can try to take as many as possible. And again, you can ask the question in six languages plus Portuguese. For journalists who are on Zoom, you will need to go to settings to find your language. And because of a bug we have, Arabic is under Korean, so if you want to listen in Arabic you have to click on Korean. That's a bug that we have in Zoom, and it's not really our fault. We will start with EFE News Agency. Isabel is online. Isabel? Isabel: (11:53) Yes, do you hear me? Tariq: (12:04) Yes. Isabel: (12:05) Thank you. [Spanish 00: 11:56]. Dr. Maria Van Kerkhove: (12:58) Thank you for the question. So there are a number of diagnostic tests that are currently available and are being sold globally. In fact, there's hundreds of them. And the tests that you're referring to are these molecular tests or these PCR based tests that can diagnose somebody as having active infection. It's difficult to answer that question because I don't know exactly which tests you're referring to. What is really important is that the tests that are being used by any governments or being sold, that there's clear results of how well these tests work. There are the possibilities that if they are not validated, we call validated, where we test them against known samples of whether the samples are indeed positive or negative. It's very difficult to know if the test result that you're getting is a true result. And as you've highlighted, there are risks associated with having a false positive in thinking that you are infected, and you are indeed not. And more importantly, if you test false negative, where in fact you are infected, and the test tells you that you're not. Dr. Maria Van Kerkhove: (14:05) So there are some risks associated with being sold over the counter. Having said that, the ingenuity, the rapid development of these tests is very positive, and we welcome this innovation. We welcome the speed at which these tests are being made available, but it is important that they're validated. It's important that we really understand how well they work. Bottom line, though, is that everyone that is out there needs to adhere to public health measures, regardless. These include hand hygiene that the DG has just mentioned, and you've heard us mention well with washing your hands with soap and water or an alcohol-based rub. Practice physical distancing, so where you're physically distant from another person, adhering to the public health measures that are put in place by governments, practicing respiratory etiquette, these are the things that must be adhered to all the time while we work through the use of some of these tests that are coming online. Tariq: (15:06) Thank you very much, Dr. Van Kerkhove. Hope this answers the question from Isabel, and it was on self-testing. Next question is from Joan from Meetings Today. Joan, can you hear us? Joan, can you unmute yourself, please? Joan: (15:26) Yeah, sorry. I did. Tariq: (15:26) Okay, thanks. Joan: (15:28) [crosstalk 00:15:28] you hear me now. Thank you. Meetings and conventions are part of the tour and travel industry, and we are incredibly confused about how WHO classifies mass gatherings. Around the world and in the U.S. groups don't know what that means. We're finding different standards within the United States, and I just saw someone mentioned what France is doing in terms of the ability to travel to meetings. We need guidelines about how WHO defines mass gathering and how we're going to go forward. Thank you. Dr. Maria Van Kerkhove: (16:10) So thank you for the question. I will start. Maybe Mike would like to supplement. So the question around mass gatherings, there's different ways in which people are defining gatherings, just gatherings in general in terms of you seeing different governments put in place more than five people, no more than 10 people, no more than 50 people. Mass gatherings are obviously much larger than that. What we do is we have put out guidance which provides a risk assessment based approach that evaluate each guide at each gathering as it is defined, as it is developed. What is the gathering itself? Where is it taking place? How many people are involved in it? Is there any way in which it can be done remotely or through video? Is there a way it can be postponed? And so what we're trying to do is lay out the criteria in which those decisions can be made. Dr. Maria Van Kerkhove: (17:03) Do is lay out the criteria in which those decisions can be made. Those decisions must be made on a case by case basis because not all situations are the same. The area in which they are carried out have different ventilations, some are outdoor, some are indoors, so it depends. It's an unsatisfactory answer because we can't give you a yes or no, but what we try to do is we try to outline all of their criteria that you would need to take to be able to make that decision. The same holds true for travel, the same holds true for holding meetings some places, all of those decisions need to be taken on a case by case basis to determine if indeed that meeting needs to take place and if so, how that could be done safely. Tariq: (17:49) Thank you very much, Dr. Van Kerkhove. Next question is Radio France International [foreign language 00:01:01] can you hear us? Hello? Do we have [foreign language 00:01:10]? Speaker 3: (18:11) Yes. Can you hear me? Tariq: (18:12) Yes, please. Go ahead. Speaker 3: (18:15) Thank you. I just had a quick question regarding mass gatherings. Also, I heard that France is considering reopening movie theaters for instance, and I would like to have your opinion on that. Do you think this kind of measure is too early because we can think of a mass gathering stewing in movie theaters where hundreds of people sitting in the same place. So do you consider it to be a good measure or not? Thanks. Dr. Michael Ryan: (18:47) Yeah. I think we need to make a distinction here between what would classically be regarded as mass gatherings, which are large religious events, big sporting events where thousands and thousands of people come together and approach one point and then leave from a point in they're coming potentially from across national boundaries or within national boundaries. So they're gathering events and they're large scale, they're often multinational and require and involve the movement, not just the presence of many people in an area, but potentially the movement of people to and from those areas. Movie theaters, churches, and other gatherings are more localized events and they have to be dealt within the local context. WHO can prescribe to individual countries. What exactly is to be done in every single context. What we do advise is anywhere where people gather, where they cannot maintain social distance or physical distance or appropriate hygiene, then there's always a risk in the presence of the virus that you may amplify the virus. Dr. Michael Ryan: (19:54) And we've seen that and there's plenty evidence that that has happened in the past. So as countries open up their economies and open up the societies and as they look at different gatherings be they religious or social gatherings that occur, they've got to calibrate the risks associated with those gatherings which are based on how much virus is circulating in the area. So what is the absolute risk of exposure and then what are the increased risks of being exposed in an environment where there are a number of people who cannot maintain physical distance or potentially maintain hygiene or other measures. And you can see within that that many governments and companies, private and public are looking at what are the measures that need to be put in place, for example, restricting access to less than full capacity or some proportion of capacity to having spacing between seating to having extra hygiene and disinfection measures put in place. Dr. Michael Ryan: (20:57) Having online ticketing, there's lots of different measures that for each individual service or each individual gathering can be put in place. The same with churches. So again, as the director general has said in his speech exiting the more severe public health and social distancing or physical distancing measures or the lockdowns or stay at home orders and allowing people to reengage in social and economic life must come with a risk managed approach. How do we minimize the risk of transmission between individuals while obviously trying to maximize the way in which people can reengage in their normal lives? And that is determined by the presence of the virus that is determined by the risk of the encounter or the risk of the particular environment which people will come to. And the means and the ability of both the government, local governments, communities and private sector owners to minimize those risks to participants or to clients. Tariq: (22:04) Thank you very much, Dr. Ryan. Next question comes from Italy. Luca Rossini from [inaudible 00:22:11], Luca. Luca. Lucca R: (22:16) Hello. Can you hear me? Tariq: (22:17) Yes, please go ahead. Lucca R: (22:18) Okay, so regarding the contact tracing, what would you suggest to country like Italy to integrate manual and digital contact tracing in order to speed up not only the national process of contact tracing but even the broader process of international process of contact tracing, which is very important when the border will be opened, again? Dr. Michael Ryan: (22:51) Thank you and I think this is a challenge that's facing many countries right now. So I won't answer it in the specific context of Italy. I think when you speak to professionals in Korea and Singapore about what they did to make their contact tracing more effective, they will first and foremost tell you that they got more boots on the ground, that they went back to the basics of public health, finding cases at community level, community based surveillance, putting more surveillance officers out there following up with people, making the phone calls, knocking on people's doors. Finding out who could have been exposed and ensuring that those who are suspected are tested and isolated and then ensure that those who are in contact are given that information so they can protect themselves and their families and are offered either a home quarantine are quarantined in a third place. And this is all been aimed at breaking the chains of transmission. Dr. Michael Ryan: (23:51) If someone who is infected has no further contact with other people other than protected health workers, their chances of passing on the disease are minimized. If a contact who is developing disease is aware of that and report symptoms immediately, the chances of them infecting someone else decreases. Very, very importantly, and this is all going to that number that everyone talks about, the R number or the R0, the capacity of one individual to infect any other individual. Contact tracing and case finding is not about surveillance or interrupting people's lives. It's about trying to identify those individuals who are sick and in trying to ensure that those sick individuals are tested and cared for and that anyone who is in contact with them is monitored and then subsequently tested and cared for if needed. In doing that, we reduced their role in spreading the disease to others. Dr. Michael Ryan: (24:48) That is essentially a human process and it needs to have a human face because these are difficult times for cases and for contacts. What has emerged and what WHO, for example for a number of years has been working on a system called Gold Data. Which is an integrated information system which is app based, which allows public health authorities to integrate all of the different data, the case data, the contact data, the laboratory data, and we've rolled that out to a number of countries over the last number of months and with increasing frequency now, during COVID-19 and are willing to offer that to any country that wishes to implement it. The addition of apps that people themselves can have on their telephones that will give them information on their disease status or notify them if they've been in contact with an individual that is infected can obviously enhance the effectiveness of contact tracing and surveillance. Dr. Michael Ryan: (25:43) And we've seen various examples of that emerge around the world and be put to use. There an additional measure that will potentially enhance the efficiency of the contact tracing process. But they won't do it by themselves. In doing that, and we are very grateful for those countries and those companies and those innovators who are working on such tools and we're talking with them every day. What we need to ensure as we roll out those tools. Number one, that they enhance that process and they're not seen as a replacement for shoe leather epidemiology. They're not seen as a replacement for the basic human workforce, the army, we need to go out there and find cases. They can enhance the work of this workforce but they can't do the work of that workforce. If we add those tools and give an extra boost to that process and become more efficient, then we will get rid of this virus more quickly. Dr. Michael Ryan: (26:37) But we also have to consider and very carefully within this that these tools must be used for that purpose and that purpose alone. And we have to take into account people's personal data protection, protection of their data, protection of their privacy and ultimately protection of their human rights. I think all countries are trying to approach this in a very balanced manner, but we do believe that such tools are useful. We are very, very grateful to see the innovation, but we are very, very keen to stress that IT tools do not replace the basic public health workforce that is going to be needed to trace, test, isolate and quarantine. Tariq: (27:24) Thank you very much. From Italy we go to Brazil. Anna Pinto from [foreign language 00:27:30] Sao Paulo. Anna. Anna: (27:32) Yeah. Hi. Thanks for taking my question. I was asking for today provided the translator. [foreign language 00:10:53]. Dr. Michael Ryan: (27:54) Maria may go into the detail, but I think it is as to whether or not we're seeing this phenomenon, but it is very important. The director general has said this many times, no one is safe until everyone is safe and we cannot leave anyone behind and we have to absolutely ensure the public health surveillance and testing is available to all who need us. And it is very important that testing is not seen as the purview of the wealthy or those who can afford it. This isn't about testing people from a clinical perspective only. This is about testing people so we know where the virus is. And therefore if people see the purpose of testing in just getting my diagnosis so then I can go and get paid for treatment, then that is a distortion of the ultimate purpose of testing. Testing is aimed at doing two things. One, is giving people with symptoms and opportunity to be tested so they can get the proper care. But it also triggers a whole series of activities to understand the transmission and dynamics of the virus. So if access to testing is determined by resources, then there's going to be a very skewed understanding of where the virus actually is. And that's very dangerous. That's dangerous from a public health perspective. Not only is it inequitable, it is also dangerous. So it's very important that testing is made available to those who need it. And in fact, in some cases, I believe the testing should be more available in areas where people don't have the opportunity to physical distance, where they may have higher rates of infection and in fact may also have higher rates of death if they're infected. Dr. Michael Ryan: (30:21) We've seen with many vulnerable populations, we've seen with ethnic minorities, we've seen with indigenous people that they may have higher death rates when they are infected because of underlying conditions, because of longstanding underlying conditions. So it is all the more important that we have early testing of people who may have those underlying conditions. So if anything, testing should be prioritized in areas where there's underprivileged, where there's overcrowding, where there's poverty, but I'm not aware of this emerging systematically in our data, but certainly if this phenomenon is happening, then this is a very wrong direction because it is not only inequitable and unjust, it is also a dangerous direction because you will not know where the virus is and you will not be able to detect those who need care the most. Dr. Maria Van Kerkhove: (31:13) Maybe to supplement what Mike has said. So the speed in which the virus can transmit relates to the contact between infected people. And so we have seen in a number of urban areas the ability for the virus to spread. We've also seen this in less populated areas. Just because there's an urban area that has a seeding of this virus or the virus being detected doesn't mean that it has to take off. The ability of, our ability to suppress transmission relates to detecting people with the virus. So it relates to testing. It relates to the surveillance strategy that is in a country and how countries are actually looking for cases. It relates to the ability to isolate known cases. If those cases who are known are isolated in a healthcare facility and are treated, are provided care depending on the severity of their symptoms, then they are taken out of the general population and they can't transmit to other people. Dr. Maria Van Kerkhove: (32:13) If contact tracing is happening comprehensively where contacts of known cases are identified and those contacts are quarantine, then if they develop symptoms, they're already in quarantine. They don't have the ability to infect somebody else. So it's all about the ability of this virus to find another person to infect. And if we stop that, if we break that chain of transmission, that's what we mean. We actually mean taking, breaking the chain of transmission from one person who's infected to passing it on to another one to pass on to another to pass on another. If we're able to break that, then we can prevent that from transmitting further. Dr. Maria Van Kerkhove: (32:51) But it is important to know how cases are being detected in the country. It's important to know how once they are detected, how they are cared for and isolated and if contact tracing is occurring. But just because of virus is identified in an urban area, doesn't mean that it has to take off and we've seen a number of countries that have been able to prevent that from happening, whether it's through the public health measures or it's through these more advanced stay at home orders, but it is possible to suppress transmission and to break those chains of transmission. Tariq: (33:25) Thank you [inaudible 00:33:25] Dr. Ryan and Dr. Van Kerkhova. This is question from Sao Paulo and inequality, social inequality and COVID-19. The next question is coming from Savio Rodrigues from Goa Chronicle. Savio can you hear us? Savio R: (33:40) Yeah. Can you hear me? Tariq: (33:41) Yes, please go ahead. Savio R: (33:43) Okay. My question is for Dr. [Tedros 00:33:46] on December 31st, 2019 the Taiwan Center for Disease Control sent an email to the World Health Organization informing WHO of its understanding of the disease and requesting for more information. In that email, they use the word atypical. Savio R: (34:02) In that email, they used the word, "atypical pneumonia," which they claim is a word commonly used to refer to SARS, a disease transmitted between humans. Why did WHO not take Taiwan's CDC observation seriously is my question? Tariq: (34:20) Thank you. Thank you, [Salia 00:34:20]. I think Mr. Solomon will take this one. Dr. Michael Ryan: (34:25) I may follow. Dr. Maria Van Kerkhove: (34:27) [inaudible 00:00:34:26]. Steven Solomon: (34:30) Thank you, [Tariq 00:34:31] and thanks very much for the question. It's appreciated because it gives us an opportunity to set the record straight, which I'd like to do right away and then I'd also like to address questions of their participation at WHO meetings because these questions continue to come up as well. Steven Solomon: (34:52) So, did Taiwan warn WHO on 31 December, 2019? The answer is no, they didn't. They did send an email, but that email was not a warning. It was a request for more information on cases of atypical pneumonia reported by news sources. Steven Solomon: (35:12) They sent that request through the IHR system that Taiwan, China and all IHR focal points are part of. The email asked for more information, more information about news reports that WHO and most public health services already knew about. Others, in fact, sent similar emails that same day also asking for more information. Steven Solomon: (35:38) These reports about atypical pneumonia cases came from Wuhan itself on the internet and they came through a website run by ProMED. That's an acronym for Program for Monitoring Emerging Diseases. The reports were therefore already available and the Taiwanese email just requested, in very kind terms, more information. Steven Solomon: (36:03) Why then has this story of warning continued to circulate? Well, the answer to that is in part because of the rules for the IHR system itself. That is the electronic communication system supporting the International Health Regulations and its focal points from around the world. These focal points around the world are the direct channel to WHO for information about disease outbreaks. The communications are confidential in order to promote openness within the IHR system. Steven Solomon: (36:41) So, until Taiwan CDC indicated that they didn't expect confidentiality about that email, we couldn't offer details. Then on the 11th of April that changed. Taiwan's authorities held up the email at a media briefing. Since Taiwan has made the message public, I'll read out the full content today. Steven Solomon: (37:04) It reads and I'm quoting in full, "News resources today indicate that at least seven atypical pneumonia cases were reported in Wuhan, China. Their health authorities replied to the media that the cases were believed not SARS. However, the samples are still under examination and cases have been isolated for treatment. I would greatly appreciate it if you have relevant information to share with us. Thank you very much in advance for your attention to this matter. Best regards." Steven Solomon: (37:42) The email wasn't a warning and it only contained information that WHO already had picked up from internet reports. It's also important to say that the Wuhan situation had already been captured by WHO on that day, 31 December, 2019. WHO activated its incident management protocols the next day on January 1st. And then along with embedded scientists from other governments WHO began the work, which continues to this day analyzing the data and seeking additional information. Steven Solomon: (38:18) On the 4th of January, WHO provided information about this situation publicly. On the 5th of January, WHO shared detailed technical information through this IHR system. This included advice to all member States and all IHR focal points to take precautions to reduce the risk of acute respiratory infections, providing guidance on the basis that there could be human-to-human transmission. Steven Solomon: (38:48) On the 10th and the 11th of January, WHO published a comprehensive package of guidance on how to detect, test for and manage cases and protect health workers from potential human-to-human transmission based on our previous experience with coronaviruses. And as you know, there was a global press briefing on January 14th where WHO spoke about likely scenarios around human-to-human transmission. I hope that's helpful in understanding the December 31st email. Steven Solomon: (39:20) We know there are also questions about Taiwan's participation in WHO expert meetings and questions about their participation in the World Health Assembly. Steven Solomon: (39:29) WHO is an inter-governmental organization, meaning that countries decide how the organization is structured and on its policies. Some 49 years ago, the UN and WHO decided that there was only one legitimate representative of China within the UN system and that is the People's Republic of China. That decision still stands. Steven Solomon: (39:56) WHO is also a specialized agency of the United Nations and as such aligns with the UN and must do so coherently. The work of WHO staff in line with our Constitution is to promote the health of all people everywhere and to assist with, but not decide on, issues at the World Health Assembly. Steven Solomon: (40:22) So, regarding expert meetings on technical health matters, last year, Taiwanese experts were included at eight expert meetings and there were six other informal technical meetings. This year, in response to COVID-19, Taiwanese experts are involved in key groups and networks. We've had telephone conferences with their CDC, Dr. Van Kerkhove and myself, and we'll do so again. And as noted there, HR contact point links their CDC directly to WHO Headquarters. In the COVID-19 response, especially they have had notable successes and we appreciate their contributions. Steven Solomon: (41:02) Regarding the World Health Assembly, the next one will be in two weeks, starting on May 18th. The involvement, if any of Taiwanese observers, in that assembly is a question for the 194 governments of WHO. This is not something that WHO secretariat has authority to decide. And indeed, two countries have already formally proposed that member States consider this matter at the World Health Assembly. Steven Solomon: (41:35) And a final word, a lot of attention has focused on Taiwan's participation with WHO and we understand that. We are also mindful that there are other places too that for many different reasons look for connections to WHO. But, it is not the role of WHO staff to be involved in geopolitical issues. In fact, our principles of neutrality and impartiality exist to keep us out of those issues and to promote the role of evidence-based science in all our work. Steven Solomon: (42:11) Our role, even when we operate in sensitive political areas, or in complex humanitarian emergencies, is to follow the rules and policies that member States set out, and working within them, to strengthen health systems and access to healthcare for all people everywhere. Others may want to add to this. Thanks very much. Dr. Michael Ryan: (42:38) Just one small clarification on the issue of atypical pneumonia. Atypical pneumonia is an extremely common form of pneumonia that occurs around the world. There are millions and millions of cases every year. And atypical pneumonia effectively refers to the fact that the cause of the pneumonia is usually atypical or not necessarily diagnosed as some of the normal causes of pneumonia and one of the usual causes for a community-acquired pneumonia. Very often they can test negative on first testing and then they're subsequently retested for specific pathogens. Dr. Michael Ryan: (43:13) In studies I know, up to one third of community-acquired pneumonias can be considered to be atypical in that you have other pathogens that are found, will be known as atypical pathogens, pathogens that don't typically cause that type of pneumonia. And certainly at a global level, they would most be represented when they're finally diagnosed by Legionnaire, Legionella pneumonia, chlamydia pneumonia, and mycoplasma pneumonia as the causes, which are bacterial causes of atypical pneumonia. Dr. Michael Ryan: (43:44) So, the most common causes of atypical pneumonia are bacterial causes and not necessarily viral or others, but obviously viruses can cause atypical pneumonia. But, to say that atypical pneumonia is a homonym for SARS is entirely incorrect. Dr. Maria Van Kerkhove: (44:06) If I can also supplement. So just to say in the beginning that email that Steve read out did not mention human-to-human transmission and I think that is important. But from day one, from all of our experience with other respiratory pathogens and from SARS, from MERS, you operate on the possibility that, that may be possible. And from the beginning with our partners, with our global expert networks, with all of our internal staff at the three levels of the organization prepared for this. Dr. Maria Van Kerkhove: (44:34) And so, even the first notifications that we had through our Event Information System, which is what Steve has mentioned, which is the IHR mechanism by which we notify all member States and contact points, we talked about protection against acute respiratory infections and there was details in there about this. And as more information became available and as more details come from the investigations that are taking place, we, you modify the guidance. Dr. Maria Van Kerkhove: (45:02) Having said that, our first technical package of guidance that was issued to our emergency directors at all of the regions to all of the WRs and made public on our website put out guidance preventing against human-to-human transmission and it focused on transmission via respiratory droplets and contact. And in the situation of healthcare settings focused on the potential for aerosol transmission or airborne transmission when you have in the context of aerosol generating procedures. And again, this is based on our experience with other respiratory pathogens, SARS, MERS, influenza with the first and foremost idea to protect our healthcare workers who are caring for patients. And this was before diagnostic tests were even widely available. Dr. Maria Van Kerkhove: (45:51) And so, what we aimed to do was immediately try to put out information to warn all of our member States and contact points about how to find cases through surveillance guidance, how to collect samples safely through our laboratory guidance, how to protect healthcare workers who are caring for patients in our infection prevention and control guidance, how to care for patients in our clinical management guidance, which was focused on severe respiratory disease. Because again, even without information on the details of what disease this might have caused, you anticipate that this would cause a severe disease or could cause a severe disease. Dr. Maria Van Kerkhove: (46:32) And lastly, we also put out a readiness checklist, which was a series of questions, which helped all, everyone look at how ready are we, how ready are we for an emerging respiratory pathogen, which is what this was. And we've said previously, this COVID-19 virus, SARS CoV-2, turned out to be the latest disease X and disease X is what we are all anticipating. It's not a matter of if, it's a matter of when, and the DG has said this before. So this was something that could happen because diseases come from, they spill over from animals. This is happening all the time. But, we need to ensure that we put out guidance as quickly as possible to help prevent onward spread and protect people who are caring for those patients. Tariq: (47:24) Thank you very much for this answer on this topic. The next question is from CNBC. That's, Will. Will, can you hear us? Will: (47:36) Hi. Yeah, can you hear me? Tariq: (47:37) Yes, please. Will: (47:39) I wanted to ask, the DG mentioned earlier about equitable distribution of therapeutics and vaccines. I wanted to ask about Gilead's remdesivir, which received emergency use authorization in the US this past week. The US government is controlling the supply of remdesivir at the time. I'm wondering if the WHO would like to comment specifically on that drug? Dr. Michael Ryan: (48:08) Just to say we are grateful that the company Gilead and the director general had direct discussions at the highest level to ensure that we were, had access to the remedesivir drug in order to launch the solidarity trials around the world. And just to remind everyone, that remdesivir is one of the arms of those trials. We welcome the recent data on the, from the randomized control trials that were at the... the randomized control trial that has been done in the United States. There's signals of hope there for the potential use of the drug. Dr. Michael Ryan: (48:43) And we will be engaging in discussions with Gilead and the US government as to how this drug may be made more widely available as further data emerges on its effectiveness. But, we are grateful for the fact that the drug is within the solidarity trials and that drug was provided by the company for that purpose. Thank you. Tariq: (49:08) Thank you very much. We have a time for maybe two more questions. So let's try AFP and Nina Larson, Nina. Can we hear Nina? If you can unmute yourself please. Nina Larson: (49:23) Hello. Can you hear me? Tariq: (49:24) Yes, now it's okay. Nina Larson: (49:25) Okay, thank you and thanks for taking my question. So, I had a question about President Trump and his secretary of state. Mike Pompeo said that they've seen enormous evidence that the novel coronavirus originated in a lab in Wuhan. Nina Larson: (49:44) I'm just wondering if the US has discussed or shared this evidence with the WHO, and if the WHO is looking to investigate these claims if or when you're invited to China to participate in investigations into the origin of the outbreak? Thanks. Dr. Maria Van Kerkhove: (50:03) So, I can start it and perhaps, Mike would like to supplement. So, let me start with the public health importance of really understanding where this SARS CoV-2 virus, the virus that causes COVID-19 comes from. Dr. Maria Van Kerkhove: (50:16) What's really important is for us to understand the zoonotic source, what we call the animal source. This is a coronavirus and coronaviruses circulate in bats. And so, there is an ancestral link to bats and that is something that we know based on the genetic sequences of this virus and other coronaviruses that circulate globally. So we know that bats are an ancestral link. Dr. Maria Van Kerkhove: (50:39) What we really need to understand is the intermediate host, the animal that was infected by bats and that infected people, in some of these early, in the earliest cases. And that's a very important piece to understand from a public health perspective, so that we could prevent that from happening again. We've learned this in MERS, for example, in the beginning. We didn't know the intermediate host for MERS and there were investigations that were- Dr. Maria Van Kerkhove: (51:03) ... know the intermediate host for MERS. And there were investigations that were taking place in the middle East. And there was a link that was made with dromedary camels. This happens for a lot of these zoonotic pathogens. And what we need to do is we need to do these investigations, these studies to better understand what is the animal host for COVID-19. We have discussed this with our colleagues in China. And we discussed it during the mission that I took part in, in February. And one of the recommendations was to be able to do those investigations and do those with our colleagues at FAO and OIE and different ministries across China. And this is an important part of our understanding of how this all began so that we could prevent it from happening further. Dr. Maria Van Kerkhove: (51:47) From all of the evidence that we have seen, from all of the sequences that are available, and there are, I believe, more than 15,000 full genome sequences available or close to 15,000, that this virus is of natural origin. But we do need to still find the intermediate host in China. And that is something we are very supportive of to provide that support to our colleagues in China. Dr. Michael Ryan: (52:15) Just a supplement on your first question, no. We have not received any data or specific evidence from the U.S. government relating to the purported origin of the virus. So, from our perspective, this remains speculative. But, like any evidence based organization, we would be very willing to receive any information that purports to the origin of the virus because, as Maria said, the origin of the virus is a very important piece of public health information for future control. So, if that data and evidence is available, then it will be for the United States government to decide whether and when it can be shared. But it's difficult for WHO to operate in an information vacuum in that specific regard. So, we focus on what we know. We focus on the evidence we have. And the evidence we have from the sequencing and from all that we have been advised is the virus itself is of natural origin. And we need to understand more about that natural origin, and particularly about intermediate hosts. This issue was one of the recommendations of the emergency committee on the 30th of January. It was subsequently repeated and the advice the other day. The director general, when he visited China when I was there with him, raised the issue at the highest level, not as a specific issue. But we've been saying this since the beginning. We have to control this outbreak. And this is the most important thing we have to do. But we have to also understand the origin so that we can put in place the right public health and animal human interface policies that will prevent this happening again. Dr. Michael Ryan: (53:53) This is not unique. We have done the same in the middle East with MERS. We have done the same with Ebola in Africa. Understanding the host animal, understanding the intermediate species, and understanding how to protect human beings in that cycle is exceptionally important. Whether that requires changes in our engagement with the natural environment, whether it requires changes in animal husbandry, whether it requires changes along the food chain, we won't know exactly how that is to be managed unless we understand the animal host and the animal intermediate species. And that's an exceptionally important piece of information. Dr. Michael Ryan: (54:28) Right now, we have to deal with the pandemic and we've got to get it under control. But that does not lessen the importance of doing that other work. We have offered, as we do in every case with every country, assistance with carrying out those investigations. And I'm sure our colleagues and OIE and FAO are equally keen to offer that support. But again, a bit like the mission in February, we need to understand that we can learn from Chinese scientists, we can learn from each other, we can exchange knowledge, and we can find the answers together. If this is projected as an aggressive investigation of wrongdoing, then I believe that's much more difficult to do. But that's a political issue. That is not a science issue. Dr. Michael Ryan: (55:13) We see scientists in China communicating, collaborating around the world right the way through this pandemic. We would like to see that spirit continue. And we would like to see scientists at the center of the exploration of the source of this. Science needs to be at the center. Science will find the answers. The implications of those answers can be dealt with from a policy and political perspective. So, if we have a science based investigation and a science based inquiry as to what the origin species and the intermediate species are, then that will benefit everybody on the planet. And we believe that can be achieved with the appropriate approach to that very important question. Speaker 5: (55:58) Thank you very much. Let's maybe try to take one more question before we conclude this press briefing. It's Simon Ateba from Today News Africa. Simon, can you hear us? Hello? Do we have Simon? Simon Ateba: (56:16) Yeah. Speaker 5: (56:18) Yes. We can hear you. Simon Ateba: (56:20) Okay. Can you hear me? Speaker 5: (56:23) Yes. Simon Ateba: (56:24) Okay. My name is Simon Ateba from Today News Africa in Washington D.C. WHO Africa released this statement not long ago about that WHO welcomes traditional medicine. I wanted Dr. Tedros to expand on that, what they mean by traditional medicine. Do you mean black magic? Or what do they mean? And I also wanted WHO to react to the controversial bill being introduced in Nigeria, the Infectious Disease Bill. Are you concerned some government may use the Coronavirus to turn their country into a police state? Thank you. Dr. Michael Ryan: (57:25) WHO, and I think our African regional office released a statement on this, does support the use, as we do all over the world of... there's a difference here between what are natural remedies or natural supplements where people take things to feel better, if people want to take a honey and lemon drink in order to ward off infectious diseases, that's a very different thing to taking a drug with an active ingredient, whether that's of natural or pharmaceutical origin. Dr. Michael Ryan: (57:51) What we're talking about here are potential treatments that have active pharmaceutical ingredients. And an active pharmaceutical ingredient can help you if it's targeted at the virus that's infecting you. But it can also hurt you if it affects any other system and doesn't deal with the virus. So, what we try to do in medicine is not make the difference between what are pharmaceutical agents and what are traditional. I think what we found more and more on the world that sometimes what ends up as a drug coming from the pharmaceutical side, very often starts as a traditional medicine. Aspirin, anti- malarial treatments, many of these came from traditional medicines that were well-recognized by communities. And then, when the active ingredient is identified, that's often taken and developed, and scaled up, and put into tablets. Dr. Michael Ryan: (58:43) So, we must recognize that traditional medicine has a value, has a value both clinically, and socially, and culturally. But what we do want to make sure is that any of those products that have active pharmaceutical ingredients in them are tested in the same way as normal drugs. And that, particularly in the context of Africa, we want to make sure that any material, any drug going into the body of an African gets exactly the same testing, and safety, and efficacy trialing as it would in any other part of the world. So, this is not about denying Africans traditional therapies. This is about making sure that those therapies are safe and effective. And WHO will support those researchers who have traditional medicines that have some potential or are showing some promise or have some indication that they may work. And we will support them in building the necessary clinical trials that can test the safety and efficacy of those potential traditional remedies. This is both as a way to protect people from remedies that may hurt them, but also to select out those remedies that may actually work in this case. Maria? Dr. Maria Van Kerkhove: (01:00:03) Just to supplement that, I agree with everything Mike has just said, of course. But the idea of traditional medicines, particularly for COVID-19, is something that is well under investigation. There's hundreds of clinical trials that are ongoing right now. And it is important that these are done through these types of studies called clinical trials. Even within China, the use of traditional medicine, many of them are under clinical trials evaluation right now. And I haven't seen the full statement from our regional office, but WHO has been working with a number of research groups to ensure that any drugs, any, whether it's traditional medicine, or whether it's quote unquote Western medicine, that these are done and evaluated through clinical trials to ensure their safety and their efficacy. And clinical trials should be conducted the same way no matter where they're conducted, no matter which continent they are conducted on, no matter which individuals that they involve. They need to follow the same scientific and ethical principles all over the world. Dr. Tedros: (01:01:09) Yeah. Thank you. Yeah, just very, very brief. There are many traditional medicines actually that are beneficial. And that's why we have a unit in WHO that follows traditional medicine. But, as has been said, the use of any traditional medicine should pass through a very rigorous trial like the modern medicine before it's used for anyone. So, that's our position. But we encourage traditional medicine. Thank you. Speaker 5: (01:01:47) Thank you very much. This will conclude the press conference here. An audio file will be sent to you shortly, as well as the opening remarks. And the transcript will be available most likely tomorrow. We have also just sent you an invitation for the press conference of our regional office in Americas that will take place tomorrow. I wish everyone a very nice evening. Dr. Tedros: (01:02:11) [inaudible 00:01:02:16], thank you very much. And thank you all for joining today. And look forward to seeing you on Wednesday. Thank you so much.