World Health Organization Coronavirus Update Transcript – February 18, 2020

Tedros Adhanom Ghebreyesus: (00:01)
… Including 1,850 deaths. In the past 24 hours, China has reported 1,800 new cases, including both clinically and lab confirmed cases. Outside China, there are now 804 cases in 24 countries with three deaths. In the past 24 hours, there have been 110 new cases outside China, including 99 on the Diamond Princess cruise ship. We have now had cases of CORVID-19 outside China for more than a month. We’re supporting national authorities in every country that has cases to track the virus and understand how people were infected. So far, there are 92 cases in 12 countries outside China, of human-to-human transmission. At the moment, we don’t have data on cases outside China.

Dr. Michael Ryan: (01:15)
That’s you boss. There you go.

At the moment, we don’t have enough data on cases outside China to make a meaningful comparison on the severity of disease or the case fatality rate. We’re following up with countries to get more information about what happens about each case and the outcome. However, we have not yet seen the sustained local transmission except in specific circumstances like the Diamond Princess cruise ship. Yesterday I spoke to Singapore’s Minister of Health and we’re very impressed with the efforts they are making to find every case, follow up with contacts, and stop transmission. Singapore is leaving no stone unturned, testing every case of influence-like illness and pneumonia, and so far they have not found evidence of community transmission.

I also spoke to the Minister of Health of Malaysia to discuss the Westerdam case and other aspects of their preparations. These signals show the importance of all countries being ready for the arrival of the virus, to treat patients with dignity and compassion, to protect health workers, and to prevent onward transmission. Many countries are taking steps to prepare themselves with WHO support. We have shipped supplies of personal protective equipment to 21 countries and we’ll ship to another 106 countries in the coming weeks. By the end of this week, 40 countries in Africa and 29 in the Americas are due to have the ability to detect CORVID-19.

Many of these countries have been sending samples to other countries for testing, waiting several days for results. Now, they can do it themselves within 24 to 48 hours. Some countries in Africa, including DRC, are now leveraging the capacity they have built up to test for Ebola, to test for CORVID-19. This is a great example of how investing in health systems can pay dividends for health security. Other countries like Namibia, Nigeria and Timor-Leste are running workshops with the media to ensure accurate and reliable reporting. Several countries are prioritizing surveillance and monitoring reports of injury including Bangladesh, Cambodia, Ethiopia, Pakistan, Serbia and South Sudan.

We are also working with partners in some of the most fragile contexts from Syria to the Central African Republic, to prepare countries for the arrival of the virus. There are many other examples. We still have a chance of preventing a broader global crisis. WHO continue working night and day with all countries to prepare them. I thank you.

Moderator: (04:41)
The address for journalists who are dialing in by phone, it’s star nine and you will be put in queue. Those who are watching this through Zoom online, it’s clicking raise hand on your right hand side of the screen. We will start by taking questions from the floor. Jamie, [ Jagome 00:05:00] then Shane. Please use the mic.

Speaker 1: (05:08)
Can you hear me? Hi, Jamie, Associated Press. You mentioned the Diamond Princess and you that there’s some specific instances where there has been some transmission outside of China. How was it possible that this ship, which was meant to be quarantine… I was thinking… Sorry. That was meant to be a quarantine has turned out to turned out to be a vector or has actually turned out to spread the COVID-19 more then it’s done anything to stop it? Thanks.

Was there a question in there, Jamie?

Speaker 1: (05:46)
Yeah.

Could you repeat it because I…

Speaker 1: (05:49)
You know me well enough.

The situation on the ship, obviously has evolved and the authorities in Japan, obviously initially made the decision to quarantine all their passengers on that ship, which allowed passengers to be kept together in an environment where they could be observed and where they could have separate accommodations and everything else. This was much more preferable, obviously at the time, then necessarily having everyone disperse around the world. But obviously the situation on the ground has changed and clearly there’s been more transmission than expected on the ship. And I think the authorities in Japan are adjusting to that reality now and taking the necessary public health measures with other countries to evacuated people and deal with their follow up in a different way. But it’s very easy to retrospect to make judgements on public health decisions made at a certain point.

Speaker 1: (06:53)
How do you explain it?

I think it’s clear that, they’ve said it here in previous press conferences, that they’re sometimes environments in which viruses can spread and cruise ships and other [inaudible 00:07:08] I mentioned before and others. There are particular environments in which disease can spread in a more efficient way. But again, in terms of the overall number of people who are on the ship, the vast majority of people in the ship do not have COVID-19. A good number do and a good number have very, very mild symptoms. So I think we need to, again, keep our heads here and put this in perspective. It’s an unfortunate event occurring on the ship and we trust that the authorities in Japan and the governments who are taking back people will be able to follow up those individuals in the appropriate way, to ensure that they get the appropriate care if they are cases, and if not that they are reintegrated into their communities. But yes, it will be very important to study this particular event and see what the issues have been that have led to transmission to the people who’ve been on that ship.

Moderator: (08:13)
Go back to Jagome, then Shane, then Nina. If you could just press the little button.

Jagome: (08:18)
This one?

Moderator: (08:19)
Yes, thank you.

Jagome: (08:22)
Okay. I would like to have your comments on the recent measures taken in Beijing. Basically, everyone leaving the cities based on the quarantine. I don’t think you had a comment on that yesterday, so I’d like to have a comment on that. Do you think it’s effective? Do you think it’s too much? I remember at the beginning of the crisis you hoped that the confinement measures won’t take too long, in Hubay. Apparently, that’s completely the opposite now. So, just a word about those recent measures and maybe from Dr. Briand in french, if I may.

Dr. Briand?

Dr. Sylvia Briand: (09:18)
Do you want me to start in french?

Jagome: (09:56)
Or Dr. Ryan…

[foreign language 00:09:10].

… Very short English version of what is.

So okay, currently, the measures…

Currently, the measures are evaluated based on the modeling. We use the data we have to imagine what could be the scenario if nothing is done, and what could be the scenario with what is the current situation with the data we have? And so modelization has shown that those measure on movement restriction have delayed the dissemination of the outbreak of two or three days within China, and a few weeks outside China. Two, three weeks. So based on this, then it shows that those measure, if well implemented, could have an impact on the propagation of the outbreak. And that’s why measures are now taken in Beijing to strengthen the control of the outbreak and postpone the peak of it, give more time to treat the problem. But in fact we will know only after sometimes when those measure are really effective because it takes more or less, from some studies we have now, around 19 days between the onset of symptom and the days where people are completely cleared from the virus.

Moderator: (12:29)
Thank you, Dr. Briand. Shane, and then Luisa.

Jagome: (12:35)
[inaudible 00:12:35] small ones just [inaudible 00:12:38] Okay. Thank you. So my first… Yeah, I have original questions about Dr. [inaudible 00:12:47] television. Sorry to mention that. Dr. Tajos, you mentioned that you are not getting enough data from the other country outside of China. So what’s the problem inside that? Are the countries [inaudible 00:12:56] to provide the data or what’s the reason behind that problem? And also, for Dr. Briand, that you just mentioned there was some modeling that to date have been delayed for the trans patient and to all three weeks for the world to date for China. So that is the [inaudible 00:13:15] or that’s from the China side that you are coating from?

Speaker 2: (13:18)
Would you like to take this?

Sure. With regards to [inaudible 00:13:28], we fully recognize that all the affected countries are under extreme duress and their primary responsibility is to their own citizens and to dealing with the public health challenge that they face. We continually ask that they share with us the core data that we need. I would say that it hasn’t been absolutely smooth sailing with any country so far because we’ve had to request a number of countries to speed up their data sharing. Well, we don’t believe this is not been for a lack of transparency. But frankly, this has been through the urgency and the difficulties of gathering data in these situations, collating that data, and then sharing it outside the country. And in some cases there are data protection issues, there are citizen protection issues, there are issues around sharing any kind of line list that are individualized data on individual patients. And then there are obviously some logistics issues.

We are very pleased in general overall with the cooperation we’ve received on data sharing. And we hope that that continues. We do want to be able to see more and more data, things like community studies, hospital transmission investigations. Jamie, the investigations aboard the AC princess to establish exactly what the conditions were that led to transmission. And we would obviously like to be seeing those investigations early so we can use them to learn lessons in other circumstances that we may face in the coming days and weeks.

Again, we encourage all of our partners, both government and academic, to share with us that information. Which they can, which will help us as a global agency to provide the best possible advice and evidence to countries. And just while I have the floor, just reflecting on our colleague’s question of the control measures from Beijing. I think if you look at what’s happening in Wuhan, the government authorities in China spent a number of weeks pressuring the virus and you saw the numbers have dropped away. Now they’re engaged in door to door surveillance and they’re going around doing active surveillance. This is a very good public health practice.

I think we’ve got gremlins in the system today everywhere, aren’t they? Screens are going crazy, the lights are going crazy. But we like to see progressive implementation of public health measures. So the first objective in Wuhan was to contain the virus at the epicenter, and you’ve heard the director general speak fight the virus at the epicenter. Suppressing that virus now allows space to really do much more active surveillance. While the authorities there are doing that active surveillance, they don’t want the virus to return to other places. Beijing is a central point in the country or many, many workers return to. So what China are trying to do is while they’re getting success and putting out one fire, they don’t want the fire to start somewhere else. So they’re taking very directed measures to ensure the people returning to the city are observed and monitored.

Now you can argue whether those measures are excessive or whether they’re restrictive of people, but there’s a lot at stake here. There’s an awful lot at stake here in terms of public health, and in terms of not only the public health of China but of of all people in the world. So what we like to see is well thought out evidence based public health measures that pay due respect for people’s individual liberty and individual human rights. And finding that balance is sometimes difficult. But right now the strategic and tactical approach in China is the correct one. And also, [inaudible 00:17:04], you mentioned the strategic and tactical approach in places like Singapore. We’re seeing countries more and more having very directed, well planned operations to detect this virus, contain it, stop it, and slow down the spread. We want all countries to take that sort of public health evidence driven approach in the coming days and weeks.

Yes. On the modeling, these are not WHO data. These are data coming form the expert network we have and we conduct a teleconference on a weekly basis with a number of modeling group across the world. As those groups usually are publishing their data on the scientific literature, but we have the lucky to have some free print articles and this is where it comes from. But just a note of caution, modeling is based on assumption so the modeling are getting better when you have better data to put into the model. So currently we are still on those publicate’s measure using assumptions and I hope that soon we’ll have much better results, more robust results when we have also better data on the speed of spread of the infection.

Moderator: (18:23)
Thank you very much. We’ll just try to have one question for journalists so we can give chance to others. Nina, and then we’ll go online.

Nina: (18:35)
[inaudible 00:18:35] On the data, I was wondering, for the international mission that’s in China now, are they going into Wuhan? And also, are they going to go Shenyang? Because I’m wondering if you are confident of the numbers that are coming out of Shenyang due to the fears that it could spread pretty quickly within the camp system there? And the same for DPRK. They’re saying they have no [inaudible 00:19:06] cases. Are you confident if that’s correct? Thank you.

On the expert team, they’re traveling to the two provinces and then based on the needs they may also travel to Wuhan. All options are open. And specifically on the Wuhan situation, although this team can also travel, we had our double H experts already in Wuhan starting from January. So we had presence on the ground actually. The presence of the experts could also help, but we were there before.

On the issue of DP, we have Virginia Yang and others. We’ve picked at the moment that the two problems is Wandong and Shenyang because they’re the places where we have differential impacts and they’re accessible to us, as well as Beijing itself. And then there will be another decision to move out beyond that again into another way, but that will again be with risk based. Certainly anywhere where there are high proportions of vulnerable people will be prioritized in that.

With regard to DPRK, in fact that we have prioritized supplies for DPRK. The supplies for protective equipment should have left I think for there last night or this morning. I’ll just need to confirm that for you. We’re very close contact and we have a one on one meeting with the mission of DBRK here in Geneva tomorrow. Our representative was [inaudible 00:20:45]. We have no reason to believe that there are any specific issues ongoing in DPRK, and we will be providing them again with the lab reagents to be able to make the diagnosis. But at the moment there’s no signals or no indication that we’re dealing with any covert 19 there. The government are very anxious, as you can imagine, as all governments, to make preparations and are seeking our technical and operational assistance to help them get ready.

Moderator: (21:09)
Thank you very much. We’ll take one or two questions online before we conclude for today. Angaland, can you hear us?

Angaland: (21:17)
Oh, hi there. Hi. Thanks very much for taking my question. I was just wondering, I was going to ask about the data that came out yesterday, that [inaudible 00:21:28] 4,000 cases. That data showed that the death rates are going down as the outbreak progresses. There’s a few questions about that because not all the people that would have died would be counted in that. I just wondered if that fit with what you have seen generally, as a general trend, that the death rate was higher at the beginning of the outbreak and it’s getting smaller. Thank you.

Yes. It’s very difficult to make that judgment purely from the data that’s been presented in the paper yesterday.

… yesterday. Clearly, there’ve been at least an apparent drop in fatality through the outbreak. But remember at the beginning of the outbreak, what people were finding were the severe cases, so you have a huge bias at the beginning of an outbreak because once you find are the really sick people coming forward.

And now we’re going out looking for the sick, the less sick people, so you can have an act of factual and false sense of mortality at the beginning. We saw that, remember in the pandemic of H1N1. We saw fatality rates of 10 and 20% in the beginning because only the severe cases were presenting. A few weeks later, the pattern was entirely different. So, that’s an important factor. There was also the fact that if that the fatality, case fatality, is different inside Hubei and Wuhan to the other provinces, and that may also reflect the fact that the pressure on the system in Wuhan, Hubei has been so severe, and the lessons that have been learned in Hubei and Wuhan are being applied elsewhere. People are getting into earlier critical care.

One of the issues has been predicting the patients who have the comorbidities and the underlying conditions, and ensuring that they’re transitioned into the critical care or the severe care pathway early, and that we’re not locking up the system with the mild cases. And I think the system in China, for example, has got much better at prioritizing those more likely to be severely ill into the system. It’s also very difficult in critical care to ventilate so many patients and do ECMO on so many patients. It takes quite a lot of technical skill. It’s not just the machinery. It’s the technicians who use that. And again, bringing them up to speed, bringing in the emergency medical teams. Remember, 127 emergency medical teams with nearly 10,000 specialist medical workers were sent into Hubei from outside. Pre-trained, pre-certified medical teams who were used to mass casualty management.

They would have helped to reduce case fatality. So, what we’re seeing is both a mixture of the fatality reducing probably because of better and better interventions over time, but also because we’re finding more mild cases. So, we need to be careful. Well, what it is very clear, I think, that we need to remember in this, sometimes this is projected as a mild disease and sure, most people just get a very mild disease and everything is over in a couple of days. And that’s true, and for those who have that, and for the younger people and adults who get that form of disease, that’s great. But there’s a significant number of people, remember, 20% of people who get this disease are either severe or critically ill. So we really do have to focus on how we can engage in providing them with life-saving interventions. We are graced with the fact that China has an advanced healthcare system and can provide such intensive care to so many.

Our fear has always been that disease reaching a country with a weaker health system, who will not be able to mount such a response. And again, there are many, if you look at the numbers, many, many people have been admitted to hospital, many have been released, but there are still lots and lots of people in hospital for a very long time.

It takes a huge effort on behalf of a health system to have people in hospital on average for 20 days at the level of intensive care. So, the system becomes over driven by so many people requiring such long-term care. So, we can see the stresses in the system and we need to be mindful of that. But our hope is, as we find more and more milder cases, that the overall fatality of the disease will be less, because obviously that’s less scary for people.

But we must remember that there are at-risk groups, vulnerable people, generally between the ages of 40 and 79 or older, people with underlying medical conditions, and they can have a very severe course of disease. And we must be aware of that if disease is imported to third countries. We need to prioritize the protection of those individuals and prioritize their clinical care.

Moderator: (26:00)
Thank you very much. Maybe we will go to our last question for today. And it’s Adam Dockett. Can you, Adam, hear us? Chemical engineer.

Adam Dockett: (26:10)
Yep, can you hear me?

Moderator: (26:11)
Yes, please, Adam. Go ahead.

Adam Dockett: (26:14)
Excellent. Just wondering, do you have an update on how vaccine development is progressing and when you might expect first chemical trials in humans to begin?

Moderator: (26:19)
Thank you, Adam.

We don’t have new data since the research meeting and at this meeting, they were discussing about having a candidate vaccine by, in around 16 weeks from now, but again this would be just to have the candidate and then depending on the safety, best deciding if it would be used in humans so it’s still a matter of weeks.

Months.

Months.

While we’re very supportive and we’re working very, very closely with Sepi, with major donors and with the World Bank and others on the strategic investments that are going to be needed to develop vaccines. That’s going to be a lot of money. We’re very conscious that those funds cannot and should not be pulled away from supporting weaker health systems to get ready. This isn’t a trade off between one or the other. We can save many, many lives in the coming months with or without a vaccine.

We all want to invest in the vaccine as a longterm solution, but there are people sick now and there are health systems that are vulnerable now, so we need to balance our investments and invest in the weaker health systems or old systems, we can save a lot of lives through supportive therapy by testing the drugs we’re currently testing and by getting everything in our systems working and then, we do the other things and we develop the vaccine and we do have to make decisions on the vaccine investment now and the DG will be working with Sepi, with the world bank and with other agencies at global level to ensure that we get the strategic investments we need, the vaccine development without disrupting the investments we need in national systems to get ready.

Yeah. Maybe I’d like to add into that related to the first [inaudible 00:28:13] case fatality. When you see the number of cases in the rest of the world, we have 804 cases and three deaths, but that doesn’t mean that it will not increase. For us, this is a window of opportunity that we shouldn’t squander and we have to invest in preparedness and in really using this window of opportunity to keep, or to stay away from any serious crisis. So in order to use the window of opportunity, the maximum, we need to have a balance of the use of the publical’s interventions immediately and then the development of vaccine. We have to strike a balance.

The vaccine could it be the long term because it could take up to 12 to 18 months and this is like preparing for the worst situation, but in order to avert any serious problem in the rest of the world and use the window of opportunity to the maximum, it’s the simple political solutions that we should do. That should really be our focus, while of course preparing for the vaccine. So that balancing act is very, very important. We do what should be done today and then we invest also in the future to prepare for the future.

As Mike said, we’re already discussing with partners on the vaccine development, but the approach is striking a balance and giving the right focus, especially to the things that we should do today. But one thing I’d like to underline is there is a window of opportunity. If you see the case fatality rates or the number of days in the rest of the world, it’s really low. It’s three out of 804. Even the number of cases, 804 is low, but it doesn’t mean that it will stay the same.

This is a window of opportunity that should not be missed. That’s what I would like to underline. And in order not to miss this opportunity, we should do everything to contain it and finish within that window of opportunity and that’s why we’re speeding up to help countries, especially with weaker health systems in order to really minimize the impact. Thank you.

Moderator: (30:47)
Thank you very much, Dr. Tedros. Thank you to Dr. Ryan and Dr. Briand. We will conclude with this. Just to let you know that our colleagues in Eastern Mediterranean region will hold a press conference in Cairo tomorrow. It’s 11 o’clock Cairo time, 10 o’clock Geneva time, where our regional director will speak to media there on the preparedness in the region regarding COVID-19 and also about how the information should be shared. This press conference will be broadcast at [inaudible 00:09:23] Twitter account, so journalists from here can also follow…

World Health Organization Coronavirus Update Transcript – February 18, 2020

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