Jan 23, 2020

World Health Organization Coronavirus Update Transcript – January 23, 2020

World Health Organization Coronavirus Update Transcript
RevBlogTranscriptsPress Conference TranscriptsWorld Health Organization Coronavirus Update Transcript – January 23, 2020

The World Health Organization (WHO) provided an update on their efforts to contain and control the deadly coronavirus stemming from Wuhan, China. Read the full transcript of their January 22, 2020 media conference right here on Rev.com.

Speaker 1: (00:00)
Thanks for bearing with us for the last hour and a half, almost two hours. Thanks also to all journalists who are online. I understand we have more than 150 journalists who are watching us and listening to us right now, either by dialing in or by watching us on WHO Twitter and WHO Facebook account. We are late, so I will just keep it short. For those online who would like to ask questions, please dial 0-1 on your key part and you will be put in the queue. As we have announced earlier, and you have the name plates here with us, we have Dr. Tedros, WHO director general, Professor Didier Houssin, who is chair of the emergency committee, we have Dr. Michael “Mike” Ryan, and we have Dr. Maria Van Kerkhove from Department of Diseases and Zoonosis units. Mike Ryan is the head of emergencies at WHO. You know today was the first meeting of the Emergency Committee on International Health Regulations on novel coronavirus, and I will give a floor immediately to Dr. Tedros.

Dr. Tedros: (01:30)
Thank you. Thank you, [inaudible 00:01:33], and good evening to everyone in the room and everyone online. We’re really sorry that we’re late, but thank you all for your patience. As you know, this is an evolving and complex situation, and I would like to thank Dr. Houssin for his leadership of the emergency committee and all members of the committee, the advisors, and those who made presentations earlier today during the deliberation. I was very impressed by the detail and depths of China’s presentation. I also appreciate the cooperation of China’s minister of health, who I have spoken with directly during the last few days and weeks. His leadership and the intervention of President Xi and Premier Li have been invaluable, and I know you’re following the actions they are taking, all the measures they have taken to respond to the outbreak.

Dr. Tedros: (02:46)
Today, there was an excellent discussion during community meeting, but it was also clear that to proceed, we need more information. For that reason, I have decided to ask the emergency committee to meet again tomorrow to continue their discussion, and the chair, Dr. Houssin, has agreed with that request. The decision about whether or not to declare a public health emergency of international concern is one I take extremely seriously, and one I am only prepared to make with appropriate consideration of all the evidence. Our team is on the ground in China as we speak, working with local experts and officials to investigate the outbreak and get more information. We will have much more to say tomorrow, and thank you very much. I would be glad to answer any questions you have, but before that I will give a chance to the chair, Dr. Houssin, To say a few words, and after that, Mike, to say on the actions we have recommended. Thank you.

Dr. Houssin: (04:12)
Thank you very much, Dr. Tedros, and thank you for you all present this evening. It’s true that the committee met during several hours today. We heard very interesting reports from the Republic of China about the situation in China. We also heard reports about the situation in Japan, in Thailand and in Korea. Following these, we had also the analysis of the situation made by WHO secretariat, and then we entered into a discussion about important advice to provide to the DG of WHO. That is, is the situation corresponding to a public health emergency of international concern, and what advices should be given to the DG.

Dr. Houssin: (05:05)
The views of the members of the committee considering the information provided was split about the opportunity to advise the creation, the decision of a PHEIC, but we formulated a series of recommendation concerning the improvement of containment and mitigation measures, which are already important in China, and also about the measure that should be taken by member states. One of these measure is the improvement of sharing of information and cooperation between member states in such a situation. One of our advices was to suggest to the DG that the emergency committee should be reconvened very early if necessary, and, in fact, the situation is evolving rapidly, as said Dr. Tedros. For this reason, we of course agree completely with his decision to reconvene the committee tomorrow, considering the evolution of this situation and the measures taken noticeably in China. Thank you.

Speaker 1: (06:28)
Dr. Ryan?

Dr. Ryan: (06:29)
Good evening everyone, and let me again thank our member states for their excellent presentations today at the emergency committee, and also for their actions already taken in the face of this evolving epidemic. Just to briefly summarize to you, the WHO has been on full activation of our incident management system since the last day of 2019 across the three levels of our organization. We’ve been coordinating a series of global expert networks and partnerships that have dealt with laboratory diagnostic, assay development, infection prevention and control, clinical management, standardized data collection, medical modeling, research and development and many other pillars of the response. We’ve been providing technical support to member states, both member states affected and on unaffected states.

Dr. Ryan: (07:21)
We’ve been sharing critical updates with member states through our EIS platform with member states, with disease outbreak news and through the WHO website. We have released a comprehensive technical package of interim guidance for 2019 nCoV. These materials are online, reviewed daily and updated regularly. We have updated travel advice for international travel and health in relation to the outbreak. In addition, we have been working very, very closely with global partners and the global coordination mechanism for research and development for epidemic diseases as part of the research and development blueprint, working with institutions such as SEPI and others on advancing medical interventions, diagnostics, therapeutics and vaccines. At the moment, the landscape’s analysis for those who have been completed. We’re working on a sample of virus sharing. We’re working on developing and disseminating clinical trial protocols and many other issues related to the the carrying out of structured evidence-based research in the field as needed.

Dr. Ryan: (08:32)
The priorities right now, not withstanding the deliberations of the committee, the member states affected having implemented a number of control measures. These have focused, and WHO agrees, the primary issue is to limit human to human transmission, to reduce secondary infections, especially amongst close contact, and particularly in healthcare environments. We need to prevent transmission through amplification events and super spreading events, and obviously prevent further international spread. Reducing zoonotic transmission or transmission from animals to humans is important, and identifying the animal source or sources and limiting exposure to those sources is exceptionally important.

Dr. Ryan: (09:17)
We need all member states to focus on early identification and isolation of suspect cases and probable and confirmed cases. We are working closely to equip countries to be able to detect and isolate and provide optimize standards of care. There are many unknowns to address in this event, including clinical severity and the true extent and nature of disease transmission. Communicating critical risk and event information to all communities is the responsibility of everybody, our member states, the media and WHO, and we at this time was particularly counter misinformation that may affect people’s behavior. Lastly, minimizing social and economic impact is important at this time. So the organization is fully activated at all levels with our partners in response to this event, and we await the further deliberations tomorrow of the committee. As I said, we wait those deliberations.

Speaker 1: (10:27)
Thank you very much. Before we go to questions, first I have to apologize to Dr. Sylvie Briand, who is sitting next to Dr. Mike Ryan. Dr. Briand is our director for global infectious hazard and preparedness, and she together with the Maria answer some of your questions, so we will start with the questions from the room. For those online, I will just repeat that if you have a question, please type 0-1 on your key part and you will be put in line. We will take questions, if our speakers agree, one by one, and I will ask you to introduce yourself first and the outlet you are working with. So we will start with, I think colleague from China.

Speaker 2: (11:09)
Thank you very much. I’m a journalist from CCTV, and my question is to your excellency, Mr. Director General, Dr. Tedros, about WHO’s evaluation of the measurements by the Chinese government in response to the epidemic. After the outbreak of 2019 novel coronavirus epidemic, how do you comment on the liaison and reporting between the Chinese and government and the relevant departments with WHO? With your expert group already in China, what evaluation does WHO have on Chinese medical institutions regarding outbreak control and patients’ treatments? Thank you.

Dr. Tedros: (12:05)
Yeah, thank you. Of course, this is a novel coronavirus and it’s a new discovery, so identifying the pathogen was done swiftly, and it shows the capacity that China has now. The sequencing was done quickly, but more importantly it was shared immediately, and that’s why Korea, Japan, Thailand were able to diagnose the new coronavirus quickly. In addition to that, action was taken immediately, especially on the market, the Wuhan market, seafood market, and followed by other actions was very commendable. The involvement of the leadership, starting from the president himself, who gave really clear guidance, the premier and the minister was also very impressive and different actually from previous actions. You see the capacity and you see the political commitment.

Dr. Tedros: (13:18)
That’s continuing and we appreciate that, but at the same time, although there is good capacity in China, they have also invited our experts, so our experts are there on the ground as we speak with Chinese experts assessing the situation. That’s why we’re saying we will have more information and we will reconvene tomorrow. That’s what we see from WHO side, and we really encourage China to continue that way, because not only that will help China to clean the outbreak as soon as possible, but also to help in preventing it from spreading internationally.

Speaker 1: (14:07)
Thank you very much. Please, introduce yourself, Marco.

Marco: (14:10)
My name is Marco [inaudible 00:14:12]. This is my question. Which is the level beyond which a local emergency becomes an international emergency according to WHO? That’s the question.

Dr. Tedros: (14:27)
Would you like to take, or …

Dr. Ryan: (14:28)
Well, pointing to the criteria in the IHR, the international regulations is a very specific formulation related to the international aspects of the risk, but there are three essential criteria about the nature of being unusual, expected, whether the disease has demonstrated transmission beyond borders. In that, it’s not just necessarily the movement of the case somewhere else. It may involve determination of whether local transmission has occurred when that case arrives, and that’s a nuanced and very important distinction to make. Also, whether there has been interference or likely interference with travel and trade. So the IHR as an instrument is specifically designed to ensure that the appropriate public health actions are taken to contain the disease without unnecessary interference with travel and trade. There’s a balance here to be struck, and that balance is something that the emergency committee tried to address in their advice to the director general, but that does not mean the public health action starts with the declaration of a PHEIC.

Dr. Ryan: (15:45)
Public health action is already underway. Comprehensive international public health action in support of the affected states is already underway, but what deliberation of the PHEIC can allow is the issuance of temporary recommendations that are more binding in terms of international law on those members states. So one would ask the question, are our member states implementing all those measures at the moment that we would consider necessary to contain this disease? And then beyond that, are the further temporary recommendations that will be needed? So in that sense, it should be a reinforcement of existing action, and that’s why I took the time to explain the actions that are being taken. In that sense, we need to separate … The PHEIC is a very particular concept in this regard.

Speaker 1: (16:42)
Thank you very much. Stephanie, please.

Stephanie N.: (16:52)
There we go. Sorry. Reuters, Stephanie Nebehay. Could you tell us whether the panel, I don’t know if it would be appropriate for the chairman or Mike, tell us about the discussion of evidence that you are seeing about human to human transmission, and what evidence you might have been presented with about any mutation in the virus, which possibly has made it more transmissible or any super spreading events that you may have seen? Can you give us an idea of what your understanding is at the moment?

Dr. Ryan: (17:33)
I think we are in agreement with Chinese authorities, who have been very clear and transparent, that there is evidence of human to human transmission. The evidence points to human to human transmission in the context of close contact with the suspect case or within a healthcare environment. So the virus clearly … and this is not unusual. Previous SARS epidemics and MERS epidemics have demonstrated …

Dr. Ryan: (18:03)
As our SARS epidemics and MERS epidemics have demonstrated human to human transmission. The current Ebola epidemic in Congo has gone through multiple generations of human to human transmission. It is not the existence of human to human transmission that purely determines the impact of the event. What matters is the root of that transmission of whether we’ve identified those roots adequately and then give the proper advice to break the chains of transmission and whether we can track those chains of transmission in an appropriate way.

Dr. Ryan: (18:29)
And we’re back to the simple actions of public health, early identification of cases, identification of high risk contacts, following those contacts and ensuring that if they develop illness that they’re isolated quickly. So those are the principles. So we may go through generations of human to human transmission. If the route of transmission is still due to close personal contact and droplet infection, then the diseases essentially containable. The issues that arise are the unknowns as to whether or not there are other routes of transmission occurring. And at this time it is not possible to determine that absolutely. It would appear that the main routes of transmission or allowing the expected routes of transmission for Corona viruses. and that is part of the extension of the deliberation of the committee is to further consider these matters.

Moderator: (19:25)
Thank you very much. If other speakers… Does anyone want to add something to this? If not, we will give a chance to some of the journalists who are listening as online and who dialed in. We will start with the Helen Grandswell if Helen can hear us. Helen, do you hear as well?

Helen Grandswel: (19:50)
Yes, thanks very much for taking my question. I was hoping that perhaps Mike could expand a bit further on the transmission issue. Have you clear indication that this is sort of stuttering transmission from among people? Or are you seeing any sort of third, forth generation cases among people? And I would also be interested in WHOs reaction to the news that Wuhan is effectively being quarantined. This is a very severe action and would like your thoughts please.

Moderator: (20:25)
Thank you very much. Helen, we didn’t hear you very well, but I understand there was a question about a transmission and possible generations of transmission.

Helen Grandswel: (20:36)
You want me to try again?

Moderator: (20:37)
The second part of your question please.

Helen Grandswel: (20:40)
The second part was I would like WHOs comment on the decision by authorities in China to effectively seal off Wuhan? It’s a very severe measure and I’m wondering what, WHO thinks about that?

Moderator: (20:57)
Thank you Helen, we understand first question is about transmission, and second question is about the measures put in place by Wuhan City. Who would like to take?

Dr. Ryan: (21:09)
I can start hand over to Sylvie or Maria. My understanding is that we have not at this point confirmed third, fourth generation transmission. But our colleague speak to that. And in reference to a previous question, Stephanie’s previous question on the genetic diversity the virus is showing stability and the not showing a divergence around any unusual activity. All viruses change. Every time someone has infected tiny differences in the virus, but we’re not seeing a huge changes in the viral genomic sequence in that regard. So maybe I could pass to Maria or Sylvie to just maybe address the issue of generational transmission.

Maria: (21:52)
Yeah, thanks for that question. So we had some… Thank you. Thank for that question. With regards to, human to human transmission, what we’re very thankful to the colleagues who are sharing information about the situations in their country. What our colleagues have shared with us is as Mike has described, some human to human transmission amongst close contacts. And investigations are underway to fully determine the extent of this. So at the present time we don’t know the full extent of human to human transmission. But what we’ve seen are human to human transmission events, amongst close contacts in families, and in healthcare settings. And as Mike said previously, this is not unexpected for a respiratory pathogen. We have not been presented any evidence or have seen any evidence, of ongoing transmission where we’ve had third or fourth or fifth generation. But as we said, our colleagues are working very hard to better understand the extent of infection and where this infection is occurring.

Dr. Tedros: (23:07)
Thank you. Thank you Laurie. On one hand, the measures that have been taken, we’re following the situation and we’re in contact with Chinese authorities, 24 seven, and almost daily contact with directly with the minister himself. And what they’re doing is a very, very strong measure and with full commitment.

Dr. Tedros: (23:36)
So based on the situation, taking the action that they think is appropriate is very important. We stressed to them that by having a strong action, not only they will control the outbreak in their country, but they will also minimize the chances of this outbreak spreading internationally. So they recognize that. And they’re doing both that’s for their own country, but at the same time, China should play a bigger role in global health. So they are taking more and significant measures to limit or minimize the international spread.

Dr. Tedros: (24:20)
So as long as it’s tailored to the problem and with the commitment that we see, I think we commend their actions. But since we have a team on the ground, we will get more information on the situation and the actions being taken. I mean an assessment of that. On the mutation, I agree with what Mike said. There is a stability. We don’t see any significant variation, but at the same time we also believe that we have to be cautious and continue our assessments critically. Because significant mutation can can happen anytime. So we should keep that within our attention. Thank you.

Moderator: (25:15)
Thank you very much. We will stay with journalists online that we will go to John Klein from science. John, can you hear us?

John: (25:26)
I can. Thank you. Can you hear me?

Moderator: (25:28)
We can hear you but please speak loud and go ahead.

John: (25:31)
Yes, I will. Thanks for taking my call. I just wanted to clarify what it is that the committee is deliberating. It seems like the three things that Mike [Ryan 00:25:39] off have been met in terms of declaring a [inaudible 00:25:44] So what is it specifically that gives the committee pause to determine a fake what needs to occur? Is it third generation transmission? What is it exactly? All those things you mentioned that seems to have been met.

Moderator: (26:00)
Thank you. Thank you John for that question.

Dr. Houssin: (26:02)
Thank you for this question. Well, it’s precisely the question which were raised during the meeting of the emergency committee. It was the question of the assessment of severity and transmissibility. Of course, we had information provided by the Chinese authorities but this information of course they are limited by the recent outbreak which has occurred and the committee felt that it was a little too unprecise to very clearly state that it was time to declare, to suggest to the DG to declare a [inaudible 00:26:45] This is why the opinion of the committee was split. And this is why it was suggested that according to the evolution of the situation, we of course would be extremely ready to reconvene as soon as necessary in order to discuss about additional information and clearly the information provided by Wuhan is one information.

Moderator: (27:10)
Thank you very much. We will go back here to the room. There was a gentleman who really wants to ask a question here. Please introduce yourself.

Speaker 3: (27:18)
Thank you [inaudible 00:27:19] from Tyson Media. I have two questions. First, do you have any rough ideas about the victim of this virus, the people who died, do they share any characteristics in terms of gender, age, or existing, preexisting health problems? And second, has the animal factor been identified? Or which animal did the disease come from? Do you have any idea on that too? Thank you.

Moderator: (27:53)
Thank you very much for these questions. So it’s about source and group of among populations. Maria?

Maria: (28:00)
Yes. So okay. Yes. So there have been some deaths associated with this outbreak. And from the information so far, there are some characteristics of those individuals. Many of them have had underlying conditions, underlying medical conditions, and have been of older age. So based on our past experience with other respiratory pathogens, advanced age and underlying conditions are known risk factors for developing severe disease and death. With regards to the animal source, there are many investigations that are currently underway in China, in Wuhan and in the live animal markets, for example. We understand that they are investigating and taking samples from animals that were in that market. And they’re also doing some environmental samples of those markets to determine if the viruses in those markets.

Dr. Ryan: (28:59)
Possibly just to supplement Dr, Feng from the national health commission today presented a very deep presentation and give a lot of very useful information. So Dr. Feng from the national health commission. The from the data presented from China, the age distribution of the cases is as Maria said, very much skewed to older age groups with 72% of cases being over 40 years of age. The male to female ratio is, males represents 64% of those cases. And interesting that they report also the 40% of cases had underlying diseases like diabetes, high blood pressure, cardiovascular disease.

Dr. Ryan: (29:47)
So we have to be very careful on looking at age distributions because if the disease more severely affects older people because of underlying conditions, that doesn’t mean that there aren’t infections in other age groups. It just means that the visible infections of very sick people maybe in those older age groups. So that’s I think what Dr. [Hussein 00:30:07] was pointing to. The data we have and again, we thank China for that data and for the excellent presentations today. But there are still unknowns and we don’t have the full extent of that data to do that. But from what we know now, two thirds males, mainly people over 40 years of age, with this more severe spectrum of disease. And the cases as Maria said, who died, many of them had underlying, significant underlying conditions, which is again, a feature that we’ve seen in previous outbreaks of Corona viruses. So if I’m not mistaken, right?

Moderator: (30:51)
Thank you very much. We will go back online with the James Gallagher from BBC. James, can you hear us?

James Gallagher: (30:59)
Hello? I wanted to ask a very similar question to the one that Helen did and that was about the public transport, shutdown in Wuhan. And I suppose first of all I was want to know whether that was made in consultation with the WHO, on the recommendation of WHO? Was this something that was initiated by the Chinese authorities themselves? And also what would you say to the people in Wuhan, who in some respects are in quarantine, in the face of this novel coronavirus that you’ve not decided whether or not is a global emergency. What do you say to the people who are really living this tonight?

Moderator: (31:40)
Thank you very much. Someone would like to answer this question?

Dr. Tedros: (31:47)
On the public transport and other mass gatherings as you know, should be avoided. So they are taking measures based on that. And also our recommendations are going to go based on the discussion today later on. But these are from our previous discussions and they where the measures they should take in order to prevent transmission. Especially mass gathering is one of the risks. So we don’t think on public transport, we cannot say they have done something unusual. On the population, I think the measures which are taken, as I said, they were just announced today, so we will need some time to understand the specific measures that are being taken since we’re working with them. If there are any recommendations that we should give them, we can give them.

Moderator: (33:03)
Thank you very much. Hope this answers your question. We will go out to Denise Grady from New York Times. Denise, can you hear us?

Denise Grady: (33:13)
Yes, thank you. Can you hear me?

Moderator: (33:17)
Yes, please go ahead.

Denise Grady: (33:19)
Okay. Thank you. Dr. Ryan could you please clarify the numbers, the figures, that you just gave. It wasn’t clear to me if with the percentages you were talking about, the overall picture of people who are sick, or the people who have the severe cases. So if you could go through that again and make it very clear what those numbers are again? Thank you.

Dr. Ryan: (33:54)
Yeah. The data we presented was referring to what we were reported to today, which was 291 cases, which included those clinical cases requiring admission to hospitals. So probably, as I said at the more severe end of the spectrum. The figures that I quote of 64% male, and 72% over 40., Referred to that group of 291 individuals. I hope that clarifies.

Denise Grady: (34:25)
Okay. Thank you.

Moderator: (34:29)
Okay. Thank you very much. Denise.

Denise Grady: (34:30)
Can I ask one more thing?

Moderator: (34:32)
Please.

Denise Grady: (34:32)
Did you actually have a vote on this? And was it a tie vote or something? Is that what you mean when you said there was a split?

Dr. Houssin: (34:48)
You are questioning the divergent views within the committee?

Denise Grady: (34:51)
Yes.

Dr. Houssin: (34:51)
50, 50, even.

Moderator: (34:59)
Thank you very much. So we got back here to the room Gabriela, please.

Gabriella: (35:05)
Yes. Thank you very much. Gabrielle [inaudible 00:35:08] Mexico. I have one practical question. What is going to be the name of this virus? Do you have it already? I mean what is going to be then the name? And it is a virus is spreading exponentially. What is your observation on this? Thank you.

Moderator: (35:28)
Dr. [inaudible 00:35:33] please.

Sylvia: (35:37)
Currently, we use the name of 2019 [inaudible 00:35:44] Corona virus, but we will convene a committee to decide on the official name. As you know, the tradition for viruses is to name them after the place they have emerged, but have just been discovered. But yet it’s not known yet because investigation are under way. And-

Sylvia: (36:03)
It’s not known yet because investigation are underway. And so we are for the time being using this nickname, I would say, and the committee will further discuss what is the appropriate name for this new virus.

Moderator: (36:17)
Maybe do one more question of-

Maria: (36:18)
Yeah, sure. This relates to the earlier questions about what we know about the human to human spreading, and it is still very early days to characterize the full extent of this human to human transmission. What we’re hoping for from our Chinese colleagues and also from any countries that have an exported case or a case imported into their country, is to look for onward transmission. What level of secondary transmission amongst close contacts exists? We haven’t seen any secondary transmission from any of those exported cases, and that is quite important.

Maria: (36:52)
Within China, we’ve asked our colleagues in China to further explain to us what they’re doing to better understand the extent of infection in Wuhan, but also in other parts of China. And then, importantly, amongst those cases that they’ve identified, how many of those are related to human to human transmission, and then in what context did that human to human transmission take place? Was it in a household? Was it in a healthcare facility? Was it in the community?

Maria: (37:20)
So those are critical pieces of information that we need to know to be able to characterize the full extent of transmission.

Dr. Ryan: (37:27)
Maybe I could supplement here because there’s a difference between a daily reporting of cases and when those cases had their onset. And many of the cases reported over the last two days could be cases that have been picked up retrospectively based on enhanced surveillance. And their dates of onset would be over many, many days, many weeks. We don’t know.

Dr. Ryan: (37:49)
That is why we did receive some really helpful disaggregated data from China. A number of days go around the original cluster around the Wuhan cluster around the seafood market. It will be extremely helpful at this point that China, and I believe they’re every intention to do so, is to share that dis-aggregated data because it’s really important that we’re able to do that secondary analysis, construct those epidemic curves, and estimate the doubling times and the the rates of movement of the virus, both in terms of temporal rate and the geographic rate. So we look forward to receiving that data from China as soon as possible.

Moderator: (38:33)
Thank you. Well, first, I have [Modidh 00:38:36] and I have [Badi 00:38:37] first. Go ahead and then Modidh.

Badi: (38:44)
I have to complain because for we need more opportunities to Chinese media, put more questions in whatever here or online in Chinese issues.

Badi: (38:54)
So [ foreign language 00:02:55] Please, sir, I have another question to Mr. [Delarose 00:00:39:23]. Could you give us the exact time for tomorrow? What time you would keep us on resource or answer. Whatever morning or afternoon, but we need at least an exact time or around. Thank you.

Moderator: (39:37)
Okay, just to say that first question was about whether the committee is giving directions to Wuhan authorities on their actions or not, and that was directed to Professor Houssin.

Dr. Houssin: (39:57)
Thank you. I will start maybe from the second one because you want to know when to come. So we will start at noon like today, at 12:00.

Dr. Houssin: (40:08)
On giving advices, we give advices to China, the national government, and also of course it will not be limited to that. And most of the guidelines that are given to the international community, to neighboring countries and beyond. Thank you.

Moderator: (40:29)
Thank you very much. Modidh, please.

Modidh: (40:35)
Sorry. [inaudible 00:40:35] from Eurovision News.

Modidh: (40:41)
What advice would you give people who are planning to travel to China? Should they cancel or postpone plans? And also what precautions for those who deem travel necessary should people be taking if they are visiting China?

Dr. Tedros: (40:52)
We will come back with tailored recommendations tomorrow. That’s why we are reconvening tomorrow.

Modidh: (40:59)
[inaudible 00:05: 01].

Moderator: (41:03)
Yes. Yes. Because a question on the role of the committee was directed to a chair.

Dr. Houssin: (41:08)
The response is, no, the committee did not provide an advice concerning the measures to be taken in Wuhan, but it’s clear that the information about the measures taken by the Wuhan authorities very recently today are important information, and will certainly be useful to the reflection of the members of the committee tomorrow. Thank you.

Moderator: (41:39)
okay. Thank you very much. I’m just checking if we have more questions online. I’m just repeating again that those who are online and want to ask a question can type zero one. I would like to see if we have a Euro news online.

Gerard: (41:59)
Gerard.

Moderator: (42:00)
Hi, Gerard. Please go ahead.

Gerard: (42:03)
Yeah, so we were wondering how can we differentiate between virus or the flu, and in Europe without the no borders, how can government apply these procedures to restrain the epidemic?

Moderator: (42:19)
Gerard, did you say that how we can distinguish virus from the flu?

Gerard: (42:26)
Yeah.

Maria: (42:29)
Yes, so that’s a good question. Thank you for that. So many of these respiratory pathogens that are circulating, it’s very difficult to distinguish between different viruses. What we understand from the 2019 novel coronavirus is that it can cause a range of disease in individuals who are infected from mild disease all the way to severe disease and death. That’s quite a range. Investigations are still ongoing to better articulate what proportion of individuals will have mild disease or severe disease, and what risk factors they may have to result in more significant disease.

Maria: (43:09)
In the beginning of an infection, you start out perhaps with some mild respiratory diseases. What we refer to are the diagnostics that have been rapidly developed, thanks to the rapid sharing of sequences by Chinese authorities. So there are labs all over the world now that are able to detect this virus in patients, and so our recommendation is to ensure that individuals can be identified quickly and isolated quickly, tested quickly, cared for, and managed so that they can prevent any further transmission.

Moderator: (43:45)
Thank you very much. We will maybe take a one or two last questions before we conclude for tonight. Maybe we start first with Betsy McKay for Wall Street Journal, and then we will give a photo with John here. Betsy, can you hear us?

Betsy McKay: (44:05)
Yes. Can you hear me?

Moderator: (44:06)
Yes, please.

Betsy McKay: (44:07)
Okay, great. Thank you very much. I just wanted to ask a little bit more about the contact investigations going on in China. How much information you have on them, and given the rapidly expanding number of cases, do you feel that China has the capacity to do these contact investigations at this time and stop the spread, or does it need help from outside?

Maria: (44:39)
So I’ll start with that question, and maybe others would like to add to that.

Maria: (44:42)
So what we understand in terms of the activities for looking for cases is that Chinese authorities are conducting what we know as active surveillance. As you’ve heard, the initial cases were picked up through their pneumonia surveillance system, which was established after SARS. Once they identified that cluster, they initiated this active case-finding and retrospective case finding of individuals who had pneumonia. Of the people that they identified with infection, they identified their contacts, and then they follow those contacts for a number of days. So they’re doing some active contact tracing amongst the identified patients, but they’re also looking at healthcare workers, family contacts in healthcare workers, and so those investigations are ongoing.

Maria: (45:26)
We’ve requested more information to get better details on this, but, yes, it’s active surveillance and then contact tracing amongst those identified.

Moderator: (45:37)
Thank you very much. [foreign language 00:09:39] John, please, if you can just come to the mic.

John Z.: (45:45)
Yes. Good evening. John Zarocostas, France 24 and [foreign language 00:09:48]. I was wondering, sir, in your deliberations this evening, if you analyze the prospects of the trend in case fatality, the anticipated shooting up, it’s quite low at the moment at around 3.8%, but in other cases of similar coronaviruses, it’s been much higher. What’s the information coming from the field? And, secondly, with reference to antivirals, what are the prospects of coming up with one that’s effective? Thank you.

Dr. Houssin: (46:23)
Yes to the question about the fatality rate, it is clearly one of the question mark which was raised during the meeting of the committee. If we refer to the previous coronavirus epidemics in 2003 and more recently with the MERS coronavirus, the fatality rate was much higher than it appears to be today.

Dr. Houssin: (46:45)
But this is one of the aspects for which we would like to have more information because it’s, of course, one very important point to decide whether it is a major public health threat or not. That’s the response.

Moderator: (47:05)
Thank you very much. And maybe we can really take that the last question for tonight from-

Maria: (47:12)
Antivirals.

Moderator: (47:13)
Antivirals, sorry.

Dr. Ryan: (47:16)
Yeah, there are, there have been a number of compounds that have been used in the fight against coronavirus, but it’s very important to recognize that there is no recognized effective therapeutic against coronaviruses. There are protease inhibitors and interferons that may help as adjuncts to treatment, but they have their own issues with toxicity. So the primary objective in an outbreak related to a coronavirus is to give adequate supportive care to patients, and particularly in terms of respiratory support, multiorgan support, because the disease can cause a multiorgan failure. And many, many patients can be saved in that regard. However, there are potential clinical trials that could be done with agents, and that’s what we’re really focused on right now is identifying other therapeutic agents and other opportunities to test new drugs. And, again, we’ve been working very closely with the authorities in the four countries, and, again, very much welcome particularly in this case the participation of Chinese experts and all of the expert networks that are helping us to move towards. One of the opportunities that sometimes can get lost in an epidemic is not collecting the structured data to understand the clinical disease, and then using drugs even on a compassionate basis, but collecting the data in a structured way under what we call a [Murie 00:48:47] protocol, which is a protocol that allows the compassionate use of drugs, but also collects very important data to allow us to advance knowledge. And, again, we thank all the countries for working with us to this end. I don’t know if, Sylvia, you want to add anything there.

Sylvia: (49:05)
No, I think it’s really part of the research effort and research collaboration that WHO is coordinating currently to make sure that discovery also on therapeutics and vaccine is accelerated as much as we can.

Dr. Ryan: (49:21)
And just to remind everybody, the research and development blueprint for epidemics has a broad global partnership called the global coordination mechanism, where all of the major research institutions in the world are involved in that collaboration. And, again, this is the type of collaboration we need, the sharing of sequences, the sharing of viruses with revision of guarantees around the adequate benefits that go with the sharing, the sharing of clinical knowledge. This is global solidarity and action, and we need to see that to continue in the coming days.

Maria: (49:56)
And if I might add to say that the global community has learned a lot from SARS and a lot from MERS, and we’re building upon that knowledge. So the advancements that have been made for diagnostics and therapeutics and vaccine, as Mike has said, through global collaboration and with the research and development blueprint, the advancements that have been made for MERS over the last seven years could be applicable here. And so we’re trying to build upon that knowledge base to see if that work can help in the current situation.

Dr. Ryan: (50:29)
Thank you very much.

Dr. Tedros: (50:32)
Okay. Maybe I will say the final thank you, I think.

Moderator: (50:35)
Okay. Well, I promised this lady one last question.

Dr. Tedros: (50:37)
You did? I didn’t know.

Moderator: (50:42)
Short. Natalie [Mara 00:50:43] from [inaudible 00:50:43] News. As you mentioned SARS and previous outbreaks before, I was wondering if you could comment on the Chinese transparency, and if you could draw a comparison to the outbreak now.

Dr. Tedros: (50:58)
I think on the Chinese transparency, probably I have said a lot earlier, so it will only be repetition. But the cooperation and transparency is very, very commendable, and we really appreciate, and we want that to continue. And, today, the community members have witnessed that during the presentation from China when they were presenting the details of what’s happening. So would like to encourage them to continue that way.

Dr. Tedros: (51:29)
Transparency is very important. That really, really helps. And if we are going to keep the world safe, transparency is number one, and that’s what we are seeing happening. And we encourage them to continue in that direction.

Dr. Tedros: (51:43)
You have also heard [inaudible 00:51:44] from the Chinese leadership exactly the same thing. We have to be transparent, and do everything we can to protect ourselves, and also to protect the international community or the world.

Dr. Tedros: (51:56)
So with that, thank you so much again for joining us, and my apologies for keeping you waiting. And tomorrow, as we said, we will reconvene at 12:00, and any information that we will have, we will keep in touch with you. Thank you.

Moderator: (52:10)
Thank you very much. [foreign language 00:16:15] Tomorrow, we will inform you about ways we will communicate the outcome of the emergency committee. Thanks again and thanks for patience.