World Health Organization COVID-19 Briefing Transcript April 3

Derek: (15:27) Hello to everyone from Geneva from WHO headquarters. Welcome to this regular COVID-19 press briefing. Welcome to everyone who is watching us on number of WHO platforms. There is more than 400 journalists watching us on Zoom as well, with a number of questions waiting for our guest today. And today we have a special guest that's Kristalina Georgieva, the managing director of the International Monetary Fund. She will join this briefing to update about the economic impact of the COVID-19 pandemic and the response of the International Monetary Fund. Derek: (16:11) For journalists who are online and wish to ask questions, please click raise hand. We will start to with Dr. Tedros, who is joined by Dr. Maria van Kerkhove and Dr. Mike Ryan. Dr. Tedros, please. Dr. Tedros Adhanom Ghebreyesus: (16:28) Thank you, Derek. And good morning, good afternoon, and good evening. As Derek said, we are delighted to be joined today by Kristalina Georgieva, the managing director of the International Monetary Fund. Welcome, my sister. Kristalina will say more in a few minutes about the economic impact of the pandemic and what the IMF is doing to support countries and the global economy. Dr. Tedros Adhanom Ghebreyesus: (16:59) More than 1 million confirmed cases of COVID-19 have now been reported to WHO, including more than 50,000 deaths. But we know that this is much more than a health crisis. We're all aware of the profound social and economic consequences of the pandemic. The restrictions many countries have put in place to protect health are taking a heavy toll on the income of individuals and families and the economies of communities and nations. We are in a shared struggle to protect both lives and livelihoods. In the short term, countries can ease the burden on their populations through social welfare programs to ensure people have food and other life essentials. Dr. Tedros Adhanom Ghebreyesus: (17:50) For some countries, debt relief is essential to enable them to take care of their people and avoid economy collapse. This is an area of cooperation between WHO, the IMF, and the World Bank, but ultimately the best way for countries to end restrictions and ease their economic effects is to attack the virus. With the aggressive and comprehensive package of measures that we have spoken about many times before, find, test, isolate, and treat every case, and trace every contact. If countries rush to lift restrictions too quickly, the virus could resurge and the economic impact could be even more severe and prolonged. Financing the health response is therefore an essential investment, not just in saving lives but in the longer term social and economic recovery. There are three main areas for countries to focus on. Dr. Tedros Adhanom Ghebreyesus: (18:58) First, we call on all countries to ensure core public health measures are fully funded, including case finding, testing, contact tracing, collecting data, and communication and information campaigns. Second, we also call on countries and partners to strengthen the foundations of health systems. That means health workers must be paid their salaries and health facilities need a reliable supply of funding to purchase essential medical supplies. Dr. Tedros Adhanom Ghebreyesus: (19:36) So, we call on all countries to remove financial barriers to care. If people delay or forego care because they can't afford it, they not only harm themselves, they make the pandemic harder to control and put society at risk. Several countries are suspending user fees and providing free testing and care for COVID-19, regardless of a person's insurance, citizenship, or residence status. We encourage these measures. This is an unprecedented crisis, which demands an unprecedented response. Suspending user fees should be supported with measures to compensate providers for the loss of revenues. Government should also consider using cash transfers to the most vulnerable households to overcome barriers to access. This may be particularly important for refugees, internally displaced persons, migrants, and the homeless. Dr. Tedros Adhanom Ghebreyesus: (20:47) The pandemic is also having an effect on the fight against other diseases like polio. As you know, in recent years, we have driven polio to the brink of eradication. This has been a massive global effort started by rotary, supported by many other partners, and led by thousands of health workers, vaccinating children in some very difficult and dangerous areas. Many of those health workers are now supporting the COVID-19 response. They're tracing contacts, finding cases, and providing public health information to communities to reduce the risk of increasing transmission of COVID-19, the Polio Oversight Board has made the hard decision to suspend house to house vaccination campaigns, knowing that this may lead to an increase in polio cases. To reduce this risk, we will support countries to maintain essential immunization for all vaccine preventable diseases. WHO has published guidance for countries on how to maintain essential services, even while responding to this crisis. Dr. Tedros Adhanom Ghebreyesus: (22:02) ...services, even while responding to this crisis. The global polio eradication initiative is working to ensure that one, is it safe to do so. Countries can be supported to rapidly restart polio vaccination campaigns. While all our energy may be focused on COVID-19 now, our commitment to eradicating polio is unshakeable. Dr. Tedros Adhanom Ghebreyesus: (22:28) Sadly, there are reports from some countries have an increase in domestic violence since the COVID-19 outbreak began. As people are asked to stay at home, the risk of intimate partner violence is likely to increase. Women in abusive relationships are more likely to be exposed to violence as are their children. As family members spend more time in close contact and families cope with additional stress and potential economic or job losses. Dr. Tedros Adhanom Ghebreyesus: (23:03) Woman may have less contact with 5 million friends who may provide support and protection from violence. We call on countries to include services for addressing domestic violence as an essential service that must continue during the COVID-19 response. Dr. Tedros Adhanom Ghebreyesus: (23:23) If you are experiencing or at risk of domestic violence, the speak to supportive family and friends. Seek support from a hotlines or seek out local services for survivors. Make a plan to protect yourself and your children any way you can. This could include having a neighbor, friend, relative or shelter identify to go to should you need to leave the house immediately. There is never any excuse for violence. We abhor all violence of all forms at all times. Dr. Tedros Adhanom Ghebreyesus: (24:08) Finally, the global response to COVID-19 would not be possible without the generosity of countries and partners. Two months ago WHO issued its strategic preparedness and response plan with an initial ask of 675 million US dollars to support the response. I'm delighted to say that almost $690 million has now been pledged or received. Of this amount, 300 million has been given to support WHOs work and the rest has been given on a bilateral basis or to other organizations involved in the response. Dr. Tedros Adhanom Ghebreyesus: (24:53) I would like to thank the state of Kuwait, which today is becoming one of the largest donors with a total of 660 million US dollars. Dr. Tedros Adhanom Ghebreyesus: (25:07) Separately WHO solidarity response fund, has now raised more than 127 million US dollars from more than 219,000 individuals and organizations. I would like to thank [inaudible 00:25:24] for its contribution of 10 million US dollars. I'm also pleased to announce that I have invited UNICEF to join the solidarity response fund. Dr. Tedros Adhanom Ghebreyesus: (25:34) UNICEF has extensive experience both in fundraising and implementing programs and our partnership will help us to work together closely to save lives. And thank you so much my sister, Henrietta, for accepting my invitation. Dr. Tedros Adhanom Ghebreyesus: (25:50) We still have a long way to go in this fight. WHO is working every single day with all countries and partners to save lives and to mitigate the social and economic impact of the pandemic. The IMF is a key partner and I would now like to hand the floor to my sister Kristalina to make a few remarks and thank you so much for joining us, Kristalina. Thank you Kristalina Georgieva: (26:19) Thank you very much Dr. Tedros for the invitation, but most importantly for the work you and your staff do. And I want to express from the bottom of my heart a gratitude to all health workers that are on the front line to save lives, sometimes risking their own. Kristalina Georgieva: (26:45) At the outset I would like to make three points. First, this is a crisis like no other. Never in the history of the IMF, we have witnessed the world economy coming to a standstill. We are now in recession. It is way worse than the global financial crisis and it is a crisis that requires all of us to come together. Kristalina Georgieva: (27:26) WHO is there to protect the health of people. The IMF is there to protect the health of the world economy. They both are under siege and only united we can do our duties. I want to stress the message that you and I have sent to the world that saving lives and protecting livelihoods ought to go hand in hand. We cannot do one without the other. And in that spirit we at the IMF are concentrated on making sure that there is a strong response to the health crisis as well as protecting the strength of the economy. Kristalina Georgieva: (28:32) My second point is about emerging markets and developing economies. They are hard hit and they have very often less resources to protect themselves against this dual crisis, health and economic crisis. We know that in many countries health systems are weak. We know that in flight to safety, a lot of capital has left the merging economies, the developing world. Nearly $90 billion have flown out. This is way more than during the global financial crisis. And some countries are highly dependent on commodity experts with prices collapsing, they're hit yet again. It is paramount for us to place these countries and especially the weakest among them in the center of our attention. Kristalina Georgieva: (29:39) The same way the virus hits vulnerable people with medical preconditions hardest, the economic crisis hits vulnerable economies the hardest. And that takes me to my third point. Kristalina Georgieva: (29:56) We at the IMF are mobilizing strongly working together with the world bank and other international financial institutions bringing the world together to provide protection against this crisis. We have $1 trillion war chest and we are determined to use as much as necessary in protecting the economy from the scarring of this crisis. We are mobilizing emergency financing assistance to countries and I can tell you we have never seen ever such a growing demand for emergency financing. Already over 90 Kurt countries have been placing requests to the IMF for it and this emergency financing is to [inaudible 00:30:59] the appeal that you and I are putting out. And it is, please prioritize health expenditures, use money to pay doctors and nurses. Make sure if hospitals function, that they are makeshift clinics where necessary and protect your economy, the most vulnerable people. Firms so they can hold on their workers because the highest risk we see is a wave of bankruptcies and layoffs that would make the recovery from this crisis a harder. Kristalina Georgieva: (31:37) Third, in this line of financial support, we have the big one, 1 trillion, we have the emergency financing, we are also taking strong action for the poorest of our members by mobilizing grant funds to serve their duties to the IMF so they don't have to use scarce resources today for that purpose. And together with the president of the world bank, we put out an appeal to official bilateral creditors. For the time the economies standing still to have debt service obligations also standstill. A moratorium on that service for either countries. Kristalina Georgieva: (32:26) Let me finish by saying that this is, in my lifetime, humanities darkest hour. A big threat to the whole world and it requires from us to stand tall, be united and protect the most vulnerable of our fellow citizens on this planet. Thank you. Thank you Tedros for having me. Speaker 3: (32:59) Thank you very much. Ms. [Inaudible 00:33:02] for this very remarkable speech. Thank you Dr. Tedros. Speaker 3: (33:06) We will now open the floor to questions. I would ask journalists to ask only one question and if it's possible to specify to whom this question goes. So we will start first with CNBC and Dawn from CNBC. Dawn, can you hear us? Dawn: (33:25) Hi yes, can you hear me? Speaker 3: (33:29) Yes, please go ahead. Dawn: (33:31) Okay. Thank you for taking my question. I am calling from quarantine in New York City. Dawn: (33:36) My question is that the fatality rates in Italy and the United States, especially Italy, are significantly higher than in Asia and it appears that that may be the case in the next few weeks in the US. I've seen research reports on ACE inhibitors and ibuprofen affecting this disease. Is there anything in the diet, the lifestyle, the typical drug protocols that Americans or European views that make this virus a more severe? Dr. Michael J. Ryan: (34:11) I can begin and Maria can follow up. Certainly the experience in Italy and a large number of patients were questioned on their use, for example, of ACE inhibitors and there was absolutely no association on the use of those ACE inhibitors on having disease or not, or having severe disease more importantly. Obviously we need to gather more evidence, but the evidence thus far would indicate that these antihypertensive drugs that are used and many people are on, do not appear to have any impact on the severity of disease. Dr. Michael J. Ryan: (34:50) With regard to the reasons why we have different mortality in different countries. A lot of it is mediated by two factors. One, the age profile in those communities. Populations that have older populations or a higher percentage of people in the older population. It may not be that the overall case fatality is different, it's just that case fatality is higher in that older age group. Dr. Michael J. Ryan: (35:14) Equally, the presence of underlying conditions in those individuals and the incidents of underlying conditions in those individuals, can also lead to worse outcomes. So you have a lot of issues that have to be factored in when you try to work out why one country's mortality rate is higher or lower than others. Dr. Michael J. Ryan: (35:35) Obviously as well, and this has to be taken into account, that systems that come under huge pressure, systems that are overloaded with the fatigued doctors and nurses with many, many sick patients at one time, clearly the outcomes for those patients can be worse. That's what we've been saying and many countries are trying to do. We need to take the pressure off the healthcare system. We need to reduce the tsunami of patients coming through the door to give doctors, nurses and other carers the opportunity to save more lives. We can only do that if we pressure the virus and put it under pressure, reduce the incidents and get back to a situation where we can deal with this virus within the healthcare system in an effective way. Maria. Dr. Maria Van Kerkhove: (36:26) Thanks Mike. The other reason why it's challenging to compare mortality rates is because indeed it is a rate which you are calculating on any given day, which means you are looking at the numbers of people who have died divided by the number of people who have been reported in that country. And so there are significant differences in terms of the activities that areas are doing to identify cases based on the epidemiology, based on the transmission scenario that they're in. And in many situations where systems are overwhelmed, they're focusing on severe cases and those are the cases that are being detected and you're missing mild cases or unrecognized cases that may be in the community and so that could lead to a higher number of a mortality rate. Dr. Maria Van Kerkhove: (37:11) At the same time, you have individuals who are still in hospitals that are developing. Either progressing to more severe disease and some people who are experiencing severe disease will have advanced treatments. They could be on ventilation, they could be on ECMO and it will take some time for them to either recover or to die. And so it is very difficult and misleading to be comparing mortality rates. Dr. Maria Van Kerkhove: (37:38) What we really need to be focusing on right now are what is the age profile of people who are in ICU. We've talked about this before. We're seeing more and more individuals who are of the younger age group in their thirties, in their forties, in their fifties who are in ICU and who are dying. Dr. Maria Van Kerkhove: (37:55) Overwhelmingly, we do see a trend across countries that people who are older, people who have underlying conditions will have more advanced disease. So if the population that is affected have those characteristics, then you'll have a higher risk of death. But, we have some time to go before we can really understand what mortality looks like across different countries. So I would urge you to take those mortality rates with caution when comparing across countries. Speaker 3: (38:24) Thank you very much, Dr. Ryan and Dr. [inaudible 00:00:38:26]. Speaker 3: (38:27) We will now go to Simon Ateba from a Today News Africa. Simon, can you hear us? Simon Ateba: (38:34) Yes, I can hear you. Can you hear me? Speaker 3: (38:35) Yes, please. Please go ahead. Simon Ateba: (38:38) Thank you for taking my question. My name is Simon Ateba from Today News Africa in Washington DC. And my question goes to the managing director of the IMF, Miss Kristalina Georgieva. Simon Ateba: (38:50) From Legos in Nigeria to join Johannesburg in South Africa and even to Kinshasa in the democratic Republic of Congo, Africans who have been forced to stay home are complaining about hunger. Many of them said their hunger may first may kill them faster than even the coronavirus. The WHO director recently said the IMF and the world bank granted debt relief to developing countries including African countries to provide food to the citizens and curb the spread of the coronavirus. Can you guarantee here today that you will pay special attention to African nation who contain this pandemic by granting debt relief to African nation before it's too late? Thank you. Kristalina Georgieva: (39:39) Well, I want to thank very much for this question. It is the continent, we at the IMF worry a lot about. There has been a momentum built in Africa. Africa has been growing and many countries have done really well in recent years and we are risking to lose this momentum and even worse to reverse it. And therefore it is hugely important to provide substantial financial support to Africa and we do it in two ways. Kristalina Georgieva: (40:19) One, we are scaling up emergency financing and I can tell you that yesterday our board approved emergency financing for Rwanda and today two more African countries are going to be in discussion for approval. Kristalina Georgieva: (40:39) Our objective is to double what normally is being provided as emergency financing and we do that in a very highly concessional terms with a big component of this financing being defacto grant component. We do so because we recognize that many governments are faced with this dilemma. Kristalina Georgieva: (41:07) Do they provide support to people to simply survive? Do they fight the virus and we want this to be a false dilemma. We want them to have for the next months, substantial financial resources so they can step up their support for people against the pandemic and their support for the economy. In many cases, informal economy that requires social safety net to be strengthened to help people. Kristalina Georgieva: (41:47) Two, we do see the issue of debt as one that has to be addressed urgently. For us at the IMF, what it means is that for our tourists members, we are raising grant financing to cover their use to the IMF. It is called catastrophic containment relief trust and we have been getting support from the UK, Japan and others so we can do what you're saying, provide that relief visibly our own obligations. Kristalina Georgieva: (42:24) Beyond that, we are also calling on official creditors to countries, either countries, many of those are our countries in Africa, to provide much needed space for countries to address their immediate priorities by a stent steel on that service to official creditors for a period of one year. And I can tell you that I have been in touch with many of the leaders in Africa. I know how important it is right now to stand up and support Africa. Build a bridge over what is such a dramatic drop in their economic performance. Speaker 3: (43:21) Thank you very much Miss. Georgieva. And thanks to Simon for this question. Speaker 3: (43:26) We will go now to Randy from Al Jazeera. Randy, can you hear us? Randy: (43:31) Yeah, I can hear you now. Thank you. Speaker 3: (43:34) Please go ahead. Randy: (43:36) My question goes to Miss. Kristalina Georgieva of the IMF. Randy: (43:40) I'd like to ask you something more specific on the economic impact in Southeast Asia, because I'm wondering, based on the IMFs assessment, what has been the economic impact of the pandemic on Indonesia, Southeast Asia's largest economy in life and what does the [inaudible 00:43:59] in Jakarta, the capital city need to do more in order to overcome the issue? Thank you. Speaker 4: (44:03) We need to do more in order to overcome the issue. Thank you. Kristalina Georgieva: (44:05) Well, thank you very much for this question. Indonesia, over the last years has done a lot to build very strong macroeconomic fundamentals, and buffers exactly in a case of a crisis. And what is happening today is Indonesia is taking a set of measures that are significant, they're large, and they're well targeted to support the economy to go through this very difficult time. Like many other emerging market economies, Indonesia is experiencing a significant outflow of capital, and that makes it so much more difficult for the country because there is a drop in production, and that is to say drop in revenues, and at the same time the needs of supporting the population in this crisis are growing. What we see Indonesia doing very well is to have a coordinated response between the ministry of finance, and the central bank. Kristalina Georgieva: (45:20) So measures that are taken are impactful, they're strong and impactful. We are also fully aware that a issue of dollar liquidity is one that many countries including Indonesia needs to wrestle with. And this is where we are very strongly supporting central banks of advanced economies, and especially the federal reserve in the United States to do more of what they have started doing, and it is to offer swap lines to banks in emerging market economies. On our site at the IMF, we have been very much encouraged by Indonesia among many other countries to look into whether we can offer more, in terms of instruments that are fitting for emerging and market economies, and address the issue of liquidity and our board is going to review a proposal in the next days on creating a short term liquidity line that is exactly targeted to countries with strong fundamental, strong macroeconomic fundamentals that may be experiencing short term liquidity constraints. Speaker 5: (46:47) Thank you very much [crosstalk 00:46:48] Kristalina Georgieva: (46:48) And I actually, if I may add, what is very impressive is to see how much attention Indonesia is paying exactly on this issue of protecting firms, especially SMEs in this period that would allow then, when the recovery comes, for the country to step up. It's a very well thought through targeted fiscal measure. Speaker 5: (47:14) Thank you very much, Ms. Georgieva. Now we will go to Italy to [inaudible 00:47:19] who tried, on a couple of occasions to ask a question [crosstalk 00:47:24] So, we will try this time please. Speaker 6: (47:27) Yes. Can you hear me? Speaker 5: (47:28) Yes, go ahead. Speaker 6: (47:29) Okay, so can I ask you, what's the WHA stance on antibodies testing? Have you already approved some of them, and is that a good practice that we widely use tests for antibodies before the lockdown is actually over? And of course the immunity passport also. Is that a good idea? That comes from Germany I think? Is that feasible for countries such as Italy? Thank you. Dr. Maria Van Kerkhove : (48:00) So, thank you for the testing. There's a very large number of molecular tests, and serologic tests that are now available for use, some of which have gone through approvals in their country's regulatory approvals. We are working with a number of countries right now that are looking at the use of serologic assays in the form of research, where they are looking to estimate the seroprevalence, or the antibody levels in populations in their countries. There's a number of countries across Europe, and across Asia that are currently doing this, and they're looking at different types of tests. They're looking at screening assays, which are ELISA's, but they're also looking at micro neutralization assays which are more confirmatory testing. Dr. Maria Van Kerkhove : (48:45) There is a large amount of work right now, and we're working with Find, and we're working with other groups that are trying to evaluate these against a well-characterized panel of sera from infected individuals and noninfected individuals or controls, and that work is still underway. What we would like to be able to do in the form of research is to be able to compare some of those serologic assays with individuals who are known to have been infected, so identified through molecular testing, and all of this work is underway, but there are a number of tests that are available, and this is very positive, in terms of being early four months into a pandemic where they were rapidly developed because full genome sequences were shared very quickly by China. Dr. Michael J. Ryan: (49:40) Just to add, the tests that are currently being used are PCR type tests that the tests detect the virus, and unusually in the nasal cavities of individuals. So, if someone is symptomatic and they get tested, you test for the virus. The serologic tests don't test for the virus. They test for the immune response to the virus, and they say you've had a recent infection, or maybe not so recent infection. And there are different parts of that test for IGM, which tells you if you've had a very recent infection, or [inaudible 00:50:12] infectious, and IGG, which says you've had an infection at some time in the past. Dr. Michael J. Ryan: (50:18) So, we have to be careful in using these tests that they may diagnose you as having had the infection, but they're not necessarily used in the act of diagnosis of an active case. You can be sick, and infected with the virus and you may not have yet developed a serologic response to the virus. So how these tests are used has to be very carefully calibrated. We welcome all the innovation, and we need a comprehensive set of testing tools, but they need to be rolled out with the careful objectives of what they're actually supposed to achieve, but we do welcome the innovation. We welcome the private sector innovation, and we welcome governments introducing these testing into their national policies in the appropriate way. Speaker 5: (51:03) Thank you very much. We will go now to Anyiss our colleague based here in Geneva from AFP, Anyiss can you hear us? Anyiss: (51:12) Yes, hello, Tarek, I can hear you. I wanted to had a question to something that Maria Kerkhove said before. She said if I understood well that more, and more it appears that more, and more young adults are in the intensive cares. If she can give us some figures about that, and if she has any explanation. Thank you. Dr. Maria Van Kerkhove : (51:40) So, thank you for that question. Yes, indeed. We are seeing more, and more younger individuals who are experiencing severe disease. I should say overall, most of the people who are experiencing severe disease, and ending up in ICU, and needing advanced care are people of older age, and are people who have underlying conditions. But what we are seeing in some countries is that there are individuals who are in their thirties who are in their forties who are in their fifties who are in ICU, and who have died. We've seen some data from Italy, we've seen some data from China, we've seen some data from a number of countries across Europe where people of younger age have died. Some of those individuals have had underlying conditions, but some have not. And so what we need to better understand is why there are young people who are dying from this infection. Dr. Maria Van Kerkhove : (52:34) There are still many unknowns, at the present time, so I can't give you a complete answer on that. But what is important is that people who are infected with this, even if they have a mild disease, what is classified as a mild disease, or a moderate disease, moderate disease still includes pneumonia. And if you hear anyone who has infected who explains the kind of disease that they've had, it's still pretty significant even if you don't require hospitalization. But what we need to better understand, and these will come through these natural history studies which are being conducted of why are some people progressing from moderate disease to severe disease to critical disease? Dr. Maria Van Kerkhove : (53:17) Why are some people progressing backwards from very severe disease to more moderate disease, and recover. So these are really fundamental questions that we need to better understand so that we can improve our standard of care for anyone who is infected with this. There's also a large number of clinical trials that are underway that you're aware of that are looking specifically at therapeutics for COVID 19, and those are currently being conducted and we're hoping for results of those in the coming months. So, again, we can have more specific options for people for treatment for COVID 19. Anyiss: (53:52) But sorry if I understood well, you were saying that, at the beginning of the epidemic there was more older people, and that now there are more young people infected, and in intensive care is it a change? Dr. Maria Van Kerkhove : (54:10) So, it's not a change, but with more countries affected, and more virus circulating, we're going to see maybe some slight differences in epidemiology in different countries. It's too early to conclude one way, or another if this will be the same in all countries. As we mentioned before, it depends on the populations that are affected, that are infected. But what is important is that everyone needs to do what they can to prevent themselves from getting infected, and by preventing themselves from getting infected, and taking those measures will prevent the onward transmission to someone else who could perhaps be more vulnerable. Mike? Dr. Michael J. Ryan: (54:49) And if I may add, there was a tendency at the beginning, in the last number of months for almost a dismissive attitude to say, "Well, this disease is severe and older people, and it's fine in younger people", and maybe that was a way of people assuring themselves that younger people we're not going to be so badly affected. But we've been saying again and again in this forum and with our data. In Korea, even in Korea, who have managed to control the disease, one in six deaths have been in people under 60. In Italy over the last five, six weeks at least 10 to 15% of people in intensive care have been under 50. It's not that anything has changed. It's that we collectively have been living in a world where we've tried to convince ourselves that this disease is mild, and the young people, and it's more severe in older people, and that's where the problem is. Dr. Michael J. Ryan: (55:51) And I think the evidence has been there all along that there is a spectrum of severity, and it is definitely more severe in older age groups, but there is a spectrum of severity in younger people as well, and sometimes in younger people with underlying conditions, and sometimes not. So I don't think there's been a significant change. As the numbers grow, as the clinical data's collected, we begin to see that this disease has an impact on the young as well as the old. But again, younger people tend to have a milder course of disease, but that is also younger people. Dr. Michael J. Ryan: (56:29) And that is not to scare younger people to say, "Oh, you need to be careful because you may become very sick", in the main, younger people still have a milder course of disease. What we've also been saying is my older people who get sick can transmit the disease to people who are even more vulnerable. So, there are two reasons here for younger people to avoid infection. One, it is not always a mild disease in your age group. And two, if you get sick and you start to transmit that virus, you may infect someone who's in an older age group who is vulnerable and therefore you need to try and do whatever you can to protect yourself, and protect others. Dr. Tedros Adhanom Ghebreyesus: (57:07) Thank you. Maybe I would like to add, in order to remind young people I said several weeks ago that to young people in my message, in one of our presses, that you are not invincible. And because we had cases actually how the virus was affecting young people too. Still, older people are more vulnerable and people with underlying conditions are more vulnerable, but we have even now more evidence that it affects younger people too, and that's what we're saying today, but if you compare that to still the senior citizens are the most affected, but we have now more, and more cases also from the younger population. Speaker 5: (58:06) Thank you very much, and we will go now to Latin Finance Network and Jo. Jo, can you hear us? One second we connect [inaudible 00:58:19] Yes, please. Go ahead. Jo: (58:21) Yes. Oh, thank you. This question is for World Bank. So for the IMF, I'm sorry. So, the question is, I'm sorry. In this situation, there's probably been a lot of work on trying to do institutional innovation, and the role of the IMF has been very active in raising funds to help the poor economy. But there's also been talk about expanded quantitative easing from central banks in Europe [inaudible 00:59:01] global level. And I was wondering if the IMF is considering a role, a new kind of role there in sort of a serving as a guarantor, or intermediary in a global level of quantitative reasoning for central banks in Europe, and US by [inaudible 00:59:20] bonds from [inaudible 00:59:21] Kristalina Georgieva: (59:25) Yep. But thank you. This is a very interesting question. Let me first say that we have seen unprecedented stepping up of action of central banks and also of ministries of finance in advanced economies that has been done in a very short period of time with a tremendous significance, because we have seen as a result of this determined action, some stabilization in markets, and most importantly finance in going to protect people, protect firms, protect jobs that could have not been done by central banks alone, on their own only, it does require the monetary side, and the fiscal side to come together. So, I just want to recognize that what has been done is unprecedented. The problem we face is gigantic, but also the actions that are taken are very significant, very big. When it comes down to the role of the IMF. Our main preoccupation in this crisis is one, to very rapidly step up financing for countries, especially emerging markets, developing countries that are faced with very significant, and growing needs, and two, to think of what may be needed, but is not there in the defense system of the world. Kristalina Georgieva: (01:01:13) And in that context what we have done is on one side to encourage central banks in advanced economies to do more for liquidity in the emerging markets. Actually I must say I think that they have recognized that need on their own, and we have seen both stepping up of swap operations with emerging markets by the Fed. We'll have seen rapid operations that are directed towards this stabilization of emerging markets, and then too, we looked at our own instruments, and what we have identified is that we are short of one particular instrument, and it is to provide short term liquidity to countries that are basically strong but may find themselves in a tight place. We have not been pursuing anything beyond the mandate of the fund that traditionally we have been exercising. We have been asked by some of our members on something that the fact to go seem to, if you wish, quantitative easing for the world, and it is, whether or not what was done in 2009, by the allocation of additional SDRs. Kristalina Georgieva: (01:02:49) This is to boost liquidity. Mostly useful for emerging markets in developing countries. The special drawing rights, this is what the fund offered that as an addition during that crisis, many of our members are saying, we should look into this again. At this point, however, our membership, our shareholders are saying, use everything you can use right now, fast. And that is the focus of our attention to step up double emergency financing from 50 to a hundred billion, that order of magnitude, and then make sure that we are ready to deploy the 1 trillion we have as lending capacity as this crisis continues to evolve. But as you said, we do need to think beyond what we have, and in that context, the questions around what more we can do are always very welcome. So, I really appreciate you bringing up that question. Speaker 6: (01:04:05) Thank you very much Ms. Georgieva. We will go to Bloomberg now to Naomi. Naomi, can you hear us? Naomi: (01:04:13) Hi. Yes, I can. Thanks for taking my question. I actually have one for each organization. First of WHO, we saw some countries in Asia tightening restrictions on public life today after virus infections popped up again. And I just wonder if you can help us understand how this sort of raising and lowering of restrictions might work throughout the world. And if this would be the new normal for the next year, and maybe the next 18 months, what should we anticipate? And second, an IMF question. Do we have any assurances that China supports a postponement on official bilateral debt repayment? Dr. Michael J. Ryan: (01:04:55) On the issue of measures, I think many countries around the world have been claiming a very tragic, and dangerous mountain of disease. And we need to be also extremely careful on the descent. We need to be watchful, be aware, we want this disease to go away. We want the numbers to drop. But as they drop and as we try to come up with transition strategies to allow economies, and social life to re-emerge and nobody wants that more than us here at WHO, and all our medical nursing colleagues around the world, our healthcare professionals. But what we need to absolutely ensure that as we, if we want to transition back to a steady state with a virus, if we want to reach a point of disease control. We need to put in place the public health architecture. We need a massive investment in our capacity to do surveillance, contact tracing, isolation and quarantine. We need very good information systems. We need a highly educated- Dr. Michael J. Ryan: (01:06:03) ... We need very good information systems. We need a highly educated, engaged and empowered communities around the world who understand what to do if they're sick, where to go. Have access to a doctor, to a nurse to testing, to isolation to quarantine. And at the same time we strengthen our healthcare system to deal with those who are really sick. And all the while developing new therapies and vaccines to solve this problem once and for all. If we want to reach that this situation where we can live with this virus and have our economies back on track, we must make those other investments. As we do that there will always be the chance as we lift and as governments lift shutdowns, lockdowns, as people go back to school, we have to have in place to protect almost a safety net. The other things in the system that can trigger and maybe and may happen, we may have to modulate that. We may have to decide which are the measures we can put back in place if necessary to create more physical distance. And we don't want to end up in a cycle of a lockdown, followed by release, followed by another lockdown, followed by release. That's not the way forward. And the way to avoid that is we need a transition strategy that gets us back into more control of the virus. We need to get ahead of the virus. And then if we are in control, we can protect our economies. But if we lurch from lockdown to poor control and back to lockdown and back to poor control, that is not what anybody needs right now. So the investment we need to make, the lockdown have given some time. They've taken the pressure out of the epidemic. You see that. This is precious time not only to strengthen the healthcare system as the DGS said, but precious time to put in place the public health architecture, the testing, the community education and build this response from the community. Dr. Michael J. Ryan: (01:08:05) That's the challenge. And if we do that, we have a chance of transitioning back into a life, and economic and social life, that may in some senses not be the same again. Maybe a more caring, engaged society with a better healthcare system. With better universal access to healthcare. With more social justice and more care for each other. And that won't be a bad society to go back to. So from my perspective, we need to work hard now to put in place the comprehensive architecture of public health and health care, if we're going to unlock safely from the economic measures, from the societal measures and population measures that are affecting and impacting people's social and economic future. Speaker 7: (01:09:01) Thank you very much. Would you, Ms. Georgieva, would like to answer the question please? Kristalina Georgieva: (01:09:07) Yep. Yes, thank you. Thank you for your question. China constructively engaged on this issue of that standstill for poor countries so they can weather the tremendous difficulties they're faced with during this crisis. We had a G20 ministers of finance call earlier this week. This topic of potentially having a debt relief for either countries, for poor countries was on the agenda and China addressed that issue by framing a set of principles they would be interested to see being in integrated in that process. Kristalina Georgieva: (01:09:58) And it is also important to point out to China's decision to contribute to the catastrophic containment relief trust that the IMF has been mobilizing to make sure that poor countries do not have to serve their debt obligations to the IMF, that this would be taken over by grant provision. And China is one of the countries that are making commitments to that fund, to that trust, the catastrophic containment relief trust. We will be obviously working with everybody in the next days, the G20 the Paris Club, IMF, World Bank. By the time of our spring meetings, we look forward to advancing this discussion. Speaker 7: (01:10:57) Thank you very much Ms. [inaudible 01:10:59]. We will now go to Dhaka in Bangladesh. Mr. [inaudible 01:11:07] can you hear us? Speaker 8: (01:11:09) Yes. Dr. Tedros Adhanom Ghebreyesus : (01:11:10) Please go ahead. Speaker 8: (01:11:12) Thank you very much. I would like to address Mr. Director General and WHO Headquarters. Just I want to echo [inaudible 00:05:27]. Have any special of observation in Bangladesh testing policy or testing system on COVID-19, it's run through [inaudible 01:11:44] or wrong anything wrong [inaudible 01:11:46] of [inaudible 00:01:11:46]? Dr. Michael J. Ryan: (01:11:49) I can take that, DJ. I think your mic is still on. Thank you for your question. Dr. [Poonam 01:11:57] Singh, our regional director for the Southeast Asia region and myself actually spoke with the minister of health in Bangladesh yesterday as part of a ministerial meeting with the all ministers in Southeast Asia. And we spoke about laboratory testing and our support to beef up that testing in Bangladesh. And what is interesting is that Bangladesh has already implemented a very wide network of testing based on the gene [inaudible 01:12:25] platform. This was put in place for TB and HIV and other diseases and there's a real opportunity for us to be able to use an existing platform that has been invested as part of health development and health systems development and to leverage that platform in order to scale up testing in Bangladesh. Dr. Michael J. Ryan: (01:12:42) And we see that as a way forward in doing this. I think Bangladesh is taking the issue of testing very seriously and the minister was extremely keen to broaden the testing availability in the country to improve and drive surveillance using polio surveillance and other avenues. So I think there's a strong focus on good surveillance in Bangladesh and we will do everything in our power to support Bangladesh in their efforts to beef up surveillance and to ensure that there's adequate lab testing available. Speaker 7: (01:13:18) Thank you very much. We'll go now out to South China Morning Post if we can connect to, I think it's [Murray 01:09:18] Stuart, Stuart from South China Morning Post. Murray Stuart: (01:13:34) Hi, can you hear me? Speaker 7: (01:13:35) Yes, please go ahead. Murray Stuart: (01:13:37) Hi, Dr. Tedros and the team, I have a question about the use of masks because throughout the last 48 hours we've seen a lot of media reports suggesting that the WHO is considering revision on the advise of the use of mask on the public level. May I check with you guys whether there is any plan undergoing about potential changes to encouraging the public or at least not dissuading the public from wearing surgical masks publicly? And also have you guys seen the report from team of Hong Kong scientists on the Nature magazine about the potential effectiveness of using masks in preventing coronavirus? Thank you. Dr. Michael J. Ryan: (01:14:21) Yeah, I can start and maybe Maria will follow up. On the issue of masks, there's a very important and very healthy debate at the moment looking at how masks are used in this response. First and foremost, surgical and medical masks and masks like N95 and FFP2 and FFP3 respirators are for the medical system and we must prioritize their use to protect our workers in the front line. And that's what we're working on with all our partners around the world and with all governments, with our colleagues in the UN system and with governments to try and ensure that we get the best possible protective gear to our frontline health workers. With that in mind, WHO already advises the use of medical masks for people who are ill at home or people who are caring for people who are sick at home. Dr. Michael J. Ryan: (01:15:19) The debate regarding using masks in general public is base is built not on the paradigm of protecting yourself. The evidence is quite clear that the wearing of a mask in public doesn't necessarily protect you. But if a sick person wears a mask, then it is less likely that there may infect others. At the moment and from a WHO perspective, people who are sick with COVID-19 should be in isolation and we need to make sure that people are in isolation. But there are circumstances and we need to be open on this. This is a new epidemic. It is challenging everything we know. It is challenging systems. So there are particular contexts, circumstances, in which it may not be possible to do physical distancing in which people may not have access to all of the services that may be available in other countries. And there may be situations where the wearing of masks may reduce the rate at which infected individuals may infect others. Dr. Michael J. Ryan: (01:16:20) It is not the ideal solution in this sense, but it should be considered in the context of the comprehensive strategy to control the disease. It should be considered in terms of the types of transmission that are happening. How intense transmission is at community level. What the circumstances and context of that transmission is and what the resources are to deal with that. And we must preserve medical, surgical and respirator masks for our frontline workers. But the idea of using respiratory coverings or most coverings to prevent coughing and sneezing, projecting disease into the environment or towards others. That's a mechanical process. And that in itself is not a bad idea, but that doesn't negate the need for hand washing. It doesn't negate the need for physical distancing. It doesn't negate the need for people to stay at home. If there's a stay at home order in place. It doesn't negate the need for everyone to protect themselves and try to protect others. Dr. Michael J. Ryan: (01:17:21) So we can certainly see circumstances in which the use of masks, both homemade or cloth masks at community level may help in an overall comprehensive response to this disease. And we will support governments and making those decisions based on the situation they find themselves in terms of transmission based on the context in which they're dealing and the resources that they have at their disposal. But above all, we must ensure that our frontline health workers are the ones who are most exposed. They're the ones that need the high-performance protection in order for them to stay healthy, do their jobs and save lives. There are many articles coming out at the moment on types of transmission and pre-symptomatic transmission. I've seen one recently from I think Singapore where there was an estimation that about 6% of presymptomatic people or 6% of cases may have been caused by people who are presymptomatic and I'm not here to question that. There are many different estimates. Dr. Michael J. Ryan: (01:18:25) But the corollary of that, the opposite of that is clearly that 94% of infections are caused by people who are symptomatic. So we have to look at what's driving this epidemic. There are always and always the possibility of asymptomatic transmission. There's always the possibility that we can have some element of airborne transmission. But we have to look at is what is the main driver of this pandemic. And in this case we still believe the main driver, this pandemic is symptomatic individuals coughing or sneezing or contaminating surfaces, or contaminating other individuals. Breaking that chain means ensuring that infected individuals are diagnosed and isolated. Their contacts are traced and tracked and quarantined and that people are cared for very quickly in the system. Dr. Michael J. Ryan: (01:19:14) Having said all of that, as I said, we are having a very open, very healthy debate. We had a long meeting today with our strategic and technical advisory group on infectious hazards from all over the world. I know our expert group on infection prevention and control has been talking about this very, very intensely over the last days. We will look at all that evidence. We will read, we will every single paper. We will engage with every single researcher. And we will see what place can be found for this intervention in this overall response. And we will support governments who wish to have a measured approach to the use of masks and who include that as part of a comprehensive strategy to control this disease. Brilliant. Speaker 7: (01:20:01) Thank you very much dr terrain. We will have to conclude here. Maybe did you have one last word maybe to thank our guest? Dr. Tedros Adhanom Ghebreyesus : (01:20:15) Yeah. First, if you would like to have Kristalina, a few words as a closing. And thank you so much for joining us, but please. Kristalina Georgieva: (01:20:27) Well thank you. Thank you very much Dr. Tedros for inviting me. I do believe that bringing together epidemiology and economics is absolutely crucial. My closing message is that we will get through this, but how fast and how effectively would depend a lot on the actions we take. And on making sure that in this actions we bring the world together. The commitment of my institution of the IMF is to play our part. Thank you again very much for all you do. Dr. Tedros Adhanom Ghebreyesus : (01:21:14) Thank you, thank you my sister. It's because as we have agreed in our op-ed, both lives and livelihoods matter. And that's why we join forces today and thank you so much for this very important cooperation. And we have now our plan together that we need to implement and we agree on how to handle this pandemic. And not only that, we also agree that together we can defeat this virus. This is a new virus, a new coronavirus and the first ever coronavirus also to cause a pandemic. There are many unknowns and we should learn every day and why learning the united force is really, really key. So together, as you said, I fully agree, we will overcome this. And thank you so much again for joining and look forward to working with you very, very closely. Thank you. Speaker 7: (01:22:32) Thank you very much, Dr. Tedros. Kristalina Georgieva: (01:22:33) Thank you. Speaker 7: (01:22:37) Thank you Ms. Georgieva, Dr. Van Kerkhove and Dr. Ryan. We will have a audio file sent very soon and a transcript as well will be posted tomorrow. We will also send you some of the news from our regional and country offices in their activities against COVID-19. Wish you a very nice weekend.