World Health Organization March 5 Briefing Transcript on Coronavirus

Tarik: (00:00) On Zoom to ask question, you have to click the raise hand on your screen. Journalists who are dialing in, please type star nine on your phone. And welcome to everyone watching us on our Twitter account. We had a little bit of technical issues while preparing for this briefing. Hopefully, it's all sorted so everyone will be able to hear us well and to ask questions. If that's not the case, then please switch on to watch on Twitter account. We have Dr. Tedros with us, Dr. Mike Ryan And Dr. Maria Van Kerkhove for the regular press briefing regarding COVID-19. Dr. Tedros, please. Dr. Tedros: (00:41) Thank you, Tarik. And good afternoon and thank you once again for joining us in person and online. Today, I want to start by saying thank you to all our colleagues in the media. As providers of information, you play a vital role in the response to COVID-19 the fight against rumors and misinformation is vital part of the battle against this virus. We rely on you to make sure that people have accurate information about the threat they face and how to protect themselves and others. Dr. Tedros: (01:32) Now to the numbers. There is now a total of 95,265 reported cases of COVID-19 globally and 3,281 deaths. In the past 24 hours, China reported 143 cases. Most cases continue to be reported from Hubei Province, and eight provinces have not reported any case in the last 14 days. Dr. Tedros: (02:07) Outside China 2,055 cases were reported in 33 countries. Around 80% of those cases continue to come from just three countries. We see encouraging signs from the Republic of Korea. The number of newly reported cases appears to be declining and the cases that are being reported are being identified primarily from known clusters. Although a few countries are reporting large numbers of cases, 115 countries have not reported any cases. 21 countries have reported only 1 case and 5 countries that had reported cases not reported new cases in the past 14 days. Dr. Tedros: (03:04) The experience of these countries and of China continues to demonstrate that this is not a one way street. This epidemic can be pushed back, but only with a collective coordinated and comprehensive approach that engages the entire machinery of government. We're calling on every country to act with speed, scale and clear minded determination. Dr. Tedros: (03:40) Although we continue to see the majority of cases in a handful of countries, we're deeply concerned about the increasing number of countries reporting cases, especially those with weaker health systems. However, this epidemic is a threat for every country rich and poor. And as we have said before, even the high income countries should expect sharp rises. The solution is aggressive preparedness. Dr. Tedros: (04:18) We are concerned that some countries have either not taken this seriously enough or have decided there is nothing they can do. We're concerned that in some countries the level of political commitment and the actions that demonstrate that commitment do not match the level of the threat we all face. This is not a drill. This is not the time to give up. This is not a time for excuses. This is a time for pulling out all the stops. Dr. Tedros: (05:03) Countries have been planning for scenarios like this for decades. Now is the time to act on those plans. These are plans that start with leadership from the top, coordinating every part of government, not just the health ministry, security, diplomacy, finance, commerce, transport, trade, information and more. The whole government should be involved. We need a whole government approach, so activate your emergency plans through that whole government approach, educate your public so that people know what the symptoms are and know how to protect themselves and others, increase your testing capacity, get your hospitals ready, ensure essential supplies are available, train your health workers to identify cases, provide careful and compassionate treatment and protect themselves from infection. Dr. Tedros: (06:20) If countries act aggressively to find, isolate and treat cases and to trace every contact, they can change the trajectory of this epidemic. If we take the approach that there is nothing we can do, that will quickly become a self-fulfilling prophecy. It's in our hands. Dr. Tedros: (06:47) WHO has published step-by-step guidelines for countries to develop their national action plans according to eight key areas which are supported by detailed technical guidance. We call on all countries to accelerate those plans and we stand ready to work with them to do that. Dr. Tedros: (07:12) More funding is being made available to support countries that need it and that have plans in place. As you know, the World Bank, the international monetary fund have both made funds available to stabilize health systems and mitigate the consequences of the epidemic, the economy consequences of the epidemic, with a special focus on enabling access to critical supplies and equipment. I had also a very fruitful discussion with the president of the African Development Bank. This is funding that's available now to countries who need it, in line with WHO's strategic preparedness and response plan. These funds are essential for supporting the response now, but also for longterm preparedness. Although COVID-19 presents an acute threat now, it's absolutely essential that countries do not lose this opportunity to strengthen their preparedness system. Dr. Tedros: (08:34) We know people are afraid and that's normal and appropriate. That fear can be managed and moderated with accurate information. Today, WHO has launched a new social media campaign called Be Ready for COVID-19, which urges people to be safe, smart and informed. If you feel overwhelmed by fear, reach out to those around you, find out what your community's emergency response plans are, how you fit in and how you can help. Dr. Tedros: (09:19) There is still a lot we don't know, but every day we're learning more and with working around the clock to fill in the gaps in our knowledge. Ultimately, how deadly this virus will depend not only on the virus itself, but on how to respond to it. This is a serious disease. It's not deadly to most people, but it can still kill. We're all responsible for reducing our own risk of infection and if we're infected for reducing our risk of infecting others, there is something all of us can do to protect vulnerable people in our communities. That's why we keep talking about solidarity. This is not just a tread for individual people or individual countries. We're all in this together and we can only save lives together. I thank you. Tarik: (10:41) Thank you very much Dr. Tedros and apologies for issues we have with the sound. I hope that those watching us on Twitter and online and dialing in can hear us very well and hopefully they will be able to ask questions. I will remind everyone before we start the questions to ask only one. We will start with Katrine and then Gabriela. Katrine please. Katrine: (11:08) Thank you. Tarik: (11:09) You can just press the little button. Katrine: (11:12) Oh, yes. Tarik: (11:13) Thank you. Katrine: (11:15) Do you hear me? Yeah. Okay. It works. I'm Katherine [foreign language 00:11:19] This is a question especially for Dr. Maria Van Kerkhove related to pets. We hear and read a lot about transmission from humans to pets or from pets to human. We don't know exactly. So, would you please give us more details about that. Thank you so much Doctor. [inaudible 00:11:45]. Dr. Marie Van Kerkhove: (11:51) Yes. So the question about pets, so we are, as we've mentioned earlier, we are aware of a dog in Hong Kong that has tested positive for coronavirus. Initially, these are weekly positive samples that came from the dog. The dog is doing well, we understand. He doesn't have symptoms. It's an older dog that we know of. But it's only one dog so far. So we're working with authorities in Hong Kong, we're working with our colleagues at FAO and OIE. We're working with the partners in Hong Kong who are looking at these pets who have been in homes of people who've been infected with COVID-ID, COVID-19, excuse me. We're only aware of this one animal that's tested positive and he's doing well. Dr. Marie Van Kerkhove: (12:33) In terms of what this means for transmission, we don't believe that this is a major driver of transmission. We don't have evidence of transmission from the human to the dog or the dog to the human. But again, it's only one example of this. And so of course, it deserves much more study. But we're working with the partners who can help us to address this question. Dr. Michael Ryan: (12:53) Can I just add that it's not unusual in emerging diseases, outbreaks to find that that animals can be transient hosts or there can be. Involving SARS and MERS, we had similar issues. So it's always a question with an emerging disease. And we're back to the core question, are animals intimately associated with the spread of this disease? And the answer to that is no. In this case, this dog is a victim, no more than others and we need to establish quite clearly what part animals might play in further transmission. But that is unknown. But this is not an unusual or unprecedented finding. It happens regularly with emerging diseases. Tarik: (13:35) Thank you very much. Gabriela, please. Gabriela: (13:38) Yeah, thank you very much for giving me the opportunity to ask. Dr. Tedros, you mentioned that there are countries that are not taking this very seriously and that other countries, that they said there is nothing to do. Could you mention those countries and just a very, very quick, if you can clarify if you have any evidence that the coronavirus is seasonal. Thank you. Dr. Marie Van Kerkhove: (14:09) I'll take the seasonal question. So the question is, is this virus seasonal? So we've only known about this virus for eight weeks or so, starting in late December and into... now we're into March. We don't know much about what this virus will do over the course of a season. And so we've had some questions previously about what this virus will do in different climates and different temperatures. We have no reason to believe that this virus would behave differently in different temperatures, which is why we want aggressive action in all countries to make sure that we prevent onward transmission and that it's taken seriously in every country. Dr. Marie Van Kerkhove: (14:46) But this is something that will be of interest. In the Northern Hemisphere, we have the flu season, which was ending fairly soon and in the Southern Hemisphere we'll have the flu season starting. And so it will be interesting to see what will happen in the Northern Hemisphere and the Southern Hemisphere. But to look at seasonality, you need to look at patterns over time. And we do need some of that time to be able to see what happens. So it's important that we aggressively look for cases and so that we can understand the extensive infection and how that the virus behaves in different populations. Dr. Michael Ryan: (15:19) It's important to explain that seasonality is driven by factors in the virus, its ability to survive in the environment, but it's also driven by human factors, which are the coming together of humans and influenza and other respiratory diseases can spread efficiently in winter and not necessarily because of the temperature, but because human beings come together in closed environments and therefore transmission is more facilitated. So in this particular case we've seen this disease now in a number of different climates. Singapore is a very hot, humid climate and the disease spread. It's coming under control. So we will need to wait and see. Wait and see. Do you wan to- Dr. Tedros: (16:03) Yeah, thank you. There are a good member of countries who have left epidemics up to the ministry of health, the minister of health and the health's emergency institutions. We're saying that's wrong. It needs a whole government approach. And I don't have the list now, but it's a long list and that's why my statement today was focused on advising all countries on earth to trigger the whole government approach,. so all sectors in the government that are involved and this should be led by the principal head of state or head of government or the second person who has the mandate to coordinate all sectors. Dr. Tedros: (16:54) But governments alone cannot beat this virus. In addition to the whole government approach, the focus should be in mobilizing everybody, all citizens to take care of themselves and to also take care of others and to make significant progress in the fight. And we're saying it's everybody's business and that's how it should be. But it's a significant number of countries who are not mobilizing the whole government. I can give you the list next time, but I don't have the list now. Thank you. Gabriela: (17:32) Thank you very much. Tarik: (17:34) Thank you very much. So we have a little bit of audio issues here, so I hope we will have a clean audio version available after the press briefing for those, and I can see on social media that people are not able or were not able to hear clearly from the beginning, so there will be audio file and we apologize one more time. Shaka, please. Shaka: (18:03) I want to thank you for taking my question. [inaudible 00:18:02]. Gabriela: (18:03) Regarding North Korea, as I understood, they have not yet reported any confirmed cases of COVID-19. Is WHO in touch with the authority of North Korea? How [inaudible 00:18:18] are you regarding this case? Thank you. Dr. Michael Ryan: (18:22) Yes, we are. We've had multiple contacts with our colleagues through our office in the Democratic People's Republic of Korea. Obviously the country is right in the heart of the epidemic zone in the region. So, there are risks there. We have no reports so far of issues. We are making available supplies, as I think our colleagues in China are as well, and are ready to provide technical assistance like to any country. So, it's very, very important that countries like DPRK are well prepared, their systems are well prepared. We're ready to go in at any moment should there be a report of a case from the country. Dr. Tedros: (19:10) We had a very good discussion with the foreign minister of the Republic of Korea. She expressed her willingness and readiness to help in any way possible if there's a need or a support that North Korea asks for. Dr. Michael Ryan: (19:27) Thank you very much. Jamie DaShane, please. Then we will try to get to a few questions from online. We are trying to sort out the technical issues. Jamie, please go ahead. Jamie: (19:38) Hi. Good afternoon. Jamie, Associated Press. Doctor Marc Lipsitch, an Epidemiologist at Harvard was quoted in The New Yorker yesterday saying that as many as 40 to 70% of the world's five billion adults could at some point contract coronavirus. I guess I just wanted to know, is it really that dire in your perspective? Just with that in mind, could you also tell us what you know more about both asymptomatic transmission and whether or not surfaces could be a source of contamination? Thank you. The latest you have on it. Dr. Michael Ryan: (20:15) I can take a stab at the first question, Jamie. Yeah. I mean, we've had these numbers almost every week now for the last eight weeks. We need to, as I've always said, take each prediction into account. We need to know what data that's based on. This is usually based on modeling data based on certain assumptions about transmission and about R-nought and some assumptions about controlled measures or not. Certainly you can model with control measures or model without control measures. So, I'd like to see the data and see what that prediction is based on. We will listen to all good science. Dr. Michael Ryan: (20:53) Having said that, there are obvious real things happening in the real world that contradict that. If we look at China today, 20 provinces in China have today downgraded their public health emergency risk level. That's 20 of 31 have actually gone in the reverse. They've gone from red to yellow or from yellow to green. Now, that's flying in the face of that prediction. I'm not saying which one is correct, but I'm telling you in the real world today China is moving back towards the green. Dr. Michael Ryan: (21:29) In the 11 provinces in China today have moved to green, which is their lowest level of risk. There are five levels of risk. On the 29th of January, all provinces in China were at level one risk, the highest possible risk, red, red. The whole of China was red. So, there's hope in that. Today there were only four cases of ... yesterday, the last 24 hours, there were only four cases of confirmed COVID-19 infection outside Hubei were actually from China. Most cases outside Hubei in China yesterday came from other countries. Dr. Michael Ryan: (22:10) So, when I look at that, which is happening in the real world, and then I look at predictions, I need to look and we need to look at both of those. We need to see what's happening in Singapore. The DG said it in the speech, this is not a drill. We need to fight. We need to fight now, because our predictions will come true if we do nothing. So, we have choices today. Some countries are stepping forward and turning to face the fire. We need all countries to do that right now. Dr. Marie Van Kerkhove: (22:46) The second part of that question. So, the question around asymptomatic transmission in the role of surfaces, we know that this is a respiratory pathogen and it spreads through droplets. So, as these droplets that come out of our mouths and noises if we cough, we sneeze will move some distance and they'll settle on surfaces. There are some experimental studies that are currently underway that are looking at how long these viruses will survive on different types of surfaces. Some preliminary results from that look like this virus behaves similar to the SARS coronavirus. Dr. Marie Van Kerkhove: (23:21) Those viruses can be inactivated with disinfectants. So, cleaning of surfaces can clear those viruses away. That's important. The role of asymptomatic transmission, this is ... I understand why this is a very important question. It is a very important question to us as well. We know that this infection with COVID-19 causes a wide range of symptoms, including people who don't develop symptoms. What we understand is that because contact tracing is so strong in some countries, cases that have not yet developed symptoms are being identified by being PCR positive. So, these are people who are pre-symptomatic. It's a few days before they develop symptoms. Dr. Marie Van Kerkhove: (24:05) Now, the question is whether or not those individuals can transmit to other people. We know that that is possible, but we do not believe that that's a major driver of transmission. The reason we know that is because if we look at the actual epidemics and how these epidemics are unfolding, if they were a major driver of transmission, it would have caused much larger numbers of cases. Dr. Marie Van Kerkhove: (24:28) The big question that we have right now is whether or ... serology and looking at how many people have been infected overall and how many people are truly asymptomatic, that is how many people have been infected but don't develop symptoms. Those studies are starting now. There are serologic essays that are in use right now. We are advocating for population based serosurveys to be conducted so that we can have a better understanding of which proportion of the population has evidence of infection as detected through antibodies. Dr. Marie Van Kerkhove: (25:02) We do not believe that asymptomatic transmission is a major driver of transmission. It's still early days. It's still a few weeks into this outbreak. We're learning every day something new about this virus. That can change, as every statistic, everything that we say here. But based on the evidence, we're an evidence based organization, we're taking the evidence we receive from countries. We're looking at all of the scientific papers that are coming out and we're looking at the evidence. So, right now and what we know based on the evidence that asymptomatic transmission is not a major driver of transmission. Dr. Michael Ryan: (25:36) Thank you very much. Shane. Then we'll go online. Shane, please. Shane: (25:43) Shane from China Central Television CCTV. My question is, you just mentioned some countries are not ready for the virus. While you have also called so many times before that China's experience can be shared with the world, that the world can learn from China. Why when China has been degrading much ... that most of these provinces, the risk of the COVID-19. Do you think any approaches or mindset that can be shared, specifically with the world, or can be adopted by other countries? Thank you. Dr. Michael Ryan: (26:15) I think the DG has spoken to this many times. That was the whole purpose of having the joint WHO goal and international team join our Chinese colleagues was to do exactly that lessons learned. Let me be clear, and I've been at this a long time, nobody has ever responded to an epidemic perfectly. No one has ever responded in perfect time with the perfect response. This is the real world we live in. Every emergency response is dotted with missed opportunities and unfortunate delays. Sometimes decisions that have to be made on limited data that subsequently turn out ... you look back and you think, "You know what? If we knew that now then what we knew now, we might have done something differently. Dr. Michael Ryan: (27:04) So, we need to be really careful on the one hand to learn the lessons, and on the other hand, not to say that exactly what happens in China needs to now happen exactly the same everywhere else. The issue is one of the lessons, and the lessons I think we've learned from China, Singapore is to break down your problem. Understand where you have just sporadic cases. Understand where you have clusters. Understand where you have community transmission. Adapt your response to those needs. Distribute your resources according to priority. Be persistent. Be consistent. Be coordinated. Be joined up. These are the things we need to see. Command, control, coordination, coherence. Dr. Michael Ryan: (27:44) That the DG has been speaking to, an all of government approach. Community, society, public sector, private sector and government coming together to work together and in weeks, and it's been shown. It can be turned around in weeks if that is what people are prepared to do. Dr. Michael Ryan: (28:03) Now, the DG has said it many times, there are no guarantees with that approach. There are no guarantees that that can be achieved. At the very least, that will significantly slow down the spread of this virus allowing our health systems to catch up. I think all of you have seen that health systems, even some health systems with a very small number of cases have already struggled. They've already struggled to deal with a small caseload. So, we need to get our health systems stronger. One of the ways of doing that is to slow down the spread of this disease. Dr. Michael Ryan: (28:39) So, containment and controlled measures slow down the disease. It's really important that we don't turn this into, "China was right about everything, and someone else is wrong about everything," or, "Everyone else is right and ... " because there's been too much of this on both sides. We need to learn the lessons that have been offered, move on, because each new context is different. What we do in country X will not be the same exactly of what you do in country Y, because the context is different, the evolution is different. There are wonderful lessons we can learn from China. Yeah. Dr. Marie Van Kerkhove: (29:16) [crosstalk 00:29:16] I just wanted to say that one of the things we've learned is that the fundamentals work, the fundamentals of public health work. The fundamentals of identifying your cases, identifying your contact. I'm an epidemiologist. This is epidemiology at its core. You need to look for your cases aggressively. You need to find all of those contacts and find those contacts. You need to mobilize your population. Dr. Marie Van Kerkhove: (29:40) One of the things I was most touched at, if I could say, in China was the absolute drive of every single person we met. Every person of the population knew what their role was in this outbreak. They knew what they needed to do. They knew how they had to protect themselves, how they could protect their families and what they needed to do collectively to bring this under control. We've said it before, just because you have cases doesn't mean you're going to have clusters. It doesn't mean you're going to have large outbreaks. It doesn't mean that it's going to go out of control. Dr. Marie Van Kerkhove: (30:10) We've seen not only in China, we've seen these fundamentals being used in Singapore, being used in Vietnam, being used in many countries and they're bringing that back down. It comes back down to the fundamental, these fundamental public health measures. That is something every country can do. Dr. Tedros: (30:25) Mm-hmm (affirmative). Thank you Maria and thank you Mike. I just wanted to add, there is common factor for all countries, common, which we call political commitment or political intervention. As you know, political intervention is like surgical intervention. It brings a paradigm, meaning if the highest level of the government, the head of state or head of government starts to lead and coordinates all sectors, that brings qualitative change in the way we respond to the epidemic. Dr. Tedros: (31:14) That can be done by any country on Earth. That can bring a new paradigm in each and every country. That's why in my statement today we focused on whole government approach. No government, no country has an excuse, because each and every country has a government. That's what we are asking for. Take it to a higher level. This is not up to the ministers of health only. This is the responsibility of the head of state, the head of government. It should be coordinated from the top, and all sectors should be involved. Dr. Tedros: (31:59) This virus is touching everything in the country. It will ... in those countries that is not there. That's why if it's going to touch everything, if it's going to touch the politics, if it's going to touch the social fabric of the country, if it's going to touch the economy, then no sector is immune or untouched. That's why we are saying we have to raise it up, and then the political commitment is at the center. The political intervention is at the center, because that's the surgical intervention. That brings paradigm. Dr. Tedros: (32:45) I was so ... encouraged to get a call from President Sebastián Piñera of Chile at his own initiative calling and discussing about what the situation is, the global and in his own corner also and exchanging ideas on how we can really beat this virus. Not only that, we had a very good discussion. This was the day before yesterday with President Sebastián Piñera, but today with the Prime Minister of Sweden. Another excellent discussion on the global situation, on the importance of whole government approach. By the way, he was just coming out of a meeting with this cabinet discussing about this issue, mobilizing all sectors. Dr. Tedros: (33:50) I said, "There is nothing I can comment on, that you're taking the right approach." I told you before after our visit to Beijing and seeing China's approach and President Xi leading that and also in the US with President Trump himself and also for a regular coordination designating the Vice President, these are the approaches we are saying are the right ones. These are the approaches we are saying are going to mobilize the whole government, but not only the one government but that whole government should mobilize the whole society and making the response every citizen's business. Dr. Tedros: (34:45) If we do that, we can push back on this virus. We can be successful in the containment strategy. Some people, you are following the media, are saying it's already the pandemic. There is nothing we can do now. We should move into mitigation and containment may not work. We don't think that containment should be abandoned, because I have already said many countries are succeeding in that strategy, in containment strategy and containing the virus. We're not saying just follow containment strategy. Dr. Tedros: (35:33) What we're saying is, in addition to our aggressive containment strategy, please also prepare for an eventualities. There could be crisis in our hands. So, let's prepare for any eventualities. We should not give up on containment strategy. The worst thing that can happen to any country or even any individual is giving up. Dr. Tedros: (36:03) Country, or even any individual is giving up. WHO is saying don't give up. Don't surrender. Use comprehensive approach. Don't use dichotomy. Let's use a comprehensive approach. Everything that we can do to contain it. If not, we will see it. Then, we will have the other strategies at hand because we are saying let's prepare for the rest too. That's what we are saying. This is linked with the political commitment we said. Dr. Tedros: (36:39) This kind of approach, comprehensive approach, cannot be sustained without sustainable, political, commitment. Political commitment at the highest level, coordination at the highest level, political intervention. I repeat again, political intervention and surgical intervention, it brings paradigm. That's what we believe. Then, of course, there should be technical competence too. You add both technical competence and political commitment, you can get the highest, and the biggest impact you can. Many countries are showing that now. It's not time to give up. Let's go for a comprehensive approach. That's our advice as WHO. Tarik: (37:27) Thank you very much, Director- General. We will try to take a few questions from journalists being online. Just to remind everyone that audio file will be available immediately for those who may have not had a good reception. I understand that on our Twitter account and on YouTube, the audio is clean. Let's try, if we can, get South China Morning Post, Karen. Karen, can you hear us? Tarik: (37:59) Try to take a few questions from journalists being online. Just to remind everyone that audio file will be available immediately for those who may have not had a good reception. But I understand that [inaudible 00:00:38:18]. Jamie: (38:30) I have a question for, have you all heard the syntheses of genifique transition has became two different versions, ECE and allotypes. Karen: (38:35) Hello? Tarik: (38:39) Karen, we will get back to you after this question. Please, stay on the line. Jamie: (38:45) Another question, for Dr. Tedres, you just mentioned pandemic, the word again. You said we would not decorated any word for this disease, but this has a different type of insurance in different countries. If you concerned that it became to the pandemic, it will be covered or no covered in countries for health insurance. Could you just mention it? Tarik: (39:08) The first question was about two different types of the virus. Dr. Marie Van Kerkhove: (39:14) You can. Yes. As you're aware, many sequences, full genome sequences have become publicly available, thanks to authorities and scientists posting those on publicly available sites. So these genetic sequences have been analyzed by a large number of virologists and scientists across the globe, and WHO is working with a network of scientists on this. And when you do the phylogenetic analysis of these, we know that there are some early clades that have been visible on the trees. And the paper that came out that you're referring to, these tree, these divisions were seen on this tree very early on. It's an analysis based on 103 full genome sequences, and they have no known association with severity in terms of these difference. So looking at the phylogenetics as more sequences become available and we encourage countries to please make your full genome sequences available so that these analyses can continue, but this virus is very stable based on all of the sequences that we've seen so far. Dr. Michael Ryan: (40:23) I would just add just kind of genetic analysis is very important for two reasons. Obviously, one, it can help us in looking at disease spread, because you can compare viruses and spreads and try and link chains with transmission and that's a race. We're using that right now in Congo. We've been using that. Well, hopefully we won't have to use it again as we're no more cases. But it's also useful for tracking the development of vaccines and others, because you've a eventually have to pick a strain that you want to base a vaccine on, and you want that to be the closest possible to what you have circulating. Dr. Michael Ryan: (40:57) The data that's been published most recently has actually been publicly available for weeks. And what's happening is researchers are going back into those wonderful resources that are now available and asking questions and looking at these two clades. But I'd liken it more to license plates. It says if they found two cars, exactly the same make of car, but the license plates are a little bit different, is it a different car? No, it's not a different car. It's got a slightly different signature, but it's not fundamentally a different virus. And that's the most important thing here. But this is very important that these inquiries still go on. And that's the wonderful thing about having publicly accessible databases is that researchers and others have access to that data, can question that data, can generate hypothesis, can publish those hypothesis, we can discuss them in the open. But it's also very important that we don't over-interpret the results of the conclusions of any single study. And I think that's the balance we need to strike. Dr. Tedros: (42:06) I would start by saying, I said it earlier, I'm very concerned, especially the past few days, because more and more cases are being reported from countries with weaker health systems. And that adds to the concern that many are already saying this could evolve into a pandemic, or some people say we are almost close. And that could be true. I'm saying the situation, I also agree that the situation could be worse than what we are now. And it could be a pandemic level. But what are the same time we are saying is there are countries within this situation who have shown that it can be contained. So we should not give up. So we need to use a comprehensive approach. Dr. Tedros: (43:06) And we have also said many times there is no like one size fits all. And if you see from country to country there is variation, and even within one country there is variation. So unless we're convinced that that is uncontrollable, why do we call that it's pandemic. But, I mean, with flu, we know it's uncontrollable and it affects a big part of the population. Probably what person, two billion, for instance, with H1N1. If we reach into that conclusion, then it's uncontrollable. We may be able or we may be in a position to say that. But with what we're saying is that's not the time. That may happen, but we don't give up without fighting hard. That's what we're saying. Those who fought hard have already contained it. So there is already a positive signal and experience within this virus itself. So let's really use the comprehensive approach. Dr. Tedros: (44:25) And you remember some countries have already said, we don't mind whether WHO says this is pandemic or not. We would like to continue with a comprehensive approach including aggressive containment. Then we said, you're right. That's exactly what we're saying. That's exactly what we're saying. So if we agree on the approach, which is a comprehensive approach, then the name may not matter. But even the name may matter, and if we get there we will say it, no problem at all, based on science and evidence. So that's what we are saying. But for now we're not yet there. Also, there are very, very concerning signs and this virus making it into more and more countries with weaker health systems. But that doesn't mean that we should give up. We're saying we shouldn't until the last attempt, and that's what we are advising. And the political commitment and political intervention should be triggered in all countries and try our best to contain it. That's what we're saying. Dr. Michael Ryan: (45:54) Just to add, Dr. Ghedreyesus used two very important words there in terms of the difference between uncontrollable and uncontrolled. And I think it's an important and very precise distinction that he's used. In an influenza situation, pandemic situation, the usual assumption is that the disease is uncontrolled. The spread is uncontrollable, regardless of what we do. So we focus on saving lives. We focus on saving lives by treating cases or developing a vaccine to protect the most vulnerable in our population. That's the approach. Dr. Michael Ryan: (46:27) In this case, some countries are demonstrating that it is possible to control the spread. It's possible to slow it down. And in that calculation you now have two chances to save lives. If you contain and suppress the virus, you save lives by making sure that vulnerable people in your society are not exposed. And then if they are exposed, you have time, more time to get your system ready to save their lives. So you got another shot at lifesaving intervention. So when the director general speaks about uncontrollable spread in which we focus on saving lives versus uncontrolled spread of what we do have at the moment in some countries, is a situation where the disease has spread, and in some countries not under control yet. So far it's not controlled or uncontrolled. But what he's saying is we have a chance to control that. And I think it's a very, very important distinction of words. And I really want to second what he's saying, and I think it does explain a lot of the underlying logic that we're using here around the pandemic word. Tarik: (47:30) Thank you very much. We have a time for one question, and we will try to get that question from online, because we were not really able to do that. And we apologize for all those. Let's try Chris, one more time with Karen from South China Morning Posts. Karen, can you hear us this time? Karen: (47:48) Hello? Hello? Yes, I can. Yes, can you hear me? Speaker 1: (47:50) Yes, please go ahead. Karen: (47:55) Hi. My question is about the pets. As you know, and also you mentioned that the dog has been tested, weak-positive, and yesterday the Hong Kong authorities announced that the dog is has low level infection with the Coronavirus. So my question is do you think that governments need to quarantine the pets and monitor them, like the pets belong to the [inaudible 00:48:29] patients [inaudible 00:48:34]? Tarik: (48:37) Thank you, Karen. That question already came at the very beginning of the briefing, and I apologize if you were not able to listen. So maybe now you can just like two words repeat. Dr. Marie Van Kerkhove: (48:50) Yes. So we are aware of the dog in Hong Kong that tested positive, and as I mentioned previously, we're working with our partners in Hong Kong at FAO and OIE to really understand what this means. We do not believe that having pets infected or one pet infected is a driver of transmission in this outbreak. But as Mike had said also, that this is not unprecedented to have this example. But again, this is something that we're working with our partners to better understand. Dr. Michael Ryan: (49:21) And we've also had followups with FAO and OIE, and interestingly enough, the authorities in Hong Kong officially reported that under the Organization International Epizootic, OIE. So that's OIE and FAO are actively tracking that situation, and we've had teleconferences with them. At this point there is no need for any special measures, but follow-up studies are underway. But certainly, the care of the animals is important, and obviously, any potential impact on disease spread. As we keep saying, outliers and unusual observations are very important in epidemic response. But we also need to be careful to be sure that we don't allow that to drive our thinking at its core. They need to influence what we do. And at the moment, we don't believe there's any need for a change in policy based on the evidence we have. But we will continue to work with OIE to see if there's a need for a change in our public health advice. Tarik: (50:18) So our first and last question was about pets. And we will conclude here. Tomorrow is another day, John, and we will be here. I thank everyone for watching us, and apologies one more time for those who have wanted to ask question and they were not able. So hopefully we will be able to take more questions tomorrow. A clean audio file will be available immediately after. Thank you very much everyone. Dr. Tedros: (50:47) We'll see you tomorrow.