World Health Organization (WHO) Coronavirus Press Briefing Transcript August 21

Margaret Harris: (00:00) Hello, everybody. This is Margaret Harris in hot sunny Geneva on this Friday, August 21, welcoming you to today's World Health Organization press briefing on COVID-19. We have with us, as always, in the room, the WHO Director General Dr. Tedros along with Dr. Mariangela Simao, our assistant director general for access to medicines and health products. Dr. Bruce Aylward, our senior advisor to the director general who leads the ACT Accelerator. Also Dr. Maria Neira, who is the director of the public health environment team department that deals with climate change and the effects of those issues on health. And we also have, as always, Dr. Maria Van Kerkhove, our technical lead for COVID. And joining us remotely is Dr. Mike Ryan, our executive director for the health emergencies program. Margaret Harris: (01:45) So as usual, we are translating this simultaneously in the six official UN languages plus Portuguese and Hindi. And remember that under the Zoom system, you need to go to the Korean button to use Arabic. I'd also like to mention that all of this is being live captioned. We have an amazing live captioning service so that people who are hearing impaired can also follow this fully. And we really appreciate the work of the live captioners. So now without further delay, I will hand over to Dr. Tedros. Dr. Tedros, you have the floor. Dr. Tedros: (02:19) Thank you. Thank you, Margaret. Good morning, good afternoon, and good evening. I'd like to begin today's briefing with an update on the Ebola outbreak in the Equateur province of the Democratic Republic of the Congo. The outbreak continues to increase and to spread geographically. Yesterday, the 100th case was reported with 43 deaths in 11 health zones across the province. There currently a delay of about five days from the onset of symptoms to when an alert about a suspected case is raised. This is concerning because the longer a patient goes without treatment, the lower their chances of survival and the longer the virus can spread unseen in communities. The situation has been further complicated by a strike by health workers, which is affecting activities including vaccination and safe burials. Dr. Tedros: (03:29) DRC has the best trained workforce in the world for Ebola. This situation needs to be resolved as quickly as possible. WHO and our partners are working intensively in communities to find cases and shorten the delay. We are also supporting the government of DRC to take a stronger role in the response and to prepare areas that have not been affected so far. There continues to be an urgent need for increased human resources and logistics capacity to support an effective response across an ever expanding geographical area and to help health officials identify cases earlier. The government of DRC has developed a plan that needs about 40 million US dollars. We urge partners to support this plan. Dr. Tedros: (04:28) Now to COVID- 19. Last month, my colleague, Dr. Maria Van Kerkhove, contacted a group called LongCovidSOS representing patients with long term effects from COVID-19 infection. This afternoon, I had the privilege of speaking with them. They told us about their experience and the ongoing challenges they face. These patients want three things. Recognition, rehabilitation, and research. Recognition of their disease, appropriate rehabilitation services, and more research to be done into the long term effects of this new illness. Although we have learned so much about this disease, we only have less than eight months of experience to draw on. We still know relatively little about the long term effects. My message to these patients was we hear you loud and clear, and we're committed to working with countries to ensure you receive the services you need and to advancing research to serve you better. Dr. Tedros: (05:48) Globally, there are now more than 22 million reported cases of COVID-19 and 780,000 deaths. But it's not just the numbers of cases and deaths that matter. In many countries, the number of patients who need hospitalization and advanced care remains high, putting huge pressure on health systems and affecting the provision of services for other health needs. Several countries around the world are now experiencing fresh outbreaks after a long period with little or no transmission. These countries are a cautionary tale for those that are now seeing a downturn, a downward trend in cases. Dr. Tedros: (06:41) Progress does not mean victory. The fact remains that most people remain susceptible to this virus. That's why it's vital that countries are able to quickly identify and prevent clusters to prevent community transmission and the possibility of new restrictions. No country can just ride this out until we have a vaccine. A vaccine will be a vital tool, and we hope that we will have one as soon as possible, but there is no guarantee that we will. And even if we do have a vaccine, it won't end the pandemic on its own. We must all learn to control and manage this virus using the tools we have now, and to make the adjustments to our daily lives that are needed to keep ourselves and each other safe. So-called lockdowns enabled many countries to suppress transmission and take the pressure off their health systems. But lockdowns are not a long term solution for any country. Dr. Tedros: (08:02) We do not need to choose between lives and livelihoods or between health and the economy. That's a false choice. On the contrary, the pandemic is a reminder that health and the economy are inseparable. WHO is committed to working with all countries to move into a new stage of opening their economies, societies, schools, and businesses safely. To do that, every single person must be involved. Every single person can make a difference. Every person, family, community, and nation must make their own decisions based on the level of risk where they live. That means every person and family has a responsibility to know the level of transmission locally and to understand what they can do to protect themselves and others. Dr. Tedros: (09:06) At the same time, we will not, we cannot go back to the way things were. Throughout history, outbreaks and pandemics have changed economies and societies. This one will be no different. In particular, the pandemic has given new impetus to the need to accelerate efforts to respond to climate change. The pandemic has given us a glimpse of our world as it could be. Cleaner skies and rivers. Building back better means building back greener. In May, WHO published our manifesto for a healthy and green recovery with six policy prescriptions for protecting nature, investing in water and sanitation, promoting healthy food systems, transitioning to renewable energy, building livable cities, and stopping subsidies on fossil fuels. In July, we added actionables for each of these policy prescriptions, providing 81 concrete steps for policy makers to build a healthier, fairer, greener world. Since then, over 40 million health professionals from 90 countries have sent a letter to G20 leaders to call for a healthy recovery from COVID-19. Dr. Tedros: (10:53) And we have seen many examples of countries acting to protect lives, livelihoods, and the planet on which they depend. Nairobi, Kenya is improving parks, adding urban forests, building more sidewalks, and improving drainage. Pakistan has set up a green stimulus scheme offering laborers who are out of work as a result of lockdown a chance to earn money by planting trees. In the United Kingdom, the use of coal, the most polluting form of energy, fell to its lowest level in 250 years. Spain is becoming one of the world's fastest decarbonizing nations with seven of the country's 15 coal-fired power stations recently closed. Portugal has announced it will become coal free by next year. Chile has committed to reducing air pollution and black carbon. Great cities such as Paris have committed to becoming 15 minute cities, where every service can be easily reached by foot or bike, reducing air pollution and climate change. Dr. Tedros: (12:16) Hardship is always an opportunity to learn, to grow, and to change. COVID-19 is a once in a century health crisis, but it also gives us once in a century opportunity to shape the world our children will inherit, the world we want. I thank you. Margaret Harris: (12:44) Thank you, Dr. Tedros. I will now open the floor to questions. And I would remind everybody that if you wish to ask a question, please use the raise your hand icon to get in the queue to ask your question. I'll also apologize now to those who miss out as we have hundreds of people connecting and ask those who do get to a question to please restrict your question to one question. Now, the first question goes to Imogen Foulkes at BBC. Imogen, could you unmute yourself and ask your question? Imogen Foulkes: (13:17) I'm interested in this report. It seems to come from Singapore, that there seems to have been a new and less or kind of weaker version of the virus has been detected that doesn't cause such grave effects in many people. Do you have any comment on that? Dr. Maria Van Kerkhove: (13:36) Yes. Thank you, Imogen. And thanks for the question. So I'll begin. Yes. So I think, as you know, our laboratory network is monitoring and following all changes in the virus. And as you know, there are, I don't know exactly as many today, more than 80,000 full genome sequences that are currently available. There is a study that was recently published from the Republic of Korea looking at a mutation in the S gene that we are aware of which encodes in the spike protein. And so our group is looking at that. So these mutations are common, as we have mentioned, that these are changes in the virus. And there are many known changes that are happening. This is what viruses do. Dr. Maria Van Kerkhove: (14:20) Most of these mutations don't cause greater or lesser infectivity or severity. And this is one of the ones that we are looking at. So we have a special working group that we have formed, which is not only identifying different mutations that are being identified and being reported in the sequences that are being shared. We're actually looking at how do we better understand what these mutations mean in terms of the way that they behave? So this is one of the mutations that we will be looking at. And much more research is needed on all of these potential changes in the virus. Margaret Harris: (14:56) Thank you, Dr. Van Kerkhove. The next question goes to Byrom from the [inaudible 00:15:02] Margaret Harris: (15:01) From the Anatole [inaudible 00:00:04]. Byron, please go ahead and unmute yourself and please, go ahead with your question. Byron: (15:16) Thank you very much for taking a question. European... Can you hear me? Hello? Margaret Harris: (15:18) Yes, we can. There's a little interference, but we can hear you. Byron: (15:21) Okay. Europe could not suppress the COVID-19 outbreak in the summer. In addition, recently in countries such as Spain, France, Germany, Switzerland, and Turkey, daily cases have started climbing all through [inaudible 00:00:38]. What do you recommend around the opening of schools in European countries? Or do you support the decision of reopening schools across Europe? Thank you. Dr. Maria Van Kerkhove: (15:52) So thank you for the question. I understand the question is around the reopening of schools. So yes, so this is a major concern over the opening and closing of schools globally. As we've mentioned before in these press conferences, what is important when we consider schools is we consider the context in which schools are operating. Schools do not operate in isolation. They operate in communities and they work in communities. And if there is the virus circulating in those communities, if there's widespread transmission in those communities or intense transmission, it's possible that the virus can enter the school system. And so it is important that what is done in the community of trying to reduce transmission and bring those outbreaks under control is really what the focus needs to be than to consider opening schools. Dr. Maria Van Kerkhove: (16:41) What we've done as an organization is we've outlined considerations for decision makers about the partial opening or reopening of schools. Remember that schools operate differently globally. They have different types of building structures, they have different types of age groups that they include by various ages. And so what we've done is we've outlined a number of considerations for the schools. First of all, taking into consideration the circulation of the virus in the area where the school operates, where the children live that go to that school, and where are the adults that work in that school live. And then look at what are the types of control measures and prevention measures that can be put in the school, such as physical distancing, such as washing of hands and making sure that there's hand washing stations or alcohol based rub, making sure that there's good ventilation, making sure that masks could be worn if appropriate. And so there are a number of considerations that are outlined. Dr. Maria Van Kerkhove: (17:40) Schools need to also have plans in place so that if there is a suspect case, that there are clear plans of what to do, and how to quickly test and do contact tracing if necessary. Those plans need to be clearly outlined. Dr. Maria Van Kerkhove: (17:56) And also to have good communication. So not only communicating to the students and to the adults that work at those schools, but to the parents of the children that go to that school. How can we communicate about how the school is going to be operated? If it will be a partial opening or a total opening or reduced class size? There are lots of different ways that this could be done. Dr. Maria Van Kerkhove: (18:16) I think we all recognize the importance of schools for children of every age, not only for education, but for security, but for food in many situations, and for social interaction and mental health. So there are a lot of reasons why it's very important that schools can reopen safely. But it's really critical, I will say again, that it is important that we bring outbreaks under control and transmission under control in the area where those schools operate. Margaret Harris: (18:44) Thank you very much, Dr. Van Kerkhove. The next question comes... We're going to South Africa for the next question, to Sophie from the South African Broadcasting Commission. Sophie, could you kindly unmute yourself and ask your question? Sophie: (19:00) My question is directed to the director, Dr. Tedros in particular. We have a situation in many countries where we see they have workers complaining, protesting, and even [inaudible 00:19:16] on strike because they don't have the PPE. But on the other hand, we get reports of officials in different parts of the world in the government systems abusing and engaging in corrupt activities, particularly [inaudible 00:19:36] to combat this pandemic that is ravaging the world. What is your reaction? Are you watching? Are you monitoring? Are you concerned? Dr. Michael Ryan: (19:51) Maybe I could take a quick stab at that. Can you hear me? Margaret Harris: (19:55) Very well. Sophie: (19:57) Yes. Dr. Michael Ryan: (19:58) Yes, no, I think Dr. Tedros has said this many times. We've seen the best of people in this response and in this pandemic, and we've certainly seen the worst of people, and certainly corruption is something that is not new to the world. And at this point it's really, really important that governments govern and that we see very clear, transparent action by governments. Dr. Michael Ryan: (20:22) In the case of health workers and others, it is very, very tough for health workers to continue to operate when they don't have appropriate PPE or they're not receiving payments that can feed their families. So it's equally important that governments focus on ensuring that frontline health workers have adequate pay, have adequate conditions, adequate safety. They are our heroes. They are in the front line. But it's also important that those workers to recognize that they have to put in place if they are taking action. They also have a moral duty to their patients as well. So any actions that are taken by health workers to protest, and protest is something that everyone should be able to do, but it should not come at the expense of the health and welfare of patients. Dr. Maria Van Kerkhove: (21:08) Thank you. Just briefly to supplement that on the healthcare workers. I think this is a good opportunity to, again, remind everyone that we are seeing healthcare worker infections. We are seeing a large number of healthcare worker infections across the world. There are some estimates that 10 to 20% of reported cases in an individual country are among health workers. Dr. Maria Van Kerkhove: (21:29) So it is really, really critical that health care workers, that frontline workers receive training so that they know how to protect themselves, how to put on and take off appropriate personal protective equipment, that they are provided the right supplies to be able to care for patients and provide the care that they are trained to do, that they have adequate rest periods, that they have support. This is tremendous mental strain and physical strain on health workers who are putting themselves at risk for caring for COVID patients and other patients all over the world. Dr. Maria Van Kerkhove: (22:02) So just a reminder that it really is important that we all have a responsibility to ensure that we protect health workers with the personal protective equipment that they need, the training that they need, and the support that they need. Margaret Harris: (22:16) Thank you Dr. Ryan and Dr. Van Kerkhove. The next question comes from [inaudible 00:22:22] from Science. Yes, from science. [inaudible 00:22:26], please, could you unmute yourself and go ahead? Speaker 1: (22:29) Thanks. I just wanted to ask for an update on the China mission. Is the advanced team still there? Is the full team there? I'm just curious where that's at, what you can tell us about what's happening? Dr. Maria Van Kerkhove: (22:47) So I could begin, Mike may want to jump in. So the advanced team has returned. The advanced team spent a few weeks there with Chinese counterparts to work with them and to learn from them of the ongoing work that has been ongoing to look at the SARS-CoV-2 origin, and to develop terms of reference for phase one and phase two study. So shorter term studies that need to take place where the first cases were identified, and longer term studies to fully understand the origins of the virus. Dr. Maria Van Kerkhove: (23:18) The team is being compiled. And so we discussed with our member states yesterday at our member state briefing that a request through our global outbreak alert and response network will be issued so that we can receive some requests for interest for people who might want to be on that mission. I'm not sure if Mike wants to add? Dr. Michael Ryan: (23:39) No, I think that's fine, Maria. It's important that the mission goes ahead, but there's also a number of preliminary studies that need to be carried out as well. And our colleagues in China have discussed those in depth with the advanced team, and we hope that those studies can begin as soon as possible. What we're hoping is that the international team to begin to work on a remote basis with our Chinese colleagues and then join them in the field at the appropriate time when we've got the appropriate arrangements in place. Margaret Harris: (24:12) Thank you Dr. Ryan and Dr. Van Kerkhove. For the next question, we're going to Mexico, to Alejandro from Medicina Digital. Alejandro, please unmute yourself and ask your question. Alejandro: (24:25) [foreign language 00:09: 32]. Thank you and very good afternoon from Digital, as you said. We have 126 million inhabitants in Mexico, and we are spending a certain amount to control the epidemic. And I just wanted to know if you thought that we were spending enough in the network of medical centers that we have in such a large territory? Thank you very much. Margaret Harris: (25:06) So that question was you basically... Sorry, I'm just repeating the question for Dr. Ryan because he doesn't have the simultaneously translation. That question was about are we spending enough or is enough being spent on the response specifically for Mexico, I understand, Alejandro? And testing. Dr. Maria neira: (25:30) I think the question is in a country with 146 million inhabitants they are doing every day 40,000 tests. Would you consider this a [inaudible 00:25:44] number for a country of such a dimension? Excuse me. Dr. Maria Van Kerkhove: (25:48) Thank you, thank you. Sorry for that. But thank you, thank you for the clarification. We do get quite a lot of questions about how much testing is enough testing, and we receive a lot of questions specifically as you have phrased that. The answer to that is it really depends. It depends on the situation that is happening in terms of transmission. What WHO recommends for testing is to test suspect cases, and there are definitions for suspect cases. And in situations where testing capacity is limited, or there may not be enough tests, or where transmission may be incredibly intense, you may need to prioritize how much testing is being done. For me, what is a very helpful metric is looking at your percent positive. How many of those tests that are being done come back positive? And if that's a high number, then more testing may need to be done because that means that you may be missing additional cases. So it's a hard question to answer specifically in the context that you have provided, but in many situations where testing is coming back, where you have 30%, 40%, 50% positive out of all of the tests that you've done, that means that you're missing a large number of cases. Dr. Maria Van Kerkhove: (27:02) In other countries where they may not see as much intense transmission or they're doing a large amount of testing, they're seeing a percent positive of 1%, 2%. That's what we would more like to see, but I don't want to put a specific cutoff, because it depends on the situation that you're in and the capacities that you have. But what is important is without testing, we don't know where the virus is. And without testing, it's very difficult to put in place the public health measures that need to take place. With active case finding, we are detecting cases that are infected with the virus, that are potentially transmitting that virus to somebody else. We can carry out contact tracing, which is identifying all of the contacts around a confirmed case and putting them in quarantine, and so on and so on. So testing is a very important part of that strategy. Dr. Michael Ryan: (27:51) Can I just add, Margaret? Margaret Harris: (27:55) Yes, please do. Dr. Michael Ryan: (27:57) Yeah, no, just specifically on Mexico itself. Most certainly the scale of the pandemic and the epidemic in Mexico is underrepresented. The testing in Mexico has continued to be limited, approximately three tests for 100,000 people daily. If you compare that to somewhere like the U.S., which has over 150 tests for 100,000 people daily, test positivity has remained very high, up near 50% at times. And that means many, many, many people are either being under-diagnosed or diagnosed late, and certainly this is having a differential impact in the country. There's a sharp difference in mortality between the wealthier districts and the poor municipalities. And people who live in impoverished areas of Mexico are almost twice as likely to die from COVID as those who live in more affluent areas. Dr. Michael Ryan: (28:53) It's also having a differential impact on the indigenous populations in Mexico. The overall case fatality ratio is high, but amongst indigenous populations, the clinical case fatality [inaudible 00:29:10] almost one in four to one on five. And a large number of people from the indigenous communities reporting cases and deaths from COVID to date. Dr. Michael Ryan: (29:29) So there's a complex situation in Mexico with this differential impact on the poor, on the indigenous populations, relatively low testing strategy, which means the scale of the epidemic in Mexico is clearly under-recognized. And therefore more could and probably needs to be done to really address the surveillance issues and also the differential outcomes for patients in different groups. Margaret Harris: (29:57) Thank you, Dr. Ryan, and thank you, Dr. Van Kerkhove. The next question- Margaret Harris: (30:02) Thank you, Dr. Ryan, and thank you, Dr. Van Kerkhove. The next question, we'll go to Grace from Health Policy Watch. Grace, please unmute yourself and ask your question. Grace : (30:11) Hi, thank you so much for taking my question. Can you guys hear me all right? Margaret Harris: (30:15) Very well. Loud and clear. Grace : (30:18) Okay, thank you. So my question is for Dr. Maria Neira, what do we know right now about the relationship between exposure to air pollution and COVID-19? Dr. Maria Neira: (30:35) Thank you very much. Yes, there have been several articles, several papers published about that. And as you well know, air pollution is responsible for killing more than 7 million every year. Therefore, for what we know for sure is that any intervention you can do now to reduce air pollution, to reduce exposure to air pollution, will have a very beneficial effect on anyone at risk for COVID-19. What we know as well, that exposure to air pollution is a risk factor and will make you more susceptible to be, if you are infected by SARS-CoV-2 you will be more susceptible to develop morbidity and mortality, because those diseases that are caused as well by exposure to this air pollution will be making more vulnerable. So it will increase your risk and your susceptibility. Therefore, we don't know about the correlation, the real correlation, between mortality of COVID and exposure to air pollution, but we know for sure that it's an important risk factor that we need to tackle. Thank you. Dr. Maria Van Kerkhove: (31:51) Sorry. If I could just supplement specifically on the underlying conditions that you mentioned, Maria Neira. We know for certain in the research that is being done, that people with underlying conditions such as underlying respiratory diseases, underlying heart diseases, put them at an increased risk. If you are infected with SARS-CoV-2, you are at an increased risk for severe disease and death. And air pollution causes these chronic conditions. And so there's a clear correlation here. And we just want to be very clear that those with underlying conditions are at an increased risk for severe disease and death. So again, I will say it's really important that we try to prevent as many infections as we can, especially in vulnerable people who have these underlying conditions, some of which are caused by air pollution, because those individuals can be very severely ill and they can die. Margaret Harris: (32:48) Thank you very much. Dr. Neira and Dr. Van Kerkhove. The next question goes to Agnes from Agence France-Presse. Agnes, could you unmute yourself and ask a question? Agnes: (33:03) Yes. Hello everybody, could you hear me? Margaret Harris: (33:07) Loud and clear. Please go ahead. Agnes: (33:10) Great. Thank you. I will ask in French if I may? [foreign language 00:03:18]. Translator: (33:18) I would like to ask a question about wearing masks in schools. In Switzerland, wearing masks in schools is not mandatory for those under 16. In France, however, it is mandatory for those under 11. That's a recent change in France, and yet the two countries seem quite similar. So is there some scientific evidence about the role of children in transmission? Is there any fresh information about that that might explain this? So that's my question. Thank you. Dr. Maria Van Kerkhove: (33:51) So thank you for the question. I will begin. Yes, there is a lot of research that is happening right now on children of different age groups. And we're learning, we are constantly learning. So one of the things we know about infection in children is that children can be infected, children of all ages can be infected with the SARS-CoV-2 virus. Luckily, the majority of children that are infected with this virus do tend to have mild disease or asymptomatic infection. But there are some that can develop severe disease. And there are some children, unfortunately, that have died. What we understand about transmission in children is limited. There are some studies that are looking at transmission by age groups, looking at under fives, for example, looking at up to 10 years old, looking at teenagers and looking at young adults. These studies are preliminary and there are few that are available, but there are more that are being conducted. And there appears to be a difference in transmission by age group. With the younger children able to transmit less than teenagers, for example. But this data is really limited. And there are some studies that are ongoing. Dr. Maria Van Kerkhove: (35:01) WHO and UNICEF will be issuing guidance on the use of masks in children. And we break this down by age. The guidance will be available in the coming days, if not today. Where we advise, we give advice to decision makers and we give advice to public health officials and child health professionals and educators about making the decision about when and where masks can be used. And we break those recommendations down by age, looking at under five, looking at six to 11 and then looking at over 12. But again, there's limited information that we have on children. There are more studies that are being done. We're working with a large number of partners, including UNICEF. We have a technical advisory group that we have established to specifically support us on understanding and advice for educational institutions, knowing that different look differently across the globe. Margaret Harris: (36:02) Thank you very much, Dr. Van Kerkhove. Agnes: (36:04) Margaret can I just add? Margaret Harris: (36:05) Please do. Go ahead. Dr. Michael Ryan: (36:09) Not specifically on schools, but I think it's important when we look at masks. Masks are our great tool. They're very useful as part of a comprehensive strategy to stop and break chains of transmission. But it's also very important when we talk about the context of schools or the wearing of masks in schools, and as that guidance emerges, that the wearing of masks is not an alternative to physical distance. It's not an alternative to hand washing. It's not an alternative to decompressing class sizes. It's not an alternative to all of the other measures. Just because kids or others put masks on does not mean we can forget about the other measures. In fact, it would decrease the benefit of masks if people close physical distanced don't wash their hands. And we may end up losing the benefits of some interventions while gaining the benefits of masks. Dr. Michael Ryan: (37:04) The real advantage of masks is using masks as part of a comprehensive strategy in the right place at the right time in order to reduce transmission and reduce exposure. And in doing that, and in using masks as part of a comprehensive strategy, that can be extremely useful. But there are not an alternative to a strategy. They're not an alternative strategy in themselves. And therefore it's really important, especially in the context of schools, that the school is an environment, and as Maria said, it's in a community, it's part of the community's transmission dynamics. And managing the risks of transmission in schools and detecting those risks and dealing with them, masks can be an important part. But they're only one part of a complex equation that school authorities and governments need to put in place. Margaret Harris: (37:51) Thank you, Dr. Ryan. And thank you, Dr. Van Kerkhove. For the next question, we'll be moving back to the region of the Americas, I suspect, because it comes from Jamil Chade, who is a Geneva correspondent for major Brazilian outlets. Jamil, please unmute yourself and go ahead. Jamile Chade: (38:10) Thank you very much, Margaret. Hello to everyone. This is a question probably to Dr. Ryan. I would like you to basically tell us what else can Brazil do? Because the number of deaths continue to be extremely high. If you could give us a little bit of a readout on the situation in Brazil at the moment, and whether the peak has already been reached, or this is very hard to predict. Thank you very much, Dr. Ryan. Dr. Michael Ryan: (38:46) Hi. Yes, the situation in Brazil has somewhat stabilized in terms of the number of infections detected per week. Certainly the intensive care units across Brazil are under less pressure than they were before. And when we look at the weekly incidents across many of the regions, the R naught or the R0 across the country has reduced, and the acceleration of cases has stabilized. But there's still a very high number of cases in the order of 50 to 60,000 a day, and a large number of deaths. And, again, credit to the health workers and to the communities of Brazil for taking the necessary actions to stabilize the situation. The question is, is this a lull? Can this be continued? And can we see that downward trend? And there is a clear downward trend in many parts of Brazil. But there are also areas in which the disease is still very prevalent, it's still unstable in it's transmission. So we're in that sort of difficult period in Brazil where things look like they could be getting better, but it now requires a very, very strong and dedicated approach to drive transmission down and to continue to protect the health system. Dr. Michael Ryan: (40:08) Now, within those numbers, Brazil is a very big country, there are areas that are experiencing increases. But in general, the trend in Brazil is stable or downwards. And that needs to keep going because Brazil has been contributing a huge proportion of global cases in this pandemic for a long number of weeks and months now. And any success in Brazil is success for the world. Because if countries like Brazil, countries like India countries like the US, and other large countries control the disease, then that's not just contributing to national numbers going down, but that will ultimately contribute to the overall impact of the pandemic being reduced. So still much to do in Brazil. But again, the health system continues to cope. The positivity rates are still higher than they necessarily should be, but the pattern is clear. The question is whether that pattern can be sustained in a downward direction in the coming weeks. Margaret Harris: (41:07) Thank you very much, Dr. Ryan. So the next question goes to Michael from CNN. Michael, can you unmute yourself and go ahead with your question? Michael: (41:21) Sure. Thank you for taking my question. Greetings from Ottawa, Canada. I recently flew for the first time in a long time and wrote about the experience. And what I noticed was social distancing was near possible. As you know, a lot of travelers, and I'm talking about even seasoned travelers, are very reluctant to fly. A lot of airlines are on their knees right now because they can't attract passengers. And just, quickly, a lot of airlines, including the two big ones here in Canada, Air Canada, WestJet are even selling the middle seat to passengers. Is there anything you can say based on the information you have to reassure the traveling public that it is safe to fly? And is there anything you can say to airlines to reassure passengers to come back into the skies? Thank you. Dr. Maria Van Kerkhove: (42:09) So, thanks for this question. It, again, is one that we receive quite a lot. We are working with IATA and the travel and tourism industry to look at how we can have safe and confident resumption of travel. Again, there are a number of considerations that need to be taken by individuals who fly. Every part from leaving your home through going to the airport and the physical distancing and the measures that need to be taken at airports, through when you board the plane, during that flight, and then when you arrive. And we're working with our partners to come up with and to issue guidance. And we have recently issued guidance around this and continue to work with IATA and others on how to do this safely. It is difficult to do physical distancing on aircraft, of course, but there are other measures that may be put in place, and we need to follow the guidance that is put out by the airline that you choose to travel. Dr. Maria Van Kerkhove: (43:09) Whether this is wearing masks while you're traveling, a fabric mask or a medical mask depending on who you are. And some are offering other different types of measures. But it's following the guidance of what is being put out there. But I think this reluctance or this hesitancy, I think, is normal to feel that. But I think there are ways in which the resumption of travel will happen safely. We also need to consider where an individual is traveling from to where an individual is traveling to, and look at the transmission intensity in those different areas. And then as an individual, I think you've heard Mike say before, if something doesn't feel safe, then it probably isn't safe. So there are decisions that individuals need to make when you leave your home, when you choose to do things. But there are measures that you can put in place and keeping your distance while you're at airports, wearing a mask if you're on board a plane, but following that guidance through the duration of your travel. Margaret Harris: (44:06) Thank you, Dr. Van Kerkhove. Dr. Ryan, is there anything you'd like to add? No? Okay. So the next question, we'll go to Isabel from the Spanish news service, EFE. Isabel, could you unmute yourself and ask your question? Isabel: (44:23) Yes. Good afternoon. Today a judge in Madrid has revoked a measure to ban smoking on the street in case social distancing cannot be respected. And this happened in the region where the infections are increasing faster in Spain. Do you consider this as a setback in the fight against the coronavirus pandemic in Spain? How could you explain such a decision in this moment? What is the message that this decision sent to people? Thank you. Dr. Maria Van Kerkhove: (45:02) Thank you for the question. Dr. Maria Van Kerkhove: (45:03) Thank you for the question. I think your question is a good one, and many countries right now are opening up their societies, Spain included. Many countries across Europe and across the world are opening up their societies. Some countries are seeing resurgence in activity and transmission in the form of clusters, in the form of small outbreaks, and-or seeing increasing in numbers. And this is happening across a large number of countries right now. It is really important that we learn how we can begin to live with this virus, to continue to suppress transmission, be ready to identify any cases and clusters that pop up so that we can quickly put those out, so that those small numbers of cases in clusters do not become community transmission again, and minimizing as many deaths as possible. Dr. Maria Van Kerkhove: (45:57) And in doing so, countries may need to implement some measures again. And what we are seeing in a number of countries is that they are choosing to implement some measures in a targeted area. And so in the area where the transmission is happening, they're implementing them for a certain geographic area, and they're implementing them for a certain amount of time. And what we're seeing now is a targeted approach to adding interventions that need to be put in place to bring outbreaks under control and to try to reduce the number of infections that are happening. Dr. Maria Van Kerkhove: (46:29) Countries are doing this in different ways, and they're doing this, and what we're seeing, and the ones where we're seeing some positive effects is they're doing this in a data-driven way. Where is the virus circulating? What are the case numbers that are increasing? Where is transmission occurring? Is it occurring in clusters? This virus is being driven by outbreaks in clusters, and we see this over and over and over again in countries. They're finding clusters and entertainment industries and nightclubs. They're seeing clustering in longterm living facilities, in prisons, in certain occupations, and so it is really important that we know where this virus is. If we know what those clusters are happening, we can bring those under control. So it's how these different types of interventions are put into place, and hopefully these will bring these outbreaks under control. Margaret Harris: (47:19) Thank you very much, Dr. Van Kerkhove. So we're coming past the hour and we've only got time for one last question, and it will go to one of our regulars, Simon Ateba. Simon, could you unmute yourself and ask your question? Simon Ateba: (47:37) Yeah. Thank you for taking my question. This is Simon Ateba from Today News Africa in Washington DC. My first question was answered, so we'll ask the second question. Yesterday, personally, I went to try to renew my driver's license here in DC, and the earliest date I received was February, 2021. Everything has been impacted, and it's almost obvious that we can't sustain this way of living for a long time. I was wondering if WHO can tell us, one, how long did the 1918 pandemic last, and was there similarity between that particular pandemic and what we are witnessing now? Thank you. Dr. Maria Van Kerkhove: (48:32) Thank you, Simon. I will begin, and I hope others will supplement. That's quite a question. So the 1918 pandemic was a novel strain of influenza and it circulated over a number of years. And in fact, once the pandemic, there were several waves of that pandemic impacting the globe. And that virus itself, once the pandemic, once the really intense transmission was over, after those waves, that virus circulated for many years, for decades, until another strain replaced it, circulating globally. So I think there are similarities. I mean, these are respiratory pathogens. There are numbers of interventions that are put in place for the 1918 pandemic, many of which are being implemented now during the SARS-CoV-2 pandemic. Dr. Maria Van Kerkhove: (49:23) And I think one of the things that you reminded me of in your first part of your question about your driver's license and the impact that this has had, pandemics have incredible impacts. They are pandemics. They are affecting every aspect of our lives right now. And so what we are trying to do in our control program around SARS-CoV-2, is about, "How do we save lives?" But not only focusing on health aspects, but, "How do we save livelihoods, and how can we help save economies and bring economies back up?" Dr. Maria Van Kerkhove: (49:58) And right now in the current, we are still very early on in this pandemic. I know many people are tired and many people have fatigue as it relates to this. We do as well, but we have quite a long way to go. So we need to remain focused, we need to remain ready, and we need to apply pressure to the virus. We need to apply pressure to try to prevent as many infections as we can, and save as many lives as we can, not only from COVID-19, but from all of the other diseases that are circulating that plague many populations, to make sure that essential medical services continue and other services continue so that people can go on and live their lives. Margaret Harris: (50:39) Thank you, Dr. Van Kerkhove. Dr. Michael Ryan: (50:42) This is Mike. Margaret Harris: (50:42) Yes. Yes. I was going to say, I knew you had something to add. Please go ahead. Dr. Michael Ryan: (50:46) No. I think maybe Dr. Tedros might want to add, because he's been saying for so long that we will get through this together. In human populations, we've through collectively so many different epidemics, wars, conflicts, political crises, and human beings are resilient. We are a resilient species, and we will get through this. And yes, the disruptions are terrible, and they're awful, but they will end. And there will be a brighter day, and some countries are creating that reality right now in the way they're approaching this response. Dr. Michael Ryan: (51:24) What we do need to do is get real. We need to be very, very serious in dedicating our efforts to suppress this disease, reduce mortality, and learn to find a way to control and suppress this virus, learning to live with it, in effect, and then hopefully bring online vaccines that will ultimately help us to bring it under control. Dr. Michael Ryan: (51:42) But with regard to the 1918 flu pandemic, it was, as Maria said, in three waves, and it took about 15, 16 months for those three waves to pass. In fact, in the US, the second wave, which started in the fall of 1918, was actually the wave that caused the most damage in terms of deaths. And then the third wave occurred in the winter-spring of 1919. So it took three waves for the disease to infect most of the susceptible individuals, and then settled down probably into a seasonal pattern. For example, the seasonal viral flu we have now contains the pandemic flu virus from 2009. So very often the pandemic virus settles into a seasonal pattern over time. Dr. Michael Ryan: (52:39) So yes, but this virus is not displaying similar wave-like pattern. Clearly when the disease is not under control, it jumps straight back up. But from that perspective, the classic wave pattern of the 1918-1919 pandemic was very clear, but it did take three complete waves for that disease to spread around the world and infect most susceptibles. The second wave was actually the most impactful in terms of deaths and hospitalizations, particularly in the US. Dr. Maria Van Kerkhove: (53:14) Thank you very much, Dr. Ryan. I was [inaudible 00:53:18]. Speaker 2: (53:16) [inaudible 00:08:19]. Dr. Tedros: (53:17) I think it has been said, but the waves that have been described, actually they took two years, I think from February, 1918 to April '20, two years. So it took two years to stop, to end. And in our situation now with more technology, and of course with more connectedness, the virus has better chance of spreading. It can move fast, because we are more connected now. But at the same time, we have also the technology to stop it, and the knowledge to stop it. So we have a disadvantage of globalization, closeness, connectedness, but an advantage of better technology. So we hope to finish this pandemic before less than two years, especially if we can pull our efforts together. And with national unity, global solidarity, that's really key. With utilizing the available tools to the maximum and hoping that we can have additional tools like vaccine, I think we can finish it shorter, in a shorter time than the 1918 flu. Margaret Harris: (54:57) Thank you so much, Dr. Tedros. And on those positive words, we can do it and we will do it, I will close this press conference and thank everybody for your excellent questions. The transcripts will be available via audio file as will Dr. Tedros' speech, and any other questions that weren't answered or asked, please send in media inquires and we'll follow through. And even though Dr. Tedros already finished this press conference on such a strong note, I'll hand back to him for final words. Dr. Tedros: (55:26) Yeah. Thank you. My final word is maybe I was hoping to make a comment on what Sophie asked, actually. It's very important, about the strike by health workers and about corruption, especially related to PPEs. I agree with Mike that when health workers protest or strike, it should be in a way that doesn't affect the service they provide to those who need it most. That's one. And second, on the corruption, any type of corruption is unacceptable. No level or any level of corruption is unacceptable, or any type of corruption is unacceptable. However, corruption related to PPE, lifesaving, for me, it's actually murder. Because if health workers work without PPE, we are risking their lives, and that also risks the lives of the people they serve. So it's criminal, and it's a murder, and it has to stop if it's happening anywhere. Thank you. Dr. Tedros: (56:52) And finally, I would like to thank all who have joined today and look forward to seeing you in our next press conference. Thank you.