World Health Organization (WHO) Coronavirus Press Conference June 22

Tarik: (00:38) Hello everyone, and welcome to our regular press briefing on COVID-19. Today is June 22nd and with us we have Dr. Tedros, WHO Director General, Dr. Maria Van Kerkhove and Dr. Mike Ryan. Before I give the floor to Dr. Tedros for his opening remarks, I would just like to remind journalists who are watching us on Zoom that you can listen, this briefing in six UN languages. That's English, French, Spanish, Arabic, Russian, Chinese, but also in Portuguese and Hindi. If you look on your tab under settings, and that's possible thanks to our interpreters who are here with us today. You can also ask questions when we get to that in all those languages except Hindi. I'll give the floor now to Dr. Tedros for his opening remarks. Dr. Tedros: (01:36) Thank you. Thank you Tarik. Good morning. Good afternoon. And good evening. It seems that almost every day we reach a new and grim record. Yesterday more than 183,000 new cases of COVID were reported to WHO. Easily the most in a single day so far. More than 8.8 million cases have now been reported to WHO, and more than 465,000 people have lost their lives. Some countries are continuing to see a rapid increase in cases, and as some countries that have successfully suppressed transmission are now seeing an upswing in cases as they reopen their societies and economies. All countries are facing a delicate balance between protecting their people while minimizing the social and economic damage. It's not a choice between lives and livelihoods. Countries can do both. Dr. Tedros: (02:38) We urge countries to be careful and creative in finding solutions that people stay safe while getting on with their lives. We continue to urge all countries to double down on the fundamental public health measures that we know work. Finding and testing cases works, isolating and caring for the sick works, tracing and quarantining contacts works, and protecting health workers works. At the same time, these measures can only be effective if each and every individual takes the measures that we also know work to protect themselves and others. Maintain physical distance, continue cleaning your hands, and wear a mask where appropriate. Dr. Tedros: (03:29) Just as we do the things that we know work to prevent the spread of the disease, we're also learning more about how to treat the sick. Although the data is still preliminary, the recent finding that the steroid dexamethasone has life saving potential for critically ill COVID-19 patients gave us a much needed reason to celebrate. The next challenge is to increase production and rapidly and equitably distribute dexamethasone worldwide focusing on where it's needed most. Demand has already searched following the UK trial results showing dexamethasone's clear benefit. Dr. Tedros: (04:14) Fortunately, this is an inexpensive medicine and there are many dexamethasone manufacturers worldwide who we're confident can accelerate production. Guided by solidarity, countries must work together to ensure supplies are prioritized for countries where there are large numbers of critically ill patients, and that supplies remain available to treat other diseases for which it is needed. Transparency and constant monitoring will be key to ensuring needs dictate supplies rather than means. It's also important to check that suppliers can guarantee quality as there is a higher risk of substandard or falsified products entering the market. Dr. Tedros: (05:03) WHO emphasize that dexamethasone should only be used for patients with severe or critical disease under close clinical supervision. There is no evidence this drug works for patients with mild disease or as a preventative measure, and it could cause harm. WHO is also continuing to support countries with essential supplies of personal protective equipment and laboratory diagnostics. One way we're doing that is through the COVID-19 Supply Portal, an online platform through which countries that need supplies can enter requests. So far, 48 countries have made requests for supplies with a value of 92 million US dollars. Dr. Tedros: (05:52) WHO is currently in the process of shipping more than 140 million items of personal protective equipment to 135 countries, 14,000 oxygen concentrators, and millions of tests. Meanwhile, WHO is also working with countries to maintain essential health services. WHO recently surveyed countries to assess the impact of the pandemic on essential health services. Of the 82 countries that have responded so far, more than half have limited or suspended at least one service delivery platform such as outpatient or inpatient services or community based care. Dr. Tedros: (06:40) Almost three quarters of countries reported that dental and rehabilitation services have been partially or completely disrupted. Around two thirds of countries reported disruptions to routine immunization, diagnosis and treatment for noncommunicable diseases and family planning and contraception. More than half of countries reported disruptions for mental health disorders, antenatal care, cancer diagnosis and treatment, and services for sick children. Countries are using a variety of strategies to deal with these disruptions, including triage, telemedicine, and redirecting patients to alternative health facilities. But still, the consequences of these disruptions will be felt for many years to come. Dr. Tedros: (07:32) The world is learning the hard way that health is not a luxury item. It's the cornerstone of security, stability, and prosperity. That's why it's essential that countries not only respond urgently to the pandemic, but also that they invest in strong health systems domestically and in global health security. Last year, world leaders came together at the United Nations General Assembly in New York to adopt a landmark political declaration on universal health coverage. No more than ever all countries must make universal health coverage a priority. It's not a question of whether countries can afford to do this. It's a question of whether they can afford not to. I thank you many. Tarik: (08:28) Many thanks Dr. Tedros for these opening remarks. We will now open the floor to questions, and we will try to have one question per journalist. So we will start with Sputnik, and we have a Valentina online. Valentina: (08:45) Hi, thank you very much for taking my question. Do you hear me? Tarik: (08:49) We hear you very well. Valentina: (08:50) Thank you very much. I would like to ask WHO's position on announcement made by the South Korean authorities that the country is experiencing now a second wave of the novel Coronavirus infections in Seoul. Are there indeed indications of a second wave rather than a second peak within the first wave there, and should other countries, which were like South Korea among those hit by the pandemic first anticipate a second wave as well any time soon? Thank you very much. Dr. Maria Van Kerkhove: (09:21) So, thank you for the question. I can start. So yes, I mean, there are many countries right now that, which have had success in suppressing transmission and bringing human to human transmission down to a low level that are starting to see increase in cases. And there's a number of reasons for that. They've either seen outbreaks in certain settings or close settings like we've seen related to either religious events or related to outbreaks in dormitories of expatriate workers or in different types of facilities. Whether that's a second wave, you've heard us speak about this before where any opportunity that the virus has to take hold it will. And it's really important that countries are in a position to be able to rapidly detect these cases and put everything they can to isolate cases so that the outbreaks don't become larger, and that these small numbers of cases don't become clusters, and that these clusters of cases don't become community transmission again. Dr. Maria Van Kerkhove: (10:23) Korea has a lot of experience in dealing with COVID like all countries do now. And in particular, when they see outbreaks that are occurring in specific settings and they know what to do. And so, we urge all countries to be at the ready to able to detect any cases that pop up regardless of where they may be. We know that there are particular vulnerable settings primarily where there may be patients. So in healthcare facilities. Whether you have close settings where people are in close contact with one another and be really ready to find those cases, isolate cases, carry out comprehensive contact tracing, and care for those individuals who need care and medical facilities. Dr. Michael Ryan: (11:09) And if I can supplement, certainly, I'm not aware of an announcement by the Korean authorities on the subject that you mentioned, but I can note that there's only been a 3% overall increase in cases in Korea in the last week. And in fact, I think only three deaths reported in the last week. Well, what is clear is there have been a new clusters in multiple settings in Seoul. And the overall number of cases actually in South Korea is very, very stable. They're actually dropping. These new clusters, obviously, they are linked to various settings. To clubs, to shelters, to amusement parks, and to particular settings in which transmission has been diagnosed. Dr. Michael Ryan: (11:58) My understanding is that the vast majority of cases being detected are linked to existing and recognized clusters. And as such the South Korean authorities still have great visibility over where the virus is and the dynamics, and the chains within which the virus is transmitting. But that's a constant struggle to stay ahead of the virus. So, continued vigilance is extremely important. I know the Korea Center for Disease Control and the government, the Republic of Korea are usually skilled now in detecting clusters and investigating clusters. And in doing the kind of targeted measures that allow them to bring these clusters under control. Dr. Michael Ryan: (12:40) It is a challenge for all countries, and I think South Korea with other countries demonstrate that even when you get down to very low incidents, you still have to have a very strong public health surveillance system. And you still have to have a very capable public health infrastructure. You still have to have a population that is willing to take the necessary actions. And I think what we see in the Republic of Korea is a highly engaged community that believes in science, believes in its authorities, and is willing to implement measures at a sub national level that are aimed at reducing transmission. Dr. Michael Ryan: (13:18) So, from that perspective, I would say that Korea is still on track with its disease control efforts, but like all countries, there are always risks of any disease getting out of control. Tarik: (13:33) Many thanks. Next question comes from Juan Miguel Hernandez from El Pais, Juan. Can you please unmute yourself? Juan Hernandez: (13:45) Hello? [foreign language 00:13:49]. Speaker 1: (13:51) Hello. Can you hear me? I wanted to ask, with regards to reports in recent days of people in Spain who have said they have persistent symptoms of Coronavirus, cough, fever, respiratory difficulties, and this over the last three months, what's the research ongoing or the WHO's perception with regard to that? Thank you. Dr. Maria Van Kerkhove: (14:21) Thank you for this question. Yes, we are... We're working through our clinical network and with clinicians who are dealing with patients infected with COVID-19 to understand not only how the patients are dealing with disease and what kind of disease they experience while in hospital, but after they recover and when they are released from hospital and they go home. We have guidelines around rehabilitation and follow up of those who do recover. And we should say that we are seeing millions of people who are recovering from COVID-19, which is a very good sign, but indeed there are people who have persistence... Some people who have persistent symptoms like- Dr. Maria Van Kerkhove: (15:03) Some people who have persistent symptoms, like a long-term cough, like a dry cough, for some time, they may feel quite fatigued for some time. They may feel some shortness of breath while they're climbing stairs. We are working to better understand what recovery looks like, and more specifically, and more importantly, what type of long-term care, if needed. What does that look like for people who have recovered? We do know people who have more severe infection, who have perhaps been intubated, may have some damage to their lungs, and that may take a longer time to recover. Again, we're still learning about this disease. We're still learning about how people recover and what care they need after they are discharged from hospital. Moderator: (15:47) Thank you. Next question coming from AFP, Nina Larson. Hello, Nina. Nina Larson: (15:59) Hello. Hi. Can you hear me? Moderator: (16:01) Very well. Nina Larson: (16:02) Okay. Thank you for taking my question. I wanted to ask, following the release of data from a National Health Institute study of wastewater in Italy last week suggesting that the novel coronavirus was present in two large Italian cities in December, I was wondering if WHO is still confident that the virus source is in China, and also if you're aware of other wastewater studies showing similar results that might raise questions about the understanding of when and where this pandemic actually began. Thank you. Dr. Michael Ryan: (16:41) The Italian findings, I think, are very interesting. I don't believe that the live virus was cultured, but I do believe it was related to RNA fragments. It is always important that if RNA fragments are recovered from water that was collected in December, then clearly, there is a chance that this virus was circulating in Northern Italy, obviously, before anyone had realized that it had been. Having said that, the documented importation of cases, which temporarily, from a timing point of view, led to the explosion of cases. What's not clear is to what extent the presence of the virus or the potential presence of the virus in the environment before the known importation. In what way did that contribute to the amplification of disease at community level? Dr. Michael Ryan: (17:35) It's very important that these results are further pursued. I know there have been other wastewater-based studies. Maria give you more details on those studies. It is important. These are important findings. It's very important that they're pursued. I don't think, at this point, it changes the hypothesis on disease origin per se. We must remain open to any scientific findings that offered us clues as to the potential emergence and amplification of this disease in human populations. Maria? Dr. Maria Van Kerkhove: (18:11) Yes. Only to very briefly add that the use of looking for the virus in wastewater... As Mike has pointed out, this is looking for fragments of the virus, so RNA fragments of the virus, not... Live virus has not been isolated from wastewater. What we're looking at is in the context of surveillance for COVID-19, we know, primarily, we need to focus on looking for people who are infected with the virus, actively infected with the virus, because this is important for making sure that they have the right clinical care and that we follow their context, and so we could break chains of transmission. Dr. Maria Van Kerkhove: (18:45) In addition to that, we're looking at other ways, potential ways, in which we can look to see if the virus is circulating. We've mentioned looking at the influenza-like illness, and the severe acute respiratory illness, respiratory disease surveillance that exists in most countries to see if it's circulating in the community. Wastewater is another potential way in which we can look to see if the virus may be there. Again, that won't help you find individuals who are infected with this virus, which is so critical at looking at suppressing transmission, so finding those individuals. That is something that is in our overall surveillance portfolio for COVID. We hope that this will be helpful in determining where the virus may be present, where it may be more difficult to find individual patients. It is critical that most of our surveillance efforts are focusing on finding individuals who are actively infected with COVID. Moderator: (19:41) Thanks. Next question... N1 TV from Bosnia Herzegovina. We have Smir online. Smir? Smir: (19:49) Hi. Can you hear me? Moderator: (19:51) Yes. Nina Larson: (19:53) My question is regarding region of the Western Balkans. Are you afraid that we are going to have increased number of cases because yesterday, in Croatia, we have a tennis tournament in Zadar with quite a few players and officials. In fact, with COVID-19, also in Serbia yesterday, we had parliamentary elections with almost three and a half million people voting. Bosnia has number of cases reporting over the last 24 hours, increased. Also in Montenegro, we have religious processions. In all those cases, we haven't seen many masks and protections. Are we on the road to have more and more cases reported? Thank you. Dr. Michael Ryan: (20:48) From the perspective of the Western Balkans and also, countries further to the south, certainly they have been in the main, less affected than other countries in the European region, early on in the epidemic. Some have been very successful in ensuring that the disease numbers have been kept low. As we've said, in other countries in Asia, they've managed to get their numbers very low. In countries that still have low numbers, there is always the chance of disease amplification, particularly in association with mass gatherings. We've seen that in some of the outbreaks in Europe and in other places where amplification events can occur. Super-spreading events can occur and disease can explode very quickly. We've seen super-spreading events in any number of different settings, mainly in closed indoor settings, both occupational, residential, and other setting. There are always risks. Dr. Michael Ryan: (21:43) It's really important that the gains that have been made by countries in the Balkans that have avoided the worst of this disease, that they continue to sustain those efforts. It is very important that the same measures are applied, that people are aware and are applying hygiene measures, that physical distance is being respected even in the situations of low incidence, that people are wearing masks in the appropriate settings, and that organizers of mass gatherings are aware and managing the risks associated with those gatherings. All countries have specific recommendations related to the gatherings, the size of gatherings that can occur, and how those should occur, and how risk should be managed. Dr. Michael Ryan: (22:27) I can't specify for any individual country what those are, but organizers of gatherings, whatever those gatherings may be, should respect the advice of national authorities and try as best as possible to implement those. The measures that are being advised are very simple. They're very practical. It's incumbent on all to apply them. We do hope that the countries in the area that have had a great deal of success in keeping the numbers low will continue to do so if those measures are applied in a systematic way. Moderator: (23:03) Next question is from Sarah Newey from Telegraph. Sarah? Sarah Newey: (23:12) Hi there. Can you hear me? Moderator: (23:17) Yes. Sarah Newey: (23:17) Brilliant. There's been reports that today, that Africa is nearing 300,000 cases. I mean, how much do you think that's an underestimate? Do you think that Africa could be the next hot spot? We've seen it's obviously focused in Latin America and North America at the moment. Are you concerned that that might shift in the coming months? Dr. Michael Ryan: (23:43) Yes. Is that on? It is. Okay. I think the situation in Africa is mixed. I think Africa is a very large continent, both in sub- Saharan sense and North Africa, which are in two different WHO regions. We've seen increases of disease in some countries in excess of 50% in the last week. We've seen other countries with very, very stable numbers. In general, the numbers are on the rise in Africa. We've seen large increases in places like South Africa. We've seen increases in places like Benin, in Eritrea, in Ethiopia, in Burundi. Dr. Michael Ryan: (24:29) What we haven't seen, yes, are large increases in the number of deaths. Africa, at this point, is still avoiding the large proportion of that, that have been associated with this disease in other continents. Now there are important caveats here. Testing is not as frequent in Africa, so there clearly could be under-reporting of cases. Hospitals do not appear, in most countries, to be overwhelmed, but in certain countries, like in Nigeria, and in heavily-populated areas like Lagos, hospitals have come under significant pressure. I would say the situation in Africa in general is very mixed. It very much depends on the context in which people are living. Larger cities seem to be more affected. We've seen outbreaks in refugee camps. We've seen, as I said, increases in cases in a number of different settings. Dr. Michael Ryan: (25:26) Will Africa be the next epicenter for this pandemic? I certainly hope not because the health systems in Africa in general are weaker than in other parts of the world. Populations, while they have the benefit of an age profile that's much younger, there are many people with underlying conditions. There are many, many vulnerable people. We need to try and keep these numbers as low as possible while at the same time, making sure that the lives and livelihoods are protected. This is a constant challenge. Dr. Michael Ryan: (25:59) There is no room for complacency on the African continent. This is a time to really focus in on improving surveillance, really focus in on improving the capacity of healthcare to treat cases and to focus in on some of those countries that are experiencing quite large increases of cases. Our African regional office, our Eastern Mediterranean office, continue to work with those countries. We have WHO offices in all of the countries in Africa. We'll continue to work closely with governments there, both to suppress transmission and to reduce case fatality where that is a problem. Moderator: (26:41) We will have now, China Daily. We have Chen with us. Hello? Chen: (26:48) Hello. Hi. I just have a question. Forgive me if you have already published such a guidance. Countries who have actually reopened lately, I mean, like Europe, or some other places, started traveling. Has WHO published the guidelines... our travel industry? I mean, whether car rentals, or hotels... Could it be safe? I mean, would it become a super spread? Thank you. Dr. Maria Van Kerkhove: (27:23) I can start, and maybe Mike would like to supplement. Yes. I mean, we are working very closely with the travel and tourism industry to support them in the process of opening up, and the process of having travel that's safe, and making sure that we reduce the risk of transmission within facilities related to travel. We do have a series of documents out on guidance around hotels. We're working with the airline industry to look at the safe resumption of flights. We will have more guidance coming out in the coming days on this to be able to support the safe reopening. Dr. Maria Van Kerkhove: (28:05) It is important that while people travel, through the whole process of travel, leaving their home to where they reach their destination, that that is done in a safe manner. Not only is it important for the industry, and the airlines, and the hotels to be able to offer safe experiences, we need individuals to also play their role. For example, the DG highlighted this in his speech today. It's important that everyone at an individual level know what they can do to protect themselves, to protect their families, to protect their communities from infection and from onward transmission. This includes the basics. It includes all of the basics of physical distancing of at least one meter, making sure you practice respiratory etiquette, that you wear a mask when you need to wear a mask. In situations where you can't do physical distancing and where there's transmission, making sure that you practice hand hygiene. All of these things need to be practiced globally as we move forward as this pandemic evolves. Dr. Michael Ryan: (29:11) As Maria said, we will be issuing further guidance in the coming days as countries open up to travel between each other. Again, I think it's important to emphasize that it's the responsibility and duty of each sovereign state to put in place the protections for its own population. That applies not only within countries, but with regard to travel into and out of any given country. We do recognize that countries exist at states of different risks. Countries who have very, very low incidence of disease or no incidence of disease may design measures that may appear stricter than in other countries because the risks to them of importation of disease and the consequences of that importation are much, much higher. WHO... Dr. Michael Ryan: (30:02) ... Consequence of that importation are much, much higher. WHO has been clear on this over a very long time. That measures and facilitation of travel and measures that result in any restriction of travel should be based on public health protection, on public health principles, they should be measured. They should be reviewed regularly. But in the end, countries are in a position to measure and manage the risk to their citizens, to their society, and to their economy. As such, as we open up and as we travel between countries, it's really important for Member States and others to put in place those measures that they feel are commensurate and are balanced that protect their populations. While at the same time, as we've seen balancing risk of disease against lives and livelihoods. Within countries, we see this dilemma, how do we manage lockdowns, and how do we manage stay-at-home orders, while at the same time protecting lives and livelihoods? Dr. Michael Ryan: (31:01) That same factor comes into play when you talk about international travel and international trade. You're trying to balance public health risks against lives, livelihoods, economy. It's not an easy challenge for any government. It is a dilemma. It involves trade offs. There are no zero risks. As such, we will support Member States in making their risk assessments, and coming to measure judgements regarding the risks to themselves and the measures they need to put in place. But ultimately we would like to see public health-based measures that are reviewed regularly, and that we all move towards a new normal that involves us being able to move around, and being able to travel and trade in a normal fashion, while at the same time managing those public health risks. We will be issuing more specific guidance in the coming days around that process. Tarik: (32:00) Now we will have [Laga Pinyairov 00:32:02] from Globo, Brazil. Laga. Speaker 2: (32:07) Hello can you hear me? Tarik: (32:10) Yes, please go ahead. Speaker 2: (32:11) Hi, good afternoon. Thank you for taking my question. I would like to know what the role is of ivermectin, if there's any in fighting COVID-19? What do we know so far? Dr. Michael Ryan: (32:33) I think we had this question sometime ago. We'll have to get back to you on the details. There are many, many molecules and older drugs that have been tested as either prophylaxis or as treatment. We'll have to get back to you on whether or not there are any ongoing trials using ivermectin. We'll probably get back to you before the end of the press conference. We just need to check that we give you the right information. Tarik: (33:00) Okay Laga stay in touch, we will provide that. We will now hear from Reid Wilson from The Hill, Reid. Reid Wilson: (33:11) Sorry about that. Can you comment on the rising number of cases in the United States, particularly in Southern states? What do you make of the rise in both positivity rates and cases among younger people? Dr. Michael Ryan: (33:28) I think there's been upticks in cases in a number of states in the US. I'm not 100% sure about the age profile, but I've seen the reports that some of this is amongst younger people. That may reflect the fact that younger people are more mobile and are getting out and taking advantage of the reduction in the restrictions of movement. This is something that WHO has spoken about many times. Many countries have experienced clusters of disease or upticks in the aftermath of reducing stay-at-home orders or allowing population mobility to happen. What we've said and I believe the scientists in the US are saying this over and over, is that maintaining vigilance around physical distance, personal hygiene, the wearing of masks according to the national guidelines, and where appropriate the increase of surveillance, so the clusters are investigated, testing, tracking, isolating cases, quarantining contacts. Dr. Michael Ryan: (34:42) This is what needs to continue. I believe that is happening in many countries and in many states in the United States. I think it's for at the federal level, I'm sure our colleagues there are looking at this and what the implications of this are state by state. Each state is unique. I'm sure each state is looking at the implications of this for their population. What is clear is that the increase is not entirely explained through just increased testing, there's some evidence of increasing hospitalizations. But this was always a possibility when restrictions are lifted and again has happened in many countries. The issue is not the rising numbers per se, the issue is what is to be done to bring those numbers back, and what combination of measures can be used in order to do that. Dr. Michael Ryan: (35:37) In terms of targeted public health measures, increasing surveillance, increasing cluster investigation, and ensuring that we identify cases and contacts as quickly as possible, isolate the cases, quarantine the contacts. Where necessary, and hopefully at a much more localized level, there may be a need to put some restrictions in place in order to suppress infection. Again we've seen countries do that at a micro level, not at a state level or even as a national level. But to where needed, if there are clusters of cases with the potential for community transmission, that there may need to be some adapted measures to suppress infection while the clusters are investigated. Maria. Tarik: (36:29) We will now go to Carlo [inaudible 00:36:31] if I pronounced well, from Politico. Carlo. Can you hear us? Carlo: (36:38) Yes. Can you hear me? Tarik: (36:40) Yes. Carlo: (36:41) Yes. Thank you for taking my question. This is regarding the outbreak in Germany at the meat packaging plant. I wanted to know if you were monitoring that outbreak, and if you could just provide any guidance as to which particular workplace locations we're seeing might be more vulnerable for starting these outbreaks and potentially for giving more momentum to a future second wave. Thank you very much. Dr. Maria Van Kerkhove: (37:15) Thank you for the question. Yes, indeed we are following this outbreak in this meat packing plant in Germany, as well as a number of outbreaks in clusters that are happening in food processing plants across a number of countries. What I can say is that we need to know more, to really better understand why these clusters are happening, why these outbreaks are happening, so that we can learn how to stop them. There may be some, I don't want to speculate too much because we need to learn more about these and the outbreak investigations need to be carried out. To better understand what's happening at the factories, the plants themselves, as well as the individuals who are infected. Dr. Maria Van Kerkhove: (37:58) The living conditions in which they live and any other potential sources of infection for these outbreaks. We are working with a number of countries, a number of groups to better understand and consolidate our understanding around these outbreaks. What we do know is that like we've said before, this virus likes the possibility of close quarters. Whether that's at the home or whether that's at work, we need to ensure that we make sure we prevent these outbreaks from happening. We need to find out a little bit more to be able to give a more well-rounded answer. Tarik: (38:37) Now we will go to Bayram Altug from Anadolu Agency, Bayram. Baryam Altug: (38:45) Hi, can you hear me? Tarik: (38:45) Yes. Baryam Altug: (38:47) Thank you very much for taking my question, good afternoon all of the people there. My question is also related to Italy, professor Alberto Zangrillo, head of intensive care at Italy's San Raffaele hospital in Lombardy has said that, "The new coronavirus is losing its potency and has become much less lethal." He said that COVID-19 mutates over time and hopefully one day will become a common quote virus. It can also be noted that while the number of cases broke a record in recent days, there is no serious increase in the number of death. In the light of this data, do you think the virus really loses its effect? Thank you. Dr. Maria Van Kerkhove: (39:37) I will begin. Thank you for this question. We've mentioned before that there's a large number of virologists and scientists that are looking at this virus as it emerges in all countries. I just checked today and I saw there's more than 49,000 full genome sequences that are available, that we're looking at to see, to determine if there are changes in the virus. As this is an RNA virus, there are changes, expected changes in them. We're trying to determine if those changes have any impact on the way that this virus behaves. We haven't seen that yet, but we have a group of people globally who are looking at this. To make sure that we are paying attention. Dr. Maria Van Kerkhove: (40:20) To make sure that all of the viruses that are shared, and we're grateful for countries for sharing these sequences, determine if any of those changes will mean a different change in behavior. In terms of the potency of the virus, it's an important observation that you mentioned, and we will look into it. But we should highlight that this virus is very deadly. When it does have a chance to infect people, it can kill people. We want to make sure that everyone treats this virus seriously, and make sure that we do everything that we can from preventing infection. Then from those that are infected to prevent those individuals from developing more severe disease. Dr. Michael Ryan: (41:01) If I just might add, thus far at least there is no evidence of all of the sequences that have been generated and all of the different infections in the world that we're seeing any strand of the virus emerge that has either greater or lesser lethality or clinical impact. In fact, the virus most mutations in viruses provide no biologic advantage to the virus, and in fact most are detrimental to the virus. But in some cases just now and again, this is the process of evolution for all DNA and RNA-based organisms. Just now and again, a single mutation or a few mutations can result in the virus changing. What we're always watching out for is any change that changes the clinical impact of the disease, makes it less or more virulent. Dr. Michael Ryan: (41:53) But also changes that might reduce the effectiveness of therapeutics or vaccines, or that might affect transmissibility or a likelihood of transmission, or the route of transmission. Or in this case too changes to the virus can reduce the effectiveness of our testing. Because our tests are based on recognizing very often the genetic sequence of the virus. We are constantly monitoring the genetic sequences, because it can affect diagnosis, it can affect treatment, it can affect vaccines, and it can affect the clinical impact of the disease and the patterns of spread. Because of that we maintain very strong vigilance with a network of virologists and others around the world. Dr. Michael Ryan: (42:37) In fact, I think within the laboratory working group, there is Maria and the team have put together a very specific group of virologists and genetic experts who are constantly reviewing the sequences, and looking out for exactly those signals that you mentioned. But with regard to the real world observations, we are not observing a significant difference in behavior of this virus in any of the areas that I mentioned. In terms of its transmission, it's clinically lethality, in our diagnostic capacities nor in the impact of therapeutics. Tarik: (43:18) Thank you Dr. Ryan. We will now take a question from Sophie from South African Broadcasters, Sophie. Sophie can you unmute yourself please? Sophie: (43:38) ... Is around yesterday the announcement that the WHO recorded a highest number yesterday around the world. I just want to find out if you were to attribute this to something, what would be the reason for these high numbers that were reported yesterday? Also, perhaps which countries contributed to this high number? Dr. Michael Ryan: (44:16) I can begin, DG or Maria may wish to add. Certainly the numbers are increasing because the epidemic is developing in a number of populous countries at the same time and across the whole world. From that perspective, and a large number of countries are contributing to that overall increase. Some of that increase may be attributed to increased testing. Countries are testing more, and certainly countries like India are testing more. But we do not believe that this is a testing phenomenon. Clearly when you look at hospital admissions are also rising in a number of countries, deaths are also rising. They're not due to increase. Dr. Michael Ryan: (45:03) Deaths are also rising, and they're not due to increased testing per se. So there definitely is a shift in the sense that the virus is now very well established at a global level. It has reached some of the most populous countries in the world, some of the most populated areas of the world, and because the epidemic is now peaking or moving towards a peak in a number of large countries at the same time, you're seeing that impact on the number of cases. Now, in Europe, in Western Europe, you're seeing the curves decrease. In Southeast Asia, you're seeing the curves decrease, and then the overall numbers increase, which clearly means central, the Americas are contributing, South Asia is contributing very much, but also there are countries in the Middle East and there are countries in Africa that are also contributing to that overall increase. So the situation is definitely accelerating in a number of countries with larger populations, and that is most certainly contributing to this overall increased number. Maria? Dr. Maria Van Kerkhove: (46:05) Yeah. Only to add, if you want some specifics on the case reports every day, we do have a dashboard that's online where you can look and see the actual numbers of cases and deaths that are reported. And you can break that down by country, so you can get by regions and by countries. So that can give you some granularity, if you want to see, where are those actual numbers coming from? And it's on our main WHO website. Tarik: (46:28) Okay. We have time for a couple of more questions. Anna Pinto from Sao Paolo. Anna? Anna Pinto: (46:40) Yes. Thank you, Tarik. Dr. Ryan, last week you said there were signs that COVID was stabilizing in Brazil. I would like to ask if you could elaborate a little more on which are those signs and what the trend is now, if the signs are still pointing to stabilization in Brazil? Thank you very much. Dr. Michael Ryan: (47:06) Well, I think as you know, Brazil has surpassed one million cases and just reported a record, I think, 54,000 cases in our last 24 hour reporting period. Some of that may reflect changes in reporting, as there was a lag in the change in the systems reporting, I believe from the state level. So some of that is potentially architectural, but if you look at the number of cases over the month of June, they've remained relatively stable. What you see is a stable weekly pattern, a decrease at the weekends. And it's not that the disease decreases reporting changes, but there certainly has been a spike in cases in the last 24 hours. And again, we're looking into how much of that is factual or related to reporting and how many days that reflects going back over the last week. Because on Wednesday, Thursday of last week, the number of confirmations from Brazil was actually below average. Dr. Michael Ryan: (48:05) And now we have very much an increased number which may reflect it's above average. So we're looking into that with our colleagues at the Pan American Health Organization, our regional office for the Americas. The states with the highest number of cases are still Sao Paulo, Rio de Janeiro, Sierra, Para and Maranhao. And the number of cases at Sao Paolo are approaching 212 million, or sorry, 212,000, I'm sorry. But there still is relatively low tests per population, and the positivity rates for testing are still quite high. If you look overall in epidemiologic week 17, I believe their positivity rate was 31% for Brazil. So, that generally means that there are probably more cases out there than are being reported. What we tend to see is that positivity rate dropping usually down to 5% or less in countries that are detecting all of their cases and that are, in effect, over testing. Dr. Michael Ryan: (49:10) So from that perspective, we would say that this trend or these large number of cases are not reflective of exhaustive testing, but as I said, probably underestimate the actual numbers of cases. So while the overall pattern of disease in Brazil, as I said last week, is overall flat, the number in the last 24 hours needs to be examined carefully, but also we need to look at the fact that, as I said, up to nearly one-third of all tests are positive, which does indicate that there is under detection or under reporting of cases overall. Dr. Maria Van Kerkhove: (49:52) If I could just add to that, it's not specifically about Brazil, but when we look at any case numbers in any country, it's really important that we break this down to the lowest administrative level as we can. The virus doesn't take hold evenly across all countries. There may be differences in intensity of transmission by a state or a province, but then even more importantly, it's to break that down even further. Where is transmission happening? Is it happening in healthcare facilities? Is it happening in these ex-pat dormitories that I mentioned previously? Is it related to specific events? Is it in certain vulnerable populations, like longterm living facilities? We need to break down the cases to an understanding so that we know how to tackle it. And when we look at the national level, it's very important to have that national number. And Mike has outlined some of the reasons we may see some differences, but we need to break it down and understand where transmission is occurring, because this will help us control it. Dr. Maria Van Kerkhove: (50:54) You've heard us talk before about these four Cs, where we go from no cases to sporadic cases, clusters of cases, and community transmission. What we're aiming to do with the testing and isolating and caring for cases and contact tracing is to bring transmission down from community transmission to clusters. And once we understand where those clusters are, to bring those under control and move that back down. And so as much as we can, and this may be very difficult, especially in countries that are experiencing community transmission, is to really break down our understanding to the lowest administrative level as we can and use our resources where they need to be used most intensely based on that epidemiology. Dr. Michael Ryan: (51:38) If I could add Tarik, because I answered the question directly in relation to Brazil. I don't want anyone to get an impression that I've singled out Brazil. If we look at the Latin American general, Brazil, if you count those numbers, the increase in numbers reported yesterday has been a 25% increase overall in the week. But if we look around the region, Chili has had a 41% increase in cases in the same time. Argentina has a 38% increase, Colombia 35% increase, Panama 26%, Bolivia 33%, Guatemala 39%, Honduras 38%, French Guiana 86%, Costa Rica 28%, El Salvador 24%, Haiti 26%, and Venezuela 25%. So what we're seeing is still in Latin America is an evolving epidemic in the region that's affecting all countries, and certainly Brazil as the most populous country is deeply affected, but it's amongst many others. Dr. Michael Ryan: (52:43) We've also seen worrying increases in deaths in the same period in some of those countries. So from that perspective, I think it's important to see Brazil in its regional and in the global context. So just to be sure that people don't misinterpret that in responding to a question specifically on Brazil, that we're not conscious of the regional or global context and the place that Brazil sits within that. Tarik: (53:14) All right, thanks. We will take our last question for today. We have [Pian 00:53:20] from NPR. Pian? Pian: (53:27) Hi, thanks for taking my question. There are reports of minks being culled on a farm in Amsterdam over concerns that they could be an animal reservoir for the coronavirus. So I wanted to ask, what do we know now about animals and humans transmitting the virus between them and how does that inform our approach to suppressing the virus? Dr. Maria Van Kerkhove: (53:48) So thanks for the question. Yes, we have a team that's working on looking at the animal human interface and looking at the susceptibility of animals to this virus. You know about the work related to the origin of the virus. What I'm going to mention is specifically about the minks that you mention. And indeed there are some minks that have been found positive in the Netherlands and in Denmark. And what we understand from these investigations that are currently ongoing is that they were individuals who infected the minks, so people who infected the minks. And in turn, some of these minks infected some people. It's very limited in terms of the transmission happening between the people and the minks. And some of those minks have been culled, have been killed. Dr. Maria Van Kerkhove: (54:35) We are learning about what this actually means in terms of transmission and what role they may play. I should put this in context that this is a virus that is predominantly transmitting between people through respiratory droplets, and this is the driver of transmission. This gives us some clues about which animals may be susceptible to infection, and this will help us as we learn more about the potential animal reservoir of the SARS-CoV2 virus. There's a number of studies that are ongoing looking at the animals that are susceptible from minks to ferrets, to cats, dogs, pigs. And so there's a large group of scientists that are trying to better understand the role this virus plays. But again, just want to put it into context of the fact that this is a human to human transmission primarily that we're seeing, and why we're seeing this virus spread globally. Tarik: (55:34) Thank you, Dr. Van Kerkhove. We will conclude our press briefing with this last question. And I remind you that we will get the audio file to you shortly, with the transcript being posted tomorrow. I wish everyone a very nice evening. Dr. Tedros: (55:50) Thank you. Thank you, Tarik and thank you for joining and see you on Wednesday.