Jun 24, 2020

World Health Organization (WHO) Coronavirus Press Conference June 24

World Health Organization Updates COVID
RevBlogTranscriptsPress Conference TranscriptsWorld Health Organization (WHO) Coronavirus Press Conference June 24

The World Health Organization (WHO) held a coronavirus press conference on June 24. Read their full update briefing on the latest COVID-19 news & findings here.

 

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Tarik: (00:00)
Director-General Dr. Tedros, Dr. Maria Van Kerkhove, Dr. Mike Ryan. But also we have today with us Dr. Janet Diaz who is the Head of Clinical Care within the WHO Program for Emergencies. Journalists who are watching us on Zoom can listen to us in the six UN languages, plus Portuguese, plus Hindi thanks to our interpreters who are here with us that we thank for making this possible. You can also ask your questions in those 6 UN languages plus Portuguese when we arrive to the session of questions and answers. And I’ll give the floor to Dr. Tedros for his opening remarks.

Dr. Tedros: (00:44)
Thank you. Thank you, Tarek. Good morning, good afternoon, and good evening. More than 9.1 million case of COVID-19 have now been reported to WHO, and more than 470, 000 deaths. In the first month of this outbreak, less than 10,000 cases were reported to WHO. In the last month, almost 4 million cases have been reported. We expect to reach a total of 10 million cases within the next week. This is a sober reminder that even as we continue research into vaccines and therapeutics, we have an urgent responsibility to do everything we can with the tools we have now to suppress transmission and save lives.

Dr. Tedros: (01:36)
One of the most effective ways of saving lives is providing oxygen to patients who need it. Several news reports published today have highlighted the vital role of oxygen in treating patients with severe and critical COVID-19. This has been an area of intense focus for WHO since the beginning of the pandemic. Patients with severe and critical COVID-19 cannot get enough oxygen into their blood by breathing normally. They need higher concentrations of oxygen and support to get it into their lungs. Left untreated, severe COVID-19 deprives cells and organs of the oxygen they need, which ultimately leads to organ failure and death. Medical oxygen is produced using oxygen concentrators, which extract and purify oxygen from the air. WHO estimates that at the current rate of about 1 million new cases a week, the world needs about 620,000 cubic meters of oxygen a day, which is about 88,000 large cylinders. However, many countries are now experiencing difficulties in obtaining oxygen concentrators. 80% of the market is owned by just a few companies, and demand is currently outstripping supply. WHO and the UN partners are working with manufacturers across the world through a variety of private sector networks to buy oxygen concentrators for countries that need them most. Ongoing talks with suppliers in recent weeks have enabled WHO to buy 14,000 oxygen concentrators, which will be sent to 120 countries in the coming weeks. WHO has identified a further 170,000 concentrators that can be available over the next six months with a value of $100 million US dollars. In addition, WHO has bought 9,800 pulse oximeters, a simple device used to monitor oxygen in patient’s blood, which are being prepared for shipment.

Dr. Tedros: (04:01)
Another challenge that many patients with critical disease need a higher flow rate of oxygen that is produced by most commercially available concentrators. To address this challenge, WHO is supporting several countries to buy equipment that will enable them to generate their own concentrated oxygen in larger amounts. This is a sustainable solution for COVID-19 and beyond, but requires technical expertise for maintenance. WHO has also published technical specifications for the design of this equipment, as well as guidance for countries on oxygen sources and distribution. This is just one way in which WHO is continuing to support countries with science, solidarity, and solutions.

Dr. Tedros: (04:52)
As some countries start to reopen their societies and economies, questions about how to hold gatherings of large numbers of people safely have become increasingly important. This is especially true of one of the world’s largest mass gatherings, the annual Hajj pilgrimage. Earlier this week, the government of the kingdom of Saudi Arabia announced that this year’s Hajj will proceed with a limited number of pilgrims of different nationalities who live within the kingdom. This decision was made based on a risk assessment and analysis of different scenarios in accordance with WHO’s guidance to protect the safety of pilgrims and minimize the risk of transmission. WHO supports this decision. We understand that it was not an easy decision to make. And we also understand it is a major disappointment for many Muslims who are looking forward to making their pilgrimage this year. This is another example of the hard choices that all countries must make to put health first.

Dr. Tedros: (06:09)
Finally, tomorrow, the government of the Democratic Republic of the Congo is planning to announce the end of the Ebola outbreak in the east of the country after almost two years of struggle. In total, there have been almost 3,500 cases, almost 2,300 deaths, and almost 1,200 survivors. WHO is proud to have worked under the leadership of the government of the DRC to bring this outbreak under control. This has only been possible thanks to the service and sacrifice of thousands of Congolese health workers working side by side with colleagues from WHO and many other partners. I salute them all.

Dr. Tedros: (07:02)
Many of the public health measures that have been successful in stopping Ebola are the same measures that are now essential for suppressing COVID-19. Finding every case, isolating every case, testing every case, caring for every case, and relentless contact tracing. These are the measures that must remain the backbone of the response in every country. There are no shortcuts. But Ebola and COVID-19 are only two of the health threats facing the people of DRC and many other low and middle income countries. That’s why WHO is committed to continuing to work with the people and government of DRC to strengthen its health system and support it on the road to universal health coverage. I thank you.

Tarik: (08:05)
Thank you, Dr. Tedros, for these opening remarks. We will open the floor for questions now. We wish to remind you if possible to be short and have one question per person. And again, you can ask your question in six UN languages plus Portuguese if you wish to do so. We will start with Peter Kenny who works from Anadolu today. Peter, do you hear us?

Peter Kenny: (08:37)
Yes. Can you hear me?

Tarik: (08:39)
Yes.

Peter Kenny: (08:40)
Thank you. I would like to ask my question about research on vaccines in Nigeria at Adeleke University in Nigeria’s Ede state. They’ve discovered a vaccine. I would like know about what type of research is going on in Nigeria and in other African countries. Thank you.

Dr. Maria Van Kerkhove: (09:06)
Thank you for the question. I can’t answer specifically about the vaccine that you mentioned in Nigeria, but I can tell you that we are working with researchers all over the world, including many researchers across Africa, across a number of tactical areas, whether this is through epidemiologic studies and seroepidemiologic studies, whether it’s clinical research, whether it’s the development of vaccines. And so while I don’t have anything specific on your specific question, I can tell you that we are deeply engaged with academics, with public health professionals across Africa who participate in our international networks and who also participate in our R&D networks where we accelerate the advancements of research for COVID-19.

Tarik: (09:55)
Thank you, Dr. Van Kerkhove. Peter, if you send us an email, we may try to look for particular information on this through our regional office as well. Let’s now turn to Antonio [inaudible 00:10:10] from EFE News Agency. Antonio? Antonio, can you just unmute yourself?

Antonio: (10:27)
[Spanish 00:10:34].

Dr. Michael Ryan: (10:37)
I can begin. Maria will follow. I think it’s difficult, number one, to predict the number of deaths, per se. But what we can do is the epidemic in the Americas in general is still intense. It’s particularly intense in Central and South America, and it’s across a range of countries. And we’ve seen a steady and worrying continuation of trend with many countries experiencing between 25% and 50% rising cases over the last week, which means many, many countries in Central and South America and the Americas in general are still suffering sustained community transmission. And as such, the journey for them is, unfortunately, the pandemic for many countries in the Americas has not peaked. They are not reaching a low level of transmission.

Dr. Michael Ryan: (12:03)
They are not reaching a low level of transmission within which we can achieve a sustainable exit from public health and social measures or extreme public health and social measures, so I would characterize the situation in the Americas in general and in Central and Latin America in general as still evolving, not having reached its peak yet and likely to result in sustained number of cases and continued deaths in the coming weeks. The extent of those deaths and trying to predict those numbers I think is not helpful at this point, but again, we would really stress to governments in the Americas that there needs to be an all-of government approach. There needs to be very clear communication with citizens around the measures that have to be taken for self-protection for community response. There needs to be a very sustained investment in public health infrastructure and the capacity to isolate, or tests and trace and isolate and a capacity to quarantine contacts.

Dr. Michael Ryan: (13:11)
It is very difficult to take the sting out of this pandemic or out of this epidemic in the country unless you’re able to successfully isolate cases and quarantine contacts. In the absence of a capacity to do that, then the specter of further lockdowns cannot be excluded, and really, I don’t think anybody wants to go back to population-wide, society-wide lockdowns, but the only way in some circumstances to avoid that now is a very, very, very aggressive investment in our capacity to detect cases, confirm cases, quarantine contacts, and keep our communities onboard and willing, able, without coercion, to support clear messaging and clear instructions and requests from government in a trusting environment. I can’t stress that enough.

Dr. Maria Van Kerkhove: (14:07)
Only to add I fully endorse everything Mike has just said. The only thing to add is a worrying trend we’re seeing in the number of positive cases for COVID that’s coming from the respiratory disease surveillance system, the ILI or the SARI surveillance system. In PAHO, in the Americas, the positivity rate is between 30 and 40% of those samples that are tested for ILI or influenza-like illness, or SARI, severe acute respiratory illness. This is outside of the active case finding for COVID-19.

Dr. Maria Van Kerkhove: (14:39)
That means that the virus is circulating, and in many countries in the Southern Hemisphere and the Americas, they’re entering their flu season, they’re in their flu season, so you will see an increase in respiratory diseases, which will complicate the ability to care for them because you may not know if somebody has influenza or if they have COVID-19, and so that will make the picture even that more difficult to understand, which is why it’s so important that surveillance systems that Mike has outlined are in place for COVID-19, but also that systems are also testing for influenza. It is difficult to give one a summary of a large region with many countries and many different climatic zones, which are some are dealing with influenza and others are not.

Speaker 1: (15:28)
Thanks. We’ll now turn to Maya Plentz from UN Brief. Maya. I understand. Let’s just try one more time with Maya if it’s possible. If not, then let’s move to [inaudible 00:15:53], and then we have [Emma Farsh 00:15:54]. Emma, can you hear us?

Emma Farsh: (16:00)
Good afternoon. I have a question for Mike Ryan, if I may. Dr. Ryan, in the past, you used the term driving blindly to describe some countries moving out of lockdowns, and I’m wondering, given the concerns raised by the medical community in the UK, does that description apply there? Thank you.

Dr. Michael Ryan: (16:28)
It’s difficult to make specific comments on individual governments, but I would say in the United Kingdom has been very much guided by a very steady, slow stepwise exit from lockdown conditions. The government did set out some very specific parameters or metrics for how they would do that. I think they’ve communicated those to populations, certainly to us. In the different four-home regions there, you have England, Wales, Scotland, and Northern Ireland. The chief medical officers and the governments in those four entities have worked together in a consistent way to implement that if some slight modifications of that.

Dr. Michael Ryan: (17:13)
From that perspective, testing in the UK has increased. I believe the surveillance system is capable of understanding where the disease is. I think the question we ask now for many countries is, is the public health system not just doing testing, but it actually detecting cases as soon as possible after those cases become unwell? Are we immediately identifying their contacts? Are we in a position to quarantine contacts? In other words, the contacts are either quarantined at home or quarantined in a third place or a second place, and are contacts supported in that quarantine and traced over that time with or without the support of electronic tools or apps.

Dr. Michael Ryan: (18:04)
I think this is a question that’s facing many countries now because countries have fought hard, including the United Kingdom, have fought very hard, and populations have sacrificed a lot to drive transmission down. It’s taken time. It’s taken its toll on people personally. It’s taken its toll on communities. It’s taken its toll on the economy. The reward for that are low levels of transmission across society, but as we’ve seen, the risk of that jumping back up in particular circumstances, in crowded situations, superspreading events, so we must be able to reap the harvest as such of such a sacrifice to shut down and lockdown and drive transmission down to a low level.

Dr. Michael Ryan: (18:51)
That transmission needs to be kept at that low level and driven even further down. That is going to require extreme vigilance. It’s going to require community staying on board, individuals understanding their responsibility, their contribution to their own protection, to the protection of others, the communities are involved in this process and taking ownership and feeling empowered and supported by the authorities and that the authorities are able to react quickly to each and every case, confirm the presence of the disease or not as quickly as possible, turn around testing very quickly, and isolate cases when confirmed, and identify all their contacts and quarantine those contacts.

Dr. Michael Ryan: (19:31)
I’m sorry for continuing to repeat this, but there are no silver bullets. There are no easy answers. Each government, including the UK, needs to examine itself every level and say, “Are we capable of doing that? Is every part of the system able to keep its promise?” I, as an individual, promise to keep myself safe, and I promised to do everything to keep other people safe. Communities promise themselves that they will keep each other safe. Governments promise citizens that they will keep their citizens safe.

Dr. Michael Ryan: (20:02)
Everyone has got to now live up to the promises they make, the commitments they make, and people have got… everyone at every level needs to follow through because what we’ve seen in countries that have implemented comprehensive strategies that have reacted quickly, that have operated across multiple levels of strategy, implemented all of the things that I’ve just previously mentioned, they’ve done reasonably well, and they’ve avoided the worst of the lockdowns.

Dr. Michael Ryan: (20:28)
I think we’ve all collectively learned a lot. The issue now, and the Director-General is leading a process inside our house right now really looking at this what have we learned in the last six months, what have we learned through all of these sacrifices, what have we learned about the virus, what have we learned about how to control the virus, what have we learned about our capacity at community and government level to sustain response in a coherent way, in a coordinated way? What have we learned about that?

Dr. Michael Ryan: (20:58)
Are we willing now to learn those lessons and face the next six months with the resources we have? We have the tools to suppress the transmission of this virus. We hope, dearly, we will get an effective vaccine, but we cannot count on that, and the Director-General has challenged us internally and will challenge our partners to have that discussion in the coming weeks so that we can face into the summer and into the autumn and into the rest of the year using the tools that we have in the best possible way. In summary, I would say, yes, the UK has taken a stepwise approach. UK is listening to science. Science is still driving decision-making, and yes, every government, every level, there are setbacks, there are surprises, but the stepwise approach in the UK is the right way to go. We just hope that all systems, including the UK, can put in place the necessary surveillance to support this going forward.

Dr. Maria Van Kerkhove: (22:00)
To just briefly to add some of the things that we are learning, because it is important that we look and we learn from many others, and one of the things as countries are lifting the lockdown in this slow and staggered way that we’ve been talking about is the ones that are seeing some success are doing this in a data-driven way. They’re using indicators. They’re using values of transmission, not only the numbers of cases that are declining, but the numbers of deaths. What are those trends look like looking at the reproduction number over time, looking at their testing. Are they seeing a large proportion of those tests that are actually carried out positive, or is it at a low level? They’re looking at their bed occupancy. How full are the hospitals in terms of dealing with mild patients or even severe patients needing ICU? What are the other isolation facilities and quarantine facilities? Are they full? How many contacts are traced? How many cases are coming from contact lists.

Dr. Maria Van Kerkhove: (22:59)
These are helpful indicators to know where you are in your transmission scenario, and while doing this, we’re seeing countries take this phased approach, you’ve seen phase one, two, three, four, and the slow movement of those phases, periodic, looking at it after a few weeks, can we move to the next phase, are we seeing that low level of transmission, and all the while having this direct engagement with their populations, and with their neighbors, the populations either in a neighboring province or a neighboring state or a neighboring country, are they seeing the same levels of low suppression of transmission?

Dr. Maria Van Kerkhove: (23:34)
All of this is quite helpful in terms of helping others to see how is it working in your country so that we can learn from each other, but this is what we mean by a data-driven approach, constantly looking at the epidemiology, constantly looking at the data that is being collected to determine what is that next step. Can we lift even further, or do we actually have to implement again, and keeping the population engaged that they know exactly what they need to do in each phase.

Dr. Maria Van Kerkhove: (24:00)
…in each phase.

Tarik: (24:04)
Many thanks. We will now go to Mexico. We have Paulina [inaudible 00:24:07]. Paulina, can you hear us?

Paulina: (24:16)
Ola.

Tarik: (24:17)
Ola.

Paulina: (24:20)
[foreign language 00: 00: 17].

Dr Janet Diaz: (25:06)
Thank you for that. It’s actually an incredibly important question to understand how to keep essential health services going. There are chronic conditions that those patients need to continue to have, they’re care continued. And this type of situation you consider alternate delivery platforms such as telemedicine, nursing calls, telephone calls, other ways in order to ensure that the patients can get the medical care that they need for their chronic conditions. In addition, when you consider even prescriptions, if you usually give one month of prescriptions and the alternative would be to give three months of prescriptions or six months of prescriptions in order to ensure that those patients can continue their medications. And I will refer you to our colleagues here have published operational guidance on how to maintain essential health services with very easy to use checklists and other essential information that are looking at these different types of patients that may have more limited access during the COVID pandemic.

Tarik: (26:22)
Thank you very much. This was Dr. Janet Diaz, our head of clinical care. And now we will go to Brazil. Bianca [inaudible 00:26:32] from Global. Bianca.

Bianca: (26:39)
Hi Tarik, can you hear me?

Tarik: (26:41)
Yes.

Bianca: (26:43)
Thanks a lot for taking my question. Dr. Ryan said that the Latin America has not yet reached the peak. I would like to ask you Dr. Ryan, could you comment specifically about Brazil? How far is Brazil to reach the peak? Some said July, August. Do you have something in mind?

Dr. Michael Ryan: (27:12)
Again, thank you for the question, but it’s very difficult to predict peaks. If you look across Europe, you look across the rest of the world, you look across the Americas, the peak has an awful lot to do with what you do. What you do affects the peak. It affects the height of the peak, it affects the length of the peak and it affects the trajectory downwards. That is everything to do with the government’s intervention to respond, the community’s cooperation with that intervention and the health care and public health care systems capacity to act. The virus doesn’t act alone. The virus exploits weak surveillance. The virus exploits weak health systems. The virus exploits poor governance. The virus exploits a lack of education and a lack of empowerment of communities.

Dr. Michael Ryan: (28:10)
Those are the things we need to address. If we address those things systematically, the numbers will go down. That is what’s happened. That is the reality of this pandemic. The numbers respond to response and there are no magic answers. There are no spells here. You can’t divine this away. We have to act at every level. We have to use the resources at our disposal. And we know from many, many country examples, not from WHO, just look around the world, look at the countries that have taken action. Look at the countries that have contained and controlled this disease and you’ll find your answers.

Dr. Maria Van Kerkhove: (28:58)
I just want to add that, again, fully endorsed with Mike has just said that transmission is completely in our hands and it’s not only in our individual hands, but what we do as individuals to prevent ourselves from getting infected, to prevent our families, our communities, our populations. And we have outlined steps that need to be taken at each level of transmission. We’ve just published an update of this guidance today, which is focused on critical preparedness readiness and response actions based on if you are in a situation of no cases, either you haven’t had cases yet or you’ve actually brought those cases down to zero. Where you have sporadic cases, where you have clusters of cases, where you have community transmission. And in this document, it outlines actions, detailed actions that need to be taken for everything from your emergency response mechanisms, risk communication, surveillance, IPC, clinical care, public health measures.

Dr. Maria Van Kerkhove: (29:55)
And there’s a link to every additional guidance that WHO and our partners have put out. And it’s the closest thing we have to an actual action checklist that’s online. And just to highlight that there are so many things that we can do and we need to highlight this. We have tools right now in our toolbox right now to be able to suppress transmission. And so it relates to your question about the peak. We get a lot of questions about the peak in this country or that country or globally. The one thing we shouldn’t do is predict because we need to do everything we can do to suppress this transmission and make any of these predictions that have come up from these models, not be a reality. So I encourage you to find this on our site and we can send it the list. But this is the closest thing we have to an actual checklist of what you need to do, what all countries need to do to suppress transmission and to save lives.

Tarik: (30:50)
Thank you. Next question is from Health Policy Watch. We have Gracie with us. Hello Gracie.

Gracie: (31:01)
Hi, thank you so much for taking my question. Can you guys hear me okay?

Tarik: (31:06)
Yes.

Gracie: (31:07)
Hi. So we’ve heard kind of reports of coughing, shortness of breath, normal COVID symptoms persisting in patients who have recovered, but we also know that the virus can infect organ systems outside the lungs like the nervous system and cardiovascular system as recent studies using organ models have shown. And there have also been reports of people experiencing severe neurological symptoms while infected by COVID. So can you speak a little bit more about what is known about the longterm effects of the virus on organ systems outside the respiratory system? Thank you.

Dr Janet Diaz: (31:49)
Thanks for, again, one of the big priority right now is for us to better understand the patients who have recovered from COVID and what kind of potential deficits they may have. As you’ve described already, the different types of deficits can be neurological. They can be respiratory, some impaired lung function. They can be physical if someone has been in the ICU, for example, for four to six weeks. A lot of deconditioning, immobility, those can really impact the physical functionality of patients in the mid or longterm.

Dr Janet Diaz: (32:26)
So right now, one of the priorities of the WHO clinical research working group, and we actually in fact had our meeting today, was presenting the studies that researchers are doing now to understand this. And what we’re trying to do is to create standardized data capturing systems or case records systems to be able to capture this information globally, to better understand the disease, characterize the disease. Well, the recovery phase of the disease. So I can say this is definitely a priority topic that we are working with international experts around the world to facilitate and to accelerate our understanding.

Tarik: (33:06)
Thank you, Dr. Diaz. We will now go to Jamey Keaton from Associated Press. Jamey.

Jamey Keaton: (33:16)
Can you hear me?

Tarik: (33:17)
Yes.

Jamey Keaton: (33:18)
Nice to speak with you again. This is for Mike and Maria. We have noticed that the epicenters appears to be lasting longer in the Americas than it did in China or in Europe. What accounts for the longer epidemic in the Americas? Thanks.

Dr. Michael Ryan: (33:39)
Thanks, Jamey. Nice to hear from you. Again, it’s very much depending on the country, on the arrival of the disease. It also depends on just the natural connectivity in countries. And it may take longer for a disease to spread around the country where connections and infrastructure does not allow disease to spread as quickly. There are other countries in which the disease can move extremely fast within a given country because of public transport, air and other links. So there are natural factors that might drive transmission. There are also, obviously, factors to do with how densely populations are packed and having mega cities or pockets of poverty in which disease can potentially spread undetected. If you have a situation where you’re not able to detect all your cases, then obviously the disease can burn on in areas undetected and then pop up again in other places and then the epidemic can extend.

Dr. Michael Ryan: (34:44)
But if you look at the epidemic in Europe, it lasted quite a while. You’re talking about the first cases in January in some European countries. And it’s only in the last couple of weeks that we begin to see the disease going down. If you look more broadly in Europe and we tend to be biased, and we look at Western Europe where we look at the European Union. But actually if you go further East and you go to the Western Balkans, if you go to some countries in central Europe, if you go to the Russian Federation, if you go to Moldova and other countries, there is still a rising incidence in some of those countries. And certainly in some central Asian republics, which are part of the European continent as such, the epidemic still goes on at higher levels.

Dr. Michael Ryan: (35:25)
So it really depends how you define a continent. I would say that the disease has come under control in Western Europe. It is not certainly under control, in general, in Central and South America, but there are factors that would allow a disease to sustain itself for longer in a given community. And in the end, as I said, in the previous statement, it also depends on the comprehensiveness, the speed, comprehensiveness and investment in a comprehensive response, and really sustaining a response or a period of weeks and months that allows you to bring the disease under control. And that’s obviously the final factor that you need to shorten-

Dr. Michael Ryan: (36:03)
And that’s obviously the final factor that you need to shorten any given epidemic.

Tarik: (36:09)
Thanks and indeed, we have most of questions coming from North and South America. We have now David Waldstein from New York Times. David.

David: (36:19)
Hi, thanks very much. I’m wondering in terms of the oxygen, I’m wondering if there’s any sense that if Dexamethasone proves effective, if that could alter the longterm projections for the need of oxygen.

Dr Janet Diaz: (36:42)
Thanks. It’s an excellent question. I think we will have to see the results of The RECOVERY Trial, the preliminary results are quite remarkable that this is a lifesaving intervention in severe and critical illness. What you’re asking is whether or not that will reduce progression of disease and that will reduce the general estimates of need of oxygen. So we’ll have to see. We’re working with many different experts on how to best model this, how to best forecast the oxygen need, and also understand the capacity at country level in order to make that gap assessment more accurate. So this is ongoing work and I think as we will continue to refine our tools and also take into account potential treatments that may impact that estimate.

Dr. Michael Ryan: (37:38)
If I could just add on this, because we tend, we get positive information on Remdesivir and then we all chase that for a while and then we get stuff on Dexamethasone and then we have a discussion about oxygen. And then we have a discussion about other things. I think we need to really start seeing this as, how do we optimize the clinical management of all patients who become sick? From the very moment that someone feels sick, getting an early diagnosis, being able to see a qualified physician or nurse, and understanding that physician or nurse, being able to understand your underlying conditions, your likely risk, and being able to put you into a pathway to see and seek and have the right care available. Because it’s not just about having oxygen in a country or having a drug in a country.

Dr. Michael Ryan: (38:27)
It’s about making sure that the right patient gets access to that intervention at the appropriate time, during the course of the illness. And when you put all of those small interventions together, rapid diagnosis, early hospitalization of those patients who may have risk factors, early oxygen therapy when needed, and then the use of other drugs and other supportive care, including ventilation, Dexamethasone. And if we’re capable of putting all of those interventions together and ensuring even in least developed situations, even in humanitarian situations, we can deliver a basic standard of care to every person who gets COVID-19, then we will save a lot of lives. When we look at Dexamethasone and we look, it reduces death rates by one fifth in people who are already on oxygen. That’s great, but by itself, it’s not a solution. If we look at Remdesivir, it reduces the length of illness in a proportion of patients.

Dr. Michael Ryan: (39:26)
That’s great, but it’s not enough. But if we put different therapies together, different interventions together, and we deliver them in a fair and equitable way, then I believe we can do much more. So I think we need to look at, and again, Dr. Tedros has challenged us on this over the last number of days, how can we put together all that we have learned to reduce mortality? And reduction of mortality starts at protecting those people most at risk, shielding people first and foremost, from the infection, so they never get it. And that’s how you reduce mortality. And you start there and you work your way forward. And we need a really comprehensive look at, what is affecting mortality? And what’s affecting mortality is not always just the fact that a drug exists or an intervention exists. There’s no point knowing that oxygen works if you’re in a refugee camp in Somalia and you have no access to oxygen. That’s no good. Knowledge is no good without the actual resource available to the doctor or nurse.

Dr. Michael Ryan: (40:33)
So we have to turn knowledge into knowhow and knowhow into how to, and we need to turn the how to into the materials and the resources that are needed in order to affect the mortality outcomes in this disease. So I think it’s really important and Janet and her team are really looking at how we can put that system of, you were saying yesterday Janet, the structures, the supplies, the system, the security, and all of the elements of an effective clinical management system. And we’ve learned so much about how to do that better. We just need to apply it now in a much more systematic way especially for those people who live in fragile, conflict-affected, vulnerable settings, who may not have access to healthcare like others around the world may do.

Tarik: (41:17)
Many thanks and for our last question for tonight, we will stay in the United States. We have Jim [inaudible 00:41:24] calling us from the West Coast network of radios, [inaudible 00:05:26]. Jim.

Jim: (41:29)
Hi, thank you very much and good evening to everyone. One of the problems that I’m seeing is competing science quote unquote, meaning if we hear you talk and we hear the public health officials talk yet and I’m sure you’ve heard this too and maybe you’ve seen it on television or radio, you can find someone that will claim they have science that can fill the narrative of whatever it is you believe. And I think that’s part of the problem that I’m seeing with people refusing to wear face masks or face coverings or physical distancing is, how do you convince people that the pseudoscience or fake science or twisted data science is something they should not pay attention to and understand where the real science is and the real messages are? I hope I articulated that well enough.

Tarik: (42:19)
You certainly did.

Dr. Maria Van Kerkhove: (42:23)
It’s really a fantastic question. It’s really a fantastic question. We are living in a time right now where there’s so many different groups that are carrying out really incredible research, real time research right now for a new virus that we didn’t know anything about six months ago. And we are learning about severity, we’re learning about transmission, we’re learning about treatments, we’re learning about every aspect of this virus. And it’s happening at an incredibly rapid pace. And so that’s very positive. We’re seeing innovation in areas that we hadn’t seen before. You’ve mentioned the use of masks and we talked about different types of fabrics. That didn’t exist a few months ago. We’re seeing innovation in therapeutics and in vaccines and this is really incredible. We’re seeing real time evaluation of full genome sequences and it’s happening at an incredibly rapid pace. Papers, through science.

Dr. Maria Van Kerkhove: (43:20)
When people are doing research, normally what happens is they carry out a specific piece of work with a collaborative group of individuals. They write this up, they write it up as a report, they submit it to a peer review journal. The paper goes through a robust analysis and review critiquing every single line and every single word of that paper. And then the authors respond and then it gets published. And that takes some time. What we’re seeing right now is because we need these answers so quickly, we’re seeing a lot of answers come out in the form of a press release. We’re seeing the answers come out in the form of preprints. So these are these online platforms where you could publish or you could post your paper and it hasn’t gone through peer review. So on the one hand, that’s incredible because we’re seeing these results in real time and the other, it still needs to go through that rigorous review.

Dr. Maria Van Kerkhove: (44:12)
And so WHO, we commission a lot of research, a lot of reviews that are done by independent groups on a variety of topics. And we have more than 50 reviews that are currently underway on a variety of topics. And this helps us to better understand the state of a particular topic transmission for example. Then what we do is we work with our international networks which we have for clinical management which Janet leads, for virology, for infection prevention and control, for risk communication, for epidemiology and modeling. And I can go on and on. And we debate that research. And that research is constructive. And that’s not a negative term when I say debate. It’s a constructive that we have to say, “What does this mean? How well was this study done?” Because not all studies are done well. And we evaluate what this means in terms of our advice that we give for guidance. And that also takes some time.

Dr. Maria Van Kerkhove: (45:09)
We’re accelerating that as quickly as possible, but it’s an important process to go through where you have that debate and you discuss how each individual piece of knowledge fits into the broader context. Normally one paper that comes out doesn’t change our perception of everything. However, there could be situations like the Dexamethasone for example is a good example where we’re learning something quite quickly and that may modify how we go forward. But with regards to epidemiology and virology, we put all of that research together, we evaluate it together, and then we come up with a position on, what do we know about this at the present time?

Dr. Maria Van Kerkhove: (45:50)
The other thing that I need to mention is that science, although it’s not static, we need to articulate the uncertainty around what we know. So not only are we trying to put out all of the information that we’re learning, we need to caveat that because it’s a new virus with some uncertainty. Nothing is for sure right now. And so when we give advice and when we give an answer, especially us sitting up here, and we give these answers, we try to nuance that in a way that says, “Here’s what we know right now. Here’s what we don’t know. And here’s what we’re doing to better understand this.”

Dr. Maria Van Kerkhove: (46:24)
So it’s a very long answer because we feel quite passionate about this, but just to end by saying we’re really grateful for all of the researchers that are carrying out very carefully conducted research, that are doing this so thoughtfully, really to advance science going forward.

Tarik: (46:44)
Thank you very much Dr. Van Kerkhove for this very important explanation on this very good question from Jim. So we will conclude our press briefing here with the audio file being sent shortly and transcript being posted tomorrow from my side. I wish you a very nice evening.

Dr. Tedros: (47:03)
Thank you. Thank you Tariq and thank you all for joining and see you in our next session. Thank you.