World Health Organization (WHO) Coronavirus Press Conference June 3

Dr. Tedros: (03:27) ... new and updated technical guidance based on the most up to date evidence. Just in the past week, WHO has released a new case report form for suspected cases of multi-system inflammatory syndrome in children, operational guidance on maintaining essential health services, guidance on controlling the spread of COVID-19 at ground crossings, planning recommendations for mass gatherings, a protocol for surveillance of infections among health workers, ethical considerations for the use of digital technologies in tracking COVID-19 and updated guidelines on the clinical management of patients with COVID-19. This is an update of the guideline we published in March. It includes a COVID-19 care pathway, which describes the steps followed by a patient from screening to discharge to ensure delivery of safe and quality care while stopping onward transmission. WHO continues to train millions of health workers all over the world to apply our guidance. Our open WHO.org online learning platform has now registered three million enrollment for our courses on COVID-19, and we have added two new courses. One on decontamination and sterilization of medical devices and another on our environmental cleaning and disinfection. In total, we're now offering 12 courses in 27 languages. In the past week, we launched COVID-19 courses in Amharic, Arabic, French, Hausa, Macedonian, Odia, Spanish and Vietnamese. Dr. Tedros: (05:36) As you know, last week, the executive group of the Solidarity Trial decided to implement a temporary pose of the hydroxychloroquine arm of the trial because of concerns raised about the safety of the drug. This decision was taken as a precaution while the safety data were reviewed. The Data Safety and Monitoring Committee of the Solidarity Trial has been reviewing the data. On the basis of the available mortality data, the members of the committee recommended that there are no reasons to modify the trial protocol. The executive group received this recommendation and endorsed the continuation of all arms of Solidarity Trial, including hydroxychloroquine. The executive group will communicate with the principal investigators in the trial about resuming hydroxychloroquine arm of the trial. The Data Safety and Monitoring Community will continue to closely monitor the safety of all therapeutics being tested in the Solidarity Trial. So far, more than 3,500 patients have been recruited in 35 countries. WHO is committed to accelerating the development of effective therapeutics, vaccines and diagnostics as part of our commitment to serving the world with science, solutions and solidarity. Thank you. Tarik: (00:00) Thank you Dr. Tedros, for these opening remarks. We will proceed with the questions. I will ask journalists to be a short, concise, and to have only one question, so we can take as many as possible. And to remind you that you can ask questions in 6 UN languages and Portuguese, if that is easier for you. So if we are okay, we will start with a reporter from Saudi Arabia. We have Mohammad online from Riyadh News Agency. Mohammad, can you hear us? Mohammad: (00:35) [foreign language 00:00:45]. Tarik: (00:45) Yes, please. Go ahead. Yes, we can hear you well. Mohammad: (00:48) [foreign language 00:00:54]. Speaker 1: (00:48) Yes. Mohammad: (00:48) [foreign language 00:01:01]. Dr. Michael Ryan: (01:22) Maybe I can start and Dr. Soumya can supplement. While I respect the spirit of your question, I think we need to be very careful of making associations like you've just made, because to assume that the use or not of a drug in general in the country is resulting in increases or decreases of cases is not something that one can do, quite frankly. What we have done as WHO and many other researchers around the world and national authorities have done is put in place randomized control trials in order to test which drugs are effective and which drugs actually help patients and save lives. We thank all our partners around the world who are participating in the solidarity trials, but there are other recovery trials and other discovery trials happening right around the world to look at what are the most effective drugs in use right now against COVID-19. With regard to the specific issue of hydroxychloroquine in this trial, Soumya may wish to add more detail regarding that. Dr. Soumya Swaminathan: (03:04) I think just to add to what Mike said, as of now, there is no evidence that any drug actually reduces the mortality in patients who have COVID-19. And in fact, it's an urgent priority for all of us to do the needed studies, to do the randomized clinical trials in order to get that evidence as quickly as possible. So WHO is very much in favor of and encourages the continuation of randomized trials that are looking at a different drugs to reduce mortality, but also to reduce the severity of the illness. And these are the big public health questions that we are trying to answer. Dr. Soumya Swaminathan: (03:52) And again, to repeat what we've been saying all along observational studies have limitations. You can do analysis, but there are so many potential biases in the way that patients are managed in regular clinical setting, that the only way to get definitive answers is to do well conducted randomized trials. And it's particularly important in emergency settings to do these because that's the only way to find out what really are those drugs or those strategies that will reduce illness, that will reduce infection rates in communities. And we should be guided by the science and by the evidence. Speaker 1: (04:39) Many thanks for this. Now we will go to Brazil to from Laura [inaudible 00:04:44] from Global. Laura? Laura: (04:49) Hello? Can you hear me? Speaker 1: (04:50) Yes. Laura: (04:53) Good afternoon. Thank you for taking my question. My question is actually about the new drug, which Russia actually approves to treat COVID-19 and they claimed it was effective against it, but I want to know what the current position of WHO is. And also they said that the number of patients tested for it, it was 330 people. I wanted to know also if this was a big enough sample to actually test a drug's effectiveness. Thank you. Dr. Soumya Swaminathan: (05:36) So we have received information that [inaudible 00:05:43], which is similar to [inaudible 00:05:49], has been tested and that the drug that's actually been created by the Russian Direct Investment Fund in conjunction with the Chemical Diversity Research Institute will be provided in Russia in hospitals very soon. It's been developed and tested in clinical trials in Russia, and we would very much like to see and would be keen to see the results of those trials and are eager to know if there are drugs that are effective and safe for the use of COVID-19 patients. Mary or Mike might like to add anything. That's the information that we have at the moment. Speaker 1: (06:27) Thank you, Dr. Soumya. Next question comes from All African Mews and we have Tammy online. Hello, Tammy. Would you be able to unmute yourself please? Tammy: (06:49) Hello? Yes. Speaker 1: (06:51) Yes. It's okay now, we can hear you. Tammy: (06:52) On the many reasons that you are trying so many therapies and trials for COVID-19, including hydroxychloroquine if it can be done safely and our counseling caution and lifting lockdown to too quickly, is one a danger that the more the virus spreads, the greater the likelihood that it could [inaudible 00:07:17] more dangerous? Speaker 1: (07:21) Can you just repeat the question? You just got broken at the end of your question. Tammy: (07:29) Yes. Sorry. You heard the first [inaudible 00:07:34]. Speaker 1: (07:43) Tammy, I'm afraid we lost you. Are you still with us? Tammy: (07:49) I am with you. Can you hear me? Speaker 1: (07:50) Now we can. Let's try one more time, please just define a part of your question. Tammy: (07:57) Okay. Just the last part is among the reasons that you're doing all the things that you're doing, the danger that the more the virus spreads, the greater the likelihood that it could mutate and like make it more dangerous, or is that a concern behind the many therapies you're trying and [inaudible 00:08:18] and the advice that you're giving on various levels? Speaker 1: (08:22) Thank you very much, Tammy. We finally got the question. Dr. Maria Van Kerkhove: (08:26) Thank you, Tammy, for the question. I'll start. And perhaps others would like to supplement. The first part of your question around as the more the virus spreads, there's more of a chance that it can mutate. We've been discussing here at these pressors that there's a large number of scientists and virologists who are looking at full genome sequences of the virus that are available, that are being shared by countries all over the world. There are more than 40,000 full genome sequences that are available. Some of those are available on GISAID. And some of those are available on other platforms in which scientists are looking to see are there changes in the virus. And as it is a Coronavirus, it is an RNA virus, there are normal changes in this virus that one would expect over time. None of these changes so far indicate that the virus itself is changing in terms of its ability to transmit or to cause more severe disease. Dr. Maria Van Kerkhove: (09:20) But there are many people who are looking at this and are looking at the fine details of the sequence itself to follow up and to discuss whether or not any of these changes can reflect a change in its behavior. But I do think an important point not related to the sequence and your question about with the more time that this virus circulates, can it become more dangerous? And I think part of that answer is yes, because people grow tired. It's very difficult to keep up all of these measures and we must remain strong and vigilant to have governments fully engaged and people fully engaged. As these lockdowns are lifted, that has to be done in a slow way. And in some situations, these measures, these public health and social measures may need to be reintroduced again. Dr. Maria Van Kerkhove: (10:08) And that may frustrate people, which is completely understandable. And that in a sense could make the virus more dangerous because people become complacent. And it's important that no one becomes complacent. This is far from over, and we must continue to practice the hand hygiene and the respiratory etiquette, the physical distancing, listening to our leaders in terms of the measures that they have put in place. Stay home if you're unwell, and those are the types of measures that must remain in place. And so it's just more of a caution that it could become more dangerous if we become complacent. But the virus itself is stable, is relatively stable. There are changes that are expected, but they aren't changing, aren't mutating in a way that makes the virus more transmissible or more severe. Dr. Michael Ryan: (10:58) Yeah. If I could just supplemented because Dr. Tedros sitting beside me here has been saying again and again and again, that this is a dangerous, dangerous virus. It is dangerous enough as it is. And that's why we're fighting. All viruses evolve. They can evolve in one direction. They can evolve in the other direction. RNA viruses do mutates more quickly or evolve more quickly because unlike us humans who live with DNA that corrects itself, our cold can correct itself, RNA viruses don't have that natural error checking that goes on. And that gives them a disadvantage and an advantage. The disadvantage is they make a lot of mistakes and many of the viruses don't thrive or survive. But very occasionally, a mutation can lead to a virus becoming more effective in transmission or more virulent or less effective in transmission. And in general, in human infection, viruses tend to evolve to live with humans rather than do more damage. That would be a general process of viral adaptation because it's not in the virus' interest to do too much damage in the host. It wants to survive. Dr. Michael Ryan: (12:18) Having said that, as Maria said, the world's virologists are tracking this virus on a daily basis. Today, to my knowledge, we haven't seen any particular signal in the virus' behavior or in it's sequence that would lead us to believe that the virus is changing and its nature has changed in its transmission dynamics or changed in its lethality or virulence, as a virologist would call it. So in that sense, no, we're not saying that, but we are tracking that. It's an important issue as Maria said, but this is already a dangerous virus. We've been saying this consistently for months now. Speaker 1: (12:58) Many thanks. We will go now to Mexico and Paulina Alcazar from [inaudible 00:00:13:03]. Speaker 2: (13:03) To Mexico and Paulina Alcazar from Encadena. Paulina. Speaker 3: (13:08) Hello. [foreign language 00:00:10] Dr. Michael Ryan: (13:18) I can begin and Maria can follow. I think this virus spreads from person to person by the droplet or respiratory routes or often by the contamination of surfaces by someone who has symptoms or someone who's shedding the virus. So in that sense, being out in the open is a very good thing. Being out in the open air is a very good thing. It's good for one's general health. And I think it's good for avoiding infection as well, as long as you're not out in the open with thousands of other people crowded together, then yes, it's a good thing in general for health. So we could only encourage people in the right circumstances that that happens. And as countries open up, we've seen more and more, parks and other amenities have been opened to people, but I think it is important that you listen to local authorities. They have to manage these public spaces and they're precious public spaces, but they also have to keep those public spaces safe and allow people to mix in a safe way. Dr. Michael Ryan: (14:50) So yes, we should be using nature to heal ourselves and to heal our communities. But we also need to abide by the public health advice that authorities give for the use of those amenities. Maria. Speaker 2: (15:10) Well, thanks. We will go to India Today now. We have Ankit with us. Hello Ankit. Ankit: (15:16) Good evening. What do you have to say on the AP report published, it cited WHO recordings and claimed that in your own view, China delayed providing the details to the WHO by at least two weeks. Is the report factual and what is your response to this? Thank you. Dr. Michael Ryan: (15:39) Our leadership and staff have worked night and day in compliance with the organizations rules, regulations to support and share information with our member states equally and engage in frank and forthright conversations with governments at all levels. That's what I would like to say. Speaker 2: (15:58) Thank you very much, Dr. Ryan for this. Let's try to have Isabel from EFE News Agency. Isabel. Isabel: (16:13) Hello. Do you hear me? Speaker 2: (16:36) Yes. Isabel: (16:36) [foreign language 00:03:17] Dr. Michael Ryan: (17:01) I can begin. I think, first of all, when we look at Latin America in general, it's important and the Americas in general, it's important to distinguish as happened in Europe, as happened in Southeast Asia, the epidemic is not at the same stage of development in each and every country. The small island states in the Caribbean have done a superb job in containing the virus and in stopping disease and in saving lives. But we are very concerned about Haiti at the moment because of its unique circumstance, its unique fragility, and the fact that the disease is accelerating in a highly vulnerable population. And I think you can say the same on each sub-region for the Central America, similarly we are concerned about the disease situation in places like Nicaragua. However, we're seeing a different scenario in other countries. Similarly in South America, we see increasing continued intense community transmission in places like Peru and Brazil and in other countries. Dr. Michael Ryan: (18:06) We might've said the same thing a number of weeks ago in Europe or in North America or other places, why is the situation so bad? The epidemic has developed in each and every region or sub-region in a slightly different way, but what has been common to many regions has been intense community transmission. And it is clear that once that intense community transmission has been established, it's very difficult to root the virus out. And it takes a comprehensive strategy, not just public health and social measures that require us to have a highly involved and empowered community. It requires strong coordination and governance at government level. It requires all of society approach. It requires sustained commitment. And it also, even in those situations, even in those situations, you see particular settings in which the disease can take off and cause a tremendous amount of suffering and death. Dr. Michael Ryan: (19:04) We see that scenario in Europe and in North America in longterm care facilities. We've seen that emerge in closed settings, in detention centers, in others. So there are particular settings in which the disease can amplify and cause more difficulties. We've been saying again and advising since the beginning of this global epidemic, that it's this ability to implement a whole series of measures across society that allow a country to bring a disease under control, continue to suppress the virus and ultimately exit all of these measures. We've seen many, many, many good examples of that. And it's not that every country has done the same thing. What's been remarkable in this is that countries have done slightly different things according to their context. Dr. Michael Ryan: (19:58) But what countries that have been successful have done, is they've taken all of those measures. They've been very serious about community engagement. They've been very, very serious about educating people and bringing the community along with them. They've been clear in their communications. They've let the response be driven by science. They have implemented and tried to sustain surveillance and finding the virus at all times during the response, even though it's very, very difficult when you have very intense transmission. And they are focused on targeting their public health and social measures and sustaining those measures and only lifting those measures when they see indications that they're making progress. Dr. Michael Ryan: (20:36) So it's not one thing or another. So in terms of advising countries in Central and South America, it's about persistence, it's about consistency, it's about making sure that your messages are clear, making sure your community is on board, and ensuring that you're driven by science, driven by the evidence. That evidence is global in the sense that there are global facts and global knowledge, but it's also local. There's a local context and there's local learning. We need to adapt global knowledge, but we need to implement with local knowledge as well. And I think countries that have matched the global science with their local knowledge and they've been consistent and persistent in that, they're the ones that have had success. So there is no absolute recipe for success. There is no SOP. There is no algorithm that gives you success against this virus. It is a safe complex set of actions implemented by responsible governments, driven by science, who are prepared to sustain their action for as long as it takes to suppress and stop this virus. Dr. Maria Van Kerkhove: (21:50) If I might add, just to say, to supplement what Mike has said, that many countries in other parts of the world are exactly where countries in Latin America are right now in seeing some very intense transmission and outbreaks and we can learn from them and we can learn from each other. And what we've seen in many countries where the situation just seemed overwhelming. It was unclear where exactly the virus is. It just seems like it's everywhere. What we've seen many countries do is target their efforts and prioritize their efforts to find out, where's the highest concentration of this virus? Where's the highest concentration of the virus itself circulating? And what we know about this virus is that it likes close contact with people. And when the public health workforce and the testing strategy focuses on close settings and vulnerable people, and you start testing those appropriately, and you use your limited supplies and limited workforce in targeted areas, you can start to see the boundaries of where that outbreak actually is. Dr. Maria Van Kerkhove: (22:56) And that really helps focus all of the efforts for the contact tracers, for your testing strategy, mobilizing your clinical care facilities to care for individuals. And it helps narrow down the problem bit by bit and tackling this virus at the lowest administrative level, as you can, is helpful. Looking at it at the national level is one thing and having a strong national plan, but implementing these efforts at the lowest administrative level will be helpful to help you find where the virus is and target what you need to do. Another way that countries have tried to tackle overwhelming epidemics is to focus on vulnerable workers, vulnerable people. These are our frontline workers, these are healthcare workers, and in Latin America and in many countries across the globe, we see an alarming number of healthcare worker infections and an alarming number of healthcare deaths. And so prioritizing testing there will help you see where the virus is and who's getting infected. Looking at your older populations, looking at people with underlying medical conditions, so that they are prioritized for care, so that we could ensure that those individuals do not develop severe disease and die. And as Mike said, adapting your efforts to the situation, to the context in where you live, and to do that at the lowest administrative level as you can, can help break down the problem. Looking at it at a national level is important, but targeting those efforts at the lowest administrative level as you can, can help break down the problem and start to tackle it bit by bit. Speaker 2: (24:31) We will now go to the Swiss public television, section Italian. We have Ricardo [inaudible 00:24:37] with us. Ricardo, can you hear us? Speaker 4: (24:42) Yes, I can hear you. Can you hear me? Speaker 2: (24:44) Yes. Speaker 4: (24:46) Great. Thank you very much. Thank you Mr. Ryan, to have read statement about the reportage about the inquiry of AP, the Associated Press. But there's still a question. Do you confirm the quotes appearing on this inquiry? According to the inquiry, the quotes, your quotes and [inaudible 00:25:10] quotes. And for Direct General please, do you confirm that China delayed releasing coronavirus info as written on this inquiry? Speaker 2: (25:27) Thank you, Ricardo. I think Dr. Ryan already answered this question. So unless there is something else that our speakers would like to add, we will move to our next question. We have Elena Sanchez from Euobserver. Elena, can you hear us? Can you unmute yourself Elena? Elena Sanchez: (25:52) Can you hear me? Speaker 2: (25:52) Yes. Now it's okay. Elena Sanchez: (25:54) Yeah, actually it's a followup on the question of my colleague just made. I don't want a confirmation exactly on the topic, but I was wondering- Speaker 5: (26:03) I don't want a confirmation exactly on the topic, but I was wondering more how these kind of reports can affect actually the relationship between China and the WHO. Speaker 6: (26:14) Well, I think the answer will be just the same as this to our friend, Ricardo, from Swiss TV, that Dr. Ryan has made a statement on this particular topic. So unless there is something else to add, we will move to health policy watch. We have Gracie. Sorry, Gracie online. Gracie. Gracie: (26:37) Yes. Can you hear me? Speaker 6: (26:40) Yes. Gracie: (26:41) All right. Thank you so much for taking my question. So I have a question regarding the recommendations for public use of facial coverings. So the SAGE infectious hazards group released recommendations saying that basically facial covering, supporting the use of facial coverings by the general public, especially for public transportation, or just conducting like daily tasks outside. I was wondering if the WHO is planning on updating official guidance on mask use to follow those recommendations. Thank you very much. Dr. Maria Van Kerkhove: (27:25) So thank you very much for that question. Yes, indeed the STAG-IH, the Strategic Advisory Committee for Infectious Hazards did release some notes from a meeting that they had. And we are planning to update and release new guidance on the advice of the use of masks in the coming days. But just to outline that WHO works with a large number of groups, including the STAG-IH, as well as expert networks that are global expert networks and guideline development committees and civil societies to evaluate all available literature on a variety of topics, including the use of masks. Dr. Maria Van Kerkhove: (28:01) But I think what is important is from our April 6th guidance, what we did put out and what we continue to say is that masks alone are not enough. Masks must be used as part of a comprehensive strategy for COVID-19, including all of these public health measures, test, treat, isolate, trace, and quarantine context, all of these measures. Dr. Maria Van Kerkhove: (28:24) And in our April 6th guidance, what we did is outline a number of situations and support for decision makers in taking decision about how and where masks could potentially be used. And in that guidance, we outlined areas and settings where, for example, physical distancing couldn't be achieved, that a mask could be considered. And so we are seeing a number of countries across the world now adopting that and indeed using our guidance and making decisions to say in situations where we can't do these public health measures and we can't do physical distancing, a mask would be useful. And so we're actually trying to track that to see with masks, but with all of the interventions that countries are using and how this is adopted at the country at the national, and indeed the sub-national level, but we will be issuing guidance in the coming days. Dr. Michael Ryan: (29:16) And just to add in that context and to confirm what Maria said. We have said in this press in a number of occasions, that we would fully support countries implementing broader use of masks in specific contexts as part of a comprehensive strategy. Our concerns were using masks as an alternative to all of the other measures. Masks should be additive to the risk management process. There is no zero risk, unfortunately, in this fight against the COVID-19, we're all experiencing that as we move back to work, we move back to school. Everyone is concerned. What are the risks? How can I reduce risk? How can I manage the risk to me or my family? We see masks as part of that continuum of risk management, not as an alternative to public health intervention, not as an alternative to physical distancing, not as an alternative to surveillance, not as an alternative to lock downs, but as part of a comprehensive evidence driven strategy to be able to rebuild our economies and rebuild our societal interactions. Dr. Michael Ryan: (30:21) And then specific reference to the use of face coverings in at general population level and Maria is right? I mean, we'll be, and the team will be issuing updated guidelines across a range of issues related to masks, not just community use of masks, but I also think masks in other settings. Dr. Michael Ryan: (30:39) But with regard to the use of masks at the community level, they would mainly be used for the purposes of source control. In other words, for people who may be infectious, reducing the chances that they will infect someone else. And I would, again, reiterate that if someone is sick, someone is symptomatic, they should be at home, or they should be in a medical care facility. And therefore we need to be really, really careful with the use of masks for source to control. There were always situations in which someone is unaware of their symptoms, and then the use of masks for source control could be a useful additive, but it is not an alternative. Dr. Michael Ryan: (31:15) Let me say it again. It is not an alternative. Symptomatic individuals moving about within our communities is not a good thing. And masks are not an adequate way of managing that risk. The adequate way of managing that risk is supporting that symptomatic person with adequate care, ensuring that we identify all of their contacts, that their contacts quarantine for 14 days and supported in that quarantine. And in that context, that is the primary and best way to manage this, that as Maria said, to break the chains of transmission. Masks are a potentially important adjunct and many countries are using that in a very, very measured and a very, very credible and a very, very responsible way. And I think our guidance will reflect that responsible use. Speaker 6: (31:59) And thanks Dr. Ryan. So let's go to the next question. We have [French 00:32:06] from [French 00:06:07]. Speaker 7: (32:12) Can you hear me? Speaker 6: (32:13) Yes. Speaker 7: (32:14) All right. Thank you so much for taking my questions. Hello to everyone. I will ask my question in French. If I may. [French 00:06:23]. Dr. Soumya Swaminathan: (32:53) I think we have to be very careful about how we describe these decisions. So when we announced last week that we were temporarily suspending the enrollment into the hydroxychloroquine arm of the Solidarity trial, it was based on some reports of increased mortality that was described in a large group of patients and increased mortality among those taking hydroxychloroquine compared to those who were not. Dr. Soumya Swaminathan: (33:22) And so the committee took the decision to protect the safety of the trial participants with abundant caution, while we looked at our own data, and while other trials, ongoing trials of hydroxychloroquine like Recovery in the UK looked at their data, which is a fairly substantial data set of over 11,000 patients. Dr. Soumya Swaminathan: (33:44) We are now fairly confident not having seen any differences in mortality, the data safety monitoring committees of both Solidarity and Recovery have recommended that the trial can continue. We're still talking about a clinical trial that's testing this drug for its efficacy and safety among patients who are hospitalized with COVID infection. Dr. Soumya Swaminathan: (34:12) We make recommendations for the use, routine use of a drug based on evidence. We have a process, we set up a guideline development group, it reviews all the evidence. Systematic reviews are done of both randomized trials and other kinds of evidence that are available, and based on all of that, WHO then recommends the use of a drug or a strategy for a particular disease, this is the standard process. Dr. Soumya Swaminathan: (34:39) And so decisions taken about a trial are driven by what's happening within that trial. And there are committees like the data safety monitoring committee or oversight bodies, like a steering committee that advice what should be done for that particular trial. And that's very different from making a recommendation for the use of hydroxychloroquine or any other drug for either treatment or for prevention. Dr. Soumya Swaminathan: (35:06) So like we said, we hope that the ongoing trials will continue till we have definitive answers, because that's what the world needs today. We owe it to the patients to have a definitive answer on whether or not a drug works or doesn't work, and that can only be done through well conducted randomized trials. So we encourage the other trials to continue. Of course, each of them being monitored by their own committees for safety, periodically, and that's what we will do. And it's possible that in the future, we make other changes in the trial. In fact, that's why it was set up as an adaptive trial design so that we can add arms and drop arms, but all of that is done based on very careful examination of the data and the evidence. Speaker 6: (36:00) Thanks. So we have time for one, maximum two questions. So let's try to get Gabriela Sotomayor. Gabriela, can you hear us? Please click unmute. Gabriela: (36:24) Si. Speaker 6: (36:24) A little bit of echo, but we can hear you. Please go ahead. Speaker 6: (36:28) Yes. Gabriela: (36:28) Ah, okay. [ Spanish 00:10:31]. Dr. Michael Ryan: (37:33) On the issue of vitamins. I don't believe there's any specific evidence that vitamins prevent or can treat COVID-19. But, however, there are many things that we can do to keep our bodies healthy and allow us to deal with any infectious disease in a more effective way. So a healthy diet, and sometimes supplementing those diets with appropriate vitamins is a very positive way to keep oneself healthy. But I do not think it's possible to say that any particular vitamin concoction or any other for that matter is associated with better outcomes of COVID-19. However, I'm sure we can refer to ... we're tracking so many different studies around the world at the moment on the use of specific therapies, but I'm not aware of vitamins being used as a supplemental therapy in any of the trials that are currently underway, but we can check that. Dr. Michael Ryan: (38:32) With regard to air quality. Again, I think it's difficult to make associations. There's no question that poor air quality is associated with chronic lung disease and chronic obstructive pulmonary disorders. And we do know that people with underlying chronic conditions of the respiratory system and heart and cardiovascular system have higher mortality rates in this. So it's logical to assume that if someone already has damaged lungs from severe outdoor ... Mike: (39:03) ... Lungs from severe outdoor or indoor air pollution, it is logical to assume that they will be more affected by this virus, especially if they become clinically unwell. I'm not aware, and Maria may correct me on this, I'm not aware of any specific studies that associated air pollution with worse outcomes, but it's a very interesting avenue of study, and we do know that certainly indoor air pollution is associated with much higher rates of respiratory disease in children and sometimes worse outcomes. So there's no question that air pollution plays a role in both the incidence and severity of severe acute respiratory diseases. I'm just not quite sure whether this has been proven in the case of COVID-19. Maria? Dr. Maria Van Kerkhove: (39:48) It hasn't yet, but it doesn't mean that those studies aren't underway. I'm not aware of studies specifically looking at pollution, but I do want to add to what Mike has said is that we have seen quite substantial reduction in pollution during this pandemic with the reduction in people's movement. We've all seen images of the sky in certain cities that have been quite heavily polluted, and it comes back to something the director general has said previously, and WHO has been saying is not only do we build back better, but we build back greener. And there's an opportunity here to use this time to not only help our public health infrastructure and work on universal health coverage, but also to have a safer environment. Because as Mike has said, people with underlying conditions, especially people with chronic cardiovascular disease and chronic respiratory disease do have a proven higher risk of developing severe disease and death associated with COVID-19. So that is something we do know. And anything that puts people at an increased risk of developing those chronic conditions will put them at an increased risk for severe COVID-19 disease. Tarik: (41:02) Thank you. I think we will conclude here. We will have an audio file available as well as transcript. We also sent you a number of news releases, featured stories coming on different topics not only from the headquarters, but also from our regional offices, as well as invitation for the press conferences that are held by our different regional offices, so you are welcome to listen to that as well. And from my side, I wish you a very nice day and evening. Speaker 9: (41:35) Thank you. Thank you [Tarik 00:41:36] and thank you all for joining. Thank you so much. Speaker 9: (41:38) (silence)