Christian Lindmeier (00:02):
Hello and welcome to today's special press conference here at WHO on the hantavirus cluster linked to cruise ship travel. We're very glad that we were able to call this on a fairly short notice and thank you for all of you joining us on this very short notice. My name is Christian Lindmeier, and I'll walk us through this briefing today.
(00:25)
Let me first introduce the podium. First and foremost, in the middle, we have Dr. Tedros Adhanom Ghebreyesus, WHO Director General. Then to his right side is Dr. Maria Van Kerkhove, acting director for Epidemic and Pandemic Management. Next to her is Anaïs Legand, technical lead for viral hemorrhagic fevers. On Dr. Tedros' left side, we first have Dr. Chikwe Ihekweazu, he's executive director for WHO's Health Emergency Program. And last but not least on his left side is Dr. Abdi Mahamud, he's director for Health Emergencies Alert and Response. We have a few other colleagues here, which I would introduce in case we come to them.
(01:10)
Now, we will first hear from Dr. Tedros' opening remarks and then we will go to the questions. Now for questions, two things. First, please identify yourself clearly. We will not be able to take anyone who we cannot identify online. And second, we believe we will have a lot of questions today and you are very curious, which is good. But please also remember, in case your question was already asked, put your hand down again so that we can have a better overview, but is still left what we will want to deal with.
(01:44)
Now with this, thank you very much and handing over to Dr. Tedros.
Dr. Tedros Adhanom Ghebreyesus (01:53):
Thank you. Thank you, Christian. Good morning, good afternoon and good evening. Thank you for joining us for this briefing on the hantavirus situation. Let me begin by outlining what has happened, what we know, what we don't know, and what WHO has done. Last Saturday, the United Kingdom notified WHO under the international health regulations of a cluster of passengers with severe respiratory illness on a Dutch flag cruise ship, the MV Hondius which had traveled from Argentina to Cape Verde. So far, eight cases have been reported including three deaths. Five of the eight cases have been confirmed as hantavirus and the other three are suspected. Hantaviruses are a group of viruses carried by rodents that can cause severe disease in humans. People are usually infected through contact with infected rodents or their urine droppings or saliva.
(03:06)
The species of hantavirus involved in this case is the Andes virus, which is found in Latin America and is the only species known to be capable of limited transmission between humans. In previous outbreaks of this virus, transmission between people has been associated with close and prolonged contact, particularly among household members, intimate partners, and people providing medical care. That appears to be the case in the current situation.
(03:43)
The first case was in a man who developed symptoms on the 6th of April and died on the ship on the 11th of April. No samples were taken and because his symptoms were similar to those of other respiratory diseases, hantavirus was not suspected. The man's wife went ashore when the ship docked at the island of St. Helena and was also symptomatic. She deteriorated during a flight to Johannesburg on the 25th of April and died the next day. Samples were taken, which were tested at South Africa's National Institute of Communicable Disease and confirmed as hantavirus. The third death was of a woman on the ship who developed symptoms on the 28th of April and died on the 2nd of May. Another man presented to the ship's doctor on the 24th of April and he was evacuated on the 25th of April from the island of Ascension to South Africa where he remains in intensive care.
(05:08)
Doctors from Cape Verde ordered the ship to provide care for the three other passengers with symptoms. WHO coordinated their evacuation to the Netherlands for treatment. I would like to thank Prime Minister Ulisses Correia e Silva of Cape Verde for his support in facilitating the evacuation of these three patients based on our request. Two are in a stable condition in hospital and one is asymptomatic and is now in Germany. The eighth case was in a man who disembarked in St. Helena. Following advice from the ship's operator, he reported himself with symptoms in Zurich, Switzerland and was confirmed yesterday to be infected with hantavirus. The Genova University hospitals then sequenced the virus and confirmed it as Andes. None of the remaining passengers or crew on the ship are currently symptomatic. WHO is aware of reports of other people with symptoms who may have had contact with one of the passengers. In each case, we are in close contact with the relevant authorities. Given the incubation period of the Andes virus, which can be up to six weeks, it's possible that more cases may be reported. While this is a serious incident, WHO assesses the public health risk as law. It also shows why the international health regulations exist and how they work. WHO is working with multiple governments and partners on the response under those regulations.
(07:06)
Our priorities are to ensure the affected patients receive care that the remaining passengers on the ship are kept safe and treated with dignity and to prevent any further spread of the virus. On Monday, I asked Prime Minister Pedro Sánchez of Spain to accept the ship, which he agreed to do. And I thank Prime Minister Sanchez for his generosity, solidarity and meeting his moral duty. The ship is now sailing for the Canary Islands and we are confident in the capacity of Spain to manage this risk and we are supporting them to do so. Once again, we assess the risk to the people of the Canary Islands as low. WHO has provided guidance to the ship's operator on the management of health onboard the vessel. All passengers have been asked to stay in their cabins. The cabins are being disinfected and anyone who shows symptoms will be isolated immediately. A WHO expert boarded the ship in Cape Verde and has been joined by two doctors from the Netherlands and an expert from the European Center for Disease Prevention and Control who will stay on the ship until it reaches the Canary Islands. They're conducting a medical assessment of everyone on board and gathering information to assess their risk of infection. WHO is developing step-by-step operational guidance for the safe and respectful disembarkation and onward travel of passengers and crew when they arrive.
(08:57)
WHO has also informed 12 countries whose nationals disembarked in St. Helena. Those 12 countries are Canada, Denmark, Germany, the Netherlands, New Zealand, Saint Kitts and Nevis, Singapore, Sweden, Switzerland, Turkey, the United Kingdom, and the United States of America. In addition, WHO is supporting health authorities in South Africa to follow up people who were on the flight from St. Helena to Johannesburg with a woman who later died.
(09:35)
Meanwhile, investigations into the cause of the outbreak are continuing. Prior to boarding the ship, the first two cases had traveled through Argentina, Chile and Uruguay on a birdwatching trip, which included visits to sites where the species of rat that's known to carry hantavirus was present. WHO is working with health authorities in Argentina to understand the movements of the couple and I thank the government of Argentina for its cooperation, given its experience and expertise with Andes virus. We have also arranged for shipments of 2,500 diagnostic kits from Argentina to laboratories in five countries.
(10:26)
I would also like to thank the governments of Cape Verde, the Netherlands, South Africa, Spain, and the United Kingdom for their close partnership and support. I also thank the many partners who have provided expertise including the NICD in South Africa, the Institut Pasteur de Dakar in Senegal and the HUG here in Switzerland. I would also like to thank the ship's operator for its cooperation and the passengers and crew who are going through a very difficult and frightening situation. I have been in touch with the ship's capital regularly, including this morning. He told me moral has improved significantly since the ship started moving again. I thank him for everything he has done to protect those under his duty of care. WHO will continue to work with all relevant governments and partners to provide care for those who are affected, protect the safety and dignity of passengers and prevent onward spread of the virus.
(11:39)
Christian, back to you.
Christian Lindmeier (11:43):
Thank you very much, Dr. Tedros. With this, we come now to the rounds of questions and answers. Again, please identify yourself clearly. Raise your hand if you want to ask a question, then unmute yourself if called upon and please also take down your hand in case your question has been asked and answered by one of the colleagues.
(12:04)
Now the first question goes to Spanish News Agency EFE Antonio Broto. Antonio, please go ahead.
Antonio Broto (12:11):
Thank you, Christian. So my first question is in Spain, the central government and the regional authorities of the Canary Island remain divided about the issue of the ship's stopover. So could you indicate what assurances the Spanish government has provided and what kind of assistance the WHO would provide once the ship arrives to Tenerife in this weekend?
(12:41)
If I may, I have a second question about this Dutch [inaudible 00:12:45] that has been hospitalized today in Amsterdam. Do you have data on this case and how she may be infected? Did she travel in the same plane than one of the disease from St. Helen to Johannesburg? Thank you.
Christian Lindmeier (13:07):
Thank you very much, Antonio. With the first question, we go to Dr. Abdi Mahamud, director for Health and Emergencies Alert and Response.
Dr. Abdi Mahamud (13:18):
Thanks so much, echoing again, the appreciation of the excellent support from Spain leadership, the technical team and all the actors included. In terms of our understanding, we do hear the concerns coming from the regional government and as DG indicated, we are doing everything possible to understand the risk. As of now, we know that the two confirmed cases unsuspected have been evacuated, the ship is doing everything possible to take the public health measures. So the overall risk from our side is minimal, but we know that people has a long incubation period. So we have a clear guidance working with our ECDC colleague on the ship and the authority in Spain understanding the risk stratification measures. So we have clear impactation plan that will not add additional risk. So we are taking all the measures required to reduce as overall our assessment and we'll get more details from the team on the ship, it's a low risk.
(14:24)
So we are coordinating with our ECDC colleagues with the UK, with the Netherlands, with all the countries who have passengers on the floor to understand a common way. One is to reduce a further spread of the disease, which we see is limited, and then have a common understanding, a common approach based on public health and evidence, solidarity and equity. I think we are in touch with them and we'll resolve the logistic issues and the guidance required to implement this and reduce and take any considerations and feedback from the community, the regional government. Once again, we thank the federal government for the excellent support.
Christian Lindmeier (15:10):
Thank you very much, Abdi. For the second part we go to Maria Van Kerkhove-
Dr. Tedros Adhanom Ghebreyesus (15:13):
[inaudible 00:15:14]
Christian Lindmeier (15:14):
Oh, pardon me. Oh, first.
Dr. Tedros Adhanom Ghebreyesus (15:16):
Yeah. I just wanted to add to what Abdi said based on the international health regulations guidance, we have made a request to Spain and I have actually sent a letter personally to His Excellency, the Prime Minister. And based on that request, because this is part of the IHR regulation, the Prime Minister have accepted.
(15:45)
But one thing I'd like to address here is on top of the guidelines in the HR regulation, solidarity is the most important here and that's what the Prime Minister has shown. But on top of that, I think everybody has the moral duty to take care of the people who are on the ship. I hope those who have concerns at the Canary Island will understand and support and cooperate with the federal government. Of course, we understand their concerns, but as I said in my statement, based on the risk assessment that we have, the risk to the people in the Canary Island is actually low. So the ship is now sailing to Canary Island and I hope all the support will be provided. Thank you.
Christian Lindmeier (16:58):
Thank you very much, Dr. Tedros. Second part, we go to Maria Van Kerkhove, acting director Epidemic and Pandemic Management.
Dr. Maria Van Kerkhove (17:05):
Yes, thank you. So I believe the second question was related to a potential suspect case. So as the DG said in his remarks, we're getting reports of suspect cases or potential suspect cases. These are alerts as we call them. Some of them have had reported links to the ship or passengers on the ship. All of those will be followed up with the relevant authorities in each country. The countries themselves, whether it's through the ministries or through the agencies in the countries, are actually assessing each person case by case, looking at what type of exposure did they have? Are they developing any symptoms? If anyone is developing symptoms to be isolated immediately, testing to take place and providing the appropriate support.
(17:47)
This is actually how the case in Switzerland was identified following the notification from the ship's operators, which we're very grateful for. This individual presented to healthcare, wasn't feeling well, was immediately isolated, was tested. This is actually public health actions in the works.
(18:03)
And I did just want to add on the global solidarity side of things in all of the efforts that we're doing right now, including the ship sailing to the Canary Islands and to support the Spanish authorities, we've pulled together all of the global experts related to hantaviruses in particular the Andes virus and that global solidarity also falls into place on the technical side of things as well coming in together saying, "What do we know? What have we learned from past outbreaks? What's going on in the current situation? And essentially, how can we help?" And that type of technical solidarity is really helpful.
(18:36)
Some of the diagnostic kits and the reagents that we are sending are also going to Spain so that will support in some of the further investigations that need to take place. So overall, we're very grateful for all of those who've come together from the technical side as well to support this event.
Christian Lindmeier (18:55):
Thank you very much. Next question goes to Nina Larson from AFP.
Christian Lindmeier (19:00):
Nina, please go ahead.
Nina (19:06):
Yes. Hello, can you hear me?
Christian Lindmeier (19:09):
All well.
Nina (19:10):
Great. So I was going to ask, would you consider this outbreak to be an epidemic and also what would you say about people wearing masks? Should people be wearing masks? Is it considered to be airborne and also how long should contacts remain in isolation to avoid further spread? Thank you.
Christian Lindmeier (19:35):
Thank you very much, Nina. And we go back to Dr. Van Kerkhove.
Dr. Maria Van Kerkhove (19:41):
Yeah, so thanks, Nina. So what we have is obviously the situation that's happening on the ship itself and the follow-up of the contacts of the passengers who disembarked in St. Helena. So far, as you've heard, we have eight cases so far, five of whom have been confirmed, three who have sadly died. We have no further symptomatic patients who are on board or passengers or crew on board, I should say, which is a good sign. But of course, there is a long incubation period of the Andes virus. We know on board they have taken some precautions to try to minimize the risk. What they have advised on board is disinfection of the rooms. They have confined people to their cabins and providing food and water and they have asked as a precautionary measure for anyone leaving their room, excuse me, to wear a medical mask. We certainly advise people who are caring for those who are suspected of this Andes virus or hantaviruses to wear a higher level of personal protective equipment.
(20:36)
That guidance has been given to the people on board, but also there are the two patients that are in hospital in the Netherlands and there's a patient in ICU in South Africa. And I am very happy to say the patient in South Africa is doing better and the two patients in the Netherlands we hear are stable. So that is actually very good news. So we have a situation that we are monitoring very, very carefully. These numbers may change. As we're doing follow-up, we may see some additional cases be reported and that shows that the active follow-up is happening and that the testing is being done. What we know about transmission, and there's been a lot of questions posed to us about what is actually happening. What we do know is that the Andes virus in previous outbreaks, there has been instances of human-to-human transmission, mainly among close contacts, either providing clinical care or people who have had close physical contact. And we believe that has happened in the case here on the ship as well between the couple, the first and second cases, and also a medical doctor providing care. As you probably know, those who develop symptoms, those who go on to develop disease sometimes develop very severe disease, which includes severe respiratory disease. So there may be some coughing, there may be some aerosolizing procedures that may be done. And of course, that's where we would require higher level care. So this is not COVID, this is not influenza. It spreads very, very differently. So there are different precautions that people are taking. So we are supporting the ship's operators in the mitigation measures that they are putting on board. And as we've said, we are working to have a proper and full disembarkment procedure step-by-step to support authorities in the Canary Islands for the next stage of the people who are on board.
Christian Lindmeier (22:24):
And Dr. Mahamud, please.
Dr. Abdi Mahamud (22:27):
No, there was the second part of the question about whether this is an epidemic or pandemic and all the things going on social media. I just wanted to address the situation what makes unique here is similarity crowded in a confined space. We had a similar situation in Argentina in 2018 to 2019 when a symptomatic individual attended a social gathering. So that led to a lot of people getting infected. So we are in a similar situation right now, a cluster in a confined space with close contact. Does that mean the rest of the world's disease will spread? We had that outbreak in 2018 and led only 34 cases. We may have similar cases from there. So I just want to show that if we follow public health measures and the lessons we learned from Argentina now is shared across all countries, what needs to happen in contact trace in isolation, we can break this chain of transmission and this doesn't need to be a large epidemic.
(23:28)
It's a specific confined setting where people are interacting in a prolonged plus contact. So we feel it's very quite familiar to the 2000 outbreak in Argentina and we don't anticipate a large epidemic. With experience our member state have and the actions they have taken, we believe that this will not lead to subsequent chain of transmission, but we need to be balanced reasonable supportive solidarity in containing this outbreak in a difficult environment that's happening there, being in the weeks after weeks that it's difficult. So the solidarity required and the support, most of the people there as [inaudible 00:24:13] said are healthy individuals who are going with their lives. And so is the public health measures able to break down the chain of transmission and we believe this will be a limited outbreak if the public health measures are implemented and solidarity is shown across all countries.
Christian Lindmeier (24:32):
Thank you very much both. Next question goes to Christiane Oelrich from DPA. Christiane, please go ahead.
Christiane Oelrich (24:42):
Yes. Thank you very much, Christian. My question goes in the same direction, but a little bit further. We are six years out from the corona pandemic. This also started with very few cases and you experts know how this is different, but we and our readers might not. I was wondering whether one of you can outline specifically how this is not comparable to the early days or weeks of the corona pandemic and why the risks are lower than they were six years ago with corona. Thank you.
Christian Lindmeier (25:26):
Yeah, good comparison. Let's see if it is one. Dr. Van Kerkhove, please.
Dr. Maria Van Kerkhove (25:31):
I'm going to start and then I'm going to ask our expert here, Anais, to come in because this is not coronavirus. This is a very different virus. We know this virus. Hantaviruses have been around for quite a while. There's a lot of detail that we know. I'm going to ask Anais to come in and say this, but I want to be unequivocal here. This is not SARS-CoV-2. This is not the start of a COVID pandemic. This is an outbreak that we see on a ship. There's a confined area. We have five confirmed cases so far. We completely understand why these questions are coming and we are trying to provide all of the information that we can. That's why we're having a press conference here to give accurate information and we're grateful for all of those who out there who are asking these types of questions, but this is not the same situation we were in six years ago.
(26:15)
It doesn't spread the same like coronaviruses do. It's very different. It's that close, intimate contact that we've seen. And most hantaviruses don't transmit between people at all. Most Hantaviruses are transmitted from rodents or their feces or their saliva [inaudible 00:26:31] droppings to people. And only this one particular virus, the Andes virus, which has been identified here, we've seen some human-to-human transmission. And again, I want to reiterate the actions that are being taken on board are precautionary to prevent any onward spread. And so there's a lot that is being done right now to be able to try to minimize the risk even further. But I do want Anais to come in and provide a little bit ... No? Oh, okay. Thank you.
Christian Lindmeier (27:00):
Thank you very much. Next we have a question actually from Cabo Verde, but it came in writing. So I'm going to read it out. It is ... Hello and good afternoon. It is the [inaudible 00:27:13], the news website in Cabo Verde. Thank you for that question. On May 2nd, a person died aboard the MV Honduras as we know. The ship arrived afterwards in Cabo Verde. The question is, where was the body stored of the deceased or where is it right now?
Dr. Maria Van Kerkhove (27:35):
Yeah, thank you very much. So yes, in fact, you are correct. An older woman died on board. The ship's operators are making arrangements for the remains to be stored appropriately carefully and to make the onward movement of the remains in a dignified way. So the remains still are on board. We are in touch with the ship's operators about this and about any onward passage of the remains. So I think I'll just leave it at that. But yes, of course, and this is a reminder, these are people. These people have families and they have questions, but we're in contact with the operators about the safe storage and the onward movement of the remains.
Christian Lindmeier (28:22):
Thank you very much. Next question goes to James Gallagher from the BBC. James, please go ahead and unmute.
James Gallagher (28:36):
Hello. I'm James,
Christian Lindmeier (28:36):
Do you hear us-
James Gallagher (28:38):
It took a while for the popup to unmute to arrive. Thank you. My main question is, could you outline what you think is unusual about this outbreak or does it fit entirely within what we would expect of hantavirus outbreaks? And related on that, could you draw on whether you think there is anything fundamentally different or shifting within hantaviruses at the moment? I'm just looking at the PAHO reports from the end of last year citing increases in cases and in some countries' lethality in South America, if you could draw on those as well, please.
Christian Lindmeier (29:11):
Great, Jim. Thanks. And we got to Anais Legand next, technical lead on viral hemorrhagic fevers.
Anais Legand (29:16):
Thanks a lot for the question. What is most unusual obviously is that we have a transmission in a boat, which I think that the first documented to date with this particular virus. As mentioned by my colleagues before, a boat makes it a very specific environment for which we want to make sure that we have a good understanding on how the transmission has happened, and most importantly, to strengthen all the measures that my colleagues developed previously. There is no indication to date that there is something further unusual, but obviously the fact that it happened in a cruise ship with people from different nationalities is something that we haven't seen before. Regarding your comment on the PAHO report, the epidemiological situation related to antiviruses in the Americas, you are right, a slight increase has been noted in few countries. Just to recall that this update covers all antiviruses that are documented in the Americas where most countries at risk have good surveillance system and the increase can be related to several factors that needs to be determined what countries are working on probably linked to incidents on rodent population and different ecological and behavioral factors.
(30:49)
This doesn't specifically relate to this virus we are talking about. I want to recall that most antivirus cannot transmit human to human only the NS1. So it's relating to the rodent population over.
Christian Lindmeier (31:05):
Thank you very much, Anais. Next question. No, before I come to the next question, we have a lot of long list of questions still and we want to really get to everybody. So please try to limit your questions to one. I'm pretty sure many people want to ask the same questions anyway. So next question goes to Laurent Siero, from Swiss News. Now we come to Switzerland. Lauren, please go ahead.
Laurent Siero, (31:34):
Yeah, thank you for the briefing. A question on contact tracing and the extent of what has already been done, because it seems that the person who is in Zurich right now was in a flight where the contact tracing was not started right away. And so there is the threat that some people might not have been traced in the first days after the contact with that person. So do you know whether most countries affected have started but also probably ended the contact tracing process? Thank you.
Christian Lindmeier (32:16):
Thank you very much, Laurent. This goes to the Dr. Mahamud.
Dr. Abdi Mahamud (32:21):
Thanks. In terms of contact tracing and the policy for that, each country has slightly different. What we recommend from WHO is extensive investigation and information sharing. So this contact passenger was informed on two channels, one from the company informing the patient and then second from the IHR South Africa sharing that information with Switzerland. So from the national level to the canton level, at least we will see how that information passes because most of the information are shared at the capital level and then it goes to canton. What was done here and that's we really need to appreciate the responsibility and the proactiveness of all the passengers contacted, they followed the public health message and taking the necessary action. Now the canton and the authorities are doing the investigation and it takes a lot of time identifying all the contacts where he went and these are retrospective, what we call retrospective contact tracing, that meaning going backward the day he arrived and all the way until [inaudible 00:33:32]. So that data is being collected and analyzed.
(33:34)
And then what we are encouraging now, now that we have a confined environment and hopefully we'll have a data departure, prepare all the countries now. There's a lot of lesson we learned from all the countries shared from South Africa. The level of preparedness may have been slightly different. Now we are all prepared and you'll have passengers and crews coming up. We are encouraging and we'll be sharing the investigation and the contact tracing format and be proactive and the necessary recommendation. Each state and sovereign state will have a different application from our recommendation, but we firmly believe that safe informed contact tracing and monitoring will reduce the further spread. So we are finalizing that in consultation with global expert from our European CDC, from US CDC, from UK, Netherlands on all that. And we will issue that guidance in the coming tomorrow, hopefully. But we believe that the retrospective contact tracing is going on and action is being taken here in Switzerland.
Christian Lindmeier (34:45):
Thank you very much, Dr. Mahamud. Now speaking of South Africa, we have a South African journalist here with us online. I'm not a hundred percent sure if you're in a position to unmute. Let's give it a try and please go ahead and identify yourself.
Marvin Charles (35:01):
Hello. Can you hear me?
Christian Lindmeier (35:03):
Very well.
Marvin Charles (35:04):
Hi, Marvin Charles here from News24. Could the World Health Organization perhaps share any information about any confirmed cases in South Africa? We understand that there have been at least four identified contacts in the Western Cape in South Africa, including in Somerset West where a resident is classified as high risk. And then I know you said that we should stick to one question, but I just want to squeeze in just one more. In terms of when the World Health Organization would advise countries to take some sort of precaution, when would that be? Because I understand that you said that this would be a limited outbreak, but when would you advise countries to take some sort of precautionary steps? Thank you.
Christian Lindmeier (35:57):
All right. Thank you very much. Let's start with Dr. Van Kerkhove and then we'll see if we have more in the context.
Dr. Maria Van Kerkhove (36:02):
Yeah, thank you very much for the question. I love to see how many people from around the world are asking questions. So there have been two confirmed cases in South Africa. One was the second case that was identified, the wife of the first case who sadly passed away. And then there is another case that is currently in ICU in South Africa and this person is doing better as we understand. We are working with the health authorities in South Africa, also NICD and others on the contact tracing. They're taking the lead on the contact tracing. Really want to thank them for the thorough job that they have been doing. Not only have they identified the passengers and are following up from the flight, but they're also following up any contacts for people who attended to the woman who passed away who went through the airport, people medically caring for the man who is in ICU and they're doing very active follow-up.
(36:59)
I don't have the details specifically on what you mentioned on where they are, but there's active follow-up by the government officials and NICD around monitoring of their health, if they have any symptoms putting in isolation and providing support, and also doing further testing. We are getting information back from South Africa. They are doing some testing on the contacts and so far all of those tests have come back negative. And again, this is showing the signs that are working. And so again, we really want to thank those that are there doing that hard work and very, very detailed work for the contact tracing.
Christian Lindmeier (37:35):
Thank you very much, Dr. Van Kerkhove. Next question goes to Helen Branswell from STAT. Helen, please go ahead and unmute.
Helen Branswell (37:42):
Thank you, Christian. This outbreak is happening at a time when the United States is no longer considering itself part of the WHO. The United States has passengers on board the ship and I think there were people who disembarked who were also
Helen (38:00):
So Americans, I'm wondering what are the interactions like between WHO and the United States in this setting? Are they the same as they are with other countries, or is there less information flow as a consequence of the US withdrawing from WHO? Thank you.
Christian Lindmeier (38:25):
Yeah, thank you very much and good one. Dr. Mahmoud, please.
Dr. Abdi Mahamud (38:31):
Thanks, Helen. In terms of collaboration with US and US institution, it has been going very well on the technical side. We've been exchanging information. As we are speaking right now, the US CDC has been joining [inaudible 00:38:47] so are the state. So the information flow is there, transparent and frank, and information sharing. That's one on the technical side. On the other aspect, there's the IHR, the IHR Channel. US is still a state party to IHR, and information is being shared through South Africa. NFP communicated with the US, and back and forth communication is going on. But how does that translate in a global solidarity? I will let time to tell, but we really need... This incident, this outbreak has seen why the world needs a global entity that coordinates this. The Argentina support, how they came forward, the support we are receiving now from US institutionals. We live in an interconnected world. That outbreak from one part affects everywhere. So in terms of collaboration, we are going both through the technical collaborations in sharing information guidance. We rely heavily as DG multiple side, but I'm saying that the expertise of USCDC is an asset for the world, and we have been benefiting from that. And we will continue, and then we go through the IHR channels in sharing formal information and a technical exchange.
Christian Lindmeier (39:59):
Anais Legend, please.
Anais Legand (40:02):
Yes. I just would like to emphasize the excellent collaboration on the technical standpoint today with my counterpart at the US Center for Disease Control. And this include sharing of technical assessment, discussion about very specific aspects, and sharing regularly what is not known. We have very positive regular interaction almost every single day. So I just want to acknowledge that among other national counterparts, this is very useful.
Christian Lindmeier (40:42):
Thank you very much, both. Oh, pardon me. Again.
Dr. Tedros Adhanom Ghebreyesus (40:46):
Yeah. No. I just wanted to add to what colleagues raised. Thank you, Helen, for that important question. As we speak, things are going, actually, as it used to be, meaning sharing information from our side. And also, we are getting information from the US side based on the IHR regulation. And as you know, the WHS mission is to help the world be safe and our mission includes the US, which is we want the American people to be safe as well. So we will continue to collaborate from our side and continue to give information. So the disease is not a problem in the US and the rest of the world as well. But as colleagues indicated, this is what makes a platform like WHO very, very important. Health security needs universality, and any vacuum, any space which is not covered actually gives advantage to the virus. And the best immunity we have is solidarity.
(42:10)
So because of the event that's happening now, and both Argentina and the US are affected, I think they will reconsider their decisions because they can see how important universality is for health security because viruses don't care about our politics, and they don't care about our borders, and they don't care about all the excuses that we may have. So I hope this could be a good lesson for the whole world because solidarity is our best immunity, I repeat. Thank you.
Christian Lindmeier (43:02):
Thank you very much, Dr. Tedros. Then now we go to Ireland, to Neil Michael from the Irish Examiner. Neil, please go ahead and unmute. Do you hear us? You still on? Neil, if we can't grab you right now, then we go on to NPR, Gabrielle Emanuel. Gabrielle, please try, and we'll come back to Neil afterwards. No?
Gabrielle Emanuel (43:34):
Hi. Thank you so much.
Christian Lindmeier (43:35):
Here you go.
Gabrielle Emanuel (43:36):
Thank you for doing this. I wanted to follow up on that point about the US engagement here. Typically, my understanding is we would've had press conferences and health alerts and other information coming out of the US CDC and NIH. We haven't had that, and I'm wondering... You say they're participating in terms of a technical capacity. Have they sent a team over like would typically happen? Can you get into some more specifics about what is missing or what is different about this situation now that they have left? Thank you.
Christian Lindmeier (44:16):
Thank you very much, Gabrielle, and we go to Dr. Dr. Abdi Mahmoud, or Dr. Chikwe Ihekweazu first.
Dr. Chikwe Ihekweazu (44:24):
So thank you very much. Our colleagues have explained in detail the collaboration with the US CDC and the response that we have managed on behalf and in collaboration with many countries around the world, and we're very grateful for that. How many teleconferences they hold to the people in the US is obviously the responsibility of the US and the US CDC, and we'll leave that responsibility to them. But however, to highlight one thing, one of the core requirements of the IHR 2005 is for countries to build the core capacities that they require to do the work that we do. And in this response, we've really seen the output of that. The institutions across the world and the collaboration between them from South Africa, the UK, Spain, Netherlands, Cape Verde, their national public health institutions, the national public health officials have really worked together with each other, supporting each other, sharing information, sharing reagents, sharing knowledge to respond rapidly to an emerging situation.
(45:32)
So I think in all of this, we see the value of, one, the IHRs and what it stands for, and secondly, the implementation of the IHR, both in real time, but also in the longer term capacities that countries have built around the world. And it is on that, that we build this universality that our Director General just commented on. One is the principle of universality, but secondly, is the implementation of it through the institutions that represent that in all the countries around the world. Back to you.
Christian Lindmeier (46:07):
And now Dr. Mahmoud, please.
Dr. Abdi Mahamud (46:10):
And Dr. Chikwe has covered the main point. I just wanted to answer there so that we have clarity. And it repeats, again, to the other question, if this pandemic is an epidemic, and how we deal with it, and how US in a system like US CDS this is dealing. There's a limited epidemic confined in a cruise ship. Idea of sending messages across the world and panicking everyone is not required. And I think I want to take those with the contacts and the passengers in the US been contacted and traced, we believe so. And we haven't formally heard from that, but informally, we're aware that rightful action is being done. So there's no need of panicking the entire population there and it's creating this the largest epidemic is going to happen. So I just want to take this opportunity, when we look at comparing institution like that, is, are there public health action being taken in each of the countries where NFP South Africa has shared? Yes. Are we getting feedback? Yes.
(47:12)
And each country will have a different approach how they deal with, and that's their own. So I just wanted to take that point answering the specific question, how is US CDC, why is no alert being sent? Because what we have there are passengers who are contact, who went back to the US who are now currently being placed by the local authority, sharing information to a CDC, and hopefully through the IHR channel, sharing back information to WHO.
Christian Lindmeier (47:40):
Thank you very much, Dr. Chikwe, Dr. Abdi. Next question, we'll try again with Neil Michael from the Irish Examiner. No? Has dropped. Then we go on to Janice Kew from Bloomberg in South Africa. Janice.
Janice Kew (47:57):
Hi, thanks very much. I wanted to find out how long does it take to get the lab test results for the Andes virus currently, and is a specific assay they needed? Just related to that and some clarity on an earlier question, the KLM flight attendant who had contact with the second patient who died, that flight attendant's been hospitalized in the Netherlands. And I was wondering, is she symptomatic? And when can we expect to know her test results?
Christian Lindmeier (48:28):
First was about time, and then... Yeah. Dr. Anais Legend.
Anais Legand (48:36):
No, no doctor. Thank you. Yes, this is a very important question about how long the tests are performed. So the PCR is a technology that is being used, and countries are scaling up their capacity to ensure the adequate reagents. As you know, this is not a very common virus, so we are supporting countries to ensure they have the capacity to test, should they have alerts. If reagents are available, the PCR performed is fairly quick in a matter of hours. And just to mention as well that there will be a complementary testing using serology, which we are also helping countries to prepare for. That's for the first question.
Dr. Maria Van Kerkhove (49:22):
And just on the second question, very briefly, so it adds on to what Anais has just said. It depends on the type of test that's actually being done. Certainly, any of the contacts, including the one that you've mentioned, the flight attendant, will be isolated and testing will be done. I don't have a specific time for when the test will be back, but we are in regular contact with the Dutch authorities to receive that type of information. So as soon as that is ready, it gets reported back to us as well, and of course, to the patient themselves, but it will depend on the type of sample that's done, the type of test that's done for the timeline and when the results will be back, but I can assure you that everybody that is involved with this is just as eager to do the testing as quickly as they can, as long as they have the right materials.
(50:07)
And again, we are supporting several countries with reagents to be able to test for this Andes virus. And as Anais has said, this is not a very common virus, mainly found in the Americas, so we're trying to provide support, as one of the functions of WHO, to ensure rapid diagnosis of any person that is tested for this.
Christian Lindmeier (50:28):
Thank you very much both. And next, we go to La Monde, Delphine Roucaute. Delphine, please go ahead and unmute. How does it look like?
Delphine Roucaute (50:46):
Can hear me, please?
Christian Lindmeier (50:47):
Here you go. Now we're good. Yes.
Delphine Roucaute (50:49):
Yeah. Perfect. Thank you for this briefing. I just have a question. When will we have more information about the virus sequencing and any differences observed compared to the strength from the 2018 outbreak in [inaudible 00:51:07] that you mentioned earlier, will we be able to identify which mutations are caused for concern? Thank you.
Christian Lindmeier (51:15):
So I did not understand everything, but I think we got it. And then we start with Anais Legend.
Anais Legand (51:20):
Yeah. If I understood correctly, it's about the genomic sequencing, and you actually pointed out toward very interesting information that we are looking at. We are awaiting the result from both South Africa, Switzerland, and Institut Pasteur de Dakar, who are all putting all their effort into performing the full genome sequencing of that virus. The full genome sequencing, if good coverage is obtained, will be very useful for us to see how it clustered compared to previous outbreak as you rightfully mentioned, especially that last outbreak you referred to. And it will give us a sense of whether or not we are seeing some changes. And again, we have to acknowledge the tremendous works that are being done by these three laboratories that I mentioned and all the international support that they have received to date.
Dr. Maria Van Kerkhove (52:18):
Just want to add to that because I think, again, this is another example of having rapid sequencing being done by these three labs who are really exceptional labs, but the sharing of sequence information, particularly when you have outbreaks like this, can provide a tremendous amount of detail. And this is important every event that we have. Not only are they doing this work as rapidly as they can, but we have pulled together expertise in Andes viruses and they will be debating, of course, what they see there and comparing with the other sequences that have been shared. We discuss this a lot up on this panel here, and we've been discussing this a lot with the pandemic agreement and the PABS annex that people have been discussing the critical importance of sharing information, but not just that; actually bringing together people to do that risk assessment. What does it actually mean?
(53:05)
So from the information we have so far and they're still doing the sequencing, we haven't seen anything unusual, but that's why we bring together the best minds to be able to do that. And again, that includes people from Argentina who have specific experience with this particular virus, and now we will have more people around the world. So as soon as we know, and as soon as that analysis is done, of course we will share that information as necessary.
Christian Lindmeier (53:28):
Thank you very much both. Now we move back to Germany. Deutsches Ärzteblatt, Valentin Frimmer. Valentin, please go ahead and unmute. Valentin? Otherwise, we come back to you. No, you're coming.
Valentin Frimmer (53:50):
Yeah. Yeah. Yeah, yeah.
Christian Lindmeier (53:50):
If we don't get to you... Ah, here we go.
Valentin Frimmer (53:54):
Sorry. Hey. Valentin Frimmer, Deutsches Ärzteblatt. Thanks for the conference. My question is... So we've learned already that the incubation time is relatively long. So my question is, with the few and the people in isolation, how long do they have to be in isolation before they are tested negatively because... Or in other words, how much time does it take, at most, until the antibody or PCR tests are positive? I hope this was clear.
Christian Lindmeier (54:35):
Thank you for the question.
Anais Legand (54:39):
I hope I understood your question correctly, and sorry for that if I didn't. Your question is how long after symptoms is the PCR detecting the RNA? Is it correct?
Christian Lindmeier (54:53):
Or how long would people need to stay in isolation to be sure that they're not infectious?
Anais Legand (54:57):
So what we know is, yes, incubation can be up to six weeks. And for that time contact who have been potentially exposed need to monitor their health for any sign of symptoms. The RNA of the virus can be detected in a symptomatic person, so someone with healed, from the first day of onset.
Christian Lindmeier (55:24):
Thank you very much. Next question we got a global, so Brazil, from global Bianca Rothier. Bianca, please go ahead and unmute.
Bianca Rothier (55:32):
Hi, can you hear me?
Christian Lindmeier (55:35):
Very well.
Bianca Rothier (55:36):
Thanks a lot. Good afternoon, everyone. A follow-up on this point because you said six weeks monitoring, but does it mean six weeks of isolation? And now my main question. What is the mortality rate of the Andes strain of hantavirus? And just as I'm covering this story for the Brazilian television, my understanding is that the Andes strain of hantavirus is also present in Brazil, correct? So should Brazil's health authorities reinforce protocols for cruise ships after this case? Thanks a lot for your attention.
Christian Lindmeier (56:16):
So the first was the specification on the six weeks, and then the question whether Andes virus is also present in Brazil and whether protocols should be adapted.
Anais Legand (56:32):
And the mortality.
Bianca Rothier (56:34):
Yes. Yes.
Anais Legand (56:35):
So maybe I will start with the mortality, and I might let colleagues to compliment on other aspect. The high mortality has been observed in previous outbreak. This is true, but we are emphasizing the importance of early supportive and intensive care. And this is why we are also putting in place this contact tracing measures. It is very
Anais Legand (57:00):
... Important that any patient can be admitted to a safe and adequately equipped with trained staff to ensure that patient can receive the level of care that is needed in case they present severe presentation and deteriorate. So hopefully with early care survival can be improved. In terms of virus circulation in Brazil, I'm not sure if there was a question, but any country who have antiviruses, not just [inaudible 00:57:34], should obviously scale up their surveillance system and [inaudible 00:57:37] approach to understand where this virus in which, sorry, animal, rodents, the virus circulate and ensure that interaction with rodents can be minimized or conducted safely to avoid rodent to human transmission in countries that have the virus present in the reservoir.
Christian Lindmeier (57:58):
Thank you very much. Maybe to add on the hantavirus as such and-
Dr. Maria Van Kerkhove (58:04):
The question. Yes. So thank you very much for the question. So Anais had described earlier and we'll talk in general, but then specifically about the situation with the ship and the people who are in contact. Certainly we have the incubation period of up to six weeks. That doesn't necessarily ... People need to be in isolation for six weeks. What is really important is that people have the right information. We understand what their potential exposure is so that we can understand their risk. Contacts are not all the same. Some contacts have a higher risk of exposure and therefore a higher risk of infection and others have less. So what is happening currently right now on the ship?
(58:41)
We have a WHO expert who is on board together with an ECDC expert. We have two Dutch infectious disease physicians who are on board. They have received protocols. They're asking questions related to the exposures of the people on board to really understand what type of contact did they have with any of the suspected cases or confirmed cases and what did they generally do on the ship before they got on the ship, during on the ship?
(59:08)
And then looking at what type of exposures and what type of risk that means. With that risk assessment that's being done, there is a step-by-step plan that is being developed and it's currently in developed with many different experts to be able to say once that ship docks, what will happen as it goes on board? So that is currently being developed.
(59:28)
Now, what is really critical is that people have the right information. This also includes people who disembarked in St. Helena, people who have been on board. If you are developing any symptoms to present yourself to healthcare and just say, "This is my potential exposure, might be hantavirus," and then you'll be isolated and tested and provided care. So what we're trying to do is take this in a staged approach, but I do want to reiterate contextually what we're talking about. The risk to the general public is low. Hantaviruses are relatively uncommon, even though there may be thousands of cases estimated each year. This is a particular situation where we are monitoring. I think it's great we're raising awareness about hantaviruses in general. It's great that countries are paying attention to this and hopefully governments and increasing their surveillance efforts and really critically using this one health approach because it is predominantly in rodents and that's how people get infected.
(01:00:22)
So this is why, as Chikwe has said before around IHR, the core capacities in countries for early detection, good surveillance, having good public health systems is critical. So whatever is circulating there, we have the right facilities in place to keep people safe.
Christian Lindmeier (01:00:41):
Thank you very much-
Dr. Abdi Mahamud (01:00:43):
Just a small clarification on the question was isolation and WHO not to be pedantic about the use of word. Isolation are confirmed cases who are symptomatic. So I just wanted to put in context.
(01:00:56)
And then the second, the context people who've been exposed to infectious, what we are recommending right now, active monitoring. What does that active monitoring means? Each country will have a different approach. Some countries are now introducing institutional quarantine where people will be put, but we have to remember most people don't have ... Putting people in six weeks are different. So we leave that decision from our WHO side, the most highly are the cases and confirm which needs to be isolated. And then the context needs to be followed, duration up to maximum of 40. How does that happen in active monitoring? Is the daily visit by healthcare workers? Is it be put in an institution?
(01:01:41)
It will change. But just to break the change of transmission, we have two different approach. One is the isolation of confirmed cases, where we know they have infections and people who are at risk, who maybe have been exposed where we call active monitoring and different countries use quarantine, institutional quarantine and all that policy. I just wanted to separate what WHO is recommending. Isolation of the confirmed cases and the active monitoring of the exposed people who may be at risk. How is that implemented may change from one country to another and then take the maximum duration of the 42 days. If you look at what we have seen right now within two, three weeks, the people, when they got exposed, they had the onset of disease, but the clear guidance were up to 42 days. So that's the maximum that we are recommending active monitoring those people who have been exposed.
Christian Lindmeier (01:02:36):
Thank you very much to all the three of you. Now we come to political, Rory Neil. Rory, please go ahead.
Rory Neil (01:02:46):
Hello. Thanks very much. Yeah, I'm just curious about what happens when passengers disembark? Okay, you just clarified your guidance on isolation there, but should passengers be going on commercial flights back to their countries when they disembark, would you have any concerns around that? Yeah, thank you.
Christian Lindmeier (01:03:08):
So the question, how should the passengers now who disembark, how should they move on with it?
Anais Legand (01:03:15):
I will start and probably my colleagues will compliment me. Yes, a step-by-step guidance is being developed to make sure that all passengers and crew members are supported throughout this journey. Don't forget what they've been through. And so WHO is coordinating with national health authorities to streamline our recommendation and guidelines on that and to ensure that first, as my colleagues say, that anyone who would have any sign or symptoms can be properly isolated and cared for while all passengers are being evaluated for their risk exposure to be able to inform them on what are the recommendations moving forward. So this is still a work in progress. The evaluation is already ongoing in the boat, but further guidance is being streamlined and developed.
Dr. Maria Van Kerkhove (01:04:19):
I think if I could just add to that. So there's a lot that's currently being discussed right now. I did want to specifically mention that we are working with all of the countries who have nationalities that are on board to discuss the plans for the safe journey of those patients' home. Once they disembark, once they're medically evaluated, what those decisions will be. And as Anais said, that is currently being developed. It needs to be very carefully done, but we are working with the countries about that onward passage home. And we are also working with the ship's operator because of the crew. So remember, onboard, we have passengers from many different countries. We also have crew from many different countries and everyone involved, all of the governments, the ships' operators want to make sure that they get home safely, not only minimizing their own risk, but any risk to others. So that is currently being developed and as those plans are announced, then we will make those available. But there's active discussion about how that will be done as safely as possible.
Christian Lindmeier (01:05:21):
Thank you very much both. Next, we go to The Globe and Mail [inaudible 01:05:27], please.
Mustafa (01:05:30):
Hello, can you hear me?
Christian Lindmeier (01:05:32):
Well.
Mustafa (01:05:33):
Thank you so much. I appreciate your time. Can I ask about the medical condition of the Canadian passengers, including the two Canadians who have been evacuated in April? And you have mentioned that all governments, you are in contact with all governments. Can I ask whether the Canadian government has been in contact with WHO regarding their safety or evacuation?
(01:05:57)
My next question is what is the WHO protocol for contact tracing and details? And also we have been monitoring two live streams from that ship. In one, the streamer appeared distressed, was crying and was asking for help. And the other, the streamer seemed calm and they stated that people on board were not under-stressed, take the situation seriously, but without panic. He said to us that the situation appears to have been extremely overstated. Could you please clarify this contrast? Thank you so much.
Christian Lindmeier (01:06:34):
Thank you Mustafa, a bit more than one question, but let's see.
Dr. Maria Van Kerkhove (01:06:38):
I heard three. I'm not sure if I got the first question, which I think was related to Canadians, if we're working with the Canadian government. We are working with all of the governments. I mean, this is what WHO does. We are a member state organization and we work with all governments and they are working with us as well about the people who are on board. I think your last question, I didn't get the second question, but I think your last question was around the passengers who have either livestreamed or said that they were under some distress on the ship. Yes, we've seen videos, we've seen that video. And in fact, in some earlier interviews, I was trying to address directly the passengers that are on board because we hear them. As you know, the DG has been in contact with the ship's captain several times and discussing ... The captain is doing the best that he can to provide the right and appropriate duty of care for those people who are on the ship.
(01:07:34)
We hear them. We are working with many including everybody on board to ensure not only do they have medical support, and that's why there are two additional infectious disease doctors from the Netherlands on board, but also providing some psychosocial support as well. This is quite frightening for those who are on board. They want to have the right information and regular information about what's happening. Our understanding right now is that the morale has improved because the ship is moving and plans are being made to get them safely to shore and for their onward journey home.
(01:08:08)
So yes, we have heard that. And I think what you highlight here and what I would like to emphasize is that it's not only the clinical care, but it's also care for people's mental health and it's really about making sure that they have good information so that they can take action because of course there is a worry on the ship, but we understand there's also a worry out there. And again, this is why we're trying to answer questions to just put this into context of what is actually happening. And again, the risk to the general public is low.
Christian Lindmeier (01:08:37):
Thank you very much. And I think although we have still many questions left, we are ready to take one more and that one goes to Sarah Newey from the Telegraph. Sarah, please go ahead.
Sarah Newey (01:08:51):
Hello. Thank you so much for doing this. I just wanted to talk quickly about medical countermeasures. There obviously aren't any treatments or vaccines available. Is that a blind spot in global pandemic preparedness and which teams are furthest ahead? If this did escalate, how quickly could we get a vaccine, for instance? Thank you.
Christian Lindmeier (01:09:13):
[inaudible 01:09:13] again.
Anais Legand (01:09:14):
Yes, thanks. Very important point. Currently, there is no approved medical countermeasure if we are referring to antiviral treatment or specific vaccine targeting this specific virus. However, as you know, there is a coordination around research and development blueprint that is supported by WHO to ensure that all priority viral families can timely develop such countermeasure and the antivirus are a big family that is considered under a cork, what we say. So WHO encourages scientists and countries to join effort and to see how feasible it is to develop life-saving countermeasure. But I want to reemphasize the importance of early supportive and intensive care as soon as possible as a patient has symptoms as this can save life. And of course we welcome additional countermeasure. I leave my colleague.
Dr. Maria Van Kerkhove (01:10:24):
If I can, yes. So the R&D blueprint for epidemics, which was established by WHO following the Ebola outbreak in West Africa, in 2017, we outlined priority pathogens. And from there, these are priority pathogens that have an epidemic or pandemic risk that didn't have medical countermeasures. And a lot of work has happened over the last almost 10 years related to the development of better diagnostics, better therapeutics, better vaccines for pathogens that we know have a risk.
(01:10:54)
Recently, the R&D blueprint has moved to more of a pathogen family approach so that we take a more holistic view of how research is done to advance what could be done ahead of time, ahead of that next pandemic. We benefited from that from COVID, for COVID for the work that was done on SARS and on MERS and on RNA technology, this is what we want to continue to see. So that investment in research, that investment in innovation, the investment in the coordination of people who are working on this, we're very grateful for that from a technical point of view, the work of SEPI, the work of many others who are advancing this type of work, but that needs regular attention, regular investment, and also follow-up. So what are we learning? What actually needs to be done?
(01:11:41)
So the R&D blueprint is working very hard on many different types of pathogens with epidemic and pandemic potential. And as Anais has said, this is one in a family of viruses where this approach is being taken. So those of you who are out there who are doing research in this area, thank you very much. Those of you who are out there, who are funding research in the area, please continue to do so because it is urgently needed because we are always preparing for the next outbreak, the next epidemic. And I want to reiterate again, this is not the start of an epidemic, this is not the start of a pandemic, but it is a good opportunity to say that investments in pathogens like this are critical because therapeutics, diagnostics, vaccines save lives.
Christian Lindmeier (01:12:26):
Thank you very much. Before I hand it to Dr. Tedros for closing remarks, let me just say any further questions please send to us, thanking the panel and then now over to Dr. Tedros.
Dr. Tedros Adhanom Ghebreyesus (01:12:40):
No, I was going to add to the question about Canada. We know that the public health agency Canada is following up on the two Canadians who have disembarked at St. Helena and of course the other four in the ship are also being followed by other relevant authorities of Canada. That's one information I just would like to add. And then on closing our session today, thank you so much to all members of the press for joining us and as needed, we will continue to keep you updated. Thank you so much. All the best.