COVID-19Speaker key:TJTarik JasarevicTAGDr Tedros Adhanom GhebreyesusJAJamilMKDr Maria Van KerkhoveGAGabrielaMRDr Michael RyanADAdrianMAMaryamANAndiUMUnidentified male speakersATAntonioPMPaul MolinaroCRChristopheTJGood afternoon, everyone. Thank you very much for watching this regular press conference on COVID-19 whether you watch it on our Twitter, Facebook or YouTube channel or you have dialled in or you are watching through Zoom. Today we have Dr Tedros, our director-general; we have Dr Maria Van Kerkhove and we have Paul Molinaro who's our chief for operation support and logistics. We also have Dr Mike Ryan on the phone, who will be able to answer some questions.Before I give the floor to Dr Tedros just two small announcements; WHO has activated its business continuity plan and this is in order to adhere to good public health guidance as well as to deliver on its mandate. From today all staff are performing their functions through teleworking arrangements. Only staffwhose critical functions can only performed on this site will have access to this campus. Therefore there will be no media presence on the WHO campus as of today.00:01:06The WHO media team will continue to provide normal services through Skype, email and phone. Our regular briefings will be virtual press conferences and our audiovisual team will continue to provide necessary support so from now on we will not have journalists in the room and we will inform you if that changes.The second piece of information is that we already sent you the media advisory for tomorrow. WHO European office will convene an online meeting tomorrow, 17thMarch, about COVID-19 of representatives from the health ministries of the 53 member states of the WHO European region. After the meeting WHO regional director for Europe, Dr Hans Kluge, and emergency experts will brief the press on the current situation in the region and they will be answering journalists' questions on COVID-19. That press conference will be at 2:00 CentralEuropean Time and in the media advisory you have details of how to access this press conference, again tomorrow at 2:00, the WHO office for Europe. I will give the floor to Dr Tedros for his opening remarks.00:02:17Thank you, Tarik, and good afternoon, everyone. In the past week we have seen a rapid escalation of cases of COVID-19. More cases and deaths have now been reported in the rest of the world than in China. We have also seen a rapid escalation in social distancing measures like closing schools and cancelling sporting events and other gatherings but we have not seen an urgent enough escalation in testing, isolation and contact tracing, which is the backbone of the response.Social distancing measures can help to reduce transmission and enable health systems to cope. Hand-washing and coughing into your elbow can reduce the risk for yourself and others but on their own they're not enough to extinguish this epidemic. It's the combination that makes the difference.As I keep saying, all countries must take a comprehensive approach but the most effective way to prevent infections and save lives is breaking the chains of transmission and to do that you must test and isolate. You cannot fight a fire blindfolded and we cannot stop this pandemic if we don't know who is infected. We have a simple message for all countries; test, test, test.Test every suspected case. If they test positive isolate them and find out who they have been in close contact with up to two days before they developed symptoms and test those people to. Every day more tests are being produced to meet the global demand. WHO has shipped almost 1.5 million tests to 120 countries. We're working with companies to increase the availability of tests for those most in need.00:04:46WHO advises that all confirmed cases, even mild cases, should be isolated in health facilities to prevent transmission and provide adequate care. But we recognise that many countries have already exceeded their capacity to care for mild cases in dedicated healthfacilities. In that situation countries should prioritise older patients and those with underlying conditions.Some countries have expended their capacity by using stadiums and gyms to care for mild cases with severe and critical cases cared for in hospitals. Another option is for patients with mild disease to be isolated and cared for at home. Caring for infected people at home may put others in the same household at risk so it's critical that caregivers follow WHO's guidance on how to provide care as safely as possible.For example both the patient and their caregivers should wear a medical mask when they are together in the same room. The patient should sleep in a separate bedroom to others and use a different bathroom. Assign one person to care for the patient, ideally someone who is in good health and has no underlying conditions. The caregiver should wash their hands after any contact with their patient or their immediate environment.People infected with COVID-19 can still infect others after theystop feeling sick so these measures should continue for at least two weeks after symptoms disappear. Visitors should not be allowed until the end of this period. There are more details in WHO's guidance. Once again, our key message is test, test, test. This is a serious disease. Although the evidence we have suggests that those over 60 are at highest risk young people including children have died.00:07:22WHO has issued new clinical guidance with specific details on how to care for children, older people and pregnant women. So far we have seen epidemics in countries with advanced health systems but even they have struggled to cope. As the virus moves to low-income countries we're deeply concerned about the impact it could have among populations withhigh HIV prevalence or among malnourished children.That's why we're calling on every country and every individual to do everything they can to stop transmission. Washing your hands will help reduce your risk of infection but it's also an act of solidarity because it reduces the risk you will infect others in your community and around the world. Do it for yourself, do it for others.We also ask people to express their solidarity by refraining from hoarding essential items including medicines. Hoarding can create shortages of medicines and other essential products, which can exacerbate suffering.We're grateful to everyone who has contributed to the COVID-19 Solidarity Response Fund. Since we launched it on Friday more than 110,000 people have contributedalmost US$19 million. These funds will help to buy diagnostics tests, supplies for health workers and support research and development. If you would like to contribute please go to who.int and click on the orange Donate button at the top of the page.00:09:28We're also grateful for the way different sectors of society are coming together. This started with the Safe Hands Challenge, which has started celebrities, world leaders and people everywhere demonstrating how to wash their hands. This afternoon WHO and the International Chamber of Commerce issued a joint call to action to the global business community. The ICC will send regular advice to its network of more than 45 million businesses to protect their workers, customers and local communities and to support the production and distribution of essential supplies.I would like to thank Paul Poleman, Agile Banga [?] and John Denton for their support and collaboration. WHO is also working with Global Citizen to launch the Solidarity Sessions, a series of virtual concerts with leading musicians from around the world. This is the defining global health crisis of our time. The days, weeks and months ahead will be a test of our resolve, a test of our trust in science and a test of solidarity.Crises like thistend to bring out the best and worst in humanity. Like me, I'm sure you have been touched by the videos of people applauding health workers from their balconies or the stories of people offering to do grocery shopping for older people in their community. This amazing spirit of human solidarity must become even more infectious than the virus itself.Although we may have to be physically apart from each other for a while we can come together in ways we never have before. We're all in this together and we can only succeed together so the rule of the game is together. I thank you.00:12:02TJThank you very much, Dr Tedros, for these remarks. I will remind journalists who are dialling in by phone, it's * 9; those who are watching through Zoom it's clicking raise hand. If it's possible to have one question per journalist so we can get as many questions as possible for different people. We will start with Jamil Chade from Brazil. Jamil, can you hear us?JAYes, perfectly, thank you, Tarik. Hello, Mr Tedros [sic]. My question is about Brazil and about the fact that President Bolsonaro yesterday, on the weekend, not only helped to call a mass protest in several cities of the country but also took part himself in one of them. How do you see this as helping or not to fight the virus and what are your suggestions on street protests, in this case specifically as we are [?]? Thank you very much, sir.MKThank you for the question. What we know that will be helpful during this time of COVID-19 in terms of what the DG just said is everything that we can do to reduce the possibility of transmission between people and one of the ways that countries are doing this is to stop gatherings-together and some countries have taken different decisions based on the numbers of peoplewhere they've restricted those gatherings.So it's important that people do restrict themselves to go to [sic] gatherings where there are large numbers of people and in doing so that will reduce the possibility that people who come in close contact with one another can potentially transmit the virus to one another. So taken together with testing and aggressive case and contact finding it's important that we limit our participation in mass-gathering events.00:14:14TJThank you very much. Just to remind, Dr Mike Ryan is on the phone. Dr Ryan, if at any time you would like to add something just unmute your phone and start talking. We will go for our next question to Gabriela. Do you hear Gabriela, do we have her online?GAYes, hello.TJHi, Gabriela. Please go ahead.
TJThank you very much. We're receiving a really huge volume of questions so we'll try to go to those technical ones maybe because I think this is important. Lara Pierre is asking, do we know anything more about children and COVID-19?MKThis is a good question. We have a lot of questions about children. What we know from the evidence to date is that children are susceptible to infection and that children can be infected with this virus. They seem to be infected -in terms of symptomatic infection, in terms of detection through reporting systems -at a lower rate than adults, which is different to what we would see with influenza.From the evidence that we're seeing we're not seeing transmission in settings like schools where we would worry about amplification of transmission. In many countries schools have closed and so that is an important thing to take into consideration. We do know that children tend to have more mild infection, havemore mild disease but we have seen children die from this infection so we can't say universally that it's mild in children so it's important that we protect children as a vulnerable population.00:44:21What we don't know right now because we don't haveserologic tests yet and we don't have the results of these population-based serosurveys is we don't know the extent of subclinical or asymptomatic infection in children and so we're waiting for the results of those, which will help us really understand what role children are playing in this.Just to summarise, we know that children can be infected; we know that they tend to have mild disease but they can die from this infection so it's important that we protect them.TJAnother technical one, maybe for you, Maria; it's Stefan from Switzerland, from [Unclear]. He's asking, what do you think about the possibility of short-lived immunity and the risk of having a massive wave of COVID-19 next fall?MKThe question of immunity is also a good one. These are the same questions we're asking so these are the right questions. There are some initial studies that are looking at an immune response in individuals. We've seen some studies that have come out that have looked at immune response in non-human primates. The data is very early and what we're looking for is whether or not we see a robust response in people and for how long that will last.We're still 11, 12 weeks into this outbreak and we do have some serologic assays that have been developed in a number of countries and so we don't have a full answer to this yet but it is something that is very important, to see what level of response individuals have in terms of an antibody response, whether this will provide protection and for how long.00:46:01TJThank you very much. Let's try to get someone online; our friend Antonio from [Unclear]. Antonio, can you hear us?ATYes, Tarik. Can you hear me?TJYes, please go ahead. One question.ATSpain has declared a lock-down to prevent the spread of coronavirus buttoday we are still seeing images of overcrowded public transport in cities like Madrid. Do you think societies have to take more seriously the threat of COVID-19? How can we really convince the population to stay at home?TAGTo convince the public... First of all I would like to commend the very courageous and bold action that the Spanish Government has taken. I had a chance to speak to the Prime Minister, Pedro Sanchez, and his commitment, I believe, is really, really strong to fight this virus. But thepolitical commitment at the highest level alone will not be enough. There should be the co-operation of all citizens of Spain.It's the co-operation from all citizens that will make the response complete and I said it many times; this should be everybody's business, each and every individual should do everything to protect himself or herself and to protect others and should listen to the advice of the national authorities.00:47:57So my advice is that this virus will not be stopped without the co-operation of the government, the whole society and the citizens. This is everybody's business and I repeat, this is everybody's response and responsibility and that's how we can stop this virus. I encourage everybody in Spain to follow the advice of the authorities. Muchas gracias and my name is Pedrito, my other name. Thank you.TJThank you very much. I would just ask Paul now to give us an update on where we are with the supply chain and PPE as we have been getting some questions, although we didn't get it right now but a couple of emails came earlier this morning.PMYes, thank you. As people are aware, we have been facing for several weeks now extreme shortages in the provision and availability of personal protective equipment for clinical workers and healthcare staff. Also with the demand for greater testing, greater availability of testing this also puts under pressure the market to supply these tests.The third area which we're taking a closer look at and where we see signals of severe market constraint is around some of the more sophisticated equipment for clinical management. We see definitely, as we've been saying consistently, that continuing to test, continuing to trace contacts is giving a window of time for the clinical system. We start now to see a lot of demand for equipment to manage the wave of patients coming into that hospital system.00:50:04Is this a challenge? It is. Is it easy? No, it's not. Is there a chance we can get availability and provide this equipment? We remain optimistic. Certainly what we've seen now is a lot of contact being made from Dr Tedros to the highest levels of government and to CEOs and we're certainly looking at a large degree of goodwill from companies and from governments coming forward to unblock the situation.It will however take change in mindset. It's certainly not business as usual; it's very unusual and if you imagine 1,000 hands with tangled string, it doesn't work to untangle it by competition; it doesn't work to untangle it my oneself; it really needs to take a step back and work together. I think certainly what we've seen over the last three or four days is the goodwill to untangle it is there. We are making efforts to increase availability in all three critical product lines.In lab we are looking attesting and validating different samples for new reagents from new suppliers to independently validate those. When we have those validated and quality-assured we'll move forward and expand the availability of those test kits so we continue to move forwardin that spirit. Thank you.TJThank you, Paul. There was a question from Jason Bobien from NPR and he was asking something along those lines; how can we expect countries to test, test, test, especially those with weaker health systems, if even some countries with more developed systems cannot do that?00:52:07PMAgain it's increasing the number of sources. If one imagines the work that's been done up to this time has been quite impressive, it's a new virus with a new genome that then needs to be shared, needs to be analysed and it needs to be researched so the fact that we've managed to get the testing availability that we do have in a number of countries is testament to that will.That's a beginning. We have to now seriously scale it up. It needs to become industrialised to a degree again with respect and quality assurance, quality standards and making sure we are providing the right test for what we need to do.MKIf I can add to that, if you don't mind, there're two parts to that question and Paul has eloquently described this. One is about increasing the capacity to test and in increasing your capacity to test there're three things.There's making sure that you have the labs that are there that can actually do the PCR testing and, as we've said in the past, we are building on existing systems in many countries and these are building on influenza systems, the national influenza centres that exist in many countries across the globe, making sure that at least one if not more labs can do PCR testing for COVID-19 and then within a country making sure we look for more labs that can do that testing whether these are public labs or private labs that can do so.00:53:37The second is the availability of test kits and really we can't emphasise enough how quickly this has come together on a global scale in terms of sharing the full genome sequence very early on in January and having the rapid development of assays by a number of labs across the globe which has enabled a number of companies, a number of labs to develop PCR tests that are now being shared globally and developed globally.The third is increasing the people who can actually run those tests in those labs. What we've seen in some countries is that -we've mentioned this before -you don't havea uniform outbreak in each country. You may need to move people around your country to support where that need is most and some of that is increasing your lab capacity workforce to be able to run those tests.But the other part to that question is a about the willingness and the efforts to actually go out and aggressively find all of your cases and test your suspect cases and test your symptomatic contacts. It's important that when we say test, test, test this is what we mean; we mean test all of your suspect cases, we mean test for symptomatic contacts and in doing so you can drive that transmission down.TJThank you very much. Mike, Dr Ryan, would you like to add something to that?MRNo, Tarik, I think Paul and Maria have given very good answers.00:55:06TJOkay, then we will move to the next question; GG Press. Who do we have from GG Press?UMHello, can you hear me?TJYes, please, go ahead.UMThank you. My question is regarding Europe as a whole.TAGRegarding what, did you say?UMRegarding Europe, the situation of Europe. I think many people are wondering why in Europe, where the health system is very well advanced, people are suffering from the virus much worse than in Asian countries which are much closer to China. Is it just because of the lack of tests which you just mentioned or is it because of free movement across borders? How can you explain the contrast between Europe and other regions? Thank you.TJThank you very much. Mike also wants to... Yes, please.MRTarik, I think it's very important to look at epidemics around the world being in very different phases at very different stages. The epidemic in China began, most likely, in early December, the first confirmed cases and it developed over weeks, it accelerated, the Government had to react to a very bad situation in Wuhan and had to take extreme measures to try and push the virus back.00:56:40I think in the context of Europe that is a very similar sort of scenario. I think we have to look at the epidemics as... Whilewe call this a pandemic the fact is that the epidemics in different countries are at different stages of development. Europe is an open, multi-country partnership and they have focused on strengthening their health systems and focused on trying to improvesurveillance and doing all of the same things that China has done.