FULL TRANSCRIPT: WHO Press Briefing COVID-19 โ€“ March 30, 2020

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Back here with you, we will have our regular press conference on Covered 19. And as usual, of Alaskan journalists who are on zoom to click race hand to be put in the queue. I understand that there are not many journalists calling on form, but if there is someone you would need to press Star Nine.

Today, uh, we have, uh, Director General Dr. Dedalus, Dr. Mega-bank or Kove and Dr. Mike and as usual, uh, we will have a audio file immediately available and transcript a little bit later in the evening or tomorrow. I'll give floor to Dr. Tartarus for opening remarks. Dr. Dangerous, please.

Thank you. Thank you, Tarik. Good morning, good afternoon and good evening. Wherever you are. The coveted 19 pandemic is training health systems in many countries. The rapidly increasing demand on health facilities and health workers threatens to leave some health systems overstretched and unable to operate effectively. Previous outbreaks have demonstrated that when health systems are overwhelmed, does due to vaccine preventable and treatable conditions increase dramatically. Even though we are in the midst of a crisis, essential health services must continue. Babies are still being born. Vaccines must still be delivered and people still need lifesaving treatment for a range of other diseases. W.H.O. has published guidelines to help countries balance the demands of responding directly to covet 19 while maintaining essential health services. This includes a set of target immediate actions to reorganise and maintain access to high quality, essential services, including routine vaccination care during pregnancy and childbirth. Treatment for infectious and non-communicable diseases and mental health conditions. Blood services and more. That includes ensuring an adequate health workforce to deal with the many health needs. Other than covered 19. For example, we're pleased by the 20000 health workers in the UK who have offered to return to work and that other countries such as the Russian Federation are involving medical students and trainees in the response to help countries manage the surge in covered 19 cases while maintaining essential services. W.H.O. has also published a detailed practical manual on how to set up and manage treatment centers for Cobbett 19. The manual covers three major interventions. First, how to set up screening and triage at health facilities using a repurposed building or a tent.

Second, how to set up community facilities to care for mild patients. And third, how to set up a treatment center by repurposing hospital wards or entire hospitals or by setting up a new hospital in a tent. The manhole covers structural design, infection prevention and control measures and ventilation systems.

This is a life saving instruction manual to deal with the surge of cases that some countries are facing right now. These facilities will also have longer term benefits for health systems. Once the current crisis is over. In addition to having facilities for patients, it's also vital that countries have sufficient supplies of diagnostics, protective equipment and other medical supplies. Ensuring free movement of essential health products is vital for saving lives and curbing the social and economic impacts of the pandemic. Earlier today, I spoke to trade ministers from the G20 countries about ways to address the chronic shortage of personal protective equipment and other essential medical supplies. We call on countries to work with, companies to increase production, to ensure the free movement of essential products and to ensure equitable distribution of those products based on need. Specfic attention should be given to low and middle income countries in Africa, Asia and Latin America.

In addition.

W.h.o. is working intensively with several partners to massively increase access to life-saving products, including diagnostics P.P., medical oxygen, ventilators and more.

We understand that many countries are implementing measures that restrict the movement of people. In implementing these measures, it's vital to respect the dignity and welfare of all people. It's also important that governments keep their people informed about the intended duration of measures and to support for older people, refugees and other vulnerable groups. Governments need to ensure the welfare of people who have lost their income and are in desperate need of food, sanitation and other essential services. Countries should work hand-in-hand with communities to build trust and support, resilience and mental health. Two months ago, W.H.O. published the Strategic Preparedness and Response Plan with an initial ask of six hundred seventy five million U.S. dollars to support countries to prepare for and respond to Cauvin, 19. We're very grateful to the many countries and foundations who have contributed. More than six hundred twenty two million U.S. dollars have been received so far. And I would like to use this opportunity to thank King Solomon Center of the Kingdom of Saudi Arabia. For humanitarian relief, for its contribution of 10 million US dollars. We continue to be encouraged by the signs of global solidarity to confront and overcome this common trend. The commitment of G20 countries to work together to improve the production and equitable supply of essential products shows that the world is coming together.

And coming together is the only option we have. Unity is the only option we have to defeat this virus. Yesterday, I sent a tweet with a single word humility. Some people ask me why? Why I send a single word on Twitter saying humility.

Corfield, 19, is reminding us how vulnerable we are. How connected we are and how dependent we are on each other. In the eye of a storm like covered. Scientific and public health tools are essential. But so are humility and kindness. We solidarity. Humility and assuming the best of each other. We can. And we will overcome this together. I thank you.

Thank you very much. The address we will start with questions, I will remind journalese that we can take only one question per person so we can advance as much as possible. So we will start with the loser news agency. That's a Portuguese speaking news agency. Can you hear us? Yes. Can you hear me? Yes. Is it Antonio? Yes. This is Antonio. Thank you.

Please go ahead. Well, I would like to ask a question on the issues of birth and newborn care and breastfeeding. Does the W.H.O. recommend any restrictions on breastfeeding? Presence of partners in delivery rooms and skin on skin contact between mother and child because of the pandemic? Because health authorities on country like my own Portugal have banned these practices for women that are infected. Thank you.

Thank you for the question. So we have recently published some guidance on clinical management of individuals who have covered 19, which includes pregnant women and lactating women, breastfeeding women. And it is very important that women are able to breastfeed their children when they're born. There are certain precautions that that need to be taken place in terms of contact precautions. But we outline the ways in which that could be done safely.

Thank you very much, Dr. Van Kerckhove. I hope this answers the question. I just been told that there was a little problem at the beginning of the ODIO for people who were on a zoom, so please listen to the audio file that will send immediately after. If you have missed those few first seconds, we go to next question. Do we have Aljazeera on online?

Yes.

And if you can just speak a little bit louder, please go ahead.

Thank you. Thank you. I'm Randi Mylanta with Al Jazeera. So I'd like to ask you with regard to the coronavirus pandemic in Indonesia, because as of today, there have been more than fourteen hundred confirmed cases and one hundred twenty two deaths in Indonesia, which is the most of any country in Southeast Asia. What needs to be done more by the Indonesian authorities in this case? Thank you.

Am I older?

Have a good question and maybe the Director-General supplement.

While the pandemic is very well developed and escalating in in many parts of the world, particularly in Europe and North America, there are countries who are still in the earlier parts of the pandemic. It remains to be seen how the pandemic will develop in those countries. But countries with relatively low numbers of cases and I would count Indonesia in that have the opportunity to implement a comprehensive strategy focused on containment and on suppression of spread and on strengthening the health system for a likely increase in demand, regardless of the scenario. It is likely that the number of cases will rise and therefore that the demands on the health system will grow. Therefore, it's really important that the health system is prepared for any increase in cases.

At the same time, you have to.

Put pressure on the virus. You have to go after the virus. Like other countries in the region, have Sean and Southeast Asia going after the virus, detecting all cases. Testing also spike cases, isolating cases and putting count identifying contacts, following them and putting them into quarantine or home isolation. Is is the way to go and matching that with the strong community education and engagement approach. And this needs to be built from the communities of so and all of society. All of community approach focused on both containing the virus where you have clusters and small numbers of cases and where you have efficient or widespread community transmission to be sure that the health systems in those areas are prepared to deal with what will be a large influx of cases.

We believe that the that that is what Indonesia attempting and we will do everything to support the government there in doing that.

Thank you very much, Dr. Ryan.

No, thank you. Thank you so much. Just wanted to add to what Mike said. We are working very closely with Indonesia. We had a discussion with the foreign minister and then followed with his excellency, the president. And we are aligned with what the response should be, and we will boost our cooperation with regard to to the Soviet situation with Indonesia. Thank you.

Thank you very much. To round up the terrorists. Next question is Mohammed from shuttle 0 6. Can you hear us? Mohammed?

Yeah, my guess is that the United States allow the use of this incredibly effective military. Does the word has organisational commander use it to commit to other governments?

You know, I will begin and Maria will give some more technical detail.

So so that we're clear there is no proven effective, therapeutic or drug against Corbitt 19. However, there are a number of drugs that have shown promise either in previous treatment of corona viruses like Pursell Cyrus in the fight against HIV or in other situations. And there is some preliminary data from non randomized studies, observational studies that indicate that some drugs and some drug cocktails may have an impact. Some of those drugs may impact the length of disease, some may impact the severity of disease and the dosage of dosages of those drugs when they're given to what patient at what stage of the disease has not been standardized. And we've never had a comparison group where we've had a randomized approach to treatment with a drug or not treatment with the drug. It is very important that we continue to accelerate the implementation of the randomized controlled trials that have already begun all over the world, including the W.H.O. coordinated solidarity one trial. But there are other large scale trials, trials underway in various parts of the world. It's also very important that those drugs are very, very needed for the treatment of other diseases and that we don't see a situation where people who need those drugs for the treatment of other diseases cannot access them because people are just playing them up and using them. Some countries may introduce compassionate use rules which allow physicians to use those drugs in certain situations off label. That is a matter for national regulatory authorities. We don't. We don't encourage that if it leads to widespread use because it will, in effect, divert drugs away from the diseases that these drugs are used for. And we really want to accelerate the trials that would give us the actual answers that we need. We also need to look at how to scale up the production of those drugs that will prove effective in the clinical trials for you.

Thank you so much. Love to run. I will read one question that's from today's News Africa. And the question is that the WTO Africa office acknowledged last week that African continent does not have the capacity to produce respirators and ventilators at the moment. What type of support can WTO provide to African countries to quickly get their material that it's needed?

As the DG indicated, we've already sent large numbers of protective equipment and diagnostic tests to Africa. All countries in Africa can now make the diagnosis of Corbitt with support from ourselves, from Africa, CDC and from others. We've been working with the World Food Program, the Jack Ma Foundation and Africa CDC to bring PPE in to Africa, as well as supplies from our own stockpile in which is based in Dubai. It is not enough and you're correct there. The issue of ventilators is a very difficult issue. One, because ventilators are technologically sophisticated, expensive, difficult to produce and distribute and require very high levels of training in order to use them properly. There are lots of innovation at the moment in in, in, in how we can scale up to production of ventilators and even use the ventilators that don't require a patient to be intubated. In other words, how can you support ventilation in a conscious patient? And there are all kinds of interesting solutions emerging on that front. The issue is getting those solutions to scale. But the one thing I will say from the perspective of supporting a severely ill patient oxygen is something we need to discuss because everybody is talking about ventilators and that's important. A critically ill person struggling to breathe a ventilator can be lifesaving.

But before that happens, what truly is lifesaving is, is the ability of a patient to be given supplemental oxygen in order that they there that the concentration of oxygen in their blood can be kept at a high level because that's what patients suffer when they can't breathe properly. The level of oxygen in their blood drops and you'll hear people talking about oxygen saturation. It means how much oxygen is getting into someone's blood from their lungs. When someone has covered 19, your lungs struggle to put enough oxygen into your blood. By increasing the concentration of oxygen in the air that someone breeds, you allow more oxygen to reach the blood. Every country in Africa has oxygen. And we need also to focus on getting better distribution of medical oxygen. So patients with moderate severe disease can benefit from that. We will work. And we are working with the World Food Programme. We're working with the UN in New York. And the DGA spoken to the efforts we're making to not only scale of the distribution of such equipment and supplies, but to coordinate that in a way that countries can expect a more smooth service in in in accessing those vital supplies.

If I could just add something very briefly, this is a this is a very good opportunity to bring more clinicians and medical professionals on board with us who are into our clinical networks so that they can learn from and share experiences of dealing with KOVEN 19 patients. Not all countries are overwhelmed right now with patients. Some have very few patients. And it's it's time right now where we can be sharing experiences. We could be doing trainings that actually look at how patients are treated and what type of care patients who develop either moderate, severe or critical disease could be cared for. So we could bring them on board and join our teleconferences that happen regularly with clinicians all over the world.

Thank you very much. The next question is the cristiana. We'll hear from a DPA German news agency. Christina, can you hear me? Can you hear me?

Yes, please go ahead.

Yeah, yeah, yeah, yeah, yeah. He cited the record make everyone wear a mask going into the show. I understood from our previous briefings that the general public should not. Grandma. What do you say about the new measure?

Thank you.

I'm not specifically aware of that measure in us in Austria. I would assume that it's aimed at people who are potentially have the disease, not passing it to others. In general, there'll be. Agel recommends that the wearing of a mask by a member of the public is to prevent that individual giving the disease to somebody else. We don't generally recommend the wearing of masks in public buy otherwise well, individuals, because it has not been up to now associated with any particular benefit. It does have benefits psychologically, socially, and there are social norms around that. And we don't criticize the wearing of mass and have not done so. But there is no specific evidence to suggest that the wearing of masks by the mass population has any particular benefit. In fact, there's some evidence to suggest the opposite in the in the in the in the misuse or wearing a mask properly or fitting a property or taking it off and all the other risks that are otherwise associated with that. And there also is the issue that we have a massive global shortage and where should these masks be and where the best benefit because one can argue that there's a benefit of anything. But where does a given tool have its most benefit? And right now, the people most at risk from this virus are frontline health workers who are exposed to the virus every second of every day. The thought of them not having masks is is is horrific. So we have to be very careful on supply. But that is not the primary reason why W.H.O. has advised against using masks at a mass population level below. Pastor Maria. On the technical side, you may have something to add.

Do you think? No. Only to reinforce what Mike has said that our recommendations are for in the community, we don't recommend the use of wearing masks unless you yourself are sick and as a as a measure to prevent onward spread from you if you are ill. The masks that we recommend are for people who are at home and who are sick. And for those individuals who are caring, for those people who are home that are sick. But as Mike has said, it's it's important that our frontline workers, who we recommend standard and droplet precautions, have adequate use of PPE. And so that we make sure that we prioritize the use of masks for those who need it most.

Thank you very much. Next question from India. From a bunch of cowards down to earth, Bundarra, can you hear us?

Hi. Can you hear me? Yes, please go ahead.

Doctor, then you must be aware that India, as part of its lockdown, is witnessing unprecedented humanitarian crisis in the form of movement of migrants from one part of the country to other. I do understand that you do not like commenting on individual countries, but this is an unprecedented humanitarian crisis. So what would be your advice to our government? And second question. It's not a question is just a clarification. None of our none of the situation reports given by W.H.O. says community transmission is happening in any of the countries. While we do know it is happening. So could you please clarify on that?

Can you just repeat the second part of your question?

I said the situation reports, which W.H.O. gives us every day, there are countries and the stage of transmission mentioned against those countries, against none of the country, there is mention of government transmission where we do know that some countries are witnessing community transmission. So could you please clarify on that?

Yeah, I think we'll go back and look at our Web sites and see if the situation there were we we I don't believe we've indicated that there is no community transmission. Somewhere like like India. But we will definitely check that we're going back to.

I think what is the more important part of your question, which is the the the impact of of of lockdowns, movement restrictions in any situation are very, number one, need to be taken very carefully and to obviously. Regardless of their intent, they are very difficult to accept by communities, by others, because people need to move and want to move for family reasons, for economic reasons, and for for many other reasons. And it's important that governments communicate openly and transparently with their people as to the reasons why lockdowns are shutdowns or movement restrictions are occurring because they do impinge on people's freedom of movement. And if people and communities are to offer up that freedom of movement, they do need to understand why that's happening. It's also and those move those movement restrictions are regrettable in all situations. Nobody wants to see those happen. But in situations where you have a very, very intense epidemic and one part of a country and another part of a country, it's not so intense. You may have to implement some measure to at least encourage. Sometimes it's advice. Sometimes it's strong advice.

And sometimes it's a restriction where transport is stopped. Each government has to choose the balance between what is advice to communities and what is what is. In some senses, it enforced lockdown, whatever is chosen. It's really important that communication and acceptance by the community is at the center of the concern of the government. It is impossible to have an effective restriction of movement without a community on board with that restriction of movement at all levels. And as the DG said in his speech, when such measures are put in place, it's exceptionally important that those measures are carried out with not only the acceptance, but with the human rights and dignity of the people affected at the center. Now, that is not always easy, but that is what should be as part of a center of the objective of the process. And I'm not here speaking specifically about Indians, speaking about this in general terms. But I think what it does speak to is that these society wide measures are difficult. They are not easy and they are hurting people. But the alternative is even worse.

And countries, if they are going to be able to move away from this approach of of having to lock down and shut down. If we're going to move away from that approach as a means of suppressing the virus, we have got to put in place.

The public health surveillance, the isolation, the quarantine, the case, finding the detection, we have got to be able to show that we can go after the virus because lockdowns alone will not work. But unfortunately, in some situations right now, they're the only measure that governments can actually take to slow down this virus. And that's unfortunate, but that is the reality and we need to continually explain the reasons for this to our communities.

So thank you. This is a very important question.

Maybe on the first one, based on the transmission in countries, W.H.O. has categorized actually countries into four that are countries with no cases, what we call the four CS. No cases. Group of countries, and then the second these countries was sporadic cases and the these cases. Countries. Weese Clusters of cases. And the forces community transmission. And we have now a number of countries with community transmission. And that's why we have developed a guideline that's tailored to these four situations. And please check our website and you'll find the four CS and the four categories. And what should be done based on on this.

But we have community transmission in many countries and we have said it many times. And then on the issue of. Lock down, so-called lock down, maybe, you know, some countries have already taken measures for physical distancing. Closing schools and preventing gathering's and so on that can buy buy time.

But at the same time. Each and every country actually differs. Some countries have strong social welfare system. And some countries don't. And I'm from Africa, as as you know. And I know many people.

I actually have to work every single day to win their daily bread.

And governments should take this population into account. OK. If we closing or if we're limiting movements, what is it going to happen to those people who have to work on daily basis and have to earn their bread on a daily basis? So each and every country based on its situation should answer this question.

We are not seeing it as an economic impact on a country, as an average of GDP loss or, you know, the economic repercussions.

We have to also see what it means to the individual in the street.

And maybe I have seen it say it many times and I come from a poor family and I know what it means to always, you know, worry about.

Your daily bread. And that has to be taken into account.

Because each and every individual matters and how each and every individual is affected by our actions has to be considered. And that's what we are.

We are saying it's about any country. It's not about India. It's about any country on Earth. Even the wildest country on earth can have people who need to work for their daily bread. No country is immune. Each and every country has to really make sure that this is taken into account.

Thank you very much. Next question. Associated Press Jamie.

I can read this. Good. Good afternoon. My question has to do with the situation some European countries. We've seen some signs that countries like Italy and Spain may be sensing that they are reaching the peak and that I believe the U.K. also mentioned some some experts. There are one expert there mentioned that they may be nearing a peak. I'm just wondering if you have any estimates. I know that, Mike, you said on Friday that there's no way to to to sort of see the end of this. But what about peaking? Do you see any any signs of peaking within Europe? Thanks.

If you if you just look at the extent of transmission and through those three countries you mentioned.

There, and we wouldn't compare them to Korea or to Japan or Singapore in terms of the situation there. Much more extensive problems. And then if you compare them to what happened in China and specifically in mewhen which was the most intense epidemic we did see among women, rather than basing this on modeling, that's based on experience. Right. We saw what happened in Ruwan after the lockdown.

And not only did they do that physical distancing and put people in their homes, but they continued to look for cases. That's the essential difference. They continued to detect cases and isolate all cases, including mild cases away from their families. But let's assume they've done that. What we saw over a period of days and I think you were one of the people who asked the question during the one event, do you think this is stabilizing? Is it going down for a number of days? You know, we said, well, we can't tell. I went up and down and up and down. So what we're likely to see, if you imagine there lockdowns and the stringent measures were put in place, are now in place, were between 2 and 3 weeks in Italy at different levels and different places.

We should start to see stabilization because the cases we see today really reflect exposures.

Two weeks ago. So the cases you see today are almost like historical in the same way when we're told that we're looking at galaxies through a telescope that we're seeing light from a billion years ago, we're seeing a reality that existed before. When you count your cases on a daily basis, an epidemic, it reflects a reality of transmission and risk two weeks before at least.

So in that sense, what we see today is what happened two weeks ago and is what we hope to see is those numbers stabilizing, which will reflect the fact that exposure started to drop over time. And some countries, as I said on Friday, have seen that through the number of contacts per case when they've continued to look for cases, they've still done contact tracing. And what they've found through the physical distancing measures and the stay at home orders is the number of significant contacts per case has dropped from the 20s to fifteen to 12 to tend to 8 to 4, which means less people have been exposed to that case than previous than would have been two weeks ago, which shows people are distancing for whatever reason they're distancing.

So there are less people at risk for any individual case. If you get those cases out of the community quickly, they'll expose even less people. And that's how you get ahead of an epidemic. So do we hope that Italy and Spain are nearly there on that? Yes, both. The way you stabilize and then move to zero and I think everyone's talked about the the curve up and everyone talks about the stabilization.

The question is how do you go down? And going down isn't just about a lockdown and let go. To get down from the numbers, not just stabilize, requires a redoubling of public health efforts to push down, not it won't go down by itself, it will be pushed down. And that's what we need countries to focus on. What is the strategy now to put in place the public health measures that will push down the virus after those measures may be released? And then how do we take care of people better in a clinical environment to save more lives? So, yes, potentially stabilizing. And it is our fervent hope that that is the case. But we have to now push the virus down and that will not happen by itself.

If I could just add to that, I was gonna say, which Mike has just said is we need to focus on the now.

We need to focus on what must be done now to get us out of this. And there is this, I understand completely the desire to want to know when we will reach the peak and when we will start seeing that decline. But that will not happen on its own. These these physical distancing measures, these stay at home measures have bought us a little bit of time.

A little window of time in that short window has to be used appropriately so that we get systems in place to look for this virus aggressively through testing, through through isolation, through finding contacts, through quarantining those contacts, through caring for further patients, because we will still see patients and many patients are still going to require need to support other countries that are going to go through this. So the focusing on what we do now is absolutely critical to make sure we use that time wisely. We use that time effectively so that we do. Once we do reach that peak that we continue to push and suppress that virus down as quickly as possible, but still be ready to find additional cases should they show up. What we've seen in a number of countries in Asia and that where they brought this this virus down, they've brought transmission down, they're now seeing repeat introductions from outside of their countries. They have not let their guard down. They are still aggressively looking for those cases as they come in and suppressing it so that it doesn't start again. So we need to focus on the now. We need to use our time wisely. And that is to aggressively find this virus and care for our patients.

Thank you very much. Next question is from a Nippon TV Atsuko.

Atsuko, can you hear us?

Can we try one more time with the. Nippon TV.

It's OK. So.

Let's go. Let's go to Jim from Westwood One. Jim, can you hear us?

Yes. Thank you very much. Very good afternoon to you. I would like to clarify a little bit on the chloroquine issue in the US and it should be.

Important to point out that the FDA hasn't approved it for wide prescription by doctors, but only in a hospital setting. And the doctors there can only get it from the national stockpile. But my question is, what exactly was observed with chloroquine or hydroxide chloroquine that could lead to the possibility of it being used to treat Koven, 19, in a hospital setting.

And you mean exactly by randomized testing as opposed to non-REM randomized testing. You can answer those that appreciate that.

Thank you. Mm hmm. Uh.

Maria, suppliment, I mean, there was some what people will describe as in vitro evidence, evidence in the lab that the drug was active against the virus, but any number of things are active against viruses in a chlorine is active against viruses.

But other things are active against viruses. The question is whether they're safe and effective to put in a human body and whether they will be absorbed and processed in a way that the virus can be attacked and not the body.

From the perspective of chloroquine, there were also some small observational studies, one in France that followed a small number of patients where there was no randomization of those patients and looked at their outcomes.

Patients were admitted at different stages of illness and improved. Their outcomes that we're really focused on was the length of illness. And the observation that was made was that people length of illness or length of hospitalization or length of significant system's significant symptoms was reduced. No one here is talking about cure. No one here is talking about taking a magic pill. And all of a sudden you recover from. Everyone's looking for therapies that will shorten the disease. Illness will prevent people going from moderate to severe and will prevent those that are critical. Dying and drugs act in different ways. Some drugs may actually prevent the virus replicating early in the disease and therefore shorten the length of the illness and reduce reduce the the progression to severe disease once the disease is very well established and in a later stage of the disease. A lot of the damage that's being caused by the virus has not necessarily been caused by the virus itself, but all of the secondary effects, the inflammation, the drug are the the organ failure and other things that happen. So a lot of anti-viral therapies are focused on getting a person with with the disease treated as an earlier stage of disease. And if you look at a lot of the anti-flu medications like like Tamiflu and others, their main benefit that has been found for those, again, has been shortening the course of illness with regards to randomised controlled trials. The importance of having a control group is to have a comparison and then be able to stratify your patients. Because if I have a drug and I treat a very severe patient who's very I've an older age with the drug and that person dies, does it mean that that drug didn't work?

And if I treat a really healthy young person who's got a moderate disease and they recover. Does that mean the drug worked? And I don't think any of us need to be rocket scientist to work out that there are many factors that predict recovery or predict death. And, well, we have to separate and we have to distill out is what is the effect of the drug itself, not the age of the patient, not the condition of the patient. And so many other factors that can affect survival. We've all been through infectious diseases ourselves and we recover. Is that because, you know, we get on one side of the bed or the other? No, we wouldn't assume that that was affecting the outcome of the illness or many natural things affecting illness outcome, including the hard work of doctors and nurses in supporting the patient and preventing organ failure and ventilating the patient. So the difficult thing at this moment is distilling out the specific effect of a drug in a complex illness. And that's what we're trying to do with the randomized control trials. And that's why we need so many patients in those trials across many countries, many age groups, genders, many phases of the disease and many levels of severity. And then we can break out what is the actual effect of the drug on the outcome of the disease?

Only to add that there are a number of clinical trials that are ongoing. Mike has described the French study that I'm aware of as well. But there are a number of clinical trials that are ongoing that look at chloroquine, that look at a number of other therapeutics.

And on the one hand, it's incredible to see this acceleration of research and development in this focus on on the evaluation of therapeutics for Cauvin 19 patients, which is building upon a history of other respiratory pathogens that have plagued us. But the challenges is that many of these clinical trials are small in size, which makes it very difficult to draw any conclusions, which is why is is very important that we have these larger trials. These multi-site trials, the solidarity trial that W.H.O. is running to be able to have enough cases to be able to get an answer to which drugs work safely.

Thank you very much. We have time for one or two more questions, so I'll start I'll try with Bloomberg and now. Now me. Can you hear us?

Hi, yes, I can. Thanks for taking my question and wanted to ask. We've seen some different approaches to quarantine in China and in European countries with group coordinate in use to good effect in China. And do you think that quarantine will be as not as effective anywhere for people who are positive or when central quarantine be needed in order to have the same success?

Hi. Yeah, it just it. So we we get our terms right and we can explain ourselves properly. We tend to use the word isolation for someone who is a case confirmed. We tend to use the word quarantine for someone who's at risk of being a case, usually a contact. So on that basis, we advise that all suspect cases are tested and all suspect cases are isolated in an appropriate medical facility. I think nobody disagrees with that where the capacity exists. When we come to contacts, it very much depends on the context, the context and the intensity of the epidemic at any given moment in low incidence areas where there are sporadic cases or clusters. We advise that all contact should be quarantined. Ideally, that quarantine should occur in a place other than the home. And for this reason, one, because if that person gets sick, they may already have infected their family. But those that's not always possible. So at least quarantining contacts at home with good health advice about not transmitting disease if they've become sick and would regular monitoring of that individual is an option for countries? It is difficult to do that in the middle of intense transmission where you might have hundreds of thousands of contacts because you're having thousands of cases a day.

It is difficult to deal with that. So home quarantine of contacts is acceptable with appropriate information, education and more importantly, a very rapid system of getting those people out of out of their homes if they become sick. I listened to the president of Singapore this morning and he had a conference call with the director general and the clarity of that in Singapore. That ability not only to isolate cases, but to rapidly detect illness in the context and remove those contacts should they become sick. Was a central part of that. And as he said, that wasn't there using apps. Now to do that, they're testing out, but that they didn't do it with apps and Singapore, they did that with community workers, with public health workers, visiting the houses, checking on people, checking their health status every day and saying, how are you? Have you got a fever? Have you got a cough? And if a contact is developed, a cough or a fever, they were taken immediately for testing.

So, yes, we need the information technology tools they help. They are not the solution. There isn't right now we don't have an alternative to what we would have considered in the old days boot leather epidemiology, public health practitioners, doctors, nurses, community workers working with communities to detect cases at community level. And the most likely person to become a case is someone who has been a significant contact of another case. And at the moment, in most parts of the world, due to lockdown, most of the transmission that's actually happening in many countries now is happening in the household at family level. In some senses, transmission has been taken off the streets and pushed back into family units. Now we need to go and look in families to find those people who may be sick and remove them and isolate them in a in a safe and dignified manner. So that's what I was saying previously about the transition from movement restrictions and shut downs and stay at home orders can only be made if we have in place the means to be able to detect suspect cases isolates us. Confirmed cases track context and follow up on the contact health at all times and then isolate and quite isolate any of those people who become sick themselves.

You were mentioned as we tried to have a variety of different outlets being able to ask questions, we don't have quite often sports outlets. So I'll call on Diane from soccer dot com. Diane, can you hear us?

Yes, I can hear you. Can you hear me?

Yes, please go ahead. Hello.

Yes, please go ahead with your question.

Then let's try one more time. Can you hear us? We were hearing you weren't very well.

Yes, I'm sorry, I'm having my phone. Hello, can you hear me now? Yes, please. Go ahead.

There is such a discrepancy of information regarding the validity of masks, and I know that you have addressed this and there's a great deal of fear regarding medical professionals have access to it. But is there any type of qualitative research that can confirm that the masks wearing a mask? Prevents the spread for normal transmission in going to the supermarket in day to day activity.

I can start and perhaps Mike or the DG would like to supplement.

So this is this is an area of very active research. There's a lot of use of masks globally for different diseases, for influenza, for other coronaviruses, for this particular outbreak. But there isn't a lot of quantitative analysis of this. And what we know works. We know that people who are sick and they stay home. That works because that prevents them from from spreading the disease to someone else. We know that washing your hands works because we know that that or using an alcohol brace rub because that will remove the virus from your hands. We know that physical distancing works because that removes the opportunity to spread that virus from one person to another. We are working with a large group of people across the globe in our IPC specialist networks to look at the use of masks in various settings. First and foremost in health care facilities so that we could better understand how PPE was used by health care professionals as they treated patients in which types of departments they were working in, under which types of conditions and the severity of those patients. That's the real focus of of of a lot of the research right now to ensure that we protect our health care workers. So we are working with a number of groups across the globe as those results become available. They will be published. They will be scrutinized. They will be evaluated by us and our partners to make sure that we are putting the best evidence forward in the best evidence based guidance forward.

And I will take one more question, because I've been getting messages.

And obviously we apologize to all those who will not be able to ask their question today, but we will have opportunity this week. So I'll call on Gabrielle Sotomayor to ask her question. Gabriela, please.

Thank you very much. Thank you very much. Timecard A. Taking my question. Dr. Dedalus on testing.

There are some countries that I think that they are not listening. Exactly. I mean, the message that they are not receiving the message. So just to clarify it, because some some countries are saying that is useless to test. So in a country, for example, in a country when you have 1000 confirmed cases and two thousand five hundred suspected cases. How many tests do you have to do? I mean, just to have like a number or something, an estimate. Thank you very much.

The positivity rates untested.

You may wish to comment as to whether people are listening or not, but on the specific issue of tests, the positivity of tests or the number of tests in general where testing has been done fairly extensively. We've seen somewhere between 3 and 12 percent of tests being positive. If you get to a point where a tiny percentage of tests are positive, then the danger is you're either looking in the wrong place. It's reassuring. Are you have to be very careful to ensure you can keep up that level of testing. So it's an issue of balancing the use of your test against their value. And again, it's like any detector system testing is a detector system. You can turn open down the sensitivity of that system as long as the batteries last. So that's the issue.

How long will your tests, the available tests of, you know, I've got X number of tests available to me over the next month, then how am I going to use those tests over the next month? So countries have been limited by the number of available tests. And that's important.

Countries have also had to ration tests according to the intensity of the disease in different parts of the country. So therefore, the return or the return rate or the percentage of confirmed tests will vary. But we would certainly like to see countries testing at the level of 10 negative tests to one positive as as a general benchmark of a system that's doing enough testing to pick up all cases. Now it can be more or it can be less depending on the circumstance. It's not an objective. Would you want you really do want to see a lot more. You would be very you know, you're missing a lot of cases. If 80 or 90 percent of the people you test are positive, you are probably missing a lot of cases.

And if I could just add to that to say that a lot of a lot of the challenges that countries are facing, a lot of the argument that comes back is just that we just don't have enough.

And so just to to say what what W.H.O. is doing and what countries are doing is they're trying to find tailored diagnostic solutions to their needs, to meet their needs of their countries in the outbreaks that are happening in their countries. And that includes a variety of things that that we are doing and countries are doing. The first is to increase the capacity of the lab. So the number of labs that can actually conduct that testing. So whether these are national labs or academic labs or private labs. But increasing that that number of labs, increasing the number of people that can actually run those tests, finding individuals that can run those tests. The second is increasing the production and availability of tests. There's a huge number of tests that are on the market right now, thanks to the rapid sharing of sequences, full genome sequencing of this virus. In early January and then the third, we are working very hard to have a tailored support to country based on their need, based on what they have in their individual countries, whether these are benchtop or manual PCR kits or whether these are automated PCR is or whether these are high throughput machines. There's not one single solution to increase your ability to test. But it is important that you continue to do so so that you know where the viruses.

I think it has been. I just wanted to add testing is very, very important.

I cannot even emphasize it more. Um, there was a meeting of ministers. This was last Thursday, I think. And we had, you know, some of the practices from four countries, actually what they have done.

The common factor in all four countries was the testing. Testing is important to understand the status of an individual. But testing is also important to see. You know what the situation looks like, for instance, from the presentations of the foreign ministers. We saw that when they test. They go back and check those positives, how they got the infection. Some of them could be from a church gathering or a religious event or others could be in a bar or a restaurant or others could be in a social gathering for for some some purpose.

And then the testing is not about that individual. It becomes about the event that happened and how to really address such events. So the testing doesn't tell you just a story about one person. It's a story about what happened when that person actually acquired the infection, and that helps you to trigger your public health interventions. Ted Correa, when it started the community transmission.

It was actually a religious event and thousands of people ended up being infected in in in one gathering. Another important event was another important lead was in a hospital.

So one was the religious event and the other one was a hospital where they so very intensive transmission and how then they mobilized their public health intervention to address not only that, but also other clusters.

So without knowing, without testing, it's like moving blindfolded.

So testing can help us not only to know the status of individual persons, but to know also what's behind it and take public health measures.

And that's why we are saying testing is very important. And from testing, you can do the contact tracing. From there, you can also do the isolation. But we fully understand when there is community transmission, the health system could be overwhelmed. Even the public health interventions could be very, very, very heavy.

But there there are ways to tailor our publicly interventions even in such situations. And the isolation may not necessarily be in a hospital or health facility. It could be in a community facility. Many countries have very innovative ways of isolating because their health system was overwhelmed and they had to actually look for community facilities. And then the last resort is when they couldn't do that.

And when they have a number of cases and when there is going to transmission, then some of them resorted into isolation in their in their in their home. And, you know, separating their bedrooms and separating the utensils they use.

But then let's be practical. OK. You can have your own bedroom or you can have your own this or that to isolate yourself and to take all the precautions you need.

But if it's in a developing country, for instance, where I grew up, if it's a one room where there is a big family, like five or seven people in one room. How do you implement that? And then that's why we say we don't have a one size fits all solution. And the solution should really be tailored to the situation of each and every country. So how do you implement isolation in a situation where a single family, a big family is living in one room or two rooms in isolation is not possible at all. So that's why we say one size fits all solution cannot happen. And each and every country knows its situation in terms of Crovitz situation. It knows its own social and other factors and it knows what solutions it has at hand to have a successful public health solutions.

So that's what we're we're saying.

And of course. Necessity is the mother of invention, and we expect a solution in every situation from the communities themselves and from the government and the country itself, because each and every situation is very unique and each and every community knows the problems, knows the root cause of the problem and knows the solution. And it doesn't need any prescription from from anyone. The general guidance we give can help you to really get solutions in in your own way. The most important thing is how can we. Traeger the human spirit. In unison to address the problem that we are facing in each and every community. Thank you.

Hiromitsu, the fact that he was with this will conclude today's press conference. We apologize to all those who have not been able to ask the question, but there will be other opportunities.

We will have a audio file sent to you in the next hour and hopefully transcripts will be posted tomorrow. Have a nice day and evening. Wherever you are.

Thank you. Thank you, Tariq. And thank you for joining us. And see you in our next presser. All the best.

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