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Popular Transcripts FULL TRANSCRIPT: WHO Press Briefing COVID-19 – 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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Good evening. Good morning. Good afternoon. Welcome to the World Health Organization press briefing on briefing on Cozied 19. We have with us, as always, the W.H.O. Director-General, Dr. Tedros. We have Dr. Mike Ryan, executive director of our Emergencies Program, and Dr. Maria Van Kerckhove, technical lead for Covered 19. Dr. Tedros will first give you an update, then when Dr. Ted Rosses finished his opening remarks. We will hear a message about the Solidarity trial. After that, I will open the meeting to questions if you have connected by a Xoom. Please use the raise your hand icon to get Nikki to ask your question. If you've connected by phone, please hit Star 9 on your keypad to indicate you want to ask a question. I apologize now to those who miss out as we've got hundreds of people connecting already and asking questions for which we thank you all. So we need to keep this briefing to under an hour so that our speakers who are all leading this response can get back to all the other pressing jobs on their endless to do lists. And right now, there's a lot to do. And to hear more about where we are and what we are doing and what we need to do, I will now hand over to Dr. Ted Ross.

Thank you. Thank you, Margaret. Good morning. Good afternoon. Good evening. Wherever you are. There are now more than half a million confirmed cases of Corbitt 19 and more than 20 thousand dollars. These are tragic numbers. But let's also remember that around the world, more than a hundred thousand people have recovered. Yesterday, I had the honor of addressing an extraordinary meeting of leaders from the G20 countries. My message was threefold.

We must fight. Unite. And ignite. Fight to stop the virus. With every resource at our disposal. Unite to confront the pandemic together. We are one humanity with one common enemy. No country can fight alone. We can only fight together. And ignite the industrial might and innovation of the G-20 to produce and distribute the tools needed to save lives. We must also make a promise to future generations saying never again. Viral outbreaks are a fact of life. How much damage they do is something we can influence. I thank the G20 countries for their commitment to fight the pandemic, safeguard the global economy, address international trade disruptions and enhance global cooperation. This is especially important for countries who are not part of the G20, but will be affected by decisions made by G20 countries. Earlier today, we held a briefing with around 50 ministers of health from around the world, which at which China, Japan, the Republic of Korea and Singapore share their experiences and the lessons they have learned. Several common themes emerged about what has worked. The need for early detection and isolation of confirmed cases, identification follow up and quarantine of contacts. The need to optimize care and the need to communicate to build trust and engage communities in the fight. Countries also expressed several common challenges. The chronic global shortage of personal protective equipment is now one of the most urgent threats to our collective ability to save lives.

W.H.O. has shipped almost 2 million individual items of protective gear to 74 countries that need it most. And we are preparing to send a similar amount to a further 60 countries, but much more is needed. This problem can only be solved with international cooperation and international solidarity when health workers are at risk. We are all at risk. Health workers in low and middle income countries deserve the same protection as those in the wealthiest countries. To support our call on all countries to conduct aggressive case finding and testing. We are also working urgently to massively increase the production and capacity for testing around the world. One of the most important areas of international cooperation is research and development. A vaccine is still at least toil of 2 8, 18 months away. In the meantime, we recognize that there is an urgent need for therapeutics to treat patients and save lives. Today, we're delighted to announce that today in Norway and Spain, the first patients will shortly be enrolled in the Solidarity trial. Which we'll compare the safety and effectiveness of all four different drugs or drug combinations against Cobbett 19. This is a historic trial which will dramatically cut the time needed to generate robust evidence about what drugs work. More than 45 countries are contributing to the trial and more have expressed interest.

The more countries we join the trial, the faster we will have the results. In the meantime, we call on all individuals and countries to refrain from using therapeutics that have not been demonstrated to be effective in the treatment of Cobbett 19. The history of medicine is strewn with examples of drugs that worked on paper or in a test tube, but didn't work in humans or were actually harmful during the most recent Ebola epidemic. For example, some medicines that were thought to be effective were found not to be as effective as other medicines when they were compared during a clinical trial. We must follow the evidence. There are no shortcuts. We also need to ensure that using unproven drugs does not create a shortage of those medicines to treat diseases for which they have proven effective. A pandemic evolves and more countries are affected. We are learning more and more lessons about what works and what doesn't. W.H.O. is continuing to support all countries in the response. We have published more than 40 guidance documents on our Web site, providing detailed evidence based recommendations for governments, hospitals, health workers. Members of the public and more more than 1 million health workers have been trained through our courses on open W.H.O. dot org. We will continue to train more. We're also delighted to report that the coveted 19 Solidarity Fund has now received donations of more than one hundred eight million U.S.

dollars in just two weeks from 200 tons, 3000 individuals and organizations. Thank you to each and every one of you. The English version of our watch is upheld. Ireland now has more than twelve million users globally. And the Arabic Cranach and Spanish versions were launched today. More languages will be added, including Bangalow, Chinese, Hindi, Kurdish, Portuguese, Russian, Somali, or do so highly and more. I have said before that crises like this bring bring out the best and worst in humanity. We have recently seen an increase in scams, cyber attacks and impressions using W.H.O. my name and covered 19. I'm very grateful to those working in various national organizations providing critical cybersecurity intelligence to the W.H.O. cyber security team. Thank you for your efforts to work with us to protect the health systems, health workers and members of the general public who rely on our information systems and digital tools. Special thanks for to Microsoft for assisting on this. I would like to end with something Singapore's Minister of Health Gein Kim Yong, say during today's briefing. We are only at the beginning of this fight. We need to stay calm. Stay united and work together. I will repeat. We need to stay calm, stay united and work together. I thank you.

Thank you very much, Dr. Tedros. And then stop the terrorist mentioned.

We've got some exciting news on the spot about the Solidarity clinical trial from Norway and we'll hear a lot more about it via a video intervention by Norway's minister of health and Care Services.

There Togrow Tartarus. Dear colleagues, dear friends, they're all I'm honored to address you in this afternoon's press conference. We are in the middle of a global health emergency, but we are also in the middle of a global quest for knowledge, unlike anything we have ever seen. I find this happening in the midst of all the bad news from around the world. If we find treatments that are safe and effective, we can save lives and we can protect health care professionals and other High-Risk groups from developing disease. It is important that all countries pull together, share data and knowledge to solidarity. Trial is an important piece in the global research effort. Together, researchers from all over the world will assess four of the most promising treatments for Code 19. This one is out. The trial starts including patients today, and I'm very happy to be able to announce that the first patient included is a patient at Oslo University Hospital. I would like to command the W.H.O. in taking on the global leadership in this difficult situation for all our countries and its initiative in setting up the solidarity trade. I would also like to thank your non investing in a seconded director of the Norwegian Research Council and for taking the responsibility of sharing. Secondly, commit Dael to thrive. The writing and will bring expertise and experience from the Bhola vaccine crisis in West Africa in 2015. This trial is and in Goodhand under his leadership. I wish us all good luck with the Solidarity trial. Thank you.

Oh, we can open the floor to questions before we start, I'd like to give you a reminder, if you've connected via Xoom, please raise use the raise your hand icon to get in the queue to ask your question. If you've connected by phone, please hit Star 9 on your keypad to indicate that you want to ask a question. Please keep your questions short and and confine it to only one question per journalist, please. I will start with Chi Koofi's Schmidt from Science Chi. Can you? Are you on the line?

We've talked about this a couple of times and I want to ask whether there's any new data on the serology. I mean, we're still trying to nail down the denominator. There's a lot of questions about how many people are asymptomatic. Can you say anything about, you know, the newest data that you have? Is there any serology data from China?

I'll start with that. So, yes. This is something that's very important to us and to the rest of the world to really understand what the results will be from these serologic studies that are currently underway. What we can say is that there are more than a dozen countries who are conducting studies that epidemiologic studies that involves horology. These countries are focusing on what we call the ethics protocol, which is looking at cases and controls. It involves molecular testing and it involves serologic testing. We're working with these countries to evaluate which assays they're actually using. And it will be a combination of a screening assay of or analyzer as well as confirmatory testing involving my micro neutralisation. In addition to that, there are a number of countries that are conducting these age stratified general population sero surveys. W.H.O. has a protocol that we've put out online, which is a core protocol which we want countries to use so that we can compare results across these countries. At present, there's at least four studies that we're aware of that are ongoing and in in different countries which involve the collection or the use of specimens that have already been collected. So these may be clinical specimens for people who haven't been hospitalized for other reasons.

We don't have results yet. We are eagerly anticipating these results so that we could better understand what is the zero prevalence or what are the antibody levels amongst people at different age groups in different parts of the world. This is critical for us to really understand what level of circulation this virus may have or may have had for in people that may have had a subclinical infection. So infection that have had has mild disease and maybe they didn't seek care or they weren't picked up through the current surveillance systems. But these are ongoing. In addition to that, we know that there are a number of serologic assays that have been developed. We're working with a number of countries right now to look at and evaluation of these to see how well they perform. And that needs to be done with well-characterized samples. We have really great partnerships across the globe to be able to do this. We're trying to accelerate this as quickly as we can as soon as we have these results. We will we will share them, but they're really critical for our planning purposes going forward.

And if I might add this, a number of these sheriff mini-Budget studies are grouped around a solidarity to platform. So in effect to the organization and our partners have prioritized different research strands. Obviously, establishing which therapeutics were effective has been a major, major priority. But in addition to many of the studies that are going on across the world, there is now a wide group of researchers who've come together, as Maria has said, to implement a common protocol which will be known as solidarity to solidarity.

Three will look at human prophylaxis and other interventions and help workers. We are trying to align all of our work not to bring together as many partners as possible. That is not to say that other large trials and other efforts around the world are not important. They are. But for some of the answers that are complex, we're going to need to pool data. We're going to need to collect data in a consistent and collaborative way. So we're epidemiologic data, clinical data, data on protection of prophylaxis. These are answers we need and we need the right answers to drive policy.

Thank you, Dr. Ryan. So the next questions are from here. Let me get a fee. Jeremy, are you there?

I'm here. Can you hear me? Very well. Please go ahead.

Thank you so much for taking the questions. It seems that for younger people are being hospitalized in the US and Europe and in China. I was wondering, how do you explain that discrepancy? And you have concerns that the data that you got in the first place from China may not be as reliable as you thought. Thank you.

So this virus, this Cauvin 19 virus in is capable of causing infection and severe disease in all people of all ages. What we know from data across a number of countries, including data from China, including data from the US and Italy, in Iran and Korea and Japan and others, is that this virus can cause mild disease, can cause moderate disease, which is described as people who still have pneumonia but don't need oxygen support, who court can cause severe disease, can cause critical disease and who can kill some people amongst children. The data that we've seen from a number of countries is that the majority of children that are infected are experiencing mild disease. But we do have reports and there are some publications now that describe severe disease in children. We have reports of deaths in children. There's one in China and I believe one in the United States as well. We do need more well-characterized descriptions of severity across the age groups so that we can better summarise what we know about this in the different age groups. Ideally, what we would like to see is the use of clinical characterization. Protocol is another data capture platform that the W.H.O. has launched, which involves systematic data collection in terms of signs and symptoms, in terms of regular sampling of hospitalized patients so that we can better characterize the natural history of this disease in people who are in hospital. But there is data that's coming out from a number of countries.

And we welcome the the rigorous data collection that is occurring in very difficult situations in hospitals, whether this is clinical data or epidemiologic data across a number of countries.

Maybe I could just add that we've been reporting for quite a while now. The spectrum of disease. There's no question that the elderly and those with underlying conditions have been have been affected much more than other age groups. But we've certainly spoken here before about the the age profile of patients. The fact that in Korea, 20 percent of the deaths were people under 60 years of age in in in mean in Italy, the fact that up to 15 percent of people in intensive care were under 50 years of age, I think we'll find in Germany and other countries up to 10 to 15 percent of people with disease, people under 50 who have disease will have a moderate or severe infection. So they may not progressed into critical condition, but the 10 to 15 percent of people under 50 will have a moderate to severe infection. So this is not for most people is a very mild infection, most young people, but a significant minority of people between the age of 20 and 60. This is a significant infection. And if you listen to people who were interviewed on the media, the one thing I've seen again and again and again from people, adults who've got this and young adults and they keep looking at the camera and saying this is not flu. And I think I think what's really emerging is a perception that this disease, while not fatal and not causing critical disease in a younger age group, is causing a severe illness in many people.

I just wanted to add the point that we've made a few times is that young people are not invincible. The DG has said in his speech. And it's it's not just the disease that this virus will cause in people. Every infection of Cauvin 19 presents an opportunity for onward transmission. So even in younger populations, if you do have mild disease. And you think it is no big deal. What the big deal is that you may transmit to somebody else who may be part of that vulnerable population, who may advance to severe disease and who may who may die. So every single person has has a role to play in this outbreak in preventing themselves from getting infected. And we've listed a number of ways in which you can do that, which involve hand hygiene and respiratory etiquette, physical distancing, adhering to the recommendations of the national governments. By following those rules, by adhering to that, you are preventing yourself from getting infected and you're preventing the opportunity for onward transmission to someone who may be vulnerable, more vulnerable.

Thank you, Dr. Van Kirchhoff. I now have Shockoe from NHK, Shockoe. Have you on the line?

Yes. Can you hear me?

Yes, very well. Please go ahead.

Thank you very much for taking my question. Margaret. Regarding the way of counting, in some cases, the Chinese authorities said last month that they don't count confirmed cases who don't have symptoms as confirmed cases, but apparently there is a huge number. Such results, symptom cases. Given these facts, John, W.H.O. still make reliable global statistics, relying on the data given by the Chinese authorities. I mean, data not including without seeing them who thumped cases. Thank you.

So I can start with that so we we we have case definitions that we are using which include a laboratory confirmation regardless of the development of symptoms. What we know from case reports from several countries is that on the date of reports, some patients may not have yet developed symptoms and so they may be pre symptomatic. We need to be very careful in our language here. The use of the word asymptomatic globally is, I think, not appropriate. And some people, most people who are identified as asymptomatic because they were identified as part of contact tracing, that means they're already being medically followed and therefore they're being tested early. Many of those individuals who are listed as quote unquote, asymptomatic are indeed pre symptomatic and they go on to develop symptoms a day or two later. What is really important for us in terms of our understanding of this epidemiology is when is transmission taking place and what are the drivers of transmission from the epidemiologic data that we have from the viral shedding data that we have. We know that the majority of transmission, the drivers of transmission for Cauvin 19, are people who are symptomatic. Now that that includes people who are in the very early stages of symptom and the viral shedding data supports that in the earlier stages of disease when people are feeling just a little bit unwell and they haven't yet had pneumonia and they're certainly not hospitalized yet. Those individuals are the ones that are driving transmission. So it is really important that we follow all of these measures where we keep our physical distance. Transmission of Cauvin 19 is through droplets. It is not airborne. Therefore, someone who has these small liquid particles that come out of their mouth, they travel a certain distance and then they fall. So that's why we recommend the physical distance to be separated so that you remove the opportunity for that virus to to actually pass from one person to another.

Thank you, Dr. Van Kirchhoff.

Now we have honor from Nova TV in Croatia. Honor. Are you on the line?

Yes, I'm on the line. Can you hear me? Yes, please. Go ahead. And so as you could hear these days, Oxford experts said that Croatia has one of the most strict measures when it comes to number of cases. We have less than 1000 cases right now. I can see that this is changing our lives. So I wonder if you have any idea for how long this covered 19 academic can last. And is there any proof that higher temperatures can stop or slow down spread of this novel virus?

Thank you.

At this point, no one can predict how long this epidemic is going to last. And there are a number of scenarios that take us forward in time.

The I think the the other question people are asking beyond how long is the pandemic going to last is how long are there shut downs?

How long are the lockdowns? How long are all the measures going to last?

And will these measures be changed or be different? We are entering and moving to an uncertain future. You see, many countries around the world are just beginning the cycle of this epidemic.

Some have been through the the cycle of the the epidemic like Singapore and China, and now desperately trying not to have the disease reemerge and cause another wave of infections because of disease importations.

So each country is in a different position and Croatia is probably in a different position to many other countries in Europe right now. The the real trick for countries is to look at the national situation, to look at the sub-national situation, to see if you know where the virus is.

If you know where the virus is, you can break the chain. If you know who has the virus, if you know who the contacts are, you can break the chain.

If you have that knowledge and if you had the knowledge at subnational level, you can only take action at the level at which you can measure. If you know what's happening in every town, if you know what's happening, happening in every municipality, every county, every province, you can then begin to adapt your measures for the situation in that particular area. And all of us want to see the measures that we're using for public health, for a community level to be adapted to the maximum control of the disease. But to the minimum impact on economy and social life. And in order to do that and in order to transition from the current measures that are in place. Countries just simply have to have in place a system to detect.

Isolate, contact, trace.

And quarantine, as well as to continue appropriate hygiene and physical distancing measures. They must be in a position to do that in different parts of a country at different times, and they must be in a position to re-implement measures should the situation deteriorates. That's takes a very sophisticated surveillance system. It takes a very strong health system to absorb the surge of cases in any particular area. And what we need to do now is evolve from measures that have been designed to suppress and just take the heat out of this epidemic or pandemic to much more precise targets, directed measures that will allow us, at the very least, to live with this virus until we can develop a vaccine to get rid of it.

Thank you, Dr. Brian. I now have Thomas from Bloomberg. Thomas, can you hear me?

Hello. Yes, this is Thomas me there from Bloomberg News. I was just wondering, as the rate of infection increases so dramatically, is there a point that it's no longer controllable globally?

I'll start with that. Maybe Dr. Tedros, maybe Michael would like to answer. So I think, you know, you're saying that the rates are increasing. I think I think the more we test some more we're going to find. And that's that's in one aspect. You know, it's it's the it's an overwhelming thing to see these case numbers increase in it. And in some cases and in many countries, the case numbers are going to increase care. They don't progressed to severe disease, if that's possible, to find all of their contacts to follow them for 14 days. If you quarantine your contacts or remove them from the family home or remove them from the communities so that they have they don't have the possibility of transmitting to other people, to having strong leadership, strong political leadership, repurposing your government and having this whole of government approach to engaging your population, communicating with your population regularly so that they can go through this with you. As you adapt your measures, you implement certain control measures. You may lift other control measures empowering your population so that they know what they have to do. In this fight against Colvert, 19, we have seen in a number of countries and the director general had a very important meeting today with many ministers who who shared what works and what works. Is this what works is case finding is contact tracing is mobilizing your population and communicating with your population. It's making sure that you have arrangements in place so that people who need to be cared for can be so that health care workers are protected, so that PPE is used appropriately and that they're saved for frontline workers and utilized by those that need it most. So your answer to can this be controlled is yes, but it takes a lot of aggressive measures. This comprehensive approach that we have been outlining and countries will see improvement as they move through the different transmission scenarios. And so we need to apply what works to show that this that there can be suppression that can happen with this virus.

And if I could add it, it's really important at this moment that we don't create a.

Perverse disincentives to detect cases, we should commend countries that are testing and we should not punish countries for getting larger numbers. We should recognize when countries recognize reality. We should reward countries and governments for looking. If we create a situation where we we overreact to the daily no, then there's a disincentive to actually test countries who test and find cases and do lots of testing and know other viruses should be commended. Secondly, we need to look at rates of things. We compare raw numbers and it's very, very unhelpful at times. We need to look at what is the number of cases as a proportion of the whole population. What is the number of tests?

As a proportion of the whole population? What's the positivity rate of tests? How many tests have been done and of them, how many are positive? They give you a much better idea not only of the impact of the disease, but to give you an idea of the effort being made by the public health authority.

But it is important that when we look at these numbers rising, part of that rise in numbers is increase detection due to better testing. And we need to be careful that we don't punish people for testing. Having a large number means I know where the virus is better.

Thank you very much, Dr. Ryan. We now have Abu Bakar Hamidou from Nigeria, you be Abu Bakr. Are you there?

Yes. Please go ahead with your question.

Well, is there any country that now you get an information about specific meditation for this topic, 19? And secondly, it's an exact sequence of.

I think that. Peoples in Nigeria. Thank you.

Sorry, could you repeat the question, we lost you a little bit. Your second part of the question wasn't clear.

Again, I say it when it is zuck's. Figures of cases in Nigeria that you will have.

So I think your question was about medication.

Is there any medication that works? And what are the what are the issues with cases in Nigeria?

So think thank you for these two questions. With regards to medication, as the director general outlined in his speech today, there are eight there. Currently, there are no specific medications that have been approved for Koven 19. However, there are a number of clinical trials that are ongoing and there is the solidarity trial that is currently starting, which is just enrolling patients now, which is looking at therapeutics in controlled clinical trial in a clinical trial.

And what is very important is that these medications are evaluated appropriately. So we know what works and that we have the right data to support what works. With regards to the numbers of cases in Nigeria, we have seen I don't know the exact number if you have 46, 46. You want to take that one, Mike?

And you know, the number of cases in Nigeria remain quite low, despite Nigeria having a reasonable capacity to detect those viruses. But the risks are nonetheless there. And we see disease now covered 19 in almost every country in in Africa at this stage. So the risks are certainly rising, but the numbers are still low.

And again, we we need to ensure that we have a very strong public health response on the African continent. We need a response that's built from the community up. We need to try and avoid the worst impacts of lockdowns, slowdowns, shutdowns. So we minimize the necessity of measures like that, which will have a very hard impact on people's lives and livelihoods from which they may not recover as quickly as people in other countries.

We also need to look at the very vulnerable populations we have in Africa, refugees, in some cases, people who are living with her HIV and and and children with malnourishment. So there are. Well, Africa is a relatively young continent, and that may be an advantage for Africa right now. There are many, many other vulnerable people in Africa for whom we must provide maximum protection. Africa, again, has demonstrated with polio elimination. This demonstrated with cholera response, with Ebola response that African countries have.

Capacity to respond to epidemics.

The resilience to live through epidemics and to recover from them. But what we need to do is bring our communities on board. We need to leverage the power of community based surveillance. We need to empower and engage with communities, with NGOs, with civil society, with local government, and then all of government approach. As Dr Tedros continues to say, it is even more important in the context of Nigeria and the context of Africa that those that those approaches be taken in terms of I think you said medication's.

I think it's really important that we say quite plainly right now that there are no proven effective therapies. Are drugs in the fight against Colvert 19 fairly answers. We're trying to find a good supportive care.

Early admission to hospital for those who are with underlying conditions were are developing severe disease oxygen. And the provision of oxygen to people is lifesaving. And in certain small number of patients, the ability to ventilate patients in order to get them through the worst of the infection. So we have things that are that work in terms of clinical management. We do not have effective drugs. And that is why the solidarity trial is so important and so many of the other daughter trials around the world are so important to to answer these questions.

Thank you, Dr. Ryan.

I think Margaret wants me to say, yeah. Thank you.

That just one 1.2 aunt, when we have a small number of cases like what we have in Nigeria and many other countries in Africa.

That's when you can also be able to do the public health interventions effectively to test cases, to follow up contacts and isolate the cases. So the problem doesn't grow, meaning from those sporadic cases or cluster cases, it will not grow into community transmission. The problem comes when community transmission starts, when the number of cases builds. When that happens, then the you know, doing the public health solutions, we're saying the follow up, the quarantine and so on will be difficult or if not impossible. But at the same time, the growing number of cases means the health system or the health care system could be overwhelmed, too. So that's why for Nigeria, the best option is to really cut it from the bad end. When you have the small number of cases to invest more in the publicans interventions and do the things that we have always been saying from the start. By the way, I as W.H.O..

So from preventing it becoming a community transmission.

Thank you, Dr. Tedros. We now have image and folks from the BBC on the line. Imagine either. Yes, I am. I can hear me.

Ok, very well. Please go ahead.

Hi. This is, I think, primarily for Dr. Tedros. And I mean, first of all, it's an incredibly difficult time. And you are showing leadership, which I think all countries need. However, I'm sure you're aware that you're advising things like aggressive measures, sophisticated surveillance.

There was a talk of identifying people and removing them from the community. What do you say to some of the human rights groups who warn that this could set precedents in some some countries where these measures to stay and be used for other purposes? Does that concern you at all?

Um.

You know, on especially social distancing or just staying at home, less travel. We know this actually influences the individual human rights, but this is a choice that we should we should make meaning in order to have collective security, to be better society and to fight the virus.

We give our freedom, you know, for a while, and this can be arranged by governments that there are many ways they can use their parliament to have, you know, provisions for a short, short period. And people will agree as long as it brings collective security, they will they will agree and people understand to have to limit their their individual freedom if it's for the betterment of the society. And when it's for a short period. So it's a dialog that should continue between the government and the community.

And that's what we're we're we're seeing. And without that, I don't think this virus could be could be stopped.

And something we have been saying to government is, one, you need to have the whole of government approach. All sectors should be mobilized and whole society approach. And there should be a regular communication and increasing awareness and in a way, actually, that creates trust in the community. And when there is trust. Community trust in the government, then there is cooperation.

And what the community is being asked now can, can, can, can happen because through trust, you can ensure community empowerment and ownership.

And we say it many times. This is everybody's business. This is our collective security.

And it can only be assured that when each and every one of us contribute to that.

If I could just supplement this image of that, we take the issues of personal data, data protection and intrusion very, very seriously.

And our chief information officer, Fernando Mariano, is working with our health information director, Dr. Oliver Morgan, to many others across the house on ensuring that all of the initiatives we're involved with while aiming to develop good public health information, be it through absolute replications, in no way interfere with the individual rights to privacy and protections under the law. And it is important when we talk about surveillance and the surveillance society, that in the case of public health, the gathering of information about individuals, their movements must be done with the consent of the community and in many cases of the individual themselves and their third-year.

There are serious issues here that have to be addressed. And that's not just for public health, that's across society and so many other sectors. But there are times when the good of community and the good of the population is something that we're in a crisis and it is much better through community, as the DG said, true trust and community engagement that individuals are prepared to offer a little piece of individual sovereignty in order to support the community, the self, the sense of the one to help the many. But that must be a temporary gift. That must be an explicit gift, and that must be something that is not taken for granted. That is a gift of the individual to society, not a demand upon the individual.

And I think this is really important point that guides us in our work inside W.H.O.. And Tedros is very keen and and constantly reminding us of our responsibilities in that regard. Also, in addition to that, A, we will be and have been working very closely with UNICEF, with the Red Cross movement. Another NGO is and will be further strengthening and launching a major initiative on risk communication and community engagement for called with 90, joining together with UNICEF with the Red Cross movement on scaling up our ability to engage with drive the participation and ownership of communities all over the world in the fight against Cawood. It is through strong communities that we avoid the worst outcomes of this disease, and it is through strong community ownership and participation. We will avoid any abuses of human rights that may emerge as the world's fights a deadly force.

Thank you very much, Dr. Ryan. We're coming up to the hour, so we've only got time for one question. I apologize very much to everyone else. You can send your questions to media inquiries. And we will make sure that we get them answered. The last questions for Antonio at Effy.

Antonio, you're on the line.

Thank you for taking my question. So, Mr. Peters. Mr. Bennett, as you said today, that there were must unite against coronavirus back in the European Union this week. We have seen a lot of difficulties to ordinate a united response. It looks like countries in the north of Europe, like Germany or Netherlands, are showing some reluctance to help countries in the south, like Spain or Italy. Do you have a message to European Union concerning these problems?

From what I know, what you say, it is new.

New information to me, what we have been advocating and what we know is that they're working together. They have a regular forum of the European Union and the ECB. ECD is at the center while W.H.O. through our regional office and headquarters, also we're working with them. And I think a coordinated effort in Europe is important. And that's what I know as far as the information I have is concerned.

May I just add that we're extremely grateful to the European Union, the commission, and particularly to our colleagues of Echo, who've been providing outstanding support to countries outside Europe and to countries, particularly countries affected by crisis. And it is wonderful to see that even in the midst of crisis in Europe, Europe can still reach out to those that are even more vulnerable and more at risk. And we spoke today at length with Michael Koehler and his team at ECKLE. We've been working with our colleagues in difficult and it is impressive to see that fail in crisis and trying to support each other.

Europe is still willing, ready and able to reach out and support those in the south who need their help as well.

And if I could just add that we are seeing globally the world uniting in this. We are seeing the solidarity that the DG has been talking about since day one. We are seeing the sharing of information.

We're all connected. One country's success is another country's success. One country's failure is another country's failure. We are all in this together and and through this solidarity, through Europe, through North America, through Asia, through the entire globe, is how we are going to beat this.

So this is a respiratory pathogen. It circulates. We know these so many countries are affected. The only way that we are going to beat this is together.

I'll wrap up this press conference for today, will reconvene on Monday. And we'll send you a media advisory with all the details on Monday during the day. If you have a question you want answered, please send it to media inquiries and we'll do our best to answer as quickly as possible. Thank you very much.

Thank you. Thank you. I got it.

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Margaret:
Good morning, good evening, good afternoon, everybody, and thank you for joining this press briefing. We’ve got a very special guest we’re highly honored to have with us. Dr. Tedros will tell you more.

Dr Tedros Adhanom Ghebreyesus:
Yeah. Thank you. Thank you very much, Margaret. And good morning, good afternoon, and good evening wherever you are. Less than six months ago, WHO and FIFA signed an agreement to work together to promote health through football. We didn’t know then what we know now, that a new virus would emerge that would bring many parts of society to a standstill including the beautiful, beautiful game itself.

Dr Tedros Adhanom Ghebreyesus:
Many football matches have stopped, but our collaboration has become even more important during these difficult times. In fact, it’s given us the opportunity of working together more closely than we imagined with FIFA. Football can reach millions of people, especially younger people, that public health officials cannot.

Dr Tedros Adhanom Ghebreyesus:
Today it’s my great pleasure to welcome my dear brother, Gianni Infantino, president of FIFA, to talk about our joint campaign to pass the message to kick out coronavirus. I will repeat that. This is a campaign we’re starting jointly called “Pass the message to kick out coronavirus”. Pass the message to kick out coronavirus.

Dr Tedros Adhanom Ghebreyesus:
I would also like to take this opportunity to thank FIFA for its generous contribution of $US10 million to the COVID-19 Solidarity Response Fund. Thank you, my brother, for your generous contribution. To date, the fund has raised more than $US70 million in just 10 days, from more than 187,000 individuals and organizations to help health workers on the front line to do their lifesaving work, treat patients, and advance research and treatment and vaccines.

Dr Tedros Adhanom Ghebreyesus:
I would also like to thank TikTok for its contribution of additional $US10 million and for its valuable support in helping to reach its large, young audience with reliable health information. Speaking of which, our new WhatsApp health alert has now attracted 10 million users since we launched it last Friday, this is just in four days, delivering reliable health information directly to their mobile phones. Details on how to sign up are on the front page of our website.

Dr Tedros Adhanom Ghebreyesus:
The Arabic, French, and Spanish versions will be launched this week and this is the best way to be connected directly with people. So thank you, Gianni, for your support and the support of the whole footballing community.

Dr Tedros Adhanom Ghebreyesus:
And I would like to give you the floor to say a few words, but I would like to also recognize that it’s your birthday today so I would like to say happy birthday, my dear brother, and thank you so much for joining us today. Happy birthday, Gianni, again. Thank you.

Gianni Infantino:
Well, thank you very much to my dear brother Tedros, Dr. Tedros. Thank you. My heartfelt thanks for the opportunity to be here at the WHO today. First and foremost, I would like to express our deepest condolences, of course, to all the families of those who have lost their lives across the world as victims of the coronavirus.

Gianni Infantino:
I would also like to thank everyone, especially those involved in the medical profession, who continue to put the lives of others in front of their own in fighting this disease. We are all in their debt and their example should encourage us to follow the advice that we are given.

Gianni Infantino:
So now regarding the campaign. Dear Tedros, dear friends, football means so much to billions of people around the world. So it is clear to me that we have to show leadership and solidarity in these difficult days. When you announced, dear Tedros, on a Thursday afternoon at five o’clock that this was a pandemic, on the Friday at nine o’clock, I was in your office asking you, “How can football help? What can we do?” So we have to get the message across the world and football wants to help. This campaign actually came to us. We didn’t need to go looking for it.

Gianni Infantino:
There are no actors in this campaign, just the players themselves, and they all want to highlight the advice that is provided to all of us, to all of them, by the WHO. For that, I would like to thank all these football players, all the legends who are part of this campaign for making it possible. And actually, the FIFA teams, dear Tedros, includes, of course, the greatest footballers in the world, but also our 211 member countries in the six continental confederations.

Gianni Infantino:
Together we are going to roll out this campaign in the next days in videos and graphics and in many languages so we can really pass the message to kick out coronavirus. Well, I think that this virus has shown to all of us two things. One is how vulnerable we are, and the other, how global the world has became. Exceptional situations require exceptional measures and global problems require global solutions.

Gianni Infantino:
We have to make sure that we recover from this by bringing the entire world together as one and reminding everyone that we are all one kind, the humankind. We have to prove that we are capable of extraordinary global acts of solidarity all together, because health comes first. Everything else comes after.

Gianni Infantino:
So now we have to be strong, we have to follow the guidance of the WHO, of our governments and after we’ll have to rebuild our relations, maybe and hopefully, with more solidarity and understanding for each other. Football is ready to play its part on that and we are here for that. And I am sure of one thing that, like in football, by acting together with determination, discipline, and teamwork, we will win. Thank you.

Dr Tedros Adhanom Ghebreyesus:
Thank you. Thank you. Grazie mille, fratello. Grazie mille, Gianni.

Dr Tedros Adhanom Ghebreyesus:
And now I would like to call Alisson Becker, our ambassador, WHO ambassador, who is online, you know, the best goalkeeper and he plays for Liverpool and he’s from Brazil. Obrigado, Alisson, for joining us and the floor is yours. Please.

Alisson Becker:
Hi, Dr. Tedros. Hi, everybody. Good morning, good evening, good afternoon. Mr. Gianni, first of all, happy birthday for you. I would like to say that this is a great opportunity for me to be together with you being part of this movement that is starting now, that is starting today, “Pass the message to kick out the coronavirus”. We football players, we used to act together, we used to work together, to train together.

Alisson Becker:
I know now in this tough moment, tough times, everybody have change the life for something, for staying home, cannot going out, cannot go into the work. In my case, I’m not able to be together with my colleagues, with my teammates, to do what I love, what is my passion. I was made for playing football and now, because of these tough times, we are not able to do that, to bring happiness for the people through football.

Alisson Becker:
But we also understand that it’s necessary to stay home, it’s necessary to think on the next, to be solidarity. I think in this moment, I believe in this moment, we have to put our solidarity out. It’s the moment that we have to put our passion out and think on the next. And I am glad to participate of this movement because the people need the right information. It’s necessary in these moments that we have the right information and also that we follow the right information.

Alisson Becker:
So I would like to say for the people, follow the information from the local authorities. Try to follow the information from WHO. We can trust on them. We can trust that is the right thing to do. And we understand also that health comes first in this moment. It’s time, like in football, to have a teamwork, everybody doing they own job that includes to be safe, to be at home, to follow the advices, for example, washing hands properly, from keeping distance from the people.

Alisson Becker:
But we can’t forget that we need now to work as a team. So I would like to show my support for the “Pass the message to kick out coronavirus” and say to you, thank you for let me participate of this movement. Now that is tough times and we also need to trust in ourselves, trusting the human capacity to go through adversities. It’s not the first time in our lives that we need to overcome from something bad. But now we need the participation from everybody. So I’d like again to say thank you. Thank you, Dr. Tedros, and thank you, Gianni.

Dr Tedros Adhanom Ghebreyesus:
Portugese, muito obrigado, meu irmão. I hope that’s the right one. Obrigado, my brother.

Alisson Becker:
That is right.

Dr Tedros Adhanom Ghebreyesus:
Thank you, Alisson. Thank you for being our ambassador.

Alisson Becker:
Obrigado.

Dr Tedros Adhanom Ghebreyesus:
Please pass my greetings to your wife also. You both as a pair are helping us as ambassadors so thank you so much. Good to hear from you today and look forward also to hear from Natalia some other time. So thank you so much again. Thank you, Gianni, my dear brother. Grazie mille. [Italian]. Thank you.

Dr Tedros Adhanom Ghebreyesus:
I would now like to continue with the rest of my remarks on the COVID-19 pandemic. More than 300,000 cases of COVID-19 have now been reported to WHO from almost every country in the world. That’s heartbreaking.

Dr Tedros Adhanom Ghebreyesus:
The pandemic is accelerating. It took 67 days from the first reported case to reach the first 100,000 cases, 11 days for the second 100,000 cases and just four days for the third 100,000 cases. You can see how the virus is accelerating, but we’re not prisoners to statistics. We are not helpless bystanders. We can change the trajectory of this pandemic. Numbers matter because they’re not just numbers, they are people whose lives and families have been turned upside down.

Dr Tedros Adhanom Ghebreyesus:
But what matters most is what we do. You can’t win a football game only by defending, you have to attack as well. And my brother Gianni can tell you more. Asking people to stay at home and other physical distancing measures are an important way of slowing down the spread of the virus and buying time, but they are defensive measures that will not help us to win. To win, we need to attack the virus with aggressive and targeted tactics, testing every suspected case, isolating and caring for every confirmed case, and tracing and quarantining every close contact.

Dr Tedros Adhanom Ghebreyesus:
We recognize that some countries are struggling with the capacity to carry out these offensive measures. Several countries have shown that mobilizing resources internally from less affected regions is one way to increase capacity and help the overwhelmed health system in some regions. We are also grateful that several countries have sent emergency medical teams to care for patients and train health workers in other countries that need support.

Dr Tedros Adhanom Ghebreyesus:
This is an incredible example of international solidarity, but it’s not an accident. WHO has been working with countries for years to build a network of emergency medical teams for exactly this eventuality to provide surge capacity of high-quality health professionals who can be deployed to care for patients and save lives. And I would like to use this opportunity to thank all countries who have contributed their emergency medical teams to support other countries.

Dr Tedros Adhanom Ghebreyesus:
Health workers can only do their jobs effectively when they can do their jobs safely. We continue to hear alarming reports from around the world of large numbers of infections among health workers. Even if we do everything else right, if we don’t prioritize protecting health workers many people will die because the health worker who could have saved their lives is sick.

Dr Tedros Adhanom Ghebreyesus:
As you know, WHO has been working hard with many partners to rationalize and prioritize the use of personal protective equipment. Addressing the global shortage of these lifesaving tools means addressing every part of the supply chain from raw materials to finished products. Measures put in place to slow the spread of the virus may have unintended consequences of exacerbating shortages of essential protective gear and the materials needed to make them. Solving this problem requires political commitment and political coordination at the global level.

Dr Tedros Adhanom Ghebreyesus:
This week I will be addressing heads of state and government from the G20 countries. Among other issues, I will be asking them to work together to increase production, avoid export bans, and ensure equity of distribution on the basis of need.

Dr Tedros Adhanom Ghebreyesus:
We need unity in the G20 countries who have more than 80% of the global GDP. Political commitment at the G20 level means a very strong solidarity that can help us to move forward and fight this pandemic in the strongest terms possible.

Dr Tedros Adhanom Ghebreyesus:
So while asking the specific issues, the three issues I said, the most important ask to G20 leaders is solidarity, to be one and to act as one because they have the biggest stake in the world in all respects.

Dr Tedros Adhanom Ghebreyesus:
We also recognize that there is a desperate need for effective therapeutics. There is currently no treatment that has been proven to be effective against COVID-19. It’s great to see the level of energy now being directed to research and development against COVID-19.

Dr Tedros Adhanom Ghebreyesus:
Small observational and non-randomized studies will not give us the answers we need. Using untested medicines without the right evidence could raise false hope and even do more harm than good and cause a shortage of essential medicines that are needed to treat other diseases. That’s why WHO has launched the solidarity, trying to generate robust, high quality evidence as fast as possible.

Dr Tedros Adhanom Ghebreyesus:
I’m glad that many countries have joined the SOLIDARITY trial that will help us to move with speed and volume. The more countries that sign up the SOLIDARITY trial and other large studies, the faster we will get results on which drugs work and the more lives we will be able to save. Through SOLIDARITY trial, we will move faster and we will do bigger and, of course, with good quality. Faster, bigger, and good quality.

Dr Tedros Adhanom Ghebreyesus:
So I would like to end by reminding everyone that although COVID-19 is dominating the world’s attention, there is another respiratory disease that’s both preventable and treatable, but which kills 1.5 million people every year. And that is the old timer tuberculosis.

Dr Tedros Adhanom Ghebreyesus:
As you know, tomorrow is World TB Day, an opportunity to remind world leaders of the commitments they have made to end the suffering and death caused by this ancient and terrible disease. The world is rightly responding to COVID-19 with urgency and purpose. We call on the global community to harness that same urgency and purpose for the fight against tuberculosis and for a healthier, safer, fairer world for everyone.

Dr Tedros Adhanom Ghebreyesus:
The rule of the game to kick COVID-19 out, as we have agreed with my brother Gianni, is to kick it out. And that game is solidarity. So myself and my brother Gianni ask for solidarity to kick out this virus. I thank you. Grazie mille, again, my brother, for joining today.

Margaret:
Thank you, Dr. Tedros. And as Dr. Tedros said, solidarity and leadership in all spheres is critical for ending this outbreak. And that is exactly what the football legends involved in this are doing, leading the way. We have a video now which will show you exactly what that means.

Male voice:
For the first time ever, we, the entire world, are all playing on the same team. Our opponent is a disease. We need determination, discipline, and teamwork to beat the coronavirus. The world of football is united and together we will win.

Gary Lineker:
There are five key steps to tackling the coronavirus. Hands, elbow, face, distance, and feel.

Alisson Becker:
It starts with your hands. Please wash your hands frequently with soap and water or an alcohol-based solution.

Carli Lloyd:
With your elbows bent, please cover your nose and mouth if you sneeze or cough. If using tissues, dispose of them immediately.

Lionel Messi:
For your face, avoid touching your eyes, your nose, and your mouth.

Han Duan:
In terms of social interaction, take a step back. Stay one meter distance minimum from everyone that coughs or sneezes.

Samuel Eto’o:
If you feel unwell, stay at home. Please follow all instructions from your local health authority.

Gianni Infantino:
So if I may, I would just like to express really a word of thanks to my dear brother, Tedros. Thank you very much. Thanks to Alisson as well for the birthday wishes. At least on the day of my 50th birthday I do something useful, I hope. But let me just say that we are really delighted to have Alisson as a WHO ambassador and being part of the team. His approach is being echoed, as you have seen, by players from all over the world. They might be rivals on the pitch, but their message to tackle coronavirus is united. They are, we are all part of the same team.

Gianni Infantino:
So I would like as well to thank all the players from all over the world, all the legends who are part of this campaign, who are part of this FIFA WHO team. And this is only the beginning of the campaign and the beginning of our fight together but we will continue, we will continue in solidarity and all together and, as you said, together we will win. Thank you very much.

Dr Tedros Adhanom Ghebreyesus:
Thank you. Thank you, my brother.

Margaret:
So now we move on to the second half. I don’t have a whistle, but now I can open the meeting, the briefing for questions. We do have a referee here which is a good thing. So if you wish to stay, you’re welcome. Otherwise, you’re welcome also to retire. We now open it for questions from the media who are all online. First question we have is from Pamela, Uganda Radio Network. Pamela, Uganda Radio Network, you have the floor. Can you hear me? Looks like we’ve got a problem with our line.

Margaret:
I will remind everybody while the technicalities are being fixed, I remind everybody that if you wish to ask a question, use the raise your hand icon on your screen. If you’re called in, use the hashtag nine. One question per journalist. Please don’t ask five questions. There are many, many, many of you and you’re all waiting. It looks like Pamela has left the call so the next question is from Agnes of Associated AFP. Agnes, are you there?

Agnes:
Yes. Hello. Do you hear me? Yes.

Margaret:
Very well. Please go ahead.

Agnes:
Hi, everybody. I have a question concerning Italy. The question is about the situation there. And I wanted to know if Dr. Tedros is recommending that supermarkets should be closed in order that people shouldn’t go anymore in the streets and that it should be the government who would be in charge to organize the distribution of food to the people in the house, giving the tragic situation the country is living. Thank you.

Dr Michael Ryan:
Good afternoon. From WHO’s perspective this is clearly a decision for national and local public health authorities. They have to obviously make decisions based on what they see on the ground. I mean, in most situations, people have been able to visit local supermarkets with proper spacing and distancing. Many have used limited access and only allowing a certain number of people to visit at one time.

Dr Michael Ryan:
So the arrangements are really dependent on the local transmission situation and are really up to local authorities to decide how best to manage the physical distancing issue. If supermarkets are closed, then obviously there’s a major logistics issue on how to actually get food to people.

Dr Michael Ryan:
So each government must make that decision on their abilities to replace that service, should that service need to be curtailed. So we would very much leave that to Italian authorities to make that decision.

Margaret:
Thank you, Dr. Ryan. I should’ve said we have our top team here, as usual. Dr. Ryan and Dr. Van Kerkhove, as well as our Director-General, Dr. Tedros. The next question comes from Michael from CNN. Michael, are you there?

Michael Bociurkiw:
I’m here. Can you hear me?

Margaret:
Go ahead, please.

Michael Bociurkiw:
Thank you for taking my call. Michael Bociurkiw, I’m a contributor to CNN Opinion. I’m dialing in from British Columbia in Canada, where we’ve now reached 424 cases, somewhere between the numbers in Hong Kong and Singapore. My question is about sports, since that’s the theme of the day. Dr. Tedros and colleagues, as you know, the Canadian Olympic Committee has said that it will not be sending its athletes to Tokyo for the health and welfare of their members. And also, I think we’re getting the same messages from Australia and elsewhere.

Michael Bociurkiw:
My question is, a lot of national Olympic committees are looking to WHO for guidance on this ahead of the IOC making a decision. I know it’s a very sensitive topic. I know there are business and other considerations, but I really think a lot of athletes who cannot go to training facilities, who are caring for loved ones, even perhaps suffering from COVID-19, are looking for some kind of guidance from you as time is really ticking on. Thank you, sir.

Dr Michael Ryan:
Thank you for the question. The future of the games is clearly under very, very close observation at the moment, and you’ll have heard premier in Japan himself has spoken to this and has expressed the doubts about the games as well. We are feeding into the IOC and the Japanese government and the Tokyo 2020 committee’s deliberations on this and I believe a decision will be made very soon regarding the future of the Games.

Dr Michael Ryan:
The decision to postpone the Games would be purely a decision of the Japanese government and the IOC but we are obviously in the process of offering them risk advice. And as we’ve said previously, we have every confidence that the Japanese government and the IOC will not proceed with any Games should there be dangers to athletes or spectators.

Margaret:
Thank you, Dr. Ryan. I’ll now go to Bayram from the Anadolu Agency in Turkey. Bayram, are you on the line?

Bayram:
Good afternoon, good evening, everybody. Mr. Tedros, as you know, there is a great panic in many countries in Europe as COVID-19 pandemic is spreading rapidly. People don’t know what to do and panic is at the high level. Do you have a strategy and plan to prevent psychological and traumatic situations that the COVID-19 may create or can cause in humans? Thank you.

Dr Maria Van Kerkhove:
Thank you for that question. It’s a very important one in terms of the way people are feeling as numbers increase and as, in some countries, the situation gets worse before it will get better. What is very important for everyone across the world is to know what they can do to protect themselves and what they can do to protect their families.

Dr Maria Van Kerkhove:
And we need everyone to be well-informed. And it’s important that everyone knows where to get good, reliable information, whether that’s through WHO, to know how to protect yourself and your family, or whether that’s through your national governments. Not only to know how to protect yourself, but know what is the plan? What are the plans of the government that are being enforced and to know what your role is in playing that?

Dr Maria Van Kerkhove:
It’s important that that fear that people have, which is normal, be used in a productive way, turning that fear, turning that energy into ways in which you can keep yourself busy if you have to stay home because of national measures. Just because we have mentioned physical distancing, it doesn’t mean that you have to be socially disconnected with your loved ones. So find ways in which you can communicate with your loved ones and your families to keep that connection while you’re still being physically apart.

Dr Maria Van Kerkhove:
Practical things we’ve been mentioning are washing your hands, making sure that you do good hand hygiene. And if you don’t have access to soap and water to use an alcohol-based rub. Make sure that you use your respiratory etiquette – you just heard the five from the video just now – making sure that you don’t touch your face. These are things that everybody can do. Making sure that you keep your distance from individuals, especially if you’re outside of your home, making sure you’re keeping your distance from people. And if you’re feeling well, stay home.

Margaret:
Thank you very much, Dr. Van Kerkhove. The next question is for Nobu from Jiji Press. Nobu, are you on the line?

Nobu:
Yeah. Thank you. Do you hear me? Hello?

Margaret:
Very well. Please go ahead.

Nobu:
Okay. Thank you very much. My name’s Nobu from Jiji Press, Japanese news agency. My question is about Japan. If you look at the official statistic of Japan, it’s obvious that reported cases in Japan is much less than other big population countries. But there are some critics saying that the scope of tests carried out there is not enough. So the reality of the infection is not reflected in the official statistic.

Nobu:
But on the other hand, the hospitals or clinics in Japan are not overloaded so there are not so many patients with suspicious symptoms. So I’m a bit confused if Japan is doing well in containing the virus or what we are seeing is just tip of iceberg of the much bigger infection. So what’s your view on this topic? Thank you very much.

Dr Maria Van Kerkhove:
So I can start with that. I just touched my face. I shouldn’t touch my face. What we know works in countries is countries aggressive actions in terms of finding cases, testing those cases, isolating those cases, treating them, and making sure that there is comprehensive contact tracing. And we have seen that in Japan and we’ve seen that in a number of countries. We know that when contacts are identified, if they are quarantined and then followed so that they are tested if they develop symptoms, we know that that is a very effective way in which we can prevent onward transmission.

Dr Maria Van Kerkhove:
We know that mobilizing your population and getting your population to be involved in this response, performing all of these actions of personal measures and hand hygiene and respiratory etiquette, staying home when necessary, we know that that works, but testing is a key part of the strategy globally. And you’ve heard the director general emphasize and you’ve heard Mike and I emphasize the need to do testing and to do this strategically, making sure you’re focusing on your suspect cases and that you’re testing your contacts who develop symptoms.

Dr Maria Van Kerkhove:
These are fundamental actions that need to be part of a comprehensive approach all countries need to take to tackle this virus. And we have seen in several countries the effectiveness of these measures in terms of a reduction in cases.

Dr Maria Van Kerkhove:
We’ve also seen in a number of countries they’re looking for additional cases through existing respiratory disease systems, for example, looking at their ILI or their influenza-like illness surveillance systems that have been established for influenza. Several countries are looking at those individuals who have respiratory disease, who show up through those surveillance systems to test for COVID-19 to see if the virus is circulating.

Dr Maria Van Kerkhove:
And we’re gaining good insight from those countries to find out how many of those are positive and it seems to be low in several countries that are doing this. So it’s a comprehensive approach that we need all countries to take, outlining through testing, case identification, contact tracing, making sure these public health measures, these physical distancing measures, strong government leadership, an all-of-government approach have been successful in reducing transmission in several countries.

Margaret:
Pamela managed to send us her question by text. This is Pamela from Uganda. She’s got an excellent question. She wants to know, with the increase in cases on the African continent, would you say that Africa is prepared to fight this disease, especially in terms of equipment? What do you think needs to be done to get Africa to the position that they need to be in to have a fair chance to fight the disease? Is this one for you, Dr. Tedros?

Dr Michael Ryan:
I think we’ve seen the evidence in this pandemic thus far that no one has been quite ready to deal with this disease and countries in Africa are in no different a situation and some in a more precarious situation.

Dr Michael Ryan:
Having said that, countries in Africa have a long history and a very recent history of dealing with large-scale epidemics. We’ve seen many countries in Africa deal with large-scale cholera outbreaks over the last couple of years, deal with Lassa fever, deal with measles, deal with meningitis, deal with multiple outbreaks of Ebola. And in my more than 25 years responding to outbreaks, I have found African countries, and particularly communities in Africa, to be exceptionally resilient, hugely creative, and capable of mounting responses right from the community level up.

Dr Michael Ryan:
Clearly, we need strong governance. We need strong integrated government leadership. The UN system is fully activated to support countries in Africa. In preparation, we have established laboratory diagnostic capacities in every country. We have sent personal protective equipment to nearly every country in Africa. Our country officers are deployed in all countries in Africa and have been there for years and are working very hard with government authorities on integrated national action plans for response. And again, all countries in Africa have those plans now in place. The challenge is implementing those plans at all levels from the community right the way through to the head of government.

Dr Michael Ryan:
We’re seeing strong leadership from heads of government in Africa but the challenges are great. There are many large countries in Africa with high populations. Africa has become an urban continent over the last 20 years. More than 50 percent of people in Africa live in cities and increasingly in high density peri-urban settings. So the challenges are great.

Dr Michael Ryan:
We have seen what can happen when infectious diseases can spread very, very quickly in those situations. So there’s a huge need to protect populations from infection. There are highly vulnerable populations in many countries. There are large numbers of refugees which are very kindly hosted by many countries. In fact, Africa has the highest burden of refugees in the world and African countries host more refugees than any other continent.

Dr Michael Ryan:
There are large numbers of vulnerable patients who have HIV or are living with HIV and many other challenges. But Africa is strong and with good leadership, with rapid implementation, we can save lives too. And I have every faith that African leaders are doing everything possible to prepare their countries for this disease and reacting. And the United Nations system and the World Health Organization are there with them to stand and fight.

Dr Tedros Adhanom Ghebreyesus:
Yeah. Thank you. Thank you. Mike had already said most of it, just would like to add a few words. With many of countries in Africa there is alignment between WHO and African countries. One, we’re very encouraged to see that many countries are following the all-of-government and all-of-society approach.

Dr Tedros Adhanom Ghebreyesus:
And with strong political commitment at the highest level and mobilizing all sectors, because this is not about one sector or it’s not about the health sector, it’s about all sectors and the whole government should act in unison. And that’s one.

Dr Tedros Adhanom Ghebreyesus:
And then on the technical side, we’re also very encouraged that many countries in Africa are testing, although they have meager resources. From testing, they’re moving into identifying contacts of confirmed cases and at the same time isolating. And this what we have been proposing and advising many countries and I hope this will help many countries from Africa to cut the problem from the bud.

Dr Tedros Adhanom Ghebreyesus:
So that’s what we would like to encourage them to continue to do, political commitment at the highest level and having a political commitment that mobilize all sectors and at the same time, from testing to contact tracing and isolating, continue to do what they’re doing. And that will really help to suppress and ultimately control the pandemic in the continent.

Dr Tedros Adhanom Ghebreyesus:
Of course, the number of cases in the African continent is still small, but that doesn’t mean that it will continue same way. It may change, but the approach you’re using can help in suppressing and controlling it. And what we are saying from WHO’s side is to continue to do the same, but more aggressively and more aggressively expecting that the problem could get larger. Thank you.

Margaret:
Thank you, Dr. Tedros. We’re running out of time, so I’d really ask all the questioners to try to keep your questions short, to give other people a chance. Now the next journalist on the line is Pranay from ABP News in India. Pranay, are you on the line?

Pranay Upadhyay:
Yeah, I am online. And my question is to the panel that, you know, India is seeing the surge of the cases right now. You pointed out about the aggressive testing and the aggressive strategy in this match against coronavirus. How do you suggest and what is the WHO’s observation about the situation in India? And there is a shortage of kits. So how WHO is going to help the second most populous country on earth?

Dr Maria Van Kerkhove:
So this is a question that we receive from a number of countries that are really facing some increasing case numbers and the questions are around how do we best use the resources that we have? So we’ve been very clear in our messaging that, you know, to fight this, we really need to find all of the cases. We need to know where the virus is so that we can tailor our approach to the areas that need it most. And to do so, we need to find the cases. So we need to be testing the suspect cases and testing those contacts who develop symptoms.

Dr Maria Van Kerkhove:
When the outbreaks become large and resources become limited, we have recently put out some guidance around how to make some choices about where testing can be used, first and foremost, to really understand where that outbreak is, to find patients who are most severe so that they can have treatment.

Dr Maria Van Kerkhove:
This binder here is our binder of guidance that we have put out, that we have developed. Our first package of guidance came out on the 10th of January and since then, we have been working across the globe with all of our member states, our regional offices, people working in labs, clinicians, IPC specialists, modelers to try to tailor our guidance to best support countries according to the four Cs, according to if they have no cases, if they have sporadic cases, if they have clustering of cases, and if they’re facing community transmission and what we’re trying to do through our guidance.

Dr Maria Van Kerkhove:
And we need you to look at the guidance in full. Our press conferences are ways in which we can highlight some of these key aspects to our guidance, but the real detail is what’s online. We know not everybody is going to read that, but those that do need to read that, who are taking decisions in countries, please look at that in full because we have detailed information there that can provide and help you make decisions to make a tailored approach, all with the goal of suppressing transmission and ending these outbreaks.

Dr Maria Van Kerkhove:
But there are some decisions that may need to be made in certain countries where resources are scarce. At the same time, we are working very hard with manufacturers who are developing test kits and the supplies, the supporting supplies, to be able to use those test kits. We are working with countries to increase the number of labs that can actually run these tests. So there’s a multi-prong approach in terms of how we can support countries through our regional offices and our country offices to build and increase that testing capacity.

Dr Michael Ryan:
If I could just possibly add specifically on India. Obviously, India, like China, is a hugely populous country and the future of this pandemic, to a greater extent, will be determined of what happens in very large, highly-populated, densely-populated countries. So it’s really, really important that India continues to take aggressive action at the public health level and at the level of society to contain, control, suppress this disease and to save lives.

Dr Michael Ryan:
India led the world in eradicating two silent killers or eliminating them in the country, smallpox, one of the greatest successes of mankind. A virus that killed more people on this planet than all the wars put together. India, through targeted public health intervention, ended that disease and gave a great gift to the world.

Dr Michael Ryan:
India also eliminated polio, another silent killer, and did a tremendous job on surveillance and finding cases and vaccinating and doing all the things that need to be done. So India has tremendous capacities. All countries have tremendous capacities when communities are mobilized, when civil society is mobilized, when, as the director general says, heads of state and governments drive an all-of-society approach.

Dr Michael Ryan:
There are no silver bullets here. There are no easy answers. If there were, we wouldn’t be having to work so hard. We’ve got measures we can take now while we wait for other solutions. And we must take them now. So it’s exceptionally important that countries like India lead the way and show the world what can be done and do as they have done before, show that aggressive, sustained public health action from community right the way through to head of state can have a profound effect on the trajectory and the outcome of this pandemic.

Margaret:
Thank you, Dr. Ryan. The next person on the line is Peng Wei from the People’s Daily. Peng Wei, are you on the line?

Peng Wei:
Yeah. Thank you. Can you hear me?

Margaret:
Very well. Please go ahead.

Peng Wei:
Thank you. This is Peng Wei Jong with People Daily of China. Some American officials, including Secretary of State Mike Pompeo, criticized the China for its handling of COVID-19 in the early stage and they continue to call COVID-19 virus as Wuhan virus or Chinese virus. So what’s the WHO’s comment on the position on that? Thank you very much.

Dr Michael Ryan:
I think we’ve spoken on this issue at a number of press conferences, and I think WHO’s position on this has been clear in the past and is clear now. And I think at this point it’s not a core issue and it’s an issue that’s, quite frankly, is a distraction right now. So I think we need to focus on what we need to do now.

Dr Michael Ryan:
There is no blame in this. There is only a future. And we choose the future. And we have capacities to fight this virus. It is affecting, as the director general said, almost every country on the planet, every population. And it’s not just communities. Everyone can look around at sons, daughters, mothers, and fathers and see who’s at risk. We need to fight this thing together. And I will reserve any comments for later regarding blame.

Margaret:
Thank you, Dr. Ryan. And now we have Gabriela from Mexico on the line, Gabriela, can you hear me?

Gabriela Sotomayor:
Yes. Yes. Thank you for taking my question. Gabriela Sotomayor, Mexico Proceso. Dr. Tedros or someone on the panel, if they can answer, how far behind is testing versus the real spreading of the virus? I mean, is it 10 times, 100 times? What is your estimate? Are we only looking at the tip of the iceberg?

Dr Maria Van Kerkhove:
So thank you, Gabriela, for the question around testing and highlighting the importance of testing. So with any new virus, I think what is the most tremendous story here, and I don’t think any of us have ever, ever seen the speed at which testing has been developed for a novel pathogen. So as you know, this virus, this new virus was identified within days. The sequence was shared a few days later and because of that, testing began really across the globe.

Dr Maria Van Kerkhove:
And with the sharing of the sequences on public platforms, labs all over the world were able to develop assays. And in doing so, the amount of production for testing grew exponentially across the globe. Of course, we always need more testing. Of course, we always need more labs. But that’s the case for every pathogen, especially an emerging pathogen. What we are seeing now are countries finding ways in which they’re trying to improve the production, the availability, the access, the sharing of these assays so that more testing can be done.

Dr Maria Van Kerkhove:
And what we need are all countries to be focusing on testing as part of a comprehensive strategy. And we’ve mentioned what that strategy entails. That strategy includes public health measures, it includes physical distancing, it includes a strong government approach, it includes mobilizing the population, it includes every single individual knowing what they have to do to fight this pandemic. And we’ve outlined what that is before, and testing is a critical part of that.

Dr Maria Van Kerkhove:
But every day we are looking for ways in which production can be increased and which more labs can be available to do those testings and that testing can be done faster so that we know where this virus is and that we can fight it without being blindfolded.

Dr Michael Ryan:
And again, just to again qualify that the virus was isolated on January the 7th and the whole genome sequence was shared with WHO and the world on January the 12th. It’s just 10 weeks ago since we had a genetic sequence for this virus. The fact that so many tests are out there, the fact that there are so many testing platforms available now is a remarkable success for science, for collaboration, and for public/private partnership. So, yes, of course, it is very difficult to go to absolute scale on testing while at the same time maintaining quality, and maintaining the validity of these tests has been extremely important.

Dr Michael Ryan:
So the question you specifically asked, there’s no question in some countries that all cases have not been detected and that’s been the case in most countries. But what we’ve seen is a huge catch up in testing in most countries and we want to see more. We do say, and the DG has said before, test, test, test. But again, we’re not talking here about testing everybody in the community.

Dr Michael Ryan:
We need to focus on two priorities, making sure that suspect cases are tested – that is absolutely the central priority – and obviously, that people presenting in hospitals with clinical symptoms, with pneumonia, who are entering the system are also tested as a priority. They would also be suspect cases.

Dr Michael Ryan:
We would also like to see contacts of cases who are unwell or are showing symptoms that they also be tested. The measures we have in place now, or many countries have in place, of movement restrictions and people staying at home and physical distancing, all of these measures are helping to, in some senses, dampen down, push down the intensity of the epidemic.

Dr Michael Ryan:
But if we have to work our way out of this situation as we gain some success with those strategies, we have to be able then to identify who is infected and be very, very quick and agile at identifying who’s infected at community level and ensuring that they are isolated.

Dr Michael Ryan:
So testing is important now, but testing will become even more important in the coming weeks, not less important. So we all have to work hard. We’re working very, very hard with both public and private sector partners as are all governments to scale up and make testing more available and to push testing right down through the system. But that has to be done with an eye on quality and ensuring that those tests are the best and highest quality.

Margaret:
Thank you, Dr. Ryan. We’re really running out of time, so only two more questions. We will take one from Kai Kupferschmidt. Kai, are you there?

Kai Kupferschmidt:
Yes. Thank you very much for taking my question. I wanted to ask about the strategy that we’re seeing in some countries. I mean, the UK has talked about it, the Netherlands are suggesting it and they’re basically trying to find a balance between shutting everything down to suppress the virus and letting it spread at a very low level in order to have some semblance of normality. You’ve talked very little about the end game because you’re concentrating on what’s happening now. But I’d really love you to address a little bit how you see the future, you know, for all of these countries that are in a shutdown now. How do you see this proceeding?

Dr Michael Ryan:
Thanks, Kai. You are correct, this is a very, very important issue because as so many countries around the world have gone into this mode of people staying at home, of movement restriction, countries are obviously and justifiably concerned of the social, psychological, and economic impacts of those moves. Countries are doing their best to suppress infection and take pressure out of the epidemic and, more importantly, off the health system.

Dr Michael Ryan:
But we do know that that is very difficult to sustain and therefore, how are we going to turn that around? And the DG said it – how do we move from what is a defensive mode into an offensive mode? How do we move from trying to avoid the virus to actually going after the virus? We’ve seen this in Ebola, we’ve seen this in polio. There is a moment at which you have to step forward and go after the virus.

Dr Michael Ryan:
In order to do that, and we’ve seen examples in places like Singapore and Korea, where governments haven’t had to shut everything down, they’ve been able to make tactical decisions regarding schools, tactical decisions regarding movements, and been able to move forward without some of the draconian measures. But they’ve only been able to do that because they have had another weapon. And the other weapon they’ve had is highly aggressive case finding, contact tracing, community surveillance, isolation of cases, quarantining of contacts, testing of contacts if they get sick. They’ve put together a comprehensive public health toolkit, which they’re able to match with their more society-wide measures like movement restrictions.

Dr Michael Ryan:
And we’re working extremely hard, our Strategic and Technical Advisory Group for Infectious Hazards is working with us right now looking at those strategies to move forward from where we are now. And governments need to use this, to use the DG’ words, second window of opportunity. All that we get from movement restrictions and people staying at home and all of these measures, we buy some time, we take the heat out of the epidemic or the pandemic. We buy some time. But we’d then need to find strategies and tactics to get us to move forward.

Dr Michael Ryan:
And we have to make those decisions, each government will have to make those decisions. We’re working hard to provide advice to governments on how to do that. But very, very clearly in order to move forward is scale up, and I mean a massive scale up, in public health capacities to do case finding, isolation, quarantine of contacts, and being able to go after the virus rather than the virus coming after us is one of the key ways we can move forward and we’ll be coming back to governments and in public around our advice on this to governments. There is a very, very precious window now in which we can prepare to do that.

Margaret:
Thank you very much, Dr. Ryan. And our last but certainly not least, we have Helen Branswell.

Helen Branswell:
Oh, thank you very much for taking my question. This is probably for Maria. People are reporting a loss of the sense of smell. I don’t know how frequently that’s been seen. Can you give us any indication of whether that is actually a reliable marker of infection?

Dr Maria Van Kerkhove:
Yes. So, yes, we’ve seen quite a few reports now about people in the early stages of disease may lose the sense of smell, may lose the sense of taste, but this is something that we need to look into to really capture if this is one of the early signs and symptoms of COVID-19.

Dr Maria Van Kerkhove:
We have a number of countries that are conducting early investigations where they are capturing standardized information from cases and contacts where they’re looking at signs and symptoms is one of the features that they’re looking at, these early investigations, and we’ve published protocols on our website of how to conduct these and we have over a dozen countries conducting these.

Dr Maria Van Kerkhove:
It’s called the first few X, the first few hundred cases where there’s a systematic data collection using molecular testing, using serologic testing. As you know, these serologic assays are being developed where we systematically collect information on signs, symptoms, on clinical features, where we can capture this more robustly. But we are reaching out to a number of countries and looking at the cases that have already been reported to see if this is a common feature.

Dr Maria Van Kerkhove:
We don’t have the answer to that yet, although there’s quite a bit of interest in this online. There are likely to be many signs and symptoms that people have. We have a good handle on what the major ones are, and those are fever, this is dry cough, this is shortness of breath. And of course, other features would be aches and pains, some people have headache, very few, between three and five percent, will have gastrointestinal symptoms, and very, very few will have a runny nose or sneezing.

Dr Maria Van Kerkhove:
And so a loss of smell or loss of taste is something that we’re looking into and we’re looking forward to the results of these early investigations that are being conducted by a number of countries so that we have a more evidence-based approach and we can add that to the list. Thanks.

Margaret:
Thank you so much, Dr. Van Kerkhove. We’ve, unfortunately, run out of time, but to all the people who didn’t get their questions answered, please come to our website www.who.int or write to mediainquiries.who.int. We are working 24/7 and we will answer your queries. And the next press conference, press briefing is scheduled for Wednesday. And we’ve also taken note of those who did not get their questions answered. We will try to put you on top of the queue next time. Thank you so much for attending this press briefing. And be well all of you.

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Popular Transcripts FULL TRANSCRIPT: WHO Press Briefing COVID-19 – March 20, 2020

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For the rest of the world that even the most severe situation can be turned around. Of course we must exercise caution. The situation can be worse, but the experience of cities and countries that have pushed back this virus give hope and courage to the rest of the world. Every day we are learning more about this virus and the disease it cause. One of the things we are learning is that although older people are the hardest hit, younger people are not spared. Data from many countries clearly show that people under 50 make up a significant proportion of patients requiring hospitalization. Today I have a message for young people. You're not invincible. This virus could put you in hospital for weeks or even kill you even if you don't get sick. The choices you make about where you go could be the difference between life and death for someone else. I'm grateful that so many young people are spreading the word and not the virus. As I keep saying, solidarity is the key to defeating coveted 19 solidarity between countries, but also between age groups. Thank you for heeding our call for solidarity, solidarity, solidarity.

We have said from the beginning that our greatest concern is the impact this virus could have if it gains a foothold in countries with weaker health systems or with vulnerable populations. That concern has now become very real and urgent. We know that if this disease takes hold in these countries, there could be significant sickness and loss of life. But that's not inevitable. Unlike any pandemic in history, we have the power to change the way this God W.H.O. is working actively to support all countries and especially those that need our support the most. As you know, the collapse of the market for personal protective equipment has created extreme difficulties in ensuring health workers have access to the equipment they need to do their jobs safely and effectively. This is an area of key concern for us. We have now identified some producers in China who have agreed to supply W.H.O.. We are currently finalizing the arrangements and coordinating shipments so we can reveal our warehouse to ship BP to whomever needs it most. Our aim is to build a pipeline to ensure continuity of supply with support from our partners, governments and the private sector. I'm grateful to Jack Ma and his foundation as well as aleko Angotti for their willingness to help provide essential supplies to countries in need. To support our call to test every suspected case. We're also working hard to increase the global supply of diagnostic kits. There are many companies globally that produce diagnostic kits, but W.H.O. can only buy or recommend kits that have been evaluated independently to ensure their quality. So we have worked with Find the Foundation for Innovative New Diagnostics to contract additional labs to evaluate new diagnostics. In parallel, we are working with companies to secure the supply and equitable distribution of these tests, and we are also working with companies to increase production of the other products needed to perform the tests from the swabs used to take samples to the large machines needed to process them.

We're very grateful for the way the private sector has stepped up to lend its support to the global response. Just in the past few days, I have spoken with the International Chamber of Commerce with many CEOs through the World Economic Forum and with the B20 group of business leaders from the G20 countries. We understand the heavy financial toll this pandemic is taking on businesses and the global economy. We are encouraged by the solidarity and generosity of business leaders to use their resources, experience and networks to improve the availability of supplies, communicate reliable information and protect their staff and customers. And we are also encouraged that countries around the world continue to support the global response. We thank Coed for its contribution of 40 million US dollars in addition to increasing access to masks, gloves, gowns and tests. We are also increasing access to the evidence based technical guidance. Countries and health workers need to save lives. W.H.O. has published guidelines for health ministers, health system administrators and other decision makers to help them provide lifesaving treatment. As health systems are challenged without compromising the safety of health workers, the guidelines detail actions all countries can take to provide care for patients, regardless of how many cases they have. They also outline specific actions to prepare health systems according to each of the four CS. No cases, sporadic cases, clusters of cases and community transmission. These guidelines provide a wealth of practical information on screening and triage, referral staff supplies, standard standard of care, community engagement and more.

We encourage all countries to use this and other many other guidelines which are all available on the W.H.O. Web site. But we are not only advising countries. We also have advice for individuals around the world, especially those who are now adjusting to a new reality. We know that for many people, life is changing dramatically. My family is no different. My daughter is now taking her classes online from home because her school is closed. During this difficult time, it's important to continue looking after your physical and mental health. This will not only help you in the long term, it will also help you fight colvard. If you get it first, eat a healthy and nutritious diet which helps your immune system to function properly. Second, limit your alcohol consumption and avoid sugary drinks. CERD don't smoke. Smoking can increase your risk of developing severe disease. If you become infected with Corbitt 19 fourth exercise W.H.O. recommends 30 minutes of physical active, a activity a day for adults and one hour a day for children.

If your local or national guidelines allow it, go outside for a walk around or a ride and keep a safe distance from others. If you can't leave the house, find an exercise video online, dance to music, do some yoga or walk up and down the stairs. If you'd working at home, make sure you don't sit in the same position for long periods. Get up and take a three minutes break every 30 minutes. We will be providing more advice on how to stay healthy at home in the coming days and weeks. Fifth, look after your mental health. It's normal to feel stressed, confused and scared during a crisis. Talking to people you know and trust can help. Supporting other people in your community can help you as much as it does.

And check on your neighbors, family and friends.

Compassion is a medicine.

Listen to music. Read a book or play a game. And try not to read or watch too much news. If it makes you anxious. Get your information from reliable sources once or twice a day to increase access to reliable information. W.H.O. has worked with what's up and Facebook to launch a new W.H.O. health alert messaging service. This service will provide the latest news and information on Kivett 19, including details on symptoms and how to protect yourself. The Hildes Alert Service is now available in English and will be introduced in other languages next week. To access it, send us a word. Hi to the following number on what's up? 0 0 4 1 7 9 8 9 3 1 8 9 2. We will make this information on our website later today. Corvin, 19, is taking so much from us, but it's also giving us something special, the opportunity to come together as one humanity, to work together, to learn together, to grow together. I thank you.

Thank you, Dr. Tedros. Ah, no. Open the floor to questions. Well, we don't have a floor, but I'll open the virtual world to questions.

And first in the very long queue is to new from Gene Oua, too. Can we please have your question?

All right. Do you hear me?

Oh, yes, we hear you very well.

Hi, is you from John from one news agency. Almost a week from now, G20 countries will be had a meeting to discuss the Kobe 19 and the impact on a global economy. My question is now, China has reported no new cases since yesterday. So what does it mean? What does it mean for China? What does that mean for the rest of the world? And what what are the difficulties that lie ahead for China in combating this global pandemic? Thank you.

I think the simple message accusing the director general's comment is it's a message of hope.

It's a message that this virus can be suppressed. We can break chains of transmission. It takes a huge effort. It takes in all of society effort. It takes coordination, it takes solidarity, it takes activated communities, it takes brave health workers. It takes supply chains that work. It takes commitment. And if it's done, this virus can be turned around. Other countries are showing the same thing and not by doing exactly the same thing that they're achieving the end by mixing and matching and creating a comprehensive strategy that's matched to the threat they face and to the context in which they're working. So I think there's a message of hope there from China. And that's a message of hope to many countries around the world who are very low numbers of cases right now and who can turn this virus back. We've seen the damage this virus is doing in health systems in a number of countries, but we've also seen that this virus can be pushed back. So that's the I suppose, the the implication that we see for for this. But it's going to take time. It's going to take effort and it's going to take solidarity and it's going to take coordination at community level, government level, at international level to make this happen. There wasn't a specific question.

Thank you. Thank you very much. I'll now hand it over to Badia from some notes in Iran.

Hello, can you hear me now?

Please go ahead. I asked this question before and I walked away with purpose more today.

What was the very first day of spring in Northern Hemisphere Spring? I Kanaks many people in Central Asia, Western Asia. They are celebrating it as a sign of renewal, a new beginning.

In this climate, what will be done? But you airshows message to people who are celebrating Nowruz, especially Iranians who are among people struggling the most with the outbreak of Coheed, 19.

Yeah, Hibernia, and you had a safe trip back to Iran.

We missed you in Geneva. The I think, you know, it's celebrations and gatherings, particularly religious gatherings, the ones that celebrate renewal or are obviously very important, but we may need to change the way we celebrate things.

For now and in countries like Iran and it's very clear from the government that in Iran we have to separate people physically so we don't transfer disease and mass gatherings, particularly mass gatherings, to bring people from far away to one place and they mix and then they go again far away. And that's very often religious gatherings. They can not only amplify the disease, but they can disseminate the disease very far away from the center so they can be very, very, very dangerous in terms of epidemic management. We see that the authorities in the kingdom of Saudi Arabia, how careful they have to be every year with the harsh because of the health risks. And that's managed extremely well. But in this particular case, with this virus, with this seriousness, I think we need to heed the instructions from the government in Iran.

We need to heed the structures all around the Middle East that the gatherings of a certain size and there are differences in each country need to be avoided. We will support the government's efforts on that. But as we've seen and it's not just in Iran, in Iran, where we might have religious gatherings, we have other gatherings around the world, young people gathering, as the DG has said, and other people coming together. So whatever reasons we have to come together and that can be very good reasons.

We need to listen to local authorities. We need to listen to national authorities. And if national authorities believe that those gatherings represent a risk to those individuals, but more importantly to the vulnerable people, they will go to visit after the gathering. Then I think we really do have to take it upon our own personal responsibility. This is not about the responsibility of government. This is about each individual making a decision to protect themselves and protect others. We shouldn't always have to have a government telling us to do that. This is about personal responsibility.

But in the case of mass gatherings, in the context of countries like Iran, I think we need to be exceptionally careful at this point and we need to be very, very careful not to bring too many people together too closely at any one time.

But if I can just add, you may have heard us use the phrase physical distancing instead of social distancing. And one of the things that you know to highlight and what Mike was saying about keeping a physical distance from people so that we can prevent the virus from transmitting to one another, that's absolutely essential. But it doesn't mean that socially we have to disconnect from our loved ones, from our family. Technology right now has advanced so great that that we can keep connected in many ways without actually physically being in the same room or physically being in the same space with people. So as the D.G. highlighted in his speech, a lot about this is, you know, we say social distancing. We're changing to say physical distance. And that's on purpose because we want people to still remain connected.

So find ways to do that. Find ways through the Internet and through different social social media to remain connected because your mental health. Going through this is just as important as your physical health.

Thank you. And we'll now have a question from Brazil. It's Diego from Vortex Diego. Are you on the line? If so, please go ahead.

Yes, I am. Thank you very much. I was to ask a very basic question. I mean, how central and crucial is physical distancing at this point when you have community transmission? Because there is a lot of debate going on around the world about the physical distance seeking measures. So I'd like the most accurate data and comment possible regarding the physical distancing measures of.

I think there are there are sort of a toolkit of measures that can be taken to deal with this, whereas there are public health measures that focus on containment.

And that is identifying cases, identifying their context. And the principle there is you take the case of the confirmed case and the context away from everybody else. So you separate the virus from the population when disease has reached a certain level, especially in community transmission, and it's no longer possible to identify all the cases or all of the context. Then you move to separating everybody from everybody else. You create physical distance between everybody because you don't know exactly who might have the virus. Now, if we look at that situation, that's very difficult to manage because that's costly in social terms. That's costly in economic terms. And ideally, our approach to this should be to really focus on containment measures, case finding, isolation, quarantine of contacts. And in that situation, do social distancing, are the physical distance measurements or the movement restriction mechanisms may not have to be as extreme. If you think about Singapore in its fight against scored with 19, it never closed at schools. It didn't shut down its public health system. It didn't do lockdowns, but it was absolutely committed to the concept of case investigation, cluster investigation, case isolation, quarantine of context. And it really, really, really stuck to that task. Now, that was OK because Singapore had a relatively small number of cases. So we're not criticizing in any way countries who have to take physical distance in measured. That's a necessary measure in situations where the virus is fairly widespread in communities.

But what we should hope is and this is maybe the thing that we have to be very careful with. Large scale physical distancing movement restriction are, in a sense, a temporary measure. What they do is they slow down to some extent. The spread of infection in communities and thereby take pressure off the health care system. They don't fundamentally deal with the problem of disease transmission. And if you want to get back to what countries like Korea are doing. Japan or China, Singapore and Hong Kong and others. If you want to get back to that, you really have to get back to the hard core public health measures of case finding, contact tracing, quarantine, isolation. So in some senses, we need to slow down the virus. Then we need to suppress the virus and then we need to go after the virus. And that takes different combinations of different measures. But social or physical distancing measures and movement restriction measures are very hard socially and they're very hard economically. And we need to use whatever time those measures are in place to put in place the public health architecture that can then go after the virus because lifting those measures may result in the disease returning. If you don't have in place the public health measures to deal with the virus. Maria?

Yeah, I think if if you think just very simply about what physical distancing can do, if you think of think of a large gathering or you think of such a crowded space and people are very close to one another. If you have infected individuals in that clustering of people, the opportunity for the virus to pass between people is much greater because you are physically closer to one another. What physical distancing does is just that it actually separates people out.

So think of that same cluster of people but spread out over a much larger geographic area. Just think of a drawing, you know where you're seeing a bunch of dots. Either they're very close together or they're very spread apart. If those dots are spread apart and those dots represent people and you have infected people in those areas, you remove the exposure, you remove the opportunity for that virus to pass between one person and another. But as Mike has said, and as have we have said before, social distancing, physical distancing alone is not enough. It has to be part of a much larger package of interventions.

Thank you, Maria. So now I have a question from Imogen Image in FUC. So are you on the line, Imogen?

Yeah. Can you hear me? Hi. Can you hear me, sir? Well, go ahead. Great. Yeah.

There've been some questions about the mortality rate in Europe for Italy. This is tragically really, really high. Germany so far is quite low. And there's been some questions about how the cause of death is being recorded, for example, with somebody, an individual who already had serious underlying health conditions.

Do you have any data from the different countries about how they're recording cause of death?

I don't have any specific data about how each country is recording a cause of death, whether it was associated with COBA 19 or if there were other reasons why why people died. We do know from the confirmed cases if those individuals have been reported as having recovered or who have died. We spoke about this the other day, the differences in mortality as you compare them by country. We have to be very careful about how we compare countries right now. There's a combination of factors of why we're seeing differences in mortality by country. The first is about the populations that the virus is affecting and infecting. We gave the comparison between the virus moving and older populations because we know that the virus can cause more death in older individuals as opposed to the virus circulating in younger populations where you would see less mortality. So there's there are a number of factors in which the mortality rate can can vary by different populations. And we also discussed previously about the challenges of describing mortality as an epidemic unfolds as this pandemic unfolds. Looking just at the numbers of deaths over the numbers of cases that are reported is only a snapshot and it's an incorrect snapshot of what the true mortality is because we don't know the extent of infection in the population. On the one hand, and on the other hand, there are a number of individuals who are in who are very severe, who are still in ICU, some of whom will recover and some of whom will die. So we don't have those precise numbers yet of how many will die out of those that are infected. And we still don't know the overall infection rate in the general population.

Thank you, Maria. I'm just going to ask now a question that was sent to me by email from a correspondent, a health writer in India who's been struggling to get on virtually.

Her name is my UNK bhagwat asks. India has tested a close to who has tested close to 13000 samples. W.H.O. says Test, test, test. She asks. By not scaling up the tests. Has India lost critical time?

So it's wonderful that we're seeing testing being done across countries.

We know that there are challenges associated with doing that test. We know we are working very hard across all of our regions with many different manufacturers to ensure that tests are available in countries that need them. We're working with labs across all countries to ensure that the lab capacity in each country is increasing and we're seeing many countries take additional steps to further increase that capacity.

What the DG meant when he said test, test, test was that we would like to see all we recommend that all suspect cases be tested and we recommend that all contacts that have symptoms are tested. And the reason that that is absolutely critical is that we need to know where this virus is so that we could stop the onward transmission from those who are infected to infect other people. And so by doing that, by having adequate testing and ample testing as part of your strategy, we'll help reduce this down. But that isn't enough. We know that by finding those cases, isolating cases in caring for those cases is critical quarantining of your contact so that they cannot pass that virus onward.

It's absolutely critical to stopping transmission moving between people.

Thank you, Maria. Did you want to do it? No. Okay, so now Adak to ask. Ask child shall Underland from liver R.S. on Shali You on the line.

Hello. This is a question to the D.G.. Dr. Teds also like to know how you are coping with the different press pressures you might have from member states who don't really have the same priorities or ways to fight this virus. How do you cope with the different applications coming from the larger member states?

I think for for Babli Joe, whether it's a small country or big, whether it's a rich country or poor, it's the same. We treat them the same same way and to treat, you know, all same way. The best principle is to actually be principled and to help them to give them advice or to respond to their queries based on principles. So as long as we do that, then I think I don't consider any the thing that comes from member states as pressure.

Thank you, T.J..

I've got an I got another printed question that was e-mailed to me by John Zahra Kostis on behalf of France 24 and The Lancet. What is the shortfall in the global supply of PPE and critical, say, lifesaving medical equipment and in view of the surge of cases? How much production these supplies needs to increase?

Oh. Jells, it's difficult to make an estimate, obviously, for the whole world.

We don't know the stocks that the national governments actually hold. So we can only make estimates based on the number of health workers that we would expect to be in the front line at a certain level of service. So it's making a shortfall is the difference between what you need and what you have. And right now, we don't know how much we're going to need because we don't know how fast this is going to develop. So we have projections for that. And there are different scenarios. And equally, it's difficult to know where the gap is because we're in. We don't have full knowledge of what countries actually themselves have.

We are going through a very sophisticated process of establishing and finalizing the gaps as we see them. We're asking countries what their gaps are specifically. We're doing market analysis as to what the supply chain has within us. It's safe to say that the supply chain is under huge pressure.

We're working with the pandemic supply chain network to maximize the amount of flow of PPE into a protected supply chain for PPE for health workers around the world. But it's not just the PPE itself. It's getting that PPE now to countries. We have issues with flights. We have issues with getting access. So we're going to need a HUME and architecture. In effect, we're going to need air bridges that allow us to bring staff to bring stuff to countries to help and assist them. And that stuff maybe lab tests, that stuff, maybe PPE, that stuff, maybe expertise. It's becoming increasingly difficult for us to move material around because of.

Even ships in Kabul, I think as we speak, over one hundred thousand merchant seamen are currently sitting in ports all over the world and can't either come into the country they're in or move on in the ships they're on. So we have some serious issues within the supply chain. We are, though, and it is not without hope. And indeed, you may wish to speak to this with the manufacturers in China in cooperation with the Chinese government have moved very significantly and offered to resupply our warehouses in Dubai. And we're currently finalizing the shipments of finalizing the needs. And we will obviously continue to do that. We do have a whole series of numbers, John, around what is potentially needed. And I'll be very happy to share some of them with you in the next couple of days as soon as they're validated. We're currently validating the number of lab tests. But if I give you a sense of scale, W.H.O. has distributed one and a half million lab tests around the world.

If we look forward in this epidemic, we project ourselves forward a number of months and the amount of testing that's going to be needed, we need to scale that up approximately 80 to 100 times. So it's not about doubling the availability of lab tests. It's not about trebling. It's it's about potentially increasing that 80 fold. Now, that's an extreme analysis, but that's what we need to aim for. And the director general outlined the mechanisms by which we're going to achieve that, working with the public private partnership and scaling up production and access to tests as they are needed. Equally, we estimate that there are probably, if you look again around the world, probably in excess of 26 million healthcare workers who may have to at some point engage in health care to people who potentially have Corbitt 19. That's an awful lot of health care workers to protect. You work out that those health care workers are doing a few hour shifts. They have to change PPE every time they do a shift. They have to be trained to use that PPE.

I think you can see just what the gaps are in terms of masks and gowns and gloves in that. But as I say, we're we're validating those numbers because we have to match them against what countries actually have. The greatest tragedy for me, among all the tragedies we're seeing in this outbreak is the prospect of losing part of our health workforce, that those individuals, those doctors and nurses and hygienists and others who put themselves in the frontline to care for our most vulnerable would themselves become exposed, become sick and potentially die because they don't have protective equipment. It is a it is a huge responsibility at local, national and global level that we protect the supply chains for health workers around the world and that we have solidarity between governments, between producers, manufacturers and others to ensure that our bravest get the best possible protection.

I would like to add a few issues. I think Mike had covered almost everything.

Whatever the amount we need, we are saying we have shortages. But whatever amount the shortage is without political commitment of our leaders, I don't think this shortage of supply of peoples could be addressed.

And as a result with that, because of lack of political commitment, when the supply is short, too, because the supply is short.

Some countries are closing borders and banning exports and that cannot be a solution.

And the solution we're proposing is, one, if there is political commitment and we need political commitment. We need to do three things.

With political commitment, one increased production because there is the supply demand mismatch. So to address that, increasing production is the answer.

Second, we need to have free cross-border. Mobility.

Meaning we should not ban exports and and CERD.

Equitable distribution is key because all countries may not have access base based on their on their needs. So we're asking those three things and we're working with the International Chamber of Commerce very closely and with B20, these are the businesses that belong to the G20 to address the problem of the logistics we're facing at its root.

Thank you.

If I can speak to the individual level. So even the individual actions that all of you take affect the supply chain.

So as it relates to masks, members of our team are having teleconferences across our infection prevention and control networks where there's very serious discussions about the use of medical and surgical masks. We need to ensure that we prioritize the use of these masks for our frontline workers. And so we plead with you. If you do not need to wear a mask at home as an individual in the community. Don't wear a mask. Don't hoard those masks. Make sure that those masks are available to the frontline workers because they're making very difficult decisions about extended use or potential re-use. And we don't want to put our health care workers in any further danger. So please, if you don't need to if you're not caring for a sick person at home, then there is then you don't need to be wearing a mask. So again, please prioritize the use of these masks for our frontline workers.

Thank you. We now have a question from Karrine at Bloomberg Korean, are you on the line? Korean. Are you on the line? Yes, can you hear me? Yes, we can. Please go ahead.

Ok. So given that 10000 deaths have been reported and many researchers estimate that the mortality rate of Kobe 19 is at 1 percent. Is there any reason not to estimate that 1 million people may have already been infected?

Yeah, I think you may be mixing up two lines of logic here.

There have been over 200000 confirmed cases reported and we have 10000 deaths. So deaths, can we calculate the proportion of those we tried to avoid death in general because very often your reported cases reflect infections up to 14 days before which deaths can actually reflect people who were exposed two weeks, three weeks, four weeks before. So it's it's it's not necessarily a good thing to make that calculation, but you're using debt as a way of calculating how many people are infected. Is making an assumption that you actually you can make that calculation. And unfortunately, we we can't make that calculation.

What I think we need to focus on and many people are we will have to wait for serology tests to really understand what the population attack rates are. But all of the data so far suggests that asymptomatic cases are a relatively low proportion of symptomatic cases.

We don't know beyond that whether there are others who just get infected and just develop antibodies that never, ever know they're infected or may not even be infectious. The question is what's driving infection? And what we believe is driving infection is. For the overwhelming majority of people are, in fact, of they're infected by a symptomatic other individual, somebody who is sick and symptomatic, who either scoffs or sneezes close by or who contaminates the surface close by.

That is the main driver of transmission. And that's what we have to focus on in court in order to avoid infection. We can worry about all of the other ways that we could possibly be infected, theoretically. And that's important. And there are outliers in all of science. But the driving force is that with regard to the deaths, rather than trying to win, we we can say 10000 deaths and sounds like a laugh. And then other people say, well, you know, people die of other things, too. But take one look at what's happening in some health systems around the world. Look at the intensive care units, completely overwhelmed. Doctors and nurses utterly exhausted. This is not normal.

This isn't just a bad flu season. These are health systems that are collapsing under the pressure of too many cases.

This is not normal. This is not just a little bit worse than we're used to. This is this is tough for systems. And therefore, trying to use the absolute number of deaths as a measure of the overall impact of this outbreak is probably not the right term to use. But certainly when we say 1 percent overall case fatality, it it's it's a it's a number.

But when I would say to you that in in certain situations, and particularly in the over 70s, in a number of situations, the case fatality, the clinical case fatality, the case fatality in those people admitted to hospital is up to 1 in 5 4 people over the age of 70 years of age. That's a really, really serious outcome for anyone being admitted with would go with 19 and a equally when we look at people in intensive care. If you look at the in Italy at the moment, two out of three people in intensive care in Italy are under the age of 70. And in fact, 12 percent of people in intensive care in Italy are under the age of 50. So again, let's look not just at deaths. Let's look at severity. Let's look at the impact this is having in society.

I just want to take this opportunity to say something about models, so mathematical models, we W.H.O. works with a large number of modeling groups across across the globe, statisticians and modelers. And this is really important for us to help work through scenarios and work through the what ifs, what may happen if we don't do anything. What will the trajectory of this outbreak in each country and at the global level or by region look like if we do nothing and those numbers are scary. I'm sure you've seen some scary numbers that have been reported in the media and those numbers will likely continue. But the important thing is, is that there's something we can do about this. We have seen in a number of countries now that there are several actions that can take this comprehensive approach that we've been talking about to drive those numbers down. And we owe this to ourselves and the rest of the world to do everything we can to make sure that those predictions do not become a reality.

Thank you, Maria. So now I have a question we got we're moving around the globe to Greece. Kostis from a.r.t. Are you on the line?

Yes, I am. Do you hear me?

Please go ahead.

I will be asking the question to Dr. General, give us, please, is an update about the vaccine research. How far away we from the lucky first day to win. Calvet 19.

Question about the vaccine.

So we are working across with their research and development blueprint, the R&D blueprint, with a number of scientists and researchers all over the globe, and one of the areas that we are working on is the acceleration of vaccine development, not just us. We're working with people across the globe.

There's at least 20 vaccines that are in development for Cauvin, 19. And you heard us report. I think, Mike, you can give a little more detail on this. Of the first trials that are starting 60 days after the virus was sequenced. If I'm not mistaken, the acceleration of this process is is really, truly dramatic in terms of what we are able to do. Building on work that started with TSAs, that started with murres and now being used for colvard 19, we're still some time away before we would have a vaccine that that could be used. And they still need to go through the trials to look at efficacy. But this work is underway and we are very grateful for all of it. All of the partners that are working to get these clinical trials on your way. Mike?

Yeah, maybe I could. So it again. Yes. And I'm very, very pleased to see the work accelerating.

And we we thank our colleagues in separate, but also working very closely with which at Berkeley and his colleagues at the gallery.

And many, many others, the Gates Foundation and others, I think, beyond the scientific research to vaccine.

It's fantastic to see the innovation going on to develop vaccine candidates and to take those candidates through the necessary testing. And many people are asking, well, why do we have to test the vaccines? Why don't we just make the vaccines and give them to people? Well, the world has learned many lessons in the mass use of vaccines. And there's there's only thing one thing more dangerous than a bad virus, and that's a bad vaccine.

So we have to be very, very, very careful in in developing any product that we're going to inject into potentially most of the world's population. We have to be very, very, very careful that we first do no harm. So that's why people are being careful. Why? Well, to be eight weeks into a major event of a new disease and have a vaccine going into the arm of well, A.L.S. this week is is just unprecedented in its speed.

And that would never have happened had countries not put the genetic sequences out in public. And I think that, again, shows to play solidarity is so important. But we will face another challenge down the line and one that the director general is very concerned about and is reaching out to other institutions like GAVI and others to discuss right now.

And that is that even if we get a vaccine that's effective, we have to have that vaccine available for everybody. There has to be fair and equitable access to such a vaccine, not just for ethics reasons, but because the world will not be protected until everyone is protected.

So in that sense, there are other hurdles to cross now. Not just the hurdles of science, but the hurdles of how do we scale up to production of such a vaccine? How do we ensure we get enough of that vaccine in time? How do we distribute that vaccine to populations all over the world? And how do we convince people to take the vaccine? Because you've all seen over the last few years the lack of the loss of confidence in vaccines. It's one thing having a vaccine, but people need to avail of that vaccine. So there's a lot of work to do. And the director general will be leading a process with with other organizations to address the issues of production, scale-up financing, advance market commitments and a fair and equitable distribution of those vaccines and has already been reaching out to major institutions and global health leaders on this.

And on the vaccines, one thing I would like to stress. As Mike said, it is.

1 The speed is really unprecedented in 60 days.

To have the first person to be enrolled in vaccine trial is is really amazing.

I hope the vaccines and trial work and at the same time, though, before even we have the vaccine, as Mike said, we have to prepare so that the vaccines can reach everybody who needs it, because this vaccine should not be for the haves. It should be for those who cannot afford it, too. So we need to answer that question as early as possible. But the solidarity we're witnessing is very, very encouraging. My colleagues were sending me a text about another solidarity, this solidarity, which we are saying is a solidarity of scientists who came together, as you remember, six weeks ago, to find solutions, diagnostics, treatment and vaccines. And then the other Solidarity's, the financing, the Solidarity Response Fund. As you know, we started it last week. And today, we have mobilized already 66 million U.S. dollars.

This is a record, but it's not the money. One hundred seventy five thousand people were involved in one week, and not only that, there is an outpouring support which is still flowing.

And including many stories that really touch our hearts.

I will give you one of some of the stories in New York, theater group started a virtual singing challenge getting people to donate.

And in Ireland, Mike's country car and Ford is staying active in pledging 4000 squats in GoFundMe campaign to support the fund. And then online, a popular video game streamer started hosting regular fundraisers with his followers. Very innovative. And on and on. I don't want to take but the time on this. But these are stories of solidarity and when. Humanity is confronted with a common enemy like this.

It also gives us a chance to bring. The best of us, and that's what we need, solidarity in in in everything.

And.

With that kind of solidarity, which is we said it last week, which is more infectious than the virus itself.

We will be able to stop this virus.

On that note, I'm going to close his press conference. It's so important that we all stay positive. I'm so sorry to the 277 journalists online that you didn't get to ask your questions. We will be sending the transcript out. We'll also send the number of the WhatsApp chat board. You just have to put in plus 4 1 7 9 8 9 3 1 8 9 2 and send the word high.

But we'll send it to you so you can all use it and see what a great check but it is.

And we will also send the usual audio files. Thank you so much for joining this this briefing today. Goodbye.

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Popular Transcripts FULL TRANSCRIPT: World Health Organization (WHO) Press Briefing – March 18, 2020

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Tarik Jasarevic :
We'll have a questions for other guests. Before you applaud to Dr. Tedros, just to remark that we've had some issues, technical issues with sending media advisories. We had a we had some meetings just as just few hours ago. And hopefully this will be sorted.

Tarik Jasarevic :
And everyone who is on our lists will be getting the notes from W.H.O., including media advisories, press releases and all the other notifications. We will have an audio file, as we always do, and hopefully a transcript will be available tomorrow. Dr. Tedros, please.

Dr. Tedros:
Thank you. Thank you, Terry. And good morning and good afternoon, everybody. It's now more than a month since the last case of Ebola in DRC. If it stays that way, the outbreak will be declared over in less than a month's time.

Dr. Tedros:
We would like to thank all our partners for their solidarity in staying the course in the service of the people of DRC and my special appreciation, especially to the government and people of the Democratic Republic of Congo. That same spirit of solidarity must be at the center of our efforts to defeat Coheed, 19.

Dr. Tedros:
More than two hundred thousand cases of Cobbett 19 have been reported to W.H.O. and more than 8000 people have lost their lives.

Dr. Tedros:
And more than 80 percent of all cases are from two regions the Western Pacific and Europe. We know that many countries now face escalating epidemics and are feeling overwhelmed. We hear you. We know the tremendous difficulties you face and the enormous burden you are under. We understand the heart-wrenching choices you are having to make. We understand that different countries and communities are in different situations with different levels of transmission. Every day. W.H.O. is talking to ministers of held heads of states, health workers, hospital managers, industry leaders, CEOs and more to help them prepare and prioritize according to their specific situation. Don't assume your community want to be affected. Prepare as if it will be. Don't assume you won't be infected. Prepare as if you will be. But there is hope. There are many things that all countries can do. Physical distancing measures like canceling sporting events, concerts and other large gatherings can help to slow transmission of the virus. They can reduce the burden on the health system and they can help to make epidemics manageable. Allowing targeted and focused measures but to suppress and control the epidemics. Countries must isolate, test, treat and trace. If they don't. Transmission chains can continue at a low level, then resurge once physical distancing measures are lifted. W.H.O. continues to recommend that isolating testing and treating every suspected case and tracing every contact must be the backbone of the response in every country. This is the best hope of preventing widespread community transmission. Most countries with sporadic cases or clusters of cases are still in the position to do this. Many countries are listening to our call and finding solutions to increase their ability to implement the full package of measures that have turned the tide in several countries. But we know that some countries are experiencing intense epidemics with extensive community transmission.

We understand the effort required to suppress transmission in these situations, but it can be done.

A month ago, the Republic of Korea was faced with accelerating community transmission, but it didn't surrender. It educated, empowered and engaged communities.

It developed an innovative testing strategy and expanded lab capacity iteration ration the use of masks. It did exhaustive contact tracing and testing in selected areas, and it isolated suspected cases in these designated facilities rather than hospitals or at home.

As a result, cases have been declining for weeks at the peak. There were more than 800 cases. And yesterday the report was only 90 cases. W.H.O. is working in solidarity with other countries, with community transmission. To apply the lessons learned in Korea and elsewhere and adapt them to the local contexts. Likewise, W.H.O. continues to recommend that wherever possible, confirmed mild cases should be isolated in health facilities, where trained professionals can provide good medical care and prevent clinical progression and onward transmission. If that's not possible. Countries can use community facilities to isolate and care for mild cases and refer them for specialized care quickly if needed. If health facilities are at risk of being overwhelmed, people with mild disease can be cared of or cared for at home. Although this is not the ideal situation, W.H.O. has advice on our Web site for how homecare can be provided as safely as possible.

W.h.o. continues to call on all countries to implement a comprehensive approach with the aim of slowing down transmission and flattening the curve. This approach is saving lives and buying time for the development of vaccines and treatments. As you know, the first vaccine trial has begun just 60 days after the genetic sequence of the virus was shared by China. This is an incredible achievement. We commend the researchers around the world who have come together to systematically evil Lloyd experimental therapeutics, multiple small trials with different methodologies may not give us the clear, strong evidence we need about which treatments help to save lives. W.H.O. and its partners are therefore organizing a study in many countries in which some of these untested treatments are compared with each other. This large international study is designed to generate the robust data we need to show which treatments are the most effective. We have called this study the Solidarity Trial. The Solidarity trial provide simplified procedures to enable even hospitals that have been overloaded to participate.

Many countries have already confirmed that they will join the solidarity trial and these countries.

Ah, Argentina Bukharin, Canada, France, Iran, Norway, South Africa, Spain, Switzerland and Thailand and I trust many more will join.

I continue to be inspired by the many demonstrations of solidarity from all over the world. The coveted 19 Solidarity Response Fund has now raised more than 43 million US dollars from more than one hundred seventy three thousand individuals and organizations. Few days since we launched it, I would especially like to thank FIFA for its contribution of 10 million U.S. dollars. This and other efforts give me hope that together we can and will prevail. This virus is presenting us with an unprecedented threat, but it's also an unprecedented opportunity to come together as one against a common enemy, an enemy against humanity.

I thank you.

Thank you very much for these remarks, so we will start with the questions. I will just remind once again, if it's possible to has only one question per person so we can get as many questions as possible.

So if we are ready, we can start with father'll from Boland's. Hold it. His Bible. Can you hear us? Yeah.

Can you hear me? Hello?

Hello? Yes, we hear you. Go ahead, please. Pappalardo.

Up to today, Paul on the run. Nine thousand test on a population of thirty eight million, which many consider as far too few. Do you have any recommendation on a hat on how much testing is advisable for our country in containment phase like Poland? And when can we expect cheaper version of diagnostic tests to be available in Europe?

Thank you.

If I understood well, the question is about how much testing should be done in a country of a size of bowling.

Yes. Yes.

And when the tests would be available in Poland, no one when the cheaper version of diagnostic tests be available in Europe.

When when? When cheaper tests would be available in Europe.

First of all, the value of testing is clearly determined by the number of suspected cases that you that you have.

So I think the focus here is not how much testing it needs to be done to reach a certain number. Though the answer there, the real challenges, are you testing every single suspect case? Every suspect case should be tested, their contacts identified. If those contacts are sick or showing symptoms, they should be tested. That requires a scale up because many countries have not been systematically testing all suspect cases. And that's one of the reasons why we're behind in this epidemic. So we need that to happen. Secondly, there are many manufacturers producing tests. W.H.O. has contracted with a manufacturer of production of tests mainly aimed at supporting developing countries. I am sure that Poland and through the European Union and others has access to too many companies who are producing tests either in the academic or in the private sector. But if if there is a need, any country may contact W.H.O. and we will either point them to a manufacturer or if needed, provide them with emergency testing capacities.

Thank you very much. Hope this answers question from Butler.

If if we can go now to Seeman at caber from today's News Africa. Simon, can you hear us?

Yes, you can. Can you hear me?

We will try to level up the sound a little bit.

Please go ahead. So send.

Ok. Thank you for taking my question. My name is Simon. I step back from today's News Africa. Washington, D.C. I know that Corona virus is spreading in Africa is largely over 30 countries and almost 600 people have been affected. But there's a problem. You still have big gassings.

You still have big religious gods and you still have people waiting. Speak with, for instance, a popular pastor in Nigeria. So TB Joshua has told his followers that the virus will be defeated on the 27 of March and he's not the only one. So my question is, do you think this is the time to avoid a two star big religion gods in big wedding and all the things that bring us together in Africa and be naming sounds for the first time?

But I will just repeat question for everyone. The question is about a big religious gatherings in Africa. And is this a risky thing for spreading the virus on the continent?

First of all, congratulations to you, to many of our member states in Africa reacted very quickly to put in place the necessary surveillance, the laboratory testing and other measures. Africa is a resilient continent with a resilient population who've dealt with and deal with epidemics every day of every year or every year, unfortunately.

At the moment, the incidence of Corbitt, 19 in Africa is low. It may be higher due to lack of detection, but within reason, Africa still has a major opportunity to avoid some of the worst impacts of the epidemic and to prepare prepare its public health system and its health system for this. With this in mind. African countries are looking at all of the different options. And I'm sure they're looking at their experience in Asia. They experience in Europe and looking at what options work best for them. Certainly at this moment in time, all countries that have a disease inside their borders need to examine the appropriate measures to limit contact between individuals, particularly large mass gatherings that have the potential to amplify disease. But we fully understand that. Depending on where countries are in the disease development or in the evolution of the epidemic, those decisions are based on different risk management factors. But in principle, W-A Jal's view at this moment is that all countries with with community transmission are clusters of cases inside the country. In order to avoid disease, amplification should be seriously considering delaying or reducing mass gatherings that bring people together in an intense way and have the potential to amplify and spread disease, particularly in large religious type gatherings that bring people from very far away into very close contact.

Maybe you'd like to add to what Mike said.

You know, as of today, the number of cases reported from sub-Saharan Africa is 233 cases in four days, and it's actually in terms of confirmed cases. It's the lowest region. But as Mike said, we we have we cannot take this number, as you know, the amount of or the number of cases we have in Africa, probably we have undetected cases or unreported cases. But in addition to that, even if we take this, 233 cases are true. We have to prepare for the worst in other countries.

We have seen how the virus actually accelerates at after a certain tipping, tipping point.

So the best advice for Africa is to prepare for the worst and prepare today.

It's actually better if these numbers are really true to cut it from the bad. And that's why we're saying we have to do the testing, we have to do the contact tracing, we have to do that isolating isolation and cut it from the blood.

And with regard to mass gathering and so on, it will help if we avoid that. And W.H.O. is recommendation is actually mass gatherings should be avoided and we should do all we can.

Look at it from from. From that.

But expecting that the worst could happen because we have seen how the virus really speeds up and accelerates in other continents or or countries. So that's our advise. And I think Africa should wake up. My continent should wake up. Thank you.

Thank you so much. The terrorists end up to run. Let's try to get to myself from my iodine, sir.

I understand.

Sir, can you hear us?

We were just left out of his day on Monday, but the Met again. He did? Oh, I guess not with me. It's a mixed blessing for him. We're on medication.

Let's go over to a larger idea. In case you think Sonix. Let's see what comes up.

So our friend from from magazine is asking about a sanctions to Iran and how sanctions on Iran have impacted the capacity of the country to to respond to this outbreak.

We've been working very closely with the authorities in any round and with many, many countries around the world now who have worked with us to ensure that Iran gets the assistance and help that it needs.

We've again said right the way through this epidemic that we want to avoid politicization of these events and we thank those member states. And there are a wide range of member states from different political and different persuasions and ideologies who have agreed to act in solidarity together to support Iran's situation. And we are focused as we have been on providing lab supplies and reagents in supplying PPE and ensuring that Iran has access to the markets. It needs to do that. And we've been working at a very detailed level, not only through the sanctions, but through the banking system and others to free up the necessary resources and to free up and provide the necessary assurances to companies and others that they can without with comfort and without fear of any consequence, supply Iran with essential medical equipment and supplies for the purposes of the control of Corbitt 90. The DG may wish to speak on some of his political engagements that have successfully ensured that the circumstance has come to pass. We are in solidarity with our brothers and sisters in Iran and all over the world and will ensure that every citizen in every country has the opportunity to access a global goods.

At this point in time, let us know. Thanks. Thank you very much.

The only thing I would like to add to that is we have already we are already in contact with senior officials from Iran. I had spoken to the minister of health yesterday and also had a chance to speak to Secretary Pompeo yesterday. And we have underlined the need for full solidarity. And I remind all of us the statement that the United States and especially Secretary Pompeo issued some weeks ago and we have discussed on how best that can be implemented. And as Mike said, some of the process, especially with with banking and so on. But in emergency situations, the sanctions can be addressed. And this is, you know, already agreed from the US side. And that's why we heard the statement. And we hope that we will have the needed solidarity to fight this enemy together. At the same time, I would like to use this opportunity to thank the crown prince. He sent the second round of support to Iran the day before yesterday. Two aircraft chartered shipping materials needed.

And that's what we're calling for, to for the whole world to know for the time.

I think we are in the most important solution in fighting an enemy like this by a dangerous virus is solidarity. And we hope this spirit will will continue.

Thank you very much and really sorry myself. We'll try to take your second question next time and just to say that we all miss our Geneva press corps.

So speaking about let's go to Jamie. We missed Jamie as well. Jamie. Please go ahead and ask your question. One question.

Candy, can you hear me, Terek? Yes, please go ahead.

Ok, great. Hi, Jimmy. Associated Press. We're wondering why might the death rates across Europe is so variable? Italy's death rate is at about 11 percent and they will soon overtake Hubei Province in terms of numbers of deaths, while other countries like Germany, France, Spain and the UK have reported far lower death rates closer to one to two percent. What might explain that discrepancy? Thanks.

Hi. Jamie here. I almost miss you as well.

The the.

It's a good question and there are a number of factors that might explain that.

But certainly one of them is testing. If you look at the Germany we had we had some very good communication with Germany today. They've had a very aggressive testing process. They've they've tested and confirmed over 6000 cases with just 13 deaths. But that may reflect the fact that they're really aggressive in their testing strategy. So the number of tests and the number of confirmed cases may be detecting more mild cases as a proportion of all cases. That's an important determination. The second issue is the the evolution of the time of evolution in the outbreak. What we do see is a pattern of long hospital admission. So Italy being having experienced the first wave of major transmission much earlier than other European countries is now experiencing those deaths because a lot of people reach a point where they can no longer be saved in the clinical system. So therefore, the deaths occur sometimes two to three to four weeks after the infection starts. So, again, it's you have to look at where each country is in the epidemic cycle. The other factor may be to do with the age profile of populations. For example, Italy has a very or a much older age profile and has a higher proportion of people in the very elderly category. And in some ways, Italy has been a poster child for healthy people living into old age.

And we've always asked ourselves the question, you know, why Italians and people living on the Mediterranean are healthier and live longer lives and. And.

But unfortunately, in this case, having that older population may mean that the fatality rate appears higher because of the actual age distribution of the end of the population underneath. There may be technical reasons as well in terms of the ability to provide standard of care. We saw this in China. We saw this in Hu Bay. When you looked at the case, fatalities inside Hubei, an outside Hubei. There were significant differences in case fatality. And anyone who's ever worked in the frontline of an emergency, when patient numbers begin to overwhelm, it becomes a simple factor of your ability to provide adequate care and react to every change in the patient's condition in the intensive care environment. So I think there are circumstances in which the standard of care cannot be maintained when patients are being overwhelmed and appointed to the tremendously courageous and brave physicians, nurses and intensivist in Italy who haven't been dealing with one or two patients in intensive care, for example, in northern Italy, over twelve hundred patients in intensive care at the same time. It's an astonishing number. The fact that they're saving so many is a miracle in itself. So I think there are many factors Jamie. And they all play into the the actual numbers. Maria May for more technical advice on that.

The only thing to add is, is exactly where the virus is, is is circulating in each country. And so you have to look at the demographics of where those where it is circulating in Korea. We had these clusters, these very large clusters related to a church and that the age distribution of those cases was much younger than what we're seeing in northern Italy, for example. You may see outbreaks in long term care facilities where the age is much higher. And so it's important where those clusters are occurring and where you're capturing your cases from. But we do need to be very careful when we look at mortality rates and we compare mortality rates. It's it's not right to compare them yet. What we need to do is find out why we're seeing differences and what that actually means in terms of our understanding of this virus and how it impacts different populations. We've said previously that we need to we need to be very careful when we compare a calculation of the number of deaths over the number of cases that are reported per country. And Mike has outlined the reasons why that is difficult. But we have not seen the way this virus will behave in other vulnerable populations. We have not seen how this virus will behave if and when we see it in vulnerable populations of high prevalence. HIV, for example, or malnutrition, children, for example. And that's what we need to prepare for. So every death is significant regardless of where this takes place. And we need to ensure that all of the measures that we take are preventing transmission because every step that we take there will prevent death.

Suppliment here on the issue severity, if you look at the case series that reduced and published from Korea, almost 20 percent of their deaths have occurred in people under 60. So the idea that this is purely a disease that causes death in very in older people, we need to be very, very careful with physicians again, initially will attest to this. And in Korea, this isn't just a disease of the elderly. There is no question that younger, healthier people experience a much overall less severe disease. But a significant number of otherwise healthy adults can develop a more severe form of the disease. And that's why we need to be ever vigilant in ensuring that we observe everyone. Even the mild cases for any signs of clinical progression to a more serious disease.

Thank you very much. Be good. Next question, that should be Diego from Brazil. Diego, can you hear us?

Yes, I can't. Can you hear me? Yes, please go ahead.

Yes. There are a lot of speculation about cases regarding children. So if you could please clarify, what is the data right now about the symptoms on children and how fast they can spread? The virus can spread on children.

Thank you, Diego, so I can start with that. So, yes, we know that children are susceptible to infection.

We know that children are infected with this virus. But in terms of the reporting of cases across a large number of countries now where we have data, the number of cases of reported cases in children is lower than adults. We know that children can have to develop disease. And the disease that they develop in terms of the signs and the symptoms are similar to what we're seeing in adults, which include fever, which include dry cough, which include fatigue and muscle pain. There are a overall the majority of children that are infected will experience mild disease, but that is not universal. There is a recent study that came out in China that showed that a number of children have developed severe disease in critical disease. And in China, one child has died. And so what we what we need to prepare for is the possibility that children can also experience severe disease. But the evidence so far is that children have mild disease. And only one death reported in China so far.

Thank you very much. Thank you. We will take one question from from journalists who are for some reason unable to get on the line.

So here is Camilla Hudson from Financial Times asking, is there a shortage of tests and or test processing centers in Europe? Is that the reason that more testing isn't being done in countries like the United Kingdom?

I think countries in Europe have been scaling up their capacity to do testing over the last number of weeks. There are different options for countries. One is not lab testing kits which do a small number of tests per kit. The other are automated machines that allow you to test a number of samples at one time. And then there are high throughput machines that allow up to 5000 samples to be processed per day. And many European countries are moving through to to put in place those more high throughput mechanisms to be able to test more and more cases. So, yes, I think there's a scale up going on and testing, but I don't believe that the ability to test has been the reason for the not testing. I don't think that's been this step in the limitation. I think it comes down to what the strategy of an individual country is. If you're going to make an attempt to detect every suspect case and test every suspect case, then I believe countries in Europe do have the capacity to do that. The tough part is then when you get those cases being able to identify context and follow those contacts and quarantine contacts, then you need to leverage a much larger public health response that comes in behind that lab testing and allows you then to suppress the virus through those individual isolation mechanisms.

Isolating individuals or quarantining contacts is about removing people who are potentially infectious from the community. What in balance with that and in line with that social distancing or physical distancing measures, in a sense, ask everybody to separate themselves from everybody else on the basis that we're not quite sure where the virus is. A combination of those two allows you to really suppress the virus if you really focus on individual measures to try and take people who are known to have the virus or could have the virus out of the general population for a period of time and at the same time you create some physical separation at the population level. Those two combined can be very effective at suppressing transmission of the virus in order for that strategy to work. You must have the capacity to do more extensive lab testing as you really tried to search for and identify all of those suspect cases.

And countries are coming up with different strategies to meet the testing demands. And maybe Maria can explain a little more on what those strategies are.

Yes. So there's there's three major areas in which countries are working on to increase their testing capacity. The first is the kits themselves that Mike has has described the sheer number of available tests and companies they're developing tests in countries that have developed test is incredible considering where 12 weeks into this outbreak, this pandemic. The second area is increasing the number of labs that can actually run these tests. So in every country, there are national labs that can do PCR work there. They're building on a flu national influenza system that has been in existence for decades. But increasing the number of labs that can actually run those tests is an important part of the strategy. Whether you're using public health labs or using private labs or academic labs, whatever it may be, the number of labs that can do those tests needs to be increased. And the third area is the number of people, the workforce who are actually going to run these tests. So this three pronged approach of being able to have more labs that can do these and run these assays, more people who can run this and have more tests available are really critical. We've also seen in the D.G. gave a good example in Korea, where countries not only in Korea, but countries are finding innovative ways to test people. So finding individuals, how can we run these tests? We saw this drive through system, for example. But countries need to be creative in the way they use the fundamentals of public health in terms of tackling this virus. But think of innovative ways and creative ways in which you can find people that fit your transmission scenario.

Thank you very much. Let's go to next question, Helen branswell, Helen.

Hi. Thanks for taking my question. I was hoping you could give us some more information about the Solidarity trial. Could you please tell us what drugs have been prioritized?

Hi, Helen. Annamaria. I know Restrepo will join us to give you the specifics on the trial, but it's a multi it's a multi armed trial and countries are able to choose between any one, I think, or more or five therapeutics that are currently being evaluated. But it may be more some. Anna-Marie, it will speak to this and give you the details.

Good afternoon, Helen. Is is that the design? Initially, we have five arms. The first arm is the standard of care. They're useful care that is provided to the patients in the country. The second arm is round NCB. The said arm is lapping that weird routine every year. Therefore, arm is lapine. We had royalty navvy with interferon beta and their fifth arm. It was chloroquine. The good thing about the trial is, as Mike indicated, that the randomization could be adjusted to the drugs available in each individual hospital over time. The other good thing about adaptive design is that we can include additional arms or drop arms as our Global Data Safety Monitoring Committee advises we should do. Finally, Dr. tetras mentioned that this is a very simple trial and we think that is very important, that other research goes on that will contribute to our understanding of this disease. But this trial focus on the key priority questions for public health. Does any of these drugs reduce the mortality that any of these drugs that reduce the time a patient is in hospital and whether another patient is receiving any of the drugs needed, ventilation or intensive care unit?

Very much. Dr. Hanno.

If needed, we will provide the exact title of Dr. No.

But now we will go to next question to South Africa.

We have Stephen from Hot's 9 1 9. Stephen, can you hear us?

Yes, I can. Thanks very much for taking my question. I was gonna ask Stephen.

Stephen, we don't hear you very well. Can you speak a little bit?

I can't speak, right. How is it that you got it? Yeah. OK.

I wanted to ask. We've seen some schizophrenic government activity, I have to say, looking at the way our government here in South Africa has responded.

I have been fairly impressed as the journalist and the response you've been potent factor for the government to be unified on this. Opposition politicians have come out and said they support government. We are to be on the same page. I don't know what sort of interaction that W.H.O. has had with South Africans. Maybe your with is not they interact to communicate out. I'd like to get an insight from you.

Again, as as the director general has said many times, an all of government approach is in absolutely underpins success in fighting any emergency. But in this particular case, all the more so, I think that has been the case in many countries, including South Africa. Another point to make here is that African countries have been dealing with emergencies, climate disasters, natural disasters, epidemics for a very long time. South Africa has had to deal with a terrible HIV epidemic over many, many decades. So the ability to create coherent responses to what our biologic threat is is not easy for governments because these are threats you can see and sometimes can't quantify. So having been through that kind of a crisis already prepares government for that leadership role when when the time comes. Building trust with communities is tough at a time when many citizens have lost faith in government and all around the world. This is not easy. This is both an opportunity for governments to rebuild trust with their citizens, to rebuild that confidence that's needed to manage adversity and to reach out and create a nonpartizan all of government. All of society approach to dealing with disease. But again, the idea here and I say this with caution. Many countries in sub-Saharan Africa and there are many countries in the world that are fragile health systems. That is correct. But they are not helpless. And I have worked with with an African colleagues in Africa for many, many years. And what I see is a story of resilience, a story of coping and an ability to overcome adversity through communities by building on community intervention, building on community acceptance. If we can match community participation with good governance, then I believe that Africa can succeed. It has demonstrated that time and time again. But it does require strong, united governance to deliver for citizens. And I think we're we're seeing that in Africa and I hope we continue to do so.

Thank you very much. Dr. Tedros, as you can see, has left.

But I'm sure our our speakers will be able to answer one or two more questions. Let's go to Emma Farge from Reuters. Can you hear us?

I can hear you. Hopefully you can hear me. I had a question about the strategy for the supply crunch. You think that the only way to demand for equipment such as ventilators and people is for medical factories to be retooled to make this.

And are you calling for that on a large scale? Thank you.

There you are. Correct. Or there is a real pressure in the market for personal protective equipment, for essential medical supplies, for providing care for people. Most countries are are still in reasonable shape, but there are great disruption and there's great distortion in the market and many would characterize that as a market failure.

We're working very, very closely with governments and in particular with our colleagues in the United Nations system, with the World Food Programme, who have are working extremely closely with us, like we have World Food Programme staff here with us. No better logistics organisation and the whole world in terms of supply chain management. We're working with UNICEF. We're working with other agencies in order to maximize our ability to access those materials on the global market. We also have some fantastic support from from governments in trying to prioritize supplies for us so we can provide them to to to all countries the most basic needs. China being the lead in driving that approach of prioritizing our supply chains. In order to do that, there is a scramble on the market and we do need order and discipline in that. And I do believe that the institutions like the European Union and others are trying very hard to bring that order and coherence to the process of procurement and ordering and prioritization.

It's like any rush.

We've seen this in the supermarkets of the shops. If everybody rushes to to buy everything they think they need for the foreseeable future, then many people lose out. That is the same if it's a if it's toilet roll or if it's a personal protective equipment. But, you know, we can afford maybe to run out of time. A robot help. Workers can't afford to run out of PPE. And it is a huge responsibility for governments around the world to ensure that not only their health workers, not only their health workers, but all health workers have a fair opportunity to. Excess PPE. That is a responsibility of industry. That is the responsibility of governments. That is a responsibility of the U.N. system. We're trying to do our bit. Working very hard across the U.N. to make that an easy process for governments. Governments who wished prioritize giving help to others can use W.H.O. use the U.N. platforms to do that. I know they're very busy and may not be able to do that themselves, but we would welcome any contributions, donations to an international system to supply PPE to those most in need. And in addition, other essential supplies like oxygen concentrators and the rest in terms of them. We've seen some positive moves. For example, some countries in Asia are really looking at self production of PPE. And we do again look and again, there are some companies around the world part of our pandemic supply chain network who are actively working to license their production capacities to local producers for Masks for Peepee in order to be able to produce that at local level. That's a fantastic development to transfer technology license that so that local manufacturers can come into the game. Ventilators and other sophisticated equipment is another scale of production and another scale of safety and ISO standards that are needed to meet that. We have to be very, very careful in scaling up production of sophisticated technology like that. But countries like China and others have immense capacities for ramping up production. And we're working with them to see how that can be achieved and with other large scale producers of such equipment.

I yeah, if I could supplement that. So in addition to everything that Mike said, it's important that every individual knows what their role is in to ensuring that the supply that is needed is being used for in the most appropriate way. So what is what what countries are doing in terms of what is their strategy for dealing with mild patients? What is their strategy for dealing with with severe patients? Individuals need to know what their role is in terms of how they can prevent overburdening a health care health system. For example, if you're feeling unwell, you know, if you're feeling unwell, you generally stay home. You don't rush to a health care facility. You contact the either the hotline number that is available in your country or you call your health care provider. And you and you say, these are my symptoms. Do I need to come in? And in most cases, you will not need to go in. You will not need. But if you do have the symptoms that we worry about for Cauvin 19, which include fever, which include dry cough, which include shortness of breath, then you will need to seek care. And so it's important that that processes in place in countries so people that they know where they can go and when they should go seek health care. It's about the rational use of masks. We have provided guidance about using a medical mask in the community. And if you're not sick, you shouldn't be wearing a medical mask. But if you are, then you should.

Those decisions that are being made on an individual level impact the global supply for all of these materials. So please know that each individual has a role to play in this global supply issue.

Thank you very much. Sure. Next question will go to we will have two more questions and then we will let you go.

Next year will be KACL fresh meat. But before that, I just need to see what's Anna-Maria title because it has been asked.

So Anna-Maria now and I will spell the name A and a Maria is a high H now as HP and a OAP.

Maria is a unit head for research and development blueprints as Health Emergencies program here at W.H.O.. Keiko Fishman's. How are you?

Thanks for taking my question. So maybe if I can, just a quick clarification on the Maria, the fifth arm of you're trying to win Portwenn, plus something else. And then the question I wanted to ask you, keep talking about testing, of course, and you know, a lot of discussions, but there also seems to be a problem with the supply of reagents, some of the testing. And I'm curious whether W O is working on addressing that in some way or whether you have some thoughts on that.

Ok. You are very good friend of W.H.O., but I have to enforce the policy of one question. So it was a question and the clarifications. OK. So what you please.

It's clear Kim alone. So we are going to test in some countries chloroquine and in some countries in dose of chloroquine. And we are looking into the equivalence between the two doses. And we have an independent expert panel who help us with the proteasome process. And this is how we arrive to this selection. Over.

Them on the lab side. Right. Might actually, Anna-Maria, bring Mac to the table there? Mac Perkins leads ah ah ah lab portfolio under marías coordination. There are lots of questions being asked about his lab supplies and and all of that.

And again, as Maria said, there are different manufacturers producing tests on different platforms. So there could be a shortage in one area and nothing. Another. So it's very hard to do a global evaluation.

We've seen, for example, in some of the high throughput systems in the last few weeks, they haven't run out of the testing reagents. They've actually run out of of equipment and supplies to support the high throughput system. So it's very easy to extrapolate a single problem in a single testing system to the whole system. But I will let Mark as we close off our thanks to Mark and the team, because they've worked really hard over the last number of weeks and within days of of of of this virus been sequenced. We were working with scientists and collaborating centers and with manufacturers to produce highly qualified, validated tests that have actually been distributed to 120 countries. They're operating at a very high level of quality and quality assurance. And we're very, very pleased at the way in which they have performed throughout the world over the last number of weeks. And we thank Mark. We also thank all of those in the laboratory networks who've been working on this, all of the scientists, all of the manufacturers, all of the collaborating centers and those who've worked to validate these tests in the fields. It's been a huge success and something that we are proud of. We continue then to work with others to make sure that they're able to scale up at the same level. So, Mark, maybe a word or two on some of the issues around reagents, supplies, assays, concerns around this?

Yes, there have been shortages of some of the materials on the ancillary materials, as Mike mentioned, used in PCR reactions, which are the most common way to diagnose coronavirus. These are sometimes important chemistries that you can't find any place else other than a diagnostic manufacturer. Some of the diagnostic manufacturing, a lot of it has been done in China and with the outbreak in China. It decimated the workforce, at least made them unable to work and make some of those reagents and made it difficult to procure the vast number of diagnostic companies are scaling up their own capacity to generate those reagents. And I think we'll get over that hump. There are more than 200 companies now working, already declared sometimes already finished working on diagnostics for coronavirus. And so we have a plethora of choices and sorting out which ones work and which ones meet, whose needs is really the next step for the future.

Thank you.

Thank you very much. That was Mark Perkinson.

I was trying to find the exact title maybe. Can you just say the exact title for those who would like to use?

I'm the lead of laboratory networks in infectious hazard management.

Thank you very much, Mark. And we will go to last question and then we'll go to South China Morning Post.

Did we have anyone from South China? Morning Post, Yeganeh.

Amy.

Hopefully we will hear you better try again.

Yes. Yes. Great. Thanks so much for taking my question. Doctor Tenderize mentioned the importance of international unity on this. And I just wondered whether anyone there at W.H.O. had comments about the US president, Donald Trump's continued usage of the Chinese choir as recent as this morning to refer to it. You know, given that there continue to be reports of racism and xenophobia, attacks against ethnic Chinese people around the world, not wondered whether you had any black made me or distract from the international community's opinion on this.

You very much. I think we've been very clear right since the beginning of this event that the viruses know no borders and they don't care your ethnicity, the color of your skin or how much money you have in the bank.

So it's really important that we be careful in the language we use, lest it lead to profiling of individuals associated with the virus. This is just something we need to all avoid it. It's easy.

You know, in in in situations to summarize or to make comments that are not intended to do that, but ultimately end up having that outcome. And I'm sure anyone would regret profiling a virus along ethnic lines.

That's not something anybody would would want. We need solidarity. We need to work together.

There are many different origins. I've said it before in these press conferences that the pandemic of influenza in 2009 originated in North America. We didn't call it the North American flu. So it's very important that we have the same approach when it comes to two other other viruses to avoid that.

And we ask for for that to be the intent and that everybody that everybody has. This is a time for solidarity. This is a time for facts. This is a time to move forward together, to fight this virus together. There is no blame in this.

All we need now is to be able to identify the things we need to do to move forward quickly with speed, with certainty, and to avoid any indication of ethnic or other associations of this virus.

To say something on international unity, we've seen overwhelming international unity and solidarity for this pandemic. And I think every single instance that we can highlight that we should we see this in not only support for countries, verbal support for countries that are dealing with horrible outbreaks.

We see this through donations, whether it's through PPE or whether I, you know, eyes. I see children drawing pictures for health care workers. Every single one of those acts of kindness is an act of international unity. And we'd like to see more of that. We see this through through donations to the Solidarity Fund, which we're so grateful for, which will be used towards fighting this response. We see this through acts of kindness, of people helping older people in their neighborhoods, of doing grocery shopping, delivering care, packaging, of helping your parents and grandparents set up your their phone so that they can talk to each other over over different platforms. All of that is international unity. And we every single one of us has a responsibility to contribute to that. And every single reporter that's out there that's covering this has a responsibility to cover that, too. It's really incredible that these are very tough times. And in many countries, this is going to get a lot worse before it gets better. But this will be temporary and we will get through this and we will get through this together.

Thank you very much for this important message. We will conclude today's press briefing. Will have all your files on to our very shortly and transcript tomorrow.

And next press conference is scheduled for Friday. We sure. A nice evening.

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Sam Harris:
Welcome to the Making Sense Podcast. This is Sam Harris. Okay. So, it is all coronavirus all the time now. In my world. I’m actually gonna be releasing two podcasts on coronavirus this week. This has preempted the other things I have in the pipeline because I think you know, if you’ve been listening, I’ve been doing a series on nuclear war, and I also have a podcast on child sexual abuse. The podcast seems have taken a dark turn, and I find that I can not drop either of those podcasts into the current environment when we need to be thinking about coronavirus and its resultant disease, COVID-19. So, I will try to find some good cheer for you at some point, but let’s talk about the problem at hand.

Sam Harris:
So, this the first of two podcasts I’ll do this week, if everything holds together. I just wanna say a couple of things upfront, lest they get lost. I’ve been spending a fair amount of time focusing on this, as many of you have. I’ve been frankly alarmed by several encounters I’ve had with very smart people, both in person and online, which have revealed a mismatch between what I think is true and what many smart people believe. Here are a few statements which I think are true. COVID-19 is worse than the flu in every way. So, comparisons with the flu are highly misleading. And it is not just bad if you catch it and you’re over 70 or you’re immunocompromised. There are healthy, fit people getting killed by this virus.

Sam Harris:
Another point I want to make upfront, which we make at some length in this podcast, is that even if we’re all destined to catch this virus, eventually, social distancing at this point is essential. So-called flattening the curve is actually a very big deal, right? So, just think about this – to get the worst flu in your life is bad, but to get it when the health care system has collapsed under the pressure of everyone else getting this flu is very different than getting it when hospitals are functioning normally. And the only lever within reach right now in the absence of a vaccine, the only thing we can do is delay the spread of this by changing our behavior. So, the time for hugging people and shaking hands is over. You are not being friendly by shaking someone’s hand. In fact, you’re being quite rude. You’re advertising your obliviousness to the risk you’re posing to others.

Sam Harris:
And wherever you are on earth at the moment, if you can work from home, you should work from home. And this should be a company policy, right. If you have a company where some percentage of the work can be accomplished by telecommuting, you should implement that policy right now. And this is also true for schools. Stanford, two days ago, announced that all their classes would be moved online. Schools everywhere should implement that policy as quickly as they can. Now, there’s an obvious tradeoff between economic incentives and containing the spread of this disease. We should be privileging the latter. This is absolutely the time to avoid social gatherings and public transport as much as possible. And anyone who has taken his or her cues from President Trump at this point is dangerously out of contact with reality.

Sam Harris:
Anyway, all of that and more will be made clear in this episode. And there’s no paywall for this one, obviously. This was yet another public service announcement. Today, I’m speaking with Nicholas Christakis. Nicholas is an Md PhD and a professor of Social and Natural Science at Yale University, where he directs the Human Nature Lab and is the co-director of the Yale Institute for Network Science. He was elected to the National Academy of Medicine in 2006, and the American Association for the Advancement of Science in 2010, and the American Academy of Arts and Sciences in 2017. And his New York Times bestselling book, which is just coming out in paperback, is Blueprint, which I’ve read and discussed before in this podcast with Nicholas. And I highly recommend it.

Sam Harris:
And so, here, Nicholas and I cover this emerging epidemic – now, certainly a pandemic from many sides. And again, whatever we don’t cover here, if you have remaining questions, please direct them to me on Twitter because I’ll be recording another episode with a doctor from Johns Hopkins. As you know, things are changing very quickly here, but this conversation was a very good snapshot of what we knew on March 8th. And now, I bring you Nicholas Christakis.

Sam Harris:
I am here with Nicholas Christakis. Nicholas, thanks for joining me.

Nicholas Christakis:
Thank you so much for having me, Sam.

Sam Harris:
We are going to talk about coronavirus, which is if you’re in my particular bubble, it is all that anyone is thinking about it. I don’t know how wide that bubble extends. I am noticing that it doesn’t extend perfectly across the political spectrum. On social media, I’m noticing many people who seem to be in Trumpistan thinking that this is much ado about nothing. And we’ll talk about the political implications of this as well. But how much of your bandwidth is being taken up by a coronavirus at the moment?

Nicholas Christakis:
Well, a huge amount of my a scientific bandwidth around January 25, a longstanding collaboration with a group of scientists from Hong Kong, who in turn are connected to some other scientists in China, and around January 24th or 25th, we started emailing about the situation there and what kind of work we might be able to do. And I began to think more deliberately about how I might turn my laboratory over to trying to help with a pandemic, which was, for me, at least, obviously, going to happen.

Nicholas Christakis:
And I had done some research with the H1N1 pandemic 10 years ago related to using social networks as a way of forecasting the course of the epidemic. So, I began to resurrect that work and some other work and began these new collaborations with my Chinese colleagues. And I haven’t slept much honestly in the last month because we’ve been working nonstop on a number of fronts. So, my scientific bandwidth is totally devoted to that right now; although, we have a few other projects going on. And my personal bandwidth is I’m concerned. I’m monitoring the situation.

Sam Harris:
Right. We should just remind people who you are. You’ve been on the podcast before. Last time, we spoke about your wonderful book, Blueprint, which I believe is just now coming out in paperback. Is that right?

Nicholas Christakis:
Yeah. By coincidence, this week.

Sam Harris:
Okay, cool. So, if people want to hear that podcast, it’s in the archive. And I certainly encourage that people get the book. You have a great background for this conversation because you are an MD PhD, who has also focused of late primarily on networks and the way really anything spreads in a network. You want to give a potted bio here to get us rolling?

Nicholas Christakis:
Well, I have become obsessed over the last 15 years with the study of networks in general. And of course, there are networks of computers, and networks of neurons, and networks of genes, and, of course, networks of people. And it is through these networks that everything from germs, to ideas, to norms, to behaviors spread. And they are not the only lens with which we can understand spreading processes, but they’re very powerful and important lens. And right now, we have, for example, what I would consider to be a dueling contagion between biological contagion, namely the coronavirus, which is spreading on this network from person to person to person. And in parallel with that, we have another set of social contagions, which is, for example, ideas about whether people should be vaccinated or whether people should self-isolate. And those spread, your probability of vaccinating depends on whether your friends get vaccinated, for example. So, we have these parallel biological and social sociological contagions. And in some sense, the fate of what happens in our country will depend in part, not completely, but in part on who wins in those contagions.

Sam Harris:
Yeah, okay. So, our goal here is to spread some good and useful contagious ideas. And I think before we dove into the details, I went out on Twitter asking for questions and suggested topics. And I got close to a thousand responses so far. So-

Nicholas Christakis:
Oh, my God

Sam Harris:
…. there’s no want of interest here. But I think I should just mention that I see some obvious ways in which people can fail to absorb what we’re saying in good faith here. And one variable is certainly political. I think that any criticism of the government’s response to this crisis, thus far, will be interpreted by many, many people as both of us or one of us, I mean, certainly, in my case, trying to score a partisan political point against the president. And I can just assure you, dear listener, this isn’t the case. I’ve made no secret about how unfit I believe Trump is to be leading this country. And he has proven that to me in spades in the last few weeks. But everything I’m going to say at any point in this conversation that touches on what seems to be political obfuscation and general cluelessness from this administration, I would say about any administration that was responding this way in the face of a clear public health emergency.

Nicholas Christakis:
Yeah. I mean, the virus is wholly apolitical. And I think there is a biology, and a sociology, and an epidemiology to the virus that doesn’t really care what politicians say or do. And I think it’s important to remember that we can speak about plain facts, about the epidemiology of coronavirus. And in doing so, says nothing about our political leadership. Now, it is the case that the political leadership may also be failing, and that’s a distinct topic. But merely discussing facts about the epidemic is not an indictment of the administration per se.

Sam Harris:
Or discussing facts like the fact that the Trump administration cut the US Pandemic Response Team in 2018 because they thought we didn’t need it. And this is, at best, a shortsighted view of reality. I mean, one of the most prescient and relevant things that’s been said in recent weeks about this whole moment is that whether or not coronavirus is as bad as the most alarmed people think it is or whether it might just be a dress rehearsal for some coming pandemic that really is as bad as people fear.

Sam Harris:
Two things are true. One is we’re failing the dress rehearsal to an impressive degree. And the we in particular, the United States and that should matter to us. And two, some pandemic, whether this is the one or not, is guaranteed to come. Bill Gates made this point. Like this is the most predictable emergency you could possibly name. This was guaranteed to happen. And if this isn’t it, let’s learn all the lessons we can from our missteps here. But this was a gift courtesy of evolution that we knew was coming. And the fact that we have an administration that seems to think that a pandemic response team is optional is pretty depressing.

Nicholas Christakis:
Well, I agree with much of that in the sense that I totally agree that the predictability of these pandemics, and this can also be reassuring to listeners. We have pandemics of viral pathogens, including in the category of coronaviruses, which is a category we’re facing now every 10 or 15 years. People will remember the SARS outbreak and the H1N1 outbreaks of the last decade. We can talk about the ways in which this virus is different than those outbreaks. And people who’ve studied history know that there was a major global pandemic in 1918. So, every century or so, there is like a major pandemic like that in which the pathogen is both very deadly and very transmissible.

Nicholas Christakis:
In other times, we have passengers that are very transmissible and not so deadly. And those proved to burn out very quickly, like the pandemic in 2006-2007. In other times, we have pandemics of diseases that are very deadly, but not so transmissible, for example, SARS. And then, when the disease is too deadly, it actually works against itself. If it kills its victims, it doesn’t transmit as much. So, in a way, right now, we have a disease that’s moderately deadly and moderately transmissible, and that could be quite a perfect storm. It could be a condition that, let’s say, in every 50-year event.

Nicholas Christakis:
But the main point is that these influenza pandemics come every 10 or 15 years. And sometimes, they fizzle out. And sometimes, they don’t. Sometimes, they’re very serious. And when they’re very serious, they wreak havoc not only in terms of the health and people’s lives, but they can wreak economic havoc as well, which is another thing that many observers are beginning to be concerned about.

Sam Harris:
Yeah, yeah. And there really is a tension between the focus on the epidemiology, and the straightforward health concerns, and this other concern about the economics, and the the social implications of people not going to restaurants, and closing schools, and all the rest.

Nicholas Christakis:
Those are the first order effects. So, the travel industry is being devastated even as we speak. And it’s unclear how long that will last. But then, we’ll begin to have second order effects. So, breakdowns in the supply chain and factories not working. And if those things begin to happen, this epidemic could tip us into a significant recession. But that’s another whole thing. And it’s still a little bit early to forecast that and be certain about that. But it is the case that major epidemics, for example, the 1918 pandemic definitely played a role in the global depression. So, I think it’s too early to know that for sure, but it’s not crazy to think about the economic implications.

Nicholas Christakis:
And incidentally, on the economic issue, and I’m no expert on this, this is not a demand shock. This is potentially a supply shock. So, a demand shock is when a recession due to declining demand, and then a stimulus might work, for example, a dropping interest rates, as the Fed recently did. But a supply shock is more like the Arab oil crisis of the 1970s that many listeners may remember. And that’s when you have a shock to the supply on the supply side. And there, lowering interest rates doesn’t really help. So, if for the sake of argument, you begin to get disruption in the global supply chain, this could be a very difficult thing to address until you get the factories working, producing the goods and distributing them. So, it’s too early to know for sure what’s going to happen in that regard. But I know that many sophisticated observers of this, including many economists and many extremely wealthy individuals who are tracking this, are unsure still what’s going to happen.

Sam Harris:
Except the one thing we can be sure about here is that-

Nicholas Christakis:
On the economic side, I mean, I’m sure.

Sam Harris:
Yeah, I know, but I mean, we can be sure that the incentives aren’t aligned here. And this is what has been worrying me for now, at least, I would say two weeks, the moment I recognize that the health incentives, the reason, say, to close schools seemed fairly straightforward; and yet, the economic reasons to keep them open were and are incredibly powerful and pointing in the opposite direction. And my concern is that because the economic incentives are so powerful, I mean, to just take school closure as one variable, the fact that once you close the schools, then you have almost every working adult faced with the problem of what to do with their children. How do you get to work? How do you care for your children? Do you homeschool them? Does that cut the workforce more or less in half? I mean, this is just a huge hassle with economic implications.

Sam Harris:
And so, the reasons not to have the epiphany that we should close the schools yesterday are legion. And yet, the health wisdom of closing the schools has been fairly obvious for some time. We’re gonna get to lots of specific questions in a minute, but let’s just touch this topic of school closure just to give a sense of the problem in microcosm. What are your thoughts on that?

Nicholas Christakis:
Well, first of all, with school closures, we have to make a distinction between reactive and proactive school closures. So, let’s talk first about reactive school closures. A reactive school closure is a school closure in which there’s a case at the school. And when that happens, typically, everyone is alarmed and is quite eager and willing to close the school. It sort of makes sense to the man on the street or the woman on the street that, well, there’s an epidemic raging, and there’s a case at the school, and we should close the school.

Nicholas Christakis:
The problem is by the time you do reactive school closures, many, many analysis show that it doesn’t delay the overall epidemic or doesn’t help the overall epidemic very much. For example, an analysis of reactive school closures in the last influenza epidemic in Italy showed that a policy of reactive school closures, I think, reduced the epidemic by like 24% or 25%, the ultimate number of people afflicted, which is good but not as good as you might want. So, you can postpone the peak of the epidemic in your community and reduce the number of people ultimately infected if you close schools once someone gets sick in the school.

Nicholas Christakis:
A similar analysis done in Japan found, basically, the same conclusions. And modeling exercise as sort of mathematical models, sophisticated models, including a paper published in the Journal of Nature in 2006, also found that a policy of reactive school closure delayed – I’m just going to look the numbers up because I have them somewhere here. For a moderately transmissible disease, reduce the cumulative attack rate by about 24%, and delayed the peak by about 13 days. So, the models and the empirical results of prior school closures in Japan and Italy, which is the literature I am familiar with, I’m sure there’s even vaster literature on this, suggests that reactive school closures help.

Nicholas Christakis:
But the real problem or the real dilemma is whether we should have proactive school closures. And this is a much more difficult decision, but from my eye, something we should be doing, frankly. And the reason is that if you imagine you’re in a — let’s not pick a major, let’s not pick New York or Miami yet, because that’s another whole kettle of fish. Let’s pick a mid-sized town for the sake of argument. If you believe that the moment someone in your school gets sick, you are going to close the school. Probably, what you really should do is the moment someone gets sick in your community or in what is known as the epidemiologically relevant region, so if you believe that the moment someone gets sick in the epidemiologically relevant region, your town, that it eventually will afflict your school, then the more rational policy is, as soon as someone gets sick in your community, shut the school. You’re going to shut it anyway in a week because your school’s going to be afflicted, but if you jump the gun and shot it, you actually might radically improve the course of the epidemic in your community.

Nicholas Christakis:
And there is actually amazing evidence about this. So, again, just to crystallize the point, let’s say you set some threshold, and we can discuss what the threshold is, some number of cases in some specified area in your town, or in an adjoining town, or a case that you know is not an imported case, it’s not like someone flew from Italy to your town and presented with the disease, but instead you find what is known as a community transmission, someone who has the disease, and you don’t know where they got it, that means the disease is loose in your community. If you set as a threshold one such case or two such cases in your town or in a nearby town, you could then proactively close your school. And then, you would have much bigger benefit than the reactive closure.

Nicholas Christakis:
And there was a wonderful analysis that was done of 43 cities in the United States during the 1918 epidemic, which very carefully examined across these cities when did they close their schools with respect to the pace of the epidemic and for how long were they closed. And it found, for example, if you use as a threshold how far in advance of the epidemic reaching — if you create the standard of you have twice the level of respiratory deaths as you usually have in prior years, you have excess deaths, how far in advance of hitting that twice the amount level did you close your schools, it found that actually districts that closed your schools in advance proactively had dramatically lower death rates in the end.

Nicholas Christakis:
And so, for example, there is a comparison between St. Louis and Pittsburgh. St. Lewis close the schools in the 1918 influenza pandemic earlier and longer, and it had less than half the death rate of Pittsburgh, for example, ultimately. Many fewer people died. So, this is the issue and this is what’s hard. But in general, my own bias, my own opinion is that proactive school closures makes sense.

Sam Harris:
Yeah. I completely agree with you there. And there’s one meme being spread, which is perhaps entirely factual, but I would argue misinterpreted and that is giving people comfort around this idea that we can just keep the schools humming along. This idea that kids aren’t getting this or if they’re getting it, they’re not getting a bad case of it. And that’s great. That seems to be true thus far. But it also seems true that they could still carry it and pass it to the rest of the community.

Nicholas Christakis:
Correct.

Sam Harris:
So, your kid is coming home from school and hugging grandma and-

Nicholas Christakis:
Correct.

Sam Harris:
… this is a very different disease when grandma gets us.

Nicholas Christakis:
Yes, that’s exactly right. And in fact, it is the case that everything we just said about school closure is especially important when kids themselves might die, but the requirement that kids be sick is not the critical point. Schools are areas of congregation, of large numbers of people, including all the adults, the parents at the drop-offs, the teachers, and the kids are little vectors here. And incidentally, as long as you’re talking about like how to school closure work, one of the ironies about one of the ways that school closures work, paradoxically, is precisely because they compel adults to stay home. So, modelers that have modeled this have said, “Okay, what happens when we require the kids to stay home, so we reduce social clumping in our society, because we’re requiring the kids to stay home, but let’s assume that 10% of the parents, or 50% of the parents, or 90% the parents are staying home as a result of the school closure?” And unsurprisingly, that also has a further effect, the number of parents that stay home.

Sam Harris:
And so much of this is psychological. I mean, just take that fact I just mentioned that some comfort is being taken in this idea that this is not preferentially targeting kids; rather, it’s targeting old people. But if you flip that around, if this were a flu that had an inordinately high mortality rate that was targeting kids preferentially, well, we would have closed the schools already. I don’t think we would be debating school closure.

Nicholas Christakis:
Well, we might. Yes, we might have. But there’s another kind of moral issue here. You’re right. That very good data we now have on the mortality rate and how it varies by age. So, young people, one study of 5000 Koreans shows that basically nobody under the age of 30 afflicted with a condition died in that study. And another study of 44,000 Chinese, I think, showed a case fatality ratio of 0.2%. So, two out of a thousand young people might die. Now, that’s still bad. I mean, that’s a high risk of death for a young person, but the number rises quite dramatically. So, by middle age, it’s 1% to 2% of people die. And by over the age 80, it’s let’s say roughly 20% of people die.

Nicholas Christakis:
So, yes, you’re correctly summarizing the situation. But one of the things that distressed me in reading all this is that I, too, like most people, would prefer that the young be spared and the old the afflicted. But the older members of our society too, they are our neighbors, our parents, they’re our teachers. I mean, I hate this idea that, “Oh, well, it’s just like afflicting old people. Who cares?” It’s ridiculous. I mean, they’re human beings. So, this is, again, a situation which we can talk about the epidemiology of the condition, but I don’t think we should lose sight of what’s happening, which is that people will die from this condition.

Sam Harris:
Right. Well, let’s tackle another meme here, which seems to be doing an inordinate amount of work in people’s reaction to this. And it does seem, at this point, frankly, misleading, which is the idea that this is essentially just like the flu. Here are some of them factoids that come in this cluster. One is 50,000 people die every year in the United States from flu. In 2018, it was something like 80,000, which I think is the worst year in recent memory. So, comparatively, only about 4000 people, just nearly 4000 people have died worldwide from coronavirus thus far.

Sam Harris:
This really is a tempest in a teapot. If we were tracking the flu with the same paranoia that we’re tracking this, well, then we would be alarmed every day of our lives. And then, also there’s the fact that though the mortality rate of this seems higher than the flu, it also seems clear that we’re not testing widely enough to know what the actual denominator is to properly calculate the case fatality rate. So, it’s been reported that it’s as high as 3.5%.

Nicholas Christakis:
No, it won’t be that high.

Sam Harris:
It won’t be that high, but then, they’re estimates. It seems like the most sober estimates are more like half that, between 1% and 2%. But there seems to be the expectation on the part of many people that, at the end of the day, we’re going to recognize, this is just another flu essentially running in parallel with the flu that we deal with year after year, and nobody freaks out about it, and nobody closes the schools. What are your thoughts on that?

Nicholas Christakis:
Yeah, I think that’s all wrong. And I can explain why. So, first of all, let me back up and say a couple things, a bunch of things. First of all, if I told you that motor vehicle accidents were leading killer in our society, and they are, about 35,000 of people die of motor vehicle accidents every year, and our society is very gravely concerned about these deaths. We invest huge resources in improving the safety of our roads and cars. We have enormous campaigns and penalties for people who drive under the influence. We cry and are sad when we read about motor vehicle deaths. And the public health community, and our government, and the people on the street expend enormous resources and attention in driving down one of these leading killers in our society.

Nicholas Christakis:
And if I told you that I could wave a magic wand and remove that cause of death tomorrow, many people would be amazed, and excited, and incredibly proud. Well, right now, we’re in the midst of adding such a cause of death in the case of the coronavirus, that is to say, our best estimates, the most optimistic estimate is that only 35,000 Americans are going to die of this condition. So, we’ve just added a whole other extra cause of death to the list of things that kill us right now in our society. So, I just don’t see the reason for nonchalance or optimism with respect to a new condition, a new killer that might kill us. Imagine if instead of being, “something that sounded so benign as influenza or the flu,” imagine instead if I said it was Ebola, imagine the panic that people would feel if I said we now have Ebola loose in our country killing 35,000 people. So, I totally reject that.

Nicholas Christakis:
Furthermore, there is a wide range of estimates as to how many people will get infected and/or die. And this is, still, we’re in early days and it’s difficult. And it’s difficult for people. It’s difficult for me, just I’ll speak for myself, because I don’t want to be alarmist, and I don’t want to overestimate it, and then have people call me to task and say, “Oh, you were Chicken Little, and you were an alarmist,” and then maybe lose some credibility, let’s say. In the other hand, I don’t want to minimize it and underestimate it, and then people say, “Why didn’t you warn us? Why didn’t you tell us? You should have been in a position to know. You’ve been studying this topic and related topics for so long.” And, of course, there’s only going to be one outcome. It’s not like I’m making a thousand predictions and on average, I’m correct or other experts who are similarly situated as I am. There’s gonna be one outcome. And so, we have to speak in terms of a range of outcomes.

Nicholas Christakis:
So, at the most optimistic end, I think, we’ll have over a million Americans infected with this pathogen and perhaps 35,000 dead, but that’s just at the most optimistic end. The much more likely scenarios, or equally likely, or other possible scenarios move up the range. So, for example, Mark Lipschitz, a very famous epidemiologist at Harvard who’s an expert in this area, estimates, and he’s revising his estimates as more data comes in, but he estimates as of last week that perhaps 20% to 60% of Americans will ultimately, over the course of a year, be infected with this pathogen. And if we use the lower bound of his current estimate, 20%, that means 60 millions Americans will be infected. And if we use a lower bound of the case fatality ratio, which is 0.5%, that means 300,000 Americans are going to die of this condition. And that is like one of the top three killers in the United States.

Nicholas Christakis:
And that’s within the realm of the possible. I’m not saying that’s going to happen. I’m saying we need to sit up and pay attention because that is possible. It’s not an extremely unlikely event, and it could even be worse than that, honestly. I don’t think, if you forced me to predict, do I think 300,000 Americans? It seems so inconceivable to me. But look what’s happening in Italy, 16 million Italians are now under lockdown. Their hospitals are full to the brim. What makes us think we’re so special? We think we’re different than the Italians or than the Chinese? We’re not.

Sam Harris:
The truth is we are different from the Chinese. And this is another meme that is doing some mad work in the brains of otherwise very smart people. I even saw a Stanford doctor reference China as a source of optimism. And China has the spread of the disease, has been fairly well contained, it seems at the moment. The fatalities are dropping off, so far as we can trust the information come out of China but-

Nicholas Christakis:
That’s true.

Sam Harris:
Yeah, it seems to be true, but what is also true is that China just executed the most draconian quarantine, perhaps in human history. And we are not poised to be poised to do anything like that ever.

Nicholas Christakis:
Yes, I’m actively writing about just that. And according to New York Times reports, 700 million Chinese have been in under some form of house arrest basically since January the 25th. So, these people are basically homebound. And that’s extraordinary. I mean, that’s just an extraordinary dimension. And it is the case the Chinese have, miraculously, driven their cases down to about a hundred a day, which is unbelievable in the whole nation. But it’s through the imposition of such a cordon sanitaire. Technically, it’s not a quarantine. A quarantine is when you put sick people in quarantine. When you put healthy and sick people, it’s a cordon sanitaire, which is what they’ve done.

Sam Harris:
Right, right. So, the lesson to draw from that, I mean, it seems to me that we can draw no real comfort from that because-

Nicholas Christakis:
Not reproducible.

Sam Harris:
Something miraculous would have to happen in our society for us to emulate that in any way. And again, it seems the kind of thing that need not be accomplished at the point of a rifle as in China. But the idea that we’re going to accomplish it just by getting it into our thick heads that we should practice social distancing to that degree, it seems very far fetched. So, what we should anticipate is a much freer spread of this contagion in our society.

Nicholas Christakis:
Yeah, yes. And we’ll come back to this, I’m sure as what can people do. And I absolutely think we Americans should be practicing social distancing. On Twitter, I’ve been talking about this for quite a while. Sensible policies of not engaging in any nonessential travel, not going to meetings, washing your hands, not hugging, instead bowing or doing namaste or something, not touching people, not handshaking, which is very instinctive in our society. These are all basic things all Americans, in my view, should be implementing now.

Nicholas Christakis:
And the reason we do this, incidentally, just to be very clear, it’s not just so that you don’t get sick. When we do these things, we interrupt the contagion chains that flow through the network. In other words, we’re stopping the virus in its tracks by interrupting the means with which it spreads from person to person. So, the reason I don’t shake your hand is not just that I don’t get sick, but that in not having shaken your hand, I block all paths of the virus from you to anyone else I might meet in the future. And that’s extremely effective. And social distancing repeatedly has been shown to be an effective so-called non-pharmaceutical intervention.

Nicholas Christakis:
But I want to I want to tackle one other thing which relates to, perhaps, another meme on your list, I don’t know which. This claim that the Trump administration cessation of international flights was effective. And this has been studied for an extremely long time by scientists of all stripes. And just to quote one analysis, typically, countries are not aware of the emergence of a pandemic until, let’s say, the 30th day of the disease, which is, again, roughly what happened in this country with this coronavirus epidemic. By the time the disease emerges in Wuhan around late December, it’s spreading throughout the district, in the prefecture, in Hubei for at least a month or so. And before, let’s say, no more flights from China or something. But again, here, economics weighs against it. People are reluctant to do this. But the point is that it’s been studied repeatedly how effective is cessation of international flights on day 30 of a pandemic.

Nicholas Christakis:
And I’ll just read you some numbers. So, if you stop 90% of the flights on day 30 of a pandemic, you delay the peak in the epidemic in your country by about 10 or 12 days. If you stop 99% of the flights, you delay the peak of your epidemic by, let’s say, 26 days. And if you stop 99.9% of the flights, you only have one out of a thousand flights still coming into the country, you only delay the peak by 42 days. Now, that’s good. Delaying the peak is good, but it’s not this panacea that, “Oh, we’re gonna stop the thing at our border,” because it’s still going to come to us. Either it already came to us by the time we stopped the flights, and it’s now brewing, or we cannot totally hermetically seal our country, so it’s going to afflict us. So, this fantasy that we can somehow, in an age of pandemics, stop them at our border is not justified by the epidemiological modeling.

Sam Harris:
Right. Well, let me just say, in defense of Trump, that’s the one decision or one utterance attributable to him that I don’t fault him for. I mean, it seemed like it was worth a shot. Why not try to delay it that way if you can? But yeah, I mean, I take all your points.

Nicholas Christakis:
Yes. But earlier, we were talking about how economic considerations might lead us to not close down schools. But here, economic considerations do not lead us to abandon the effort to stop flights. And yet, the school stoppage is known to be effective; whereas, the flight stoppage is known not to be effective.

Sam Harris:
No, no, no, no. Point taken. I mean, I think, we should be firing on all cylinders here. But let’s talk about the timeline for a second because I want to just get our bearings here. And it’s interesting to consider my own psychological timeline as these events unfold. So, as you said, at the end of December, actually, December 31st, the World Health Organization reported that there was this mysterious pneumonia in China that seemed to be associated with the Wuhan live animal market. Perhaps, we can just cut through all political partisanship here and agree that eating bats and pangolins is a bad idea. Can we agree on that?

Nicholas Christakis:
We don’t think people are eating bats. We do think they were eating pangolins. And the pangolin thing is still a little bit — well,, first all, yes, I don’t think we should be eating those things. Correct. But just to be clear for your listeners, it’s not necessarily the case that people were eating those animals. It seems like it’s still a little bit unclear that the virus spent part of its time in pangolins although, top my knowledge, that’s still not been resolved, but it’s fairly clear that it originated in bats, and this is also a bit of a mystery. Like even in the movie Contagion, the disease begins in a bat that drops and spit on a pig. I think it’s sort of what is setup in that movie. But one speculation is that the immune system of bats is maybe very similar to the immune system of humans. After all, bats are mammals. And that when viruses adjust to the immune systems of bats, when they then somehow leap to us, they’re already well adjusted to infect us. That’s a theory.

Sam Harris:
So, all of you who are against cultural appropriation, I think I’m with you here because it’s culture that we should not appropriate. So, I’ll get back to a timeline here. So, January 11th, China announced the first death in Wuhan. And then, January 21st, we had the first confirmed case in the US. It was a man in his 30s, I believe, who actually traveled from Wuhan and came ashore here. So, that was 10 days after we heard about the first death.

Nicholas Christakis:
Genetic studies now, reconstruction using genetic fila-dynamics or suggesting that there was some transit. And this goes back to stopping the air travel example you were discussing, that we can use the genetics of the cases in Seattle and what we know about mutation rates to reason backwards and discern how many introductions were there in Seattle and roughly when. And my understanding of the status of that science right now is that, roughly, in the middle of January, someone came from Wuhan to Seattle. And then, the disease started having what we call community spread. That person, we don’t know who they are, but the disease was then transmitted to other people, and then still to others. And then, eventually, the epidemic broke a couple of weeks ago.

Sam Harris:
And so, by January 30th, the World Health Organization had declared a global health emergency, which they’ve only done six times since 1948. So, January 30th is when those people whose job it is to keep watch over these things decided that this thing was going global, and we had to worry about it now. Then, it seems like we had at least a month. I mean, some people would say we had two full months, but we had at least a month here to get our bearings and prepare, assuming that community spread was already happening, and that things like school closure would be more things we need to think about.

Sam Harris:
And now, I have a couple of timelines here. I have a timeline of Trumpian insights. At the end of February, February 24th, Trump announced that the coronavirus is very much under control in the USA. And then, he said, “Crying Chuck Schumer is complaining for publicity purposes only that I should be asking for more money than $2.5 billion to prepare for coronavirus.” And there was just an absolutely transparent layer of political obfuscation and messaging essentially to the stock market rather than providing real information about this virus. February 26th, we had the first case of community transmission in the US that was acknowledged. I’m sure it happened before that, but this is when we were talking about it. And on that same day, we’ve got Trump saying, “I don’t think it’s going to come to closing the schools, especially the fact that we’re going down,” meaning that the rates of transmission and death are going down, not up. And then, this is more of a quote. “We’re going very substantially down, not up. We have it so well under control. I mean, we’ve really done a very good job.”

Nicholas Christakis:
Yeah, that’s just really irresponsible. I mean, it’s a lie. That’s a lie. It’s not true and it’s really irresponsible.

Sam Harris:
Yeah. Okay. So, that’s-

Nicholas Christakis:
Two things are irresponsible – not doing anything or not doing enough is irresponsible, and then misrepresenting the situation is irresponsible.

Sam Harris:
Right, yeah. So, this is where I come to my own psychological timeline because it’s been fascinating for me to watch my own mind here and watch my sense of the situation change and cease to second guess my emotional reaction to it. And so, I actually went back and looked at my emails and texts over the last few weeks. So, I can see that on February 22nd, I was thinking about canceling some upcoming trips and still feeling fairly crazy about even thinking that way. And by February 27th, five days later, I canceled everything. And so, that was exactly 10 days ago. We’re recording now on March 8th. So, for instance, 10 days ago, Tim Ferriss and I, who we were both supposed to speak at South by Southwest, he was going to interview me for an episode of his podcast, he and I decided to pull out of the conference. And it was widely perceived at that moment, again, just 10 days ago, to be slightly paranoid. And it was perceived among my circle of friends to be slightly paranoid.

Nicholas Christakis:
Sam is being an alarmist again.

Sam Harris:
Yeah, exactly. Yeah. And yet, eight days later, that is two days ago, the whole conference got canceled.

Nicholas Christakis:
Yes.

Sam Harris:
So, I’ve been watching this unfold, and I’ve been feeling more or less a week ahead of where everybody is or, at least, most of the people who I’m communicating with and most of what society is mirroring back to me, and way ahead of where the president is. On March 2nd, Trump said, “We had a great meeting today with a lot of great companies and we’re going to have vaccines, I think, relatively soon.” Okay. So, he’s promising a vaccine soon-

Nicholas Christakis:
That’s not true.

Sam Harris:
… whereas, the the only rational promises that, maybe, by the first quarter of next year. What’s the most aggressive timeline that we could have a widely distributed vaccine?

Nicholas Christakis:
I would say 18 months. And we don’t have any other vaccines against coronaviruses. I mean, the common cold is a coronavirus. If we if we could stop the common cold, people would make billions of dollars for a common cold vaccine. You think that pharmaceutical companies haven’t been trying? I’m sorry. The common cold is many viruses. There are some coronaviruses-

Sam Harris:
Like 25%, yeah.

Nicholas Christakis:
Yeah.

Sam Harris:
Okay. So, I mean, I’ve heard that the most optimistic timeline is a year from now.

Nicholas Christakis:
Yeah. And it, probably, would ne some kind of inactive virus vaccine that we’ll have. So, there are difficulties. There’s a lot of steps involved in being able to produce such a vaccine. That’s correct.

Sam Harris:
Right. So, Trump, six days ago, is saying, “There’s only one hotspot, and that’s pretty much in a home, as you know, in a nursing home,” but this is obviously a point after which the CDC had already announced community spread in Oregon and California, at least. It’s just useful to keep reiterating how unreliable the administration’s talking points have been. So, here again, six days ago, we have Trump saying, “So, if we have thousands or hundreds of thousands of people that get better by just sitting around or even going to work, some even go to work, but they get better,” right? And this is Trump talking so sloppily – I believe this was an interview on Fox – that it seemed like he was saying that it was okay to go to work even if you have this virus, right?

Nicholas Christakis:
Yes, which is wrong.

Sam Harris:
Right. And then, the final, this was truly phantasmagorical, on March 6th, just a few days ago, we have him at the CDC wearing a Keep America Great hat. And he’s saying things like, “I love this stuff. I really get it. People are really surprised I understand this stuff.” Every one of these doctors said, “How do you know so much about this?” “Maybe I have a natural ability.” Now, pause for a moment. And this is maybe rightly perceived as point scoring against the president, but I mean, just pause for a moment to reflect on the fact that it is extraordinarily unlikely that even a single doctor said anything like that to him. He’s standing in front of all these doctors, almost certainly lying about what they said to him in the middle of a press conference.

Nicholas Christakis:
But even if they syncophantically said something like that to him, the real problem is the narcissism in believing that. For example, I know a lot about certain things, and I know what I don’t know, especially in my field. I’m extremely aware of my ignorance in my own field, but there are things I know about. But when I take my car to the mechanic, or when I need to have thyroid surgery, I trust those people. Like, I don’t think I know more about how to fix a car than my mechanic. That would be just the height of arrogance and presumption. Or when I go to my surgeon, I say, “What do you think we should do?” And I trust that that person has devoted their life to acquiring this expertise, and that’s the whole reason I’m going to an expert.

Nicholas Christakis:
So, the idea that President Trump, who may be a skilled businessman and maybe a skilled politician, that he would think that he knows as much about epidemiology as the people at the CDC, the real problem there is the narcissism in this individual, not even what the syncophantic behavior that may have led him to that conclusion. So, it’s astonishing to me that someone would — and I think this is a broader problem in our society right now, both on the far right and on the far left, this sort of denigration of expertise, this idea that the right doesn’t trust experts because they know they want to think that everything is a political decision. And the far left to actually feel similarly actually about experts. They don’t like the hierarchy. They don’t like the idea that someone knows more than you do.

Nicholas Christakis:
But this is absurd. In our society, there’s some of the best scientists, if not the best scientists in the world. We feel we have the best soldiers in the world. Aren’t those guys experts at doing battle? We feel we have all these people that are really terrific. We feel we have the least corrupt judges in the world. We have expert judges. You pick, we think we’re great at it. Are we really going to throw that out or are we really going to think that there’s nothing to say about the role of expertise? I think that’s just misguided.

Sam Harris:
I think this is a a moment where most people are going to acquire a taste for expertise because-

Nicholas Christakis:
A healthy respect for expertise, yes.

Sam Harris:
Yeah, because we’re waiting for experts to produce a vaccine for this thing.

Nicholas Christakis:
Yes. Yes, correct. That’s right. Joe Schmo is not going to be producing a vaccine in his garage. I can assure you. Like that religious figure, I’ve blocked in his name that was saying that he was literally hawking some kind of substance that would cure coronavirus, he said. And it was like that awful character in Contagion that was selling for-

Sam Harris:
Right.

Nicholas Christakis:
I mean, this is-.

Sam Harris:
Yeah. I mean, it’s this thing. The analogy to a movie is disconcerting here because this is playing out a bit like a movie. I mean, you can feel like, at several points here along the way, I felt like, okay, I’m the guy in the first act of the movie who’s having an inappropriately sanguine response to facts that should be fairly alarming.

Nicholas Christakis:
Yes.

Sam Harris:
And still, who knows what part of the movie we’re in here, but it’s a disconcerting comparison. So, anyways. So, the last thing that Trump said at this press conference, which was truly appalling was, “Anybody who needs a test gets a test. Anybody that needs a test as of right now and yesterday, anybody that needs a test can get one.”

Nicholas Christakis:
That’s not true.

Sam Harris:
Now, he was saying that at the moment when the most glaring feature of this crisis was the utter failure of the government to provide tests at scale. So, I think there’d been something like 2000 tests performed in the country at that point. And the CDC wasn’t even answering the questions from the press about how many tests had been performed. I mean, it had to be reconstructed by asking everyone at the state level what had happened. So, I mean, perhaps people who only follow the president, and his Twitter feed, and watch Fox News can be forgiven for not understanding what the situation really is.

Sam Harris:
But we have to break out of this political bubble and just encounter the facts here insofar as we can understand them. And I’ve had a slightly weird angle on just what we were not finding out about this in real time because I’m in Los Angeles. For the longest time, the number of cases in LA, according to the Johns Hopkins website, were reported to be at seven. But I happened to know a person who was skiing in Italy with five friends, and they all got it, and they all got on a plane, and probably infected half the plane, and they got back here. And now, at least, two of them are hospitalized. I only know one member of this group. He’s not a close friend, but he’s a very close friend of a very close friend. So, I have a very close friend talking to his very close friend on a daily basis who has this thing. And this is at a moment where I’m hearing that there’s seven cases in Los Angeles. And apparently, I know five of them. That seems very unlikely.

Sam Harris:
We’re also hearing that this thing is in reasonably healthy people, people who are not immunocompromised, or people who are not 80 years old, this is just like the flu. Well, this friend of a friend is now hospitalized and on a ventilator. And his other friend is hospitalized and in an induced coma, I think, because the coughing associated with it was so bad. And so, again, I’m well aware that these are two anecdotes, and this is not really data, but from this sort of ground level experience of just hearing these stories once removed, this isn’t seeming like an ordinary flu. I mean, these guys are both extreme skiers, they’re fit, and 50 years old. They’re not in the cohort that you’d think would be on death’s door associated with a flu. And so, let’s just linger on this claim that, honestly, I’ve heard this from doctors in social situations. I had a doctor say to me, “Well, maybe we should all get this thing. We’re gonna get it anyway and we’ll be fine. You’re fit, Sam. You’ll be fine.” What do you say to this notion that this is basically the flu?

Nicholas Christakis:
Well, it’s not the flu. We know it’s not the flu. We know it’s more severe than the flu, first of all. Second, I’ve been thinking about this issue, which is like if you’re gonna get it anyway, is it better to get it sooner rather than later? And it’s definitely better to get it later because this relates to another topic, which I can’t remember if we’ve discussed already, but I’ve been talking about this notion of flattening the epidemic here. So, imagine that you have a pulse of disease that’s hitting our society, so that a million people are gonna get sick. Those million people could get sick in a very peaked way like over the course of a month, but if we implement social distancing and other procedures like school closures, then we flatten the epidemic. So, we still get a million people sick but, now, they’re sick over six months, so that we have a smaller number of cases on any given day. It decompresses as the demand on our health care system and on our supply chain, so that we can actually cope with the people who are sick and need ventilation.

Nicholas Christakis:
So, flattening the epidemic is a really important fundamental idea in epidemiology, which is one of the reasons we engage in what is called non-pharmaceutical interventions like social distancing, and school closures, and all of that stuff. That’s why we need to do it, to flatten the epidemic, so that if anyone gets sick, they get sick, fewer people are sick on any given day, and we push the cases out into the future, so that some fraction of those cases occur at a time in which we’ve discovered, perhaps, some drugs that could treat the disease or have a vaccine available, so we never get those cases because we’ve postponed them so far.

Nicholas Christakis:
So, there are many benefits to flattening the epidemic. Now, when you flatten epidemic, it’s also the case that the people at the beginning, they also aren’t putting heavy demands on the health care system. So, maybe if you’re gonna get it, if you get sick sooner, that might be a sensible strategy. But actually neither from the individual nor from the collective point of view have I been able to discern any wisdom in that because first of all, you might not actually get sick anyway. So, rushing to get sick now is sort of stupid. Not everyone is gonna get the disease. And second, from a public health point of view, if you encourage people to get sick now, you might actually compress the epidemic. You’re going to create a pulse upon a pulse of disease. So, no, I don’t agree with your friend for multiple reasons in what they said.

Sam Harris:
Just to be clear, a disease that has a 5, or 10, or 15, or 20x higher mortality rate than the flu is very unlikely to be just like the flu.

Nicholas Christakis:
Yes. And we haven’t seen this pathogen before. It’s a new pathogen for us. And there’s a whole other list to telegraph. There’s a whole other debate about whether the pathogen — typically, these pathogens mutate and get milder as they adapt to our species and as we fight it off. Also, they tend to kill off the more vulnerable members of our species to this pathogen. It’s all very sad in clinical, honestly. But we also, to recognize, there are likely to be waves of this condition. So, we’re right now at the beginning of the first wave of COVID-19. But probably, we’re going to see a second wave, and even a third wave perhaps. And that’s very common for these types of pathogens.

Sam Harris:
Yeah. So, I just want to reiterate the point that you just made, but I just don’t want it to get lost because it’s probably the most important point here, which is even if we’re all destined to get this thing or even if 75% of us are destined to get it, getting it later is absolutely better when you consider the implications for our health care system.

Nicholas Christakis:
Yes.

Sam Harris:
Because here are just the numbers, and we have something like a million hospital beds speaking now about the United States. There’s something like 2.5 beds for every thousand people.

Nicholas Christakis:
2.8 in our country. Just to put some numbers in perspective. In Japan, it’s like 13.8 beds per thousand people. So, we have we have bed capacity that’s much lower than many other countries. Australia has more beds than we do. We have about as many beds as England does per capita, but we don’t have a great number of beds per capita. That’s correct.

Sam Harris:
Right. And so, just imagine, in a situation where everyone gets this more or less all at once, it’s just a tsunami of illness, you have the breakdown of the health care system. You have-

Nicholas Christakis:
Yes.

Sam Harris:
Figure out just the lack of beds. You have doctors and nurses also getting sick, right, and unable to work.

Nicholas Christakis:
Yes. And that’s also true. And we can look to China for what the health care professionals in Wuhan have been doing. And I have friends there, or friends of friends there, let’s say, I have reports from there via indirectly. And it’s unbelievable what those doctors did, but they’ve been working around the clock, taking great personal risks, many of them have died, and they’re exhausted. So, it’s serious. And if you even look at Seattle right now, there is concerns in Seattle they’re going to run out of medical supplies to care for their patients there. We have a regional sharing system and setup in our society, so that if a hospital has a crisis and needs many dialysis machines or respirators, they can be loaned regionally. But when you have a pandemic situation where they’re needed everywhere, we don’t have the excess capacity for, for example, respirators. So, it’s a very serious situation we’re facing. And I hope and pray that we do not run out of respirators in our society, but we need to consider the possibility we do that we don’t have enough of them. And the fact that we are in that situation is alarming.

Sam Harris:
Yeah. So, let’s talk practically about what people can do and what is likely to await us in the future. And just a few more questions about the disease or about the virus. And these this is some questions we’ve gotten from Twitter.

Nicholas Christakis:
I’m on Twitter, obviously, and I follow other people, and I’ve been trying to send out rational information for weeks now to help people. Part of me, as I noticed the breakdown, I noticed this interesting phenomenon, which many of my scientific colleagues have been sort of stepping up. Like earlier, we talked about how they’re redirecting their laboratories to see how they could help the nation. But I’ve also noticed that many people are like tweeting out more information. And I think they’re trying to fill the vacuum, the lack of information or the spread lies. So, for weeks now, I’ve been trying to send out the most precise, scientifically accurate information that I can, partly to help educate the public about different things like social distancing, like why does hand-washing work, like what’s the latency period for the virus, how does it spread, what are reservoirs of the virus, what about school closures? These are all topics that I think the American public needs to be educated about.

Sam Harris:
Yeah, yeah. Okay. So, what about the prospect of acquiring immunity for this once you have it?

Nicholas Christakis:
Yeah, I think there was some concerns that people could be reinfected. The best data that I’ve seen so far suggests that that either doesn’t occur or it’s extremely unlikely. So, let’s just say once you’re infected and recover, you have immunity for some period of time, at least a few months, probably a few years. That’s still not fully known. But the fears that you could be reinfected rapidly, and there’s been some case reports of this, those case reports were probably false negative tests. So, in other words, you had the condition, you had positive tests, then you had a negative test, you think, “Oh, you’re cured,” and then you have a positive test afterwards, probably what happened is that negative test was a false negative, now that you were reinfected.

Sam Harris:
Right, right.

Nicholas Christakis:
I mean, even the fact that we’re doing this podcast is a noble or makes me happy because I think you have like a million listeners or some huge number of people. And you could think of it as a public service to try to get out some basically accurate information. I hope people listening to this will think, what’s the harm in my engaging in social distancing? I could do it for a week, or two, or three. If it turns out that the epidemic fizzles out, well, I just didn’t shake people’s hands for a week and canceled a few meetings. On the other hand, if it turns out the epidemic is large, I’ve done some stuff to protect myself, and I’ve made a contribution to the well-being of our society. When you social distance, when you engage in these basic practices, you are interrupting the flow of the pathogen through our society. You are part of a super organism. I argued this in my book. You’re part of a collective that’s engaged in a battle with this virus, and you’re doing your part.

Sam Harris:
Let’s put a fine point on that recommendation because this is advice that I have taken as of two days ago. So, we decided to pull our girls out of school on Friday. So, spring break is not for three more weeks, but we’re starting now and we’re going to homeschool them and just to wait and see what happens because it just seemed like the school was the weak link in our world and we have, at least, one person in our family who’s got chronic lung disease who really can’t afford to get this virus. So, we decided we’re just going to pull up the drawbridge, and we’re now going to practice fairly extreme social distancing. I mean, we’re not going to restaurants. I cut all travel. The TED conference is probably going to get canceled anyway on the 27th of February, I pulled out of everything I was supposed to do, and we’re just going to lie low, but I’m half expecting this is going to be a fairly long experiment in social distancing. I’m wondering whether I just pulled my girls out of school for the rest of the year here, but-

Nicholas Christakis:
It’s hard to know for sure. But let me do a thought experiment with you. If, in fact, your girls were going to be pulled out of the school for the whole year, you’ve just added a couple of weeks to pulling them out, and those weeks may have been the wisest weeks in the whole period.

Sam Harris:
Right, yeah. So, I’ve been following your tweets, and I took them to heart. And frankly, I felt a little late. And the only thing standing between me and doing it several days earlier was just a sense of social stigma. It’s like I didn’t want to be the first-

Nicholas Christakis:
Yeah, and you don’t want to be alarmist, right? You do want to be like — but that’s the problem. These are type 1/type 2 error.

Sam Harris:
Yeah. Everyone everyone’s feeling some version of that.

Nicholas Christakis:
Yes.

Sam Harris:
They’re feeling paranoid and yet ineffectual even when they’re taking steps, which seem fairly extreme.

Nicholas Christakis:
But what I want to emphasize is that it’s like so much else in our society has become polarized and dichotomized, and people think in terms of dichotomies. There are shades of behavior. So, we are not. I don’t want anyone listening to this podcast to think that you and I think that people need to go to the woods to their bunkers or something. It’s not what I’m saying. What I’m saying is that there there’s a range of behaviors from proceed as if there’s no epidemic and go about your business, the usual social interactions, to total social isolation, sail off on a sailboat or something or whatever and in between. So, what I’m recommending is adopt some simple practices already that are in between that will reduce your own personal risk and help our society. Don’t shake hands. Wash your hands several times a day for what is that, the word isn’t out till you sing happy birthday twice, avoid all non-essential travel and meetings. Just do those things. It helps you, it helps our society, and we’ll know more in a few weeks as to what the situation is really like. That’s a reasonable thing to do.

Sam Harris:
I mean, the other way to think about it is just probabilistically, if there are a thousand ways you might get this thing, if you cut out 900 of them, you’ve reduced your risk by 90%. And as you say, you’ve blocked that path through society to all the other people you’re gonna be in contact with. So, the reason why most people can’t do that is just the health argument is straightforward. It’s just there’s an economic and social argument that’s pressing for so many people.

Nicholas Christakis:
Yeah, but no, But hold on. I’m not saying that people — the things that I was recommending did not include you stay home yet. What I’m saying is things that you can do right now are non-essential travel, non-essential meetings, hand-washing, avoid handshaking and physical contact. Those are things people can do and still go to work.

Sam Harris:
Right. Anything that can be done from home probably should be done from home, right? There are many companies where people can telecommute and-

Nicholas Christakis:
Yes, yes, that’s right.

Sam Harris:
I would imagine many have not pulled the trigger on that yet as a matter of policy.

Nicholas Christakis:
Yes, that’s right. That’s exactly right. And also, in the past, let’s say you shopped for food three times a week, now might be a time to consolidate all of your shopping list and go once a week. There are different sorts of ways you can manage your life to reduce social contact for a while until we see what’s happening with this thing. That’s correct. And I don’t see that as alarmist. I think that’s just common sense you can do and that doesn’t require you to quit your job or lose your income yet.

Sam Harris:
Right. So, a related question there. It’s just, what about panic and-

Nicholas Christakis:
Panic is bad.

Sam Harris:
What alarms me is that when government is clearly — like in any of these press conferences, when the purpose is transparently to reassure without actually giving good information, they’re just trying to dampen panic, that is in the uncanny valley of reassurance and it actually is just frankly alarming to see people obfuscating for the purpose of dampening emotional or arousal. So, how do you think the government and scientists should speak about this, given that panic and the reality of social contagion is also worth worrying about?

Nicholas Christakis:
Yes. So, how do you think we’ve been speaking about it? Do you think that when I agreed to come on, I was trying to make sure that I communicated factual information, that I was balanced, and that I was not alarmist? And I hope I have not been alarmist, and I hope I’ve communicated factual information in a balanced way. That’s my objective. And your listeners and you can decide that. But we have very sober-minded scientists that speak in calm and rational ways. For example, Dr. Anthony Fauci. And these are the sorts of people that if I were president, I would be putting before the public. These people will, sort of like when they’re of military importance, the generals that speak, they may be misinformed, they may not know everything, but they speak in measured and serious ways about the matters of military operations. And I think that’s what we need right now. And we have such people in our government and in our society. And I think we should be listening to them and we should be allowing them to speak.

Sam Harris:
It would be a related benefit to social distancing, if we had a new norm around how people behaved when they were sick with anything, with anything infectious, a cold or a flu, if people simply did not go to work sick, that would exert an evolutionary pressure on all these bugs to become less symptomatic, right?

Nicholas Christakis:
Well, I mean, that’s another thing, relatedly, that we should be doing in our society. If you don’t have an essential health problem, you should not be seeking medical care right now. Not only because you don’t want to go to a health care and be exposed to other people, but in order to unburden the health care system. What the Chinese did, which was unbelievable, is they moved 50% of their medical care online when the epidemic struck. Anyone that just needed a prescription refill, for example, they just started doing that online. You don’t have to go see your doctor to get your heart medication. Just call your doctor and say, “Okay, we’re going to do that.” So, it decompress as the health system, frees the doctors up and nurses up to do other stuff that’s more important, and it reduces the risk of exposure, the social mixing, especially of sick patients. So, people listening to this, they should say, “If I’m not seriously ill or I have routine health care stuff, I should help my country by not seeking medical care right now.” Now is not the time to do that.

Sam Harris:
Yeah. But the point I was making is that if social distancing were the norm whenever people got sick, personally, if you just didn’t go to work when sick, that would exert evolutionary pressure on all of these bugs, whether bacteria or viruses to mitigate their symptoms, so that like colds wouldn’t be as bad if you only spread them when they were truly almost undetectable, from your point of view. So, what do you do with the fact though that it seems that people are infectious prior to being asymptomatic and perhaps for as long as two weeks? I mean, that seems like a-

Nicholas Christakis:
No, I don’t think it’s that long. I mean, we don’t know yet exactly. That’s still unknown. So, there are two epidemiologically relevant facts here. There’s something known as the incubation period. That’s from the time you’re infected to the time you’re symptomatic. And then, there’s something known as the latent period. And that’s from the time you’re not infectious to the time you become infectious. And the difficult thing is if the latent period ends before the incubation period ends. In other words, if you transition to being infectious before you transition to being symptomatic. We don’t know for a fact yet whether asymptomatic coronavirus patients can transmit the disease. And if so, for how long? But there are people actively working on it. But it’s not more than a couple of days, even if it is. But if that’s the case, that’s worrisome because that means people are out there spreading the disease, they can’t even use their own symptoms as a heuristic for staying at home.

Sam Harris:
Right. What do you see as the possibility of our taking extreme steps of the sort that China or even Italy have taken at this point to contain the spread in any given city or any given region?

Nicholas Christakis:
Well, I don’t think it’s culturally or politically viable for us to do what the Chinese have done. I don’t know how similar we are to the Italians. My understanding of the authority that governors of our States have, and I don’t know what the federal authorities are, but I’m pretty sure the State Governors have authorities to basically shut stuff down in the public interest and enforce it with the State National Guard sort of power. So, rightly, the power of quarantine exists in our society. And I’m not a legal expert, so I don’t know the details of where those powers are vested and how they’re enforced. But I can imagine that there would be a lot of political will to do such things if the situation got really bad. There would be checkpoints on roads to reduce transit. The president can order the flights not to fly, and this has been modeled. Internal restrictions on an on air traffic have been modeled as a way to reduce the epidemic. So, I don’t know, I can’t forecast what would happen. But I do believe the government at multiple levels has the authority to do such things as it should. As a society, if we’re trying to confront this, we need to do it in an ordered cooperative way.

Sam Harris:
There’s a point that I think we might have made, although perhaps we dropped it in differentiating this from influenza. From everything we know, coronavirus is more infectious than influenza.

Nicholas Christakis:
It’s difficult to measure. So, the so-called R nought or, actually, more precisely, something called the effective reproductive rate, which is the number in a steady state, the number of new cases for every old case, people are estimating is between 2 and 4. So, we don’t know yet exactly how it is. And just to be clear, that number is related to intrinsic properties of the virus, but it’s not solely determined by that. So, for example, the transmission rate of a pathogen depends, for example, on the extent of social mixing. If I suddenly obliged everyone to sit in a prison cell, if one person got sick, they wouldn’t transmit it to anyone else. So, it’s something about how we’re organized socially that determines the RE, the effective reproductive rate.

Nicholas Christakis:
And so, we estimate right now that it’s around between 2 and 4, which is high. The Chinese, at the beginning of the epidemic, there was a nice paper that was just written by a group of Chinese scholars in collaboration with some investigators at the Harvard School of Public Health, at the beginning of the epidemic, if I’m remembering these numbers correctly, they estimated the effective reproductive rate at around 3.8. So, for every sick person, 3.8 new sick people were created. But because of their social engineering in China, where they, as we discussed earlier, had this incredible quarantine basically that’s nationwide, they have driven that down to like below one. And when you get the number below one, that’s when the epidemic peters out because cases aren’t replacing themselves.

Sam Harris:
What about the prospect that this is essentially always gonna be with us once it’s a pandemic?

Nicholas Christakis:
Yes, that’s what’s going to happen.

Sam Harris:
So, if it’s always with us, and it’s much worse than flu — I mean, flu, we need a new flu vaccine every year because the old one didn’t do the trick because it’s mutated. What’s a rational picture of the future if, in fact, this just keeps circling the globe and mutating, either getting worse or getting better depending? What do we expect is harder here?

Nicholas Christakis:
It’s hard to know for sure. Many experts believe that this will join the existing corona viruses that afflict humans or be like another common cold type virus. We’ve just now added a pathogen to the list of pathogens that circulates in human beings. It’ll become what’s known as endemic. Always there in us. It’s a little unclear still. Earlier, we discussed how the virus might become less problematic as time goes by, as it adapts to us, and we modify it with our collective immune systems fighting it off. So, I don’t think it’s going to disappear completely. I think it will remain in the human population. It’s hard, very hard. I’m not willing to forecast how serious it will remain as time goes by. But I think we’re going to have this current wave, which I think there’s a good chance it will be serious. And then, we will have another wave or two. And in a few years, we’ll know what is the status of this virus with respect to us, like other viruses that affect us.

Sam Harris:
Can you think of something we haven’t touched that you think we should be hitting?

Nicholas Christakis:
No. I mean, I think we’ve covered a lot of things. We’ve covered some basic facts about the virus and what it is that we can do. We’ve talked about the prospects for pharmaceutical interventions versus non-pharmaceutical interventions, which we clearly need to implement as a society. We’ve sort of benchmark the severity of the condition. We’ve talked about flattening the epidemic, which is really important. We’ve covered, I think, the gamut of sort of basic epidemiology as such as it is of epidemic or pandemic influenza. I think I’d like to end on an optimistic note. I mean, I think our species, this is not the first time-

Sam Harris:
It’s already not sounding optimistic if you’re going to the species level.

Nicholas Christakis:
Okay, yes. Good point.

Sam Harris:
It’s really bad.

Nicholas Christakis:
Our society, it’s not the first time America has been afflicted with a pandemic disease. And I think we will see the other side of this. But I think it’s going to take a lot of working together to address it. I think it’ll take the full attention of our political leaders and of our scientific establishment. Our commercial sector is going to have to rise to the occasion to build more respirators, and more masks, and whatever else we need in order to confront the condition. And I think people on the street are going to have to adjust their lifestyle for a while in order to contribute to our society, in order to confront this disease. And I hope that it is much milder than it could be. And there’s a range of outcomes, as we’ve discussed, and I hope it’s on the milder end of that range.

Sam Harris:
Yeah, yeah. As do I. I certainly hope that my current state of mind seems like an overreaction in retrospect. I mean, the only point in my life that had an analogous feeling was 9/11, where it’s just like, “Okay, this is a moment in history. This is not life as you have taken it for granted year after year.”

Nicholas Christakis:
I think this could be a moment in history. I think in a few months, we’ll know, whether in in the early spring or early winter of 2020, the world was afflicted with a pandemic and a serious pandemic. I mean, pandemic, by the way, just means an epidemic that strikes multiple region. And you could have a mild pandemic or a severe pandemic. That’s a different topic. And so, I think we’ll know within a few months how serious this is. And we’ll all remember where we were when we first heard about it. Or if it’s mild, we’ll forget. Nobody remembers very much about SARS and H1N1. And maybe, it’ll go that way. And I hope it does.

Sam Harris:
Okay. Well, I will be touching this topic again, no doubt. And-

Nicholas Christakis:
Thank you.

Sam Harris:
… you and I will be talking about happier things at some point. I trust.

Nicholas Christakis:
Thank you for having me again, Sam. And thank you so much.

Sam Harris:
Yeah, yeah. To be continued.

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Claire Reilly:
The Coronavirus outbreak is spreading across the world and it's got a lot of people asking questions. How bad is this? Is there a vaccine and what can we do to protect ourselves? Well, step one, don't panic. We're going to break it down.

Claire Reilly:
First of all what is Coronavirus? Well, for starters, it's a whole family of viruses, SARS, which first hit Hong Kong in 2002, was an outbreak. That was caused by a type of Coronavirus. But the Coronavirus family also includes the common cold. This Coronavirus was first discovered in Wuhan, China in 2019 and it's a whole new strain.

Claire Reilly:
It's officially known as SARS COV2. Now, the SARS part is confusing. It's not actually the same virus that caused that 2002 outbreak, but it's related. The disease you get when you catch the virus that's called COVID19. Coronavirus, COVID19, SARS I know it's all incredibly confusing, but for a long time health officials didn't actually know what they were even looking at.

Claire Reilly:
They now suspect that it was an animal virus that crossed over into humans potentially at a live animal market. We've seen that kind of thing before with swine flu and avian influenza. It gives us a whole new mutated strain of the virus that health officials have never seen before.

Claire Reilly:
We now know that the incubation period, the time between when someone gets infected and when they start showing symptoms, that could be as long as 14 days. And that's a problem because you could have people that are not showing outward signs of the virus, but are walking around and infecting other people without even knowing it.

Claire Reilly:
And that's why we've seen so many travel lockdowns. In early 2020, countries like the US enforced a compulsory 14 day quarantine. That's the same time as the incubation period. That applied to anyone traveling from known problem areas like China.

Claire Reilly:
And before we start scaremongering, no, it doesn't mean that all the people coming from those places are infected. It's just a really easy way to minimize the spread. You keep the people who may have been exposed away from the people who definitely haven't been exposed.

Claire Reilly:
The only problem is now we're starting to see cases of COVID19 in people who haven't been to China and haven't been in contact with people who have. And that's got public health officials worried.

Claire Reilly:
So what happens to those people who contract COVID19? Well, it's a respiratory illness. So think things like coughing, fever, shortness of breath. It also spreads like other respiratory illnesses. So sneezing and coughing on people.

Claire Reilly:
We don't know how long it survives on hard surfaces, but it's safe to say you shouldn't go around licking handrails. But it's also not a sudden death disease.

Anne Schuchat:
It doesn't seem to be as severe as we first feared, but it does seem to be quite transmissible. And some people have very mild symptoms or possibly even no symptoms at all.

Claire Reilly:
So for some people, it might just feel like a really, really bad cold. But in severe cases, it can lead to things like pneumonia. People have been hospitalized, put on respirators, and according to data from China, 2.3 percent of patients have died.

Claire Reilly:
So who's at risk here? Well, think about like regular flu season. It's the immunocompromised. Elderly people, people who have lung conditions or chronic illnesses. In fact, elderly people with COVID19, they're particularly at risk.

Claire Reilly:
But unlike regular flu season, it doesn't seem to be affecting young people, which is good news. The other difference with flu season, we don't have a vaccine and we probably won't have one for a while because we're dealing with a new strain here, scientists need time to develop the vaccine and put it through tests and trials to make sure it's safe and that it's actually effective.

Anthony S. Fauci:
Although this is the fastest we have ever gone from a sequence of a virus to a trial, it still would not be any applicable to the epidemic unless we'd really wait about a year.

Claire Reilly:
So no vaccine anytime soon, but it's not all bad news. Remember, the CDC said that not all cases will be severe and 2 percent is a low mortality rate, especially when you consider it to things like the most recent Ebola outbreak where 50 percent of people infected died.

Claire Reilly:
But the problem is just how transmissible it is and therefore how many people could become infected. When we start to get into pandemic territory where large parts of the population are getting infected and the virus is spreading across international borders, then that 2 percent mortality figure gets really terrifying.

Claire Reilly:
Not only that, but our hospitals will be incredibly stretched. They will be dealing with a lot of severe cases and they may not have the resources to cope.

Claire Reilly:
So what's the hope here? Well, no, you don't need to go and stockpile six months worth of food. Nobody wants to be eating sardines that long. No, the answer is kind of basic and it's also within our reach. And that's standard public health measures, hygiene, things like washing your hands, do it way more than you think you need to. Soap and water and for at least 20 seconds. And if you can't wash your hands, well, use hand sanitizer. At least 60 percent alcohol and rub it on.

Claire Reilly:
And if you start to feel sick, don't be a hero. Stay at home. Don't go to work. Don't go out in public. Don't catch transport. Yes, you will get very bored. But that's better than being patient zero in your neighborhood.

Claire Reilly:
Isolate yourself at home and make sure you clean high touch surfaces, things like door handles, bathroom fixtures, your phone. And if you do need to go to the doctor, make sure you call ahead so that they can protect themselves.

Claire Reilly:
And one last thing. I can't emphasize this enough. Cover your coughs and sneezes and not with your hand. Just remember to destroy all bacteria (DAB). Door handles, laptops, benches like everything in the bathroom. Sorry, I'm just making a list. We got more videos you can watch here. Couches. I'm going have to wash all the sheets and towels.

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Popular Transcripts FULL TRANSCRIPT: Eminem #GodzillaChallenge

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Eminem:
Fill 'em with the venom and eliminate 'em. Other words, I Minute Maid 'em. I don't wanna hurt 'em, but I did, I'm in a fit of rage. I'm murderin' again, nobody will evade. I'm fittin' to kill 'em and dumpin' their fuckin' bodies in the lake. Obliterating everything, incinerate a renegade. I'm here to make anybody who want it with the pen afraid. But don't nobody want it, but they're gonna get it anyway 'cause I'm beginnin' to feel like I'm mentally ill. I'm Attila, kill or be killed, I'm a killer bee, the vanilla gorilla. You're bringin' the killer within me outta me. You don't wanna be the enemy of the demon who entered me or be on the receivin' end of me, what stupidity it'd be. Every bit of me's the epitome of a spitter. When I'm in the vicinity, motherfucker, you better duck. Or you finna be dead the minute you run into me. A hundred percent of you is a fifth of a percent of me. I'm 'bout to fuckin' finish you, bitch, I'm unfadable. You wanna battle, I'm available, I'm blown up like an inflatable.

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Popular Transcripts FULL TRANSCRIPT: Nancy Pelosi announces formal impeachment inquiry

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FULL TRANSCRIPT: Nancy Pelosi announces formal impeachment inquiry transcript powered by Sonix—the best video to text transcription service

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Nancy Pelosi:
Good afternoon. Last Tuesday, we observed the anniversary of the adoption of the Constitution on September 17th. Sadly on that day, the intelligence community inspector general formally notified the Congress that the administration was forbidding him from turning over a whistle blower complaint. On Constitution Day. This is a violation of the law.

Nancy Pelosi:
Shortly thereafter, press reports began to break of a phone call by the President of the United States calling upon a foreign power to intervene in his election. This is a breach of his constitutional responsibilities.

Nancy Pelosi:
The facts are these. The intelligence community inspector general, who was appointed by President Trump, determined that the complaint is both of urgent concern and credible. And its disclosure, he went on to say, relates to one of the most significant important of the director of national intelligence and his responsibility to the American people.

Nancy Pelosi:
On Thursday, the inspector general testified before the House Intelligence Committee stating that the acting director of national intelligence blocked him from disclosing the whistleblower complaint. This is a violation of law. The law is unequivocal. The DNI staff. It says DNI DNI, director of National Intelligence shall provide Congress the full whistleblower complaint.

Nancy Pelosi:
For more than 25 years, I've served on the Intelligence Committee as a member, as the ranking member as part of the gang of four, even before I was in the leadership. I was there when we created the office of the Director of National Intelligence. That did not exist before 2004. I was there even earlier in the 90s when we wrote the whistleblower laws and continue to write them to improve them, to ensure the security of our intelligence and the safety of whistleblowers.

Nancy Pelosi:
I know what their purpose was and we proceeded with balance and caution as we wrote the laws. I can say with authority, the Trump administration's actions undermine both our national security and our intelligence and our protections of the whistleblowers more than both.

Nancy Pelosi:
This Thursday, the acting DNI will appear before the House Intelligence Committee at that time. He must turn over the whistleblowers full complaint to the committee. He will have to choose whether to break the law or honor his responsibility to the Constitution.

Nancy Pelosi:
On the final day of the Constitutional Convention in 1787, when our Constitution was adopted, Americans gather on the steps of Independence Hall to await the news of the government our founders had crafted. They asked Benjamin Franklin, What do we have? A republic or a monarchy? Franklin replied a republic, if you can keep it. Our responsibility is to keep it.

Nancy Pelosi:
Republican doors, because of the wisdom of our Constitution, enshrined in three coequal branches of government serving as checks and balances on each other. The actions taken to date by the President have seriously violated the Constitution, especially when the president says. Article 2 says, I can do whatever I want.

Nancy Pelosi:
For the past several months, we have been investigating and our committees and litigating in the courts. So the House can gather all the relevant facts and consider whether to exercise its full Article 1 powers, including a constitutional power of the utmost gravity. Approval of articles of impeachment.

Nancy Pelosi:
And this week, the president has admitted to asking the president of Ukraine to take actions which would benefit him politically. The action of the Trump, the actions of the Trump presidency revealed dishonorable fact of the president's betrayal, of his oath of office, betrayal of our national security and betrayal of the integrity of our elections.

Nancy Pelosi:
Therefore, today, I'm announcing the House of Representatives moving forward with an official impeachment inquiry. I'm directing our six committees to proceed with their investigations under that umbrella of impeachment inquiry. The president must be held accountable. No one is above the law.

Nancy Pelosi:
Getting back for our founders. In the darkest days of the American Revolution, Thomas Paine wrote, the times have found us. The times found them to fight for and establish our democracy. The times have found us today. Not to place ourselves in the same category of greatness as our founders. But to place us in the urgency of protecting and defending our Constitution from all enemies, foreign and domestic. And the words of Ben Franklin to keep our republic.

Nancy Pelosi:
I thank our chairman, chairman, chairman, Nather, chairman, Schiff for another judiciary chairmanship of intelligence, chairman Engle of Foreign Affairs, Chairman Cummings of Oversight and Chairman Cummings, I've been in touch with constantly. He is the master of of so much, but including inspectors general and and whistleblowers. Congresswoman Richie Neal of the of the Ways and Means Committee, Congresswoman Maxine Waters of the Financial Services Committee. And I commend all of our members, our colleagues, for their thoughtful, thoughtful approach to all of this, for their careful statements.

Nancy Pelosi:
God bless them and God bless America. Thank you.

Anonymous:
Now, of course, you've been convicted by the Senate. What does this accomplish? If the Senate doesn't convict?

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Popular Transcripts The 4th edition of “Phireside with Phil”, Justin Thomas threw shade at Phil Mickelson

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The 4th edition of "Phireside with Phil", Justin Thomas threw shade at Phil Mickelson was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your video to text in 2019.

Phil Mickleson:
Welcome to another edition of Phireside with Phil with my special guest, JT, when we played together before he was known as JT. He was just Justin. You have a story to share.

Justin Thomas:
I do Phil. It was the 2014 U.S. Open at Pinehurst. I was on the web.com, now the KornFerry tour at the time. So the crowds are a little overwhelming, to start, but we had a little match, myself and Jordan, versus you and Ricky and kind of just came right into the lion's den.

Justin Thomas:
And playing the fourth hole, I forget what the status of the match was, that's irrelevant to the story. But a fourth hole, I think it is. It's a hard dogleg left. I remember do whatever he hit the drive down there, a long iron and the green's kind of sitting in a bowl.

Justin Thomas:
And just to the right of the greens, just a little crevice. And we both hit it right next to each other. Not bad shot, just right of the green. All sloped away from us. Couldn't really figure out. I couldn't figure out how to play it. If I wanted to kind of skip one and spin and go up, putt it whatever. Tight, sandy, grainy…how Pinehurst is.

I decide to putt it. Hit a nice putt up there about like this far. You go after me and bones at the time. Look right at him. He's just grabbed the 64. It took a full swing. Just took a full earth bunker divot all over the green, straight up in the air, pop down about like this.

Justin Thomas:
Just a little outside of mine. And, you know, like we knew each other, but weren't quite as close as we are now. But I know that you like to talk smack. And I was like, nice shot Phil just a little bit outside of mine.

Justin Thomas:
Without batting an eye, you just look at me. You go, yeah my dad probably would've putted that one, too, and then just walked up there.

Justin Thomas:
I love it when you send shade because it allows me to bring the heat. And you all we all know you don't sit Phireside unless you can handle the heat.

Justin Thomas:
That's exactly right.

Phil Mickleson:
Thanks for being on.

Justin Thomas:
Absolutely.

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