COVID-19 Virtual Press conference

2 October 2020

Speaker key: FC Fadela Chaib TAG Dr Ghebreyesus MI Michelle MK Dr MR Dr Michael Ryan BA Dr AN Anias KA Katrine GA Gabriela JA Jason KO Konstantin SS Dr Soumya Swaminathan LA Laurent AS Ashley EC Dr Emer Cook JO John MC Michael

00:00:49 FC Hello, everybody. I am Fadela Chaib, speaking to you from the Geneva WHO headquarters and welcoming you to our global COVID-19 press conference today, Friday, October 2nd. I'm sorry for the delay in starting this press conference. Today the briefing will focus on the COVID-19 epidemiological situation and overview. Before we go deep in developing this important aspect Dr Tedros, our Director-General, will address you first. Joining him in the room are Dr Mike Ryan, Executive Director, Emergencies Programme, Dr Maria Van Kerkhove, Technical Lead for COVID- 19, Dr Mariangela Simao, Assistant Director-General, Access to Medicines and Health Products, Dr Soumya Swaminathan, WHO Chief Scientist, and Dr Bruce Aylward, Senior Advisor to the Director-General and Lead on the ACT Accelerator. Welcome, all. This briefing is being translated simultaneously into the six official UN languages plus Portuguese and Hindi. Now without further ado I will hand over to Dr Tedros for his opening remarks. Dr Tedros, you have the floor. TAG Thank you, Fadela. Good morning, good afternoon and good evening. Overnight we heard that the President of the United States of America, Donald Trump, and First Lady, Melania Trump, tested positive for COVID-19. I want to start today by wishing them both a full and swift recovery. Our prayers are with them. 00:02:42 The world is still grappling with the COVID-19 . Every week we're adding approximately two million cases and, as you know, the world passed the tragic milestone of one million deaths this week. We mourn the loss of so many. At the same time we continue to support all countries to prevent and save lives. There are roughly four different situations that countries are currently facing. First, some countries jumped on the virus quickly and have avoided large outbreaks. Second, some countries have had large outbreaks but were able to bring them under control and they continue to suppress the virus. Third, while some countries brought the virus under control as economies and societies have eased restrictions there has been an increase in cases. Fourth, there are still some countries that are in the intense phase of transmission. 00:03:51 However what we have learned in every region of the world is that with strong leadership, clear and comprehensive strategies and consistent communication and an engaged, empowered and enabled population it's never too late to turn the tide. In Europe countries have done it. In Asia countries have done it. In the Pacific countries have done it. In the Middle East countries have done it. In Africa many countries have done it. In the Americas countries have done it and in the Pacific countries have done it. In every region countries have been able to develop a collective blueprint for suppressing the virus and working to save both lives and livelihoods. WHO will continue to support national action plans through our regional and national country offices and spread these lessons of success across the globe. This is a critical moment in the outbreak response. We urge every single leader to strengthen their response, put target measures in place that we know can suppress the spread, ensure that health systems and workers are protected and save lives. For us all the fastest way for us to get through this is to act together. If we all keep doing the basics - physical distancing, hand washing, mask wearing, coughing and sneezing safely away from others, avoiding crowds and keeping windows and doors open when you can't meet friends and family outside, together we will suppress this virus. 00:05:42 When we are able to successfully control it it's important governments keep going. Stay vigilant and be ready and keep investing in your national health systems including contact tracing. As well as focusing on their own national context it's important to also drive global solidarity by investing in global public goods. This week we were pleased that countries stepped up and announced US$1 billion of new funding for the ACT Accelerator, which is driving progress on diagnostics, treatments and vaccines. On Monday we announced that WHO had approved our first antigen-based rapid diagnostic test for emergency use listing and had secured supply of 120 million tests for use in low and middle- income countries. The emergency use listing procedure streamlines the process by which new or unlicensed products can be used during public health emergencies. 00:06:53 It's designed to provide information to procurement agencies and member states using an essential set of quality, safety and performance data provided by the company. Today we're pleased to announce that we have finalised approval for a second antigen-based rapid diagnostic test to be granted emergency use listing. These tests are simple to use and provide reliable results in approximately 15 to 30 minutes rather than hours or days at a lower price. We have also published today a call for expressions of interest for manufacturers of COVID-19 vaccines to apply for approval for pre-qualification and/or emergency use listing. As with the new rapid tests WHO looks forward to receiving expressions of interest for COVID-19 vaccine. Then through our ACT Accelerator and COVAX facility we will ensure that any vaccines that are proven to be safe and effective are rolled out equitably across the world. I have said it before but it's worth repeating; sharing finite resources from tests to therapeutics to vaccines isn't charity. It's the smart play for all countries as it will ensure that they can protect those at most risk like front-line health workers and ultimately across the world this is the strategy to save lives, stabilise health systems and ensure a truly global economic recovery that helps us to recovery together. 00:08:40 I'm pleased to say that 168 countries have now joined COVAX and another 25 have told us they will do soon. This sends a very powerful message of solidarity across the world that we're uniting to end this pandemic for the sake of all humankind. There is something very important I want to speak about now. I want to address some of the disturbing news from the response in the Democratic Republic of the Congo regarding reports of alleged sexual exploitation and abuse by people identifying themselves as working for WHO. To be very clear, we're outraged to read these reports. WHO works around the world in the toughest emergency environments and situations in the world. We come to save lives and spread hope. The betrayal of people in the communities we serve is reprehensible. We will not tolerate behaviour like this from our staff, contractors or partners. Anyone identified as being involved will be held to account and face serious consequences including immediate dismissal. 00:10:16 I have initiated an investigation of the specific allegations as well as broader protection issues in health emergency response settings. WHO has a zero-tolerance policy with regard to sexual exploitation and abuse. I take these reports very seriously and I will have more to say on this very soon. Before I turn back to Fadela I want to leave you on a message of hope. Yesterday on the International Day of Older Persons I had an inspiring conversation with Captain Sir Tom Moore, who raised nearly £40 million for the United Kingdom's National Health Service with a charity walk. Just today we received a message from Janet Bank of Durban, South Africa. Janet, we know you follow our press conferences and I want to say hello. Thank you for the beautiful keyrings from Mozambique and Zimbabwe and for letting us know about the amazing story of Ida Ezekwete, who at 99 years of age was able to defeat the coronavirus. We're all in this together and across the world. We will continue to drive science, solutions and solidarity until we beat this virus together. From myself, Mike, my general, Maria - and thank you also for sending another one to my daughter and to Gabi - we all appreciate and express our gratitude for your gift, the whole way from South Africa. Thank you so much and one day we hope we will be able and will have a chance to see you in person. Thank you so much. 00:12:32 FC Thank you, Dr Tedros. We will now open the floor to questions from journalists. I remind you that you need to raise your hand, use the raise your hand function on in order to get in the queue to ask questions. I would like to make a small correction. Today unfortunately we do not have Portuguese translation so apologies to our Portuguese-speaking journalists. I would like to invite Michelle Cortez from Bloomberg News to ask the first question. Michelle, can you hear me? MI Yes, I can hear you. Can you hear me? FC Not very well. Hello, Michelle. Michelle, can you please unmute yourself? MI Can you hear me? 00:13:30 FC Yes, now very well. Go ahead. TAG Perfect, thank you so much. I wanted to ask you first if you can walk us a little bit through the case fatality rates that we're seeing here, the most updated numbers of course around the ages of, say, 60 and 70. Wondering of course - I know you won't want to speak specifically about President Trump but just what expectations are given the circumstances and whether or not the amount of , mask-wearing, that type of thing that we're seeing at the White House is appropriate. Then on a completely different topic, a question on why Spain has had such a severe outbreak while Italy hasn't at this point. Thanks. FC Thank you, Michelle. I would like to invite Maria Van Kerkhove to take your first question. MK Thanks very much for the question. The estimates of the case fatality ratio - which is the estimate of the number of cases of deaths over the number of cases reported to date - vary greatly by country and they vary greatly over time. One of the things we know about the risk for severe disease and death is if you have underlying conditions, if you are of older age, above 60, above 70, above 80 you have a higher risk of death. 00:14:46 What we're looking at in terms of case fatality ratio is a crude estimate because estimates of mortality are under-represented at the present time and so they're crude; that's why I say that they're crude and they vary by country. In some countries it's less than 1%; in some countries it's over 20% but we do know that the case fatality ratio increases by age. The other measure that we look at is what's called the fatality ratio and this is the number of deaths divided by the number of total infections and you've heard me say before, there are some estimates of the infection fatality ratio which overall is around 0.6% but that also increases dramatically by age. So what we advise - as we have advised from the beginning - is a comprehensive approach to not only prevent people from developing severe disease and dying but also to prevent infections because the more infections we have the more opportunity there is for those infections to reach people of older age who are at a higher risk of dying. 00:16:00 MR You asked specifically about the differences between Spain and Italy. Perhaps Bruce may also be able to offer some insights given that he's worked closely with our regional team and with both countries over the last number of months. I think it's very difficult to compare countries at any particular moment because the evolution of their epidemic is at different stages. Clearly Italy way back earlier in the pandemic was perceived to have done badly because it was hit badly and taken unawares and then as it recovered we saw the numbers in Spain deteriorate. This time around Spain has had a deterioration earlier; Italy in that sense has coped better but as we spoke again previously about Africa and other places, it's very hard to say that people are out of the woods; relative performance versus just unpredictable events that can occur and can amplify disease in particular settings and can set off these brushfires particularly in urban settings that can be very difficult to control. We've seen that in Australia, we've seen that in China. You can have very small events that can actually spark a major issue within an urban setting in particular and that can make a country look very far behind the curve. 00:17:17 We also have the artefacts of testing and other things, that we have to be very careful when we compare countries. Both countries have really had to fight very hard, both countries have really had to adapt their systems, they've had to dig deep to improve their public health systems, to shore up and strengthen their health systems and it really has required a massive social effort. You certainly see that particularly in Italy where there's been a huge re-imagining of the social contract that, I think, is having a great impact in keeping the disease under some degree of control. But Bruce has been much closer to offering direct technical advice. He may wish to make a comment on either country. Bruce. BA Thanks, Mike. I think I would first just add to Mike's recognition of the extraordinary response that we saw in both countries, both Spain and Italy, when working in both countries. 00:18:16 In Spain in particular it was just extraordinary, the breadth and depth of the response, the commitment of the healthcare workers, of the ministries, of the governance at all levels but of the general population. Madrid was an extraordinary place, as was Barcelona and the other places we visited while in the country, to see that level of co-operation and solidarity in trying to beat this virus and very much reflecting, I think, some of the advice you, the Director- General, have always been giving countries and individuals; you really saw it play out in both countries really very impressively. I think, to the point Mike made, we're dealing with a biologic process and we don't understand everything about this virus and everything about why it takes off in some places and doesn't in others and when it takes off in some places undoubtedly what we're seeing is very rapid and sometimes very subtle shifts in behaviours in other countries that just help keep them from hitting a tipping point. It's clear that there're tipping points with this virus and as soon as you get behind that 8-ball it's very, very difficult to get it back so part of this is, as Mike said, bad luck because in both countries you've got very, very impressive responses, very well-trained people and populations that really know what they're doing so I think at this point our thoughts are really with the Spanish people in particular, who are going back into some very, very difficult decisions right now as they try and get this virus back under control. 00:19:49 I think we have full confidence they will because they've got the experience, the expertise and the commitment to do that. I think we'd also note - Mike, you may have mentioned it - that there are parts of Italy where we are seeing it's heating up and they're moving very, very quickly to try and address that as well. FC Thank you. I would like now to invite Katrine [Unclear], France 24. Katrine, can you hear me? Okay. I would like now to invite Anias Padrero, IFP. Anias, can you hear me? AN Yes, I can hear you, Fadela. Hello, everybody. FC We will come back to Katrine later on but Anias, we can hear you very well. Go ahead, please. AN Thank you. I will ask a question that was just asked but I didn't hear any answer. I wanted to know if you think that the US President's disregard for the mask has made it inevitable that he would be infected at some point. Thank you. 00:21:09 FC Dr Mike Ryan, please. TAG Yes. I think we don't generally comment on the behaviour of any specific individual and we don't know what risk management measures were in place around any given individual, especially someone as prominent as a president. What we will reiterate is that each and every individual and each and every citizen should be guided by the national guidance in their country and that the combination of different measures that reduce risk - and we know these reduce risk; washing your hands, staying a safe distance from other individuals, avoiding crowded spaces, wearing a mask both to protect others and yourself in situations where you can't physically distance and where there's a risk and doing all of that to protect yourself and others is the best way to protect society. Our advice doesn't change so we will not comment on the specific risk management measures or behaviour of a specific individual. We are a community. We need to get through this together. This is not the time to turn on each other. 00:22:18 FC Thank you, Dr Ryan. I would now like for the second time to call Katrine [Unclear] from France 24. Katrine, can you hear me? KA Yes, Fadela. Thank you so much. This time I got the sign to fix my sound. Good evening to all of you. I would like to come back to the allegation of sexual abuses by Ebola aid workers as I know that Dr Mike Ryan and Dr Tedros did follow very closely what happened in the fight against Ebola. I would like to have their reaction on that and also about the fact that apparently the women that complained were drugged, abused, locked up. Could you give us more details about the WHO people involved? Because we know that people from other agencies and NGOs apparently are also involved. Will you share some reports with names with the press when you have evidence? Thank you. FC Thank you, Katrine. Dr Ryan. MR Thank you. We simply don't have any of those details. We have what you have which is the report in the newspaper. We start from a position of believing those individuals who have suffered abuse or exploitation. That is the first. 00:23:54 The second thing; we are absolutely concerned that the individuals who've been abused and exploited receive the proper care, the proper support and absolute access to justice and a bright future. We will do everything possible to make that happen but frankly right now we have absolutely no details of any of the individuals, any of the specific allegations. I know David Webb, who leads our internal investigational side, and others throughout the UN are working together to establish how much information may be in the system. I know that he Director-General will and is launching an independent investigation and will make announcements; he said he will make announcements in the near future on that. So the organisation is taking this deadly seriously. These allegations are horrific and it is awful to hear. Both the Director-General and myself spent significant time in the field. I feel terrible to hear these stories. I feel awful for the people affected; I feel awful for their families. I feel awful for the wonderful WHO, the NGO and the UN staff who have risked their lives over the last two years and given their lives to help these people. 00:25:21 To think that any group or individual would destroy and degrade our image or the lives of other people is just almost too much to contemplate but we first have to get the facts, we first have to get this properly investigated. Right now we have no more information than you have. We will and are actively seeking that information but we also need to ensure that we're very sensitive in the way we do that and that those affected by this are not further traumatised by the process. FC Thank you, Dr Ryan. I would like now to invite Gabriela Sotomayor, Procesa, to ask the next question. Gabriela. Can you hear me? GA Yes, hola. Thank you for giving me the opportunity to ask. It's on Mr Trump. We saw the debate and at times Mr Trump was shouting and... I would like to know if, as you saw, Mr Biden may be in danger of contracting the virus or not if you can comment on that. Thank you. 00:26:45 MR No, it's not possible for us to make a comment on that. We have no idea of the nature of the confirmation of the diagnosis, the timing of the diagnosis, viral counts, distances or anything else. We absolutely trust the US public health authorities to make the appropriate decision and advise those individuals whether there may be a risk. FC Thank you, Dr Ryan. I would like now to give the floor to Jason Bobian from National Public Radio. Jason, can you hear me? JA Yes, I can. Thank you very much. This is not specifically about President Trump but it's about the United States overall at the moment; basically plateaued at about 40,000 new cases a day. This is an outbreak that is not just the President; it's in the White House; other members are also testing positive. I'm wondering if you are concerned that this is a sign that the United States is not on the right track to be taking the basic measures which you guys have been calling for in terms of getting this particular under control. MR I think we've seen all around the world many political and other leaders have been impacted by this disease and they deserve the same care and consideration as any other citizen as they suffer the consequences of the disease and recover. 00:28:14 In the classic epidemic dictionary two cases of any disease that are linked in space and time can be considered to be an epidemic or a cluster. There clearly is a cluster of cases occurring in that scenario. It needs to be properly investigated and those individuals who may be at risk need to be advised; the necessary quarantines need to be put in place. This is 101 and quite frankly many of our colleagues in they US and the CDC in the United States taught the world epidemiology 101. I think in this case there is no reason why the United States of America cannot control this disease, turn a corner, get this disease under control but that requires work. Corners don't turn by themselves, they need to be turned; in the case of biologic processes, as Bruce said, you've got to fight the virus, you've go to push the virus down, you've got to protect individuals, you've go to save lives. That costs; it costs effort, it costs commitment, it costs transparency, it costs honesty and it costs a sustained support to get that job done. 00:29:33 If we don't see that in countries all around the world countries are going to go through a tougher experience, particularly in the northern hemisphere. Bruce spoke to that effort that we've seen in places like Spain and Italy. No response is perfect. Mistakes get made. The virus is unpredictable. There is no absolute guarantee at any moment in the response but what is needed is effort, what is needed is a sustained, all-of- government push to control this virus, to protect vulnerable populations, to reduce mortality and to build the confidence of our communities both to be able to live sustainably with this virus and protect our social and economic lives. FC Thank you so much, Dr Ryan. I would like now to give the floor to a journalist calling us from Georgia. Konstantin, can you hear me? Press Georgia. Konstantin. KO Yes, can you hear me? FC Yes, very well. 00:30:42 KA Thank you. Konstantin [Inaudible] Press Georgia. My question is, it seems that people suffer more in the areas where the environment is more polluted and the diets are less plant- based. Several researchers suggest that the presence of free radicals increases mortality rates and the presence of antioxidants helps to decrease mortality. In your opinion should research in this direction be supported internationally and by your organisation to bring more conclusive results? FC Konstantin, do you mind repeating your question? It wasn't very clear at the beginning. KO Yes, of course. FC Thank you, Konstantin. KO I will repeat the full question, okay. It seems that people suffer more in the areas where the environment is more polluted and the diets are less plant-based. Several researches suggest that the presence of free radicals increases the mortality rate and from other [unclear] and that the presence of antioxidants helps to decrease mortality. 00:31:56 In your opinion should research in this direction be supported internationally and by your organisation to bring conclusive results? FC Konstantin, thank you for this question. I would like to invite Dr Swaminathan to answer it. Dr Swaminathan, you have the floor. SS Thank you. Thank you for that very interesting question and you highlight something that the WHO has been saying a lot over the last couple of years since we had our five-year strategic plan, the GPW13. We talk about a whole pillar of wellness, not just the absence of disease or focusing on healthcare delivery but how do you promote health and well-being. That's by paying attention to the kind of things that you're talking about. Air pollution is very important; nine out of ten people today in the world live in areas where the air quality is not fit for breathing, is not healthy. Inadequate diets; we know that there are 800 million people worldwide who are hungry and undernourished but many, many more who suffer from micronutrient deficiencies, who do not get a balanced diet, safe water and sanitation. 00:33:11 These are the risk factors that actually determine one's health and therefore attention to them is very important. They make you more susceptible to all kinds of diseases, both communicable and non-communicable diseases so whether it's COVID-19 or other diseases that we're talking about our aim is to have a healthy population and to increase not only longevity but to improve healthy longevity. Therefore I think the points that you mention about air pollution, about adequate diet and nutrition, about physical exercise and safe water and sanitation are extremely important and looking ahead these are exactly the areas we should focus on. Very specifically you asked about whether there should be more research on this and absolutely there should be and the WHO, as you know, produced a research roadmap in February, which we've been updating that actually identified many of the knowledge gaps and research priorities and we encourage research both into risk factors and where prevention efforts can be focused but also into therapeutics. 00:34:24 The only way to know whether antioxidants or any other drugs actually would improve outcomes for somebody who already has COVID is by doing clinical trials so clinical trials for treatment, clinical trials for prevention; these are very important when we think about very specific interventions but many of the factors are broader and affect communities as a whole. Those are things that communities, societies and governments need to work towards improving. Thank you. FC Thank you, Konstantin, and thank you, Dr Swaminathan. I could like now to give the floor to Laurent Zero from ATS, the Swiss news agency. Laurent, can you hear me? LA Yes, can you hear me, Fadela? FC Yes, very well. Go ahead, please. LA Thank you and thank you for taking my question. I'd like to come back to DRC. Besides the independent investigation that was launched have you already identified internal process that might have failed and that should be reviewed? Thank you. 00:35:35 MR WHO's been working on a number of processes both to reduce the risk of sexual exploitation and abuse and also to deal with its consequences. The most important thing we need to do is make sure that our organisation or any other is not in any way associated with or engaged in that and there's lots that has been done in terms of mandatory training of staff and of monitoring, of having SEA focal points within the organisation, hiring SEA specialists and driving that whole culture through the organisation. Because it's about an organisational culture, number one, of prevention, of reporting, of whistle-blowing or whatever is needed and then the confidential and protected mechanisms by which staff or others can make reports into the system and know that there are no consequences to that for them. We do have a completely parallel mechanism; we have independent mechanisms which report directly to the assembly and the governing bodies that are there and are in place to deal with issues like this. But certainly I am sure as we go through this process we will find shortcomings and we will find areas in which we need to improve our performance and tighten up on the mechanisms. 00:36:54 Clearly if it is found that WHO staff were involved in this type of behaviour then clearly something has not worked either in our training, in our staff recruitment, in our detection, in our monitoring and in our disciplinary procedures and we will look at each and every one of those processes to ensure that this is dealt with definitively and decisively. The organisation will not stand back from making that happen quickly and also in the best interests of the victims. Again I will say, the victims are to be believed. It is our job to do the appropriate investigation. FC Thank you, Dr Ryan. I would like now to invite Ashley Furlong from Politico. Ashley, can you hear me? AS Yes, I can hear you. Can you hear me? FC Yes, very well. Go ahead, please. AS Thank you. The European Medicines Agency just announced that it is investigating reports of acute kidney injury in some COVID-19 patients taking remdesivir. Could you comment on that? Is this not going to be a massive blow possibly to the very small arsenal that we have to treat COVID-19? 00:38:17 FC Ashley, can you just repeat your question? You were very quick. AS Yes, sure. The European Medicines Agency has announced that they are investigating reports of acute kidney injury in some patients taking remdesivir. I just wanted to know if you could comment on that. FC Dr Swaminathan, if you want to take this question, or Dr Simao. SS We are collecting data on all the investigational drugs. As you know, we maintain a living review and a meta-analysis of all the ongoing trials and remdesivir is still being tested in trials and at the same time of course it's also being used to treat patients on an emergency authorisation or a compassionate use basis. So we will be reviewing this periodically. I have not heard specifically about this particular report from the EMA but we can certainly investigate and come back to you on that. 00:39:22 FC Thank you, Dr Swaminathan. I would like to introduce one of our experts, Emer Cook, who would like to add some comments to this question. Dr Emer Cook. She is the Director of Pre-Qualification and Regulation at WHO. Dr Cook, you have the floor. EC Thank you very much. Just to say that we are in very close contact with the European Medicines Agency and we follow any investigations that they are doing. As far as I understand this investigation is at an early stage of development but we will be in touch and make sure that we follow up and liaise in terms of the trials that are ongoing. FC Thank you. I would like now to invite John Zaracostas, France 24 English service, to ask the next question. John, can you hear me? JO Yes, hello. Yes, I can hear you. FC Go ahead, please. JO Good afternoon. Firstly I'd like to get some comments from the experts around the podium on the press release by WHO Africa on 24th September that said a mix of socio-ecological might be behind the lower infection rates on the continent. It listed among the factors hot and humid climate along with lower age groups, etc. That comes as news to me. Is there any evidence behind this? Thank you. 00:41:06 FC Dr Van Kerkhove, do you want to answer? MK Yes, I can begin. Yes, there are different... We know that this virus circulates in all countries all over the world, it has circulated in all type of climates, cold conditions, hot conditions, different types of humidity. The virus operates in clusters, it operates where people are in close contact with one another and it can spread very rapidly in those types of situations, particularly when you're indoor, there's crowded spaces, there's poor ventilation. What we do know; in different types of climates people act differently. When you have warmer climates people tend to spend more time outdoors than they spend indoors. We're noticing that in the northern hemisphere as we enter the autumn and as weather gets colder people will tend to spend more time indoors than outdoors. 00:41:54 I think there are a number of factors why we see differences in circulation of the SARS-CoV2 virus in Africa, as has been outlined by the press release that you indicate. But indeed this virus spreads where we allow it to in a sense because this virus is controllable. MR If we speak to the specific issues that pertain in Africa - and again I'll remind you, as the DG reminded last week, when we speak about Africa we're speaking about 54 different nations on a continent - 55; sorry, boss, I got it wrong. Therefore we can't put all that experience into one description of what's happening. There's a huge diversity of climate, of population, of economic development, of social inequalities and so many other issues. Having said that, we did have a very interesting conversation during the week with the director of Nigeria CDC and some other health leaders around the world and that question was actually put to Chikwe and some other - Lucy Bloomberg from South Africa - because people are intrigued and naturally intrigued as to why Africa seems to be avoiding the worst of this pandemic up to now. That's a good question to ask because you can learn lessons in asking that question. Part of that is certainly due to population demography because with half of the population of Africa being 19 years or younger and very few relatively - percentage-wise - of people being over the age of 65 it may mean that we have a higher incidence of disease in Africa but a much lower mortality just by nature of the fact that it's a younger age profile and the fact that some countries in Africa probably don't have enough testing going on, they don't have the resources and therefore may be under-detecting the incident cases. 00:43:57 So that might create an impression of fewer cases and fewer deaths. The fewer deaths is real; the fewer cases may not be as real. The other thing is that while Africa is increasingly becoming an urban environment large parts of countries are relatively not so densely populated and it may be that the virus finds it hard to establish and spread in some of those environments. There are many other reasons but I think I would point you back to some of the positive reasons. I remember again speaking with Chikwe and others during the week and people were asking, in terms of Africa's first reaction how did you manage to keep a lid on this? 00:44:44 I think Chikwe said, we just treated this like any other outbreak, we went after the virus, we investigated, we detected the cases, we identified the contacts, we isolated the cases, we asked the contacts to stay at home, we tracked and traced because we've had lassa here, we've had cholera here, we've had monkey pox here, we've been doing this for years and years and years and years. What it probably demonstrates is that in many countries in Africa there is a very well-practised, well-trained core of public health people. It may not be a huge army of people but if we take eradication, something again which in Africa has generated huge numbers of individuals who know how to investigate cases, they know how to respond to clusters of disease. So paradoxically countries in Africa may actually be well ahead of countries in the rest of the world in terms of their instinctive response to how to deal with an epidemic and countries in the industrialised west and north may have lost that muscle memory. Equally too - and this is something I think I've said here before - in Africa public health practitioners, doctors and nurses, others instinctively think of how the community is going to deal with a problem, the community issues associated with a public health threat just as quickly as they think about intensive care, just as quickly as they think about other things. It's taken many countries a long time to move from a biomedical concept of this disease to a community concept of this disease, to how to stop this disease in the community, how to work with the communities on behaviour, how to empower communities. Many of my African colleagues have learned many years ago that unless you get the community on board you're not getting anywhere in epidemic response. So I do think while there are factors, epidemiologic and others, that might explain why Africa's not as impacted, I think we should also give credit that there's instinctively a very, very good public health response in many, many countries in Africa. FC Thank you, Dr Ryan. I would like to give the floor to Dr Maria Van Kerkhove, who has some addition to make. 00:46:58 MK Yes, I'm sorry. I want to come back in again because I was trying to keep my answer quite short but there is data that comes from Africa and one of the things that we look at is the seroepidemiology studies that we've been talking about. So there may be differences in surveillance and testing capacity. There are a number of seroprevalence studies that are being done and these are studies that measure unrecognised cases as they test for antibodies, which is an indication that there had been past infection. To date there are more than 150 publications on seroepidemiology ten months into a pandemic. These are peer- reviewed publications and preprints. Five of those are from our African region and similar to other parts of the world the results of those are that in the general population in non-outbreak settings the seroprevalence is below 10%, which is similar to what we are seeing in countries all over the world. There is one study from Nigeria that looked at healthcare workers and found a higher seroprevalence, again similar to what we are seeing in other countries. So there shouldn't be any suggestion that countries across Africa - again, 55 countries, very different, incredible responses, very aggressive, using that public health infrastructure that is in place and that has been strengthened over decades - are looking and they're seeing the same levels of seroprevalence that we've seen in other countries. 00:48:23 I just wanted to add that because this is a growing body of evidence that is helping us to understand the extent of infection in all countries across the world. FC Thank you, Dr Van Kerkhove. I would like to invite Michael Busiorkip, who is a contributor to CNN, to ask the next question. Michael, can you hear me? MC Yes, I can hear. Merci beaucoup, Fadela. Bonjour, tut le monde. I had a question not specifically about President Trump or the First Lady but they're not the first heads of state to succumb to the virus of course. As we have found in other and outbreaks heads of state are crucially important in public health messaging and signalling, especially when it comes to the importance of things like mask wearing. I'm wondering if you have any thoughts on when heads of state get the virus and recover, that their public messaging can become even more effective or impactful. 00:49:24 Just quickly I refer you to what Honduras' President Juan Orlando Hernandez said after his recovery; he said, many think that this is a game and it's not until they see a relative who gets sick or when they get sick themselves that they understand the seriousness of this issue, the truth is I don't wish this on anyone. Thank you. MR Thank you. I'm not sure that was a question but again we wish the President and his partner well as we would wish anyone facing this disease well. This is a nasty virus and this virus can cause severe disease, particularly in older individuals with underlying conditions so we wish the President and his partner well in this process and anyone else who's affected within that cluster. Disease can be transformative. We've all been through things in our lives, health events that transform our lives whether we want them to or not and other things that allow us to learn and absorb lessons from our lives. We want everyone possible in the world, we want all public leaders, particularly leaders of great countries, to lead us and to give us hope, to give us certainty, to give us truth and to give us a chance to fight and win against this disease. 00:51:00 So it is never ever, ever too late for that to be true and therefore I hope that all leaders around the world in health, in medicine, in politics reflect upon what we're all facing and that we can all come together to fight this disease and particularly to be very practical; each government to invest enough in its community, in its surveillance, in its clinical care so we can bear the burden of the disease for now and push the disease to the lowest possible level. But as well - and I say this quite clearly - there is a solution potentially coming down the line. There is huge innovation, developing the vaccines, the therapeutics and the diagnostics we need. There is a barrier between us and that achievement and it is a relatively small amount of money when we think about what has been spent and what has been drained from our collective pocketbooks, from the global economy. Vaccines particularly don't offer an absolute, final guarantee of getting this done but they're a massively important tool, as they've proven themselves to be in the past. 00:52:15 So I would say fine words are find and we need those words but what we need now is action, what we need now is investment and what we need now are solutions and I hope everybody can reflect right now as we send our best wishes to the President and his spouse, that we can redouble our efforts, find the right investments and get this job done. FC Thank you, Dr Ryan. I would like to thank Dr Tedros and my colleagues today for their participation and to journalists who are following us very regularly. I would like now to close this briefing and remind you that you will get the DG's opening remarks as soon as this press conference is over as well as the audio file. The full transcript will be posted on the WHO website most probably tomorrow morning. As always I would like to apologise to those journalists who could not get their questions answered. Thank you so much and see you next week. Thank you all. Have a nice weekend. 00:53:47