Happy Scribe
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Being regarding COVID 19, we have Dr. Tetris double-checked, a general Dr. Μike Ryan and executive director of WHO Health Emergency Program, and our technical lead, Dr. Maria Van Kurkov for journalists. Dialing in by phone. It's a Star 9 to get in line for questions. Those who are joining us via Zoom, it's, uh, clicking on Trace Hand. We also sent you to Dave with our media advisory. A few links to documents issued by our regional offices regarding COVID 19.

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So we invite you to read that following this press briefing. We will have an audio file and the transcript. The next day, I give a floor immediately to Dr. tetras. Thank you. Thank you, Derek, and good afternoon to everyone online and in the room. And hope you had a good weekend. The number of cases in China continues to decline. And yesterday, China reported 206 cases of colvard 19 to W.H.O., the lowest since 22nd January.

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Only eight cases were reported outside Hubei Province yesterday outside China. A total of eight thousand seven hundred seventy nine cases of Corbitt 19 have been reported to W.H.O. from 61 countries with one hundred twenty seven days in the last 24 hours. There were almost nine times more cases reported outside China than inside China. The epidemics in the Republic of Korea, Italy, Iran and Japan are our greatest concern. I would also like to inform you that a w.h attack team have arrived in Iran this afternoon to deliver supplies and support the government in their response.

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I would like to use this opportunity to thank Crown Prince Sheikh Mohammed bin Zayed Al and a hand of the United Arab Emirates for his support in making this mission possible. Shukran. New Zealand Crown Prince W.H.O. staff member in charge. Iran country, of course, has now tested positive for coveted 19 and he has mild disease. The Republic of Korea has now reported more than 4200 cases and 22 dess, meaning it has more than half of all cases outside China.

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However, the cases in the Republic of Korea appear to be coming mostly from suspected cases, from the five known clusters rather than the community. That's important because it indicates that surveillance measures are working and Korea's epidemic can still be contained. Knowing and understanding your epidemic is the first step to defeating it. Korea situation also underlines that this is a unique virus with unique features. This virus is not influenza. We are in unchartered territory. We have never seen before a risk, a risk, a respiratory pathogen that is capable of community transmission.

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But at the same time, which can also be contained with the right measures. If this was an influenza epidemic, we would have expected to see widespread community transmission across the globe by now and efforts to slow it down or contain it would not be feasible. But containment of Cobbett 19 is feasible and must remain the top priority for all countries. With early aggressive measures, countries can stop transmission and save lives. We appreciate that people are debating whether this is a pandemic or not.

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We are monitoring the situation every moment of every day and analyzing the data. I have said it before and I will say it again. W.H.O. will not hesitate to describe this as a pandemic if that's what the evidence suggests. But we need to see this in perspective of the eighty eight thousand nine hundred thirteen cases reported globally so far. Ninety eight ninety percent are in China, mostly in one province. Of the eight thousand seven hundred thirty nine cases reported outside China.

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Eighty one persons are from four countries. Of the other 57 affected countries, thirty eight have reported ten cases or less. 19 have reported only one case. And a good number of cases have already contained the virus and have noted, posted, reported in the last two weeks. We know people are afraid. We know they have many concerns and questions. Is the virus spreading in my community? Will my kids be okay? Will my parents be okay? Is it safe to hold an event?

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Should I travel? The answers to these questions will vary depending on where you live, how old you are and how healthy you are, individuals, families and communities should follow the advice provided by local health authorities and local health professionals. W.H.O. will continue to provide evidence based guidance to help countries and individuals to assess and money their risk and make decisions. There is no one size fits all approach. Different countries are in different scenarios. More than 170 countries have not detected any cases yet.

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Some just received their first cases yesterday. Some have clusters of cases with transmission between family members and other close contacts. Some have rapidly expanding epidemics with signs of community transmission and some have declining epidemics and have not reported a case for more than two cases to two weeks. I would repeat this and some have declining epidemics and have not reported a case for more than two weeks. Some countries have more than one of these scenarios. At the same time, for example, China had a community transmission in one, but relatively small numbers of cases in other provinces.

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Other countries have a similar pattern. W.H.O. is advising countries on actions they can take for each of the three CS scenarios. First case, first cluster. First evidence of community transmission. The basic action is in each scenario are the same, but the emphasis is changed depending on which scenario a country is in. Our message to all countries is this is not a one way street. We can push this virus back. Your actions now will determine the cause of the outbreak in your country.

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There is no choice but act now. I thank you. Thank you so much.

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Dr. tetras, we will start first here in the room. And then we will go online. And I repeat again that we would like to have each journalist asking only one question. All started.

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So copies mine instead of Japan Broadcasting Corporation.

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The number of confirmed cases have links to 2000 to the total number you want. And Corona later has spread now to 55 countries. Are the interface there. We can contain the virus.

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Mm hmm. Yeah, I think your question may have been formulated before the director general spoke. I think he was very clear on where we are. The fact remains that for most countries, the vast majority of countries, we don't have community level transmission or at least demonstrated in those countries. There is a very small number of countries in which we have demonstrated and established community transmission. That's not a good situation for those countries and it's certainly not a good situation in terms of the impact on the health systems.

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And we've seen that and the very unfortunate, regrettable and tragic deaths. But when we look at this at a global level and we look at the number of countries affected and of them the number of countries who have established community transmission, we are still hopeful that containment A is the right first strategy, but clearly containment with the purpose of slowing down the virus. And if we're lucky and if we do the job really well, we may get the opportunity.

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We just might get the opportunity to interrupt transmission. But at the very minimum, containment is allowing us to significantly slow down the spread of the virus, thereby giving an opportunity for health systems to prepare for PPE to be made available, for training to take place, for laboratories, to get reagents for a laboratory. Laboratory technicians to be trained. So we've still firmly believe that that the strategy of containment with slowing down spread, with protecting the health system is still the best combination or blend of strategies right now.

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I would like to to add to that in this statement I just made. I have tried to categorize the countries and you can have a look for yourselves. By the way, why we say containment works. One. A good number of countries around 8 have actually not reported cases in the past two weeks, more than two weeks, although they had cases before that they had reported and then they were able to contain it. But in addition to that, if you see what's happening in China, it shows from the result so far that this outbreak can actually be contained even where there are many cases.

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So it would be safe to assume that especially in countries where they have less number of cases, it's even more possible to to contain it. And from the 62 countries will have reported cases. Thirty eight of them have reported ten or less cases, actually. 76 countries, 34 countries have reported less than 10 cases and four countries 10. So that makes it 78 less or equal to 10 countries. This country should really invest in containment. And of course, we are also saying at the same time, even if you have more cases, it could be thousands like, for instance, Korea or China or Italy.

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Still, containment is is better, by the way, in Italy. We see that the prime minister is now coordinating the whole effort. The central government and also the local government are aligned and we can see a very clear political commitment and surveillance is now boosted. Of course, they were surprised, but they have strong institutions that them bringing it together. And we have confidence in in Italy and we believe that they can also contain it. So that's what we're saying.

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Containment is possible in all countries that are affected and that should be number one. And then, of course, the other strategies can also be applied. And that's why also we are seeing the comprehensive approach is very, very important. So, OK, giving the overall picture globally, like saying, OK, we are close to 90000 and we have more than 3000 dess 65 countries are affected is fine. But at the same time, let's go down and see.

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What's the situation in each and every country? Like what I say it out of the sixty two or sixty five countries said the eight are equal to or less than 10 cases, and I can give you even those with more than between. For instance, 14 and one hundred seventy cases, which if you take as the lowest, is only twelve. You have 20 countries. So if you add the 38 and 20 countries already fifty eight countries are actually less than one hundred thirty cases fifty eight and thus more than 1000 are only four or five countries.

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So that's why we are also saying one size fits all approach doesn't work. Blanket recommendation doesn't work. And each and every country should have its own risk assessment and have a tailored approach. But all countries, we believe, should start from containment strategy. Thank you. Kuzmich Chen, please, the Chen latched the press Kempler. Well, he'd be the only good option. But the got behind some of it could also be a suggestion. That's a dumb idea that you have to get it.

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Meanwhile, Yang hopes they'll probably set out to identify a moment that leaves behind a new identity. The man. You'll be down, actually.

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So much so. The question is that China has said that they will reinforce their cooperation with other countries in the response to Kobe. So what's your opinion? Where D Corporation could be reinforced, especially in the light of a meeting we had a few weeks ago on research and development?

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So the the experience that China has with Cauvin 19, the work that they are doing and taking an evidence based approach to this response is something that the world needs to learn from. We have been communicating and working with colleagues in China from the beginning. They have participated in all of our teleconferences across all of the different disciplines. They have participated in the research and development roadmap meeting that we had a few weeks ago. They continuing to work with us. I've just returned from two weeks in China where we again discussed what they are doing in terms of building an evidence base and the world needs to learn from them.

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So we are looking forward to continuing to collaborate with Chinese scientists and public health professionals across all of the different disciplines to better understand epidemiology and transmission, to better understand what they're doing around severity and understanding treatments. There are a number of clinical trials that are ongoing in China and we are awaiting those results. We are still only eight weeks into this outbreak. There are a number of clinical trials that are ongoing and we're hoping to learn of the results of those very soon.

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There are diagnostics in terms of molecular diagnostics and serologic assays that are that have been developed. There are sero surveys that are being done. There's a number of research studies that are ongoing and we are working closely with them to better understand what we can anticipate in terms of results coming out and how that will impact our response going forward. So this is a feedback loop. Every evidence, all the evidence that is being gathered as part of this response is fed back into the response so that we can always, always be better and take another approach.

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In addition, China has sent technical team to support the response in Iran and has committed to supporting countries with weaker health systems, with materials, supplies and with teams in collaboration with W.H.O.. And that is very much in line with what many other countries are doing. We very much appreciate that. Specifically at the international level now with a research, we absolutely need the data from the clinical trials that are ongoing for the existing therapeutics and some of them in the US, some of that in in China.

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And we have strong commitments from our Chinese collaborators on sharing that information as soon as possible. We are establishing a global data safety monitoring board so we can create a centralized way of pooling data. We're working with the NIH in the U.S., with the European and other institutions in China on a master protocol for clinical trials and for serology studies that will allow us to create common endpoints, common datasets that will allow us to add value and power to the data we're collecting and get answers for the world.

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So the outcome of the meeting a month ago, I think there's now accelerating this collective approach, a standardized approach. What we really do need is and I believe they're coming on stream now, but standardized, reliable, serology testing is something we absolutely need at this point. And we've just come out of our scientific advisory group meeting this morning with the group for the already blueprints. They're currently meeting as we speak and they're discussing the super priorities like and accelerating these specific aspects of the research in the coming days.

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You please. Yes, thank you very much. Post front that this address is regarding the mission that she sent to you on the post on the flight restrictions to your word. Any other difficulties that her mission are facing the plane, things, you know, to help you to tackle the cone of silence? Does the sanctions imposed against Iran affect the W.H.O. mission? He may supplement, but certainly the team didn't just arrived today, the team arrived with the capacity and reagents and supplies for over one hundred diagnosed thousand say one hundred thousand diagnostic tests.

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And with PPE, that will supply over 15000 health workers. So the team hasn't arrived without supplies. Clearly, the recent announcements on the easing of sanctions regarding med medicinal medical products and supplies is something that we're we're very happy and hopeful. Will will continue research into the health system in Iran needs to be supported. It is a very strong health system, historically very strong, has a proud history of responding to disasters like earthquakes. But clearly, all health systems come under pressure from this disease.

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And we've seen that at a global level. It doesn't matter what country you're in. This disease will stretch your health system. And therefore, we fully support further support to Iran's medical system in order that Iran may contain this disease, because containing this disease in Iran not only helps Iran, it helps the world. Yeah, I think Mike Mike had already stated would like to comment, actually the statement from the United States in support of Iran. I think we have a common enemy now and using health and especially fighting this virus as a bridge for peace is very, very important.

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And U.S. support is also another example of solidarity, which we have been calling for some time now. And this is very encouraging. And we would like to actually, uh, thank the two countries, but at the same time call on, you know, stressing the importance of solidarity at this time. This Vytas, these enemies are known that are something no, no. But many unknowns. And it's a common enemy and we have to stand together in unison to to to fight it.

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And this early signs are very encouraging. And as humanity, we should stand together. Thank you very much. We will go on line for a couple of questions from journalists watching us. We will start with National Geographic and sorry if I mispronounce the name. Second akpan, can you hear us? You hear us?

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Yeah. That is exactly right on the mark in terms of my name. Oh, thank you. I appreciate that.

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My question is about the clinical attack rate. I was wondering if you have an estimate for the clinical attack rate, for one for Hubei Province or for China as a whole? So, yes. So as far as you know, we've just come back from two weeks in China and the Internet, I was there two weeks, but the international mission was there for nine days. And we've just published a very detailed report on the W.H.O. Web site and it's in English and in and in Chinese.

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It will be in the National Health Commission's Web site in China. So I do encourage you to read that in full. There's a lot of detail in there around what we've learned about transmission. What we've seen in terms of attack rates, much has been published by the Chinese CDC. There was a paper that came out in the China CDC weekly looking at attack rates by age. And we do see varying levels of attack rates by age. I'm not going to quote with what the percentages from from that paper, but we did see some some variation in terms of attack rates.

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For example, we saw low attack rates in children. And that was something that is something that is important and warrants some further study. We do see a higher attack rates in adults. And what we've seen there is that transmission is occurring amongst close contacts. And that is something that has been confirmed through the data that we've seen in China. And that transmission is being driven by close contacts between families. And so what we've seen is higher attack rates in adults than we've seen in children in terms of quantifying that specifically.

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It's still quite early days in terms of what we know, what we're finding are symptomatic context, because this is what surveillance is focused on, what we need now, our population based serologic surveys. And so these are looking at an age stratified. Looking at all different ages across in the general community to really better understand what infection looks like at different age groups. This is being conducted now. These sero surveys are starting to be conducted now. And we hope to have results.

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We hope to see some preliminary results of these in the coming weeks and maybe maybe a few weeks before we actually get those. And then we will be able to determine what kind of attack rates we're seeing by age. But right now, we can say higher attack rates in adult clinical attack rates in adults versus children. And just to add to that, the operative word here been a clinical attack, rape, because obviously without a serology test, you can't tell how many people have actually overall being infected.

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But colleagues in Korea and other places as well as in China, certainly in family situations, the secondary attack rate within a family is lower than we would have expected in a respiratory with a respiratory pathogen and the same amongst contacts. The number of contacts followed up now in China is and is in the hundreds and hundreds and hundreds of thousands. And again, the attack rate in that group is 1 to 5 percent and 5 to 10 percent, I think in family contacts.

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And they're relatively low in that sense. And similar observations are now emerging in Korea and South Korea and Republic of Korea. So, again, all of this is easy to say. Well, what does. As as Maria said, without a validated serology test, there will always be the doubt that there is a larger proportion of subclinical or non non detected infection going on a community level. Much. Next question from Keiko schmitter from science to you, can you hear us?

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Can you hear us?

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Yes, story. Thanks a lot. So, yeah, I did actually read the report. And I'm curious because the report basically makes the point that China managed with its with its very extreme measures to to beat back. You know, it was quite sizable epidemic in hand.

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So the question for me is, what does that mean for the other countries that find themselves at the start of this? Because, you know, not every country will be able to implement these extreme measures. And the question to me is, at what point do you recommend some of these measures being implemented when you have a place where you have a few dozen cases? We know that that's, you know, a picture of what it was like a week ago maybe.

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So I'm curious what your recommendations are. I think you need to look at the experience inside Hubei and the experience in the other 31 provincial municipality city regions and administrative regions. The measures certainly that were taken in Hubei were extremely aggressive, very, very strong in the face of a massive thousands of cases per day. If you cast your mind back, thousands of cases per day, if you look at the experience in the other provinces, the experience of the other provinces is probably more akin to what some countries are experiencing now outside.

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And the measures that were put in place in those other provinces in China are nowhere close to as stringent as what was put in place in Hubei. So I think we need to again, when we look at China does not look as a country that's implemented the same measures everywhere. The measures have been very graduated against what was perceived as the transmission dynamics at any given time. And those measures have changed over time and have been adapted to each provincial need.

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So I think matching those measures, but certainly it is clear in the likes of Singapore, for example, if you take another example outside or in Hong Kong that measures that have not involved walling off cities or completely banning travel have been very effective in both suppressing and driving transmission down over the last six weeks. So I don't think we're talking necessarily about measures at the Hubei level because quite frankly, other countries may not be capable in terms of their levels of social acceptance or resources to be able to sustain that type of effort for so long.

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That's a real question mark in our minds. But those measures don't necessarily have to be as aggressive or as robust. And Maria may wish to comment on your observations in Guangdong and Sichuan, all the places.

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The point Mike is making about this approach that has been different and based on the intensity and transmission is is true. And you know, what we've seen in China and what we're seeing in other countries, it's not just China. It's all it's all countries that are that have been able to slow down this virus. And there are examples of countries outside of China that have been able to slow this virus. They're really applying these fundamental principles of public health. These are public health measures at at the core, you know, and this involves identifying cases, you know, aggressively, you know, the earlier and the and the more action that takes place early on, as cases are identified in countries, the better outcome you're going to have in your country, finding those cases, finding those contexts, following and managing them over the incubation period, making sure that you you it provide the right provisions to those individuals who are in hospital, providing adequate care and having social distancing, practicing hand hygiene and respiratory etiquette.

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These things work. There have been some movement restrictions. But as Mike has said, and as we have seen and move on, there's been some very extreme use of these for temporary periods of time. But we are seeing that these have been successful in other countries can do this. All countries are able right now to talk to their communities. All of them are able to tell their their population what they can do and what they should avoid. All hospitals can get ready.

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That is something that can be applied across across the globe. All countries can be looking for cases right now. All countries can be aggressively finding those first cases and following those contacts over time. And we can all help each other and look out for each other. So there's a lot of fundamental things that were done in China that can be done anywhere. Thank you very much. Next question is from Sara, from Derek, Sara. Can you hear us?

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Yes.

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Thank you. In that book, I think it was mentioned that there was an arrest patri virus capable of community transmission. Could you clarify what that means? Is the flu not capable of community transmission? And what are the implications of a respiratory virus capable of community transmission?

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Well, you know, I think you have to include the second part. It's capable of community transmission. But at the same time, it can be contained. The coroner. But if you're talking about another respiratory infection like flu, then it will not be you know, we're not able to contain it, actually. So that's the contrast. That's what I meant to say. But if Mike or Maria, if you want to add you, I think with many respiratory pathogens and we especially respiratory viral pathogens, we experience them every winter.

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We don't necessarily attempt to contain or stop them because we fundamentally believe they will spread unabated. We tried to protect ourselves from that individual infection, but we don't have a principle of trying to stop the infection at a societal global level. You don't see restrictions or any measures put in place with seasonal influenza. Yes, we want to protect individuals from seasonal influenza by vaccination or avoiding infection, but we don't implement specific measures at airports or we don't have thermal screening or any of those things because we have a disease for which we have a vaccine.

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We have treatments. We understand the strains, transmission dynamics. We understand its patterns. Here we have a disease for which we have no vaccine, no treatment. We don't fully understand transmission. We don't fully understand case fatality. What we have been genuinely heartened by is that unlike influenza, where countries have fought back, where they've put in place strong measures, we've remarkably seen that the virus is suppressed, or at least the clinical appearance of the where's the number of clinically apparent cases has been greatly suppressed.

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And they are hoping that is that this virus is and that he said in this speech, it's not influenza and it's not behaving like influenza. It is behaving like colvard 19. The problem is we don't know exactly how Corbitt, 19, behaves, but we know it's not transmitting in exactly the same way that influenza was. And that offers us a glimmer, a chink of life that this virus can be suppressed and pushed and contained. And at the very least, by doing this, we give all the health systems in the world a chance to prepare and potentially develop therapeutics and vaccines to prevent this.

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This is about containment and buying time. And in doing this, we can. We can save a lot of lives.

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If I could just add to that. So what the DG said in his speech about these three C's, you have cases, clusters, communities. What everyone expects is that you go from cases, you go to clusters, you go to communities and that's it. What we are actually seeing is that we're seeing community transmission in some countries actually bring this back down to seeing clusters again. And that is something that we need to learn from and we are learning from.

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And that is the hope. That is where we can see that. You can drive this down. You can bring it back. There is no eventuality here. We're planning for every type of scenario in every type of country. But just because you have clusters of cases doesn't mean you can bring that down to individual cases. Just because you have community transmission doesn't mean that you can't bring that back down to clusters that you can follow. And I think that's really important.

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We are seeing positives here. We are seeing declines in cases. We're learning from that. That's why we're up here every day talking to you, being so aggressive in our language of saying the time is to act now. The time is to act early. The time is to be aggressive. The earlier you act, the better chances you're going to have. And all of that buys us time. As Mike has just said, this all buys us time to better prepare our systems, our hospitals, the development of medical interventions, vaccines.

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Thank you very much, we'll take one more question from online. Then we will have time for two more questions here in the room. Uh, he said Banjo Cowcher from India from down to earth. Can you hear us? Yeah, I can hear you. Can you hear me? Yes, please go ahead. Hello. I don't. OK. So, Mike, you said you give a very detailed statement the other day differentiating between mitigation and containment.

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Dr. Ross, you also said that all countries are capable of containing the virus.

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The European CDC, in a statement issued today, has said that in the event of established and widespread community transmission, current containment measures may no longer be effective and do wish to have efficient use of resources.

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We have more than 50 mitigation phase, so they are saying that containment is not possible in that jurisdiction. I would request you to comment on that. My second question is, Dr. Ross, you were saying that, you know, the country should set a job.

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I typically just just just just quickly.

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Quick, quick question that we should have enough ventilators and enough oxygen, etc., ideal equipment to ensure that we are able to provide care.

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Can you define for for for us what is that enough? Because what is enough for a big country like India or for a small country like Finland may not be enough for a big country like India, if not big numbers. If you could just elaborate. What is that enough for us? Thank you so much. On the issue, I don't believe the US have made ACTC or anyone else have made me OK, oh, European C.D.C. I believe everyone's still very much committed to containment.

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I would hate to think that countries in Europe who currently have no cases are now moving to mitigation and they will be find that quite difficult to explain to their citizens right now. So I do believe that when we speak as a regional level, it's very important this we're not saying that containment has no place in this. And I would like we can see the statement and see what it says. There is a point in any epidemic where you believe you can no longer contain the virus or like if it was influenza and you you have to shift your resources to saving lives.

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But in doing that, you're accepting that you can no longer affect the course of the disease. You can no longer change the shape of the epidemic, and you're purely mewe moving in that sense to save as many lives as you can now, W.H.O. does not believe that we're there yet. Based on what the Director-General has presented to you today, we can have that argument. We can sit around the coffee tables all week long and for the next month and we can talk about who's right and we can talk about who's wrong or we can get on with it.

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That's true. That's the question. History will tell who was right or who was wrong. The real question is we can't miss this opportunity to save lives. We can't miss this opportunities to protect our health systems. So let's just get on with it. Yeah. And earlier I have been saying seventy eight countries, 10 or less cases. And if you take eleven two hundred cases, you have additional 17 countries. So 17 plus eighty eight fifty five out of 62 with less than a hundred cases.

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And I think the figures can show us what kind of strategy actually countries should should follow, that they should start from containment. And the number of cases, countries reporting more than 1000 cases for countries. And we are saying even those countries should actually in their comprehensive package. They should include containment. And moving from containment to mitigation without testing the containment itself in all those countries, I don't think is a wise decision. Even with more cases, more Morawa, more than 1000, having a comprehensive approach is much better than having you know this.

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Strategy which moves into mitigation, which to us and what this is, I hope is clear surrendering. I don't think is is right. So we have to give it our best. Using containment strategy irrespective of the number of cases. But this doesn't mean that we will not. Monitor the situation on a regular basis. We will and we will adjust our strategies based on that. But in terms of strategy, still, whatever the announcement would be, whether it's pandemic or not, we will still go for a comprehensive approach.

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But in the strategy, the combination of strategies could could vary based on the situation. So that's what we're we're we're seeing. And this is coming from a proper analysis of what has happened in the last two to three months after the announcement or the declaration of this outbreak where we have seen success with containment strategy and which we believe that it's worthwhile to continue with that kind of strategy. There was a question on ventilators. Yeah, very the question about preparing hospitals for respiratory support and ventilators and oxygen is is a good one.

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This is something that all countries need to to be doing some assessments of in terms of what would be needed should they start to see cases. We do know in terms of the severity spectrum, we do know that. Excuse me, 80 percent of those that are infected will have mild disease and recover. We do know that there's approximately 15 percent that will have severe and another 4 or 5 percent that will be critical, which will require which will require oxygen support.

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So there are some estimates that are coming from the laboratory. Excuse me, the clinical teleconferences, which would give some indication of 30, 40 percent of people who are hospitalized that would need oxygen support. And those types of those types of percentages are preliminary. Those types of percentages need to be more refined so that so that people can prepare for that. And then you need to take that into an assessment of what would be required within your country, based on your population, based on the demographics and the underlying conditions and in your in your countries.

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Just remember, in most countries, even even sophisticated health systems have very limited intensive care capacity as an overall proportion of the number of clinical beds that they have. So this is this is not just an issue for the south or for a weaker health systems. The careful planning and use of intensive care beds is is is not a straightforward process. And the idea of just having having ventilators, for example, needs trained technicians exmo an extra corporeal oxygenation is a process that requires very high levels of skill.

[00:43:43]

It's not just the equipment. So I do think this countries need to focus on basic levels of care, basic support to patients early in the course of the disease so that they don't develop the more severe forms of the disease, early use of oxygen to support people. Because most countries will struggle if they start to see large numbers of patients requiring intensive care. It's not a straightforward nor an easy process. And we've also seen that people are spending many, many, many days up to 20, 24 days in a critical care environment that's occupying a lot of beds for a very long time.

[00:44:18]

So I think all countries are going to have to think very carefully about how they manage the critical care component of this of this disease.

[00:44:27]

I imagine we'll come back to the room body and then Gabriela. Good evening, City from Hong Kong. It's just a fill up. My colleague from India, some countries probably in Europe perhaps. And it's estimated that there is this epidemic and no transparency and probable ignored warnings to public. Do you have any comment on. I'm unemployed and now has a with. The discrimination against the union or against Italian history. Give us some comments.

[00:45:04]

Yeah, I think we've all been on that merry go round once before. We're not in the business of apportioning blame to countries nor to individual ethnic groups. All countries have experienced this disease, have been unfortunate victims. We've been in the pathway of the disease. What Maria said before on the D.G. said before is we don't believe the countries are being non-transparent. There's an issue. And in the beginning of any outbreak, when something starts, it's very hard sometimes to distinguish that from all of the other background of winter, influenza and other things.

[00:45:40]

And sometimes it's difficult to pick up that signal of what's happening. I've said it and read it written myself in the past and I've done many, many outbreak responses. It's very easy to get caught unawares in an epidemic situation. It's very easy to get behind the curve, to get behind on the back foot. And that happens almost invariably. It almost is a rule of epidemic response. The real question is how quickly you catch up. Do you realize the situation you're in and can you catch up quickly?

[00:46:10]

And what we're seeing is countries catching up quickly. No country is really beginning to understand what they're fighting and beginning to take concrete actions towards doing that. We want to push, promote and support those countries who wish to take aggressive concrete action to control this disease, not to start criticizing, apportioning blame or doing all of the other negative things that help nobody. It helps nobody to do that. And particularly when it comes to ethnic profiling of people. It's not only unhelpful, but it's it's it's abhorrent and we reject it entirely.

[00:46:44]

And the DG has been saying this. Solidarity, solidarity, solidarity. We can always after this outbreak is over. We can sit down and we can see where where did we go wrong? Where do could we do things better? Where can we increase transparency? Where can we improve systems? Where can we improve all the things we know now? We would love to have stronger. But there's no point looking for something you don't have. You got to build it now.

[00:47:09]

Make it work. And then we'll come back and see what we're prepared to invest in future. And it is, the director general said. We spends quantums more, thousands, millions times more preparing for every type of other security challenge except a public health one. And we may be paying a heavy price for our Ignat for ignoring preparedness as one of the central measures of human security on this planet. I hope we don't pay too heavy a price for that, but we will certainly learn the lessons and hopefully we've learned our lesson this time.

[00:47:41]

Yeah, maybe you do.

[00:47:43]

I do. I did too. That, to be honest. It's so painful to see the level of stigma where we're observing. Of course, we are human beings, we are not angels. We make mistakes. But at the same time, we can make rational decisions to. And we can have the right attitude and behavior. And that's what we are calling for. We cannot be angels, but we can be rational human beings. Who can do the right things and avoid the wrong things?

[00:48:30]

I remember once this is long time ago, I was very, very young, actually. And there was a lot of destabilization in the world and somebody was asking a question, when do human beings stand as one was a question and another one was responding. This is in school when we have a common enemy from another planet.

[00:48:55]

Why do we need another enemy from another planet to be one? When we have in the same planet a common enemy. That could affect us all equally. So that's what we are saying. There is a common enemy in this planet itself. Where? We need to fight in unison. And the stigma. To be honest. Is more dangerous than the virus itself. And let's really underline that a stigma is the most dangerous enemy. For me, it's more than the virus itself.

[00:49:51]

Yes. We'll take a Gabriela. And then probably will have to conclude, Jamie, there will be another day change to. Thank you, Tariq, for taking my questions. Let's let them go to Mexico. Proceso in the potatoes. As you may know. And you know, a coffee. The 19 just arrived in Mexico. We have five important cases now, but people are a bit skeptical with the layback attitude. Some some say it's a light disease.

[00:50:20]

They don't understand why so much saturation, isolation, containment. So they say that people die more people die from influenza in the world. So I understand, but fear is not an option. But the other extreme is not the solution either. And I know that you have been repeating and repeating the same message. But what can you say to them? And just a quick question. And what about North Korea? We don't have the. Are you in contact with the health authorities?

[00:50:53]

Thank you. Yeah, we are. Yeah, we are. With health authorities in North Korea, with her office there and have had multiple meetings here in Geneva with representatives of North Korea, and we've sent equipment, supplies of diagnostic equipment to the north and again, subject to the same release and own on sanctions and under the proper resolutions. We know and we know that the DPRK has stepped up its preparedness procedures, were not aware of the cases.

[00:51:27]

They're right now, I don't think. And and we're certainly ready to both strengthen our country office and send teams as needed. And I know that the North Korea is also in contact with the South and also in contact with Chinese colleagues and officials as well. DG We'll speak to the issue of what you you mentioned regarding this outbreak of this epidemic being like flu or not like flu or whatever. It's a it's a difficult position for any individual or organization or anyone to be in.

[00:52:08]

Because if you say we have a disease for which we don't know the full transmission dynamics, for which on the face with has a case fatality of 2 percent or possibly more in certain circumstances, we're up to in some cases, 10 percent of people with underlying conditions can die. Who who who are present clinically. Then if someone is trying to tell me we shouldn't be trying to stop that we should just accept that as normal business, then I don't know why I'm doing this job, frankly.

[00:52:37]

Having said that, we have to be very careful and detectives have been very careful since the beginning of this event. We've tried at every possible opportunity to say to people, we need we don't know. We're hoping we've said it today. Only 80000 cases, only so many thousand deaths around the world. We're not the ones trying to scaremonger here. We're trying to be realistic. We're trying to be balanced. We're trying to get across the right message.

[00:53:01]

We're trying to tell people what they can do. I'll ask you and others, what are you doing to to balance that message and the international front? What what's your responsibility in this in doing that? And if we can all answer that question and go to sleep at night, then we will be better. But I do think that we have been trying to be balanced, as many of you have been balanced in this, as China has gone through a huge punch to its system system.

[00:53:30]

Just a small little thing the past over China. This has been a massive punch to the economy and to the social system and to the health system in China. We don't want the rest of the world to have to absorb that punch. We're trying to do our best to avoid us. And as Dr. Federer said, we may not be able to, but we at the same time can prepare, can get ready. We can spread this disease out over a longer period.

[00:53:52]

We can reduce the impact on the health system and the capacity of the health system to absorb that and make this less impactful. Links say, I think, among communities. And we hope we can communicate the right level of risk. We've said it again and again. Society should go on. Communities should continue to work and thrive. We don't necessarily need the kinds of measures that have been put in place and obeyed because we're not there yet. Most countries, the simplest and most straightforward of public health measures in countries, if applied aggressively and persistently over time, have shown in many countries that the disease can be brought under control.

[00:54:28]

And if we can apply those minimum measures for the maximum time, I think we'll make progress. I just hope we're not scaring people unnecessarily. That is certainly not our intention. So what we have been saying that bitterly. My God said it already is. Fear and panic are dangerous. Very, very dangerous. Concerns and worries are understandable. And what we are saying is it's fine to be concerned and worried, but let's calm down and do the right things.

[00:55:12]

That's our embassy that has been our message. And from there started when the number of cases in the rest of the world was so small, it was less than hundred when we declared publicly emergency of international concern. You remember. And it was actually a day or two days after we have seen human to human transmission that we declare publicly emergency of international concern. Less than undead cases in the rest of the world and not as actually. And we had window of opportunity, and what we said then was let's.

[00:55:50]

Of course, we can have concerns and worries. It's understandable. But let's really calm down and do the right things. And use the window of opportunity to contain this outbreak. So still the same message. But in some places we're not seeing that level of response that we expected. And that's why we have been again. Saying to the world or reminding the world that the window of opportunity is narrowing and that we have to still do our best to catch up.

[00:56:32]

So still the same message, comprehensive approach. Of course we can have concerns and worries, but calm down and do the right things. And there are positive signals we we're not saying this without any reason or facts. I cannot say calm down without seeing any good reason. The good reason is there are successes already in some countries where they have already contained the virus. And I said it. Fifty five countries, less than 100 cases. I leave the question, do you.

[00:57:11]

Can that we contain but we are saying not even less than other cases, even if it's more. It can be contained. And we have seen already examples starting from China. So the question now is how hard can we continue to hit it? How committed are we to really hit hard? That's that's the question. Thank you so much. It is. Thanks to everyone here in the room and everyone watching, guys. I'm sorry for all those in the room, but also online who have not been able to ask their question.

[00:57:47]

But we will see each other again. Audio file will be available immediately and transcript hopefully tomorrow.

[00:57:52]

Have a nice evening tomorrow. Thank you again.