China reported a cluster of cases of pneumonia in Wuhan, Hubei Province. A novel coronavirus was eventually identified.
1 January 2020
WHO had set up the IMST (Incident Management Support Team) across the three levels of the organization: headquarters, regional headquarters and country level, putting the organization on an emergency footing for dealing with the outbreak.
4 January 2020
WHO reported on social media that there was a cluster of pneumonia cases – with no deaths – in Wuhan, Hubei province.
5 January 2020
WHO published our first Disease Outbreak News on the new virus. This is a flagship technical publication to the scientific and public health community as well as global media. It contained a risk assessment and advice, and reported on what China had told the organization about the status of patients and the public health response on the cluster of pneumonia cases in Wuhan.
10 January 2020
WHO issued a comprehensive package of technical guidance online with advice to all countries on how to detect, test and manage potential cases, based on what was known about the virus at the time.
Evidence at that time suggested there was “no or limited human-to-human transmission.” Based on experience with SARS and MERS and known modes of transmission of respiratory viruses, infection and prevention control guidance were published to protect health workers recommending droplet and contact precautions when caring for patients, and airborne precautions for aerosol generating procedures conducted by health workers.
12 January 2020
China shared the genetic sequence of COVID-19.
13 January 2020
Officials confirm case of COVID-19 in Thailand, the first recorded case outside of China.
14 January 2020
Dr. Maria Van Kerkhove noted in a press briefing there had been limited human-to-human transmission of the coronavirus (in the 41 confirmed cases), mainly through family members, and that there was a risk of a possible wider outbreak. Dr. Kerkhove noted that human-to-human transmission would not be surprising given our experience with SARS, MERS and other respiratory pathogens.
20-21 January 2020
WHO experts from its China and Western Pacific regional offices conducted a brief field visit to Wuhan.
22 January 2020
WHO mission to China issued a statement saying that there was evidence of human-to-human transmission in Wuhan but more investigation was needed to understand the full extent of transmission.
22- 23 January 2020
The WHO Director- General convened an Emergency Committee (EC) under the International Health Regulations (IHR 2005) to assess whether the outbreak constituted a public health emergency of international concern. The independent members from around the world could not reach a consensus based on the evidence available at the time. They asked to be reconvened within 10 days after receiving more information.
28 January 2020
A senior WHO delegation led by the Director-General travelled to Beijing to meet China’s leadership, learn more about China’s response, and to offer any technical assistance.
While in Beijing, Dr. Tedros agreed with Chinese government leaders that an international team of leading scientists would travel to China on a mission to better understand the context, the overall response, and exchange information and experience.
11-12 February 2020
WHO convened a Research and Innovation Forum on COVID-19, attended by more than 400 experts and funders from around the world, which included presentations by George Gao, Director General of China CDC, and Zunyou Wu, China CDC’s chief epidemiologist.
16-24 February 2020
The WHO-China Joint mission, which included experts from Canada, Germany, Japan, Nigeria, Republic of Korea, Russia, Singapore and the US (CDC, NIH) spent time in Beijing and also travelled to Wuhan and two other cities. They spoke with health officials, scientists and health workers in health facilities (maintaining physical distancing). The report of the joint mission can be found here: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
Read More
https://www.who.int/news-room/detail/08-04-2020-who-timeline—covid-19
The Twenty-fourth meeting of the Emergency Committee under the International Health Regulations (2005) (IHR) on theinternational spread of poliovirus was convened by the Director General on 26 March 2020 with committee members only attending
via teleconference, supported by the WHO Secretariat. In order to ease the burden on affected State Parties in the exceptional situation following the determination of the COVID-19 outbreak as a Public Health Emergency of International Concern
(PHEIC) on 30 January 2020, characterized as a pandemic on 11 March 2020, the invited State Parties were asked to present their reports electronically only instead of attending via teleconference. Reports were received from Afghanistan, Burkina
Faso, Central African Republic, Cote d’Ivoire, Democratic Republic of Congo (DR Congo), Ethiopia, Ghana, Pakistan, and Philippines.
The Emergency Committee reviewed the data on wild poliovirus (WPV1) and circulating vaccine derived polioviruses (cVDPV). The WHO Secretariat presented a report of progress for affected IHR States Parties subject to Temporary Recommendations.
Wild poliovirus
The Committee remains gravely concerned by the significant increase in WPV1 cases globally in 2019 and 2020, with 175 cases in 2019 compared to 33 in 2018, and already 32 cases as at 17 March 2020, compared to six for the same period in 2019, with no
significant success yet in reversing this trend.
In Pakistan transmission continues to be widespread, as indicated by both acute flaccid paralysis (AFP) surveillance and environmental sampling. While the issues of vaccine hesitancy and refusals by individuals and communities and problems with management
of the national polio program are being addressed, these are yet to have impact on the current worrying epidemiology. The added pressure on the program due to detection of cVDPV2 and ongoing spread in several provinces (see below) has continued
into 2020.
In Afghanistan, the security situation remains very challenging. Inaccessibility and missed children particularly in the Southern Region have led to a large cohort of susceptible children in this part of Afghanistan. The risk of a major upsurge
of cases is growing, with other parts of the country that have been free of WPV1 for some time now at risk of outbreaks. This would again increase the risk of international spread.
The Committee noted that based on sequencing of viruses, there were recent instances of international spread of viruses from Pakistan to Afghanistan and also from Afghanistan to Pakistan. The recent increased frequency of WPV1 international
spread between the two countries suggests that rising transmission in Pakistan and Afghanistan correlates with increasing risk of WPV1 exportation beyond the single epidemiological block formed by the two countries.
The Committee noted the continued cooperation and coordination between Afghanistan and Pakistan, particularly in reaching high risk mobile populations that frequently cross the international border and welcomed the all-age vaccination now being taken
at key border points between the two countries.
Vaccine derived poliovirus (VDPV)
The multiple cirulating VDPV (cVDPV) outbreaks in four WHO regions (African, Eastern Mediterranean, South-east Asian and Western Pacific Regions) are very concerning, with two new countries reporting outbreaks since the last meeting (Malaysia and Burkina
Faso). Unlike historical experience, cross border spread of cVDPV2 has become quite common, with recent spread from Angola to DR Congo and Zambia, and from Chad and CAR to Cameroon, and from Ghana to Burkina Faso. In addition, local emergences
attributable to mOPV2 use have recently occurred in Togo, Chad and Ethiopia.
The Committee noted that the GPEI has published a strategy to address cVDPV2 outbreaks but was extremely concerned that the monovalent OPV2 stockpile was still depleted. The Committee strongly supports the development and proposed Emergency Use
Listing of the novel OPV2 vaccine which should become available mid-2020, and which it is hoped will result in no or very little seeding of further outbreaks.
Impact of COVID-19
The Committee noted the very recent policy guidance of the GPEI:
GPEI recommendations for countries during the COVID-19 pandemic. This document summarizes the recommendations from the Polio Oversight Board meeting on 24 March 2020 which calls for postponement of both preventive and outbreak response campaigns,
while ensuring surveillance and nOPV2 development and roll out plans continue in full.
The COVID-19 Polio programme continuity plan. The operational guide was developed in collaboration with the regional polio eradication teams and the GPEI Partners to ensure essential GPEI functions continue, polio programme personnel and staff are
kept safe, and to plan for a fast and effective resumption of polio eradication activities including supplementary immunization activities as soon as the public health situation with COVID-19 allows.
The Committee is extremely concerned about the impact of the COVID-19 pandemic on the risk of heightened transmission of polio and consequently the potential for international spread and significant reversal of polio eradication.
Conclusion
The Committee unanimously agreed that the risk of international spread of poliovirus remains a Public Health Emergency of International Concern (PHEIC) and recommended the extension of Temporary Recommendations for a further three months. However
noting that some if not many international borders are closed to prevent international spread of COVID-19, State Parties may not currently be able to enforce the Temporary Recommendations in all places. The Committee strongly urges countries
subject to these recommendations to maintain a high state of readiness to implement them as soon as possible ensuring the continued safety of travelers as well as health professionals . The Committee recognizes the concerns regarding the lengthy
duration of the polio PHEIC, but concludes that the current situation is extraordinary, with clear ongoing risk of international spread and ongoing need for coordinated international response. The Committee considered the following factors in reaching
this conclusion:
Rising risk of WPV1 international spread: The progress made in recent years appears to have reversed, with the Committee’s assessment that the risk of international spread is at the highest point
since 2014 when the PHEIC was declared. This risk assessment is based on the following:
the WPV1 exportation in 2019 from Pakistan to Iran and to Afghanistan, and more recently spread from Afghanistan to Pakistan;
ongoing rise in the number of WPV1 cases and positive environmental samples in Pakistan, and to a lesser extent Afghanistan;
the quickly increasing cohort of unvaccinated children in Afghanistan, with the risk of a major outbreak imminent if nothing is done to access these children;
the urgent need to overhaul the leadership and strategy of the program in Pakistan, which although already commenced, is likely take some time to lead to more effective control of transmission
and ultimately eradication;
increasing community and individual resistance to the polio program.
Rising risk of cVDPV international spread: The clearly documented increased spread in recent months of cVDPV2 demonstrate the unusual nature of the current situation, as international spread of cVDPV
in the past has been very infrequent. The number of new emergences of cVDPV2 in Africa raises further concern. The risk of new outbreaks in new countries is considered extremely high, even probable.
COVID-19: This new and unprecedented pandemic is likely to substantially negatively impact the polio eradication program and outbreak control efforts. There is a risk of exportation of both
WPV1 and cVDPV to known high risk countries, to which it may take a lot of time and effort to adequately respond.
Falling PV2 immunity: Global population mucosal immunity to type 2 polioviruses (PV2) continues to fall, as the cohort of children born after OPV2 withdrawal grows, exacerbated by poor coverage
with IPV particularly in some of the cVDPV infected countries.
Multiple outbreaks: The evolving and unusual epidemiology resulting in rapid emergence and evolution of cVDPV2 strains is extraordinary and not yet fully understood and represents an additional risk
that is yet to be quantified.
Weak routine immunization: Many countries have weak immunization systems that can be further impacted by various humanitarian emergencies including COVID19, and the number of countries in which immunization
systems have been weakened or disrupted by conflict and complex emergencies poses a growing risk, leaving populations in these fragile states vulnerable to outbreaks of polio.
Surveillance gaps: The appearance of highly diverged VDPVs in the Philippines, Somalia and Indonesia are examples of inadequate polio surveillance, heightening concerns that transmission could be missed
in various countries. Furthermore, the missed transmission in China for a year illustrates that even countries with generally good surveillance can miss VDPV transmission. COVID-19 is likely to have a negative impact on polio surveillance
also.
Lack of access: Inaccessibility continues to be a major risk, particularly in several countries currently infected with WPV or cVDPV, i.e. Afghanistan, Nigeria, Niger, Somalia and Myanmar, which all
have sizable populations that have been unreached with polio vaccine for prolonged periods.
Population movement: The risk is amplified by population movement, whether for family, social, economic or cultural reasons, or in the context of populations displaced by insecurity and returning refugees.
There is a need for international coordination to address these risks. A regional approach and strong crossborder cooperation is required to respond to these risks, as much international spread of polio occurs over land borders.
Risk categories
The Committee provided the Director-General with the following advice aimed at reducing the risk of international spread of WPV1 and cVDPVs, based on the risk stratification as follows:
States infected with WPV1, cVDPV1 or cVDPV3, with potential risk of international spread.
States infected with cVDPV2, with potential risk of international spread.
States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV.
Criteria to assess States as no longer infected by WPV1 or cVDPV:
Poliovirus Case: 12 months after the onset date of the most recent case PLUS one month to account for case detection, investigation, laboratory testing and reporting period OR when all reported AFP cases with onset within 12 months of last case have been tested for polio and excluded for WPV1 or cVDPV, and environmental or other samples collected within 12 months of the last case have also tested negative, whichever is the longer.
Environmental or other isolation of WPV1 or cVDPV (no poliovirus case): 12 months after collection of the most recent positive environmental or other sample (such as from a healthy child) PLUS one month to account for the laboratory testing and reporting period
These criteria may be varied for the endemic countries, where more rigorous assessment is needed in reference to surveillance gaps (e.g. Borno State, Nigeria)
Once a country meets these criteria as no longer infected, the country will be considered vulnerable for a further 12 months. After this period, the country will no longer be subject to Temporary Recommendations, unless the Committee has concerns based on the final report.
TEMPORARY RECOMMENDATIONS
States infected with WPV1, cVDPV1 or cVDPV3 with potential risk of international spread
WPV1
Afghanistan (most recent detection 25 February 2020)
Pakistan (most recent detection 2 March 2020)
Nigeria (most recent detection 27 Sept 2016)
cVDPV1
Malaysia (most recent detection 26 October 2019)
Myanmar (most recent detection 9 August 2019)
Philippines (most recent detection 28 October 2019)
These countries should:
Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained as long as the response is required.
Ensure that all residents and longterm visitors (i.e. > four weeks) of all ages, receive a dose of bivalent oral poliovirus vaccine (bOPV) or inactivated poliovirus vaccine (IPV) between four weeks and 12 months prior to international travel.
Ensure that those undertaking urgent travel (i.e. within four weeks), who have not received a dose of bOPV or IPV in the previous four weeks to 12 months, receive a dose of polio vaccine at least by the time of departure as this will still provide benefit, particularly for frequent travelers.
Ensure that such travelers are provided with an International Certificate of Vaccination or Prophylaxis in the form specified in Annex 6 of the IHR to record their polio vaccination and serve as proof of vaccination.
Restrict at the point of departure the international travel of any resident lacking documentation of appropriate polio vaccination. These recommendations apply to international travelers from all points of departure, irrespective of the means of conveyance (e.g. road, air, sea).
Further intensify crossborder efforts by significantly improving coordination at the national, regional and local levels to substantially increase vaccination coverage of travelers crossing the border and of high risk crossborder populations. Improved coordination of crossborder efforts should include closer supervision and monitoring of the quality of vaccination at border transit points, as well as tracking of the proportion of travelers that are identified as unvaccinated after they have crossed the border.
Further intensify efforts to increase routine immunization coverage, including sharing coverage data, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication.
Maintain these measures until the following criteria have been met: (i) at least six months have passed without new infections and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the above assessment criteria for being no longer infected.
Provide to the Director-General a regular report on the implementation of the Temporary Recommendations on international travel.
States infected with cVDPV2s, with potential or demonstrated risk of international spread
Afghanistan (most recent detection 8 January 2020)
Angola (most recent detection 9 February 2020)
Benin (most recent detection 9 December 2020)
Burkina Faso (most recent detection 11 January 2020)
Cameroon (most recent detection 30 January 2020)
CAR (most recent detection 5 February 2020)
Chad (most recent detection 5 February 2020)
Cote d’Ivoire (most recent detection 11 February 2020)
China (most recent detection 25 April 2019)
DR Congo (most recent detection 22 January 2020)
Ethiopia (most recent detection 21 February 2020)
Ghana (most recent detection 28 January 2020)
Malaysia (most recent detection 18 January 2020)
Niger (most recent detection 3 April 2019)
Nigeria (most recent detection1 January 2020)
Pakistan (most recent detection 12 February 2020)
Philippines (most recent detection 16 January 2020)
Somalia (most recent detection 4 February 2020)
Togo (most recent detection 10 January 2020)
Zambia (most recent detection 25 November 2019)
These countries should:
Officially declare, if not already done, at the level of head of state or government, that the interruption of poliovirus transmission is a national public health emergency and implement all required measures to support polio eradication; where such declaration has already been made, this emergency status should be maintained.
Noting the existence of a separate mechanism for responding to type 2 poliovirus infections, consider requesting vaccines from the global mOPV2 stockpile based on the recommendations of the Advisory Group on mOPV2.
Encourage residents and longterm visitors to receive a dose of IPV four weeks to 12 months prior to international travel; those undertaking urgent travel (i.e. within four weeks) should be encouraged to receive a dose at least by the time of departure.
Ensure that travelers who receive such vaccination have access to an appropriate document to record their polio vaccination status.
Intensify regional cooperation and crossborder coordination to enhance surveillance for prompt detection of poliovirus, and vaccinate refugees, travelers and crossborder populations, according to the advice of the Advisory Group.
Further intensify efforts to increase routine immunization coverage, including sharing coverage data, as high routine immunization coverage is an essential element of the polio eradication strategy, particularly as the world moves closer to eradication.
Maintain these measures until the following criteria have been met: (i) at least six months have passed without the detection of circulation of VDPV2 in the country from any source, and (ii) there is documentation of full application of high quality eradication activities in all infected and high risk areas; in the absence of such documentation these measures should be maintained until the state meets the criteria of a ‘state no longer infected’.
At the end of 12 months without evidence of transmission, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.
States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV
WPV1
none
cVDPV
Kenya cVDPV2 (last env positive specimen 21 March 2018)
Mozambique cVDPV2 (last virus detected 17 December 2018)
PNG cVDPV1 (last environmental positive specimen 6 November 2018)
Indonesia cVDPV1 (last virus detected 13 February 2019)
These countries should:
Urgently strengthen routine immunization to boost population immunity.
Enhance surveillance quality, including considering introducing supplementary methods such as environmental surveillance, to reduce the risk of undetected WPV1 and cVDPV transmission, particularly among high risk mobile and vulnerable populations.
Intensify efforts to ensure vaccination of mobile and crossborder populations, Internally Displaced Persons, refugees and other vulnerable groups.
Enhance regional cooperation and cross border coordination to ensure prompt detection of WPV1 and cVDPV, and vaccination of high risk population groups.
Maintain these measures with documentation of full application of high quality surveillance and vaccination activities.
At the end of 12 months without evidence of reintroduction of WPV1 or new emergence and circulation of cVDPV, provide a report to the Director-General on measures taken to implement the Temporary Recommendations.
Additional considerations
Impact of COVID-19 on the polio program:
The committee urges all countries, but particularly those at high risk of polio, to maintain a high level of polio surveillance throughout the pandemic period, noting that the postponement of polio immunization campaigns whether preventive or in response to outbreaks may lead to an increase in polio transmission including international spread. Maintainenance of access to laboratory diagnosis in the face of widespread transport and shipping disruption is critical.
Secondly, countries affected by campaign postponement should strive to maintain a high degree of operational readiness in order that immunization activities, including border vaccination, can resume quickly adhering to principles of good hygiene and safety for the vaccinee as well as for the health professionals to prevent COVID-19 spread. This includes ensuring teams have access to appropriate personal protective equipment.
Given the risk of international spread, countries need to ensure that they are ready to use appropriate vaccines, as recommended by the Strategic Advisory Group of Experts on Immunization, in response to new outbreaks.
The committee urged countries to maximize the use of polio assets to synergistically address the COVID19 pandemic, noting that polio affected countries may be vulnerable to poorer outcomes in the pandemic due to health care system fragility and poorer health status of the population generally.
Lastly the pandemic should serve as a reminder to high risk countries with poor immunization coverage that infectious disease outbreaks can lead to social and economic disruption as well as straining the health care system, and countries can increase their population resilience and recovery through prioiritising robust immunization programmes. This is relevant not only to polio, but to all other vaccine preventable diseases particularly measles.
Based on the current situation regarding WPV1 and cVDPV, and the reports provided by affected countries, the Director-General accepted the Committee’s assessment and on 7 April 2020 determined that the situation relating to poliovirus continues to constitute a PHEIC, with respect to WPV1 and cVDPV. The Director-General endorsed the Committee’s recommendations for countries meeting the definition for ‘States infected with WPV1, cVDPV1 or cVDPV3 with potential risk for international spread’, ‘States infected with cVDPV2 with potential risk for international spread’ and for ‘States no longer infected by WPV1 or cVDPV, but which remain vulnerable to re-infection by WPV or cVDPV’ and extended the Temporary Recommendations under the IHR to reduce the risk of the international spread of poliovirus, effective 7 April 2020.
Read More
https://www.who.int/news-room/detail/08-04-2020-statement-of-the-twenty-fourth-ihr-emergency-committee
The COVID-19 pandemic is having a devastating impact across the world. Efforts to contain the coronavirus are vital to the
health of the world’s population, but they are also exposing children to increased risk of violence – including maltreatment,
gender-based violence and sexual exploitation.
As leaders of organisations committed to ending violence against children, we come together in solidarity to share our deep
concern, call for action and pledge our support to protect children from violence and reduce the impact of COVID-19 on
children in every country and community.
A third of the global population is on COVID-19 lockdown, and school closures have impacted more than 1.5 billion children.
Movement restrictions, loss of income, isolation, overcrowding and high levels of stress and anxiety are increasing the
likelihood that children experience and observe physical, psychological and sexual abuse at home – particularly those
children already living in violent or dysfunctional family situations. And while online communities have become central to
maintain many children’s learning, support and play, it is also increasing their exposure to cyberbullying, risky online behavior
and sexual exploitation.
The situation is aggravated by children’s lack of access to schoolfriends, teachers, social workers and the safe space and
services that schools provide. The most vulnerable children – including refugees, migrants, and children who are internally
displaced, deprived of liberty, living without parental care, living on the street and in urban slums, with disabilities, and living
in conflict-affected areas – are a particular concern. For many, growing economic vulnerability will increase the threat of child
labour, child marriage and child trafficking.
We must act now. Together, we call on governments, the international community and leaders in every sector to urgently
respond with a united effort to protect children from the heightened risk of violence, exploitation and abuse as part of the
broader response to COVID-19.
Governments have a central role to play. They must ensure that COVID-19 prevention and response plans integrate age
appropriate and gender sensitive measures to protect all children from violence, neglect and abuse. Child protection services
and workers must be designated as essential and resourced accordingly.
Working with and supporting governments, our collective response must include: maintaining essential health and social
welfare services, including mental health and psychosocial support; providing child protection case management and
emergency alternative care arrangements; ensuring social protection for the most vulnerable children and households;
continuing care and protection for children in institutions; and communicating with and engaging parents, caregivers and
children themselves with evidence-based information and advice. National helplines, school counsellors and other child-friendly
reporting mechanisms enable children in distress to reach out for help, and must be adapted to the challenges of COVID-19.
Given the heightened risks of online harms, technology companies and telecoms providers must do everything they can
to keep children safe online. This includes providing access to cost-free child helplines, age-appropriate services and safe
e-education platforms – and using their platforms to share child online safety advice. They must also do more to detect and
stop harmful activity against children online, including grooming and the creation and distribution of child sexual abuse
images and videos.
As global organisations working to end violence against children, we will continue to advocate for and invest in effective child
protection solutions. We will collectively develop and share technical resources and guidance for policymakers, practitioners,
parents, caregivers and children themselves. And we will support the courageous health, child protection and humanitarian
professionals working around the clock to keep children safe during these unprecedented times.
In recent years, the global community has made significant gains in protecting children from violence. We must not allow those
gains to be lost during the current turmoil. We must do all we can to keep children safe now. And we must plan ahead together,
so that once the immediate health crisis is over, we can get back on track towards the goal of ending all forms of violence,
abuse and neglect of children
Read More
https://www.who.int/news-room/detail/08-04-2020-joint-leader-s-statement—violence-against-children-a-hidden-crisis-of-the-covid-19-pandemic
Does a cell surface protein explain why the coronavirus is more likely to kill people with diabetes or heart disease? Researchers are trying to find out Read More
https://www.newscientist.com/article/mg24632773-500-does-the-ace2-protein-explain-covid-19-risk-for-underlying-conditions/?utm_campaign=RSS%7CNSNS&utm_source=NSNS&utm_medium=RSS&utm_content=home
WASHINGTON: The new coronavirus isn’t biased about who it infects – so why does data emerging from some states suggest that African Americans are bearing the brunt of the pandemic in the US?
Experts say blacks are disproportionately impacted by underlying health conditions linked to poverty, face discrimination in medical care, and are more likely to work jobs that require them to leave their home.
“We know that blacks are more likely to have diabetes, heart disease, lung disease,“ the nation’s top doctor, Surgeon General Jerome Adams told CBS News on Tuesday.
These chronic illnesses, which are in turn linked to poverty and structural racism, can lead to more serious forms of the COVID-19 disease.
Adams, who is himself black and has high blood pressure and asthma, added: “I represent that legacy of growing up poor and black in America.
“And I, and many black Americans, are at higher risk for COVID.”
– Emerging trend –
There is no nationwide data available on COVID-19 cases by race, but a pattern of over-representation by black Americans has emerged in states or jurisdictions that are sharing the numbers.
Sixty-eight percent of coronavirus deaths in Chicago have been among African Americans, who make up just 30 percent of the city’s population.
“Those numbers take your breath away,“ the city’s mayor Lori Lightfoot said Monday at a coronavirus briefing. “This is a call to action for all of us.”
The trend is repeated in North Carolina, Louisiana, Michigan, Wisconsin and the capital Washington.
Doctor Georges Benjamin, executive director of the American Public Health Association, told AFP the issue was also linked to social class, with black people more likely to work jobs deemed essential that expose them to potential infection.
“That population is more public facing,“ he said. “More bus drivers, more people taking public transportation to work, more people providing services in nursing homes, more folks working in grocery stores.”
– Structural bias –
The problem is compounded by implicit and explicit bias that African Americans face in the medical system.
Doctor James Hildreth, president of the historically black Meharry Medical College in Nashville, Tennessee told AFP that in his city, most of the initial testing took place at Vanderbilt University Medical Center.
Most of the patients who go to hospital systems like these have insurance, and it was only recently that three assessment centers run by the city of Nashville were built for the underprivileged and minority communities — one of them located at Meharry’s campus and run by its staff.
“My point is, depending on which community you live in, and whether or not you have insurance… the chances for getting assessed are much less,“ he said.
What’s more, it’s well documented that when black people seek care, they are less likely to have their symptoms believed or get adequately treated, Doctor Ebony Hilton, an anesthesiologist at the University of Virginia Medical Center told AFP.
For example, black women are less likely to have their breast cancer mammograms seen by a specialist as opposed to a general radiologist, according to a 2015 Duke University study.
Black heart patients who present with elevated levels of a group of proteins indicating cardiac injury are also less likely to be seen by specialists, per a 2018 study.
A civil rights group wrote this week to the US health secretary, Alex Azar, calling on him to “release daily racial and ethnic demographic data related to COVID-19 testing, disease burden and patient outcomes.”
This, said the Lawyers’ Committee for Civil Rights Under Law, was necessary to ensure a robust public health response, and to make certain care and testing aren’t being administered in a discriminatory manner.
The group said the Centers for Disease Control and Prevention (CDC) was already collecting the information but deliberately withholding it.
Hilton stressed that it was in the interests of Americans as a whole to address the problem, because — unlike high rates of heart disease or cancer — a wave of coronavirus spreading through the black and Hispanic population will ultimately impact everyone else.
“When you have a system that’s not treating these people of lower social economic status and these minority groups, they are then not being tested, they’re sent back home to infect their community,“ she said.
“Those workers who are now infected are going to the grocery store, and when the upper echelon of America are going to get their food, they will get infected too.” – AFP
Read More
https://www.thesundaily.my/world/why-african-americans-are-dying-at-higher-rates-from-covid-19-HX2231768
Originally broadcast live on 06 April 2020, the daily press briefing on coronavirus COVID-19, direct from WHO Headquarters, Geneva Switzerland with Dr Tedros WHO Director-General, Dr Micheal Ryan, Executive Director of the Health Emergencies Programme, and Dr Maria Van Kerkhove, Technical lead, WHO Health Emergencies Programme with special guests Lady Gaga and Hugh Evans, CEO and Co-founder of Global Citizen.
Transcript:
Speaker key:
TJ Tarik Jasarevic
TAG Dr Tedros Adhanom Ghebreyesus
LG Lady Gaga
HE Hugh Evans
MR Dr Michael Ryan JA Jamie
MK Dr Maria Van Kerkhove KA Kai
KT Kate
IN Innocent
YA Yang
00:00:19
TJ Good evening to everyone from Geneva and WHO headquarters. Welcome to the regular press conference on COVID-19. Journalists who are online can ask their questions by clicking raise hand if you are
on Zoom. Today we have a special guest but I will let Dr Tedros do his opening remarks and introduce them. Before I give the floor to Dr Tedros, just to remind you, we will also be sending you some news from other
WHO offices around the world with the audio file from this press briefing a little bit later. I give the floor immediately to Dr Tedros.
00:01:07
TAG Good morning, good afternoon and good evening. The COVID-19 pandemic continues to take a heavy toll on families, communities and nations the world over but it’s also giving rise to incredible acts of generosity,
solidarity and co-operation. We have said consistently that we’re all in this together and we can only succeed together. We need an all- of-society approach with everyone playing their part. That includes people in the entertainment
industry.
Today I’m very delighted to be joined by one of the biggest names in entertainment in the world, Lady Gaga, and my friend Hugh Evans, the founder and CEO of Global Citizen.
WHO has been working with Global Citizen for several weeks on the Together At Home concert series with artists like Chris Martin and John Legend giving free online performances.
Now we’re working with Lady Gaga and Global Citizen to take this concept and make it even bigger through the One World Together At Home virtual global special on Saturday 18th April. It’s now my great pleasure to invite
Lady Gaga and Hugh Evans to say more about this very special event, One World.
00:03:10
LG Thank you very much, Dr Tedros. Good morning, good afternoon and good evening to everyone who’s listening and watching. I would like to thank the World Health Organization and the
United Nations as well as Global Citizen; thank you very much, Dr Tedros and Hugh Evans, for all of your leadership in this fight against COVID-19 and thank you very much to the World Health Organization for asking me to collaborate
with you on this special.
We are also very grateful to all of the healthcare professionals across the country and around the world who are on the front lines during COVID-19. This global pandemic is a catastrophe. I’m so thankful to them and I’m also
praying for those who are sick. It’s been a pleasure to partner with Global Citizen and we’ve been working all together behind the scenes to raise money for the World Health Organization.
I would also like to send my prayers as well to people that are losing their jobs and are having a hard time feeding themselves and their children. We are raising money for the World Health
Organization’s COVID-19 Solidarity Response Fund and seven days ago we held a call with more than 68 corporate leaders from some of the world’s biggest and most generous companies and I asked them to join my corporate kindness
list as there have been many corporations and philanthropists that have been very, very generous during this time.
00:04:38
Since then we have also been calling on philanthropists around the world as well and tech companies included. I’d like to reiterate our deep gratitude to the medical community. My heart is very, very aching and warm for those
who are ER doctors as well as nurses who are sleeping in cars to make sure they don’t infect their families or their patients. What you’re doing is putting yourselves in harm’s way to help the world
and we all salute you and you are a triumph truly.
I am proud to say that over the past seven days we’ve raised a total of $35 million for the Solidarity Fund. This money will [inaudible] essential PPE, supplies and testing kits around the world and will help improve lab capacity
to rapidly process tests. It will also [inaudible] research development. It is so important to think globally and to support the World Health Organization to curb the pandemic and prevent future outbreaks.
I know Dr Tedros is particularly concerned about Africa and [inaudible]. We also need to act globally by supporting local charities and initiatives so that the front-line health workers in most immediate need have the resources they need
to survive during this time. It has been an honour to help with this huge broadcast event, which will take place on April 18th, where we need to tell the stories of and celebrate the front-line community, healthcare workers and their acts of kindness.
We will be on different networks, many networks actually and I want to [inaudible] about what we’re going to be doing. What’s very important is that two things happen for all of us; that we celebrate and we highlight the singular, kind global community
that is arising right now. Two, we want to highlight the gravity of this historically unprecedented cultural movement and, three, we want to celebrate and encourage the power of the human spirit.
00:06:47
I would like to, on behalf of the World Health Organization and Global Citizen, thank Dr Tedros as well as everyone that has donated so far. We are going to continue fundraising but I would like to also let you know that
this broadcast special is not actually a fundraiser. We all wanted to raise the money before we went on air so when we do air live on April 18th put your wallets away, put your credit cards away, anything
away that you need to and just sit back and enjoy the show that you all very much deserve.
I’d like to pass this now to Hugh Evans, who’s been a wonderful partner of mine. Hugh, thank you so much and thank you, Dr Tedros.
HE Good morning, good afternoon, good evening and thank you, Dr Tedros and thank you, Lady Gaga. Your Excellencies, ladies and gentlemen; Lady Gaga, Dr Tedros,
you’ve both demonstrated extraordinary leadership at an unprecedented moment when our society is being challenged like never before and we are so thankful for your leadership. I’d like to echo Lady Gaga’s sentiment and commend the incredible acts
of bravery demonstrated by the front-line community health workers around the world and I hope that we as a shared humanity emerge from this moment forever grateful for the work of doctors, nurses, teachers, grocery store workers and all of those who are
the backbone of our communities.
Global health is at the very core of the global citizen mission and we must ensure that the world’s poorest and most marginalised people have access to resources to cope with and tackle this health crisis. Through One
World: Together At Home on April 18th we’ll be calling on philanthropists, corporations and governments to fund critical global COVID-19 response efforts including distribution of resources and PPE to critical front-line healthcare
workers.
00:09:09
In our partnership with the WHO and United Nations Global Citizen is committed to driving action to help ensure our global health systems are strong enough to stop a future pandemic before it happens. April 18th is going to be a moment of global unity
connecting the world through a historic global broadcast. We are bringing together the greatest artists in the world under the passionate and extremely talented curation of Lady Gaga.
In alphabetical order some of the artists we’ll be announcing today include Alanis Morissette, Andrea Bocelli, Billie Eilish, Billy Joe Armstrong of Green Day, Burna Boy, Chris Martin, Sir David Beckham, Eddie Vedder,
Sir Elton John, Finneas, Idris and Sabrina Elba, J Balvin, John Legend, Kacey Musgraves, Keith Urban, Kerry Washington, Lang Lang, Lizzo, Maluma, Sir Paul McCartney, Priyanka Chopra Jonas, Shah Rukh Khan, Stevie Wonder and many more to be announced over the coming weeks from all corners of the globe under the passionate and extremely talented curation of Lady Gaga.
We’re grateful to all of you for participating and supporting this critical effort. One World Together At Home will be broadcast live on Saturday April 18th 2020 at 5:00pm PDT, 8:00pm EDT and 12:00am BST, airing on ABC, NBC, Viacom and CBS networks,
IHeartMedia, and Bell media networks and platforms in Canada. Internationally BBC1 will run the programme on Sunday April 19th and additional international broadcasters include BN Media Group, Multi-Choice Group and RTE in Ireland.
00:11:43
The digital broadcast will celebrate and support brave community health workers who are doing life-saving work on the front line and we’ve all seen the limitations of world leaders around this world to step up and face this extraordinary challenge
and we want to do our best to support the essential work of the World Health Organization, driving action and raising critical funds. Thank you again, Dr Tedros, and thank you, Lady Gaga, for your leadership.
Thank you all.
TJ Thank you very much to our guests for their remarks. Dr Tedros, I guess you would like to thank them too.
TAG Once again I would like to thank Lady Gaga and Hugh Evans for their partnership. We had a call last week and I was so amazed by the energy and passion of Lady Gaga. It’s incredible commitment to humanity and that’s
when I said, I think what she has planned can happen. It’s bringing the world together to improve awareness and to mobilise resources to fight the pandemic so I thank her for her incredible passion and commitment and leadership and
also to my friend, Hugh Evans, for connecting all the dots and for his leadership.
We all look forward to joining you for the One World: Together At Home concert on 18th April. As the pandemic continues we recognise that individuals and governments want to do everything they can to protect themselves and others and so do we.
We understand that some countries have recommended or are considering the use of both medical and non-medical masks in the general population to prevent the spread of COVID-19.
00:14:21
First and foremost medical masks must be prioritised for health workers on the front lines of the response. We know medical masks can help to protect health workers but they’re in short supply globally. We’re concerned that the mass
use of medical masks by the general population could exacerbate the shortage of these specialised masks for the people who need them most. In some places these shortages are putting health workers in real danger.
In healthcare facilities WHO continues to recommend the use of medical masks, respirators and other personal protective equipment for health workers. In the community we recommend the use of medical masks by people who are sick and those who
are caring for a sick person at home.
WHO has been evaluating the use of medical and non-medical masks for COVID-19 more widely. Today WHO is issuing guidance and criteria to support countries in making that decision. For example countries could consider using masks in communities where other measures such as cleaning hands and physical distancing are harder to achieve because of lack of water or cramped living conditions.
If masks are worn they must be used safely and properly. WHO has guidance on how to put on, take off and dispose of masks. What’s clear is that there is limited research in this area. We encourage countries that are considering the use
of masks for the general population to study their effectiveness so we can all learn. Most importantly masks should only ever be used as part of a comprehensive package of interventions. There is no black or white answer and no silver bullet.
Masks alone cannot stop the pandemic. Countries must continue to find, test, isolate and treat every case and trace every contact. Mask or no mask, there are proven things all of us can do to protect ourselves and others.
00:17:13
Keep your distance, clean your hands, cough or sneeze into your elbow and avoid touching your face. Less than 100 days since WHO was notified about the new coronavirus research has accelerated at incredible speed. The viral genome
was mapped in early January and shared globally, which enabled tests to be developed and vaccine research to start. More than 70 countries have joined WHO’s Solidarity Trial to accelerate the search for an effective treatment and about
20 institutions and companies are racing to develop a vaccine.
WHO is committed to ensuring that as medicines and vaccines are developed they’re shared equitably with all countries and people. I want to thank the Medicines Patent Pool and Unitaid for the initiative they announced last
Friday to include medicines and diagnostics for COVID-19 in their licensing pool.
I also want to thank the President of Costa Rica, President Carlos Alvadaro, and the Health Minister, Daniel Salas, for their proposal to create a pool of rights to tests, medicines and vaccines with free access or licensing on reasonable and affordable
terms for all countries. Muchas gracias, Mr President. I support this proposal and we’re working with Costa Rica to finalise the details.
00:19:09
Poorer countries and fragile economies stand to face the biggest shock from this pandemic and leaving anyone unprotected will only prolong the health crisis and harm economies more. I call
on all countries, companies and research institutions to support open data, open science and open collaboration so that all people can enjoy the benefits of science and research.
Finally we’re nearing the end of the Ebola outbreak in the Democratic Republic of the Congo. This is one piece of good news. If there are no more cases the Government of the Democratic Republic of Congo could declare the outbreak over as early
as this Sunday. We’re not there yet and we remain in full response mode. We’re continuing to investigate alerts and to test samples.
This would not have been possible without the incredible health workers who have put themselves at risk for more than 18 months to stop this outbreak, just as health workers are putting themselves in danger to save lives from COVID-19. Health
workers in DRC faced the double threat of fighting a deadly virus in one of the world’s most dangerous and unstable regions, exposing themselves to Ebola and bullets.
Tomorrow, as you know, is WHO’s birthday, a day we celebrate each year as World Health Day. This year we’re paying tribute to the incredible contribution of all health workers, especially nurses and midwives. Nurses and midwives are the backbone of
every health system. They’re there from the first moments of life to the last. Tomorrow we’re publishing our first report on the state of the world’s nursing which highlights gaps and makes recommendations for all countries.
00:22:00
One of the lessons I hope the world learns from COVID-19 is that we must invest in health workers, not only to protect lives but also to protect livelihoods. I thank you.
TJ Thank you very much, Dr Tedros. Also, as always, we have Dr Mike Ryan and Dr Maria Van Kerkhove, who will be answering questions. We will now open the floor. I will go to one question
that I received by email this morning and I promised to answer; that’s Ankit Kumar from India Today. Ankit is asking; we have recently seen a spike in cases caused through religious gatherings in India, in fact almost a third of new cases
were linked to one gathering in India. We have also seen incidents of violence against health workers due to fear and misinformation. Is WHO concerned with these developments, what is WHO’s message to religious and community leaders and their
followers?
MR First and foremost the idea of violence against health workers is driven by fear and it’s driven by misunderstanding but it’s really unacceptable. We ask everyone and every community to see our health workers
as our heroes and to support them in every way we can.
With regard to gatherings of any type, be they religious or be they for other purposes, there are always risks associated with such gatherings in the midst of a major epidemic. WHO has issued guidance on that. Many of these gatherings
are now postponed or cancelled. We’ve been working very, very closely with religious and faith-based organisations all over the world including groups from the Islamic tradition, Christian
traditions and others and continue to work through faith-based organisations to communicate using our Epiwin platform.
00:24:21
We’re also continuing to develop guidance specifically for the holy month of Ramadan and are working through our Eastern Mediterranean regional office to be able to advise governments and religious institutions on how best to manage
the risks associated with such holy events.
But it’s very important again; having COVID-19 is not anybody’s fault. Every case is a victim and every case needs to be treated with sensitivity, as the health workers who treat them so it’s very important that we’re not profiling COVID-19
along racial, along religious, along ethnic lines. This is not helpful.
TJ Thank you very much. This was a question from Ankit Kumar from India Today. Now we will go to journalists online. We will start with Jamie from Associated Press. Jamie, can you hear us?
JA Hi, yes. Can you hear me? TJ Yes. Please go ahead.
JA Great, thank you very much. I wanted to ask you about… Over the weekend Dr Anthony Fauci mentioned that – if I understood it correctly – as much as 50% of transmission could be asymptomatic. Just aligned
with that, if you could give us a little bit more about what you’re thinking about the fact that some countries have said that this outbreak is more infectious than influenza. The CDC is saying that it’s up
to three times more infectious than influenza so what do you have to say about that? Thanks.
00:26:13
MK I’ll start and then perhaps Mike or DG would like to supplement. The modes of transmission and the way in which this virus is transmitted are of significant interest to all of us. What we are doing is working
with member states, we’re working with everyone that’s affected by this, looking through the research and trying to understand when most transmission is happening, when any transmission is happening.
What we know from reports, what we know from published literature is that the predominant way in which transmission is occurring is amongst symptomatic individuals and these are people that can be very early on in symptoms, even when they start
to feel a little bit unwell. This is supported by some data that attempts to catch a virus from individuals who are symptomatic.
We also know that it’s possible that people can transmit in the few days before they become symptomatic or in their pre-symptomatic phase. There have been some studies that have come out and we learned about this when we were on mission
in China back in January or early February, that there are individuals that can shed virus one to three days before they develop symptoms.
However it’s very important to note that even if you are pre-symptomatic or even if you don’t have any recognised symptoms you still have to transmit through droplets, you still have to have these infectious particles that come out
of your nose and your mouth. So while we know that that is possible we do not believe that it’s a major driver of transmission.
00:27:42
We’ve also seen modelling estimates that suggest that there’re large numbers of unrecognised transmission and I used unrecognised on purpose because I’m not saying asymptomatic. I’m saying that we may be missing people who are out there who are infected
but we’re missing them because of current surveillance strategies. That is certainly possible in many parts of the globe.
Whether or not those individuals are asymptomatic; we will have to wait until we see the results of serologic studies, which we hope we’ll be seeing in the coming days if not weeks.
So what we can say is that most people are transmitting this virus while they are symptomatic.
JA Hi, Jamie. Just in addition because I think – I would never in any way contradict my good friend, Tony Fauci, such an eminent man. There are many different estimations of what might represent asymptomatic
transmission or other infections in the community and we do know and everyone accepts that when the seroepidemiology studies do come online we will probably find more people who’ve been infected unknowingly; there’s no question of that.
The thing we need to address in all of this is very often the idea of severity versus infection and there is a huge association between the dose of exposure and the severity of infection. We see this in many other
infectious diseases so we also probably need to look at who is getting sick and very sick and is the dose and the type of exposure they’re getting different to those who may be exposed and seroconverted in the community.
00:29:26
So it’s not just a matter of looking at how many people in the community are infected but are there specific elements of exposure that cause individuals to have a higher dose of exposure or a specific route of exposure
that causes more severe infection? There is also that concept of infectious dose when we talk about the different types of transmission. If somebody is exposed to a high dose from another individual directly or from a surface that’s
heavily contaminated you can imagine the large dose.
In other circumstances individual particles or virus particles potentially floating through the air; it can be demonstrated that that may happen in certain circumstances, certainly in healthcare settings. But is that significant in
terms of driving infection, is that significant, does that produce an infectious dose that can successfully infect another individual?
These are all very important things that still need to be studied. Again we’re only a number of weeks into this. I think we need to have the seroepi studies. I think we need more information on what is the infectious dose and particularly
the relationship between the dose of exposure or infection and the severity of disease subsequently, which has been seen with many, many other diseases in the past including cholera, Ebola and others.
TJ Thank you very much, Mike and Maria. We will go now to our next question; that’s Kai Kupferschmidt. Kai, can you hear us?
00:31:01
KA Yes, Tarik. Thanks a lot for taking my question. I wanted to ask about the global push to try and find a pre-exposure prophylaxis or a post-exposure prophylaxis. I understand there’re
several trials going on, most of them with chloroquine or hydroxychloroquine. I was just wondering whether you can speak a little bit to what role this could potentially play.
Of course also there’re a lot of smaller studies going on. Is there any way to make sure that they all lead to results that can be proved in the end?
MR Maria can give you more detail but certainly one of the Solidarity trials – I think Solidarity 3 or 4 – we have one of the trials under design which will be a multi-centre study which will look at prophylaxis in healthcare workers to see whether there’s evidence that giving lower doses of drugs like chloroquine or hydroxychloroquine to healthcare workers would reduce their risk of becoming infected in a healthcare environment.
Those studies are certainly underway and again there are a number of those studies underway in smaller studies around the world but again as WHO we’re trying to bring together a larger set of collaborative studies that will give
us the answers we need.
In terms of post-exposure prophylaxis I don’t believe we have at the moment studies planned but Maria can speak to that but there is certainly evidence for the use of – not proven evidence of effectiveness but there are a number
of studies underway and trials underway that use hyperimmune globulin in the treatment of disease; in other words they use that purified plasma of recovered individuals to give an antibody boost to people who are
suffering the disease.
00:32:49
Similar approaches have been used in post-exposure prophylaxis for other diseases but Maria may be aware of studies underway in that area.
MK Only to add that, as you mentioned, there are a number of smaller studies that are happening globally and across a large number of countries. We have teams through our science division and through GOARN,
through the Global Outbreak Alert Network, who are pulling together available literature on a number of topics, one of which is looking at different types of therapeutics and drugs.
The idea is until we can have a study that pulls together enough of a sample size to get these answers to these questions we’re trying to evaluate every piece of evidence that is published so that we can look at the way in
which these studies were done, we can look at the strengths, we can look at the limitations so that can help guide us closer towards an effective treatment for COVID-19.
TJ Thank you very much. The next question is from BFM Radio. Is is Kate who is with us?
KT Yes, hi. Good evening or good morning. I’m from BFM Radio Malaysia. My question is, many countries around the world have imposed lock-downs or some sort of restrictions on movement. I was wondering
what WHO’s guidance would be; what’s the sweet spot, the kind of data that governments need to consider before lifting or relaxing some of these lock- downs? Thank you very much.
00:34:29
MR Thank you. It is a difficulty for governments right now because the lock-downs in many situations are proving effective in dampening the flames of the epidemic in those countries but those
lock-downs are also causing great economic hardship and everybody especially in the developing world needs to get to a more sustainable way of managing this epidemic and controlling COVID-19 without continuing to damage economic and social life.
The transition strategy out of lock-down requires a calibrated, step-wise approach. It would be probably very inadvisable just to lift a complete lock-down, all of the measures because lock-downs are a general term that
include closure of schools, closure of churches, stay-at- home orders, closure of workplaces. It’s a mixture of different things and I think each government needs to break out, what does our lock-down actually constitute, what are the elements
of our lock-down, where is that happening in the country, do we now understand the epidemiology of the disease in each area in which we have an element of lock-down or shut- down.
Then to chart the path out, you have to build strong public health capacity to take over from the lock-down. In other words the lock-down is pushing the disease down by putting people back in their homes, by separating communities. Once you raise
the lock-down you have to have an alternative method to suppress the infection. The way to do that is active case finding, testing, isolation of cases, tracking of contacts, quarantining of contacts and strong community education and
participation and ownership around normal physical distancing, hygiene and giving communities the power to control infection by in effect managing their own physical distance, managing their own capacities to support the response.
00:36:32
In that situation, if you’ve strong public health capacity, if you’ve got a community that’s mobilised and empowered and if you’ve strengthened your health system then you’re potentially in a position to start unlocking or unwinding the lock-down.
The specific parameters you need to be looking at are on two sides.
One is, it would be very inadvisable to lock down [sic] if the number of cases coming through the hospital is already at a level where your occupancy of beds is nearly at 100%. You need to be in a position where
you now have free beds in your system so that you’re managing and coping with the caseload and that means you have some absorption capacity left.
You need to look at things like the doubling rate; how many days does it take for the number of cases to double? You need to look at positivity rates; what proportion of all samples that we test are positive? You’ll see in
somewhere like Korea two to 6% of the samples they test are positive. Last week in New York 37% of tested samples were positive so you need to carefully look at what proportion of people you test are positive.
00:37:45
You need to look at the number of contacts that are generated per case and it goes on and on and WHO will be issuing guidance to countries that is a much more specific around the parameters they should be looking at. There are no absolutes here, there
are no answers, there are no numbers that say if this number is this then you do that. That doesn’t exist but what we can do is offer countries very specific measurements that they need to look at to chart the path out of lock-down.
That step-wise approach of unlocking somewhat and then waiting to see; I think you need to say, we will stop doing this element of the shut-down and then we will wait and we will look at the data and if that works we go to the next
stage and the next stage. So a careful, calibrated, step-wise exit from lock-down with putting in place public health capacities, putting in place community capacity, building the capacity of the health system to cope should the disease bounce back up; that’s the safe path out of lock-down.
We want to achieve it as quickly as possible and we want to avoid many countries going into that circumstance and we still have many countries around the world who are not in a locked- down situation. In fact their epidemiology would suggest
they can avoid the worst of this and we need to support them to avoid them going into that situation.
The most damaging lock-downs are in many developing countries where people – as the DG has said many times – can live from hand to mouth, not from pay cheque to pay cheque but from day to day and we have to find adaptive solutions
around lock-down and around disease control in vulnerable periurban populations living in poverty, in poor rural communities. We have to find alternative, adapted ways to manage lock-downs or slow-downs or shut-downs in
those situations.
00:39:41
TJ Thank you very much. This was Kate from BFM Radio in Malaysia. Now we will go to Nigeria to Natural Star and it’s Innocent. Innocent, can you hear us?
IN Thank you. Can you hear me?
TJ Not very well but we will try. Please go ahead.
IN Okay, thank you for taking my questions. I have two questions to ask. One; how will WHO assess African countries on what they’ve done concerning the lock-down and management of COVID-19?
Then the second one; there’s news going around that vaccines are to be tested on Africans when they’re developed. How true is that and is there a window that’s in the nearer future when a vaccine will be developed for COVID-19? Thank you.
Hello?
TJ Yes, we are just trying to make sure that we understood the question but we will try. MR I think this is Nigeria. Is it?
TJ Yes.
00:41:08
MR Maria may answer the question around vaccine development. With regard to our general assessment on lock-down – and the Director-General may wish to comment on this because he’s been speaking with many leaders in Africa
and, I believe, spoke with the whole of the African Union leadership and countries late last week so therefore is in a much better position than me to speak about that.
We would characterise so far, Africa’s actually doing well in this response thus far. Countries have essential capacities for testing, many countries are taking strong action and want to really focus on finding cases and doing contact tracing and trying to stop this disease becoming much more extensive given the fact that health systems are not as strong in many countries.
They need support in that though, they need support in testing, they need support with protective gear and they need to be given the resources to be able to mount those types of responses so I would characterise that Africa has not suffered the worst
of this pandemic so far. The worst of it can be avoided with very, very swift action to support those countries in Africa who really do want to take a comprehensive approach to this disease.
With the many vulnerable people including refugees and migrants who live in those countries it is our responsibility to provide that support but, DG, you may wish to speak about your interactions with the African
Union countries.
00:42:46
MK I’ll answer the question around vaccines. What we can say is that there are a number of vaccines that are in development and vaccines will be tested through clinical trials with all ethical considerations
in place in whichever populations are under study with informed consent, with open and transparent communication. This is of the utmost importance, that not only do we have strong, robust scientific evidence
but we ensure that all of the studies that are done are done with appropriate and the highest level of ethical considerations.
One thing on the first question around Africa is that there are a number of countries in Africa right now which have very few cases and Mike has alluded to this in his earlier response.
Some only have imported cases and there is an opportunity here, this window of opportunity that the DG has spoken about exists in many countries still. There is an opportunity to prevent the worst from happening
in a number of countries across Africa and across countries that are still seeing their first case; in some island countries.
We need to support those governments, those countries, all of the people in those areas to prevent the worst from happening, to prevent these individual cases from becoming clusters, these clusters from becoming community transmission. I think that’s
where we need to put a lot of emphasis and support so that we can prevent countries from reaching a point where they need to put in these very restrictive movement restrictions.
TAG Thank you. Thank you for that question, my brother from Nigeria. On the situation, as Mike said, of course when you see the number of cases the African continent has the lowest number of cases so far but that doesn’t mean that
the situation will not deteriorate. It may.
00:45:06
So Africa should do everything to prevent this situation from getting worse and that’s why African leaders are doing their best. I had a chance to participate in a meeting, a Leaders’ Coalition which was arranged or invited by the current Chairperson
of the African Union, the President of South Africa, President Ramaphoza and many leaders from all corners of the continent have actually participated.
The main agenda is to have a continental strategy and also make sure that that continental strategy helps the national strategy but in addition to a coalition of political leaders or the heads of state and government they have also agreed to have a coalition of business leaders. Business leaders in Africa are also getting together because Africa will need resources and one of the major problems that was identified during the discussion
was especially shortage of equipment starting from medical equipment, PPE and test kits and so on.
The leaders have agreed to look for concrete solutions to address the problem and they also believe that considering the number of cases we have in the continent testing cases, tracing contacts and isolating them, meaning using the comprehensive approach,
will actually help. They believe that lock-downs alone may not help or the physical distancing alone cannot help and they have agreed to do everything to follow the comprehensive approach.
From WHO’s side we have been supporting and we increased, improved the testing capacity in Africa significantly in the past two months and many countries in Africa have now testing capability although we may have a shortage of test kits but
we’re working on that too and we’re finding different ways of addressing the gap.
00:48:06
But we will support the African Union, we will support the Africa CDC and also we will continue working through our WHO regional office in Congo Brazzaville and continue to support and fight the pandemic together.
Then on the vaccines issue there was, I think, a comment last week from a couple of
scientists who said the testing ground for the new vaccines will be Africa. To be honest, I was so appalled and it was a time when I said, when we needed solidarity these kind of racist remarks actually would not help, it goes against the solidarity.
Africa cannot and will not be a testing ground for any vaccine. We will follow all the rules to test any vaccine or therapeutics all over the world using exactly the same rules. Whether it’s
in Europe, Africa or wherever we will use the same protocol and if there is a need to be tested elsewhere to treat human beings the same way, equally.
The hangover from a colonial mentality has to stop — and WHO will not allow this to happen. It was a disgrace actually and appalling to hear during the 21st century from scientists that kind of remark and we condemn
this in the strongest terms possible but we assure you that this will not happen in Africa and will not happen elsewhere, in any country. Proper protocols will be followed and human beings will be treated as human
beings because we’re all human beings.
00:50:37
Then after saying this the vaccine development; we’re addressing two issues and we will be announcing as soon as possible, hopefully during this week, a big initiative to accelerate the research and development and production of vaccines and also
design mechanisms for equitable distribution of the vaccines.
While we’re looking for vaccines, unless we break the barriers to equitable distribution of the products, whether it’s vaccines or therapeutics, we will have a problem, so we need to address the problem ahead of time, we need to address the problem
of access or challenges to access ahead of time.
That’s why we will put together a mechanism and we will appoint senior people from the North and South that will work out the details on how they can accelerate production but at the same time how they can ensure equitable distribution. Solidarity
is very important here. When a vaccine or a medicine is ready we have to be able to deliver it all over the world.
There should not be a divide between the haves and the have-nots.
If we say solidarity, solidarity should be in its full form and I hope each and every individual, each and every human being will go for that kind of solidarity. I thank you.
TJ Thank you, Dr Tedros. We’ll take a couple more questions. We go to Yang from Xinhua news agency. Yang, can you hear us?
00:52:58
YA Can I hear you?
TJ Yes, we can hear you. Please go ahead.
YA As World Health Day is approaching what do you have to say to the front-line medical workers in China and around the world in the global anti-virus efforts? This question is
for Dr Tedros. Thank you.
TJ If we understood well, the question is what is the message to health workers in China and around the world. Maybe you can repeat the question one more time, please.
YA Okay. As World Health Day is approaching what would you say and what message do you want to deliver to the front-line medical workers in China and around the world in the global anti-virus effort?
TAG I think I have said it earlier; as you know, this is the year of the nurse and the midwife, 2020. We were ready to celebrate it in a big way and it was supposed to be the main event in our
Assembly in mid-May. Unfortunately we’re in this situation but we will be launching a report tomorrow which is the first of its kind. It’s a report on the state of nursing. We will launch it tomorrow during the World Health
Day.
00:55:01
But while launching that report, although it’s about nursing, we will celebrate all health workers, midwives, pharmacists, doctors, you name it. I think the world is now seeing the importance and the central role that health workers play. People,
when they’re asked, of course, to choose they would say health first because it’s only when you’re healthy that you can aspire to anything, whether it’s wealth or fame or anything. It doesn’t matter if you’re not healthy.
If you’re not healthy the first thing you ask for is to get back your health and our health workers are making sure that happens and they’re central and very important for any individual. So not only during COVID but during other times too health
professionals are very important because they are safeguarding that very important aspect of life — that’s health.
So we have to celebrate them every day. Of course during COVID we can see to what extent they’re sacrificing. We have lost many of them. They’re dying while saving lives so my message first is to the public at large; that each and every individual
should recognise, whether it’s during normal times or pandemics like now, the role of health professionals and help them, protect them, really appreciate and respect what they are doing.
To the health workers, although especially during this COVID pandemic you’re working in a difficult situation you should know that your work is the most blessed one, your work is something special to the extent of losing your life
while helping others to live. We respect you and appreciate you for that and we also believe in you and that you will do everything to control this pandemic.
00:58:11
But you should know that you have – and the world understands – the most important job. We can see the humility which is coming from some leaders because of this pandemic. I know they’re seeing, starting from their own lives, the whole world through
a different prism and they will also see your role.
But the most important is not the recognition from the public or from leaders but the internal commitment and passion you have and believing that you’re doing the most blessed thing and you have all our respect and appreciation and we believe in
you, that together we will finish this pandemic. All the respect and appreciation we have to you, the greatest respect and appreciation ever. Thank you.
TJ Thank you very much, Dr Tedros. I think this important message will be heard from everyone and we will conclude this press briefing with these important words from Dr Tedros. We will
have an audio file available in the minutes to come and we invite you for our next briefing on Wednesday. Thank you.
TAG [Inaudible] and see you on Wednesday – tomorrow actually for the launch. Yes, see you tomorrow.
01:00:18
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https://www.who.int/news-room/detail/06-04-2020-virtual-press-conference-on-covid-19–06-april-2020
‘One World: Together At Home’ global special to air on Saturday, 18 April 2020 in celebration and support of healthcare workers, broadcast to feature real experiences from doctors, nurses and families around the world.
Powered by commitments from supporters and corporate partners in benefit of the COVID-19 Solidarity Response Fund, Broadcast special to also benefit local and regional charities that provide food, shelter and healthcare to those that need help most.
Historic broadcast to be hosted by Jimmy Fallon of ‘The Tonight Show,’ Jimmy Kimmel of ‘Jimmy Kimmel Live’ and Stephen Colbert of ‘The Late Show with Stephen Colbert,’ Friends from Sesame Street Also on hand to help unify and inspire people around the world to take meaningful actions that increase support for the global COVID-19 response.
Curated in collaboration with Lady Gaga, broadcast to include Alanis Morissette, Andrea Bocelli, Billie Eilish, Billie Joe Armstrong of Green Day, Burna Boy, Chris Martin, David Beckham, Eddie Vedder, Elton John, FINNEAS, Idris and Sabrina Elba, J Balvin, John Legend, Kacey Musgraves, Keith Urban,Kerry Washington, Lang Lang, Lizzo, Maluma, Paul McCartney, Priyanka Chopra Jonas, Shah Rukh Khan and Stevie Wonder.
——————————————
Geneva/New York – International advocacy organizationGlobal Citizen and the World Health Organization today
announced the One World: Together At Home — a globally televised and streamed special in support of the fight against the COVID-19 pandemic. One World: Together At Home will be broadcast live on Saturday, 18 April 2020 at 5:00
p.m. PDT/8:00 p.m. EDT/12:00 a.m. GMT airing on ABC, NBC, ViacomCBS Networks, iHeartMedia and Bell Media networks and platforms in Canada. Internationally, BBC One will run the program on Sunday 19 April 2020. Additional
international broadcasters include beIN Media Group, MultiChoice Group and RTE. The virtual broadcast will show unity among all people who are affected by COVID-19 and will also celebrate and support brave healthcare
workers doing life-saving work on the front lines.
Hugh Evans, Co-Founder and CEO of Global Citizen, said “As we honor and support the heroic efforts of community health workers, ‘One World: Together At Home’ aims to serve as a source of unity and encouragement in the global fight
to end COVID-19. Through music, entertainment and impact, the global live-cast will celebrate those who risk their own health to safeguard everyone else’s.”
One World: Together At Home will also be a multi-hour digital broadcast streaming online on multiple global platforms, including: Alibaba, Amazon Prime Video, Apple, Facebook, Instagram, LiveXLive, Tencent, Tencent Music Entertainment Group, TIDAL, TuneIn, Twitch, Twitter, Yahoo and YouTube. This digital special will include additional artists and performances from all over the globe as well as unique stories from the world’s healthcare heroes. For information about how to tune in and take action, visit www.globalcitizen.org/togetherathome.
“The World Health Organization is committed to defeating the coronavirus pandemic with science and public health measures, and supporting the health workers who are on the frontlines of the response,” said Dr Tedros Adhanom Ghebreyesus,
Director-General of WHO. “We may have to be apart physically for a while, but we can still come together virtually to enjoy great music. The ‘One World: Together At Home’ concert represents a powerful show of solidarity against
a common threat.”
“The United Nations system is fully mobilized: supporting country responses, placing our supply chains at the world’s disposal and advocating for a global cease-fire. We are proud to join forces with ‘One World: Together At Home’
to help suppress the transmission of the virus, minimize social-economic impacts on the global community and work together now to advance Global Goals for the future,” said António Guterres, Secretary-General of the United Nations.
“There is no greater case for collective action than our joint response to COVID-19 – we are in this together and we will get through this together.”
Last month in response to the global pandemic,Global Citizen launched an urgent campaign in support of the COVID-19 Solidarity Response Fund for WHO, powered by the UN Foundation. Calling on individuals to take action,
and asking world leaders and corporations to support the response with sufficient resources, Global Citizens from over 130 countries around the world have taken tens of thousands of actions in support of the response fund.
At this critical moment in history, Global Citizen is also calling on philanthropists to join and support immediate COVID-19 response efforts as part of the organization’s Give While You Live effort. Investors, changemakers and foundation
leaders are being urged to actualize their giving and invest quickly in related efforts like stronger health systems and vaccine development.
Over the past three weeks, the Together At Home series has featured performances from artists including,
Chris Martin, John Legend, Charlie Puth, Common, Shawn Mendes, Camila Cabello, Ryan Tedder of OneRepublic, Niall Horan, Steve Aoki, Jennifer Hudson, Miguel, H.E.R., Anthony Hamilton, Rufus Wainwright, Hozier and Julianne Hough, among others in
support of WHO and Global Citizen’s campaign.
Commitments from supporters and corporate partners will go to theCOVID-19 Solidarity Response Fund for WHO to support and equip frontline healthcare workers around the world, with masks, gowns and other vital equipment, and to local charities that provide food, shelter, and healthcare to those that need it most. These local groups have been verified
to ensure that they are helping communities impacted by COVID-19.
For more information about Global Citizen and the campaign to support the WHO’s Solidarity Response Fund, please visit globalcitizen.organd
follow @GlblCtzn Twitter, Facebook and Instagram using #GlobalCitizen.
Global Citizen is the world’s largest movement of action takers and impact makers dedicated to ending extreme poverty by 2030. With over 10 million monthly advocates, our voices have the power to drive lasting change around sustainability, equality,
and humanity. We post, tweet, message, vote, sign, and call to inspire those who can make things happen to act — government leaders, businesses, philanthropists, artists, and citizens — together improving lives. By downloading our
app, Global Citizens learn about the systemic causes of extreme poverty, take action on those issues, and earn rewards, which can be redeemed for tickets to concerts, events, and experiences all over the world. To date, the actions of our community,
along with high-level advocacy efforts and work with partners, has resulted in commitments and policy announcements from leaders valued at over $48 billion, affecting the lives of more than 2.25 billion people by 2030. For more information, visit www.GlobalCitizen.org.
About the World Health Organization:
The World Health Organization (WHO) is the United Nations’ specialized agency for health. It is an inter-governmental organization and works in collaboration with its Member States usually through the Ministries of Health. The World Health Organization
is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing
health trends. Learn more at www.who.int.
About the United Nations Foundation:
The UN Foundation brings together the ideas, people, and resources the United Nations needs to drive global progress and tackle urgent problems. To support the work of the World Health Organization (WHO) in its global work on COVID-19, UN Foundation
helped launch the COVID-19 Solidarity Response Fund that has raised more than $100 million in less than two weeks for lifesaving work around the world. Learn more about the COVID-19 Solidarity Response Fund at www.covid19responsefund.org. Learn more about the UN Foundation at www.unfoundation.org.
Follow @unfoundation on Twitter and Instagram, and @United Nations Foundation on Facebook.
—————-
Note to Editors:
Resources donated to the COVID-19 Solidarity Response Fund will be spent in alignment with the WHO Strategic Preparedness and Response Plan and support the work of multiple organizations. These include WHO, for tracking the virus spread, equipping
health workers, making lab and testing tools available, and providing communities and frontline responders with the latest guidance; enabling UNICEF to equip children and families globally with evidence-based guidance to protect them from COVID-19,
providing water, sanitation and hygiene, and basic infection prevention and control measures to vulnerable countries, and caring for vulnerable families and children; and to CEPI, the Coalition for Epidemic Preparedness Innovations, a key partner
leading the financing for research and development for novel vaccines to combat COVID-19.
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https://www.who.int/news-room/detail/06-04-2020-who-and-global-citizen-announce-one-world-together-at-home-global-special-to-support-healthcare-workers-in-the-fight-against-the-covid-19-pandemic
The donation of an essential antiparasitic medicine can potentially accelerate the elimination of Chagas disease infection in children. A pediatric presentation of benznidazole with accurate dosage and will soon be made available freely to address
a long-standing gap in the treatment of congenital infections of Chagas disease.
The donation, by the Mundo Sano Foundation1 and INSud Pharma2 group to the World Health Organization (WHO), is expected to become effective soon.
“Making benznidazole freely available for the treatment of newborns and children until the age of 19 will be a game-changer in the fight against Chagas disease” said Dr Mwelecele Ntuli Malecela, Director, WHO Department of Control
of Neglected Tropical Diseases. “This can save future generations from developing life-threatening and fatal complications and also boost up diagnosis and treatment contributing to congenital Chagas disease elimination.”
The three-year agreement will make available 108 000 tablets of benznidazole3 – one of the two antiparasitic medicines against Chagas disease. Treatment4 with benznidazole in the early stages of infection can cure Chagas
disease, prevent or curb disease progression and prevent congenital transmission in pregnant women.
“We have now added the systematic detection and treatment of all newborns and children under 19 which was not part of our recent switch from control to elimination of congenital Chagas disease” said Dr Pedro Albajar
Vinas, Medical Officer, WHO Department of Control of Neglected Tropical Diseases. “In addition, screening of pregnant women at risk of infection who have not had past antiparasitic treatment provides an excellent opportunity for prevention of posterior transmission throughout pregnancy and birth.”
Each year, an estimated 15 000 children are born from infected mothers.
The agreement
The donation by Mundo Sano Foundation for the duration of the agreement comprises benznidazole:
105,000 tablets of 100mg
3,000 tablets of 12.5mg
Furthermore, the Foundation may donate funds to support activities associated with distribution of medicines and is ready to consider extending this agreement beyond the specified duration of three years.
The disease
Chagas disease, also known as American trypanosomiasis, is a potentially life-threatening illness caused by the protozoan parasite Trypanosoma cruzi (T. cruzi).
Although considerable progress has been achieved, particularly in reducing vector transmission and screening of blood and organ supply, reaching, diagnosing and providing healthcare for people most affected has been a challenge.
Currently, under-diagnosis of Chagas disease cases is as high as 90% and under-diagnosis of congenital and paediatric cases is believed not to be lower.
Globally, an estimated 6-7 million people are infected with T. cruzi.
The disease is found mainly in endemic areas of 21 continental Latin American countries5. But movement of people to urban areas and to other continents has expanded its transmission through non vectorial routes, such as blood transfusion,
congenital transmission, organ transplants and oral transmission through food contamination.
Considering that neglected tropical disease as a growing public health problem in many countries, the World Health Assembly – WHO’s decision-making body – decided in May 2019 to commemorate World Chagas Disease Day on 14 April.
The inaugural celebration happens this year.
1Mundo Sano is a nonprofit international foundation working with the public and private sectors, academia, and other international organizations to provide solutions to the affected communities and generate scientific knowledge.
In 2012, it led a public-private consortium in 2012 to produce benznidazole in Argentina.
2Insud Pharma (formerly known as Chemo Group) specializes in research, development, manufacture, sale and marketing of active pharmaceutical ingredients and medicinal products for human and veterinary use.
3In 2017, the United States Food and Drug Administration (FDA) approved benznidazole for the treatment of children aged 2–12, making it the first treatment approved in the United States for Chagas disease.
4Nifurtimox is also 100% effective in curing Chagas disease if given soon after onset of infection, including cases of congenital infection. It is donated by Bayer who pledged more than 7.5 million tablets for the period 2012-2021.
5Argentina, Belize, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, French Guiana, Guatemala, Guyana, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela
(Bolivarian Republic of).
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https://www.who.int/news-room/detail/02-04-2020-making-available-free-paediatric-medicine-can-accelerate-elimination-of-congenital-chagas-disease
PUTRAJAYA: All Severe Acute Respiratory Infection (SARI) patients should be treated as Covid-19 circumstances till confirmed in any other case, mentioned Health director-general Datuk Dr Noor Hisham Abdullah (pix).
He mentioned 12 healthcare employees have been suspected of contracting Covid-19 after they have been contaminated whereas treating pneumonia or SARI patients.
“So protection is very important for us; our healthcare workers must take precaution … all the necessary precaution to avoid getting the infection (Covid-19),” he mentioned at a each day media briefing on Covid-19 right here right now.
Explaining additional, Noor Hisham mentioned any affected person who failed to present full info when looking for therapy may jeopardise the security of healthcare employees.
“If a patient comes to our hospital and clinic and hides some of the information … then you put the healthcare workers at risk (of being infected with Covid-19),” he mentioned.
He mentioned healthcare employees had been advised to deal with these having cough and chilly with signs of pneumonia as suspected Covid-19 circumstances till investigation confirmed in any other case. — Bernama
Read More
https://www.thesundaily.my/local/all-sari-patients-will-initially-be-treated-as-covid-19-cases-health-dg-MA2211691
KOTA KINABALU: The Sabah authorities in principal will not be permitting Ramadan bazaar all through the state this yr in the trouble to curb the Covid-19 outbreak.
State Secretary Datuk Safar Untong mentioned the ruling was in line with the federal government’s resolution to ban the ‘tamu’ and farmer’s market.
“The state government will make an official announcement (regarding this matter) including the standard operating procedure (SOP), among others, involving every activity to be carried out in the state,” he informed reporters right here, at this time.
Safar mentioned the state authorities was now in the method of finalising the SOP, together with the operation hours of each grocery store in the state, to make sure the outbreak can be completely contained.
“If previously the SOP and the operation hours were not standardised, now we want to standardise them, for example, in supermarkets; every worker and shopper must wear face masks and use the sanitiser,” he mentioned.
Meanwhile, Safar mentioned the Public Works Department (PWD) has been ordered to restore or exchange damaged primary requirements in each quarantine centre in the state.
“Any quarantine centre in Sabah that needs repairs, we will fix them using the state’s government allocation, although the buildings are owned by the Federal government. I am sure PWD is now in process of repairing (broken basic needs in quarantine centres),” he mentioned, in response to a viraled video on social media, which confirmed unsatisfactory situation at a quarantine facility in the state.
A complete of 28 quarantine centres had been established in Sabah to isolate people suspected to be constructive Covid-19 and susceptible to infecting others.
Commenting on quarantine lodging in three-star motels, Safar mentioned Sabah in the intervening time had been utilizing two three-star motels to deal with people who returned from overseas and wanted to bear the 14-day quarantine.
“However the costs will be borne by those involved,” he mentioned, including that the federal government’s quarantine centres had been freed from cost and had meals served. — Bernama
Read More
https://www.thesundaily.my/local/no-ramadan-bazaar-in-sabah-this-year-state-secretary-YB2210023
