We can look back at many things with a smile. There's playing Johnny-on-the-Pony at the corner park, stoop ball, summer nights at Coney Island with your significant other, a great meal at a special cheap restaurant in Chinatown-but one of the most important has to do with the doctor . Remember the house call?
Back in the day receiving a house call was the norm. No one had to trudge to the hospital emergency room or their doctor's office when they were sick. This was unheard of! All you did was make a phone call and the doctor would arrive at an agreed upon time with his or her magical black bag of medical tricks and the healing would commence. How would you like to travel back to those days, the days of the house call?
Just think about the ease of a house call. When a person is ill the last thing they want to do is to schlep across town to see a doctor. No, we much rather be in our warm comfy bed with a cup of tea, a few slices of dry toast, and the television on. So many things have changed over the years it's time we look to the past for some modern conveniences. What type of doctor would travel to you these days?
Well, there are some operations out there. A board-certified doctor will arrive at your home, your hotel (or your job) laden with that big black bag of medical magic to dispense medical advice and / or write a prescription. In other words they will do what it takes to nurse you back to health. And all from the comfort of your own home (hotel or job)!
Is it easy? Sure it is. A personal visit from a board-certified doctor is awaiting you if you want one. In three easy steps you can receive a house call. Number one is to simply dial the doctor's office to explain your medical issues, needs and to arrange a convenient time for the visit. During this time your credit card number will be recorded but it will not be charged until your home visit is completed. Number two is waiting for a quick call back when you will decide if a doctor is needed or if an accredited physician's assistant will do. Number three is simply to sit back and wait for the doorbell to ring!
It's just that easy. A house call doctor can diagnose and treat so many of the same medical problems that he does in his office. So why travel all the way to him when you can receive your own personal house call today? Some things are a no-brainer, this is one of them. If a home visit is in your budget than a home visit makes the most sense of all your options. Say goodbye to the days of spending hours in a waiting room.
Dapagliflozin (Farxiga) is an SGLT2 inhibitor, given in the form of a pill for people who have been diagnosed with Type 2 diabetes and is used along with diet and exercise and sometimes with other medications. It works by making the kidneys secrete more sugar into the urine. According to a study reported on in October of 2018 in the journal Cardiovascular Diabetology, the drug is also helpful for treating heart failure, one complication of Type 2 diabetes.
Heart failure takes place when the left side of the heart is unable to take in blood from the lungs and send it out fast enough to the rest of the body.
The heart is made up of muscle tissue which grows when it is stressed. Inward growth of this muscle makes for a smaller space to accommodate blood flowing in from the lungs. This causes the heart to fail, filling the lungs with fluid from the blood.
In 2017 an estimated 26 million people worldwide had heart failure. In Type 2 diabetes high blood sugar levels damage the heart and blood vessels, and high blood pressure can result. It is vital to bring down the blood pressure reading to a healthy level to lower the strain on the heart. Heart attacks may not cause chest pain in people with Type 2 diabetes because nerve damage reduces sensation. That makes preventing heart disease even more imperative.
Investigators at Kobe University and several other research facilities in Japan looked at 58 people who had Type 2 diabetes and who also had heart failure. Dapagliflozin at a dose of 5 mg / day was added to their usual regimen. After six months the muscle tissue comprising the left side of the diabetic's heart decreased in size. Brain natriuretic peptide (BNP), a protein secreted by the heart cells in response to being stretched too far, lowered in the participants whose BNP was extremely high. From this information, the researchers concluded dapagliflozin could be helpful for improving heart failure in those who have Type 2 diabetes.
The natriuretic peptide is effective in making the kidneys secrete potassium into the kidneys, lowering the blood pressure and the amount of blood in the heart and blood vessels.
Dapagliflozin is given once a day, either with or without food. It is prescribed as part of an overall treatment plan that includes diet and exercise. Side effects include …
urinary tract yeast infections,
a stuffy nose with a sore throat,
frequently urinating in more copious amounts and at night,
About half a billion people worldwide are living with genital herpes, and several billion have an oral herpes infection, new estimates show, highlighting the need to improve awareness and scale up services to prevent and treat herpes.
About 13% of the world’s population aged 15 to 49 years were living with herpes simplex virus type 2 (HSV-2) infection in 2016, the latest year for which data is available. HSV-2 is almost exclusively sexually transmitted, causing genital herpes. Infection can lead to recurring, often painful, genital sores in up to a third of people infected.
Herpes simplex virus type 1 (HSV-1) is mainly transmitted by oral to oral contact to cause oral herpes infection – sometimes leading to painful sores in or around the mouth (“cold sores”). However, HSV-1 can also be transmitted to the genital area through oral sex, causing genital herpes.
Around 67% of the world’s population aged 0 to 49 had HSV-1 infection in 2016 – an estimated 3.7 billion people. Most of these infections were oral; however, between 122 million to 192 million people were estimated to have genital HSV-1
infection.
Genital herpes is a substantial health concern worldwide – beyond the potential pain and discomfort suffered by people living with the infection, the associated social consequences can have a profound effect on sexual and reproductive
health” says Dr Ian Askew, Director of the Department of Sexual and Reproductive Health and Research at the World Health Organization (WHO).
Herpes and HIV
People with HSV-2 infection are at least three times more likely to become infected with HIV, if exposed. Thus, HSV-2 likely plays a substantial role in the spread of HIV globally. Women are more susceptible to both HSV-2 and HIV. Women living in
the WHO Africa Region have the highest HSV-2 prevalence and exposure to HIV – putting them at greatest risk of HIV infection.
No cure: vaccine needed
There is no cure for herpes. Antiviral medications, such as acyclovir, famciclovir, and valacyclovir, can help to reduce the severity and frequency of symptoms but cannot cure the infection.
Better awareness, improved access to antiviral medications and heightened HIV prevention efforts for those with genital HSV symptoms are needed globally. In addition, development of better treatment and prevention interventions is needed, particularly
HSV vaccines.
“A vaccine against HSV infection would not only help to promote and protect the health and well-being of millions of people, particularly women, worldwide – it could also potentially have an impact on slowing the spread of HIV, if developed
and provided alongside other HIV prevention strategies” says Dr Meg Doherty, Director of the WHO Department of Global HIV, Hepatitis, and STI Programmes.
Authored by staff at the University of Bristol, the WHO, and Weill Cornell Medical College-Qatar, and published in the Bulletin of the World Health Organization, this new study estimates the global infection prevalence and incidence of HSV-1 and HSV-2
in 2016.
Read More
https://www.who.int/news-room/detail/01-05-2020-billions-worldwide-living-with-herpes
Virus causing genital herpes may put millions of people at greater risk of infection with HIV
About half a billion people worldwide are living with genital herpes, and several billion have an oral herpes infection, new estimates show.
Authored by staff at the University of Bristol, World Health Organization (WHO), and Weill Cornell Medical College-Qatar, and published in the Bulletin of the World Health Organization,
the new study estimates the global infection prevalence and incidence of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) in 2016.
“Herpes infection affects millions of people across the globe and can have far-reaching health effects. We need more investment and commitment to develop better treatment and prevention tools for this infection.” says Dr Sami Gottlieb, Medical
Officer at WHO and an author of the study.
Prevalence and incidence
An estimated 491.5 million people were living with HSV-2 infection in 2016, equivalent to 13.2% of the world’s population aged 15 to 49 years. HSV-2 is almost exclusively sexually transmitted, causing infection in the genital or anal area (genital
herpes).
An estimated 3.7 billion people had HSV-1 infection during the same year – around 66.6% of the world’s population aged 0 to 49. HSV-1 is mainly transmitted by oral to oral contact to cause infection in or around the mouth (oral herpes). However,
HSV-1 can also be transmitted to the genital area through oral-genital contact – during oral sex – to cause genital herpes. Most HSV-1 infections were oral; however, between 122 million to 192 million people were estimated to have genital
HSV-1 infection, depending on the assumptions used in the estimation model.
Because herpes is a lifelong infection, estimated prevalence increased with age; HSV-2 prevalence was also higher among women and in the WHO African Region.
Health and social impacts
Most people living with herpes, caused by either HSV-1 or 2, are unaware they have the infection.
When symptoms do occur however, oral herpes infection can lead to painful sores around the mouth (“cold sores”). Genital herpes infection can cause recurring, often painful, genital sores, often referred to as genital ulcer disease.
WHO and partners published a study in March 2020 estimating that around 5% of the world’s population (187 million people) suffered from at least one episode of herpes-related genital ulcer disease in 2016 (1). Most of these episodes were due to
HSV-2, which can recur frequently over many years.
Recurrent symptoms of genital herpes can lead to stigma and psychological distress, and can have an important impact on quality of life and sexual relationships. However, in time, most people with herpes adjust to living with the infection.
“Genital herpes is a substantial health concern worldwide – beyond the potential pain and discomfort suffered by people living with the infection, the associated social consequences can have a profound effect on sexual and reproductive health”
says Dr Ian Askew, Director of the Department of Sexual and Reproductive Health and Research at WHO.
Herpes and HIV
A strong association exists between HSV-2 infection and HIV infection. In 2019, WHO commissioned a modeling study to estimate how much HSV-2 infection might contribute to HIV incidence. The study estimated that almost 30% of new sexually acquired HIV
infections in 2016 worldwide were likely attributable to HSV-2 infection (2).
Evidence shows that people with HSV-2 infection are at least three times more likely to become infected with HIV, if exposed. HSV-2 leads to inflammation and small breaks in the genital and anal skin that can make it easier for HIV to cause infection.
In addition, people with both HIV and HSV-2 infection are more likely to spread HIV to others.
Women have higher biologic susceptibility to both HSV-2 and HIV. Women living in the WHO Africa Region have the highest HSV-2 prevalence and exposure to HIV – putting them at greatest risk of HIV infection, with negative implications for their health
and well-being.
For people living with HIV (or who are living with other conditions that compromise their immune systems) as well as HSV-2, the symptoms of herpes can be more severe and more frequent.
Neonatal herpes
Neonatal herpes can occur when an infant is exposed to HSV in the genital tract during delivery. This is a rare condition, occurring in an estimated 10 out of every 100,000 births globally, but can lead to lasting neurologic disability or death. The risk
for neonatal herpes is greatest when a mother acquires HSV infection for the first time in late pregnancy. Women who have genital herpes before they become pregnant are at very low risk of transmitting HSV to their infants.
No cure – better treatment and prevention needed
There is no cure for herpes. At present, antiviral medications, such as acyclovir, famciclovir, and valacyclovir, can help to reduce the severity and frequency of symptoms but cannot cure the infection.
As well as increasing awareness about HSV infection and its symptoms, improved access to antiviral medications and heightened HIV prevention efforts for those with genital HSV symptoms are needed globally.
In addition, development of better treatment and prevention interventions is needed, particularly HSV vaccines. WHO and partners are working to accelerate research to develop new strategies for prevention and control of HSV infections. Such research includes
the development of HSV vaccines and topical microbicides. Several candidate vaccines and microbicides are currently being studied.
“A vaccine against HSV infection would not only help to promote and protect the health and well-being of millions of people, particularly women, worldwide – it could also potentially have an impact on slowing the spread of HIV, if developed
and provided alongside other HIV prevention strategies” says Dr Meg Doherty, Director of the WHO Department of Global HIV, Hepatitis, and STI Programmes.
AGAMIC. Unmarried; unmarriageable, sometimes non-sexed.
AGENIC. Lacking in reproductive power; sterile.
AMPHIMIXIS. That form of reproduction which involves the mingling of substance from two individuals so as to effect a mixture of hereditary characteristics. It includes the phenomena of conjugation and fertilization among both unicellular and multicellular organisms.
ANABOLISM. See METABOLISM.
ANAMNESIC. Pertaining to or aiding recollection.
ANEMIC. Deficient in blood; bloodless.
ANTHROPOMORPHISM. The attributing of human characteristics to natural, supernatural, or divine beings.
ANTHROPOMETRY. Science of measurement of the human body.
ARTIFACT. Any artificial product.
APHASIA. Impairment or lose of the ability to understand or use speech.
ASSOCIATIONISM. The psychological theory which regards the laws of association as the fundamental laws of mental action and development.
ATAVISTIC. Pertaining to reversion through the influence of heredity to remote ancestral characteristics.
ATAXIC. Pertaining to inability to coördinate voluntary movements; irregular.
CALAMO-PAPYRUS. Reed papyrus or pen-paper.
CATABOLISM. See METABOLISM.
CATHARSIS. Purgation or cleansing. Aristotle’s esthetic theory that little renders immune for much.
CEREBRATION. Brain action, conscious or unconscious.
CHOREA. St. Vitus’s dance; a nervous disease marked by irregular and involuntary movements of the limbs and face.
CHRESTOMATHY. A collection of extracts and choice pieces.
CHRISTENTHUM. The Christian belief; the spirit of Christianity.
COMMANDO EXERCISES. Gymnastic exercises whose order is dependent upon the spoken command of the director.
CORTEX. The gray matter of the brain, mostly on its surface.
CORTICAL. Pertaining to the cortex.
CRANIOMETRY. The measurement of skulls.
CRYPTOGAMOUS. Having an obscure mode of fertilization; or, of plants that do not blossom.
CULTUS. A system of religious belief and worship.
DEUTSCHENTHUM. The spirit of the German people.
DIATHESIS. A constitutional predisposition.
EPHEBIC. Pertaining to the Greek system of instruction given to young men to fit them for citizenship; adolescent.
EPIGONI. Successors; followers who only follow.
EPISTEMOLOGY. The theory of knowledge; that branch of logic which undertakes to explain how knowledge is possible and to define its limitations, meaning, and worth.
EUPEPTIC. Having good digestion.
EUPHORIA. The sense of well-being; of fullness of life.
EVIRATION. Emasculation; loss of manly characteristics.
FERAL. Wild by nature; untamed; undomesticated.
FORMICARY. An artificial ants’ nest.
GEMÜTH. Disposition; the entire affective soul and its habitual state.
HEBETUDE. Dullness; stupidity.
HEDONISTIC. Relating to hedonism, that form of Greek philosophy which taught that pleasure is the chief end of existence.
HETAERA. A Greek courtesan. This class was often highly trained in music and social art, and represented the highest grade of culture among Greek women.
HETEROGENY. (1) The spontaneous generation of animals and vegetables, low in the scale of organization, from inorganic elements. (2) That kind of generation in which the parent, whether plant or animal, produces offspring differing in structure or habit from itself, but in which after one or more generations the original form reappears.
HETERONOMOUS. Having a different name.
HOROLOGY. The science of measuring time and of constructing instruments for that purpose.
HYGEIA. The Greek goddess of health; health.
HYPERMETHODIC. Methodic to excess; overmethodic.
HYPERTROPHY. Excessive growth.
INDISCERPTIBLE. Incapable of being destroyed by separation of parts.
INHIBITION. Interference with the normal result of a nervous excitement by an opposing force.
IRRADIATION. The diffusion of nervous stimuli out of the path of normal discharge which, as a result of the excitation of a peripheral end organ may excite other central organs than those directly connected with it.
KINESOLOGICAL. Pertaining to the science of tests and measurements of bodily strength.
KINESOMETER. An instrument for measuring muscular strength.
MEDULLATION. The investment of nerve fibers with a protective covering or medullary sheath, consisting of white, fat-like matter.
MERISTIC. Pertaining to the levels or spinal and cerebral segments of the body.
METABOLISM. The act or process by which, on the one hand, dead food is built up into living matter—anabolism, and by which, on the other, the living matter is broken down into simpler products within a cell or organism—catabolism.
METAMORPHOSIS. Change of form or structure; transformation.
METEMPSYCHOSIS. The doctrine of the transmigration of the soul from one body to another.
MONOPHRASTIC. Pertaining to or consisting of a single phrase.
MONOTECHNIC. Pertaining to a single art or craft.
MORPHOLOGY. The science of form and structure of plants and animals without regard to function.
MYOLOGY. The scientific knowledge of the muscular system.
MYTHOPOEIC. Producing or having a tendency to produce myths.
ORTHOGENIC. Pertaining to right beginning and development.
ORTHOPEDIC. Relating to the art of curing deformities.
OSSUARY. A depository of dry bones.
PALEOPSYCHIC. Pertaining to the antiquity of the soul.
PANTHEISTIC. Relating to that doctrine which holds that the entire phenomenal universe, including man and nature, is the ever-changing manifestation of God, who rises to self-consciousness and personality only in man.
PATRISTICS. That department of study occupied with the doctrines and writings of the fathers of the Christian Church.
PHOBIA. Excessive or morbid fear of anything.
PHYLETICALLY. In accordance with the phylum or race; racially.
PHYLETIC. Pertaining to a race or clan.
PHYLOGENY. The history of the evolution of a species or group; tribal history; ancestral development as opposed to ontogeny or the development of the individual.
PHYLUM. A term introduced by Haeckel to designate the great branches of the animal and vegetable kingdoms. Each phylum may include several classes.
PICKELHAUBE. The spiked helmet of the German army.
PLANKTON. Sea animals and plants collectively; distinguished from coast or bottom forms and floating in a great mass.
POLYGAMIC (LOVE). Pertaining to the habit of having more than one mate of the opposite sex.
POLYPHRASTIC. Having many phrases; pertaining to rambling, incoherent speech.
POST-SIMIAN. Pertaining to an age later than that in which simian or monkey-like forms prevailed.
PRENUBILE. Pertaining to the age before sexual maturity or marriageability is reached.
PRIE DIEU. A praying desk.
PROPEDEUTIC. Preliminary; introductory.
PROPHYLACTIC. Any medicine or measure efficacious in preventing disease.
PSEUDOPHOBIAC. Pertaining to a morbid condition in which the subject is continually in fear of having said something not strictly true.
PSYCHOGENESIS. The origin and development of soul.
PSYCHONOMIC. Pertaining to the laws of mind.
PSYCHOSIS. Mental constitution or condition; any change in consciousness, especially if abnormal.
PUBERTY. The age of sexual maturity.
PUBESCENT. Relating to the dawning of puberty.
PYGMOID. Of pygmy size and form.
RABULIST. A chronic wrangler; one who argues about everything.
SCHEMA. A synopsis; a summary. In the Kantian sense, a general type.
SCHEMATISM. An outline of any systematic arrangement; an outline.
SUPERFOETATION. A second conception some time after a prior one, by which two foetuses of different age exist together in the same female. Often used figuratively.
TEMIBILITY. (From Italian temibile, to be feared.) The principle of adjustment of penalty to crime in just that degree necessary to prevent a repetition of the criminal act.
TIC. A nervous affection of the muscles; a twitching.
TRANSCENDENTAL. In the Kantian system having an a priori character, transcending experience, presupposed in and necessary to experience.
TRAUMATA. Wounds.
TRAUMATISM. A wound; any morbid condition produced by wounds or other external violence.
VERBIGERATION. The continual utterance of certain words or phrases at short intervals, without reference to their meaning, as seen in insane Gedankenflucht or rapid flight of thought.
Extract from Youth: Its Education, Regimen, and Hygiene, by G. Stanley Hall
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
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
KUALA LUMPUR: The Royal Malaysian Air Force (RMAF) at this time flew in medical and health equipment to Sarawak and Sabah for the usage of the states’ front-liners within the wake of the Covid-19 outbreak.
RMAF, in a press release, stated that its A400M plane carried 100 items of aerosol packing containers, further scientific specimen to the Ministry of Health’s (MOH) amenities and Personal Protective Equipment (PPE).
“The aerosol boxes were prepared by a non-governmental organisation, Old Putera of the Royal Military College in two types, namely the ‘Intubation Type’ (used during the endotracheal intubation procedure) and the ‘Sampling Type’ (used during the swabbing procedure).
“The equipment aims to protect the front-liners against droplet transmission from patients,” the assertion stated.
According to the assertion, MOH’s further scientific specimens consisted of the availability of laboratory equipment, prescription drugs, PPEs and essential medical equipment to the State Health Department to be used in health amenities.
The medical equipment is from the MOH, National Security Council (MKN), National Disaster Management Agency (Nadma) and the Malaysian Defense Forces (APM), the assertion stated.
The RMAF will present full assist to the federal government and different companies in coping with the unfold of the Covid-19 outbreak. – Bernama
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https://www.thesundaily.my/local/rmaf-transports-medical-health-equipment-to-sarawak-and-sabah-FJ2209733
KUALA LUMPUR: A complete of 115 folks had been charged in several states in the present day for violating the Movement Control Order (MCO), and aside from administering the customary sentence of imprisonment or a wonderful, one court docket in the present day ordered 24 males to carry out community service.
This different punishment was meted out by the George Town Magistrates Court in PENANG, to the lads aged between 25 and 48, who performed soccer in a discipline in the grounds of the College General, a Catholic seminary right here on March 31 at 5.30pm, in contravention of the continuing MCO imposed by the federal government to include Covid-19.
In accordance with the provisions of the Offenders Compulsory Attendance Act 1954, all 24 who pleaded responsible, are required to report to the Prisons Department which is able to decide the kind of community service to be carried out for 3 hours a day over a three-month interval.
In KUALA LUMPUR, a complete of 22 people had been introduced earlier than Justice of the Peace’s courts throughout the town. They included Pakistani nationwide Mahmood Husaain, 40, who was fined RM2,500, with a three-month jail time period in default, for elevating his voice in direction of cops at a roadblock and for not cooperating with them.
Seven different people aged between 20 and 28, together with a feminine Kyrgyzstan citizen, had been fined between RM500 and RM1,000, with a two-month jail time period in default, for offences corresponding to loitering in a playground and jogging across the metropolis, between March 27 and April 1. Two Indonesian contract staff had been fined for gathering at a spot in Taman Mulia Jaya, Ampang and not using a legitimate purpose.
In NEGRI SEMBILAN, 14 people had been charged. These included 4 under-aged youngsters who had been accused of enjoying soccer with six others, on the Jalan Anggerik soccer discipline in Taman Marida, Senawang on March 29 at 6 pm. Sentencing for the youngsters shall be undertaken after the court docket receives related social reviews on the 4.
In PERAK, 38 people had been charged and these included 12 overseas nationals aged between 17 and 47 years who had been every fined RM1,000 by the Ipoh High Court. At the Kampar Justice of the Peace’s court docket, 12 people had been fined between RM1,000 and RM5,000, and sentenced to jail for between two and 7 months. Two of the offenders had been charged with obstructing a civil servant in the course of conducting his responsibility, and for refusing to furnish id playing cards when questioned by the police.
In MALACCA, 17 males together with 12 foreigners had been fined between RM300 and RM1,000, with two weeks to two months in jail in default, for transferring from one location to one other with out legitimate causes. The foreigners included residents of Pakistan, Nepal, Bangladesh and Myanmar.
In GURUN, six males aged between 23 and 42 years had been fined RM1,000 by the Magistrates Court right here for violating the MCO between March 28 and 30.
One of the lads, aged 23, was additionally charged with an offence below part 12 of the Dangerous Drugs Act 1952 however he was allowed bail of RM4,000, with case point out set for June 18. — Bernama
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https://www.thesundaily.my/local/mco-violations-115-charged-in-several-states-24-sentenced-to-community-service-MD2207097
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