 Good morning everybody, and welcome to another COVID-19 update with the Patient Safety Movement Foundation. I'm Donna Prosser, and I am the Chief Clinical Officer here at the Patient Safety Movement. And we're very excited to be joined today by Dr. Edward Kelly and Dr. Annegret Hanawa. I would love, Dr. Edward Kelly is representing the World Health Organization, and Dr. Annegret Hanawa is an associate professor at the Center for the Advancement of Health Care Quality and Patient Safety. So welcome panelists. Can you hear me? Oh, hi Ed, how are you today? Thank you so much for joining. Can you tell us a little bit about yourself and your background today? Sure. I'll start. Ed Kelly, Director for Integrated Health Services, and that's my peacetime job. And now during the outbreak, I am one of the team leads, or pillar leads as they're called within WHO's response team for the COVID outbreak. Wonderful. Thank you, Ed. And Annegrette, would you introduce yourself for the team, for the network, please? Yes, sure. Hi everyone. I'm Annegret Hanawa. I'm a professor at the University of Lugano, where I direct the Center for Patient Safety and Quality Care at the Faculty of Communications Sciences. Well, thank you. Welcome, both of you today. We're so excited to have you here. So as everybody knows, we are now into week five of our COVID-19 pandemic. And this has devastated the global economy. We don't have to tell anybody that. You can see that all over the news. And unemployment is at all time highs, and that has created a significant amount of depression and anxiety and despair across the world. So we thought it was important to address this topic today to talk about what we can do to mitigate some of this. So before we get started, though, Ed, could you tell us just a little bit about what is happening across the world? What is the World Health Organization seeing happening right now? Yep. Thanks so much, Donna, for that. And again, for the invitation to come and be with you. It's one of these opportunities during the week to reconnect with patient safety colleagues, and it's always good to see the names that are there. And at some level, we're dealing with sort of the world's biggest patient safety crisis ever, I suppose. But it's great to also work with Enigrette over the years in looking at some of the whole bunch of different areas that her team has examined, not the least of which is the sort of mental health impacts of patient safety events, both on providers and patients. So this issue on mental health, staying healthy during the outbreak, and others has been a big theme for WHO and for the Director General, particularly this past week. It's a health crisis, a health systems crisis, with much more on all of society crisis. So I think it's a great opportunity to do that. So maybe, shall I just, Donna, launch in and go through a little bit of background and then it could be a nice framing for Enigrette to take it from there. That would be wonderful. Yes, thank you. And just let me know when you would like for me to advance your slides. Sure. Well, I have some slides that are, I'll spend not so much time explaining, because I think it's better for people to use as a reference point. Sometimes these numbers, they get sort of a little bit mind-numbing. We look at them every day. And I think, you know, in this type of framing where everything sometimes seems like it's just going from bad to worse, it's I think very important to see, you know, to see actually what the data says and to really look at, you know, where the problems are, where the solutions are having an impact. And you can see impact being had in many parts of the world. But just to summarize, you know, this slide gives you a overall impact of a picture of the of the number of cases and number of deaths. But globally, globally, we are, there's been a sort of, if you look across the different regions, there's been an increase in the total number of cases in most regions. The Western Pacific small increase, that's mostly due to Japan, a 6% increase in the Southeast Asia region. These are like by WHO region of the world in the Southeast Asia region. 86% increase, particularly in Bangladesh and India. In Euro, there's been a 40% increase. And this is in the past week. And maybe we can just, yeah, thank you for putting up the map. And in the Eastern Mediterranean, which is the Middle East region, North Africa, there's been a 34% increase in PAHO, an 84% increase. And that's mostly a big increase in the US as people know, but also Brazil and Peru and an Afro of 57% increase. So increases in cases in all areas. But if you look at the percentage of cases that have happened in the last sort of 24 hours, and track that over time, it's just a, you know, things are going up. But as an idea of are they still going up as quickly, the percent that have happened in the last 24 hours has steadily been going down. And the percentage of deaths in the last 24 hours is going down. So this means that at least in terms of the slope of the curve, globally, globally, it's slowing. Now that's not the case in every sort of country or in every municipality, but I pulled out just a few additional numbers, maybe next slide. So this gives you the picture overall across the world. And you can see a big dip in the number of deaths this week. That was due in Italy and Germany and Spain started to dip, but it was quite a bit of a climb in the US that's been countered that a little bit later. And you can see when we now, WHO is in the midst of doing a new strategy for the, that I'll mention later. Our first strategy was done for that orange period. And the first part of the, when we thought we might have a few countries with a hundred plus cases. So it's obviously time for to update that strategy as we head forwards. You can see the growth globally. Next slide, please. This gives you sort of by region. And again, it's the number of cases and then the black line represents the number of deaths. The number of deaths jumps around a lot, but it's a, you know, it's a very different shape in a bunch of places. And just to flag for you, the scales on these are quite different, but it's just really to examine the curve that's there. Whereas, you know, Europe has started to slow in terms of cases. They're still jumping around in terms of going down in terms of deaths. Other regions have gone up, but the death rate's been relatively slow. And then in the US, climbing cases and climbing deaths, but I'd point out that the US has among the lower case fatality rates for COVID. And that's one of the, I think, one of the hardening things, at least for the US, and also a reflection of a number of factors. But we have more detailed information that's coming in terms of the types of, in terms of the types of age and gender breakdowns and other information. Next slide, please. This gives just a little bit of hope for countries that are in advance of the US. You can see things coming down in Spain and Italy, France, the number of cases, a little bit lower, but deaths had jumped a big set of deaths this week. UK, unfortunately, has been going up Turkey. And if you look at Ireland and Sweden had big jumps this week. So it really depends on the country. And you can also, in general, there's been positive feeling that overall across the world that these measures, particularly the physical distancing measures, are having an impact and having a big impact. And it's finally being realized this week. Next slide, please. This I only put in there because I go back and forth between France and Switzerland. Anyway, my daughters want to know when it is that they can see their friends again. So anyway, not probably any time immediately soon, but at least Switzerland is also having numbers go down. Next slide, please. This is just to zoom in just for a second on the Pan-American region, which has the US. And a big majority of those cases are in the US at the moment. That's the graph for Paho. Next slide. And this gives the picture for the different countries that are having some jumps in terms of Canada, Brazil in particular, and Ecuador has had big jumps and deaths. And some of these things are not quite explainable. You can see also the general picture that, and I've talked to a number of countries, even a number of states in the US, where unfortunately, we're just at the point where in terms of test availability, tracking this only by the number of cases globally will just not be possible. I don't want to say that nobody trusts the case figure numbers, but it's quite clear that we're only testing a small number of the people who are out there who actually had the disease. And availability of testing, obviously in Ecuador, you can see the numbers jump all over the place. So those numbers are as much related to testing strategy, quote unquote, as they are to anything else. Many countries and many decision makers, I know, are using hospitalization rates and death rates as two of their key indicators. Next slide. So I'll pause there and just to mention that WCHO is doing a lot of work on sort of not just what's happening with COVID, but also tracking what is the impact on other key services that are out there. And I think this leads very nicely into Annagrette's discussion, and it's quite clear that at one level, for WHO, for instance, it's really not the time for all of the different programs, the malaria program or the cancer program or the diabetes program or the HIV program to get out there and say, look, we need to focus on my disease area because this COVID outbreak is having such a big impact on people's access to those services. That is true, but for WHO as an organization, we need to be able to focus on solving this problem and then to be able to get back to it. We can't take our eye off the ball in terms of the outbreak, but it's really quite true and you hear stories all over the world and the data starting to show that it's having a big impact on people's access, ability to access services, and then even their willingness to go and get services. I think this will give us a big head start in terms of new ways of delivering care, particularly for some chronic conditions, mental health being one of them, but they're all also important to both health and health access questions that maybe be a good handover to Anagrette. So maybe back to you, Donna. Well, thank you so much, Ed. That was an excellent summary and it is quite heartening to see that everybody's efforts at physical distancing is actually helping, so thank you very much. Anagrette, I know that you have an amazing story that you can share with us that is very similar to what many people today are feeling, so would you like to share your story? Yes, Donna, thank you and thanks, Ed, for the really nice update to hear where we are today. So I've been talking to all of you these past 10 years as a scientist, as a person who's been studying the art of safe communication and healthcare and how to improve patient safety, and today I'm here as a patient, but I think with hope and not with drama, so I'm trying to just kind of see some parallels of what I experienced these past 14 months and doing a field study as going as a scientist into healthcare, unexpectedly as a stroke patient exactly a year before we really felt this COVID outbreak in our skin, so to say. So Donna and I talked about this and she invited me to join in today because maybe there are some parallels of what I experienced that can help people not go into despair, but seeing hope at the end of the horizon as to where we're going after this. There's mind-numbing issues right now, I like that word, Ed, that you just mentioned before, it's mind-numbing to hear every day in the news, here in Germany, we don't even get to see any other TV any more than the mind-numbing facts of what's happening and it's scary, it's pushing us into fear and to anxiety and some of us into depression, we don't know how to pay rent, we don't know how to get through this, so what happened last year is, it was really funnily, I just noticed that this morning, a year before it hit Germany and I was here with my parents and I was sitting on a Sunday morning playing chess with my boy, my eight-year-old then, and was trying to cuddle him because he was winning the game and he's just a cuddly guy, so I went forward and I wanted to cuddle him and then I went down on the floor and I was lying there and that's where my travel as the patient started, so I had a stroke and went into healthcare, I within a minute lost everything I had, I lost my two sons for a long time, I was in two multiple healthcare clinics and stroke units and all that, I was locked down so I know what lockdown feels like but not being isolated at home but being isolated in various stroke units and far away from the home, all by myself, life being reduced to a 30-meter hallway where you're locked on cords and cables and you can't even get out to get a coffee, so as of, you know, things are taken to you, looking in that face of mother nature telling us you can't have that anymore, where we're thinking we have our human rights and yet we notice they're just human rights that we made up for ourselves, they're not really holding up anymore when it comes down to mother nature telling us differently, so I've just gone through that really, it went through at least seven to eight months where I wish that, you know, sometimes that stroke would have let me go and I wouldn't have to live through the pains and despair that realizing lots of physical pain, lots of sacrifices and you wonder why and so I've walked through that and took me six to seven months to see why and what's happening now with COVID interestingly is reminding me a lot on what I already went through last year, lots of similarities with the lockdown, with the isolation, with the despair, with phases of depression, but then I'm on the other end now so I was thinking, you know, by what I went through maybe I can give you hope and life goes on and a lot of what we, I think what Kava is showing us is a lot of what we've seen as what our life is actually isn't really our human nature anymore and these kind of incidents bring us back to our core roots of who we are as humans and bring us together again and so to help everyone see that and also to bring everyone aboard, I did a non-academic website, I'm sure that was Donna so she's going to show that later and where I think there's some of the needs that we can address and coming together as people again and sharing our stories also for patient safety, you know, we've talked about what's really patient safety, patient safety means that we're bringing people together again right we're bringing patients with families together with healthcare professionals that they're coming together and providing good care that's safe and good for everyone so I'm optimistic about what's happening it's terrifying, I'm not saying it's not terrifying but I think what's happening is giving us an opportunity to change things so that when the next pandemic hits and the next natural catastrophe is that could be coming hit us we're going to have a system and structures around us that will get us through this better than we're doing it now so hopefully we can learn from this and take it as a chance to make things a bit better so yeah sorry so I think we can go on to the next slide Donna and I only have three slides for you guys so I'm going to take a short so there's questions and answers sessions but so I'm just addressing three I would say mental health issues I'm not a mental health professional just to make that clear I'm really now today not talking to you as a scientist as much as I'm talking to you as a patient scientist who's had experience in this field and living through this but I do know you know from as a sociologist as what our human needs are our basic human needs that all of us share and one of them is the need for belonging and I think that's a that's a really really important need in the time where our fears are coming up higher than ever before and so our human belonging is a need that we have and here we find ourselves in a context of isolation isolation that's being enforced in some countries even by military and that we we must not go out and see our loved ones and we find ourselves in an interesting context where at least here we see on the news you know there's people in isolation and I and rehab rehab clinic I was in for 10 weeks last year people can't go out anymore there's 50 cases in that clinic now and and yet there's families that are together and in those families domestic violence and things like this are skyrocketing so I find that really interesting and I think that's pointing us at a really important issue that maybe we haven't looked at before enough and to see yes there is financial issues going on but one of the real issues that humankind is dealing with here it's interpersonal issues but so in that context so we have a need for belonging yet we're isolated and one of the things I did on this website for everyone is to and I like the word you said Ed and also Donna it's physical distancing it's not social distancing here in Europe we're still using that word social distancing way too much I think and yes we need to stay physically distant but it doesn't mean it doesn't mean that we need to distance ourselves socially so I put it up on you can click click on that link if you'd like Donna a storytelling website or it's part of that website is storytelling platform where I invite people from all over the world to send in their stories and I've had you know I've forced the missions up here and I invite everyone to share their own as well and if you'd like to click on the one on fear isolation panic and sickness Donna yeah that one and it shows you yes people just writing up these beautiful things some of this this went I think went viral this story and I put it up on this website to share because I think it's so beautiful people talk talking about yes there's fear yes there's isolation there's panic buying there's sickness there's even death but in Wuhan they say there's so many years of there's been so many years of noise and they can hear the birds again and they see the blue skies again and in the CC people are opening their windows to share you know their family life with people who are alone so I think that you know with a stark tunnel of despair that that COVID has driven us into all of a sudden we see light appearing between us that we haven't seen like this before and it's a tender light and I think that it allows us to find a different interpersonal togetherness again that's giving us a chance to become healthier and yeah I think that's one of the one of the things that that I invite you to participate in and overcoming that loneliness at home with being able to join in on the web and we have that resource now that's one of the benefits of digital communication is you don't have to be lonely and storytelling is giving us a chance to really feel into that new area between us that's establishing itself here all of a sudden so that's the the one part the storytelling about loneliness and then the next slide please we have lots of stress and anxiety and where does that stress and anxiety come from well it's it's uncertainty right also we get to that in a minute but we need that's very clear I think now it's a marathon coming at us and Albert has used that word in a publication that he just sent out last week to all of us and there is a marathon coming up and we're going to need a lot of psychological and mental stamina and to get through this and also clear heads to get through this and this picture gonna ask me to share it um I've been like all of you probably homeschooling my kids at home well caring for my parents as well and so we had this fingerprints um arts class I was having to do with them and we came up with this picture together and showing what is mindful and what is mindful and I think this nicely reflects also the mind numbing nature we are in when we're in this air and that's the left picture there's you know we notice what's in front of us but there's so much cluttering in our heads and I think um with stress and anxiety we've seen that with the mindfulness based stress reduction by John Kabat-Zinn there's been lots of research on that practice we we can clear that out to to calm down and keep a clear head and heal again and I think this is a very important and resource that all of us can can benefit of and so also on this website if you'd like to click on that Donna for a second I am actually spending day and night now to provide you all this um and yeah is that is that is that a link sorry I'm having a little trouble with my mouse for some reason I apologize okay it's it's okay so on that website under resources you'll see I'm putting up in two languages for now um an MPSR program sort of a crash course and for all of you to use for free um so I'm kind of you know I've taken that course also in part of my recovery after the stroke and with my own PTSD um I I ran into and it helps you all just join in it's a day by day small 15 to 20 minutes um reading as you can see it here so there's an introduction and then I put it down into small chunks of daily information with exercises that you can do um I recorded some meditations for you to to go and feel our body again because the more we were able to come back into that here and now and cleanse our head from that clutter that you saw in that other picture uh the fingerprinting picture um the the healthier we can be and this is for health professionals I put it up there for health professionals because they don't have much time right now to add learning but it's for everyone to use if you don't want to do the full blown eight-week course that you can do online with all kinds of providers um this is a shorter version that that's um kind of help you cope yourself with with resources that can help us you know last to this marathon and particularly help your staff at the front line of care so I invite you to um look at that as well if you'd like um and then we get to the last one uh Donna on the on the slide um that is about the uncertainty so that was stress and anxiety and yes so this goes back to my patient safety background right and um I believe that you know well I'm hearing stories from a lot of frontline clinicians of course and about the despair that they also feel at the front line of care and what I'm seeing is just there's a lot of COVID and it's bringing us a lot of uncertainty right and uncertainty brings us fear because you know we're not prepared so how can we better prepare ourselves so that our fear and uncertainty decreases I think that's the key question and I think more than ever um we need to come together as clinicians at the frontline across the globe sharing with each other treatment successes and failures there's no reason to reinvent the wheel if others have done those trial and errors and learned from them so also on that website I put up a knowledge repository where clinicians can enter their stories and um if you'd like to show that for a second um so please feel free there's there's been a couple of submissions please feel free to um send you work up there you can just um there's a submission link on that website as well and from all over the world please share your stories what has worked with what hasn't worked um you can share your your ideas about better self-protection against the virus helping yourself um not get infected or about treatment of patients whatever you think other clinicians over this planet can benefit from I think this is a phenomenal way of us to start a new way of coming together also at the frontline of care and I think it's beautiful how we're already seeing that despite the despair you know nurses and physicians are suddenly you know losing their coats and they're all the same and they're coming together so closely and facing this challenge together and the borderlines between the countries are falling and everyone is just in the same spot same time in the same location so to say about how to deal with you know this virus and I think this is giving us a great chance um to come together it's really a patient safety goal we've been trying to attain for a long time so I'm very actually optimistic about what opportunity we're getting through this experience what we can hopefully carry on beyond a COVID once it's passed us again so that has been my three um yes I think we have one more concluding slide Donna is that yes about yes so we've been talking about safe communication we've been talking about guidelines of practice safe practice what you can do and you know there's more and more guidelines coming out and crisis communication and there's as many opinions as people almost out there now and again what I feel troubling about that we're already mind numb and there's so much information and facts coming at us and guidelines are not going to work well right now in addition to what else we have to deal with and you know I get I get um emails now about 70 80 a day uh clinicians asking also you know what else can I do what else can I take in I don't even know if we're prepared there's fear there's despair there's anxiety there's uncertainty and on top of that guidelines are not going to penetrate so as my as my reflection on the guidelines I've over years of research put out as such a safe communication this is what we need to practice to bring people together you know really what this is showing us is that safe communication just means us coming together as humans again and not only at the frontline of care it also applies to politics it applies to governing it applies to um patients and neighbors at home you know go now to run errands for people that are not allowed to leave the home right now it's everyone is coming together through what covet 19 is giving us as a gift so to say and I'd really like us to not fall into despair there is a light on the other side and we will get there and when we're there you may be surprised that you may not want to return back to where we came from so that's my spirit I'd like to give you as a thought for food for thought so to say thank you Donna that is wonderful line and grant what you have such a powerful story and what amazing resources you've provided for the world thank you very much we do have a question for you from the audience and for for the rest of the audience we are we have plenty of time for question and answer today so please enter any questions into the chat box or into the q&a section for us okay and a great question was for you can you comment on how the isolation after your stroke impacted your family and and how did you help your family to recover from worrying about you during that time oh that's a good question so um i i'm a single mom with two children and they were eight and ten at the time of my stroke um and i was in my first stroke unit here for four days and then i returned home for about an hour and then the next stroke came and within 20 minutes the ambulance was in front of my door to bring me two and a half hours away from my home to the next stroke unit at a big university hospital the cathedral of stroke medicine in germany and so my kids um i don't know how they i should have them here on this call they've been so amazingly inspiring and strong through this um of course they feared of losing their mom but they don't have any trauma from any of this and and um my son and i'll never forget this we talked on the phone on a weekend when i was there and weekends were really the worst because you just locked in and then i was up there far away i didn't have visitors coming everybody else get visitors coming and um so we talked on the phone and in my i talked to my my 10 year old and he said mom the the happiness and anticipation is the greatest happiness there is so the longer you're gone the greater my happiness to see you again so i didn't have to help them cope and uh it was just i don't know it was probably the most mindful experience i ever had and trust me i was the most prepared three books to do list the person in the world i was always i'd plant my life out when i was 15 um so the stroke just didn't work for me at all but it just put me into a position that we're living now with profit which is we can't plan for tomorrow it's just right now how it is and i've just i don't know what will happen tomorrow anymore i haven't i haven't i mean at november at the latest i stopped trying because our life happens now and that's the reality of it and what what we do when we think about the future and oh gosh how am i going to pay my rent at the end of the month i mean donna i told you that they cut my my sick leave insurance pay the day before christmas and i and then the offices were closed for two weeks and from you know i just said i know how that feels you know we had bread and butter for christmas eve my sons and i we just didn't know i didn't know how to make it for the next two weeks financially and we made it and you know the school director came by and brought me a filet of fish and you know for somehow we got through and and we received and we gave back and even now i just took a bike ride with my boys this morning it's evening here and um everywhere you go by there's boxes outside of people houses where things are giving away all of a sudden they have time to cleanse up the houses and they give things away and and we give things back so i think we need to just have faith that you know they're they're you know societies on this planet that don't have money you know and and they live and if we can't pay we will continue to live if it'll be different it'll be i don't want to say better words it'll be different but we will survive and we will come together and survive so but to get back to the question sorry and yeah i didn't have to help them cope and um somehow it just all came into place and it worked out and i don't know how i've seen a lot of other patients in that setting and it happened the same way for them so i wonder if that's all i can say and did you learn about mindfulness while you were a stroke patient in the hospital or did you learn about that after you got home i learned it in 10 weeks rehab so i was in fall i went into a 10 week rehab treatment and there was a wonderful it's in a and there was a psychosomatic department in there as well and um so i i went into that physical um program where you you learned to build strength again in order to gain confidence in your body again and so forth and they had this mindfulness program there and um it was mindfulness yoga so slowly coordinating your movements again and so forth and that's where i started and then when i went out of that rehab setting i i asked for resources so i got this wonderful book um it's an eight week workshop the mbisar workshop and i i continued that and then i did another one so i kind of found a lot of and eventually your body just learns to do it it sets it's really interesting because we're going back to where we were and so we already have it in us i think it's just a memory of a reminder of how we used to live when we were young and we go back and all of sudden it's like wow you know this is actually a really comforting life because whenever i get distressed now i just go back to my feet touching the ground and i feel myself here oh i'm right here in this moment why am i why is my brain out there it's it's right here and here everything's fine i'm sitting here i'm safe you know there's no storm outside like threatening my life i'm sitting here with you guys and i'm i'm fine right now so this is all that matters very well um ed i wonder if you can um answer for us we had a question from the audience that wanted to know are there any new research programs out there that you're aware of that could support the front line during and after this outbreak yeah good question i mean i guess the front line uh is um uh that's anti-grip was just making clear touches on a lot of people people who respond to emergencies both in this case you know people living at home who may not have gotten to the hospital early enough for covid but then we're also having kind of crisis situations that they weren't able to seek care for in a timely way or even just an emergency situation like a stroke so that's the ambulance drivers and others um there we um there is a bunch of research uh going on in uh WHO has um a whole big big research and development uh r&d platform working with the welcome trust and uh a bunch of other u.s government a bunch of other organizations that are looking at both the uh the whole whole bit of work on vaccine work there's over 52 vaccines and different stages of trials around the world um and it's moving faster than any other vaccine trials as ever moved um but there's also a lot of work on therapeutics um and there's also work on sort of different aspects reviewing uh use of different personal protective equipment factors in healthcare worker protection and we actually this coming week there'll be a lot of focus i think uh actually i thought it was going to be last week but the whole world seemed to focus on this issue of masks for all of us to wear or not wear which by the way and anyway i'm happy to answer questions on that offline that's uh the WHO's clear stance on that but then the uh but there is we're doing some more deep dives on healthcare worker protection and we have a whole bit of work that touches on mental health and uh for healthcare workers and the protecting healthcare workers in terms of occupational health um and so there's um both kind of in the field of operational research that's going on right now collecting data from Italy Spain um working with colleagues in the US as well as some of the r&d work on therapeutics and vaccines great thank you on a grant i wonder if you can touch on on on group therapy there was a question from the audience about virtual group therapy right now in the time of of covid any thoughts on that or where where we can point people for resources for that uh group therapy is great um it evident you know of course it brings people together it gives is another chance for people to you know just feel themselves in mindfulness but also get help and stories from others who are in the same ship so to say in the same boat um so we have that at that clinic as well and i think that would be a wonderful resource to offer if um you know this really goes to the mental health professionals out there who are i'm not a mental health professional i'm just telling my story as i said but i think that's really an important resource to offer online yes excellent well for for whoever asked that question we'll do some research here at the patient safety movement foundation and we'll find some options and post them on our website um so we have another question from the from the audience and i'll open this up to either ed or anacrette whoever whichever one of you thinks that you might have some input here but there was a question about patients who are in the hospital right now as you mentioned on a great they're in isolation because they don't have families there at their bedside what are the options that hospitals can do right now to help the patients that feel isolated and depressed if you want me to go or do you want to yeah go ahead and great okay so i am there there's been um innovations i would say that i think are really great for this situation and that is bringing in joy and happiness into that area and i've seen more and more people getting into healthcare with um comedy with magic tricks um magic tricks i think are a wonderful thing right now that any you know there's little things that you know like the trick with the light i saw this one video with them and um with the sick child how the nurse was just having this light on their hand and just playing with them and the light was gone and they're again this child just cheered up and i think magic does a way of just blowing the brains clear what we do with mindfulness is nothing but that when you do a magic trick look at the people like for a few seconds they just don't have anything in their brain so going in there and you know here in germany we have that too the humor for healing um foundation and they teach staff healthcare staff to bring in humor that just the clown noses on their face so i think we need to just be playful again and bring that joy and happiness to the frontline of care because when i was when i was in isolation it is um horrible to be alone to not know if you ever see a family again i didn't think i would come out of their life i i you know every time my body reenacted a stroke it's just reenacting this i i didn't see it whatever i would ever see my children again i didn't have a person to talk to at the stroke you know people were so busy and now also you know there's this uncertainty this fear about this virus the hectic environment people there's just so much civil resources so just having people go in there and and give that as a gift i think that's what we need to be doing and we can you know just bring that smile on people's faces will will be really really valuable right now wonderful yeah these are all the really good the points that where i couldn't agree more i think you know the attention right now in so many hospitals but then also even in primary care settings where people are you know showing up and when you have so much community in many countries you have so much community transmission and a lot of asymptomatic or pre-symptomatic as they're referred to also for patients who you have to come symptomatic it's difficult to know anyway so all healthcare settings are potential places where people can and get it just like being out in the community is so i think you then have there does need to be a focus you know the first our patient safety work is about first do no harm so we have to emphasize you know take steps to to decrease the possibility of spreading from patient to patient certainly and also patient to healthcare worker but there are some practical things i think that hospitals can do to consider how they do that and still also satisfy needs of patients can we tend to in hospital management think of groups of patients in terms of wards and group preferences and group needs and i think you have to switch to uh a little bit more towards um individual needs and preferences pardon me for the background noise um and uh that the um you know looking at uh kind of setting up individual rooms uh the way that might be needed using kind of disposable materials a little bit more during this time period which is not a grade for your green hospital movement but but um that's a possibility um that uh also you know sort of making some provisions for like integrate was saying for uh things that that people will need to do when they're spending a lot of time on their own reading watching movie listening to music and thinking of some ways that you can make that available in patients homes and in the patient rooms i think also people um are looking at uh effective ways of managing the the post-acute phase uh so that you minimize in a safe way the the sort of time that people spend as they're coming out of the if they had to be ventilated and ventilated they had to be um uh if they had to be on oxygen etc so and doing that in other spaces that might that might give them a bit more light sun um ability to uh to move around so just some a few practical things and we might be able to put together some links. WHO has not published so much on this and I think it's uh it's giving me an idea for a new piece that the organization should come up with so thanks for the question whoever. Great question Ed for you regarding uh statistics in Mexico do you have any specific uh data to share with that group who's on the call Ed can you hear me? Sorry I put myself back I'm sorry that's okay that's like the the thing by the way um one of the things I'm sure we're going to realize um when we get back into the office is that um this terrible thing of being able to take ourselves off video and put ourselves on mute um has created a lot of bad behaviors in terms of um interaction with colleagues so anyway just that's a that's not a maybe that is a mental health issue too that we need to come back to but anyway um yeah for um that we definitely on the website WHO puts out a situation report uh every day that tracks numbers from uh countries um uh and so we track all the numbers from across uh the pan american region right now if you were to look at it um Mexico is has um this is as a data reported of last night um has uh has only 2700 anyway that we used to think that was a lot uh cases 340 about in the last 345 in the last 24 hours and 140 deaths so it's it's quite low I mean compared to the US as we showed you had 395,000 cases and 31,000 in the last 24 hours so um very different it's about 10 down the list um but uh in terms of um you know it's a case fatality rate and you know how the it looks we can certainly share that afterwards with people uh are of interest but the curve if you look at it's um quite similar to the to the US but um much higher case fatality rate than the US and I think that reflects anyway reflects a lot of things but um reflects uh probably mostly health system capacity and ability to access uh intensive care units but at the I don't have any more data on you know where where is that happening the city where it is um I think that that's of interest okay well thank you and and we do have your uh situation report page linked on our website at the patient safety movement foundation so we'll be sure to send that out in we'll I'll add that to this power point before we send this out to everybody so thank you um another question ed that maybe you can help with somebody asked is do we have um resources any anything that the world health organization may be be able to provide in terms of guidance for um staff with a really large stress load right now are there any resources that you're aware of that we can send the folks to and I assume that's sort of the um both physical stress and mental stress you know WHO has to put out um does have some guidance for uh sort of uh both um and along with our regional office have some guidance on or decision makers about how to repurpose and refocus uh sort of the services in order to get ready for this type of surge we've got a couple of tools out that um help uh kind of local and even national decision makers plan for the supplies they're going to need as well as the workforce they're going to need and that those are tools that are about just having them write um number of people and what are you going to need for any given number of cases and then uh then looking at task shifting and that's a big push right now um you know you do need to have the right respiratory uh um that capacity yet in your hospital teams but you can shift a lot of tasks that are traditionally handled uh in one way by intensive care unit teams and critical care teams emergency staff and so we've got some tools on that um as well and um uh then uh in terms of the in terms of looking at how to handle the sort of overall work we have a working group right now on occupational as mentioned earlier on occupational health and and health worker protection that um uh with a guide on some of those issues and some resources so afterwards I'll I'll send the link over um and uh too we can put it up uh on the uh the foundation's website wonderful wonderful and I'll also embed that also into the PowerPoint before I send it out so people can have easy access to it that would be fabulous thank you um another question um any updates on wearing masks in public there's a lot of discussion about that right now yeah that's that was like the big topic this week um and uh uh yeah the I mean basically the bottom line is you know people live all over the world uh in different settings and you know um a crowded slum in uh West Africa Latin America or even in the outskirts of you know some of the big big cities in Europe or wherever um you know you're gonna have much more crowded situations than you were in others your ability to physically isolate is more difficult in some places than others certainly I worked for many years in West Africa and most of the people I was working with they lived in um uh you know big families of 1415 we're living in a few rooms uh and so anyway it's uh they're complicated situations that WHO has put out guidance for everybody on but from an infection prevention standpoint and also there are you know as uh Dr Fauci has said there are people's some people's job is to provide hope and you know get people engaged and get them to thinking here's something I can do maybe to help protect myself and then there are other people whose job it is to talk about science and facts and data so WHO is involved is our BG sometimes is about providing hope but mostly we are a science and fact-based organization and the fact is that the evidence from COVID which is not that much we it hasn't been around that long but then also from years of work on um the related respiratory illnesses like SARS uh and other pneumonia like illness um does not show that there is any evidence of benefits for a healthy person in the community wearing a mask it is helpful when a sick person who has symptoms who's coughing can wear a mask and so that they don't infect other people it obviously is very useful for healthcare workers who are in a high infectious environment setting to be able to protect themselves um uh but for um for the average person wearing a mask the evidence just isn't there there is even some evidence we look at about cloth masks that um you know if you don't take care of them in the right way and clean them and wear them right that um that it's even in some cases perhaps can put you a little bit at greater risk and also people tend to think that okay now I've got this on it's a magic bullet I'm protected when actually it is much more likely than rather than you breathing in something that you're going to touch it on your hands and then later when you come home put it on so I've seen many times I've had friends even uh video calls with them in the states and they've just gone to the store and uh they'd come back in and immediately said oh hey you're on the phone hey hey how you doing hey let me get this mask off and then you're thinking oh no no you should have washed your hands first who cares about wearing the mask out in the community and so anyway um you know your average person isn't trained on dawning and doffing uh personal protective equipment so all of that to say that WHO has provided all of that but fully recognizes that some uh counties some states some governments have asked their their people to wear masks um and you know we should be in compliance with your political authorities but uh and to follow up on that we have a question then about cloth masks um is there what is the proper way to use cloth cloth masks how often do we need to wash them and when are they protective and when are they not yeah I will send um you know this is like a super interesting uh piece that we literally just um put out this guidance on um on masks I'm going to copy and paste it right in uh to the chat here because um it's like uh it's anyway it's very topical but basically um you know the big push is that medical masks surgical masks and then of course N95 masks that are a little bit more protective for aerosols should be reserved for uh prioritized for healthcare workers there's a big push on making masks all manner of supplies tests masks etc more available globally the 25th of March the UN secretary general asked for the full platform of the UN supply chain which is the world food program unicef big multi multi-billion dollar operations to be fully put at WHO's disposal and to fully focus on on getting um the supply chain rolling again on masks on PPE etc so that's you know multiple large 747s flying around the world delivering already uh these things um already it's become more uh partially because that but also the US has been able to procure more uh masks so um uh that's another uh piece that's that's out there um the uh so the guidance on masks does talk about uh the use of masks and we just put out um a piece on uh uh on that's called your term rational use of um personal protective equipment so when in certain situations you need to reuse uh masks and that kind of thing so um the that also would be I think quite uh quite useful for people so you know in some cases when you need um to use uh like non-medical masks meaning cloth masks then our guidance just says that you know obviously the type of fabric and tissue um how breathable it is uh you know the shape and the fit of the mask are are important to use so that we did mention some of the data that's out there um that uh cloth masks in a healthcare facility is not um the greatest youth cotton cloth masks um not appropriate for use by healthcare workers but uh can be appropriate uh you know for use in in the community with the the idea of being that anyway the evidence is uh is not there in terms of you know having a a big impact on um what it is but the bottom line is whatever mask you use you should um you know be careful in terms of placing it and touch it while you're wearing it um uh we have videos on our website that show people how to take on and put on put on and take uh take off masks uh correctly etc great well we we do have that link on our website as well so we will share that today in the in the PowerPoint too um there was a question about um about patients who are recovering in isolation and we did address this a little bit last week when we talked about the restriction of visitation and how that has impacted our patient advocacy at the bedside and so another resource that you'll find on our website is a plan of care form that families can use at home so that when they have conversations virtually with the care team they can keep track of what's happening with their their loved ones in the hospital so that's an additional resource for everyone but Anagret I wonder if you have anything to add about particularly caring for patients in isolation and and how we can help them well as I mentioned before you know I was pointing at um looking at creative ways of getting in touch with them and bringing life back to them as something that's story full outside of that despair um but yeah it's it's tough so I think that yeah using digital communication channels as much as we can to to bond and really as I said you know guidelines are helpful but I think we need to go back to just um we keep talking about communication as you know we need to convey information and we need to provide resources and lots of information goes through those communication channels and sometimes we misunderstand communication as just sending information and instead of just sharing and understanding with each other so I think if we can maybe just at the people that we're talking through be it via the phone or through internet resources or even if we get to see them face to face it's just to ask ourselves that question do I understand them and how can we find a shared understanding with each other and that'll bring us to a different level of communication back to a much more a genuine and authentic meaning sense-making between us that no guideline could ever achieve and because communication is more than information sharing it's about finding a shared understanding and I think if we keep that in our minds and our hearts as something that guides us through this time that's the best guideline we can follow yeah absolutely and I think we have time for just one very last question um and the question is about um our supply chain obviously as you just mentioned you were talking about masks we have we've had quite an issue with our supply chain throughout this endeavor um what what do you see highlighted highlighted there about systems and training and supply chain that maybe might be new um yeah I think uh it's a really um like all these many and grab us highlighting how many of these um uh things that some of us working in sort of in patient safety and in human factors and others that that we have thought of for years as being um uh in really important factors in how sort of healthcare is delivered now are all of a sudden put under a really white hot intense spotlight um and you know sort of how the organization of service uh really matters in terms of keeping people safe how you know infection prevention control is you know Florence Nightingale shouldn't tell us this way back when would we forgotten it somehow um in the age of antibiotics and um that and then the whole like you know the importance of health workers and their health and whatever we were talking about earlier um I think this aspect of uh supplies and supply chain in the global economy I mean not to reflect on um all that but um you know the the US used to be one of the biggest producers of uh medical masks in the world and and over the past not even 10 years it's all gone overseas most of it went to China and you know I think we will really reflect on our interconnected global economy um and this kind of uh fact in an event like this of how of global solidarity that it's not just a matter no longer a Jesus I can't get my um you know avocados from Mexico because there's this trade where I'll just you know get them from Senegal you know when you have this type of breakdown and without a thought in advance of the different supply chains you're never going to fix a problem like this when you're in uh when you're in a crisis that has to be planned out beforehand and so I think there'll be a lot of reassessing of global supply and supply chain management um and uh in particular for these types of critical uh supplies that are there my big worry that's coming right now um I think is that uh you have a massive competition um between countries it's like as I have my supply managers say it's a little bit like the wild west out there even the UN in placing big orders on things is getting a big competition from other countries and if you don't watch it all of a sudden that order disappears and it's gone to another buyer um and so uh there needs to be more of uh the global solidarity we've seen around other issues really come on this full supply chain I think too but I guess anyway just to say that that there is good news and that the supplies in China and other countries have really started to ramp up again and deliveries being made around around the world I think for us at WHO we're really worried that um the uh eating up of all those supplies by the northern hemisphere is going to mean there's going to be very little left over for countries that are who are already well behind the curve in terms of bed supplies and PPE yeah well I think we are at our time we don't have time for any more questions but I really want to thank both of you Ed and Anagret thank you so much for being here today this has been very interesting and informational so for everyone else on the phone and on the web thank you all for joining and we will see you next week have a great day everybody and thank you again to Ed and Anagret