 Hi everybody. Welcome to another update from the World Health Organization on the COVID-19 response. I'm Donna Prosser, Chief Clinical Officer here at the Patient Safety Movement Foundation and we're so excited to have Dr. Ed Kelly here with us to give us an update. Welcome Ed. Thanks very much Donna. Great to be here again. Excellent. Well let's just go ahead and get started then. Good. Well thanks Donna and again it's just a real pleasure to be here with the Foundation. So I'd say every time the Foundation has been one of our real partners on patient safety in general and in particular you know in this COVID pandemic to get the word out about key messages on not just on the virus but also all the impact it's having on essential services and key considerations about how to keep health services safe and environment. So I'll go through a little bit of an update on the health services and systems support to the COVID-19 response. So the key messages that we've always tried to push and our Director General has always tried to promote is that as he said while we tackle the pandemic we can't lose focus of other health issues. We must ensure the continuity of health services really as he put it now more than ever we have a duty to give health workers safe working conditions as a particular aspect within this outbreak and I know that's been a one of the big standards of the Foundation and of course of patient safety and the general patient safety global movement around the foundations of how you deliver safe care but never was that more apparent as it is now. What I'd like to do is go through a quick update of the epidemiology of what we're seeing globally the resurgence of COVID and the possible implications for the flu season and then a few updates on essential health services and the activities that are buzzing around the world to try and keep that work going and keep colleagues up to date but also involved in all of the different partners in different countries around the world. So the current epidemiologic situation you can see here just in the previous 24 hours while it's a really an eye-popping number it's not the highest number that we've had over the past number of days just over the weekend we had the highest 24-hour period we've had since the pandemic started on Sunday before that the highest 24-hour period the day before the highest week we've ever had since the start of the virus was last week so in general while of course it's difficult to compare case numbers that we're seeing now to very early in the outbreak where we weren't anywhere near the number of testing the number of tests out there being done but we clearly are not going in the right direction you can see some of the numbers of the countries with the highest number of cases in the previous 24 hours and this is as of October 19th so there too ago but a whole number of countries with very precipitous updates especially in Europe you can see also the curve by region in terms of WHO's work the the shape of the curve across the world is very different and if people remember we've had a lot of different models put out there early on in the outbreak not by WHO but by a lot of very learned academic colleagues and we're very grateful for that some of that we use in terms of our own surge calculators for health workforce or for supplies but all of them have a more typical first wave second wave which is a little bit what you've seen in the western pacific shape to the outbreak but none of the regions actually have a typical outbreak curve normally you see a big first wave a smaller second wave that's what the models were predicting in Europe we're seeing a much bigger second wave same in western pacific but then in southeast asia you've never moved out of the really out of the first wave same in the americas it's basically placode and a very different shape in africa as well so clearly what we're seeing now as a big resurgence particularly within europe and the americas we had last week nearly 2.3 million cases nearly 40 000 deaths globally and every single one of those obviously is a tragedy but the number of cases reported in europe almost three times higher than the first peak in march and if you look in the africa region where we've had i guess relatively positive news today we've had a substantial rise in deaths something that we hadn't seen before 27 increase compared to the previous week there are reports of lower mortality in europe versus march clearly it's if you talk to frontline health providers both in north america and in europe clearly we we know better what to do we know better what to expect we know how to manage we've got sex medicine and other approaches that are that are better at managing severely ill patients and people are more conscious about when they need to get to the hospital or not but right now in many countries switzerland included france included spain included it'll included we all if you talk to i-fee providers they are very concerned that they're getting to the that tipping point where it's impossible to manage safely anymore so particularly across europe you see some of the countries here on the right that have had big uptakes particularly in the check republic but also austria and and other countries there there's at least 30 countries 49 countries reporting an increasing trend 30 countries reporting a greater than 50 increased and coven 19 is not the fifth leading cause of death in europe even perhaps higher in north america than us as we've been reported elsewhere and the mobility data that we're seeing from colleagues at google shows that we're really back to pre-pandemic levels it's quite clear that some of the countries that got down where they only had a few cases a day in the summer the people were moving around for their summer vacations and in big numbers now we are about to head into and we haven't yet formally the seasonal influenza time where these have co-circulation of influenza and coven 19 and i can personally say that with a daughter in school and co-workers who have had uh uh my daughter's schoolmates but also co-workers who've had flu-like symptoms but have not had coven it creates havoc for people having to stay home miss work miss school people having to be uh get tests other and potential contact tracing then happening so uh one of the questions we've been asking in the number of countries is actually flu rates for this same time um uh in previous flu season are down significantly so there's two things to consider there there's a strong possibility that some of these measures that contain in coven 19 are being very effective at containing flu and perhaps are more effective at containing flu than they are at containing coven 19 interestingly and there's clearly some uh co-immunity has has been termed um with uh some coronaviruses circulating for instance in in africa there are four strains of coronavirus circulating that may be increasing immunity levels for for uh people to coven 19 so this is something to be watching but um who recommending influenza vaccination for five target groups pregnant women uh people with underlying health conditions older adults and health workers and children and we have it running right now at the who so please get out there and get your flu vaccine wherever you can and i think there's a big challenge around the influenza vaccines and the demand for it may be outstripping supply in some countries with the pressure on on the supply chain that's there but our our strategic advisory group of experts on immunization has recommended uh made some recommendations related to influenza vaccine and also continuing routine immunization for others that are uh that uh for other vaccines that are there so some of the challenges that have been faced by health systems during coven 19 which are presented here the who and the un system have come together with a set of plans that we've talked about before with the foundation that bring together really a set of key actions and specific directions for the how to manage different health services for different diseases and that is something that is presented in our strategic preparedness and response plan is a pillar nine of the work on essential health services and systems that's also reflected in the global humanitarian response plan which is known as the ghrp so that's for countries that are in fragile and humanitarian assistance situations as well as the un framework for the socioeconomic response to coven 19 and actually we had a very very good presentation just yesterday from our colleagues from europe in our regular uh meeting every morning that we have on our situation meeting uh looking at how they are basically bridging their their coven response work into longer term socioeconomic response and trying to strengthen economies and the whole approach take the health first approach and unfortunately there are many countries that that somehow miss that message around the health first approach to their socioeconomic recovery and they're struggling with uh being able to reopen safely businesses schools and other elements of the economy so at the heart of that is really just thinking that uh primary health care and uh in a primary health care approach which is something that whho is advocated dating back to 1978 but kind of re uh established or re emphasized with a major conference at the in Astana Kazakhstan um now uh nursing 10 Kazakhstan um back in 2018 looking at particularly the focus on primary care and the central public health functions so those public health functions that are about and strengthen our ability to to detect and respond to pandemics as being at the core but being supported by multiple sectors so not just being a health issue but but also uh transport and energy and other sectors being there and serving empowered communities so all of those are basically the key ingredients to strong pandemic response as it is to longer term uh really serving people's health uh health needs so that idea of the of Ph.D. and U.S.C. are are part of um the idea behind setting a foundation for uh the access to COVID tools uh accelerator which is a big effort stood up to bring partners the different organizations uh uh who work in global health around the table to try and respond to the demand on vaccines demand on therapeutics and demand on diagnostics and ensure that all countries have access to that so that we we all said well look if these are going to go into countries and be sustainable they need to have a health systems connector that is based on a Ph.D. and and U.S.C. uh approach and this slide summarizes some of the some of the needs that we anticipate two billion vaccines 245 million courses of therapeutics and 500 million uh tests to be needed by mid 2021 so uh and within the ACT accelerator as a global mechanism for for taking that forward strengthening health systems is really focused around seven work streams and it goes from uh areas of health financing and engaging the private sector to data management and uh engaging communities in the response ensuring there's protection for frontline health workers and strengthening clinical care systems as well as ensuring the supply chain is supported uh to deliver all of that so there's a facilitation council that works on this and see there on the left the set of organizations who take part uh in the ACT accelerator and and help lead on the different pillars as well as the the work on the on the health systems connector um you'll see the WHO logo present in everything so uh without um anyway uh sort of pointing out the obvious um our our team that's uh quite a bit stretched to be working on all these different areas but of course WHO is the one of the places that has the expertise to be able to provide technical backups all of these very operational partners that we work with um to give you an idea about what we know is happening in countries uh on essential health services primary healthcare and how safe safely we're able to keep going with services uh and we've talked about this before that we have set up special efforts on looking at the continuity of central health services and that I think shows is both a positive but also shows the weaknesses that we have with routine health information systems uh the periodicity and and how sensitive and how quickly they can give you information on these types of things is just not uh there so this was a special survey we worked on uh as part of the WHO response um looking at the impact on the pandemic across a range of 25 essential health services and we got responses back from 105 uh countries with more probably uh to come in our next round that we're going to be instituting later this year but more than half of countries have limited uh or suspended outpatient and community based service delivery platforms and also mobile clinics are impacted so you can see a wide range of major major interruptions and services and if you look here across the big range of service areas everything from routine dental services and routine immunization all the way to emergency surgery and urgent blood transfusion major interruptions overall 50 percent of health services across the world if you were to look at this uh have been severely or partially disrupted and routine immunization interrupted uh up to 72 percent but uh if you look at other important services such as urgent blood transfusion um and then management of uh severe amount of nutrition perhaps slightly less interrupted but a big big impact on morbidity and mortality and really things that should not you would never imagine being interrupted um the countries that have come up with plans for this um are sort of increasing but still behind what we would hope for 68 percent of countries that had defined an essential health services package to be maintained during the covid uh epidemic um an upper middle and high income countries are much more commonly um uh allocating additional government funding but big gaps in terms of uh funding for those services in uh low income and lower middle income countries so how we'll be tracking this going forward will be through a set of harmonized tools that will be based now that we've looked at the national level we will be repeating that survey on the coming months uh and probably targeted for next month uh but we also now getting down to the health facility level it's quite clear that we've got a reasonable idea of at the national level about what's happening but you know are the supplies that have been procured really getting to the front line our health workers really getting the PPE they need and do they have the equipment that they have so we have a set of hospital readiness in case management capacity tools uh for covid 19 as well as a set of tools around the continuity of essential health services and those three around the survey that I just mentioned also survey on medicines diagnostics uh and supplies for central health services and then community needs assessment that's being dealt with gavi and unifep this gives a bit more detail on some of those the the the information that's going to be collected there but the modules uh are really looking at capacity and readiness and um online applications are already being developed uh and several of them ready for deployment and we have a set of countries that we've envisioned where those will go I'll just finish before coming back to you um Donna and for some questions perhaps with the the idea that a lot of this has come together uh especially with yourselves around world patient safety day which we celebrated 17th September here you see some of the amazing pictures that we have of the monuments around the world in honor of that day being lit up orange the color of the world patient safety day and uh the theme this year was really focused around the the important aspects that covid 19 has has reminded us of which is that safe patients come when you have safe health workers and so this is a linked uh element that that we really emphasize in the in the press conference we had that day and a big online global event that we had that day and then in a facebook live event but globally around 14 of covid cases reported are among health workers or we've got some recent analysis with more full data that looks at a little bit more recently and sort of the latest data it looks like it might be getting closer to 10 percent so clearly we're doing a bit better job um uh with overall globally around preventing infections and health workers but in some countries it's been as high as 35 percent and clearly that's far far too high for uh a disease that we can be preventing um uh spreading in no sacomial fashion so we launched a charter on health worker safety and we really invited all countries hospitals clinics and partners to endorse and implement and you can see the five key actions there all of which are ones that that's in different levels of the health system people can sign up to and really advance so with that maybe i'll just kind of wrap up and uh we can take a moment to consider some of the uh questions that people have uh that you have and and also to um uh we can further explore any of these topics and i'll hand back to you donna thanks excellent thank you so much Ed that was excellent um i do have a few questions um can you um first if you could address the issue of schools reopening there are you know obviously lots of parents who are concerned about the safety of their children going back to school so can you talk to us a little bit about what parents can do to make sure that um that their children are safe when they go back yeah and it's um i think and i've said it on with you before that i think when this is all done eventually um knock on wood then one of the things we will really have uh perhaps the globally not w.h.o and that's the show that but including w.h.o we'll all go back and say how we really misunderstood how important schools are school teachers and schooling are in not just the lives of our children obviously the education of our children but in keeping societies functioning we they have now moved into a part of our society that i don't think anybody really fully understood perhaps um my um mother-in-law who's um uh you know retired uh third grade school teacher she probably she understood it and probably all the school teachers out there understand it but anyway all the rest of us missed it in a big way and we should have really been um moving more quickly for with a more robust uh plan i think at national and global level but that said um right now there's a lot of discussion and it's um the around what's the right approach on schools and there's a big variability across countries clearly it's very very dependent on local epidemiology and local uh context if there is a major uh spread in the community um it's very difficult to to fully fully reopen schools um but i think the consensus has grown that uh that this needs to be one of if not the top but certainly with uh essential health services needs to be one of the top priorities for for trying to remain open safely um and having uh the basic approaches then all still apply so trying to manage the number of people who are in any given space at a time so you can try to create as much spacing as possible using uh masks um uh certainly where the in when the crowding and and as we move more inside even now in the northern hemisphere most schools are almost a hundred percent inside uh and then trying to really engage young students even uh down in the primary school age to really understand the importance of hand hygiene uh and of themselves as responsible you know sort of members of their family and their society and their community to try and reduce the spread um certainly it's not just about the schools but it's also about school age children and and the gatherings that they can particularly in secondary school have so that those types of messages are really important thank you well you mentioned masks for children going to school you know we we see on social media there's quite a debate about masks um you know there are some folks that think that they are necessary and and and wear the and here in california there are there are cities who have a a rule that when you are outside of your house at any time you must wear a mask so can you talk about you know the the disparity there between the folks that say you don't need it at all and those that say you need it every minute that you're out of your house and where where the realistic middle might be yeah um the basically uh you know wto has had uh uh advice on masks that we are now and this goes for everything that we've been doing in the the outbreak and this is true of many of the scientific agencies to give advice at the national level um where there's constant assessment of the evidence that's coming in and i've said this uh we've said this together down and before but the whole point is that this is a novel virus so it looks like some other viruses like other coronaviruses like other um droplet borne viruses but it's new so there are many many things therapeutics and and transmissibility etc that we are still studying but from what we know now it's the virus our position on transmission um has not changed we have a scientific brief on this on came out on july 9th that people can see on our website and it's the same there's no new evidence since then that has changed anything and in terms of the advice on wearing masks definitely it makes sense when you can't be physically distant from uh other people whether that be in public transport or be in a school situation where there's more people than the spacing of one to two meters um or even in a work environment um and uh for instance now who itself has recently although we've just adjusted on our approach on the number of staff in the building uh because we've had more and more people and said it would make sense to have you wearing masks in the public uh space areas such as the cafeteria and other places particularly now that um we're moving back inside and relying on on interior ventilation so um for who our position on uh masks has developed but it hasn't changed if i can put it that way thank you that's very good way to put it uh one one last question for you another thing that we see on social media is a movement for uh to just proceed with herd immunity let the virus wash over the community and um and not wait for a vaccine um can you talk about about what that would do if if we took that approach yeah um well just to back up let's let's take the idea here about what herd immunity is it's a concept that according to which like a population can be protected from a certain virus if a threshold of a vaccination is reached so this is um one of the basic sort of first things that i studied at public health school at john topkins when i was there and we looked at it vis-a-vis for instance the measles uh vaccine so herd immunity would be reached against measles that requires about a 95 percent 95 five percent of the population to be vaccinated and then the remaining five percent would be protected by the fact that measles won't spread among those who are vaccinated but um folks that are proposing that we could reach herd or population immunity it's it's a little bit turning the concept on its head because um the the idea is uh around trying to reach the threshold with a vaccine so already that's sort of a different way to think of it um and we really don't fully understand the implications of letting this virus run freely first of all it's um a dangerous virus running freely like this it's simply unethical it's just not an option because there are such a range of vulnerabilities who would be collateral damage in that push towards herd immunity and we don't also understand as we were saying this novel virus about how strong or how long immunity lasts so we've already heard of reinfections they seem to be rare but but that's something we'll have to find out because there's not so many people in terms of percentage of the populations even in hard-hits countries only 10 percent of the population has been infected so there may be many many more people who are able to get reinfected um so that that type of issue on sero prevalence is there and then third we still don't understand the long-term health impacts among people with COVID-19 there has been a lot of discussion at WHO and in other form about what's called long-haul COVID or post COVID syndrome and even people with very mild symptoms or who got very mild infections and assumingly people with who are promoting herd immunity ideas feel that you know sort of mild symptoms are not such a big deal actually those there are many people who have long lasting effects from those mild symptoms so for all three of those ideas besides the the ethical consideration herd immunity as a protection at the population level is a bad idea well thank you for clarifying that I appreciate it I think those are all of the questions that we have for now but as always I'd love to have you back and you know several weeks to give us another update if that's all right yeah I'd be happy to do it Donna and happy to link in with the foundation anytime wonderful well thanks so much Ed we appreciate you being here and everybody have a wonderful day