 Hello, everyone. My name is Haris Lidzi-Daikis. I am the Chief Executive Officer Designate of the World Organization of Family Doctors, Wonka. Before we start this very first webinar on the COVID-19 pandemic, I would like to introduce you to controls on Zoom that you can use to interact with us. On the bottom of your screen, you will see two buttons, the chat and the Q&A. With the chat, you can exchange messages with one another and with our panelists. With the Q&A on the other hand, you can ask questions and our panelists will make their best effort to answer them via text. Some of your questions will be also picked up and will be addressed out loud from our panelists today. So without further ado, I would like to introduce you to the Chief Executive Officer of Wonka World, Dr. Garth Manig. Welcome everyone to the first of a series of formal Wonka webinars after a successful pilot last week. You're all very welcome. Today we're going to hear from our President, President-Dilect and our Regional Presidents. They'll give us a global overview of how COVID-19 is affecting different parts of the world. I'll introduce the Regional Presidents in turn, but first I'd like to hand over to our President, Dr. Donald Lee, for his opening remarks. We will share with us their thoughts and experience on the COVID-19. But as we listen to and take the advice of our public health colleagues, Haris, can you put on the slide please? My first slide. This will be introduced by our Chief Executive later on, but the next slide please. Yes, as we listen to and take the advice of our public health colleagues, family doctors around the world have risen to the challenge of this awful pandemic. In the midst of this massively increased workload for family doctors, I'm proud of the level of support and collegiality displayed within and across our member organizations and from region to region. It is heartening indeed. Next please. Colleagues are disseminating scientific advice, clinical updates, reflective messages, and professional support through their social media links and connections. They are keeping in touch with each other regularly, like family members, relaying information, urging courage in these extraordinary times. Tonight, our Regional Presidents will share with you what family doctors have been facing and our contributions in combating this epidemic. Next please. This is a pandemic with an unknown end game. I wish each and every one of our family doctors well during this time. Use the best advice available. Work collaboratively with your teams. Do the best you can for your patients. You should stand proud of your contributions to tackling this world crisis. No one knows what we will face in the weeks and months ahead, but everyone knows enough to understand that COVID-19 will test our capacities to be kind and generous and to see beyond ourselves and our own interests. Our task now is to bring the best of who we are and what we do to a world that is more complex and more confused than any of us would like it to be. May we all proceed with wisdom and grace. So we will start the first webinar today. We will have a few more and we will let you know our program towards the end. But now may I hand over to Garth to introduce our Regional Presidents and speakers. Thank you very much Donald. So a reminder to the Regional Presidents that you've all got five minutes each and I will be reasonably strict in terms of time so that we have plenty of time for questions and answers. Harris has described how the audience can interact through Q&A and through chat and later on we will put some of the questions to the panel for comment. But I'd like to start with Professor Shabir Moussa who's the Wonka Africa President. So Shabir over to you. Hi everyone. It's great to have you all here. I think it's great to see the world global family medicine community coming together and I think despite the difficulty of physical distance that we can all be together. Well I'm the President of Wonka Africa and Garth if you can just move to the next slide. And I think the key question is what's happening in Africa. It's certainly not a place that is seeing a large number of cases yet and I think that at the moment as of yesterday or two days ago we have only 12,800 across the entire continent. I think you can see the hot spots. They've only been less than a thousand deaths. 686 most of it concentrated in sub-Saharan Africa in South Africa. As you can see in the chart on the right hand side that the trajectories in no way is logarithmic or exponential. So it's moving along in South Africa but not as fast as I think people expected. Of course whether this is the calm before the storm is a big question. Next. I think that the WHO is certainly brought to bear the difficulty that this region suffers from. I think that the WHO or AFRO have circulated a newsletter focusing on COVID and pointing out some important difficulties that across the entire African continent in the region itself that ICU beds are actually great to create invitation as well as ventilators. So should this epidemic hit us as is happening the rest of the world we would indeed be having a very great difficulty. I think the age distribution of the cases so far are not very different from what's happening in the rest of the world. Next. I think that the implications though despite the fact that it's not moving fast the African government starting with the South African government have said that they need to act quickly for the sake of the continent that is so fully equipped to be ruled. So in South Africa and across the continent preparations are moving ahead both in terms of ensuring that there's a strict limitation of movements with lockdowns, social isolation, a banning of large meetings, large gatherings and encouragement of people to be able to engage in good hand washing and being able to identify the illness based on travel at the outset. At the moment these travel cases have been reduced and local transmission has been picked up and this is the powder keg that people are preparing for. So at the moment a lot of preparation is going to have the primary care system response and I think there are lots of family physicians while they're across the continent who are looking at how primary care prepares for it, triaging at the front gate, being able to ensure that there are red zones created where COVID suspects can be managed and allow that not to interfere with the rest of the functional primary care. I think at a societal level there's huge problems with overcrowding transport systems that are difficult to manage with crowding in it as well as just being able to have the health system ready should the scale of it grow with field hospitals etc. So I think we are struggling with a lot of difficulties in Africa. Next. The WHO has actually said and this is the review says actually pointed out that Africa will need a lot more resources to fight COVID. There's a very useful video but I don't think it will time will allow us to play it but I think it says clearly Africa needs a lot more resources and the world may very well neglect Africa and when it hits us we may not have time to respond even at a global level and I think the speed at which it may move around will be frightening indeed. Next. Our family physicians across the continent have been trying to do things. There have been country-level responses. I think there have been responses that I've known of in Kenya and Ghana in South Africa. These are not just the responses of the government which have been there but these are responses by family doctors, organized family doctors, setting up guidelines, having activities that actually engage. We've in fact looked at clinical webinars even in country but at an Africa-wide level Wonka Africa have set up a clinical webinar that is open to all in Africa using Zoom but also weekly joint webinar with the WHO, AFRO and Global to look at country experiences in Africa on Fridays between 4 to 5 p.m. at South African standard time and this has been running for three to four weeks and will continue and I urge you all to join it to understand what are the difficulties and the challenges in each of the countries that we're going to go through. We're also exploring a weekly joint webinar with the PHCPR to explore the story of COVID-19 in Africa and how primary health care is responding. So these are some of the responses. I think there are many more that I wouldn't give the document but I think these are high-level the kinds of things that are happening in the organization of the World Family Organization of Family Doctors in Africa. Thank you. Okay thank you Shabir. That was a good start and interesting to hear. We'll move on to Asia Pacific region. Ming-Chi Li, the president, senses apologies but he's in clinical duties today. So Dr Hoosene Jamal who is the Asia Pacific region president elect will present on the Asia Pacific situation. Thanks Hoosene. Hoosene you're muted so if you can unmute. Well my topic is on the strategies and experiences of the COVID-19 pandemic in the Asia Pacific region. Next slide please. Okay the issue now is how do APR countries respond with this pandemic knowing very well the China was epicenter. There are two groups actually that responded in two different ways and the first group is what I call those that reacted very immediately and very aggressively and these are mainly from the North Asian countries of Hong Kong, Taiwan, South Korea. Unfortunately New Zealand is supposed to be in this group. I couldn't get in touch with my colleagues in New Zealand for the feedback. Now the other group is the countries belonging to the Asian region as well in Australia and these countries have their own initial responses softened in varying degrees but of late in March onwards they decided to have some kind of formal responses in varying degrees. Malaysia for instance started a movement control order in the team of March and work is right up to April. We keep reviewing every two weeks. Next slide please. Next slide. I just want to show you the basic country data. This is what happens as you know China has got the most fatalities and but what's interesting is look at the North Asian countries of Taiwan, South Korea, Japan. They've got very low Taiwan for example just across the country. They've got only 376 cases and five deaths. Then the other issue of course is the number of doctors in the frontline who are victims of these pandemics and of course mainly due to the lack of PPEs. As you see China has got 60 doctors who become victims of South Korea. It's got one. Malaysia has got none. Actually there was a doctor who died but not directly a say not in the frontline. He was has history of travel to Turkey. Philippines and Indonesia 20 and 30. So as you can see the advantage of having started very early with aggressive measures like whatever colleagues in the North Asian countries are doing. Next slide please. Next slide. Okay now the other question is how do the GPs themselves engage in this whole pandemic? So there are two groups here. One is those who can engage themselves positively and the other ones is those who just cannot get involved at all for whatever reason as listed there. Now positively they those who are really engaging like those in China and Australia and some Singapore and Hong Kong as well. They are fully engaged and they are in the frontline. They do screening. They do telehealth. Whereas indirect indirect engagement would be like training doing workshops with their colleagues and for the communities and like Philippines for example they have what they call a COVID-19 task force that generate projects for members and the communities. Now the negative effects. This is a very common problem amongst most countries where the private GPs face a sudden reduction in the daily patient load and this has become a financial issue because most of them are now facing this temporary closures that some are looking at possible closure because when you're in private practice there's a lot of competition especially Malaysia also. Then there's also the other issue of the lack of PPEs and without the property is a risk involved in getting directly engaged. Some countries even like Malaysia we don't have a formal mechanism of how GPs should come in should such an incidents occur. And finally there's also the lack of training and the lack of personal capacity amongst most of these GPs. Okay this is a final one just to show the latest data on Malaysia. There's actually 76 deaths as of today, 43, 46 cases. Now the headlines read that the movement control order which has been imposed from 18 of March until the end of April it has slashed the R0 by three times from 3.5 to 1. We are trying to go below 1 which is why we are reviewing until the end of April and should it not be satisfactory then we probably go for another two weeks every two weeks for review. The others of course the other one shows the latest number that this is our DG Dr. Hisham and where Malaysia stands amongst the rest of the world and fortunately we're doing very well. That's it last slide please. Final slide please. Thank you there's a new monument some of us are thinking that's actually a war memorial in Kuala Lumpur so we're having a new memorial in the to as they thank you to our friend learners. Thank you all. Sorry thank you Hosni. We now move to the Eastern Mediterranean region and to Dr. Jinan Ousta who's president of WONCA EMR. So Jinan over to you. Late January and since then the numbers have been increasing more or less rapidly to the extent that we had doubling of the cases in the past week. Now with Yemen identifying the case in the past two days now almost the 22 countries of the region are being affected by COVID next year. Now there are several activities that have been that have been working in order to flatten the curve and decrease as much as possible the load on the healthcare. Now one could say that the response has for the governments have been relatively early in many countries. We have screening at borders of entries. We have also stopped all religious congregations so that the spread of the virus would be more or less contained. Most of the countries have adopted the lockdown or strict confinement in their own houses. Now we are having more and more testing and we have several places adopting drive through testing and definitely with tracing of the contacts. There are also governments who have placed mandatory face mark, mandatory face mark whenever people are going out even for minor outings like shopping. And also we have most countries have adopted healthcare facilities separate for patients who are having COVID. Still we have a lot of challenges in the region. Definitely we have like in many places shortages of PPEs and testing kits. Also we have shortage of healthcare providers. Some of them are getting infected or even dead. And even when somebody is exposed they are being put on isolation and therefore we have less of healthcare providers. We also have a more or less particular problem in the Middle East which is in mashed families and we have elderly living in the household that we're not able to isolate because of the setups in our homes. So and we know that the elderly are at high risk so that's a challenge. And definitely we have difficulty to enforce confinement especially in low income areas where the people depend on their daily work to earn a living. Now one thing good is that we have a lot of community sponsors helping also the healthcare in fighting the COVID epidemic. Now many places are adopting local manufacturing of face marks. Some of them are giving it for free or at very reduced prices. And also there are people who are providing free residence for healthcare providers to stay close to the hospital so that they don't have to go back to their houses and worry about their families being infected. Next please. Now what are the family medicine are doing in the region? Definitely they are helping in the awareness and in testing. They are at the frontline in most of the areas of the region. Some of them they have like in Iran they have developed self-assessment screening app where people at home they can answer a questionnaire and they would know whether they are at high risk and therefore they can go and get tested. Now some places have started already the telemedicine under the big heading of a doctor for every citizen. Family doctors are also collaborating with other professionals including dentistry in fighting the epidemic. And also we have in Lebanon the community involvement with municipalities. The family physicians are illustrating municipalities in almost every town and they are working at advisory group and helping in providing counseling for patients. Now there are also some activities or some things that have been done to increase the health care workforce. There have been some flexibility in renewing license so people can work without having to go over the process of renewing the licenses. Also some modifications for the requirements in these exceptional situations. A lot of capacity building activities have been going on like training protocols, guidelines, webinars. Residents have been quite involved as also frontliners. Now there are still other activities we're contemplating like delivering primary health care. We're not forgetting about the other like NCDs and other problems that considering that COVID may stay for a while. These are populations that we have also to take into consideration. So it is something that we're planning ahead how to deliver care for them through telemedicine or other forms providing mental health support for patients affected with COVID because they are quite anxious, they are isolated and they feel mentally down. Also for healthcare providers caring for COVID patients who are also so much stressed and they definitely need a lot of support. The last is we're contemplating the way in elder care at home so that we can keep protecting our elders and not putting them at risk for COVID. Thank you. Thank you very much, Jin and a useful reminder I think about the mental health of the care providers as well. We really must remember them. Right, we move on like Europe to Professor Mikhmed Ungan who's the wonky Europe president and can I remind you to unmute yourself as you start. Thank you, Garth. I would like to start my work for our colleagues and for the member organizations. Happy Easter. I think today most of you would like to celebrate today with your families and I would just like to summarize some spot things but I will not give graphs on such kind of numbers to you here because the European CPC and the WHO Europe websites are already having the very accurate numbers for the Europe and Europe is a really diverse continent if you compare with the other regions I think. Some of the countries already started earlier to find to identify the cases and to take the measures and according to the cultural diversity some of the country the population the countries who are really sticking on the precautions and the measures but unfortunately I can tell you that maybe it's not correct it's not scientific yet but this is an observation when you look at the numbers the southern countries have I think have not been very keen on obeying the social isolation and such kind of things because of the cultural variations and before it was an advantage for those countries to have very warm relations and social contacts but I think this time it's not a good advantage for them and when we look at the Wonka Europe website you will see that the there is a COVID-19 resources section then if you click it you can just go to the numbers the actual numbers through the European CPC and the WHO Europe. There are some of course precautions and also changing measures across Europe. Some countries already as I said started earlier and some of them like Turkey for example the first case was 11th of March and increasing terribly right now and when you look at the numbers the numbers will change in the next 15 days as I see but for some countries like Germany and the Nordic countries always especially I think Anna will tell you more and those countries are already started to think about how to trans the transition phase to denormalizing the life so the diversity is very very very marked here in this continent. What we have had the predictions we are if we look at the predictions I can practically tell you that because of this diversity I think even in October we will not be able to to travel freely I think in Europe at least because some of the countries will still have the fight against the corona and some of them already will be over. So what we did is Wonka Europe we tried to design some kind of statements for our member organizations to use them when they are communicating with their local governments especially trying to take place in the pandemic teams I mean the brain teams they would need the international support so that's the reason those statements were very useful I know many countries use them and now they are in the pandemic councils of the country and each country has a different need of course and one of those statements the summary is you can see in the screen now we try to make a presidential letter and a video so in those statements we just mentioned that the first of all the family doctors has families also and their families are needing them for sure and they have to protect themselves and they have to be careful with healthy food and their careful work breaks and a personal protective equipment as should be already mentioned and they have to limit face-to-face consultations to a minimum and while doing them they may use the technology wisely and they can think how to improve them in daily practice with new ethical and legal regulations which should be worked together with the government also and we have to be we mentioned and we discovered that we have to be extremely careful what to post on social media because we have an influential voice in our populations especially so we have to minimize post-ecological social media to absolute science and if this is uncertain should think twice before post-ecology so the rest is the family doctors also must urge their governments to include them into pandemic management leading teams as I told you there should be call centers in some countries they have but still in some countries there are no call center for the citizens and it would be nice for the as the voice of the population the family doctors could continue to insist on having these call centers for the public like we can change it five minutes already so can I ask you to speed up just a little thank you yeah yeah for sure I'm sorry yes and there are three uh items that I should have been mentioning we are confident about the scientific decisions by the uh by the uh committees and councils scientific councils and the governments should also rely on the science which is the only truth and even the governments can follow all the precautions of sciences in each country without any political adaptation which is very important I think and quarantine isolation surveillance case detection such kind of words should be used in the scientific meaning only so this is also another one and we can just change and this is the last slide I think yeah just we try to work on the occupational diseases and try to include in some countries the the covid related disease to be an occupational disease for the public doctor's rights and it should be accepted and some countries already put them into their regulations and another very important item is we are expecting an increase in the violence towards health professionals in even in the Europe in some parts of the Europe so I think it would be very important to to include the violence measures towards the health workers in the regulations this is an important topic I just I should remind and also increasing the capacity by using the family doctors associations in collaboration with the governments thank you for listening thank you very much Mehmet and we now move on to Dr Jacqueline Ponzo and Jacqueline is wonka president for the Ibero americana CIMF region so Jacqueline if you could unmute and we hand over to you I need you to unmute Jacqueline good morning sorry good morning thank you this is the situation of the pandemic in our region between poetry and horror stories are words of young family teachers in the future in latino america our region is ibero america includes spain and portugal too of course these countries are part of europe russian but are part of us too the poetry are our primary care teams in the front line they work empathy commitment are the resident and students in primary care is the love of our patients that car used to the horror are the death of young doctors the work without protection people without food and money for a stay at home people that for covid in the street next please the pandemic traveled from east to west so it arrived to america to continent americano after other rations you can see in the slide the evolution in the american continent and look please latino america between the first cast in february 26 and april seven in the more colored map the dead is a very big problem in our region the graphics shows in orange and blue colors the case in ibero america these are 14 percent of the war but in black you can see the death in ibero america for covid there is 18 percent of the war next please this slide shows the incidence of covid in ibero america these isn't numbers of case this is incidence right case in relation to population in each countries of our region and some other countries for reference in blue is the incidence at march 23 in orange is the incidence at april 11 you can see the grow in the last two three weeks a big grow and it's possible to see how in latino america is just beginning the wars don't arrive yet about the countries is really sever the situation in ecuador where the incidence and mortality are very high and more than 40 percent of case are health workers next please these are the absolute numbers from ibero and latino america you can see that if the evolution in latino america are some iberia we can find 200 000 case in a few weeks in our subcontinent and the deaths will be are 10 times more than actually so the last slide are focused in latino america same next please our talents are the lack of tests in a lot of countries lack of ppe resulting in illness and death of members of health care teams insufficient year to satan of primary care to contain the pandemic at the community level erratic policies insufficient protocol for covid care in adequate epidemiological surveillance awakening of state investment in health worsening of social and economic inequities worsening of chronic illness other comorbidities and gender violence coexistence of dengue tv and hiv so to start influence season next please covid-19 is a community health problem so this is opportunities we have some opportunities about it family and community medicine have the best competence clinicals epidemiological and communities for to stop the pandemic learning the lesson from asia and europe and to strong the primary care in the health system is opportunity but primary care must with high quality with no resource for diagnosis and for the protection in the world next please finally the main message for our is solidarity equity and health for for us primary care and family medicine for the pandemic many sense thank you jackaline good strong message to end her thank you very much we will head north now into north america and to professor marvin reid our wonka president for the north america region so marvin over to you and remembered unmute your mic thank you guys um good morning good afternoon good night to those of you in the the internet citizens um basically uh the focus of my discussion this morning would not be on numbers there are adequate amounts of information available on the numbers at the world health organization and the cdc and and various other informatics sites the north american region is characterized by a variable distribution of health care delivery between the public the sectors and the private sectors and in addition to that it's a region that is characterized by mar has inequalities both in terms of the level of the clients and at the level of health care delivery so i thought i would focus my discussion this morning on on really three themes that have emerged in discussing this issue with my colleagues across the region and first of this theme relates to the impact that the kovat 19 pandemic will have or is having on the delivery of health care um worldwide so we recognize that especially in in countries where there's a large primary um private sector involvement um that there will be significant financial and psychological impact of kovat um both in from the family physician standpoint as well as for more clients um many practices are becoming bankrupt and many hospital systems are actually no staff family physicians have been called upon to assist individuals at a secondary care level at a hospital care level in many of the countries and this really just demonstrates the first facility and the scope of practice of family physician within this context there is clearly a need for family physician to be adequately resourced and trained with the appropriate tools including personal protective equipment that they will need to execute these functions efficiently it is clear especially in regions or countries where there is a high proportion of family physicians in the private sectors that family physician must be included in the deployment of any surveillance system if adequate numbers or preparations are going to be made and we recognize that there's going to be post-covid further introduction of appropriate technology infrastructure example telehealth or telemedicine both for in-office as well as outside of office consultations and this will become a more established or entrenched aspect of the delivery of care as we move forward next slide the second major theme that has emerged is the role of family physicians in advocacies both within our groups and between our groups and we not only advocate or should advocate not only for um work related or occupational health related issues but also issues related to human rights especially those of a vulnerable group ethics in terms of how things how resources are made available whatever resources are scarce equity which is important so there's equal opportunities for individuals to access care especially for those in private sector certainly we have to be advocating with our private providers or health insurance company and more importantly it will all inclusive in terms of our response to this pandemic clearly this pandemic also affirms the role of family physicians in health systems and therefore we have to work in partnerships with national departments and ministry of health we clearly will have to work with them to strengthen the health system and certainly in the level of um infection prevention and control measures surveillance research and of course clinical case management next slide the third theme that has emerged from our deliberations and discussion is the whole concept of comprehensiveness notwithstanding the pandemic which has caused traumatic transformation of all the health care delivery system especially because of the surge on hospital and ICU capacities some physicians are still actively caring for members of the community with particular focus on vulnerable groups so the North American region is characterized by a high proportion of poor morbidities especially hypertension and diabetes and these individuals still need care whether they become infected or not we do have other vulnerable groups included or disabled or elderly material and childhood services still have to be maintained and we do play a role in providing some support for all members of the health care team um in some particular regions or countries HIV is still a significant home morbidity as well as the genetic disorder called sick or cell disease so notwithstanding the pandemic these vulnerable groups still need care and family physicians are very active on the front line um ensuring that there's a continuity of cares for these individuals with these respective home morbidities and those that summarizes and concludes my my thought this morning that's great Marvin thank you very much indeed and a good emphasis at the end there on the patients who still have all the other comorbidities and all the other chronic diseases that we as family doctors still have to manage so thank you for that um over now to Dr Raman Kumar who is the Wonka president for the South Asia region so Raman over to you and unmute your microphone thanks uh thank you god uh oh so as rest of the world we have some special consideration uh in South Asia we have the largest population human population almost 25 percent of the whole uh human beings live in our region so it's it's difficult and it is very challenging to just think about you know if we really get this pandemic escalated to what we have currently and whether we have resources available to address such a huge public health crisis the crisis of the century next slide please so uh this is the current numbers you know although not very large compared to what we see in uh Europe and uh you know the states but it started it has started to picking up uh we have around uh 8 000 plus positive cases in India and some 250 plus deaths and similarly we have similar figures in Pakistan Bangladesh Sri Lanka are somewhat lagging we have fewer cases in Nepal and surprisingly in Maldives we have 19 positive cases but these numbers would be you know picking up there are many theories why you know the numbers are yet very low in South Asian region primarily in our understanding because it arrived a month later but it is gradually picking up and most of our countries that have been restriction of movement screening at the airports and quarantine and isolation of the potential contacts and patients and this is probably you know has worked for a while but we have to see what happens in coming few weeks time next slide please so as I said earlier we have a huge population to cater to and mostly our health systems are underfunded although we have some development in past two three four decades but still to be able to meet such big pandemic is a challenge for all of the countries in our region we also have you know hugely uh very dense population and communities living together and we have average population family size larger in our region and elderly people often live with the families so it's it's big family units are also bigger in our region and then we have almost 60 to 70 percent of our population living in rural areas which is again a challenge to protect our rural population and after the lockdown has been called in most of our countries is also talk about the economic consequences of lockdown on the you know the poorer section of the society and who do not have any formal employment and there is you know a threat of you know more people going into poverty there's an issue of hunger food availability but at the moment we are able to manage because of the low numbers most of these cases because a lot of the number of South Asian people work abroad you know like people from India Bangladesh Pakistan also from Sri Lanka and other countries work in Middle Eastern countries a lot of people return back from Europe we have a very vibrant business relationship with China students and businessmen going to China they return back so most of the initial cases which have come to our region are through this you know international travelers and there is officially not yet you know acknowledged but we are almost on the verge of community transmission but we will have to see how it unfolds in the coming few weeks next slide please so few things we are just you know thinking that you know this may protect you know as I said there's delayed impact we have a younger population because as we see through data most of the people who are dying are the elderly people in Europe and United States and it is also being discussed that since we have you know higher load of infectious diseases and prior exposure to several kinds of viruses in our region probably we have some herd immunity or so but this is still has to be you know tested on time there is talk about you know bc vaccination for tuberculosis which is protecting and you know also talk about you know the anti-malarials people might have been taking in on prophylaxis basis may be protecting our population there's also huge curiosity about India because of the population 1.3 billion and diversity how we are able to manage it I would say in India the response of the government has been very very swift from the beginning itself screening at the airports tracking and those who travel to international destinations and the public health system has become very very active across India through you know we have a federal system where the central government and state governments of 29 provinces work together and this is indeed you know good to see how these government establishments have come together to work and protect the population in India we also through past two three decades have good capacity of private hospitals but the challenge is how to organize the finances and the crisis of pandemic level at the moment we have a sufficient number of ios and ventilators in the cities and urban areas but it may be challenging in future and by the time we have this lockdown going on across India and south asian region it will give our government some time to prepare the south asian population is still at risk and we will know in future how we have done but at the moment all stakeholders are together to meet this disaster next please the last slide and I'm very proud to say that all the family physician groups in south asia have come together to issue this statement of solidarity on COVID-19 pandemic and because we have similar challenges of public health system health system deficiency or the issues related to population and poverty and first thing so all family doctors have come together we actively share our ideas we share the the interventions we are doing in our communities in most of our countries many doctors we started doing daily consultations and shifting on technological models and there are good things also in India at the moment we are not directly participating in COVID care because it is largely being taken care of by the public health of the government systems but gradually when it spreads into community if at all we will have a challenge and then probably more family would be required to work in the community and with the government health systems so this is all from the south asia region at the moment thank you very much Raman right you've heard from all seven regions and I'd now like to pass over to Anna Stavdahl our president-elect for her comments both on what she's heard so far and any other comments that she might she might want to make so Anna over to you thank you and greetings small flow we've been in lockdown for four weeks restrictions will be lifted in two days gradually and cautiously interestingly I will not go into that because that was not my task but it has been a discussion in the region between the Nordic countries which have chosen different strategies to meet the COVID pandemic and we are very close and we are small countries with no borders free migration common labour market and the discussion has been along the lines of how to achieve the herd immunity shall we control the pandemic from the start trying to control from the start it's been interesting and we don't know the outcomes yet but we are in a fortunate situation I must say compared to many of the reports I've heard now in the Nordic all the Nordic countries listening to the reports and thank you everyone it is striking that the family medicine despite that the family medicine environment internationally is characterized by a vast diversity in practice models in training programs financial resources the core values are the same we are delivering continuous personal and comprehensive care committed to the communities in which we practice but these values are currently challenged by by general societal trends and I think the pandemic makes it more visible to us how these trends influence medicine and healthcare fragmentation commercialization and digitalization just to mention a few so what I hear is that we observe closely how the pandemic affects our populations we are bearing witness or how the vulnerable groups in our communities are those who suffer the most suffer the most from the lockdowns and also from the infection itself and also how the pandemic widens the social gap and increase health inequalities so what are we doing we are pleading for adequate and sufficient amounts of personal protection equipment and we are pointing out the need for sufficient sufficient number of test kits as we've heard for our patients and ourselves we've started employing telemedicine tools like video consultations screening apps for patient self-assessment and in many cases this has been introduced overnight without or in many cases without digital skills for professionals and digital health literacy for patients that's a challenge and as primary care advocates I think we also observe a trend to politicize the pandemic and that is serious it might give rise to deeper conflicts in the time to come and we have to be vigilant because we don't want it to to lead to an increase of the already existing aggressive nationalism which we can see many places we hope for more and not less international solidarity so in this reality it is impressive how family doctors around the world are adapting regardless of differences in healthcare infrastructure and political environment if I should try and summarize what I hear from what you've said and also from my own background and say what shall our response be um maybe in the clinical setting we must ask ourselves how we can make the adequate risk assessment for the different patient groups in our populations to secure that vulnerable groups including those not infected by the virus receive the care they need after all most people do not contract the virus but they go on living their lives with the same disease burden as before the public health approach is important being disease oriented now and population based but it needs to be integrated with primary care in order to be efficient and serve the purpose this pandemic can be a showcase for integration of primary care and public health and we must also engage in the debate on capacity building in primary care the interprofessional team is the operating unit and we call to our job without other health professionals maybe the pandemic will force us to look at new practice models in some regions and after the emergency requisites and we return to the new normal we must be vigilant and not leave future digital development in healthcare to tech technologies alone we must secure that family doctors are engaged in the development the implementation and the evaluation of the digital tools which are being helping us now and helping our patients now last but not least we must work for international solidarity and i'm proud to see that that is what we're doing right now it comes down to spending our resources wherever best can impact health outcomes so lots of healthy individuals make for healthy communities and societies and the healthy international community health for all and that is our goal thank you very much thank you so much hannah uh now whilst all the presentations have been going on three of our colleagues Pratjush Kumar, Joy Maganbe and Sonja Tsutaguchi have been monitoring the Q&A line and the chat line so i'm going to ask each of them in turn to give us a question whether to an individual panel member or to all the panel members so Pratjush first of all would you like to have there been any particular themes or any particular question that you would like to put to the panel generally or to one specific member hello everyone i'm Dr Pratjush Kumar and just going by the questions here's some specific questions for Dr Husli Jamal that what was the main strategy to have such a good result in malaysia and the next question is how is strategy of movement controlled order adopted by malaysia different from circuit breaker strategy adopted by singapore thank you thank you for the question uh first of all i must say that we belong to that second group as i told you the ASEAN countries we did not respond as aggressively as our northeastern counterparts there was a certain period there was a certain various various interpretations as to whether people should come in fast or to hold on and see the situation i think the government on the day that we started to learn that response but there was a situation that was a good sense is that we couldn't come in nearly at the same time i don't want to elaborate on that but what made the decision was because as things go by the government that came in decided to put a hole on this and started what we call the movement control order as the only way to to stop the speaking of incidences that we are seeing so this movement control orders we a day before actually we were with the new minister and the issue was whether we should have complete lockdown or a restriction of movement now there are two uh the issue now is if you go off to the lockdown it's going to be chaotic uh people are caught in 24 hours there's a lot of things you'll be caught up in so it would have been a better approach to go for an mco a movement control order whereby uh like the central services are allowed but everybody else stays in the house uh self quarantine in that sense now the first two weeks was not very well taken by the majority of the citizenry because they thought well it's not a very big issue but as the cases there were some clusters at the three or four different clusters mainly a couple from religious groups and a couple from other smaller sources that balloons and then people start to worry and then the second week came in with stronger measures we are now in the second week and the review is done for every two weeks so at this last recent last Friday the prime minister decided that we will go for another two weeks so it looks like we are good for the next six weeks so the movement control order really means that everybody else stays at home wherever you are there is no way that if your family is split one up north or somewhere else in the south studying whatever you are not to come back there was an issue in the first few days when this came in everybody starts there was a mass movement on the highways and the government decided to stop so we are seeing results now in the second half but the ministry of health the team from the ministry of health feels that it is still a little bit too early so what is of concern now for Malaysia is Ramadan is coming in another one week and in relation situation when Ramadan comes it's another celebration everybody goes back home most of them to celebrate and then one month after then comes eight celebrations and another massive migration so the medical people feel that we should go on more this MCO should go on for a certain period more time lovely thank you Disney. Joy do you have a question that has there been a particular theme or any question for the panel in general or for a specific panelist are you unmuted Joy we've lost Joy. Harris can you unmute Joy or have we lost her? Yeah I think we lost Joy so shall we pass to Sonja? Sonja would you have a question for us please? Thank you. I am fielding the questions from Facebook where we have members from Uruguay, Malaysia, Colombia, Pakistan, Japan, Puerto Rico, USA, Bulgaria and Bosnia and Brazil. So we've got a good cross section of the world here and my question is actually from Elena from Spain so her question is that obviously the intensivists are quite rightly getting recognition for their incredible skill and their talent and their contribution to the fights to Covid but as family physicians we're carrying the invisible burden of all the non-covid diseases and we are making sure that the healthcare system is still running and that everyone is getting some form of healthcare so her question is how do you do you believe that the silent and unrecognised but heroic performance of family doctors in this pandemic gives us enough reason to ask for the respect so for respect for our profession it's recognition and a necessary consequent financial subsidy and that is for M400. Thank you. Are these in silence? Anybody else want to take the point Anna Stavdahl? No, no. I mean I think I think it's a really good point and I think it it like Donald through his president's columns have you know has been emphasising the important role of family doctors in every country and he's constantly talked about you know as family doctors we are first in last out and so I mean huge kudos to him for constantly emphasising that and also for publishing a number of articles and commentaries which I think highlight the role of family doctors because it is very true they're intimately involved I think in most countries in dealing with not just the Covid patients but the non-Covid patients but they're also going to have to deal with the aftermath of it you know with all the mental health issues that I think will go on for many months and many years to come so thank you to Elena I think for highlighting that as a point and I think we would all agree that it's really important and we have to keep emphasising to our governments that family doctors are absolutely vital and pivotal in any health problem like this I want to just add a comment to this I think it's not just recognition this is the perfect time for us to reinforce our trusted relation continuously relation for patients we may not be right up there in the front of the epidemic but we are there and we can always ask how our patients are you know whether the family is all right if there's been contact you know we can keep their health you know and and just check on them and no better way than to build relations I think during these challenging times this is the best time besides offering our continuous so but just really a now and then just a call to see how your patients are you know whether their families are affected or that I think this is the best time to build these relations yeah that's what I want to add thank you Donald um I don't think we've got joy back on so Pratjush do you have another question for us yeah like uh on the facebook chat and this uh the zoom chat we are seeing more discussion on telemedicine platforms like they said in more consultations happening on telemedicine platforms so but more interested to know about your experiences like how you're adapting to from in-person consultation to online consultations like do you finding it easy for yourself and how the patients are getting adapted to this telemedicine consultations and also about uh there's some technical difficulties in consulting elderly patients thank you anyone can answer this question this general question for everyone yeah would anybody like to comment on their experiences so far with telemedicine um how the patients react how how easy or difficult you have found it Viviana can you answer first yeah so uh the experience in telehealth is variable award one of the discoveries we have that people at home were more prepared than we are estimated that um many communities do have access to uh phones and with the help of personnel that help people download some of the apps that were needed people who were chronically non-connected with health systems have been able to connect through telehealth so telehealth has a real role in multiple communities across the world the the the the idea here is how to do it some of the discoveries I have had with my own patients is that it has become more almost as is as is doing a home visit because they are actually showing me pictures on the world I'm able to assess not just their health status but their mental health status and their ability to link to others and they're linking we as family physicians are becoming their link to the outside world when isolation is taken in place so I really propose that we we work as hard as possible to try to connect with those who are more disenfranchised that sometimes phone or telephone lines can actually be very helpful in a situation like this one thank you David I mean I think um there are a number of of tentative steps in all sort in all walks of life that have been slowly slowly developing whether it be cashless society or telemedicine or whatever and I think what this crisis has done has massively accelerated those processes and so we're we're many years further on now in testing the result and that may be the way for Sonya would you have one question oh sorry to the fact that telemedicine or digitalization is also the risk of the equity divide becoming bigger and I think we should also be wary of that digital divide being worsened with communities like in Africa where it's not as easy but I think it's nonetheless sure good point and Raman also wanted to answer this question yeah I can absolutely admit to the experiences shared here but also new with video consultations new for myself in my clinical practice I can see we can we can also fall into the other ditch on the other side of the road and idolize this way of communication because of course there are shortcomings and limitations also but absolutely so we have to keep both um both in our when we I mean actually when in the after this we have to look into how we are developing the tools and how we're using them yeah I think I mean there's obvious need for assessment in the in the cooler calm of dawn but yes thank you was did Mehmet want to come in on that sorry I missed no Mehmet did you did you want to make a comment yeah just just I think I already made the comments are already made but I think I can tell you that in many countries in Europe uh there is also another problem not only uh teleconsultations but there should be also we have to be very careful that that should be permitted by the government this is an important issue for us in order not to have a problem right there and I have I know that in Israel um they are using telemedicine very widely and there is a very very hard to take the whole equipment which is on the market and they are using it at all and this is interesting you can make a scoutation you can make everything you can measure the fever blood pressure everything from the screen just just you can go to the websites and you can see the other things the infrastructure of the internet is very important also in online consultations not only for thank you I just want to add I just want to add that you know wonker actually we have a working party on e-health and we've been doing some work uh starting to look at you know teleconsultations um what should be there how to keep the continuity the comprehensive and also backup and also possibly moral hazards you know prescription with our examination we look at it from the whole range it's just starting and we welcome ideas so please you know contact our e-health working party if you have views and all that we've actually started a pilot project to assess one of these internet consultation platforms and I think we'll be publishing this in the next few months and probably at the world wonker world conference we will be making some kind of presentation on this for those who are interested thank you thank you thank you donal and we're actually well over the end of our time so I think I'm going to have to wrap up unfortunately um lots of chat lots of Q's and A's um some of which are our moderators have been able to to deal with so thank you to Pradjush and Sonja we've had a WhatsApp joys have to rush off to a medical emergency which is why she's she's no longer available so may I hand over back to back to Donald um to for his closing remarks thanks Donald well thank you everybody for joining us you know I think we've had a good exposure on what is happening around different regions before I end uh want to do some advertising about the next Sunday the second webinar it's going to be on mental health and this will be moderated by Chris Dorwick the chair of the Wonker Working Party for Mental Health with contributions from WHO and also across the Wonker regions we'll consider how COVID-19 affects everyone's well-being how patients with pre-existing mental illnesses are at particular risk and how we family doctors can safeguard the mental health of our patients and ourselves so please stay to next Sunday same time uh same arrangement but we will have actually more topics to come including that on education and training quality and safety primary health and universal health coverage rural practice family violence etc etc but before I sign off and end I would like to repeat again what I said earlier um uh we don't know what's going to happen in the next few weeks or months but we know enough to understand that COVID-19 will test our capacities to be kind and generous and to see beyond ourselves and our own interests we at Wonker is here for you for mutual support um all our family doctors together solidarity advocacy our task now is to bring the best of who we are and what we do to a world that's more complex and more confused than any of us would like it to be so let's all proceed with wisdom and grace so thank you very much for coming and thank you Donald for for those lovely remarks um thank you very much to our panelists um really appreciate your inputs thanks to Pratush and Joy and Sonia for their questions and thanks very much to Harris for organizing we hope very much that you will join us next Sunday at 1300 GMT for the mental health webinar then so I wish you all a pleasant rest of Sunday and if it's a bank if it's a holiday weekend for you have a good holiday weekend thanks all thanks bye bye