 First of all, I'd just like to thank everyone for joining us on your Sunday. This is the first of a series of webinars run by the Wonka Young Doctors movement. This one is led by the Vasco de Gamma movement, which is the European network. We have just asked to run the first one. The theme for this webinar is riding the second wave of COVID-19. As many of us around the world are facing the second wave of COVID, we hope to share our experiences as young doctors and our positivity from what we have learned so far so that we can ride this second wave successfully. Next slide please. So, just as an introduction, the Young Doctors movement is a Wonka network. It's just a run through all of them. You may be familiar with this already. So, we have Polaris, which represents North America, Waianake of South America, Vasco de Gamma movement, which is Europe, Afriwon, which represents Africa, Al-Razi for the Middle East, Spice Route for South Asia, and the Rajakuma movement for Asia Pacific. And as you can see, each region has a leader who I've just put their email addresses on here in case you want to contact them. Next slide, please. So, for today, the webinar, as I mentioned earlier, the webinars will be happening every two months and this is the first one. There will be talks from representatives from each of the Young Doctors movement networks. And then we will be finishing with questions and closing. Next slide, please. Just a few housekeeping rules. So, please ensure that you're on mute at all times if you're not speaking. There are different ways to ask questions. So, you can type a question in the chat or in the Q&A box and Kerry will be fielding these. You can also type a question in the Facebook chat if you're watching on Facebook and Rocío will pass the questions on. I never have to really make a point of this last one, but because it's a good family sort of network that we're part of. But just to remind each one, everyone there, you know, just be kind to each other. Thank you. Next slide. So, just to introduce these talks, I just thought I'd start with something a little bit personal to me. So, I write a blog called the Global GP Project and since February, since the beginning of essentially the first wave of COVID, I've been interviewing family physicians from across the world and to find out more about what it's like working with COVID in our setting. We are all facing the same challenges and I want to learn more and also share the lived experiences of my colleagues worldwide. Next slide, please. So, I've interviewed doctors from across the world, mainly in Europe, but from Italy, Hong Kong, Brazil, UK, Turkey, Taiwan, USA, India, Australia, the Philippines, Indonesia, Spain, Germany, Japan, Australia, Kenya, Kazakhstan and Portugal. Next slide, please. And there's lots of things that I've learned through these series. Just as a reminder, one of the main things is the fact that primary care looks different from across, looks different across the world. So, in the UK where I work, we work mainly in the community, but there are countries where family medicine clinics are part of a hospital. Sometimes we act as gatekeepers, sometimes we don't, and what gatekeepers are is that you have to see us before you could be referred to a specialist. So, primary care looks completely different depending on where you work. But there are principles of primary care that binds us. So, this is a WHO principle, which is that we are the first point of contact, that we provide continuity of care that is comprehensive and that we coordinate it as well. But actually, I really think that what binds us and what makes us very similar is a fact that we all practice patient-centered care. So, when I've been doing these interviews, the main thing that I've learned is whatever political system we work in, whatever public health implementation that has happened, we are actually all facing the same challenges, the same concerns, and actually, we all have very similar temperaments. We've all had issues around PPE, especially at the start, and worrying about how to keep ourselves safe. We're also humans and that we've had to face lockdowns, our own anxieties and social isolation whilst trying to be upstanding members of the community. It's also been really struck by the fact that family physicians are trusted members of the community and that we are there to engage with local leaders and individual patients to keep everyone safe, whether that's through dispelling myths, correcting fake news, picking up on family violence, even ensuring that people have enough to eat. And also, it really was touched by how much we care about the social determinants of health as doctors. We know that there is a widening disparity of health and wealth during this pandemic, and it was the compassion that my colleagues expressed that was very touched by. So, next slide please, Nick. So, we're going to move over to Christian and then we'll be moving straight on to the panel list. Feel free to ask as many questions as you like, either on the Q&A or the chat, and then we will try and answer them as much as we can. Thank you. Thanks, Sonja. I find your results are really encouraging and showing how important we really are and that we should keep ourselves motivated. And coping with COVID, as the slide says, you will now hear spotlights from GPs around the globe showing our similarities and differences. And my impression is still that countries tend to solve fresh problems mostly on their own and now again would be the perfect time to learn from each other and realize not everything we take for granted is just that around the globe. Just mentioning universal health coverage, health illiteracy or freedom of press. COVID lights our problems and reminds us we as GPs are important and many depend on us. We can push for change and therefore we need to keep our exchange going. This is why we, the YDMs, started this webinar series to listen, to learn, suggest and discuss and to make new friendships and revive existing ones, because we can't and don't need to tolerate everything on our own. So, enjoy the ride. Next slide, please. Hello, everyone. My name is Dr. Amber Wheatley. I am a family medicine trainee from the British Virgin Islands. And I'm vice chair of Polaris, which is the young doctors movement for the Americas, the North American, the Caribbean and Canada. And I'll be talking mainly about my home country, the British Virgin Islands, but I will do some parallels with Canada and America, which will become evident as the presentation goes along. Next slide, please. So, the Virgin Islands is our official name, but we've got a next door neighbors who are the U.S. Virgin Islands, and they've decided that they're the Virgin Islands, so we're the British Virgin Islands. We're a British overseas territory in the Caribbean and we're made up of 60 islands, but only four of them are inhabited. The population is about 28,000. We've had some fluctuations in the population since the hurricanes in 2017. So, I think prior to that, it was about 34,000, and then there was a mass exodus of people, and then people are slowly starting to come back. The country has one hospital, and in that hospital, we've got a HDU that has about nine ventilators. We've got a limited number of doctors, so our healthcare system is a semi-privatized healthcare system. That means every district has a clinic with at least one doctor in it, but some of those doctors also work in private practice, and there are some doctors that work solely in private practice. As a result of this, in anticipation of the pandemic, we were part of the recruitment of a team of Cuban doctors who have come to the British Virgin Islands to help out. Next slide, please. So, this has actually been updated very annoyingly yesterday. So, the government has an information team that regularly puts out flyers such as this to let the public know the current status of how we're dealing with the pandemic. So, at the moment, we've got about 7,000 people tested at the hospital, with 73 total cases, one as active at the moment, 71 recovered, and one death. Next slide, please. This is where the British Virgin Islands also fit in with the rest of Latin America and the Caribbean. So, as you can see, we're on the lower end of the spectrum with only 79 cases at the time that this information was put in. The lower number is obviously related mainly to a population size, but it's also a reflection of how aggressively the government implemented non-pharmacological methods. And I'll contrast this with America and Canada later on in the presentation. Next slide, please. So, this is a timeline of how we've coped with the pandemic so far. So, the pandemic was officially announced on the 11th of March by the World Health Organization. We didn't have the first case in the BVI until March 25th. This was traced back to someone who had actually returned to the BVI from New York. And there was also another traveler who was a BVI native but from Europe. And that led to a small outbreak. As a result of that, the BVI went into its first lockdown as of March 27th. Hold on a moment, please. Right. So, we had our first lockdown March 27th to April 25th. And this was a very strict lockdown so people were not allowed to leave their yard. And we had police patrolling. We also put in provision for people to try and get food and necessary items delivered to them. After April 25th, the curfew then came into play so people could leave their house but only for a short period of time. And only essential businesses were open so a lot of people were encouraged to work from home. Even the essential businesses had a restricted time so they were only sort of open for half the day. We then had another outbreak as a result of lifting the curfew and then we had contact tracing that was done. So, anyone who had been to a location where a positive case had been found was then invited to do sort of a mass testing. And this was as a result of cases increasing from August to September. Interestingly, the case increase at that point was linked mainly to two things. One was that the U.S. Virgin Islands, our neighbors didn't have a strict lockdown policy as we had. And as the cases in America rose, it was one of the few places that Americans could travel so their cases skyrocketed. As a result of the cases skyrocketing, we had quite a few illegal immigrants trying to come over from the U.S. Virgin Islands to the British Virgin Islands where they knew that there was less coronavirus. And this highlighted one of the things that I'll talk about later on which is about our border security. So, at the moment we had another lockdown. We've got a curfew in place and the cases have slowed down and as of October we haven't had any new cases. Next slide, please. So, with the surveillance system, everything is sort of good old-fashioned pen and paper. So, initially with the nationwide lockdown there was no mass testing because at that time we only had two active cases. A medical hotline was put in place where people were triage for possible symptoms. Most of the cases were managed at home or in the community and only in severe cases they were taken to the hospital. As the number of cases increased, as I mentioned, we had mass testing for those who had been in contact with a known COVID positive and that included direct contact as well as being potentially exposed. The testing was all done through our clinics and then we set up some community centers where testing could be done as well. The track and trace is done via the testing centers and the government does plan to introduce a track and trace app December 1st when our borders officially reopen again. Next slide, please. Amber, I might have to get you to wrap up soon if that's okay. Yeah, that's no problem. So, after the first lockdown the borders were close to visitors so you could only access by air transport and all permission has to be requested. The very unique thing about the BVI is that everyone who comes into the BVI, you have to have proof of a negative COVID test three days before entry. You have to be quarantined for 14 days at a designated facility with 24-hour security and while you're quarantined, you get tested on arrival and on day five and regardless of your COVID status, you must quarantine. Next slide, please. So, as I mentioned, all of our consultations were through the medical hotline first and then in the medical center, mostly done over the telephone. Because it's a small community, the patient's main concern was actually confidentiality. They didn't want people to know that they were positive and the practicality of self-isolation so getting food and water to them became a problem. You only got the test at the cost of the government if you had symptoms of coronavirus or were unknown contact. Otherwise, if you just wanted it for your own interest or for travel purposes, it was about 125 US dollars for the testing. Next slide, please. So, the strength of our primary care is that in many parts of the British Virgin Islands, the primary care is literally the only care. That is the doctor that they know. So, there was already a well-established relationship with the community and that made implementing strategies a lot easier. And for good or bad, because we've had to deal with a lot of natural disasters such as hurricanes, the government already had a very easily adaptable protocol for natural disasters and they just adapted it for the pandemic. So, I've just put a little screenshot of the six step plan that they had in summary. Next slide, please. So, the lessons that we learned were that having clear information out to the public was absolutely instrumental and having a multi-agency approach was also really important. So, we used the family support network greatly in our response. Also, having rapid implementation of the pandemic strategies was very crucial. So, you can't sort of let it sit for a week. Restricting movement with the border lockdown was also, I think, what protected us from having a serious outbreak. And it's also important to signpost people to accurate information. I know a lot of us have experienced a lot of false news going around. Next slide, please. So, the lessons that we learned, as I mentioned, was about illegal immigration and the border security. And we also unfortunately had a local lockdown where some essential workers weren't sticking to PPE and that led to another transmission despite people being locked down. Access to food and water also became very challenging. Some businesses used it as a way to exploit the public and that led to a lot of mistrust and chaos. The last thing that I wanted to mention was that the borders are planning to reopen December 1st. But while in the BVI, we haven't had that many coronavirus cases, most of our tourists come from Europe, Canada and America. And if they're in the midst of their second wave and having increasing cases, it puts a lot of fear on what will happen when we lift our restrictions. Many other countries have seen that they've managed well with the pandemic. But as soon as they lift the curfew or lockdown, the cases spike. And I anticipate that the BVI will see something similar. Thank you very much for that. Thank you, Amber. And that was really interesting. And also interesting to hear about the BVI where we, which is a country that we never really hear very much from. So thank you very much for your time. And we're going to move on next quickly to Christian, who'll be representing Germany. Thanks again, Sonja. Yeah, Germany. You know all about Germany is located, I suppose. I forgot to put on a map. So I'm going on quickly now, only five minutes. Next slide. Okay, Germany initially got a lot of praise because of the good response to COVID. But nowadays, we have to consider it might have been luck mainly because we travel a lot and yeah, we had no special measures. Yeah, maybe we were simply lucky that we didn't get that many cases. And now we have the second wave like anywhere else, a lot of poo all around the country, 20,000 new cases every day. Next slide, please. The current state is that we have a soft lockdown in place to stabilize our incidents. Currently, it seems to work. The initial goal was to get the numbers dropping. That is not the case. So maybe we will see stronger measures, maybe a curfew in the end. I don't know. Locally, our ICUs are on the threshold to full capacity. But of course, in Germany, we have a lot of ICU beds. We have about 25,020 later beds. But as everybody else, we have problems finding the right personnel for it. We are taking the first measures to prepare for vaccination. For example, in my state, we have the first plans coming up where the vaccination centers will be located. Then we had a lot of media coverage about protests going on. This is kind of interesting. The freedom of speech in Germany is really a high good, of course, because of our history. We had really crazy protests against the soft lockdown measures. We had a special moment two weeks ago, the Sophie Scholl moment, where a young 21-year-old woman stated she was feeling like Sophie Scholl, which was actually a freedom fighter in the Third Reich, who got killed for her work. She was protesting escorted by police and had rights to say whatever she wanted. Now the public is not that much in favor of these protests anymore. The social impact in Germany is okay so far. We have a lot of relief programs going on. Next slide, please. On the right-hand side, you can see a map of COVID. The map shows every little state in Germany and the incidents. We have about 1 million cases right now, 20,000 per day. The engagement with public health for us GPs is that public health just tells us who we should test. When we test somebody positive, the labs directly report back to public health. The tracing is mostly done by the public health departments, but since the numbers have grown so substantially, the GPs are also involved in tracing now. So Waylands can be done, can be seen online. The Obert Koch Institute is publishing very good data. For example, the slide on the right-hand side is from the Obert Koch's page. The tracking is mostly done by GPs because we have good relationships with our patients. We try to follow them up. We also have some corporations going with insurance companies where we get reimbursed for our special needs, our timely needs. There's also some research going on with tracking, but it is rather diverse and not coordinated. Next slide. Protection measures are an important point at the moment, which is discussed among GPs. We have architectural circumstances, which are really diverse because GPs are normally self-employed and they work in all kind of buildings which make it hard to really protect the patients attending from each other. I'm in a good position because we just build a new building and I have a back entrance and we have separate rooms for all infected people, but this is not the case for most GP officers in Germany. You will hear more about that if you want to join the Vasco da Gama Movement pre-conference exchange on December 15, short ad, where you can visit three successive GP practices in Germany. Testing is done in the practice at the moment. You can also refer if you can't test in your practice under the right environment. Asymptomatic testing is also done for COVID contacts when they can be traced for returning travelers. They have to quarantine and they can get free of quarantine with negative tests. Hospital nursing homes, when you enter them, you can also get a free test before and school staff is regularly tested or can be tested. Next slide, please. I'm running out of time. Strength and local primary health care is mostly the long personal relationship we have with our patients and the growing professionalization in Germany. We have professional chairs at all universities. We have a lot of networking communities. As we are mostly self-employed, there is a lot of initiative to keep the ship afloat because if we don't work properly, we don't get the money we need to pay our employees. The federal system in Germany also developed a diversity of strategies with this, which is good if you want to find the best strategy. But on the other hand, we have a lot of miscommunication, mass document production, and we have a lot of differences between the states in what is allowed and what is not. Next slide, please. Silver linings. I want to tell, yeah, we can adapt with GPs. We can react to difficult situations and we can encourage each other and the patients trust us a lot. Society can also cope with awkward contrarians like our protestors and if you see all these slides here in the presentations, you realize the same world has similar problems and yet we can grow together with all our diversity, which was, by the way, the Motto von Kar 2017. Equity is something that benefits everyone and I hope when the vaccination is coming around the globe that we will see more equity than we have seen in the past. Thank you. Thank you, Christian. And it's really interesting because when I spoke to you before for my blog, I remember being quite surprised at the federal government in Germany and how all the different regions had different rules. Thank you. So next is going to be Dr. Makinda Ure from Nigeria. Thank you. Hello. I'm Dr. Ure Makinde from Nigeria. I'm the General Secretary for Everyone Renaissance and I'm going to be sharing with us some of what we're doing in Nigeria as we're preparing for the second wave and I believe that this is something of what is going on and representative of other African countries. Sometimes I wonder are we on the second wave already or we're still waiting for it, but I believe most of us believe that we're still waiting for the second wave. So we want to see how well are we prepared to cope with the second wave. All right. Next slide please. So it's just a few months back that was in February 28, 2020 that we heard the news that the first case of coronavirus disease had been confirmed in Nigeria. And next slide please. Where we are now is that as of the 27th of November 2020, we've had 246 new cases and these cases are mostly in Lagos and the Federal Capital Territory, which is Abuja and this is because these are the two international entries into the country, exits and entries into the country. And when you look at the total figures, we have 67,220 cases of COVID-19 in Nigeria and out of these number, we have 1,171 who have been lost because of the Ravagian disease. And this is just, this fatality rate is actually less than 0.02%, which is just the same as what we're getting in Africa as a continent. Next slide please. Now, some of us would wonder, we seem to have a low fatality rate compared with other countries all over the world, but we should also look at the number of samples that have been tested. As of yesterday, we've just tested about 756,000. We've just had that amount tested, so it's not surprising that we're having a lower number of people who are dying from the disease. Presently, we have 3,363 active cases and this data is quite important because the mindsets of the average Nigeria is that we don't even have COVID at all in the country and that's the same mindset that a lot of Africans do have. Next slide. So now talking about what we've been doing in my own home country, when we first got the news that we had a patient with COVID-19, the communities, what we did was to start tracing contacts of that person to the various communities and this was managed by the Nigerian Centers for Disease Control. We also had the Lagos State Ministry for Health coming in to do a lot of work in this area, so people were traced to their homes and after a while, we had to start community screening as well, but over time this has dwindled. We've not had a lot of community screening. Most people are screened when they present with symptoms or if they do a self-assessment online and they find out that they have symptoms that are suggestive of COVID-19, then they present to the health facility. Most people these days are getting screened because of international travel and that's because before you can go to another country, you have to fulfill the requirements by the international health authorities and get the COVID-19 tests done. Next slide please. So testing in Nigeria basically, we have approved COVID-19 test centers and these are majorly provided for by the Nigeria Institute of Medical Research. We have tertiary hospitals and accredited private laboratories, but the downside of going to some of these private laboratories is the cost. The cost is so high and a lot of people would rather use their money to fund basic supplies at home than to pay about 50,000 Naira for a COVID test. Next slide please. So talking about public engagement and the protocol so far, we have multiple levels of public health response for the federal government aside from the national centers for disease and control. We also have the presidential task force. We have talked about the federal ministry of health and we have a COVID-19 emergency operating center which caters for the issues that might arise for people who have COVID-19 and in different states we have public health authorities who are responsible for preparedness and response activities. Coming down to the hospitals, I work in a tertiary hospital that's the Lagos State University teaching hospital and one of the things that we need to do and that is done in several other centers is that we have to triage our patients. We have a huge crowd of patients that come to the general patients and without triaging them we can't know who is a suspect for the disease and so once we triage using a particular chart, then we are able to decide whether this person needs to be referred to have a COVID test. Most of the time, like I said earlier, they go to the Nigerian Institute for Research or they go to a tertiary facility to get this done. We have campaigns that have been organized by the Nigerian Centers for Disease Control. They've been at the forefront organizing campaigns, letting everyone know that they need to take responsibility. If you come to Nigeria now, you see a lot of people without face masks. They believe that this is a political propaganda and that there's no COVID in Nigeria and just last week, Africa marked the mask week, what we call the mask week. Next slide please, I'll tell us more about that. I'm going to give you a minute left if that's okay. All right, so next slide. The basic things that we're talking about during the mask week is everyone wear your mask, maintains physical distancing and hand washing and that's basically what we do in the hospitals as well. Next slide. Talking about the strengths in primary care, the strengths in primary care have to do with the fact that we have our frontline staff who work as a team, but we still want to advocate that primary health centers in Nigeria should be included in the fight against COVID-19 and that's because we have the potential to detect cases early. We get real-time information across to our patients and we're able to support compliance and ensure the continuous provision of health services. Next slide. So what are the lessons that we've learned from all of this? Pandemic preparedness is an ongoing process, whether it's a developed country, underdeveloped, even the strongest communities were not exactly prepared for this pandemic. We need to communicate with people out there, the public, they need to get contacts from the stakeholders and the government, they need to know that this is a risk. This poses a risk to you and to your family so that they can take their appropriate measures to protect themselves. Training and retraining of healthcare workers is key so that they can also pass down appropriate messages to people in their communities and strengthening of the community disease surveillance system. The surveillance system right now is quite poor and we need that to be strengthened. The fight against COVID-19 requires continuous implementation of primary health care strategies and this includes access to clean portable water, basic sanitation, hand washing, even basic supplies such as food, which was a big problem during the lockdown and that was why the lockdown had to be eased because a lot of people were even dying from hunger rather than from the disease. Next slide. So I want to thank you for listening, I'll be willing to answer questions as they come up. Thank you, Sonia. Thank you, thank you so much, really interesting and I really like the visuals and the public health campaigns as well, they're really beautiful. We're next moving on to Anas. Yes, thank you, Sonia. Good afternoon everybody. Can you hear me? Okay, so I am Anas Al-Muhtaseb, a family doctor from Jordan. I am the chair of a Razi group. Jordan is located in the Middle East so the arrow is actually after sharing the presentation is not here exactly. So this is Iran. It's just to the north of Saudi Arabia and just close to Palestine so I'm sorry that the arrow is not in the correct place. Anyway, next please. So in Jordan we have another story. It is not the second wave, we are still facing the first wave. Actually in Jordan the government did a very strict controlling banning of movement, lockdowns, contact tracing for several weeks. So we have maintained very minimal number of cases till the end of August. After that a breakthrough happened through some of the borders and the transmission of the infection started to increase. Gradually did we reach a community-spread level so we have unfortunately reached the maximum of the up limit of transmission of the virus in the community. Next please. So recently these are the figures of two days ago, 27th of November, that we have total cases confirmed cases to about 207,000 cases with the 2,570 deaths. So this is a very large number. Actually some estimates that the actual number of cases is about 10 times this figure because you know that there's some limited number of investigations that we can do per day. So we are expecting that we have two million infections or one and a half million infections in the community in Jordan. By the way Jordan population is 10 million only. So we are talking about 15 to 20 percent of the population is already infected. So as you can see we are now maybe at the peak of the first wave. Hopefully the numbers are now plateauing or hopefully come to become less than that in the future. So this is the current situation of cases in Jordan. Next please. So actually my focus was on family doctors and primary healthcare and role in facing the pandemic. So the engagement of family doctors in local public health actually on individual basis maybe some of family doctors have some administrative or policy making influence. Others were involved like me at least in research about this. Other family doctors were involved in telehealth especially during the long period of lockdown. So this is an individual experiences. However on collective basis family doctors were involved in quarantine hotels. So the story here that because there's in the first stage of lockdown any one can will come to Jordan will be quarantined at hotels. And so family doctors were involved in providing medical care for them. Also maybe the most important role of family doctors during the pandemic is that to ensure the delivery of essential health services through health centers either during the lockdown or nowadays also. Family medicine residents also have growing growth in curative services for COVID-19 and not COVID-19 patients in hospitals as you know that first few or three years they are involved in the world in internal medicine. So they are involved in treating those patients. So and next please. I will talk about the surveillance measurement now actually because at the beginning there was a very good surveillance tracing and tracking of the infected people. Now the sampling the primary health care centers are used to make sampling of patients in the main or comprehensive centers which is distributed very well over all the country. So people it's very close to people they can come to visit the center and do the tests. Analysis the analysis of the results is very centralized and unfortunately the follow-up is very limited now not at the beginning. So what about protective measures actually in the clinics we have the basic protective measures face marks sometimes full PPE hand washing keeping sufficient distance with patients also if we need testing we can do the test at the center next please. So the main actually strength of Jordanian system is that we have as about 676 health care centers in Jordan in 2019 112 are comprehensive ones large ones. Primary centers a smaller type is about 377 and a more smaller centers about 187 called branch centers. So it is well distributed on the country actually the main duration is in the middle and another western area of the country. So this is the main strength of our health care system or primary health care system and in fact the number of family doctors are growing significantly over the last three or four years. So next please maybe this is the final slide so what are the lessons learned we think that more role should be made by primary care centers and family doctors at least so this strengthening in the primary care center and family doctors is not used very well. So family doctors can follow up mild and moderate cases through telehealth for by phone for example which will minimize the pressure on hospitals. This is not done unfortunately. Also the family doctors can be and community workers community doctors can be involved in contact tracing of those infected people to ensure that they are not contacting other people. Another thing that we think that can be used which is telehealth so we can treat people apart from coming to the clinics as you know that many of our visitors in the clinic are elderly people so it's better to protect them. So the finally what do we need actually we think that maybe the policymakers are not very convinced that primary care and family doctors can play a major role so I think we need more advocacy about our importance our role as family doctors and primary care centers primary care providers in in the health system at all and especially in the pandemic. Moreover we might need more empowerment of our family doctors and to build leadership in our family doctors that they will affect the policy makers or policy making in the future. Thank you very much. Thank you Anas and I know that you're at work right now so thank you very much for joining us during a busy day. So next we have Sering from India. Hello I'm Dr Sering Uriakos from India. I'm the chair of the Spentroot India movement. Next slide please. So I think you can see on the right hand side of the slide you can see the cumulative number of cases which are confirmed cases on the left on the left hand side of the slide you can see the death which happened till date. So India is a very large country with more than 1.35 billion population and we have 28 states and eight union territories. So our data is definitely large and next slide please. So here is just I'm sharing this with thought on the left hand on the left hand side of this slide you can see the states marked with the according to the human development index. The greener areas are the states with the high human development index and on the right hand side of the screen you can see number of COVID-19 cases. So if you look the states with higher number of human development index are having the number of more number of cases maybe because they are more into testing or the other way around. The states with lesser human development index they may be under detecting the COVID cases. Next slide please. So I will be telling about the second wave and third wave etc but in India we are currently in the first wave. We had our lockdown from 25th March to 31st of May. So after that by June 1st week we had a rising number of cases and we reached a peak by September and from October we started we entered into the training phase and currently we are in a stationary phase. Maybe is attributed to the lower number of tests. Initially we used to test everyone but now we are focused more into the symptomatics as well as the high risk contact. Next slide please. So here also these are the daily number of deaths. Here you can see the death pattern is also following the total number of cases. We had our peak. Now we are into a stationary phase more or less from the last three or four weeks. Next slide please. So again this is the cumulative number of deaths. It is on the rise. Next slide please. So this is how we engage our public health system. This is how we do our surveillance and packing. So at the national level we have National Centre for Disease Control. We have as I mentioned earlier we have 28 states and union territories. We have state surveillance unit at respective states and we have states are divided into districts. There we have our district surveillance unit and every district is divided into local self-government. For every local self-government there is at least one government institute and the entire community officer is interested with the all public health activities of particular so that is how the system works and we have our private institutions and we have private as well as government laboratories. All these institutions and labs report to district surveillance unit and this is how it works. Next slide please. So again this is how our surveillance system works at every level. We have a body to monitor systems and it is a bi-directional system. We give our inputs, we get feedbacks. This happens at every level and even at local self-government we have a the local self-government area is further divided into wards or divisions. At every ward or divisions we have a rapid response team. So they will be collecting all the data regarding surveillance, active surveillance, contact tracing and a follow-up of patients those who are under domiciliary care. And this also works in a two-directional way. Next slide please. So these are some of the measures we take to ensure safety and make sure that all patients are being tracked. We have government system as well as the private system and in government for COVID management we are mainly depending on the government system for tracking and follow-up. For patients we do telemedicine consultations. We have designated fever clinics as also we keep safe distance at our workplaces. Also we ensure personal protective measures which can be full PP or partial PP. And test as everybody knows we have different kinds of antigen test artificial CP net and two net. And as of now we are testing all symptomatic patients and high risk primary contacts and vulnerable groups. And for surveillance also we are doing phantom testing and those who are in the high risk group. And as I mentioned the previous slide we get reports from the rapid response group from these wards and municipalities in the whole country and depending on their reports we do active testing. Next slide please. This is the regulatory authority for deciding testing strategies ICMR. Next slide please. So these are the various types of testing and the criteria for testing. We have rapid antigen test RT-PCR, CP net and recently we have a few more tests added to the list. Next slide please. So this is the algorithm for COVID-19 test. Next slide please. So one thing with the COVID-19 pandemic the authorities came to the senses that we have to strengthen our primary care and that is the only way to fight the pandemic. So because we have a good reach in the public and the public the primary care network is so strong in their numbers. And another thing we have a direct contact with the community so that we can be able to convince the layman. Also we can be very influential in each and every community. I already explained to structure how the system works in India. So we can reach to the root. Next slide please. So we are still in the past wave and we are expecting like any other country we are expecting and getting ready for the second wave. They are getting ready for the vaccination when we are making our list for getting vaccinated. And at the same time we have strengthened our primary care and as everybody knows our doctor population ratio is not that good. It varies from state to state but on average we have around 1500 to one. So that is our doctor population ratio. So we have to be very judicious by using it. So instead of having tertiary care for everything we have to spend some primary care. That is how we will be able to fight this pandemic and future ones. And we have to incorporate not just the doctors but we have to we have to incorporate for the community health providers and the members of the rapid response team in every local self-government and future of the local self-government to fight against this COVID as well as any other pandemic. Next slide please. Thank you. Thank you so much Seren and I always find it interesting the use of community health workers in pandemics or epidemics in general. So maybe that's something I can ask you later. So moving on to our next speaker Loretta. Hi I'm Loretta. I'm from Hong Kong and I'm the Chair of the Erotic Movement. So let's start by seeing some figures and then some updates about the condition in Hong Kong. Well for the current state of COVID in Hong Kong when although the topic is the second wave but actually we're entering into the fourth wave. This is the fourth wave of the COVID that we are experiencing. And as from yesterday we have 84 confirmed positive cases and with 80 of them are the local cases that 27 unlike that means we cannot find really where the source of the infection that the patient has contracted on but unfortunately for today we have rise to about 100 positive cases already and that the total confirmed cases are as from already reached about 6000 and but fortunately for the hospitalized patients we have only 500 something but we are expecting a further increase in numbers because in Hong Kong we admit all the patients with the COVID positive cases into the hospital. So whether they have bad symptoms or their mild symptoms, serious symptoms or even asymptomatic patients they all they're required to be admitted. So we do not have enough beds in that case so we will need to open up some we call the community treatment centers that for the mild cases that they will go into and for the more serious cases that we will allow the patients to stay in the hospital. And until today the death rate has increased from 109 patients by from COVID already that makes up the death rate of about the mortality rate of 1.7%. So the recent of social cases was explained by a very famous dance cup cluster that has made up of more than 400 patients. The people they are while at suggestion of staying indoors and have putting the mask on. So they went into the dance club and do the social dance together without the mask. So it now the cluster has spread around and then to have more than 400 patients. This is the single most biggest cluster up till now in Hong Kong. So next slide please. So I would like to talk more about our local surveillance program that maybe you you may be interested of because this is the new regulation that was just enacted yesterday. It was a compulsory testing regulation. The duration of this regulation will be lost for next 14 days. And that requires all the symptomatic patients attending the medical care that must be get tested for the COVID. And they can either get the testing services for provided by the public sector as free of charge or they can choose to test in the private laboratories that the patients have to pay by themselves. Next slide please. And this compulsory testing we will do the I don't know how the others of other places that you do the testing but in Hong Kong we generally provide the specimen box to the patients that they will provide their defrost lifer in the early morning or they can provide a defrost lifer with two hours of fasting. That means they advise not to drink or eat or rinse their mouth two hours before and then they can provide the defrost lifer price. And for younger children they can provide this two specimens. So we generally in the outpatient setting we do not usually do the throat swab or the nasal pharyngeal swab to reduce the risk of the infection to the doctors to the healthcare workers. And this is the title here the specimen boxers need to be returned to the specified collection stations collection points within two days. And the results will be available within 48 hours after the return of the specimen. And those are test positive will be contacted directly by the Department of Health to arrange for admission of these patients and for those test negative they will receive an SMS for the notification of the negative result. The next slide please. So this compulsory testing regulation the the doctor in charge will be responsible for issuing the compulsory testing direction to the patient coming to for consultation with the symptoms. And for those failed to comply they will be subject to a penalty of 2000 Hong Kong dollars that will be about 250 US dollars. And so and then they will be and then the Department of Health will issue the compulsory testing order for those refused this testing direction. And for those who still not comply with this they will be subject to a penalty of 25,000 Hong Kong dollars that means 3,400 US dollars and imprisonment for six months. So next slide please. And the local surveillance program apart from this compulsory testing services regulation which just launched yesterday. And we have the contact tracing so for those all the positive cases they will have the Department of Health will be responsible to get those close contacts to to have the the tests with the either the first lifer or the two tests. And this is also compulsory and but there is a voluntary testing services for those asymptomatic citizens who have good concern they do not have close contacts with the positive cases but they have to concern say those living in the same building with those positive cases then they or they can choose to go to some community testing centres or some mobile specimen collision stations or to have the tests done so they can they can get the doctors and provide the specimen for testing all these are free of charge. So next slide please. So this is about some of the about the testing the update on the testing and this is me in my clinic so this is my PPE a little bit of the DIY one when the when the condition is we get more cases I usually put my face face too but when the cases go down a little bit because you know we have the fourth wave so we have the up and down doing the the days that it's not that serious the condition is not serious I usually put my gong on so this is how I look in my clinic. Next slide please. And this is the specimen bottles that we use for collection of the difference lifer and in the patients will be advised to put them spit out this lifer and into the bottle provider this is one of the specimen bottles provided by the laboratory private laboratories and the patient can return the bottles to the laboratories and have the tests available and next slide please. And for the strength of the local primary care I think many there's some very good points have been mentioned by the others but just look at some statistics we have in Hong Kong this is the statistics I obtained from the footway you can see that enhanced surveillance for hyperkinects that means the clinics I mean that people have symptoms they have to they go to the clinic they will get tested so the percentage positive rate is zero point eight four percent which is very good when compared that with those in the public clinics in a public operation clinic or even quite comparable to the inpatients for because all patients with pneumonia or influenza like illness that admitted to the hospital they will get tested with the COVID so we are quite we got quite good positive detection rates and next slide please. And for learning points from COVID what I learned from is very importantly if we have some small groups of our doctors we can have the keep update with the latest public health issue it is very important for us to to know about how everything because the information flowing very fast every day just like the compulsory testing regulation that I discussed before it was just within three days it was launched within three days so we get prepared with all these the computer system and then collection of the specimen bottles and then everything within three days so it's very important for the doctors but we can have good communication and then we can discuss and to learn from each other and it's also important for the small group that we can have mutual support from each other the very important point I think is that I learned from COVID because you know Hong Kong is a little bit special we have experienced this 17 years ago so people have a more awareness better awareness of the disease prevention so the still the very important thing is that we if we can have better education of the patients on wearing mask hand hygiene I think this is the single most important thing in if only we face any kind of pandemic and kind of disease that the patient education is most important and I think all the world are GPs are overworked people as mentioned in the in the chat box center and so beware of burnout and yes this is what I would like to share today thank you thank you Loretta I'm always jealous when I hear about the advanced technology from Hong Kong and your robust racing system thank you and last but not least we're moving to Mariano from Argentina. Hey everyone how are you today? Thanks a lot for inviting us to be part of this event as Sonia said my name is Mariano Granero I'm from Buenos Aires Argentina and what I bring you today to share with you is the first learnings we are starting to have in Latin America with the pandemic of COVID-19 next please so if we are going to speak about Latin America I think it's the most important is to give you two main features that we have here one of those is the heterogeneity is one of the main features in Latin America which means this is regarding culture history people nations the city and the countryside it's like huge difference between different countries and even inside the same country in different regions of the same country and this is important not because of the culture or the history but because as I am speaking about Latin America in general you should keep in mind that this heterogeneity is also implied when it comes to diagnosis and approach of the COVID-19 pandemic so in Latin America you will find countries with mass testing and countries with no testing at all you will find countries with severe and strong and strict lockdowns and countries with no lockdowns at all so it's very difficult for us to make conclusions and compare different cancers because the strategies have no very like just a little point in common the next please and the second feature you should keep in mind is that Latin America has a huge social inequity so you will say it's like okay why why is this important for us and it's super important because what you can find here is that when I mean social inequality it's like Latin America is not a poor region we have a lot of resources we have a lot of science and we have a lot of education but the problem we have is that the access to those resources is not the same for everyone so I think this picture is from Colombia but you can find this kind of a scenario all along Latin America no matter where you go you will find like people with a lot of resources living like I don't know 50 meters away like in this case people with swimming pools in their balconies like living like 70 meters away from people who has no access to clean water to drink so next please so what I can tell you is that no matter these differences between the countries what I can give you a general idea of Latin America is that we have also a later beginning like Hong Kong and Jordan so we are still riding the first wave we have the first case at the end of February almost March of 2020 and it was in Brazil but of course it spread weekly and by the end of March to the beginning of April every country in Latin America had at least one case reported and the other feature that the epidemic curve has in Latin America is somehow this curve seems to be a little bit more flat so that's that implies a late pick for a later pick for most of the countries but of course it means longer periods for the first wave that's one of the reasons why people here is experiencing the first wave and why people here is somehow exhausted with the pandemic so next please so what I'm going to share with you today is four learnings we had from pandemics so far the first one is that somehow we mistook the part with the whole and when I say this what I mean is that the part is the co-bide of course and the whole is the health of the people somehow I don't know why what happened in the in our way but somehow co-bide seems to be the only things that matter regarding health it's like the the only things that we pay attention to is that you don't get infected by covid next please so that led us to covid center strategies and everything we pay attention to was to avoid people getting infected by covid but next please that brought us a big problem regarding non-covid conditions that we didn't pay attention to when since resources are not endless when you give resources to something you take it away from some other thing so when we focus so much on covid we turn our backs to psychological problems to social problems poverty related problems to a lot of problems so next please not only we had a covid center strategy but we also moved a lot of resources from the primary care system to the hospital we had a hospital center response which means that next please you know primary care is at both sides of it's at both sides of this wall but of course the lack of primary care is has a bigger impact when it comes to the left it has a bigger impact when it has to do with a more vulnerable population next please so this brought us something with that we already knew and this is the less primary care we offer the the more vulnerable the population is and this brings the next learning next please it's like why did this happen and it has to do with primary care it's not a priority for many of the decision makers here in latin america because the primary care is related to a lack of prestige and some people and especially the decision makers they think that what we do somehow is not important for population they think that the difference is made in hospitals and fancy hospitals with a lot of technology and that's a big problem for us at least in latin america because so far here we have a little development of the primary care so next please if you keep this in mind we can go to the third learning that is of course that next please we need to take the primary care to develop to its full potential so you you can say next please okay we know that and you will hear it's complicated it's you will find a lot of people telling you this cannot be done the the complex the system is super complex and we have a lot of problems and no one cares about primary care in in the politics maker so i think it's time for us to stop to stop thinking like this and start saying of course we can and turn from we cannot do it to how can we do it so next please i think the the fourth and the last learning we had is that so far people tell us that we need to work harder so we can change this reality so we can give access to the health system to vulnerable population and i think that's the mistake i next please what we need to do is not to work harder what we need to do next is to work smarter what we need to do next please like the the fly i i really hope you're familiar with the story of the fly and the window if you're not it's going to take me only 10 seconds to get you through it it's like a machine a fly trapped in a room and she's trying to escape and she smashes herself against the glass so we tell her you need to try harder you need to try harder but the this story is about the window it's open a little bit like at the other side of the window so the fly what she needs to go out this room is to pull her back and get the big picture and work smarter what she needs to do is to work smart if she gets the big picture she will find out and the the way out of the room and she can way she can work the way out without smashing and what we are doing at least in latin america sometimes is that we are smashing ourselves against the system so what we need to do is to say we need to pull ourselves back and get the big picture and play the game if we want to win the scene and change their reality what we need to do is to play the game and win this thing i couldn't agree more with dr anas from jordan who's who's talked about the role of family doctors i i couldn't agree more because uh no matter where we are um if we keep in mind that the the less primary care we offer the more some vulnerable people suffer uh i don't only not only i think we should change the this reality i think we must change this reality we have to make this happen as next generation of family doctors we we can do this so this is me for now thank you a lot and thanks for your time thank you mariana that was a really excellent presentation that summarizes uh essentially what we were all talking about so thank you for putting it in such an understandable and succinct way um so that's the end of our panelists i just like to say a big thank you to everyone for such an informative talk we are going to have about 10 minutes of questions um and thank you very much for everyone popping them on the um chat keri can i get you to maybe ask one of the questions and then we'll get um a couple of the panelists who um would like to answer yeah so there's been lots of good um questions and things going on in the chat um one question was around um well-being and compassion fatigue um so we're all working really hard during covid um has anyone noticed sort of compassion fatigue happening within their country and how are they dealing with it does anyone want to answer that question any volunteers i mean i just wrote a piece about it on the chat and definitely this is the case we're all getting fatigued and from my perspective this is mainly dealt unofficially in small groups of gps and friends sharing their experiences and encouraging each other i think if you have a good group where you can share your problems um then you're already in a really good state does anybody else want to um volunteer any perspectives on that i just want to add a few sentences uh to that actually theoretically we have uh we have a system of uh professional mental support to uh get rid of these fatigue and all but how far these can be effective i'm not sure because uh irrespective of all these cancellations and counseling and all we still have to work so really hard to say how to overcome that i don't know but we have a system of uh uh support through uh phone calls and uh which can be uh they they will follow basically that's the plan and we have our peer groups to support each other but uh as i already mentioned how much uh all these can be effective i'm not that sure any other questions carry yeah so we've got a question sort of about moving forward i think christian and serin both mentioned vaccination and there's been a lot of news about vaccinations recently um so questions about how your country is um is there any preparation for vaccination and how it will be rolled out um and who will get vaccinations yeah i can start actually we as gps in germany are not on the front line of getting informed so i uh transcribed something from a governmental that was sent to my wife which uh she all works in nature conservation i don't know why she gets it and i don't um we have um vaccination center planets here in germany the government seems to opt for the minus 70 degree vaccinations so in the first stage they want to establish wax centers two to three centers per administrative region and they want to vaccinate over a thousand people per day in these centers and later they want to establish centers on county level as well and construction of the primary centers should be finished by the 15th of december and they want to start vaccinating in january they're still looking for personnel and i think that's the the worst part about it because where do you get the all the people to to vaccinate they want to activate retirees i don't think they will get a substantial quota of retirees to work in vaccination centers later they also want to establish gp practices but of course they need a different kind of vaccines there and they want to establish mobile teams especially to cover the nursing homes okay what did i write there oh yeah one important point might be to identify the legitimate teammates for the vaccination and of course i think this will fall back to the gp's which could be a duty which involves a lot of stress for us in the future to say who gets vaccinated and who doesn't yet okay and of course i'd like to hear from hong kong because they seem to be on the forefront of technology i don't think we are really that really advanced in the technology as people are always saying that we are far behind better but for the vaccination i i don't think we have a really very organized plans on because we do not know how many vaccine stuff that we were able to get for the we are expecting maybe in the after the second quarter or in the fourth quarter that before we can get the vaccine and you know people in hong kong they have always have the what should i say they will have the the question whether will it be really useful to have the vaccine so even if the vaccine is available i will have the doubts if the people will say hey i will go for the vaccine first you know hong kong people are always like that they don't feel they they will have their own well they have own ideas and they they will feel that maybe just i wear the mask it's quite okay so they may not be better enthusiastic and having the i think but still we do not have any any programs any ideas about how we are going to launch a vaccine program because we don't expect the vaccine to be coming to hong kong in the next six months so this is what i'm thinking so i and i don't know whether how how you see about the vaccine the efficacy the safety because in hong kong people are always discussing about this and our our experts the microbiologists and they will also say that well maybe even if the vaccine is available we still need to be very careful we still get to be very careful about the preventive measures wearing mask and hygiene and they really do not really have that and the sizes and the size on the on the vaccine so we'll just wait and see if i can comment please yeah thank you uh so in jordan actually we don't know uh to what extent do we need a vaccination actually uh because we the number of cases is growing automatically and maybe we might reach some sort of herd immunity before the need of vaccination or the arrival of the vaccination anyway there are some plans to to provide the vaccination for the priority for healthcare workers and the main the primary care centers will take the main role in providing the vaccination for the public especially for the elderly as a second priority thank you um is there a final question there gary um yeah so we had a question and a common theme seems to be about misinformation um i think mckinsey touched on that quite a lot so are there where do we think the misinformation is coming from in your country and how are you combating that i can't participate actually the misinformation is very huge um maybe because you know the society itself has been fatigued after the strict lockdown and measurements of the government and so many wrong ideas raising uh some now and uh even uh so so there are many uh trials to to counteract these misinformation uh from doctors from the government from media uh either formal or non-formal uh efforts to to to change the wrong information in the public um still we have many people don't think that there is a pandemic you know so uh but uh actually on the other hand many people are taking the issue very serious because they are seeing their relatives their neighbors are dying due to the uh virus maybe this is the most uh significant factor that mariana i i couldn't agree with anas again more because it's like misinformation is a huge problem also here it's like um um and it's a big problem when it comes to the media but it's a big problem and when it comes to the social networks with people sending like uh like stuff in in whatsapp and their social medias and it's also a problem with the scientists and it's also a problem with the politics like creating like um uh i don't know like it's not false expectations but not correct at all so what we do is like our role we the family doctors we are uh we have we are trained to read the evidence and criticize the evidence so maybe it's our role to communicate that evidence properly so i didn't see i when i spoke about the the role of the family doctors and even more we the young family doctors we need to bring this information properly to the population it's our role uh we cannot ask uh some some other specialties that are not trained to criticize the the evidence to communicate the evidence so that's our part that's our strength you know it's like uh i think it's on our hands to communicate to communicate properly this this information but first we need to read it and we need to criticize it thank you um i'd like to thank all the um i think we'd better start to close up because we've been going on for quite a while now but um i just want to say thank you to all the panelists for being so easy to work with and also for giving fantastic presentations today um nick do you mind just sharing my closing slides please um and i i guess the take home messages from what i've learned from everyone is just how primary care is integrated in the community and how we have a really good understanding of our population and our understanding of inequity and um even the vaccination um uh sort of questions at the moment the answers to the vaccination question indicates that we really know that there may be a an up a problem with uptake um just to show us how well we know are in communities um follow following one from this webinar um as i mentioned before there are going to be further webinars with the young doctors movement um obviously pre-covid the way to stay connected was the FM 360 exchanges where you can visit another country across the world through the Wonka network and um obviously we had Wonka we did have Wonka World Abu Dhabi planned but that's been postponed to the end of next year and there are regional conferences as well i've put everyone's contact details here in case you want to learn more about your own local network um next slide please um we've also been talking a lot about well-being and you know we have all been working very hard and also relentlessly and many of us without a break um as christian mentioned earlier we are not alone um it's better to stay connected and we can learn from each other and stay energized from each other so i just really want to um highlight the Wonka YDM group on facebook it's on social media there's also regional um facebook groups as well next slide please um this is a bit more europe specific but um we are having Berlin Wonka Europe in next month on december 16th and obviously we have the pre-conference for young doctors which is the day before next slide please and then next slide and then um this is something that's again personal to me because we're the uk team are holding the seventh Vasco de Gama forum which has again also been postponed to january 2022 and these are our social media networks because we will be running an online two-hour event which will be fun um on the 6th of February 2021 which is everyone across the world is welcome it'll be online and it's at lunchtime europe so that everyone can join um next slide so all that's left for me to do and say is to thank you to all the panelists that are involved all the YDM leaders who helped us make this a reality to christian who um volunteered himself to help me on this uh to harris who is a CEO the new CEO of Wonka world um who gave us a lot of technical support and the use of the Wonka Zoom platform and also our helpers Kerry and Rocio who are furiously looking at the questions behind the scenes um so just to say thank you to everyone um have a really good sunday and thank you for sticking with this all day or not all day but bye thank you thank you bye thanks for joining hope to see you soon yeah have a nice day