 Good morning, everyone. I'm Donna Prosser with the Patient Safety Movement Foundation. We're here to bring you another COVID-19 update. Our speaker today, Dr. Ed Kelly from the World Health Organization. Hello, Ed. Be remiss, we didn't give you a little bit of an update about where things are and I guess especially given some of the foundation's core group coming from around the world, but also especially in the US, one thing to flag is the large number still of cases, the biggest cases in the United States and Russia, the in terms of confirmed cases and also deaths. You know, we are down in terms of the rate of increase, which was at a very high rate about a week and three weeks ago even, but still moving at high rates and still increasing in a whole number of countries. Next slide, please. And you can see this on the graph here. The back when we thought things were crazy is the first part of that little orange when things were in China. The number of cases is going up. It's at a rate that's a bit slower than we had earlier at the end of March, but still rising. Deaths have fallen and those are particularly because of death rates falling in a number of European countries, but we'll come back to that next slide. And I'll just go through the different regions. I won't spend so much time on them. I really encourage you to look at these because it's fascinating the different shape of the curve. And you can see very different, it's not strictly speaking a case fatality rate, but if you can see the distance between the black line and the top of the cases curve, it gives you some idea of the difference across the different regions. Concerns and whiplos is that things have moved into very big countries such as Philippines. And I would just flag briefly here this issue of solidarity and the issue on Singapore, which I'll come back to before we close. Next slide. And you can see Sierra, a very steep climb as it's moved into India, Indonesia and Bangladesh. In a big way. Next slide. Euro, you can see everybody I know who lives around where we are, particularly in Switzerland, which has had good results recently and France less good, but still better, much better than recently. Very excited. My daughters are pleased, but there is a very slow and cautious process right now about considering about reopening. And we can come to some of those in your questions and answers. That's not been the case with some nations and some states in the U.S. I guess without singling out any given country or state, that has to be done by local officials. I think we have to be cautious about the move forward on some of this. Next slide. The, this is the picture for MRO with the rising set of cases was just on with the regional office today, both with regional director and the deputy regional director. A lot of concern about big new cases in Saudi Arabia as well as in other parts of the other parts of the region. But very interesting in terms of the death rates and flattening basically through that whole time. So it looks very different from what happened in Europe. Next slide. PAHO, which obviously is heavily influenced by what's happened in the U.S. deaths just recently down in the U.S. But I would just say if you can look back a couple weeks, we thought we were headed down on deaths and cases and deaths, both of them jumped back up. So I think we should not expect that death rate to continue to fall necessarily if you look up above it with a big increase in cases that could come. Next slide please. And Afro, a very different picture in terms of we've got a lot of numbers are very much, much lower. You've got a very different case fatality rate interestingly, very different age structure there, but also very, very different capacity. We had a call with, anyway, the tiny, tiny microcosm of the continent, but South Tome and Principate, they basically have zero lab capacity. So they are, there was some WHO has managed as part of this big global supply chain operation, which was launched yesterday at a press event at the UN Palae here. We've managed to get solidarity missions with supplies to all 52 of our Afro countries, which is a great thing, but and rapid diagnostic tests out there. Actually, some countries like South Tome and Principate because of the limitations on lab capacity are using these rapid diagnostic tests, actually not in line with WHO's recommendations about those rapid diagnostic tests because there are not other capacities. So I think the health system capacity will be a big question mark for Afros as we go forward. Next slide, please. Just a quick view and I'll come back before we break, but to break question by John about Sweden's approach, but the overview of age and sex in the case reporting form, the CRF, that's our database here. Again, I'll come to the conclusions on this just after this. So next slide. And you can see here, interestingly, the sort of the age and sex breakdown that we have here across the different age groups, sort of relatively equal in terms of the two. So gives you the outbreak in different parts of the world really, but quite equal across the two time periods. Next slide, please. So just, you know, some conclusions is very rare to detect cases in children. Those of you who have followed some of the news today about this sort of, I mean, it's not a Kawasaki syndrome-like scenario, but this sort of rapid deterioration of post infection for some very, very small number of children. So that's something to apply. But generally, very small cases in children and some countries with having a shift to the oldest age cohorts and other countries with that have more of a pyramid-shaped population of disease shifted to slightly younger and middle ages. So the age distribution isn't changing much in countries across different countries. We see a few exceptions I know there. But some of this, we think, could be also the way that we track cases and tests. And then a slight difference of severity and disease based on gender as well. And obviously, we've talked about the age distribution in terms of the severity. Next slide, please. So just to spend a bit, a moment on this issue of health systems in COVID. It's been a huge, huge burden. It is, for all of our regions, the number one concern right now is the impact on essential health services and the potential for both regular chronic care services to just be left aside as well as essential sort of acute services to be done. And a big dilemma about balancing the risks associated with keeping health services up and running and what you put off to later. Next slide. So we've given a bit of an update on our work. And again, I'll go, I'm going through it quickly just so we leave time for some questions since we've left a shorter time period for this and logged on late. But we have this health services and systems work within WHO's response. That is a core piece of work that funding is coming for from World Bank, from the EU, from Gavi Global Fund and others, four countries. There's operational guidance on this. We've now just finished some work on guidance on how to maintain essential community based treatment and outreach services. Those are big important pieces of health care delivery around the world. We've also really pushed for obligatory hand hygiene stations in public spaces and given guidance about that. In some countries you see that really taking off and others like my own in France, I really wish we had some more and there's going to be a push for that as the country starts to open back up after May 11. Next slide. There's some important guidance on and work that we do on coordination and convening and really trying to manage some of the knowledge work. I think having this feature with the Patient Safety Movement Foundation has been a core piece of that in terms of both gathering information and also getting information out there. Next slide. This is the picture of the guidance and the recommendations that are there. There's a set of targeted immediate actions around this and really trying to help countries think about six real areas. Next slide. Give them programmatic guidance about how to maintain services. It's really about setting up the governance mechanisms for the response protocols in terms of the services. Identify what are the services you're keeping there. We suggest some but obviously it's related to the specific context. Trying to optimize those service delivery settings. So setting up the triage and shifting tasks and shifting services as they need to be. Ensuring effective patient flow and we have guidance on that and also redistributing health workforce capacity and then looking at what are the mechanisms to maintain available medical essential medications. The second biggest concern that all of our countries have is on this global supply chain and how the interruptions because of border closures as well as even within countries restrictions on travel have meant that essential supplies in many parts of the world were difficult to get to the front line already. So now it's even doubly difficult and some of the focus now on getting PPE and sort of testing and this kind of thing to the front line with big planes flying around means that this is something that we will have difficulty now making sure that some of the central medicines can be also brought along as well. Next slide please. So some of the hand hygiene recommendations we have already put out there in terms of obligatory stations and then trying to really improve hand hygiene and its approach on the next slide. I would try to remind people about the 5th of May which is five five and it's a meaning five fingers and on your two hands and that's our official hand hygiene day every year. It's part of our was our first global patient safety challenge and this is our global day and this year what the focus was already on the year of the nurse and the role of nurses and midwives and safe patient care and some of the messages there you see that's really for everybody. So just that's coming up and I would really encourage people to get on social media and we can through the foundation we hope to amplify the the message on this and DG Tedros will be making some good messages on this as well. Next slide. So the couple tools that are out there that help plan some of this issues around task shifting and around and around essential supplies we've mentioned and these are the the items that are there and they're available on the website. Next slide and just to close with the idea that this it's very clear that this isn't just about delivering COVID care it's about essential services and it's not just about sort of essential health services and the health system and recovering in the health system it's really about societal recovery. I mean the idea that that there is full scientific decisions being made around the reopening of societies is just not fully there's as much science as can be brought there but there's no decision maker that that is able to look at science and able to say okay now exactly at this moment is the right moment according to science to reopen by this amount kind of thing. So this framework from the Secretary General that we worked on a lot takes the last pillar of WHO's response which is around ensuring essential health services and takes a very health first approach and makes it the first pillar of the of the UN's roadmap for working with countries on this but it then looks at jobs it looks at trade it looks at a whole range of issues that need to be tackled to really bring back countries and all of us I think anticipate that we will not be going back to what we had before actually I hope we don't. I am now hoping that I never have to wonder whether someone's in the office or not about having a meeting anymore that we just send the link and people can show up virtually. I seriously hope that WHO does you know maybe not no travel anymore but at least of a drastically reduced travel the air is cleaner over Paris than it's ever been over Bombay as well over Delhi rather as well and there are many things that'll be different. I think though that one of the issues that I want to come back to to close and come to some of these questions was this aspect of solidarity. There will we will not be no country that is ready to just be back to the way it was before until all countries have really solved this issue and there's no country that can solve it for part of its population. If you look at Singapore and it's a country that I've worked with quite a bit on patient safety issues actually it has got an excellent healthcare system it's got great surveillance it's got a very good public health system it's got a population that how should we put it in relation to perhaps as an American or as someone living in France we not so good at following orders sometimes but to say in Singapore people are will you know they'll comply with messages from their government so they crack down very early as it were and and had a great control and it was a model for the world but there is also a large population that are migrant workers that come to work on construction come to work in restaurants come to work cleaning and all sorts of other tasks and they the virus because they're outside the formal economy and outside of really formal healthcare systems it restarted there and it is now restarted in a huge way in Singapore so this will happen in literally every single country in the world and the Dr. Tedros likes to say the virus the virus exploits and shines the light on the cracks big and small we have in our societies and nothing could be more true than that as we head back I think John's point about you know comments on Sweden and its approach shows that how should we put it that maybe there are fewer cracks in the Swedish society and also the sort of an ability to it may be related to sort of a trust ability there's also good testing strategy there but I think that for all of the countries that are opening back up some countries never really closed there definitely will be a rise in cases there's nothing that has changed between before when we had lots of cases coming the only thing changed we closed everything down made people stay home now that we don't if we start to not have that for sure we will have cases coming again so it's a question of watching the rate of increase where the cases come and really being able to try and trace the work and people taking a modest approach as they go forward so maybe I'll stop there and I see there are a few other questions but maybe John I'll just pause and see if how you want to go through some of the questions and see if there are any anything others that you'd like there's a few questions actually and so you know and so I have some folks helping me out who are collecting some of the information so question was the first question was about the World Health Assembly do you have any information on whether or not it'll be postponed this year or will it be virtual yes the current guidance that we've been given on that is that it'll be virtual that's been the discussion the exact sort of format is still being finalized but the the sort of draft um how should we put it the draft agenda for it right now is looks to set up a proposed set of arrangements that has between the 18th and 19th of May there would be a virtual meeting in virtual plenary using video conferencing and the specifics would be communicated you know through the governing bodies and that the agenda would be you know the agenda was agreed and at the executive board would be much abridged if they speed be the opening a discussion around COVID and the election of the executive board members and most of the other decisions the decisions would be put in an omnibus document for silent procedure and that there would be most likely later this year if possible there would be a special additional World Health Assembly sort of a that would take up some of the more problematic business great thanks another question was regarding use of chronic health care services those right now who are chronically ill or maybe have a an acute problem that can wait or avoiding health care because of COVID so how do you see that impacting serve health care services moving forward especially after we begin lifting restrictions yeah I think it's um uh you know WHO has tried to be really clear with this sort of essential services work to say that like there's a range of essential services that need to keep going and countries need to figure out a way to safely uh offer them we've offered some guidance there's IPC guidance that's offered there so people should not be staying home when they have essential services that are there now um if it's an elective surgery if it's um something that can safely wait there's absolutely no reason then to not so to wait on that um and also to give a break for uh for busy health care facilities but um definitely you are doing much much more damage if you stay at home and don't seek care for all sorts of things for chronic uh conditions whether it be um uh regular checkups for diabetes or whether it be a care for your asthma whether it be your cancer treatment now many localities and local health care providers are struggling to deliver those services so that's a different matter um in principle all of that stuff should must must keep going in practice many places are are really struggling uh with this and I think that's um something that we need to do a lot more on in terms of uh providing providing those uh services and figuring out a way to remotely deliver care to make home deliveries to um home visits even whether or there are possible okay yeah no that's a very good point I think home home care is definitely going to to be one of the things that we see changing in the future you mentioned also that you know there's we were really looking at a new normal here what do you think that that means for PPE moving forward you know we've learned a lot about the need for um for certain PPE and aerosolized procedures do you see that changing after the COVID pandemic slow down um I think what's fascinating as someone who's a patient say anyway but we're all patient safety people but so I don't know if other folks would agree but I am fascinated with how um it happened also a little bit with uh you know under SARS but like how now the topic of infection prevention and control whereas it used to be I think we said this earlier and um used to be sort of uh these the special people that were on you know the seventh floor of your hospital and we're kind of the anglery retentive people that went around and checked everything all the time and everything had to be just right kind of stuff and where you wash in your hands and everyone rolled their eyes at them to now like literally everybody in the community cares about infection prevention and control and so um I think they're they're obviously they're more effective and really sort of less effective um kind of security blanket type um uh things around PPE I think that in healthcare settings um what what I hope change is the the guidance from WHO and from most from CDC from ecdc has not really changed um in terms of the basic standard precautions so standard precautions and um need to be there but I think what will change is organizations approach to how you organize for preventing infections and everything we've ever studied on this shows that the way you organize services and the way you kind of follow up and check on on infection prevention has a much much bigger impact than whether or not you're wearing a particular mask or the a particular type of of PPE but um so I think that I hope that at least in healthcare settings every single hospital in the world and every single care provider in the world has a designated focal point for IPC who has tools like checklists and regular checks on this and that they follow some of the training that WHO is putting out that we're launching a new app with our the WHO academy that's starting just this week that'll put all of our training on online for people and uh I hope IPC is the number one downloaded uh training. Great well we'll definitely share it on our website for sure and then one more question I know we are a few minutes over but if you've got time there was a question related to um COVID and strokes we're hearing all kinds of different presentations of COVID um I even heard about COVID toe yesterday for the first time can you speak to what you're saying around the world is is every country experiencing these same odd symptoms from COVID? Yeah there has been a lot of discussion around these um uh around these different uh symptoms you know for the most part um uh you know for while we're all talking about the um loss of taste and smell and you know other things like that um that has been investigated um it's been found to be present for some patients not sort of in the vast majority and not significantly higher and not really useful as a specific um kind of symptom I and I think it's really coming it's not to say that that those don't have merit at all and I think there's tons we do not know about this disease that's the whole nature of a novel virus but um it's uh I at least our feeling is so far is that there hasn't been that kind of um breakthrough symptom that would allow us uh additional symptom because actually fever and cough is very unspecific uh in terms there's lots of stuff that goes with that but um so everyone's been looking for what what are some of those little keys that might tell us that yaha this is COVID and it's not just some regular flu or not just the um hay fever or something else um and uh that so far there hasn't been that hasn't been that breakthrough but for sure we are it's one of those things we're monitoring all the time um and uh we definitely come back to the group if there's anything that's a super substance on it on the stroke question um I'll have to do a little bit more digging about what's the latest because I haven't followed it and uh we haven't dug into it in the last couple days but um I'll come back to you down with anything that we find that would be great thanks well I know we are we are over our time and I really appreciate you joining us today as always we have enjoyed speaking with you and learning about what you guys are doing and and and it's just so it's so helpful to hear about what's happening across the world I think that you know your your comment about solidarity is so very important right now we we are all dealing with the same thing and it's great to learn from each other thank you good thank you so much John and really thanks to the foundation for um setting aside the time and for folks being online I really honestly if um if you didn't have time uh to uh if we didn't come to your specific answer um you know maybe with John and we can work together and come back with some written stuff that you can post on the website um for anything that that that would be useful particularly there's lots of stuff on long-term care lots of stuff on uh classifications of mortality and these types of questions that people are wondering about so I'm happy to happy to spend a little bit more time offline and and you can share it the next time everyone's together that would be fabulous yes everybody please send us your questions you'll get a survey after this webinar and please let us know if there are any questions that you have we can post them on our website or send them via email great well thank you very much again for your time and we hope to talk to you again in a few weeks sounds good and we'll be back okay thanks bye bye everybody