 Good morning, everybody. This is Donna Prosser with the Patient Safety Movement Foundation. We're here to bring you another COVID-19 update today. And today, again, are going to be joined by Dr. Ed Kelly from the World Health Organization. Dr. Kelly is the Director of Integrated Health Services in Geneva, Switzerland with the World Health Organization. He joins us every few weeks to give us an update on what's happening across the world. So thank you, Ed, for joining. My pleasure. So glad to have you again today. Well, it's good to be here, and it's always good to be speaking with the Patient Safety Foundation. We're basically in the midst, as I've said before, of the biggest patient safety event of at least our lifetime. So who better than the Foundation to be discussing these things with we head into the next phase of this experience? Great, great. Well, let's go ahead and get started. OK, good. Well, what I'd like to do is just as usual, just to provide a few sort of framing messages. You don't always have the same folks, at least I hope not, for these webinars. And the main point that our Director General and WHO has stated in this whole experience on COVID from very early on is that the strong health systems have been the way forward to lay the foundation for both global health security, but also for longer term efforts that on primary health care and universal health coverage. And it's really quite clear that that no other time was that more true, and that as we start thinking of what you would say in my current country of residence France, the world after COVID, that we really cannot be going back to business as usual. We have to rethink how we're doing things and try to do things better on the next slide. And this applies not just to socioeconomics and the environment, but definitely to health care. So I'd like to just outline a few things in terms of the happy updates and some updates from our side on key pieces that we're working on. And I know we have some questions already that have been coming in in advance of the discussion. So next slide, please. Just a quick update here today, 131,296 new cases in the last 24 hours. One thing that we have to be quite clear about is that we are not out of the epidemic. We've had some transitions in Europe, definitely not in other parts of the world. And for WHO, as of 8th of June, there are almost 7 million cases reported worldwide, almost 400,000 deaths. And in the last nine out of the last 10 days, we've had over 100,000 cases reported to WHO. And on June 7th, we had 136,000 cases reported in 24 hours, the single biggest day so far. So in contrast to how at least the media is covering things because for very good reasons, there's a lot of other things on people's minds right now. The virus is not only not going away, it's not even going down. Next slide. So this gives you the picture. You can see how things have moved. There is a definite change in terms of the epidemiology for in terms of deaths and what we see in terms of case fatality rate. You see case fatality. Next slide, please. If you look at some of the regional comparisons when we were looking at Euro in the European region, we had case fatality rates above 8% on average, where in the Paho region, including America and North America, but also younger populations in South America, you have something like 5%. But if you look at, for instance, just in Africa and Emero, you have rates of 2.4 and 2.3% in terms of case fatality rate. So lots of reasons for that. Partially could be reporting issues and how deaths are being captured and recorded, but also clearly much younger populations. So we'll have to see how this evolves. Next slide, please. So just in terms of providing a recap of our feeling on health systems, there's been an increased demand and really a disruption of services. And all health systems now still, and for an extended period, even if the burden has gone down slightly, will be balancing the demands of responding and treating COVID patients and never being sure if the next patient that comes through with a fever, cough, maybe diarrhea, and other symptoms is a COVID patient and a real risk to you and the rest of the patient populations in your hospital. Or is having any one of a number of other diseases, and that's the whole point of some of the guidance that we came out with. That people don't show up based on the WHO's organogram or based on our conceived notions that we're in the middle of an epidemic. So these people must be COVID, these people must not be. So this means that having guidance on how to handle that is really important. So next slide. We had, when we first came out, just a few updates since we last talked. We've come out with an updated operational guidance, detailed guidance that all of our regional directors asked us to produce. And just to remind people, WHO has six regional offices with elected regional directors who are very senior and important people and respond to member states. And when we came out with our original guidance saying, here are some programmatic things that countries need to do to keep health services open during the crisis. They said, this is great, but I need you to go back and give me detailed guidance for different populations and for different diseases. And so we've done that and I'll show you quickly some of the results of that. But we also have advice on the use of masks that was a lot of work, a lot of work looking at mask and mask use. And happy to answer questions on that. Also looking at, we're working right now on mitigating the impact of COVID in long-term care facilities. That's work based on some work done by our European office and also ongoing work on assessing the continuity of essential health services. But some of the initial data that we have showing that up to 50% of health services on average across the countries who are reporting have been disrupted. Next slide. So these are the three guidances that have come out. The first one was the programmatic high level. The third one that just came out on the 1st of June supersedes it. So it's a more detailed version. So we've taken that first one off the website. So if you have it, you can keep it as a limited collector's edition. Be happy to sign it next time I'm in the foundations gathering. But then we also have a community-based treatment, sorry, and outreach services guidance that we've talked about here before for when health workers, social workers have to leave the health facility and head out into the community to deliver services. How do you plan for that? How do you do it safely? Next slide. Just to give you an idea, I really won't go through it because it was such a massive piece of work across almost 20 or over 20, well over 20 departments and something on the order of 250 collaborators that the team worked with. But it goes through, first, more detail on programmatic considerations and systems level considerations for ensuring health services keep operating. And then what are the specific adaptations that each area needs to consider in order to deliver services? So next slide. So you can see this is the first part that goes through the operational strategies for maintaining services. And this gets into detail around actually selecting those priority services and governing those. Those are not easy questions to be made. Which services are you going to put on hold? Which will you keep going with? And there's a lot of good examples out there already. How do you manage patient flow at all levels? How do you surge and move around workforce? This is an important consideration, particularly in US and other places that are facing a struggle with fall off and demand for other services, keeping the workforce busy and keeping them optimally utilized. Then you have issues on central medicines and how you manage communication and information. But we also have a discussion around removing barriers, financial barriers to access. WHO has a position that during, in general, that we have to minimize. That's the whole goal of the UHC Sustainable Development Goal, is to minimize financial barriers, to access, minimize the number of families driven into poverty because of health care. And so during the pandemic, removing those point of care user fees and other financial barriers is really priority. And then we have some issues on digital platforms. And we can talk about that later. I know there's been some questions that have come up about how to maximize digital platforms and other tools for delivering essential health services. That was in our very first webinar that we did together. We talked about some of the examples from that. Next slide, please. So in the second part, we go through very detailed considerations across the life course, which is how WHO sees these different population groups across the life course needs and how you need to adjust for care for those types of populations. And then looks at nutrition, NCDs and mental health and what are the considerations there and adjustments that are made. And then communicable diseases across the main communicable diseases areas that we have in each section has a table that says what are the, what's the activity that's being undertaken? What are the specific adjustments? And then the third column is what are the sort of medium term kind of recovery or getting back to normal considerations you should start to make as you deliver services. So this is your roadmap that you should, everywhere we're promoting this across all of our countries right now. There's definitely parts of Europe and North America that could use this. Next slide. So we do have, it's, if you click ahead, yeah, thanks. That there's a detailed list of indicators and so when you share these, you can actually read them because they're very small but this gives you some idea of the types of things that we're asking countries to measure as they're looking at whether they are effectively keeping essential services running on schedule. And WHS collecting some of this information we can provide comparisons for those who would like to, to talk with us about more of that data. So next slide. I'll just finish with a couple of key points on, on data. This week we're really focused on data at WHO because some of the, as I mentioned about 60 countries have sent us back information looking at the, you know, how they are ensuring essential services. We've collected information on, on their plans. You know, do they have the plan? Does it talk about essential services? Is there funding behind it? Then what are the, what are the services that are disrupted and the main causes and how are they approaching efforts? You know, what are their efforts to overcome some of these disruptions? What tools and techniques are they using? And then what priorities do they have for technical assistance from WHO and from other partners on this? And anyway, maybe next time we're just pulling it together right now. I had vague thoughts that I would slip a couple of slides in, but you know, as a current and former data person, you really don't like to show data until it's like completely cooked and everything's been firmly set. So also we're hoping to get a few more countries in because it's a little bit biased right now towards Afro, EMRO, we haven't gotten the Euro data. And so next time I come, we'll be able to summarize that. Next slide. So just to mention, without getting into all the detail, I have managed the IPC team for now a big chunk of time since 2007, but I do not count myself as an IPC expert and the amount of time that the IPC team has spent on this mass guidance, you cannot imagine. So honestly, when I took over the World Alliance for Patient Safety here, never in a million years would I think there would be so much attention on infection prevention, just in the regular, sort of your regular community, regular media that probably within about three minutes of this going up, I was getting, we were getting questions from all over the world about this that are other aspects of it. So people have been really waiting for this. There's been obviously advice from CDC and others that have very good information. There is, there are some key differences, but I'm happy to maybe I won't go into it now and we can talk about it afterwards, but basically some originally WHO still stands by the fact that all the evidence suggests in our experience with previous coronaviruses and with SARS shows that mandating masks for healthy populations, i.e. just generally in the community, really, I mean, there's not so much harm except for the fact that people tend to not know how to put on and take off masks and they tend not to wear them correctly, wear them too long, not have them of the correct materials, that's not great, but on average, they really don't anyway help with community infection rates. But in this environment, this mask guidance does make the distinction that at-risk, particularly at-risk patients, elderly patients, others, people with other conditions, if you have to be in crowded settings where you're not able to really physically distance a mask may be a good idea. So there's other key points in there, particularly around materials for masks and we have a bunch of great videos explaining this on our website. So for those of you like me who would rather watch a video than read 10,000 words, you can check that out. Next slide. So I think that's basically it, that that was really the key pieces that I wanted to summarize. And I know this time to leave a little bit, a little bit more space for some discussion. And I know we always have great folks online, so probably you'll get as much information in the chat as you will from listening to me. But anyway, thank you very much, Donna, I'll hand it back to you. No problem. And we have a couple of questions coming in if you can stay for a few more minutes with us. Great. Excellent. The first question is related to the data that you showed suggesting that potentially age is a factor in death from coronavirus. Do you have any data about overall wellness? In other words, in the countries where they have a universal healthcare system where access is not as much of an issue as in other countries, are you noticing any trends? Yeah, that is a very interesting question. I mean, the bottom line is no, we haven't really looked at that. We've been doing deep dives on, we've had several different methods for doing this. We have the epi team here, who's the epidemiology team for the emergencies program, has been doing deep dives, looking at a number of factors, looking at in particular sort of testing strategy and also age structures. We have started to look at, and maybe we'll be able to come back the next time. If people looked at, I think it's a very interesting report and not just because I helped write it, but in 2019 for the biannual UHC monitoring report, which is a report we have to produce the WHO leads on, but does with the World Bank for the SDG 3.8. And this was produced for the high level meeting, the UN high level meeting on universal health coverage. If people remember that September 2019, back when we used to be able to get on planes and trains and get together in big groups, that it put out numbers on the UHC index, which is a set of 16 indicators across different service areas, and then also looks at financial protection and it doesn't rate countries, but actually you could look at that as a measure of universal health coverage. So we're just starting to look at that and how that compares with infection rates and death rates at the moment. There's no really honestly clear pattern at the moment, but because particularly for death rates, the folks that are quite weak, you have four types of countries on UHC, ones that spend a lot of money, but have decent coverage, ones that have very good coverage, but get much more value out of it, don't spend so much money, and then those that aren't able to spend very much and are still able to get decent coverage, and then ones that are really having trouble. And obviously the ones in that last one, the quadrant four are your weak countries, your Yemen, where the health system really collapsed. The people have been following Yemen. There was a pledging conference for Yemen just recently this week. It was very, and we didn't quite get as much as we were hoping. They're really, really struggling very high rates of infections. It's a little bit different than some of the other countries we've seen. So, but death rates have tended to be low in those countries because one, there's a lot of background, other background mortality that may be a classification issue. And then there's also that's a young population. So there's a lot of other factors going in there. But anyway, hope to come back next time and have a little bit more information on that. That's great, thanks. I wonder if you can tell us a little bit about MISC. This is the new inflammatory presentation that we're seeing in children. Do you know much about that in terms of presentation and treatment? Yeah, we have recently put out, and I'm happy to share, in, it's at some point after the webinar, the recent brief on this where we had, and we've got new case report form that we're looking at in terms of this particular multi-system inflammatory syndrome. We've got some information that we've put together that could be useful on this, but in terms of the work that W. Joe has done, it's been recent, it's one of these things that the overall message, I guess, is that it is really quite rare. And the vast, vast majority of how should I put it, of cases don't occur in these patients. There's definitely more information that's needed to be studied on this. And I think that there's some, clearly a mandate for examining this and collecting more information, but right now W. Joe just really doesn't have so much information that's gathered on the topic. And we can send some of this information, once we come to the end of the session here, I can give you a send the link for the recent brief that we've had and what country's doing on this. UNICEF has also published some information on this as well. And I think it's clearly something we should watch, but the bottom line is it's a very, very rare condition and the exact sort of progression from a mild infection to this is really not as of yet understood so well. So I think we really have to gather more data on it. Yeah. Well, it looks like Zandiel is on the ball. She's got links already in the chat box for that. So thank you to Zandiel. In terms of the information that's there, the number that we have now that we are looking at, number of them also have some underlying conditions. And I think that that's one of the things that we're looking at, the features are similar to what people probably heard of Kawasaki disease and also toxic shock syndrome. But the fact that it could be related to COVID is at this point even not sort of definitely sure that it's related to COVID. So and usually these kids are treated with anti-inflammatory treatments, steroids, other treatments like that. But I think understanding exactly what this is will be really important. We do have on the website a case definition that is, anyway it's basically in line with CDC's case definition as well and CDC has some good information on its website also. So once we have more data from the clinical platform that we're collecting information on, we definitely would like to come back to you. And for those of you who are providers or hospital managers who would like to participate in that clinical platform, not just for this reason but for a whole host of reasons in terms of staying on top of some of the stuff WHO is tracking, we can definitely provide you with that information. Great. Another question is related to some of the guidance strategies that you shared before that in some cases are regional. Do you have any recommendations for folks about how they can prioritize these on a local level? How they can prioritize? Some of the guidance strategies that you had discussed. Yeah, I think that on basically some of the strategies, the WHO has come out with in general have the sort of their applicability is only is sort of malleable based on the structure of the health system and how decisions are made. So in some countries decisions on public health considerations and some of the public health measures are made at a national level. Some of them are made at a state or province or region level and some are even made at local levels. And so similarly, the guidance that we've come out with on essential health services, we tried to provide that that's why we have sort of part one which is the kind of systems level or programmatic management considerations that are there. But all of those sort of detailed adjustments are really about what you do at a health facility at a hospital, what you do when you're a campaign team heading out to do immunizations or to go out to visiting on social service work or other outreach work. So the majority of the essential health services work that we have produced has really been about local decision-making. Now, I think that this is one of those questions that country context really makes a big difference. Your own context makes a big difference. So how you operationalize those are some of the lessons that we're trying to collect. We have a new learning platform that we're gathering information on and would be great to connect with the foundation and see how we can gather some of the lessons learned from how people are making their own adjustments and sort of best practices, whether it be in long-term care, hospital care or primary health care in particular that would be really useful. Great. We do have a question about long-term care but I knew that you mentioned that you have some information coming out about that. So we actually have several questions and only about five minutes left. So if it's okay, I'm just gonna pick just a few of these and then perhaps we can send these questions to you over email and then we can share them with our network later. Great. Okay, excellent, excellent. Question for you about the increase in cases that we're seeing, especially here in the United States, you've seen a lack of social distancing most recently, both with economies opening up and with some of the protests. So do you think that there is a, what do you see is gonna happen in the next few weeks? What are you guys thinking may happen with the peaks? Yeah, I've been asked this by many people from like my church council where, anyway, I'm on my church council, I hope that makes you think better of me and that up to sort of some of our national counterparts and the bottom line is like, honestly, WHO has good ideas about it but really no one knows exactly what's gonna happen but at one level, like I've said before, most countries, even now in Switzerland, it's probably only 7% of the population has been exposed. Most countries are no more than 10%. So that means that really from most communities, they're not that much different in terms of being magically immune to this virus than they were before the sort of rise in cases started. So most people are still vulnerable. We seem to have, how shall I put it, kind of come to the point where corresponding to the very understandable move away from the closing of businesses and schools and other things like that, the quote unquote lockdown that countries for lots of very good reasons have to restart. So what needs to happen though, is for a period of time until the vaccine is available to us and I think that's something that's really important. We will have to be maintaining good testing and robust testing approaches and good contact tracing. Those will be our two key tools in managing this. And then the third tool will be the public health measures and really trying to maintain and make hand hygiene stations available as much as possible, managing the numbers for any given interior space, whether it be work or school or other places. And then really depending on the communities to understand that things haven't magically ended that they still need to be responsible even if they're able to have a bit more freedom. So I think the recent big, big gatherings and it's not just the US actually, there was huge protests in France over some, there have been some recent threatened closures of because the difficulties with the economy on different factories, et cetera, big community gatherings and not respecting physical distancing. And so those are basically the definition of super spreader events. So I think we'll have to keep an eye on this but a number of countries have big spikes, bigger spikes even than the first. So for instance, like Iran and then there are countries that have just continued upwards which includes Philippines is another country with a bigger second wave into Bangladesh but France and Switzerland have also seen some increases. So we will likely see a wave like this as we go along and there'll have to be some adjustments as we go. So I think this is something that we're obviously in this for the medium term and there needs to be an approach that manages the opening up but also does it responsibly. And then one more question that's a little bit related to that. As you probably know, there was some confusion yesterday when the World Health Organization was indicating that there isn't that much of a spread from asymptomatic carriers as we had originally thought. I think, I believe that she clarified her comments. I wonder if you could help to clarify that a little bit more about the transmission from asymptomatic carriers. Yeah, we've talked about that with the mask guidance and people should check that out. It's a little bit more detailed in there but it's definitely something we're tracking all the evidence still suggests that it's quite, that it's still relatively difficult to get that people do shed the virus but it's relatively difficult to get it to be infected by an asymptomatic carrier just because the ways, the coughing and other ways that they would leave traces of the virus or expel traces of the virus are much more limited. It's definitely not unheard of particularly and a lot of the asymptomatic has been within families so they're sort of, you know, they're obviously in shared space much more frequently. So, but it's relatively difficult still from what the evidence suggests for an asymptomatic person to casually infect the casual contact rather than a close contact. I appreciate the clarification. I know that it's been all over Twitter, hasn't it? Yeah, yeah, a lot, a lot, yeah. Yeah, well, thank you very much and I always appreciate you joining us. We're looking forward to having you back in a couple of weeks and in the meantime, we'll send you the questions that we weren't able to get to today and we can send those out to our network separately. That sounds good, Donna. I know there were some questions that people had about elderly parents and our relatives and we'd be happy to talk about that. I think it's a big challenge and I'm hoping that our long-term care guidance is gonna help for some of those congregate facilities but also managing, you know, long-term care and home care obviously doesn't happen just in facilities. So you have to, bottom line is figuring out ways of managing the exposure and potential, you know, minimizing infection. Basically, everything is doable and especially things have to be doable in order to keep people's sort of mental state and spirits and their livelihoods going but it has to be thought through and done deliberately and done every single time. That's the bottom line with infection prevention. But anyway, we're happy to take those questions offline and we can write up some work and put anyone in contact with some of our experts. That's fabulous. Well, thank you again so much and we'll see you in a few weeks, I hope. Sounds good. All right, take care. Have a great day. Bye-bye. Bye, everybody.