 Good morning everybody. This is Donna Frost, our Chief Clinical Officer at the Patient Safety Movement Foundation, and we're here to bring you a COVID-19 update with the World Health Organization today. I know we haven't done one of these in a long time, and our friend Ed Kelly has moved on to better things beyond the World Health Organization, if that's even possible, and so today we are so excited to be joined by Dr. Priyanka Raylon. She's a technical officer at the World Health Organization, and she's also a clinician who is currently caring for COVID patients. Welcome Priyanka. Thanks for joining us today. Thank you, Donna. Thank you so much, and thanks for everyone for joining and for having me be part of this webinar series. I have very, very, very big shoes to go with Dr. Kelly. This is a departure, but it's my honor to be here and to talk with you today about COVID-19 updates from WHO. As Donna mentioned, I'm a clinician. I'm an emergency medicine specialist trained physician, and I work here at the WHO headquarters in the clinical management team for COVID-19, as well as on the clinical service review systems team, which helps with strengthening health systems for countries around the world, and that's where I've been working with Dr. Kelly for the last over a year. But it's really great to be here, and so today I will speak with you about some updates from COVID-19 from WHO, and I'm really happy to take your questions and discuss with you after the presentation. Well, thank you so much, Priyanka. But real quick, before you get started, I just want to be able to say that we are providing CE credit today for board-certified patient advocates. I apologize. That's the only CE that we are able to provide, but we will give you 1.0 credits for that. If you did register as a patient advocate, then you'll get an email within five to seven days from us here at the Patient Safety Women Foundation with your certificates. So with that being said, I'm going to pass it back to Priyanka, and I will be muting or monitoring the Q&A in the chat, so please enter your questions there, and we will get to all of them at the end. Thank you so great. Thanks, Sana. All right, so I'm going to spend a little bit of time talking about the current situation and my current updates epidemiologically, and what's been going on for globally and by regions, and give a little bit of history on what's going on with the vaccines at the moment, which is a really exciting new update from the last time you held your hip with X, so I will say they're a really great bright spot in the updates. And then I'm going to speak a little bit about strengthening the clinical system, again, from my clinical perspective, in the health systems, but also through the clinical COVID-19 response. And I'll focus a little bit on safety, since that's where I'm speaking, the audience that I'm speaking to today. And again, I'm really happy to discuss more details through questions as we will later discuss them as well. And the final thing is I'll just mention some safe practices for Ramadan, as today we did start the Ramadan season, and it's an important consideration for current times. So to start off with, we have had increasing cases over the last four weeks. What you can see here is over the last week, we've had 4 million 450,000 new confirmed cases in 75,597,000 deaths that have been reported to us. This is as of just a couple of days ago. Overall, 130,000 confirmed cases, and about almost the majority of the new cases, as you can see here, I have over the last two hours of new cases and the deaths that were reported coming from the U.S. for new cases, and deaths mostly in Brazil and in India. And then here you can see the EPI curve by the WHO region. Again, you can see most of the new cases in the European region and in the region of the Americas, and then deaths as well, just increasing. We had a little bit of a dip in the summer, but that again is sort of on the ups and downs in recent weeks. And then here you can see a distribution by the WHO region separately. You can see lots of sort of waves, second waves, especially in the Africa region, also in Eastern Mediterranean Americas, and a bit of increasing new cases in Europe as well here, Southeast Asia and Western Pacific. We've all everywhere globally, you can see that the cases have been on the ups and downs. And so last week we had, as I said, about 4.5 million cases, and nearly 76,000 deaths. Mostly, as I mentioned, Brazil and India as countries, but in the regionalized Southeast Asia and Eastern Mediterranean. We're seeing unfortunately some, you know, with the resurgence of COVID, as we're saying, this sort of second wave, third wave, some countries are facing a fourth wave. That there has been some complacency on the public health measures, the opening and unfortunately not to maintaining the public health measures in control in settings and in crowd settings and in workplaces, etc. So we continue to emphasize the need for public health measures and physical distancing, social gatherings, which again I mentioned now with Ramadan being an important consideration, hand hygiene and masks. For vaccines, everyone has heard about the COVAX facility and the poke at this stage. And so for COVAX, we've shipped around 36 million doses to 86 countries. And this is actually a little bit older. We have some increasing numbers in the last week. But really exciting to know that campaigns have started in so many different economies and that there's been lots of vaccines now started in low-income countries, particularly in Africa. We've seen lots of new vaccine shipments every day to new countries. And that's been very encouraging. However, we have heard in the last couple of days, especially in the media, that our RBG has highlighted to the world that there's still an enormous amount of vaccine inequity that we're seeing across the world. On average, in high-income countries, one in four people have received the COVID vaccine, whereas in low-income countries, it's about one in 500. It's quite a staggering amount of vaccine inequities. So there is a lot of work to be done in that side. And here you can see a little bit about the distribution. Again, this is information from a few more than a few days ago, but again highlighting that around 41% of low-income countries have not started vaccination. And even almost a fifth of the low-middle-income countries, again, by well-banked eradication, have not started vaccinations, whereas only 1% of high-income countries had not started vaccinations, and the majority of them have. So it's an enormous amount of need to help bring the vaccine to the rest of the world. And another thing I'll highlight from our other colleague, Dr. Nkripov, she said very importantly earlier today, the variance, the fatigue, and the fact that we've been having this uneven vaccine distribution has contributed to the rise of this resurgence that I mentioned. And we need to do it all. All of those public health measures are critical to keep encouraging and maintaining that physical distance, but also social closeness, and encouraging others to also engage in all of the public health measures, including vaccination, but all of the other things we've seen so far. So what the way that we are supporting countries into doing that is through our, one of the ways is through guidance and translating our evidence into action. So I'm going to speak a bit more about tools and their trainings, etc., but firstly, a bit more about how we get this evidence into action. And so here you see many pictures of WHO guidance and trainings and tools, and a little bit more about how these guidelines developed. Again, on the right side, you see the clinical management guidance, which I'll talk a little bit more about later. But it's important to understand that we're doing this in a very, very rapid pace, faster than we've ever done it before. Generally, as it's said here, that length of WHO, in six months or sometimes in two years, but we've been able to make these guidelines in a matter of weeks sometimes and update them quite regularly throughout the pandemic. And it's important that we've been able to do this to keep up with the evidence, keep up with the science, and really keep up with all of the different considerations at countries and economies in this difficult time. And so we've got lots of different networks, clinical networks, and networks of expertise in different areas, including environmental science and engineering and infection prevention and control and social sciences and behavior, academia, and of course, clinical networks, which have all come together and been able to generate a lot of evidence together, helping to make protocols together, do studies together, different types of methodologies, and review publications, review peer prints, and then bring it all together through this guideline development process, which we use in collaboration with our scientific review. In the clinical side, we use the grade process for the grading guidelines and the recommendations for their expert networks, make recommendations for their guideline development groups, and then to ensure that they're peer reviewed and they're quality shared through peer partner agencies, like sometimes we have MSF, for example, review the guidelines and ensure that they're actually implementable, can be implemented on the ground. And then, you know, always engaging with so many of our other networks that we've been able to develop through the pandemic and executing the know to the world and letting them know about all of the guidelines and the documents through these different avenues, as you see here on the right side with, for example, the information network for epidemics and the WHO Academy, other websites and other ways that we can disseminate the information. And at the same time, again, having to do this quite rapidly, but making sure that we don't compromise the quality of the information and the quality that goes into the process and the methods of what we're saying or what the evidence sets, because it's quite an art and it's been an incredible process to see here and to be able to support the confusion between ways and making standardized processes and standardized tools to help support them clinically and in every other sector as well. So when we talk about quality, you know, I mentioned there the quality of the methods and the quality of the processes of developing guidelines and I'm going to switch a little bit now and talk more about quality as it pertains to patient care and at the facility level, at the healthcare level, patient provider level, which you all will be quite familiar with. And this is a quote from my director general. Again, another quote that he says, the quality is not a given. It's a vision, planning, investment, compassion, meticulous execution, rigorous monitoring, from the national level to the smallest remunerated clinic. And he said it very eloquently and I think it pertains to many different ways that we think about quality, but especially, you know, what I'll move to now in sort of the patient level. So when we talk about quality, as you guys will, many of you will know, from the Institute of Medicine, the different domains of quality, what they are, what does quality mean? And you see that here, the different domains. Of course, one of them is being safety, avoiding harm to people for who are here as independent. But there's also these other domains, so effectiveness of the new measures and providing evidence-based health services to those new ones, evidence-based efficiency, you want to maximize the benefit of available resources. Integration, you want to make sure that the care that we're providing is coordinated across the levels of quality between providers and that it's available throughout all ages that the patient will go through. Equity, you want to make sure that care is provided for regardless of age or gender or any other factors. Timeliness, you want to make sure that care is not done with delay, it's not being done with delay, because we know that harmful beliefs can cause negative outcomes. And many people, some people's interviews, ensuring that the care that we are giving responds to individual preferences, to their values, to the needs of the person. So when we think about care for patients with COVID-19, these are some of the ways that each of the elements of quality that I just mentioned are relating to COVID-19. So, for example, in safety, staffing challenges can increase the susceptibility to safety events. So we need novel therapies, we need novel therapies for COVID-19, but we also need careful regulation and observation of those therapies. And timeliness, for example, outcomes can be improved with timely diagnosis and timely identification of deterioration. So constant monitoring of patients and ensuring that care that's provided to them and any deterioration that may happen to them is monitored, is caught very early on, and taken care of interviewing them. So every aspect of mild patients, moderate patients, neuro patients, they all need to be monitored at different intervals, but ensuring that there is, there's a mechanism to be able to care for them once something is noted, that their condition between which was noted. So I won't read through all of these, but this is some of the ways that care for patients with COVID-19 is impacted by the different quality elements. And then when we talk about maintaining the rest of the health services, so here we are talking about not only patients who have been diagnosed with COVID-19, but patients who may be diagnosed with any other disease or any other illness, and really even at a bigger level, the different health services that are provided across different health services, so for across primary care, from primary care to surgical care, we want to make sure no matter what that, for example, equity, that COVID-19 control measures are not limited across different population groups, between different patients who may require surgical treatment, or patients who require vaccinations for, you know, for not for COVID, but for other vaccine routine vaccinations. So there's a lot of different ways to sort of slice and dice the different elements of quality, depending on if you're looking at the system model or the patient level, but all of these are important considerations as we talk, as we think about patient care. So next thing I want to mention is a bit about how we're helping countries with supporting them in enhancing their quality and safety of patients at the clinical level. So as an emergency care physician here at WHO, I support in the strengthening emergency care systems of countries nationally and at the facility level. And so we look at, when we talk about an emergency care system, we break it up like this, this is our framework. This framework is available online, behind this framework is all the health system building blocks. And what you see here is just a pictorial about how we've thought about what it takes to get a patient, for example, here it's a little girl who's fallen down or is on the ground, and what it takes to get that patient and that little girl to the care that she needs at the facility. And what you see here is, for example, you know, there's a there's a the girl who has an acute illness or an injury. This scene, it doesn't have to be on the road. I mean, it looks like it's a road right now, but it could be, you know, at a school, it could be a store, it could be anywhere, even at home. What it what it first requires is recognition from somebody else that something just happened to this to this little girl. And that recognition is of course the first step. Then what you see here is this person with a phone. Then it requires this person to be able to number and have a phone, to have data on the phone, or have connection with the phone, to for there to be a number to call potentially, ideally a three digit number for them to call. And for someone on that, when they call that number, for someone on the other line to be able to pick up the phone and be able to give some kind of instructions, and be able to support this person. So you see already in this first, her first stage, there's a lot of different functions that need to occur in order for this patient to attain the care that she needs in a timely posture that quality, safe, effective, efficient, timely, separate care that she needs. And so this picture describes all those functions that are needed in blue, the human resources that are needed are the red text, and the equipment and the supply, the technology that are needed in green. And another thing I'll highlight here is that this applies not to just to pediatric patients, of course, this applies to patients who are adults who may have some kind of other conditions such as chest pain, which may end up being a heart attack. And we can apply to, of course, low traffic injuries or any kind of trauma falls, et cetera, who apply to pregnant patients who may have confused bleeding or has some other complication or pregnancy, and then, of course, if you get the kids, and this is just some examples that say that emergency care, as you know, can have anything can happen to anyone anywhere. And that is, that is this whole system and the activation of the system is important for all. So what we've done with, when we help support countries in this, we have helped them look at each element of the emergency care system, as I've described, from seeing to transport, to handover from some transport, to facility-based care. And what we've done over the last several years is to help, when we help countries look at these, at their national level assessment and do the national level assessments and assessment of gaps, we see a lot of the same gaps that come across from many different countries. So, for example, one here you see is there's a lot of bystander protection in many countries have told us that they have limited bystander protection, or knowing about universal access coverage numbers. So like I said, like the 911 or 112, it's a lot of countries that doesn't exist. And so on and so forth, I won't read all of these, but you get the idea, there's lots of similar different gaps across the different countries. And so here's another example of triage and the substitution capacity. So when we've done this assessment, I'm about 40 countries now. And in countries will then tell us about what kinds of gaps that they have and where they want to target the priorities, what they want to, where they want to target the intervention, what are their top priorities across the whole system, of the emergency care system. And so you see here a few different examples of the types of priorities that countries have identified. For example, a lot of countries are progressing training, a lot of countries are progressing hospital systems. And so over the over the last several years, we've developed lots of these different tools to help support them in filling gaps. And so there's tools here, for example, a triage tool, basic emergency care, which is our clinical care course that we developed with ICRC. Some different ways that we can support them in quality improvement exercises through audit, through having registries that have a second flag pieces that are preventable with that outcome for preventable. So with audit filters and things like that. And of course, some standards and protocols. Again, these are just some examples, there's a whole bunch of other tools as well that are available on our website. And so what I want to highlight here is some of the tools that are specifically designed for improving the quality and the safety of the care of patients in the emergency unit setting and in the clinical setting in general. And so for example, start with patients coming in. And the first thing that we sort of talk about is triaging the patient. So sorting the patient according to how sick they are, not according to what kind of women or what age they have, but really just based on how cute we are. And then moving them into a designated resuscitation area if they need, if they're sort of true as it's read or critical. Some of the different, some of the different process tools that we can implement in the emergency unit, for example, it'll be sort of checklist at the patient level that will support and patient safety in quality and provide care for them through the basic emergency care course. And then move them forward through the rest of the, the rest of the patient pathway. And so when we talk about adapting this to COVID, one of the things that we've done in our guidance since the summertime and it's been evolved since then is to, is to think about how patients when they arrive to the facility in the COVID era, what are all the different processes that need to happen. So what you see here is patients who are arriving to the health system in general, whether it's to an ambulance, as I mentioned, in the emergency, in the emergency, or maybe they walk into a pharmacy or maybe they walk into a clinic or they walk into a hospital, however they access the health system, they should get screened at that time for symptoms of COVID. And if they have COVID, the next, if it's a health provider who's been framed in triage, they can quickly assess the patients and see if they are critical or if they can, if they can get to a facility in an emergency death facility urgently, or if they can go back to their house, et cetera. But, but they, especially in the facility level, it should be in a foodie-based triage system. And then a formal clinical assessment with a healthcare provider who does the physical examination, the history-taking, and lab reports and radiology, et cetera, the full assessment. And then of course treatment based on how sick they are, and finally released from the pathway, when they can sort of discharge their, their infection prevention and control measures. So when you can say they're safely not going to be transmitted in COVID. And so what we've done over the last several, the last, actually now over a year that we've been in this pandemic is talk about the, the different ways that we have these emergency care tools that I mentioned previously, how they fit into the COVID growth. And so what you see here is I'm just clicking through, oops, sorry, just clicking through the different tools. As I mentioned, the triage tool that was developed with our colleagues and I see on the second FRC, the checklist, and et cetera, basic emergency care of course. So it all fits into the way that we care for COVID patients. Basically all of it's to say, patients who present to the hospital, present to the clinic, represent to anywhere, and we don't know if they have COVID based on when they present. We, we, they just have symptoms. And they need to be cared for according to how sick they are, rather than what kind of diagnosis they are. So this is something that we constantly try to discuss with the, with our country colleagues in, in terms of not having COVID specific areas, but with, with copyright, as you see measures, having suspected and confirmed COVID patients separated, cohorted separately, and, and screening and treating them appropriately according to, again, according to their severity of disease. So a couple of the tools that I'll dive into, just a little bit deeper, again, because how it's showing how they, how they input quality and some cases are so good safety. So firstly, for the triage tool, it's an emergency window triage protocol, which many of you may be familiar with, for example, the emergency severity index or the Manchester triage tool, many different types of triage tool. This one, the one that we worked on with, and developed with our colleagues in ICRC in the south, is, is a three color, very simple tool that's meant to be used by nurses and very, for, for, or checks, depending on who is trained at the facility level. And you see here how some different ways that it can improve the quality of care. So it can certainly improve kindness, because it will allow the early identification of time sensitive conditions. It'll improve the efficiency of care that is delivered to the patient to the entire population of those who are at the system. And it'll improve equity because there won't be, there won't be any biases to age or to gender or to et cetera. It's, it's blankly looking at the whole population and deciding who needs care first and hopefully optimize resources we have to provide the best care for the most. So this is a picture of the triage tool. Again, it's available online. But you can see here, it's a, it's a simple red, yellow, green type of, type of, that categorization across, and divided into the ABCDE type of approach to the patient. And then the second tool that I'm talking about is the checklist. And so we have two different types of checklists, and that is room or dizzy checklist and trauma care checklist. Again, for use for clinical providers in emergency units and ideally in the substitution area, those are available for doctors, nurses, in both adults and children. And some of the ways that this improves the quality of care is, number one, it can improve the effectiveness of the care. So they can reinforce the different considerations that are, that are not to be missed in the care of the patient. It's not that every patient, of course, will have all of the questions answered, but it's the question should be considered for every patient. And that's the point. These things, these particular points have been carefully selected and carefully piloted and validated in several countries and several kinds of environments as being the key items not to miss for patients with medical emergency and not to be missed for patients with COVID. It certainly reduces the risk of harm in that way that things are not forgotten, things are not left, things are not delayed, and that's also part of the time. And there is another question on there about was the plan of care discussed with the patient and the family. And so in that regard, it helps people with some sickness also. It promotes the dialogue and promotes shared decision making and ensuring that those involved with the care of the patient, the patient side and all informed about what is happening. And then the final tool I'll just talk about in this way is, is the recalculation area designation. And this is helping facility planners and emergency unit managers, etc. to help them design segregated area part of the emergency unit that's just as needed for the sickest of the sickest patients. And this includes a quality of care because allows for the organization of the resources and to optimize the flow of patients and the timeliness of the care that can be provided to the sickest patients. So those are some examples of the debuture tools that can help improve quality of care. These tools in addition to the course modules out of the basic emergency care course are included in a few of the educational platforms and training resources for COVID-19 and also generally for strengthening health systems everywhere because again patients are necessarily present with that diagnosis. And so these are available on the WHO Academy COVID-19 mobile application which you can download from the Apple Store or Google Play and also on openlibrarycho.org. There's a COVID-19 clinical course series on the clinical management channel which is currently under development. And we have two courses released already on the rehabilitation course which talks a lot about long COVID and post-COVID complications as well as the general considerations course and the emergency care course. The course that has these tools and these trainings is due to be released in a matter of a couple of days. So they release this week so you keep your eyes peeled for that. Moving a little bit just talking about UHC in general on the next slide I'll actually describe what we mean by UHC just as a reminder for those who aren't as as used to hearing this terms of double drug terminology as others. But this is just highlighting that overall the health system challenges that countries have been facing have a lot to do with the delivery of quality health services is what I've described. But more of a global picture we look at in you know cross countries and across sectors we're helping to strengthen health systems and not only the clinical services but of course through supply chain, through medicines, through products and what you see here is continuing with the UN framework for socioeconomic response and this is a lot of the joint efforts with across the UN agencies and WTO we've been on the on the health first. These are protecting health services and systems during COVID-19. So when we talk about again this is a reminder to everyone about what we mean by UHC talking about equity to access the health services ensuring that the quality of the health services are good enough to improve the health of the person and we talked about what we mean by quality and importantly that the services that are provided are of no do not put the patient at any financial risk and so this is what we mean by allowing allowing universal health coverage for all those who are accessing health services and certainly emergency care has been discussed at the global level across all member states to be an essential part of universal health coverage as are many other aspects of clinical service delivery but particularly the tools that are highlighted have been have been specifically named as an essential for universal health coverage for all countries and all of that we when we talk about emergency care primary care critical care all the different services we we encourage that to be discussed under the umbrella of a primary health center primary health care oriented health systems approach so we know that phc-oriented health systems are the most resilient health systems and by that we mean this we have this spectrum of of the way that patients can access the health system and their interventions with each other so emergency care systems can allow we want to ensure that the the follow-up of the patients is connected to the primary care providers that the critical care services are interlinked with the emergency care services that trauma for example is is a cross section across service now integrated approach to the grant for the trauma patients with surgical care as well so we we also we want to ensure that all of these services are speaking to them another all of it is done under this together across the health system across in the hospital but also across the the region or the country and across the the whole country so um so that's what we mean by by through surgical and so just getting to the end here the last thing I wanted to just quickly talk about as um as we are in that in that time now with Ramadan is to talk about safe practices during this time of mass potential mass gatherings so we want to ensure that countries and and people understand the the risks of coming together and consider doing an risk evaluation and risk communications we have some tools and some guidance that has been recently released and recently updated from last year released um around safe practices for Ramadan um and we encourage considering other alternatives for the gathering together um instead of doing so physically by doing so virtually and always of course professional measures um all the ones that we mentioned before about um for for safety and for public health and vaccinations will continue during Ramadan and we are certainly encouraging encourage encourage that um including supporting religious leaders to also advocate for continuation of different campaigns and to continue to exercise all the professional measures um even for those who are vaccinated during this time and the final thing is just do it all not only during Ramadan but always do everything that that we've talked about with all this public health measures in order to stop the transmission to avoid needing emergency care to avoid needing any kind of clinical care um so we still need all these things to be done all the time and um and that way we can I think I talked quite fast but I apologize but I'm happy to take any questions um and discuss further and um thank you back to you Dema excellent well thank you so much Priyanka what great information um we did have a question from the audience asking whether or not um the slides would be available um is that or the slide something you can share with us sorry I needed myself yes absolutely yes okay okay excellent excellent great um and other questions from the audience I don't have any questions I don't have anything in the chat so um if you have any questions for Priyanka please please enter them now into either the chat box or the Q&A so Priyanka thank you again so much for this wonderful information we really appreciate your time today and um and I just I do have one question for you I do have one question being on the front lines um you know what is the one thing that um that you can say to clinicians who are struggling with caring for COVID patients right now and struggling with the mental health challenges um around that what was what's the one thing that you can say to them I I would say solidarity I think um everyone everyone is everyone is burnt out I would say in some shape or form I mean we're all we're all caring for each other and caring for uh our patients and our families and you know it's affecting every part of their lives um for you know a lot of different ways and I think especially for clinicians who are seeing you know we're seeing the patients um of close and personal and seeing a lot of the ways that it's it's affecting them sort of especially at the end of their lives but even even throughout you know in different ways that again vaccine equity is affecting them or their their ability to receive the very chronic care that the care that they need for maintaining their mutual health and and just being able to access different types of services across this time it's it's it's every way someone everyone is going to do something and um so I would say the thing that we could do to help with that is talk to each other and be there for each other I mean we're we're all struggling with that and we need to be able to um rely on each other and that's that's the solidarity of being together in this time which is kind of the new time and um and I think that's that's what's been able to to help our commission colleagues um join up and and be able to uh to rely on each other support each other listen and uh and be be gentle and kind it's it's it's that's what I hello Priyanka are you there yes hi okay sorry what is it what is the um the your estimate for uh how long until we get herd immunity globally oh um well that's that's really dependent on how we do with all these public health measures that we're talking about we're seeing unfortunately as I mentioned earlier we're seeing unfortunately an increase in cases right now and um and uh you know I'm the vaccine inequity so it's it's a we're asked for that I'm always short of the moment um with um with both both sides and so it's it's it's hard to give an estimate especially then with you know Ramadan and lots of lots of different considerations during this time so um so it's really impossible to give an estimate or to encourage everyone um to to practice uh all the all the public health measures keep keep doing um keep washing your hands and keep the mask on even when you're vaccinated um to to help prevent the transmission of the disease um and of course of course we're thinking about you know how are the variants going to affect um the um the the case numbers um we need to ensure that we're we're constantly keeping all the public health measures in place so we can we can get to that very unique point as quickly as possible um so unfortunately not a great answer but not that we don't have we're really just encouraging everyone to to get as fast as possible great thank you you know there's also a lot of concern about about the variants that we hear about so um can you speak a little bit about what we know about how effective the vaccines are going to be against those variants yeah I could speak a little bit about it but I could also maybe send some information um with my my colleagues who are we're working on the vaccines more but more deep through than I am um but but there's there's been different studies um looking at the effectiveness of different variants especially these days um and um and it's uh you know there's there's different different things that we know about the different vaccines but in general what we're seeing is that um with two doses or with the full full course of the of the approved vaccines that we are getting um a good effectiveness uh for for achieving um for achieving prevention of the disease or from for outcomes of uh you know severe disease or critical disease um so it depends of course all this depends on the on the vaccine depends on the variants and sort of how they are for link and there's a lot so to be to be learned about that um but for the ones that are approved and and the full dose um if there is shown to be at least good effectiveness for the for the major variants that are out there right now great and you know this morning here in the united states there's breaking news about the johnson and johnson vaccine and just a handful of people who are having a very rare uh reaction to that also AstraZeneca um over there in europe with you know the issue with blood clots that have been coming up so can you talk about that you know what what's what's happening with um with vaccine distribution in these cases is there any kind of pause and and is it happening globally or in just certain regions yeah so countries are taking the country approach to to how to what to do with the rollout of all the vaccines um yeah we did see this um come out today and um you know there's something that unfortunately that um that we know that it's there's something that we've actually addressed um globally as well and um but I think um every country is is sort of evaluating the the risks in the bridge of country by country and we've seen some of the risk estimates for the AstraZeneca um so we'll continue to see a little bit more about the J&J as well um but yeah for us it's also a new um new ongoing development so I don't have an exact answer about what we'll say total sort of at the at the global level but um something that means people very very close eye on and I'm thinking to see what the other with the other things that they're doing and still have a bit more I don't know a lot to learn about about these sort of um these types of effects that we're seeing across the industry that we've heard about. For those on the phone who you know may not have a clinical background maybe um you know part of the the general public um how much concern do you think that they should have about about these side effects? Well um you know I think it's something that um really should be discussed with uh with their provider um with their clinical provider um and their um you know what we know right now is that we're not able to identify any kind of risk factors um you know most of what we know about this is um but uh that you know that a lot of the cases have been happening in women in a certain age group under 16 years um so there's a lot of a lot of things that we do know um but still much much more that we don't so I would encourage for those of you who have questions about it and you're considering what should I do, which ones should I get um to really discuss with your with your primary clinician or with um with your um sort of with your clinical colleagues um and to know you sort of what the national and your local advisor are are suggesting um and consider asking asking lots of every patient of course is going to have you're going to have your own um profile of what is uh as far as your age, your risk factors, your other your other vulnerabilities, etc. So it's important to to consider that as you take it very individually I would say um in the in the context of what's happening in the local area depending on the country. Great, we also have a question about getting attendance certificates for this webinar and they and um it's called it a brilliant webinar thank you so much Priyanka for your brilliant webinar today um and um just to let everybody know the only the only continuing education credit that we are able to offer for this particular webinar today is for board certification advocates so anybody who registered as a BCPA will get uh get an attend an attendance certificate in the mail for that particular certification. If anybody else is not looking for certification but just wants validation that you did in fact attend the webinar then please just let us know um you can email us at at clinicalatpatientsafetymovement.org and we can help you out with that. Okay any other questions? It doesn't look like we have any other questions so far okay well Priyanka thank you so very much for joining us today this is very enjoyable I hope to have you back again in a couple of months to tell us what what else is new happening on the COVID front there. There'll be lots of developments I'm sure but uh it would really be my honor and and I know that we all have we'll have potentially um other other colleagues as well filled out it's very very big big shoes um so uh so we'll be in touch and maybe it'd be great if we connect with you all sometimes some way um and in the meantime please everyone keep safe and take care of yourselves um get vaccinated when you can if you can and uh and um take care of one another. Thank you so much Priyanka very well said everybody have a wonderful rest of your day thank you