 Good morning, good afternoon, good evening everyone wherever you are to the 61st installment of the Stop COVID Dex webinar series brought to you by the University of the Philippines. We are glad that you are able to join us today for our third virtual international conference and the last episode actually represents the last episode for our season number five which means that we will be starting season six next week with really a very, very interesting topic altogether. We hope that you'll continue to stay on with us as we prepare for more informative topics on the next season of our COVID-19 learning journey. Today, as the world races to vaccinate against COVID-19, a highly contagious version of the virus is sweeping the globe and is feared to move faster than our vaccination efforts. This webinar will address everything that the frontliner needs to know about the Delta variants. Very, very timely episode for today, especially what with all of the new data that has come in with regards to the number of Delta variant cases in the country. I'm Dr. Raymond Francis Sarmiento, director of the National Telehealth Center National Institutes of Health, University of the Philippines Manila. It's always a pleasure to be with all of you for our regular Friday lunch date and I always look forward to our Fridays, especially because I get to spend it hosting with my partner in crime and my mentor. Also our adjunct research faculty at the National Telehealth Center, the President Special Envoy for Global Health Initiatives, Dr. Susy Pineda Mercado. Dr. Susy? Hey, Raymond. Good afternoon and I'd like to read everyone who's watching us from different parts of the country and different parts of the world. As Raymond has mentioned, the Delta variant is sweeping the globe and we are seeing exponential spread so it is very important that we are well informed because information is your power as frontliners. When we hear more about this, we have several speakers from many different places will introduce them to you later. But we are going to start first with a short video from the World Health Organization, TVUP. We need to be blunt. We're not in a good place. In Africa, there was a 16.7% increase in cases in the last seven days. There was a 16.4% increase in the eastern Mediterranean region, a 33% increase in cases across Europe, an 8.6% increase in Southeast Asia, a 10% increase in the western Pacific. There are more than two dozen countries that have epidemic curves that are almost vertical right now. This is not the situation we should be in when we have tools at hand. There are four major factors that are driving transmission. One is the virus itself. This is a dangerous virus to begin with. Now we have these virus variants that have increased transmissibility. The second factor is mixing. We know that the social mixing, the social mobility of people is increasing around the world. These events around the world drive transmission because you bring people together if the right interventions are not in place. The third factor is reduced use, inappropriate use of public health and social measures. The use of these measures does not mean lockdown. It's a combination of interventions at the individual level to the community level, and it covers everything from wearing of masks, physical distancing, avoiding these crowded indoor spaces, spending more time outdoors than indoors, improving ventilation, keeping your hands clean. The last factor that's challenging us right now is the inequitable and uneven distribution of vaccines. If you have variants of concern that are circulating, if you have increased social mobility and social mixing, if you have the inappropriate use of public health and social measures, and you have a very susceptible population, the virus will thrive. This is not theoretical. We're not talking about a what-if situation right now. It's happening now. We have the upper hand here. Let's use the tools that we have to keep transmission down and really be smart, play it safe, do what we can at individual level measures, really strong policies that are agile, that adapt to the local situation, and we all really need to play our part here and do what we can to drive this transmission down. The virus has a hold over us right now, and we need to regain control over this virus. Okay, for those of you who just tuned in, you are on the Stop COVID Deaths webinar. You might think you're on the wrong webinar. We did want to start with this little message from the World Health Organization because as we mentioned earlier, this is an international webinar and we will have speakers from, well, first of all, from our main speaker is a UP alumni from the United States who is an infectious disease specialist. We're going to have an expert from Singapore. We have an expert from the National Institutes of Health. We also have an expert coming in from the International Federation of the Red Cross Red Gress Movement based in Malaysia who's covering India, Bangladesh, and Nepal and we'll hear about that. And we also have one of our up-and-coming Filipino doctors who is based in Ethiopia and will talk to us about the variant and the virus in general in the Africa region. So stay with us. I think right now there's news coming out and it's very important that our frontliners are well-informed, not just of the news but of what really is the Delta variant. Why is it a variant of concern? How is it transmitted? How can they protect themselves? And how can you help spread information about staying safe? So I think we are in for a very, very important webinar today. And just want to thank everyone for joining us from the Metro Manila Hospitals. We've got a lot of participants from Mindanao and from, I can see here, Iloilo, Bakolod, La Union. So welcome everyone. Over to you, Raymond. Thank you, Dr. Susi. So the Delta variant, as we have seen in the news and also in that very, very short video from the World Health Organization, it seems to be more transmissible, highly infectious, and now classified as a variant of concern. Obviously, there are proven ways to mitigate the spread of the virus as mentioned in the video and we hope to be able to tackle more of these in detail during today's virtual international conference. As mentioned, we are able to accommodate up to 3,000 participants in the Zoom webinar. So for those who are joining us or will be joining us very, very soon. Please, we enjoy you to log in now so that you won't miss a beat in our webinar for today. We also would like to greet all of our regular attendees from the different parts of the country and also the world who are watching us perhaps in the live streaming channel of the TVUP in YouTube. We also have live streaming links that are being shown in the Facebook pages of the Stop COVID Bets webinar series Facebook page as well as the University of the Philippines and TVUP. So hello po and welcome to our webinar for those who are doing all of these watch parties. We are really, really grateful that you're able to join us for today. As we have looked into the data, there are nearly 3,400 registrants for this webinar alone. And they have come in from all over the country coming in from Hospital Ming Kapas in Kapas Tarlap from San Jose District Hospital in San Jose, Occidental Mindoro, from Bicol Region General Hospital and Geriatric Medical Center from Kamarinisur in Kabusao from the Philippine Obstetrical and Gynecological Society in Kagayan De Oro. Iingat po kayo dyan. In Kagayan De Oro, Region 10, northern Mindanao, Rotary Club of Midtown Butuan, Butuan City in Karaga. Also internationally coming in from the National Center for Global Health in Toyama, Shinjuku, Tokyo, Japan from the World Health Organization Office in Hanoi, Vietnam from Luwini Chi Ali University of Bleeda in Larba, Algeria first time. Manamag Bahrain, Erbil Irak, Alsuwek Oman, Islamabad, Pakistan, Dubai UAE, Alkobar, Saudi Arabia, Kuala Lumpur, Malaysia, Taipei City, Taiwan, Stockholm, Sweden, Tunbridge Wells, England, Suva Fiji and our regular from the Niagara Falls in Ontario, Canada. So you may be asking po why we are doing all of these shout outs right now because we may not have our regular poll. We'll be diving in. We want to be able to pack in a whole lot of information in the tour so we hope that you are able to tune in for the entirety of the 120 minutes that we will be covering for today's webinar. Over to you, Dr. Suzy. Okay, I think without further ado we're going to start with our opening speaker and he is one of the most esteemed doctors in the country today in the Philippines Ramon Magsaysay, awardee, former Chancellor of UP Manila, national scientist, gastroenterologist, par excellence, but I think we want to really recognize our guest as the father of universal health care even before there was a law. He was already discussing this as one of the most important things for our country today for the Philippines. So I'd like to welcome national scientist and professor emeritus of the University of the Philippines, Dr. Ernesto Domingo. Sir, welcome to the webinar and please take the floor. Thank you. Can you hear me? Yes, we can hear you, sir. How are you? Thank you. Thank you. Well, very good, very good. Asigipo, we are honored to have you. Please go ahead. I'm well pleased to be able to share with you and to the audience some personal insight into the pandemic problem. I would surmise that there is hardly a person who is not personally affected by this pandemic. Job loss, force, quarantine, loss of loved ones, and most importantly, the anxiety brought about by the fear of getting infected and uncertainty of when displayed will end. It is not surprising that despite the efforts of those responsible for controlling the pandemic, the media, both traditional or mainline and social media, are awash with criticism and unsolicited advice on the control efforts. I would like to contribute my two cents worth by asking the question, could we have done better? We, meaning Filipinos, if so, under what conditions could we have done better? Let me start by laying down the predicate of the condition, which is a legal term, laying down the predicate, by quoting Pope Francis on his statement the first Sunday he was released from the hospital after a colon surgery as reported by Reuters. The Pope said, and I quote, in those days I have been in hospital, I saw once more how important it is to have a good healthcare system that is accessible to all as it exists in Italy and other countries. A health service that is free and guarantees good service accessible to all. This previous good should not be lost. It must be maintained and everyone should be committed to this. The phone tip is of course talking about universal healthcare or UHC. I should know because I belong to an advocacy group that pushed for UHC in the Philippines since the late 2008. We, meaning many other sympathetic groups and individuals, succeeded as early as 2010 when the late President Benigno Acrino adapted and modified UHC, then called Kaluso Gang Pang Kalahatan or KP as the official healthcare system of his administration. In 2019, the UHC law was passed the Philippine Congress and signed by the incumbent president and the rollout of UHC as specified in the law should have been in two years after the laws enactment, but the pandemic has overtaken it. The question is, had UHC been in place when the pandemic broke out, could our response have been faster, more efficient and more effective? If we examine some of the features of UHC that will be implemented in the Philippines, I am optimistic that the answer to the question I posed is in the affirmative. Let me then point this out, some of the features of UHC that support this optimism. First, UHC will be grounded on primary healthcare and every Filipino will be assigned to a first contact primary care provider. Without going into details, this first contact healthcare provider will also be responsible for helping the patient navigate the healthcare system. Thus, the term used in referring to this professional is gatekeeper or navigator. Second, the healthcare system outside the developed cities will be integrated in terms of facilities, health services, planning and supervision and financing at the provincial level, which is the effects of the executive function of government outside the central government. It does provide a continuum of health services, health facilities including hospitals and referral system, not to mention administrative and financial support. Suppose this system is now in operation and optimally functioning. We can hypothetically predict how a case of COVID patient will be handled. For example, as a patient complaining of fever and respiratory symptoms, go to his first contact health worker. The health worker will now, among other things, consider the possibility of COVID because of the existing pandemic and will surely start the process, among others, of testing for the virus. And based on the severity of the clinical condition, may decide that the patient go to a district hospital by passing municipal hospital. The caregiver can initiate being knowledgeable about the background of the family which is also under his care as well as the community between working with other COVID workers, testing the family and other contacts, reporting the case and setting into motion the other required activities prescribed by health authorities that happen to fall within his area of responsibility. I might have simplified the problem with a simple example, but the point I am driving is the presence of an integrated healthcare system will allow us to implement public health measures, not to mention direct patient care that is a better chance of working. I submit that with ABAP system in place, the following activities in this pandemic may be done more efficiently. For example, mask testing, contract tracing, medical care, including hospitalization, and yes, even vaccination. Alas, there is no way of proving or disproving hypothesis. Certainly, I am not rashly wishing for another pandemic to prove we might be right or wrong. But again, in conclusion, I think if the UH is already fully operational, we might have done better in prompting the pandemic. Thank you. Okay, thank you very much. That was Dr. Ernie Domingo. Sir, I hope you'll be able to join us for the panel discussion. We'd be very interested in hearing your insights on the Delta variant and thank you so much for grounding us in a health systems perspective as we start this discussion. So we are going to go straight to our main speaker and a lot of things have been said about the Delta variant. One of the things we know is that it's highly contagious. What's the effect on younger people? How do the vaccines fare? There are so many questions as it costs more serious illness. We have an expert coming in from the United States who is a graduate of the University of the Philippines and is part of the UP Medical Alumni Society in America. He is a renowned infectious disease and internal medicine specialist. I would like to welcome Dr. Franco Felizarta for the second time we had Franco previously. So Franco, welcome to the webinar again. Thank you for the kind introduction. Good afternoon to all of you. Magandang hapon po siyan yung lahat. Laro na po sa mga taga Mauban Kesson. Taga Kesson pala kayo, Franco. Piesta sa Mauban Kesson yesterday. It's the Feast of Saint Bonaventure. He's a priest and a doctor, a physician at the same time. So kaya po maraming doctor gali Mauban Kesson. Ah, gano pa na, okay. Go ahead. I have about 40 slides. So hopefully we can finish this in less than 20 minutes. So I'll share my screen right now. Go ahead. Okay, so you can see the screen? Yes. It's good. Go ahead. So the talk will consist of three parts. The first part will be basic virology and immunology. Then variant epidemiology and the last one will be vaccine efficacy and effectiveness. These are my disclosures. Lots of pharma here. National Institute of Health. I'm one of the active site for COVID treatment, outpatient COVID treatment, and a minor contributor for OCTA. So let's start with the virology first. So as you can see, this is the SARS-CoV-2 virus, which is the etiology of the COVID-19 infection or disease. It contains the viral RNA, which is surrounded by the nucleoprotein or nucleocapsid. And then you have these several spike proteins, okay? And within this spike protein, you have this receptor binding domain, or RBD. This RBD is the one that attaches to this human cellular receptor, which is ACE2, angitensin converting enzyme 2. And then you have this transmembrane protease serine 2 that cleaves the S1S2 site of the spike protein. So this allows for evasion of the human innate immunity. So this one is the genome, the RNA genome of SARS-CoV-2. And of course, the most important is the spike protein. And this one has S1 and S2. You have the cleavage sites here with S1S2. And then you have the RBD. Remember, RBD is the receptor binding protein. So most of the mutation that creates the variants are located in this gene region as a position 318 to 510. So these are the most common mutations that created the variants. So as I mentioned, 417, 452, 484, and 501 are all within the RBD region. These are the main variants, alpha, beta, gamma, and delta based on the Greek alphabet. And then you have gamma, which is a minor variant. Now, for example, so delta, for example, has two mutations that increase transmission. And then it has a mutation that decreases neutralization. So the mutation happens if one of the amines acid is switched from one, which is like this one is leosine, and then changed to arginine. The delta plus is the same thing as delta, except that it has an additional K4017 mutation. The lambda mutation from Peru has the, sorry, the delta has the K4017 mutation. The lambda has the L452 mutation. But instead of R, it has Q, which is glutamine. So let's switch to immunology now. So in order to have a great antiviral response, you need three phases. One is the innate immune response. The second one is the adaptive immunity. And the third one is the long-lasting immunity mediated by the memory cells. So I mentioned previously that the virus is able to evade the innate immunity. And because of this, there's a lag in the innate immunity leading to an increase in the viral load. So if you have a variant that increases evasion, then it will delay the innate immunity more increasing the transmission because of increased viral load and potentially a longer pre-symptomatic period. We already mentioned about adaptive immunities and then we have the long-lasting immunity mediated by the memory cells, especially by the memory B cells. And we'll talk about that later. So in this article from Nature, it showed that you can actually have long-lasting immunity with natural infection. Usually you'll have an increase in the antibody level and then you'll have a expected decrease in the antibody level with time. But this is compensated by the antibody production of the memory plasma cells from the bone marrow. And this is expected to last more than one year. And actually it can probably last up to 10 years. The question though is, would it work against the variants? Now this one is a study from New England Journal of Medicine and this was just released two days ago. And it showed long-lasting immunity after vaccination with the J&J vaccine. J&J vaccine is a vector vaccine just like AstraZeneca. And as you can see here, the neutralizing antibody titer is increased from day 29 to day 239. So let me give you an example. This one, B1351. That's the beta variant from South Africa. Look at this neutralizing antibody titer here. Almost undetectable at day 29. But at day 239, this is one month. This is eight months. Look at this. It increased more than tenfold. It's the same thing with the P1, which is the gamma. This one is delta and this one is alpha. Same thing, the antibody titer increased from day 29 to day 239. This is another study showing that three months later, well, the serum antibodies significantly declined. This is expected. But remember, the memory B cells, it's increased in frequency and affinity. So let's shift to the epidemiology now of the virus. So there are four important parameters. One is, of course, the incubation period. And we know the median is five to six days. And the range is two to 14 days. That's why you have to quarantine for 14 days. The serial interval between two infections is four days. The dispersion coefficient is 0.1. This is considered low. The lower it is, the higher the chance of super spreader. And then, of course, the most important is the basic reproduction number. The original virus from Wuhan has a reproduction number, basic reproduction number of two to three, it will infect two persons after one generation and then four persons after the second generation. This one is showing that the more contagious the variant, the higher the basic reproduction number. So, for example, the original Wuhan virus, the reproduction number is two to three. The one that caused the Europe's first wave is three. Alpha, which is from the UK, is four to five. And delta is five to eight. Five to eight. Chicken pox is eight. Mobs is 12. Miesels is 18. Now, what's the implication for this? Remember, this is exponential. So, for example, let's start with the original Wuhan virus. It affects two, right? Individuals after first generation. Second generation four, 16, then 16, 32, 64, and so forth. So, after 10 generations, it will be 1,024. Okay? The alpha will be one million after 10 generations. Well, delta with the five will become 10 million. And eight will be one billion. One billion. So, parang anato are earthquakes. You're comparing intensity. So, intensity two is much, much less than intensity eight. Now, over dispersion, this just shows you that unlike influenza, the SARS-CoV-2 is a super spreader. Okay? 2.5% of all affected people may have a basically production number more than 20. It's like measles. And it contributes to almost 50% of all transmissions. Okay? No, no. Remember, this is not an individual. This is more of an event. So, you have an individual with high viral load. Maybe, you know, the variant, the patient has an alpha variant. High viral load, pre-symptomatic stage in a poorly ventilated room, overcrowded, no masking. That's a super spreader event. Okay? Herd immunity, the equation is quite basic. It's one minus one over the basic reproduction number. So, for example, for the original one virus, it's two, then that will be 50%. For the alpha virus, which is four, then 75% of the population has to be infected and or vaccinated to achieve herd immunity. Once you achieve herd immunity, the transmission is minimized even if there are no restrictions, even if there's no masking. Once you achieve herd immunity, which is a combination of infected and vaccinated individuals. Now, we already computed alpha, which is 75%. The original one virus is 60%. Delta at five will be 80%. At eight will be 86%. So, the higher the reproduction number, the higher the herd immunity. Now, remember, this is not an all or non-phenomenon. In this study from Nature Medicine, it's shown that on the average, each 20 percentage points of vaccination in a given population, the positive test fraction of the unvaccinated decreased twofold. So, if you have 20% vaccination, the positive test rate for the unvaccinated one will be decreased twofold. 40% fourfold, 60% eightfold, and so on. So, it's not an all or non-phenomenon. So, the higher the percentage of vaccination, the harder for the virus to transmit in the unvaccinated community. So, let's look at the variance of concern now. So, we already mentioned about alpha, beta, and gamma. These are the major ones. In terms of transmissibility, we know alpha is 50, at least 50% more transmissible than the original virus from Wuhan. Delta is 50% more transmissible than alpha, at least 50%. Beta from South Africa is the same transmissibility as alpha. Gamma from Brazil has a higher transmissibility than alpha, but less than delta. So, delta is number one in terms of transmissibility. This is a severity not really increased for all the variants, except probably for gamma. There's actually some reports from Washington State that there's increased risk of death. Resifet infection, not impressive except for gamma. Remember, in Manawas, Brazil, they thought they already have a herd immunity and they have a bad second wave. Impacts on diagnostics didn't affect the variants. Country supporting variants, alpha is still number one with 173, but delta is increasing fast 104 countries. I'm not sure why there's no gamma in Africa. USA, so what happened to the United States, though? In April, the dominant variant was B117. That's alpha, okay, from the United Kingdom. In July, that's after three months. Look at this. This one is delta variant, more than 50%. Before it was less than 1%, now it's more than 50%. That's in three months. In some states like Utah, it's more than 90% delta. In the United Kingdom, in Israel, it's more than 90%. So this shows you that this proves that delta is much more transmissible than most of the variants, including P1, which is gamma. The P1 actually increased a little bit, but it started to decrease somewhat. P1 is the gamma variant. So what's the implication here? So it really depends on the vaccine rollout. It's really variant versus speed of vaccine rollout. So in the United States, at least we, almost 90% of the elderly are protected. But in terms of the whole population, it's not number one. 56% have at least one dose. 48% are fully vaccinated. But Chile is much higher, 70% and 60%. And you have United Kingdom, and then you have Israel higher than United States. So, of course, the Philippines is down there. 9% at least one dose and 3.4% full vaccination. And this is based, remember Philippines, 110 million population. So what happened to the United States? So remember, it's not just variants versus vaccination rollout. It's also versus mobility, which is correlated with restriction. So in the United States, it's back to baseline. It's almost no restrictions, almost no masking. So mobility is back to baseline, almost normal now. And what happened? There's a 15-fold decrease in cases, but now it's double. But look at the deaths. It's still decreasing. How about Israel? So the United States has the Pfizer, Moderna vaccine, Israel has a Pfizer vaccine. And look at the mobility. It's back to baseline. What happened? There's some increase in cases, but deaths is still flat. How about United Kingdom? United Kingdom has Pfizer and AstraZeneca. So back to baseline in terms of mobility. So decreased restriction, decreased masking. Oh, they got a big way of cases. But look at the deaths. Flat. It's flat. So it means, the reason for this is because most of the cases are in younger individuals, younger adults and children where as a group, their mortality rate is probably 50 times lower. Chile. Now, Chile is important because they have Sinovac. Their main vaccine is Sinovac. So what happened? Wow. Look at this. Now, this could be explained because of seasonality. In Chile, it's in the southern hemisphere. So their winter is, what fall and winter is in June. It starts in June. So this is expected to increase more. But look at the deaths. Almost flat. Okay. And this is, despite an increase in mobility, almost back to baseline. For me, this is proof that Sinovac can prevent severe disease. Now, Philippines, you have, most of them are alpha and data from South Africa. For some reason, the gamma did not take off. The data, which is the Philippine variant, didn't really take off. So, it's already in the Philippines. 13. Okay. Remember, it's more transmissible than both alpha and beta. So in the Philippines, there's a peak in NCR and it's actually the rest of the Philippines. But overall, the tendency is decreasing. And for deaths, it's also decreasing. Is it because of the vaccine rollout? Of course not. Your vaccine rollout is very low, at 50%. It's because of your mobility. Look at the decreased mobility of the Philippines. Look, it's still about 50%. So, as long as your mobility is decreased 50%, this will continue to decrease. Of course, if your vaccine rollout goes up to at least 50%, you can decrease restrictions. Just like the United States, United Kingdom, and Israel, hopefully permanently. So, let's look at the efficacy and effectiveness of the vaccine. So, phase two vaccine trials, these are all randomized placebo control. As you can see, the number one, the highest one is Pfizer, 95%. And Coronavac, Sinovac is the lowest at 51%. In Brazil, but in Turkey it's 91%. But even with this 51% efficacy for clinical COVID, for severe COVID, it was 100%. Okay, of course there's a 95% confidence in the rollout. It will be lower than that. But overall, it's 85% to 100% efficacy in preventing severe COVID that increase hospitalization in that. How about in patients with the, this one is beta from South Africa. So, J&J, 57% for moderate, but 85% for severe. So even in in South African variant, it's effective in preventing severe disease. So this is the same phase three trials. It's just showing the correlation between the vaccine efficacy against symptomatic disease is robust compared to the mean neutralizing antibody titre compared to the convalescent. So the highest is Pfizer, which is four. And of course the lowest is Sinovac, which is 20%. But here, they actually suggest that the correlator protection should be 20% exactly like Sinovac. Not only that, the threshold for protections against severe disease is even lower at 3%. So even if you have a five-fold lower neutralizing titre from a variant, it will still be higher than the 3%. It will still prevent severe disease. Now this is real-world vaccine effectiveness. So this is based on the real world and as you can see here for infection, this includes asymptomatic infection. Most of them are more than 80%. For symptomatic, it's even higher, more than 90%. But these are all mRNA and Janssen and this is non-variance. For variants, there's some decrease for alpha, substantial decrease for beta, but this is for symptomatic, not for severe. Now this one is AstraZeneca. AstraZeneca versus alpha and delta. And as you can see here, it's quite low for symptomatic, 66% for alpha and 60% for delta. But for hospitalization, prevention of hospitalizations, it's 86% for alpha and 92% for delta. So it's pretty good, 92% in preventing hospitalization. Even with one dose of AstraZeneca, it prevents 76% of hospitalization for alpha and 71% for delta. Now this is Sinovac, efficacy and effectiveness. So, it's not too impressive the protection against symptomatic COVID, but the protection against hospitalization, severe disease, is impressive. 85% to 100%. Especially here in Chile, based on 10.5 million, they have the gamma and the alpha viruses, variants and still achieve 85%. Now this is a very busy slide, but the most important thing here is for neutralization, the Sinovac actually did better than AstraZeneca. And AstraZeneca, compared to other vaccines, actually did well. AstraZeneca is the yellow circles. It actually did well compared to the other vaccines in terms of neutralization loss. Of course, the worst is beta. Alpha did well. Gamma is worse than alpha, but better than beta. And then delta is the same as gamma. So they are the same as gamma. Remember, one with the highest transmissibility rate is delta, but beta is the worst in terms of neutralization loss. So our monoclonal antibiotics analysis doesn't even work for beta anymore. We have to use other monoclonal antibodies. Now, what happens if you have a breakthrough, a vaccine breakthrough infection? Remember, it's not too impressive in preventing symptomatic COVID, but what will happen to you if you have a breakthrough infection? Well, the viral load is decreased 40%. The fibra system symptoms is 25% versus 63% in unvaccinated. Okay. And in terms of days spent sick in bed, one and a half days versus almost four days in unvaccinated. So it's milder compared to unvaccinated. Second is if you have in terms of household transmission, the secondary attack rate is 10% if you're unvaccinated. But if you're vaccinated the AZ and the Pfizer, it's about 6%. That's a 50% decrease in household transmission in breakthrough infection in vaccinated versus unvaccinated. And thirdly, the last one is there's decreased mutations. There's decreased mutations in breakthrough infection. So the higher the vaccination rate, the lower the diversity. And here they've shown that in persons who are unvaccinated, the mutated position despite protein is two times higher than that in a vaccine breakthrough infection. So in summary, you have great protection against severe disease, including hospitalization and deaths among all vaccines against all variants. And if you develop a breakthrough infection, it will be milder. The household transmission is lower and decreased mutations compared to unvaccinated. Thank you. Raymond, I think you're on mute. Are you lost your sound? Okay. Let me introduce our next speaker. So our next speaker, so we have now, thank you very much, Dr. Franco Federisarta for that. A very comprehensive presentation and I do encourage the audience to go back to the recording to pick up on the details and I think it was really very enlightening to hear all of these things. And we will have a discussion later on. Currently, we'd like to call on now our reactor from Singapore, Dr. Lai O San, who is the head of the Human Molecular Genetic Lab, Genetics Lab, the Department of Pediatrics of Yonglulin School of Medicine, National University of Singapore and his adjunct faculty of the Genome Institute of Singapore and has been working with our genome experts in the Philippines. Welcome, Dr. Ho San and please take the floor. Thank you, Dr. Suzie. Let me begin by sharing screen. Right. Good afternoon from Singapore. It's a pleasure to be here with all of you. And I would like to thank Chancellor Padila for inviting me to share about the data variant, the science and the biology and also to share about our experience from Singapore dealing with the delta variant outbreak and which you all know that has been reported in quite a number of countries. Now to understand the data variant, let's start with the mini refresher on the biology of the SARS-CoV-2 virus and Dr. Franco has made my job easier by explaining some of the key observations and facts. The SARS-CoV virus is a genome of 30,000 bases. It's a single-stranded RNA and these bases actually code for quite a number of proteins and some of these are very important. This is the nucleocapsid protein that protects the RNA of the virus and now of course there's the amyloprotein and the spike protein. And the spike protein is very critical because it allows the virus to recognize the host and through the receptor binding domain that you've heard about, it actually interacts with the ACE receptor of the host and by this means it allows the virus to inject in the RNA and thus infect the host and replicate. So let's now talk about mutations and variants. So we heard that there are 30,000 bases of the SARS-CoV genome and any of this base can mutate. So when they mutate there could be different combinations and this gives rise to variants so that each variant can harbor not just one mutation but quite a number of mutations and this happens all the time. So why do mutations occur? It occurs because it's part of the evolution of the virus and the more chance a virus has to multiply the more chance it can mutate during the replication process. So this is actually part of the survival tool of the virus. Although most of the mutations are benign but some of the mutations that it acquired can actually create and improve strain. For example, it can survive longer in the air. It can penetrate the whole cells faster. It can replicate at higher rate and so on. So what would be some of these mutations that we would be concerned about? So mostly if the mutations occur in critical domains that is in the spike protein because this is important for recognition and binding to the host. And if we look at sequences that have been deposited in the public databases, we see actually there are quite a number of mutations that have already been reported in the spike region. And if these mutations affect the behaviour of the variant significantly, it can have implications on disease severity, prognosis or even allow the virus to acquire resistance to antibodies or to vaccine and affect diagnostic kits if the mutations occur, for example, in the primer site of PCR reactions. So the delta variant was first detected in late 2020 and you have heard from Dr. Franco that it carries actually quite a number of mutations but there are four mutations of concern here. And what actually is very sinister about the delta variant is because it carries these four mutations in combination. So some of this mutation like D614 also found in the alpha, the beta and the gamma but when it's combined like this in four and also in particular there are two of these mutations the T478K and the L452R it is present in the receptor binding domain. And the implication is that it allows stronger binding at interaction between the virus and the host and therefore that's easier and faster entry. And this could explain why it is more contagious. And you have also heard about the R0 figures that was shared earlier. You can see that the delta variant actually is 50% more infectious than the alpha variant and studies are beginning to show that there's reduced sensitivity of this variant to antibody neutralization. So this actually is of concern because infected patients may more easily is more transmissible and there's a potential for it to become a dominant strain. So let me share with you about our experience in Singapore. So in Singapore we first encountered the delta strain in April and by mid-April there were already several clusters. This included one at the hospital that affected patients, affected healthcare workers, cleaners and visitors. And community spread was detected subsequently. We had clusters coming out from the airports, canteens, market food centers and by end of May you can see here that the delta variant was already the most predominant variant. So we really essentially had to do a lot of titan control measures, work from home as a default and even our laboratories we had to go on through shifts. So weekly shifts or daily shifts where there was no overlap between shifts. Restaurants, food and beverage outlets all were were shut in for dying in. Quarantine period 2 was extended from 2 weeks to 3 weeks for most travelers that came in from a lot of countries. This were very harsh measures to deal with the delta variant that was just relax only recently. I think what we are realising with the delta variant is that it is not about tightening or easing of our controls or the restriction alone. This is a new dangerous front that's opened up in a fight against COVID-19 and with the delta variant there has to be a shift in strategy against this changing enemy because we're seeing that it's really a lot more infectious and we were actually dealing with opening up but because of this sudden outbreaks with the encounter with the delta variant we actually had to tighten up. So recently we have also decided on the shift in our strategy because of this changing enemy. So besides delta variant we also anticipate that more infectious variants will be coming in and so the trust now is on three fronts testing, contact tracing and vaccination. So for testing we are actually have been doing quite a lot but we are planning to do even more. So this includes proactive testing. So for example when residents of a when there are one or two cases a few cases detected in a housing block the residents of the entire housing blocks or visitors to shopping malls or schools will be tested if an outbreak is suspected and all patients facing healthcare workers are now currently swapped every two weeks. So in the hospitals all staff are tested every two weeks for the COVID virus. And by next week come 21st of June there will be mandatory testing that we carry out for all workers in our country for high risk work like F&B gym salons and so on every two weeks two weekly. And also to encourage regular testing the regulators have actually approved the sale of antigen rapid test kits this over the counter sale at pharmacies and they can also be used for self or home test kits so this will actually help to increase more testing and then for contact tracing is now mandatory to do check ins at all the buildings and then of course we have a lot of contact traces deployed as in all countries and then I like to talk about vaccination there was a ramp up because we when we encountered the outbreaks by the delta virus so we have extended it to all children so last June because it was a school holidays we took advantage of it there was a mass vaccination exercises for all the schools so children 12 years and above were then vaccinated so you know last week the minister of health our minister of health commented that the mRNA vaccines is only 69% effective against COVID-19 and this includes both symptomatic and asymptomatic cases but however I think we also need to realise that vaccination does protect so the local data here that I have here shows that for those who are fully vaccinated there are no fatalities there was no need for oxygen supplementation or ICU care and all of them were actually mild or asymptomatic for the partially vaccinated those who only had the first jab 4.2% needed oxygen 1.4% needed ICU care and for the unvaccinated there were more needing oxygen and ICU and there were also facilities fatalities so vaccination does offer protection against symptomatic disease and severe symptoms even for the delta vaccine what I like to highlight is that you know the virus nonetheless is always trying to break our defences so what we have in Singapore is not really a success story what we have actually is a learning curve so this week you can see the sudden spike here so this was in June in May we had the big cluster quite high we were trying to bring it down and we thought that we could open safely and this week just a few days ago there was a huge spike and again I think what it shows is that this is not an easy battle for us and what we are dealing with with the delta virus is really highly infectious so I just want to sum up that we need to be very very vigilant and this delta variant is becoming more and more prevalent in many countries we hear it being in Indonesia now also in Malaysia so we need cooperation exchange of information and so on now mutations occur all the time so the delta virus may not be the delta variant may not be the only variant that is going to be with us we should expect more and more variants because with the 30,000 number of bases in the viral genome the virus will mutate so we will need a whole arsenal of management strategies this could be public health or genomic surveillance testing vaccination contact tracing prevention or control measures it is actually important to to adapt to re-calibrate when necessary to make changes to our policies to our controls when situation changes especially when new and infectious strains appear now when the virus mutates and changes its weapon we too as the healthcare workers as the researchers we must strengthen our defenses and change our weapons to combat this I hope that this experience that we have can stimulate more discussion afterwards thank you thank you so much Dr. Pousan for giving us really an overview of what has been happening over in Singapore and also thank you for those nuggets nuggets of wisdom and very important information shared earlier by Dr. Franco Felizarta you will see on the chat the appreciation Dr. Pousan and Dr. Felizarta from our viewers as it relates to your presentations our next presenter is not a stranger to all of us already probably heard her today during the TV press or she's my boss over at the National Institutes of Health our executive director and she's also the director for the health program of the University of the Philippines Philippine Genome Center please welcome to the screen Dr. Eva Maria Puchong Podelapas thank you thank you Raymond for your kind introduction magandang umaga po sayin yung lahat ay tanghali na po pala good afternoon to all the people in the audience I will be providing updates on the variants in the country in the Philippines as of July 16 10.30 am why the time stamp because it changed by 10.31 am this morning we had our media presser and I'm going to present that data out of the 7,878 sequence as of July 16 10.30 the beta variant accounts for 23.35% the alpha 20.52% gamma has remained accounting for only two cases and the delta variant was 19 which came from incoming international travelers on the right most is the theta variant which is a variant of interest not a variant of concern this was the p.3 first detected in the Philippines and we had recorded 166 cases however as of 10.31 July 16 2021 we added data from 679 samples sequence for a total now of 8,557 we now report 16 new cases of delta variant and that totals 35 cases already detected in the country from the original 19 additional 5 cases from incoming international travelers and 11 cases are local cases the local cases are from the following regions 2 from the national capital region 1 from region 3 2 from region 6 6 from region 10 for a total of 11 cases and the 5 are from returning overseas Filipinos for the 5 returning overseas 2 cases have travel history from UAE and Qatar 1 from the UK and 2 ROFs who are still being verified as this news is really very fresh our whole nation approach to the pandemic includes the four door strategy you can see here in this slide door 1 is preventing ROFs or foreign nationals also from leaving the country of origin so door 1 involves travel restrictions as initial response to new variants of concerns and variants of interest for door 2 this is preventing the entry or containing and mitigating cases and the safeguards for when to ease door 1 to economic cost are considered so here we have your screening quarantine and testing at ports of entry door 3 is preventing further local spread and this involves strengthening our PDITR strategies prevent, detect isolate, treat, reintegrate plus vaccination and door 4 is containing widespread and overwhelmed health system by putting in strong health and critical capacity and systems putting in versus a stronger health and critical capacity systems versus a surge to ensure proper and timely COVID-19 management and continuity of essential services now before today before 1030 we strengthened door 2 and that's because we wanted to prepare our systems for the following delta VOC detected locally this has now happened increasing cases and clusters observed, sharps, spikes signaling, pastoral transmission swiftly increasing admissions especially at the ICU we shall continue to strengthen door 2 for the scenarios of 2, 3 and 4 because scenario 1 is already present in the country the PDITR strategies plus vaccination you've heard this many times this is part of our whole of nation approach which is preventing and these are individual as well as community participation is much needed in the prevention we have detection which has where in the big role is from our local government units including our isolation so detection and isolation and then now we have treatment which is spearheaded by the 1 hospital command and reintegration by being practicing again the minimum health public standards and awareness for possible infection social healing, economic recovery and of course the plus is the vaccination which allows population protection and herd immunity sustainable immunization program and self-sufficiency due to ongoing high rates of transmission around the world all variants are expected to continue to evolve over time and we've heard that from our speakers to previous speakers it has been repeated and observed to the pandemic that variants acquire the same or similar amino acid substitutions that may offer a competitive advantage likewise the understanding of the impact of these variants are expected to evolve information updates reflect these as new evidence becomes available as shared by Dr. Pawsan we need to keep on calibrating and making changes or adjustments on our policies on health measures and strategies because of this the WHO periodically reviews and adjusts working definitions these are the revised set of definitions for variants of concern variants of interest and in addition this revised definitions formalize a third category labeled alerts for further monitoring which includes variants with indications that they may pose a risk to global public health depending on the evolving pandemic but for which evidence of phenotypic or epidemiological impact are less clear when compared to variants of concerns or variants of interest these alerts are reassessed regularly a previously designated variant of interest or variant of concern which has conclusively demonstrated to no longer pose a major added risk to global public health compared to other circulating SARS-CoV-2 variants can be reclassified this are the four variants of concern which has remained still have your alpha, your beta, gamma and of course the most feared now the delta DOC plus you've heard this a number of weeks back especially for the delta plus variant DOC's with additional amino acid changes these comprise a small fraction of the total number of sequence cases there's also still limited direct evidence of further phenotypic impact there is now a shorter list of variants of interest and notably please theta or p.3 the variant of interest first identified in the Philippines and reported in March has been taken out of the list and reclassified as alerts for further monitoring this is the other piece of news apart from the new delta cases reported which I wish to share with you which happened also just recently this slide shows 8 of the 12 in this category including the p.3 here which the WHO has now reclassified as an alert for further monitoring the WHO emphasized that the assessment considers primarily global risks posed by variants and national authorities may actually choose to continue to designate this as variants of local interest or variants of local concern just of where you are recall the p.3 carries mutations with suspected and or established phenotypic impact such as potential suggestive of increased resistance to neutralizing antibodies and therefore becoming more transmissible however it has been reclassified as alerts for monitoring along with epsilon and zeta because the reported detection has decreased over a total of 269 sequences were uploaded to GSAID from 14 countries 6 2021 as of this last sequencing which we reported just today we have 44 more cases 71% of these 269 sequences were reported from the Philippines mostly from the central Visayas region and only sporadic detections or small cluster of cases have been reported globally so the key messages are as follows local cases of the delta variant have been detected as of today we all need to do our part in preventing local spread strengthening of the PDITR plus vaccination has been put in place by our government and the last one is that p.3 has been reclassified under the category of alert for further monitoring that's all Raymond and thank you very much for your attention thank you very much that's Dr. Eva Cotionpa de la Pasti Executive Director of the National Institutes of Health of the University of the Philippines and Director for the Health Program of the UP Genome Center okay, we're going to shift gears a little bit and it's my pleasure to welcome a very special speaker for today from the International Federation of the Red Cross Red Crescent Societies who I've had a chance to work with and is very, very knowledgeable on health in emergencies and disaster so our speaker has been doing this for quite some time he's the regional coordinator based in Malaysia for emergency health for Asia Pacific and he will be sharing with us the experience of South Asia which includes India Bangladesh, Nepal and of course the other countries to the region so it is my honor to welcome Dr. Abhishek Primal to our webinar Dr. Abhishek, welcome Thank you Dr. Suzy and it's great to be here in this webinar and a very good afternoon to all the participants I will now share my screen I have a small presentation like Dr. Suzy if you can confirm you can see my slides Yeah, your slides are good and they're on PowerPoint mode so you're good to go Thank you very much like on the behalf of International Federation of Red Cross, Red Crescent Societies I would like to thank the organizers for inviting us to share our experience on the second wave of COVID-19 to this esteemed participants across the world So as you may all know like at this point of time the Asia Pacific region is really battling with the second wave of COVID-19 pandemic and the reasons since the beginning of the pandemic have already confirmed more than 41 million cases and more than 605,000 deaths across all 38 countries in this region We have seen in the last two weeks like there were more than 1.5 million cases and more than 30,000 deaths So at this point in the pandemic as shown by this graph we can clearly see the Asia Pacific region is slowly again becoming the epicenter of the COVID-19 pandemic and is really getting the brunt of the second wave of the pandemic as such The percentage of COVID-19 vaccine administration has also been highlighted by some of my fellow panelists In the Asia Pacific region even we have scaled up vaccination rate but if we see the entire picture the vaccination is not very great in several countries There are very few handful countries in this region which have vaccinated more than 30% of their population and we already know like we need more than 75% of the population vaccinated in order to be getting the herd immunity and it looks like there will be an uphill task in this region to get more and more people vaccinated as several countries in this region are between 0.5 to 6% of their population vaccinated in COVID-19 vaccine So what we have seen since March is that India and Nepal have been the worst hit two countries in our region with the COVID-19 and the Delta variant was the most dominant variant India at one point was recording more than 400,000 cases in a single day and hundreds and thousand people also died in this country and now even the cases are stabilizing in India and Nepal and we are seeing a vertical rise of cases in countries like Bangladesh, Malaysia, Myanmar and Indonesia which are now recording highest number of cases since the beginning of the pandemic and again in this country we are clearly seeing the Delta variant in the most dominant variant and if we see two to three months before Delta variant was near to other variant but in the span of this short time the Delta variant have just replaced the other strengths of SARS-CoV-2 and WHO and some of the epidemiologists also describe the Delta variant at the fittest and fastest variant of all SARS-CoV-2 and with highly contagious. Another things that we are observing in our region is the high rate of the positivity rate. The countries like Indonesia, Bangladesh Nepal, Afghanistan are recording more than 30% of the positivity rate that clearly signifies that currently what absolute number of cases are recorded is not actually the true number. There are several cases in the country which is because of the insufficient testing is not yet recorded. We have also seen during the second wave that the countries are facing a massive burden on their health system and also the impact on the frontline health workers were catastrophic during these times. There were several operational challenges that we went through while responding to the peak of the second wave in South Asia. One of the things that we have observed even the country thinks like they were very prepared to really deal with the second wave. Oxygen was one of the major demand and people were gasping for breath. There were huge lines in front of the oxygen repelling center and several hospitals were running out of oxygen. There were high demand of oxygen all through and insufficient supply of oxygen and some of the medical equipment, medical equipment especially in the ICU. So that was one of the major challenges that we have seen when the second wave when more and more people requires oxygen support. There is also as we have all known like poor and unequal distribution of vaccine across the world. More than 85% of the vaccine are going to the high income countries and less than 5% coming to the low income part of the COVAX effort like we are not able to get a good vaccine doses in several countries across the world and people are suffering. There were hundreds and thousands of people in South Asia who got the first dose of AstraZeneca and because of the export restriction they were not able to get the second dose and they were slowly passing the 8 to 12 weeks time frame and was left like what they can do now where will the first dose still valid or when they are going to get the second dose. Those uncertainties were already very high. There were also uncertainty of the unknown and lack of trust on the health system like the information regarding the virus was changing. It is becoming more contagious and the people have less and less trust on the key messages and the health system and slowly we have seen the pandemic fatigue was creeping in like with 19 months dealing with the pandemic and the restriction, the movement control, etc. People were desperately wants to go back to the normal and try to open up and in doing so they were lowering their public health guards and we were seeing the cases just flare up like a bushfire in several of these countries. There were also movement restriction during the peak of the second wave and which have hindered the international rapid response in which we could have quickly mobilized human resource equipments, items because of the severe, severe movement restriction that was implied and the number of help that can come into the country so that has also impacted the global response to the hard hit countries and we all know that also not only have a direct impact on health there is also a big secondary impact of COVID-19, hundreds and thousands people haven't lost their job, they desperately want to go back and earn their livelihood and the sector that was really affected was the people working in the informal economy and since the COVID-19 was just not enough we have seen compounding disasters like several countries like India when it was in the peak of COVID-19, two cyclones hit the country of category 3 hit the country in two different source so it was really a big struggle to contain the virus as well as to respond to those disasters. At this point of time we have civil unrest in Myanmar drought in Afghanistan and the cases of COVID-19 are still peaking in those countries. So what are the lessons we have learned from South Asia that can easily be applied to other countries to better prepare themselves for the second wave, third wave or a spike surge of case in COVID-19. One of thing is like we need to redouble our epidemic control measures like the simple health messages save lives. There is no doubt around that. We need to emphasize on testing, isolating, treating and vaccinating people. These are the key and golden rule if we want to grab the pandemic. The oxygen readiness should be there. We need to ensure that our hospitals have regular supplies or essential supplies as well as oxygen in preparedness of the second wave. Even if we are not buying, we should be able to already identify who are the suppliers, where are those oxygen available and how rapidly it can come into the country in case the oxygen is needed to because of the peak of COVID-19. Mucor mycosis are the black fungus which have a fatality rate more than 50% has been seen in India largely among the diabetic patient who were on the dexamethasone or the steroid treatment for COVID-19. And it has been declared epidemic in several states of India. So this can be also something we need to be aware in countries where we are responding to the big peaks of the second wave. At the vaccination, we all are discussing about the dose and availability of the vaccine but it is also equally important in addressing vaccine hesitancy. We have encountered large number of people who are very particular on the brand of vaccine. Like we want to have Pfizer, we want to only have AstraZeneca, we don't want to have this vaccine or that vaccine, even those are approved by the World Health Organization. So overall misinformation about the vaccine like it contains subchips or sims, et cetera which is preventing people on getting those vaccines because the rumours or the infodemics are traveling faster even than the data variant itself. Deconcision of the hospital. We have also seen the hospitals are back very, very quickly when we are reaching peak and we are really getting our national society in the forefront to support those hospitals in de-consisting them by putting the tank by putting some oxygen so that more and more people can be adjusted and get critical care when needed. One of the key lesson is local preparedness and local accent is really important. As we all know, a pandemic or an epidemic all starts at the community level and ends at the community level. So it is absolutely important like our local health units, our local frontline workers have right tools, right scale and right equipment if we really want to contain the virus as well as community should be our partner in really grabbing the pandemic and following the standard operating procedure of the messages, et cetera. So in view of that like the Red Cross, Red Crescent national societies across the Asia Pacific have put forward few packages to support our national society to grab the pandemic as such. We have like emergency package where we are really focusing around the increasing the ambulance service, establishing the oxygen supply by either supplying the oxygen concentrator or if the national society at the capacity to operate even the oxygen plant. We are really want to accelerate paramedics, ambulance driver and technician for the oxygen plant, increasing supply of PPEs, enhancing our support to vaccine administration center, reducing vaccine hesitancies and spreading good word about the importance of key messages. Similarly, some of the national society across the region, even in Philippines have some clinical capacity in those country, we are really beefing up our capacity to establish isolation and treatment center just next to the hospital, providing oxygen supplies, PPE, vaccines and risk communication, community engagement on health. And we have also put forward for smaller national societies who don't have that big capacity to at least do basic community mobilization that is for COVID prevention kit hygiene kits in the quarantine facilities provide volunteer insurance, basic PPEs risk communication, community engagement as well as supporting the vaccination campaign. And on top of that, like as Red Cross Red Christian National Society has been responding to the different natural disaster across, we have also worked and developed the COVID-safe guide in better responding to these disasters where we have focusing on the four key areas like planning ahead ensuring the physical distance, maintaining basic hygiene and identifying the vulnerable people and people with symptoms. And then we have applied these four accents in eight different areas. Either we are talking about the general precaution or managing the health facility or managing a camp setting distribution, et cetera what are essential during while responding to different disasters. Philippines will from the month of September we go to the cyclone season and there I think these type of guidelines and practicing and planning ahead around this would be really, really important in saving lot of lives. We also have several more information around our health health desk and have developed the COVID-19 portal to provide the real time monitoring about the COVID-19 situation as well as the the vaccine update across the Asia Pacific solution. So this is all from my side about the COVID-19 in South Asia and how the Red Cross National Society are preparing. Thank you very much. Thank you very much. That's Dr. Abhishek Rimalu who is the Regional Coordinator for Emergency Health for the Asia Pacific Region of the International Federation of the Red Cross, Red Crescent Movement giving us a picture of South Asia and what's happening to our neighbors. So now we're going to go to our last reactor and our Filipino experts in public health are all over the world. I'm very proud and honored to present to you one of our young rising leaders in public health who is currently at the World Health Organization based in Ababa, Ethiopia at this Ababa, Ethiopia and who is the Program Management Officer for the World Health Organization Office there. I'd like to welcome Dr. Ninyo Daldayang Hira. Ninyo, welcome to the webinar. Thanks Dr. Suzy. Magadang hapon po sa lahat. Thanks Dr. Raymond. Good afternoon everyone. Bon dia, bonjour to everybody watching from different parts of the world. Asalaamalaikum as well to our Arab colleagues. I heard somebody from Algeria was joining as well. So I'm Dr. Ninyo. So let me share my slides. I only have a short time. Okay. Go ahead. Okay, Dr. Suzy can you confirm if you can see my slide. You have to go to PowerPoint at your slideshow. Thank you Dr. Raymond. Thank you Dr. Suzy. Good afternoon again everyone. Magadang hapon po. Ninyo Daldayang Hira from the World Health Organization country office here in Ethiopia at this Ababa. So I'll be reacting to as one of the invited reactors. I'll be reacting first to our main presenter and of course the sharing from the other reactors. But first and foremost thanks to all the participants. I see that there's around 2,000 participants in Zoom and most likely many more in YouTube live. So many thanks because you're taking the opportunity to get yourself updated and getting the correct information coming from reputable sources. So just to highlight you can get more information from the WTO website of the African region so the websites are there and of course the Twitter handle of WTO Afro. I just try to do as well what Abyshek did to give you a quick overview of what's happening in the African region and then of course try to give you how as a healthcare practitioner you can access reputable data. So one data from WTO is this very simple website. It's COVID-19 at wto.ind So as you can see even go to each country each territorial area you can see their cases. Here in the African region as you can see we have many countries it's separated into two different regional offices for WTO. First is the is my regional office the WTO African regional office based in Congo, Brazil we are handling around 47 countries and of course our other counterpart is the WTO Western Mediterranean regional office that's based in Cairo, Egypt which handles seven more countries here in the continent of Africa. So I just also would like to emphasize what Dr. Evo Maria said regarding the time stamps it's always very important to keep you updated on what's happening in many places of the world and it's important to know what time or date the data is the data you're getting from is for example from our site if you go to the website you'll see that this one is from 14 July and then that's for the African region and then 13 July that was from the Eastern Mediterranean region so even at WTO we have some discrepancies when it comes to time stamps because sometimes the countries and member states have different timings on how they send their information and that's how we try to report it but by going to reputable websites like the COVID-19 the WTO.int website you'll get more up-to-date information so just a quick reaction from what Dr. Franco said so I really liked what Dr. Franco and Dr. Leipo San gave us the information about production numbers so for example for Delta as you would note it was 5 to 8 you will see that in the African region this has greatly affected us you'll see more as I provide you more information and of course it's nice to see that there was no gamma as what Dr. Franco said in Africa which was also a similar experience in the Philippines and then of course it was really nice to see and the impact on how cases were spreading so it's really important for us to know that in this data that we have right now for WHO in the African region is that we're currently in the third wave so we recently passed a very grim milestone which is around 6 million cases from the data that was presented by Abhishek we were that little yellow wave but what is really of concern there is that for us to reach 6 million we had to get to 5 million so from 5 million to 6 million it only took us one month so in the past month 1 million cases were registered or reported in the African region for us to get from 4 million to 5 million it took us 3 months so for us it's really escalating very fast I was talking to Dr. Suzy last week I said it was not really a big concern as you know in the African region we have a lot of fragile conflict and vulnerable settings which we are trying to control in light of the current situation of the pandemic but in that short span of time we can see that we can see we just released this news report yesterday in that one week we registered 4,384 deaths so that was 1% shy of our peak last January so if you look at it it's getting very grim and as what we saw in the graph of Abhishek was that people tend to not look at what's happening in Africa so the focus of the vaccination efforts and all those things have become very very low so what's being highlighted right now is what's happening for example in South Africa the deaths happening from the situation the very bad situation happening there politically and of course what's happening in Tigray in this country that I am right now which is also affecting not only operations of all essential healthcare services but specifically on the distribution of vaccines to help stop the spread so as you know as you can see 18 member states and countries are now in resurgence in Africa when it comes to the number of cases being reported 21 countries have now detected delta so that's almost half of our 47 countries here in the region there have been sharp increases in Algeria so it was very nice to see that somebody from Algeria of our participants also reporting sharp increases is Malawi, Senegal and Zimbabwe but it was nice to see in the presentation from Dr. Franco that there is some hope some light ahead so we're also seeing that kind of hope and light in BRC that's the Democratic Republic of Congo which we also had some problems recently because of the volcanic eruption Eritrea, Kenya and Namibia so yesterday we had news presser regarding this current understanding of the situation of Africa specifically coming from the regional director of the African region and of course ministers from DRC and Namibia to share the experiences on how they were able to help their countries move into a declining rate of number of cases but what is again the problem that we're seeing is the number of deaths I focus on Namibia so Namibia, they are declining in the number of cases but as you can see in this news article that we have sent yesterday Namibia, South Africa, Tunisia, Uganda and Zambia accounted for 83% of those 4,300 deaths so even though some cases in some countries it looks better but what they call this for example Namibia the cases are declining but the deaths are increasing or are accounting for most of the number of reported deaths in our region so there's some problems there that we need to solve it might be operational issues it might be health information issues but again as what was presented by Dr. Abhishek it's really being not being spotlighted on because as compared to other regions other countries the situation in Africa looks not that grim as compared for example the resurgence in Asia but again as we note in just one month one million cases in the African region and it's what we call this it's in light of other problems that we have for example Tunisia as you can see here it has increased the number of total cases it's this one right here in the eastern Mediterranean region it was also in the news recently as having one of the worst cases in here in the continent so there's a lot of problems happening right now but I'll try to focus on the impact of delta variant here in the African region so I also in the presentation that's going to be shared to you so first you saw how to get easily accessible information from the COVID-19 to get more data that you can play around with and have more information you can click on this website this is the same dashboard and tool that we use for the Ebola outbreaks previously in BRC and in the West African Ebola outbreak so you can play around with the data see how it's impacting each and every country especially if you're affected by it if you're deployed to one of these countries so in last week when Dr. Suzy and I and Raymond were discussing also recently held that Africa press briefing on the delta variant so we tried to link up with Dr. Tulio Oliveira it was nice to see that Dr. Franco also used one of Dr. Tulio's and team's research when it comes to the impact of vaccinations or vaccine efficacy of several different vaccines so from my side as well I'll be presenting some of the data by Dr. Tulio in last week's press briefing during the focus on the delta variant so you can access that press briefing on this YouTube link it's a longer link but I tried to squeeze it into this very small header so that it's easy for you to access so as you can see we're experiencing the third wave in Africa so if I just get back to this slide in South Africa that little red big dot over here it represents almost 50% of our reported cases so in August or July of last year most of the cases were beta as you can see in the X axis this is the time and then the Y axis would be the proportion of genomes so from August or July 2020 most of the cases were coming from the beta variant that was heavily affecting the number of cases being reported by South Africa but starting in March to July 2021 almost 100% of those reported genomes in South Africa is the delta variant and that has if you look at it in the past month would most likely be around 50% of it since it's coming from South Africa would be delta variant and as reported earlier 21 countries have now detected delta variants in the African region so you would hear a lot of news coming out from Kwazulu Natal regrettably that's where Dr. Tulio's team is also located at so we have WTO collaborating centers at Kwazulu Natal several different departments are designated as WTO collaborating centers I was fortunate enough to designate one of them as WTO collaborating center for antimicrobial resistance I think in 2018-2019 as the regional advisor for infection prevention and control in the African regional office so given this information coming from our colleagues in Natal and then if you look at Gauteng Gauteng is where Johannesburg is both areas are currently in the news as having many deaths coming from civil unrest so in those situations where it's fragile, conflict and vulnerable settings it's always very difficult to have operations on health specifically especially here on COVID-19 so as you can see from the previous year most of it were beta variant and then it's only in the past 2 or 3 months that we see this sudden surge of delta variant that's affecting the number of cases in South Africa and affecting the reporting of cases as well in the whole African region so that would really end my talk I hope I didn't go over time okay not too much so if you need more information please do not hesitate to contact us at the previous WTO Twitter account of course you can also contact me personally I try to respond as much as possible within 24 to 48 hours so many thanks again to my boss Dr. Suzy it's nice to be included in this presentation and webinar and thank you Dr. Raymond over to you Dr. Suzy Thank you very much it's often Nino Dayang Hirang for the World Health Organization in Addis Ababa, Ethiopia we're now going into our panel discussion I would like to call everyone to open their cameras so Dr. Ernie Domingo Dr. Posen Dr. Franco Dr. Eva Dr. Abhishek and of course Nino and there are 36 questions in the Q&A box but let me just start the discussion first thank you all to all our speakers I think this is just really been a very what should I say very enlightening very enlightening session with you it's always good to to know what's happening in the rest of the world because sometimes you kind of think it's just us and we're the only ones with this problem and there's something wrong with us well it's global guys everyone is experiencing this so we just need to as I say you know put on your seat belt and your objective is to survive now most of our listeners are frontliners so they are doctors nurses working in big hospitals, small hospitals we do have members of media who are here today we do have teachers, educators, pharmacists and Filipino health workers all over the world do come and watch this webinar regularly so my first question for everyone and this is just a short response that I would like to ask this what do we do to protect our frontliners so it looks like there's no country that's been able to stop the tide of the Delta variant but what are the practical things that we need to do to prepare do we need more PPE should we be testing more should our health workers not be traveling home if there's a lot of community transmission what should we be doing so I think I'm going to start with Dr. Posan because she already mentioned some things they're doing in Singapore and then we're going to ask Dr. Franco and the others go ahead Dr. Posan So I think the first thing we should do is actually vaccinate, vaccinate, vaccinate because if the virus has a chance to replicate it will mutate and then we'll get more and more new variants so vaccination to me would be the key to actually stop or at least reduce the chance of the virus spreading and of course there are also the other controls which we would need to calibrate from time to time so to me the first thing is just vaccination vaccination, Dr. Franco from the experience in the United States I agree with Dr. Lai Posan it depends on the speed of the vaccine rollout so the faster the vaccine rollout the better the chances of stopping the delta variant but the problem is there's vaccine inequity in the world so in the meantime that you're waiting for for the vaccination level to go up you cannot really decrease the restrictions I know there's a high economic cost but that's the only way to stop stop the variant if it's already in the Philippines and based on the data it probably will become dominant within two to three months now NCR probably would be okay I think maybe NCR has at least 25% at least 25% maybe 30% vaccination rate but if you can just double that and you can probably the cases will go up just like in Chile but if you look at the hospital at the death rate it's quite stable so that probably will happen in the Philippines it will go up but hopefully the death rate will stabilize because of the vaccination if you're able to protect your elderly that's a way to do it yeah, thank you Abhishek, what do you think? So from our experience what we have seen is like vaccination definitely is one of the key but we have also seen like not in the urban or high income countries the low income countries are also struggling with basic PPE some right skills as well as providing right training standard operating procedures simulation exercise et cetera so if we are really thinking around those context apart from like vaccination definitely but we must ensure the low income setting context as well where we need to provide the right amount of PPE the right type of training and skills there has been several reports during the second wave coming from corners from Nepal the mask were also not there as basic as mask were not available for nurses working in the health facility taking care and they were wearing cloth mask for that so that is the hard reality we are now in this world and that inequality between where the high income countries or the urban setting can can afford and when we go to the rural setting and in in the remote islands so that is where we really need to focus our attention if we are prepared at each and every corner of the country especially focusing on healthcare workers and one more point I would like to highlight is the mental health which is an absolute important for the healthcare workers that we have seen they are struggling to go back to the family they are struggling to meet their children etc we have several cases that they have not met with their children for months like physically like they have just seen through Skype all things so that mental fatigue or the pandemic fatigue is quite high the level of stress is very very high among the frontline workers so that aspect of mental health also need to be taken into consideration while we are providing support around PPE, vaccines etc thank you thank you very much Abhishek Nino what do you think? sure doctora so last year when we had that first wave of COVID-19 infections rampaging through the world we tried to check on our healthcare workers because we thought they were really at the greatest risk of having a COVID-19 infection especially at healthcare facilities especially at a low middle income situation so what we saw was that the healthcare workers were not really getting the virus inside the healthcare facilities especially if the healthcare facility has good infection prevention and control measures so most of the cases that we were seeing that the healthcare workers the infections were coming from community so that was really a concern for us but right now with this new surge especially with the variants we about how it's impacting the healthcare workers but one thing is for certain we really need to vaccinate more if I remember correctly the priority for the Philippines before was to have most of our healthcare workers vaccinated and I think we're reaching that point but one of the things that we saw as well is that what Abhishek was saying our health system is currently strained right now a lot of assets a lot of a lot of essential health public health services are not being delivered properly because we have lack of human resources because everybody is trying to do their best everybody is stressed out especially mental health issue wise and of course there's this also this problem on improper guidelines what we saw recently in our countries is that many countries have ineffective guidelines when it comes to treatment so as frontline healthcare workers it might be important to revisit and especially try to look at your data how to improve your treatment because if you don't treat your patients properly it would add additional strain in your healthcare system and it would overwork our healthcare workers more and it would increase lapses in infection prevention and control measures aside from the impact of stress on the immunity of our healthcare workers Thank you very much Eva what are your thoughts Thank you Dr. Susie well our government the country has implemented the four door strategy and the first one was really to do the travel restriction especially from high risk countries where the delta variant surges were happening second is really improving our screening quarantine and testing of all those who come into the country the third is continuing on or strengthening some more the PDITR plus vaccine strategy and in the media press or a while ago Secretary Galvez announced the arrival of more vaccines for our people and the fourth is really looking at strengthening the health and critical care capacity of our country to address the surge so I think that's the roadmap that the Philippines is following to address the variants Thank you very much Sir Ernie Dr. Domingo what do you think Yes In response to that I would like to recall a statement made to our class in public health by the dean and he said we have a public health problem in this case for example a particular disease and you have two methods at your disposal one is social control and the other one is a technology that is very effective in treating the disease or the infection please start with the technology because it's easier to handle than the control measures dependent on social intervention and this is very true in the pandemic for example to me as a simple observer it's a no brainer the answer really is vaccination the only reason why we cannot do it is of course among other things there's not enough vaccine throughout the world but if that were available certainly it's much much better unless human cost than quarantine is a principle told for controlling this disease Thank you very much Dr. Domingo and I think that again points to what you earlier said about universal health care and having the right health care systems that can handle handle these situations because it doesn't look at all like this is close to over I mean we're looking at spikes we're looking at rapid increases in all of the regions really the system needs to be what should I say rebooted and investments are needed to make sure that we can detect we can treat and the name of our webinar stop COVID deaths but I think that's where we want to go with this anyway Raymond I'm going to turn over to you I think we have some questions from the audience go ahead please Yes Dr. Suzie for one of these interesting questions the one that we picked would be the one from Neneth Coronel and that relates to what's the Philippines policy and maybe other countries could share regarding genome sequencing how many of the samples undergo genome sequencing maybe that's for Dr. Eva and then we'll turn over to Dr. Pousan for the Singapore perspective you're on mute ma'am go ahead Sorry that's a very important question and in fact I have a presentation for you very short Yes a few slides because this was what I presented earlier during the media presser so our SARS-CoV-2 genome sequencing expansion efforts our current capacity for sequencing we do have at the Philippine Genome Center at NovaSeq which is the highest throughput it allows us to sequence 750 samples a week but we can double that should be necessary but we do have the next sick and the my sick as well where we can do some smaller runs especially if it's necessary because of surge or patients presenting in a more severe manner so just to go back right now we are we have just sequence of course we have to be smart in sequencing because we don't have a lot of resources but we're just very thankful that the government like through the Commission on Higher Education Philippine California Advanced Research Institute has equipped the UP Philippine Genome Center with this high end sequencers and of course with the support of the DOSD and DOH we're able to conduct our genomic surveillance so the other things that we need to that we are working on is to really increase the number of active cases sampled for sequencing and adequate representation from the region especially in areas experiencing a surge or clustering of cases and determining the phenotypic impact of the DOCs like transmissibility disease severity, risk of infection and have Philippine data about performance of vaccines the variants our local biosurveillance capacity increasing our local biosurveillance capacity would entail equipment new equipment, manpower resources data and analysis and of course most importantly strengthening the core disease surveillance by the Epidemiology Surveillance Unit which is critical for a stronger surveillance system in the country our first expansion will be through the Philippine Genome Center Visaya Satellite Facility and the Philippine Genome Center Mindanao Satellite Facility din lang po, thank you Thank you Dr. Eva Dr. Pousan, would you care to share how you do it in Singapore? Thank you Dr. Raymond so I need to qualify that in Singapore we are a smaller country we are in about 5.5 million and the numbers that we get in proportion is not that many so I mentioned like in the past few weeks it was something like a few in a day and it was only recently that we had a spike of like 20, 30 or 50 a day so we can afford to sequence every positive case but I think what is more important is that sequencing will help you identify the variant identify the phylo journey and so on but what is more important is that you want to be able to detect whether the individual has the disease or not regardless of the genome sequence and therefore testing I think is more important and the way forward would be to go for cheaper testing so that's why besides PCR testing we have now rolled out point of care testing which will be cheap available and that will help you to diagnose not only the symptomatic cases but asymptomatic cases either ask them to isolate themselves their mouth at home and that will help to prevent spread of disease so that could be a cheaper and easier community way of controlling it thank you at this point we'd like to call on to the screen our two members of the live audience who will be asking our panorist their questions let's start off with the Pierre Nicolas Montes would you like to open your video and ask your question sir please unmute sir two simple questions one is when you say increase in transmittability does that mean that if I'm only wearing one mask should I wear two masks to increase my protection I just want to get the concept of transmittability what does that mean what was that I had to pack double and then I just finished my question para mabilis tapos yung I think the data presented was 5 were ROFs yung bagong cases at 16 so there were 11 local cases that was the term for it local transmission that means I think it was Dr. Franco who said in two or three months we're just expecting it to scale up so is this at the beginning of this whole thing thank you so much thank you sir Pierre for the first question we'll direct that to Dr. Felizarta would you like to explain laymanize term about transmissibility increase in transmittability certainly one of the factors for increased transmissibility will be the higher viral load so if you have a higher viral load then in the United States actually for a while they recommended doing double masking to put the surgical mask and then plot mass over the surgical mask or to improve the fit of the mask for me the improvement of the fit is more important but double masking should work too so that's at least for that correlates well with the increase in viral load but in the Philippines though you have the face shields too I'm not sure though it contributes far less than 5% but I think double masking or fitting the mask would be more important so doctor if for example a person has the delta virus and he or she wears double mask does that prevent the virus from spreading out considering that transmissibility factor is it better for a double mask you may delta virus yeah I mean definitely if there's a surge I would do a double mask remember it's not just masking remember it's the restrictions you have to avoid a crowded place in a poorly ventilated room that's the worst scenario try to remember the transmission inside of the building is probably 20 times higher than outside the building so that's important too okay thank you sir pier for the second question will direct to doctor Eva in one of your slides you showed the distribution of that cases I think the question now remains is it fair to say that we now have community transmission at the beginnings of community transmission of the delta variant here in the Philippines no thank you for the question no we have not established community transmission if you define community transmission that should be more widespread you cannot anymore link to the source of the infection right now we do have local cases at total of 11 which are sporadic and there can be some small clustering in areas but then again what we'd like to do is to sample more in those areas especially in the now with clustering of cases so that we can have more information thank you doctor Eva our next and our final live audience question will be coming in from lunesa pinzon mam lunesa go ahead with your question please unmute good afternoon I'm actually from Illigan City which belongs to region 10 and region 10 I see that have nine cases of the delta variant so my question is are the symptoms of the delta variant infection significantly different from the other symptoms from the symptoms of the other variants do we still have fever? doctor frango actually it should be the same the only reason why there's a difference in symptomatology is because of the vaccine rollout so if you have a country where you have a high vaccine rollout most of the patients are vaccinated especially if the elderly vaccinated then most of your patients who would have infection would be younger adults and younger adults have milder symptoms okay or if you have breakthrough symptoms the symptoms are milder too so in one study they've shown that in countries with high vaccine rollout the most common symptoms are headaches sneezing nasal congestion and the sore throat so the fever went down and the shortness of breath actually decreased too but it's just because there are younger patients who have more milder symptoms or if there's breakthrough infections after vaccination it's milder but symptomatology should be the same the viral load might be higher might be faster so the pre-symptomatic phase switch might be earlier thank you po thank you very much for the question Dr. Suzie sorry here we go so thank you very much Dr. Franco for that and for our question from the vegan city we're past the top of the hour so it's time for us to ask our speakers to give a few final words to our frontliners who are watching but before that Raymond we're going to have a quick evaluation and ask the audience to evaluate our webinar today Raymond over to you on this thank you Dr. Suzie five questions we hope our attendees who are still numbering a little over 2,000 in the zoom webinar will be able to provide their feedback for this virtual international conference it reads the panelists demonstrated thorough knowledge of the topic question two the panelists were well prepared to organize three the panelists spoke clearly and audibly question four the panelists used appropriate language with technical medical jargos adequately explained and number five the panelists contributed to new perspectives and knowledge on managing various key COVID-19 health issues will maintain this poll on your screens as we go over to the final messages from each of our resource persons over to you Dr. Suzie thank you very much Raymond thank you for your parting words thanks Dr. Suzie thanks Dr. Raymond and thank you to the main presenter and all the reactors parting words po is that as frontliners we always have to keep ourselves updated try to always ensure that you have proper guidelines in place in your healthcare facilities and how you treat your patients as what was said by Dr. Trump earlier on viral road to treat your patients in an appropriate manner there would be less and less strain on the healthcare system and hopefully that would lessen the impact of the number of cases to our healthcare workers and make their lives easier and better so as a final word we're still not yet out of the woods but there's hope always keep yourself healthy over to you Dr. Suzie and Dr. Raymond thank you very much Nino I appreciate your final words please thank you Dr. Suzie as we all know we are going through an unprecedented crisis and maybe there is a lot of uncertainty and the frontline healthcare workers are the most important aspect or the most important segment in this society who can really bring us out from this crisis time so it is very very important that you are taking care of others equally important that you take care of yourself as well follow all the universal precautions don't let your guards down get vaccinated and keep your family also protected thank you thank you very much Eva thank you Dr. Suzie now that the local cases of the Delta bar that have been detected in the country we all need to do our part in preventing local spread of the variant let us help in strengthening the PDITR strategies and encourage those who have not been vaccinated to have their vaccination that's all Dr. Suzie thank you Eva Dr. Posan, go ahead thank you Dr. Suzie and thank you everyone for joining in today's session this COVID pandemic reflects the endless battle between human and diseases and the Delta variant may appear to be very potent but eventually we will overcome this and other variants like how we have overcome SARS-1, Spanish flu and other pandemics and new variants will always emerge as well as new viruses we learn from experience and we must continue to be vigilant continue with our surveillance and our research in fighting this infectious disease thank you thank you very much Franco I just want to reiterate we have great protection against severe COVID including hospitalization and deaths with all the vaccines against all variants including the Delta variant and of course in the meantime while we are waiting for an increase in the vaccine coverage avoid super spreader events avoid crowded places avoid poorly ventilated places and where you're at okay thank you very much Dr. Enid Domingo sir first Dr. Domingo I think you may have had some connection difficulties Dr. Suzie okay we'll probably ask him for some words maybe after we have our closing remarks our closing remarks are from our Chancellor of UP Manila Dr. Menchit Padilya Menchit over to you thank you today's webinar is very timely as 11 local cases of Delta variant are officially announced to be present in the Philippines that the webinar was opened by National Scientist Ernesto Domingo an advocate of universal healthcare since 2008 and after a decade of lobbying in 2019 expected to be in full implementation in 2021 it was over taken by the COVID pandemic National Scientist Domingo is asking us could we have done better in dealing with the COVID pandemic if universal healthcare is in place where there is a more efficient public health system from the first contact as the gatekeeper to the hospital referral system the universal healthcare is indeed promising and a must as we continue to face the COVID pandemic and prepare for the next for the next pandemic Dr. Franco gave us a review of SARS-CoV-2 the virus including the mutations as well as the variants he discussed the three phases of immunity innate, adaptive and long lasting immunity mediated by the memory cells and it's nice to hear a review of epidemiology from the reproduction number upper dispersion and herd immunity and as he moved on to the discussion of the variants variants of concern alpha, beta and gamma he tells it yes delta is now available in 104 countries meaning it is more transmissible and I think you know the take home from his message is that what is the implication of this information as we talk about as we look at the variant and connect it to the vaccine rollout as well as the mobility and these are the very important take away messages from his lecture vaccination flattens the death reduction of mobility reduces transmission and I think for us in the Philippines we're in we talk about you know whether we're protected with our vaccine his presentation on the comparison of the phase 3 trials is that regardless of the brand there is an 86% efficacy in preventing severe COVID and in the real world vaccine effectiveness an 85% to 100% protection from the severe kind of COVID is the most important so you know in summary he said that vaccination offers great protection against severity you know if ever you'll have another case it will be milder, a lower household transmission and definitely mutations Dr. Pousan shared the science and biology of COVID and of course the delta variant and Dr. Pousan starts by saying that the gene of SARS-CoV-2 has 30,000 bases one mistake in any of these bases can mean really another problem another variant mutations are genetic changes in a virus they are part of the evolution of the virus so the more it multiplies then there are more chances of doing a mutation and the mutation affects the behavior of the virus which is implications of the diagnosis, prognosis, treatment and prevention now the delta variant has entered Singapore and she actually presented their experience what they tightened the control measures they started mandatory testing every two weeks they have an antigen rapid test it's a home kit and they've actually strengthened their contact tracing and entry into the buildings and I think you know what is maybe for us something to look forward is that they started vaccinating the children 20, 12 years and above so the Singapore data is very I think when you get this kind of data you feel more relieved because in Singapore it shows that if you're fully vaccinated there are no fatalities no ICU or no need for oxygen if you're partially vaccinated there's a 4.2 increase of needing of oxygen and only a fourth actually with ICU but if you're unvaccinated then of course the chances are very high whether we like it or not Dr. Palsang ends by saying the mutations will always occur we will always have new variants and we will continue our strategies not only public health but you know make surveillance testing, vaccination, contact tracing prevention and control measures so we just have to be ready to adopt, recalibrate and make changes in the policies as we move and face the new variant Dr. Eva Cochonko de La Paz gave the latest news we have 16 new cases of Delta variants in the Philippines being local cases and she actually emphasized again the four door strategy of the government and I think it's always remember that a government is doing something door 1 is really preventing the people from high risk countries to come in door 2 increasing the screening and the quarantine at entry door 3 the PDIR plus the vaccine and door 4 the community quarantine you know from the presentation of Dr. Eva we realized that our government is not sleeping I for one know that Dr. Eva spent last night trying to track down all the positive cases just looking at the contact tracing whether we can make some conclusions as they presented to the at the TV presser today so indeed our government is not sleeping and they're looking at how we can actually face the increasing number of Delta variants our next reactor is Dr. Abhishek and I think it's always nice to get this international perspective knowing the threat cross not only in the Philippines but internationally is a major player in dealing with COVID and what is maybe you know bothering is when he said that Asia Pacific is an epicenter of the current wave and the worst hit India, Nepal, Bangladesh, Malaysia Indonesia and Afghanistan we do not want to be in that list and what I'd like you to do in the interest of time I'd like you to go back to the replay and listen to his operational challenges because some of them actually do apply to us and I just want to mention one which he again mentioned when he was asked for a final word it is a pandemic fatigue which includes actually the mental health of our workers, it's not just all about public health, it's not all about vaccination but we have to take a look at the mental health of our health workers Dr. Abhishek actually talks about the lessons from South Asia and again once again I'd like you to go back and listen to the replay because those are very important lessons that we must keep in mind now at last we act as Dr. Nino and it's nice to hear what's happening in Africa we actually have very little information about Africa but to hear that it's escalating fast that we've got a 43% one-week rise in COVID-19 deaths and that they've had a rise in the past eight straight weeks and that it has actually affected 29 African countries is something that we have to keep in mind if ever the COVID-19 is present in some of the provinces if we hope it stays there and as Dr. Nino said the surge is driven by public fatigue with key health measures and increased spread of variants so in summary all our speakers today highlighted the importance of vaccination as it is one of the major factors for flattening the deaths due to COVID-19 so long as we have COVID-19 there will be new mutations new variants and we just need to recalibrate our efforts we need to keep rebooting each time we have a new variant or a new surge but despite the uncertainty there is a lot of hope and a whole-of-government approach and all of us here in the audience we have our share we have to get vaccinated today but let me go back to the message of National Scientist Domingo we will be able to manage COVID-19 pandemic better if universal healthcare is in place so as we fight this pandemic that has also continued to work for the full implementation of universal healthcare in the Philippines thank you for staying with us back to you Dr. Suze and Raymond thank you very much that's Dr. Kermansita Padilla the chancellor of UP Manila and before I tell you what we're going to do next week we have a public service announcement from TVUP go ahead TVUP mga po mukhang malalib niyang mga mula ka magpaso ngayon malap ko kasi sa grocery agan ba wala rin kayong pasokahabong matinong isang araw sana makabalik na ako sa trabaho oh siya siya di na muna kitay store buyan nakukangang malalim hindi isig mo look magpabakuna na kayo tayo wala ang problem ako ay dahil malku kayo magpapabakuna ako thank you very much TVUP and we'll continue to keep on reminding our public that vaccination really is so important especially now so let's not stop educating teaching and locating for vaccination ok next week nice topic next week are we ready for the delta variant ok so that's our topic next week and I think we're going to talk about preparedness we're going to talk about response we're going to have experts from some of the major hospitals and from infectious disease control and I think it's a matter of time before we'll have to brace ourselves again but if we're informed and we know what we're going to do we don't need to worry or have anxiety we can handle this we can do it so see you next week on your online I'd like to say this is our credible online community Raymond over to you thank you Dr. Suzy and thank you for that excellent synthesis from our UP Manila Chancellor Dr. Carmen Sita Padilla on the screen you are being shown the number of respondents for our five question poll that serves as an assessment for our panel discussion thank you so much I think we breach more than 1500 respondents for the panel discussion but I think that's the first time we've done that so thank you so much for those who have stayed up until the last minute well up until this point for our webinar so next week it will be very very I think it will be helpful if our attendees also are regularly attending to see our next webinar a sort of a continuation of our current discussion from today very helpful as we try to localize the context and how we should be preparing for any potential event let's say a spread of any of the variants that we have been talking about so let's see each other next week again Friday from 12 noon to 2pm it's a date galing talaga ni Raymond gusto ko yung segue mo ah together we can stop COVID deaths thank you dollars keep safe, keep healthy and see you online the other Spain before my fist the other lives before my tears but right behind the mask I look into myself but now do I have strength to carry on oh God our Lord was this gone I need you here to keep me strong I'm here to hold the line I'll keep my until my time to say his name to realize it's fine to be afraid just hold on to the word he gave this time we'll come to pass cause this salvation makes a last you'll carry you to see the break of day the others pain before my fears the others vows before my tears but right behind the mask I look into myself and ask do I have strength to carry on oh God our Lord was this gone I need you here to keep me strong I'm here to hold the line I'll keep my until my time on my fist the others vows before my tears but right behind the mask do I have strength to carry on oh God I need you here to keep me strong I'm here to hold the line I'll keep my until my time to realize it's fine to be afraid