World Health Organization holds a news conference on coronavirus outbreak - transcription powered by Happy Scribe

All right. For those online, I guess, people on line. We do worry you keep you waiting. Folks, I agree with you. Welcome, everybody, to this press conference. To hear the findings from the joint mission, the W.H.O. led international expert mission, a joint mission with the Chinese government to investigate and look at all the issues around the coronavirus outbreak in China. We have a.. These are introduction, Dr. Bruce Aylward, who led the mission.

And it's fresh off the plane. You wouldn't believe it. It is. And I'm just a little bit of housekeeping for the people on the line if you dialed in. When you ask a question. Dial star nine more. If you came in via Xoom, raise your hand. We'll have questions after Dr. Elwin presents, gives a preliminary presentation and then we'll go with questions to you, Dr. Ellen. I think you're right here. So could we get a general water gets water in this?

Sorry, I'm getting father horse. Thank you. So, again, really apologies for keeping you all waiting. But I just got off the plane and in a rather frantic a little bit of time trying to get a few things finalized before I spoke with you. So what I wanted to do today was, as you saw yesterday, I gave a press briefing in China. It was rather long and would have taken a little time to listen through. I'm not sure everyone saw it.

So what I'd like to do is summarize some of the big points a little more quickly than I did yesterday. But if there are specific points people want us to dig in to after, I'm happy to do that. But what I thought might be most useful for the press today is if I spoke to three big questions which are around the issue of, you know, what has China actually done in terms of the response and how they've done it, which is it is extremely important to where we go next with this.

Let's say the second thing I want to talk a little bit about is what the impact of their approach has been. And then finally to some of the implications as we go forward. I want to touch those three big questions. I might spend a little bit of time on each just before jumping into that. I think as most of you know, the genesis of the mission was a request or a decision actually by the president of China in a meeting with Dr.

Tedros with it, a joint feeling that China had done a huge amount of work and it would could inform, let's say, both the global response, as well as China's own response to have an independent mission and come in and have a review and an assessment of what had been done and lessons for the way forward. So we put the team together. In the end, it constituted twenty five people. There were 13 internationals headed by myself. And then there was a team from China.

I should say a team. There was a group from China that were part of the team because it was very much an integrated team. So 12 from the China side, people may have just never been a lot of interest. And who was actually on the team? There was, in addition to myself from this side of China leading the response, it was Dr. Yang, one Yang who anyone involved in the response. Their will will we'll know. He's the actual the the hand of what's called the expert group in China for the coronavirus response.

He was my counterpart. And then we had from the international side, I'll just run through. We had to act. And Tim McManus, who is with the Robert Corke Institute in Germany, with Dale Fischer from the WHO is actually the chair of the Gawne Group right now and is a professor at the University National University of Singapore. We have Chiclet and he had a waiter who many of you will know is the director general of the Nigerian CDC, Kip Lane, who is a clinical director at the NIH in the U.S.

We had John Cooley from the National Associate National University College of Medicine. And Dr. Lee, some of you may remember from the murres outbreak in in Seoul, he actually led that that response. And then we had Gabriel Long and of course, the dean of medicine from the University of Hong Kong and China. We had two participants from Russia, Alexander Siminoff, who's the deputy director of the St. Petersburg Pasteur Institute. And Natalia Sinkin Yahaya, who is the head of international the international department.

Any and infectious diseases in in the National Medical Research Center in Moscow. I'm trying to I'm reading from this to make sure I don't forget anything, actually. Hitoshi Native Title Ohashi from the National Institutes of Infectious Disease in Japan. Maria Van Kerckhove, who many of you know, usually sits to the left of Dr. Tedros, I believe during the briefings that W.H.O. does on the evolving epidemic. And then we have from the international side also we're going to from the Center for Disease Control in Atlanta.

And if I remember correctly, that was it from the international side. And we'll put the list up of the internationals as well as the national experts from China side so that everyone has access to those. Maybe just a couple of words about what we did. As you may see in the press conference yesterday, we started in Beijing. I was there for a week beforehand, arranging the mission, looking a lot of the preliminary data, et cetera. And then the full team arrived on Saturday.

We spent Sunday getting ready and they kicked off Sunday evening. And just to give you a sense of how the work is being done in China right now, much. The team and the administrators we needed to work with were very, very engaged actually on on Sunday. And so the meeting actually kicked off at 7:00 at night and we worked till about midnight and just after midnight with multiple ministries and we had to move on in a video conference for a couple of hours of that as well.

And that was quite typical of the working days, quite frankly. So I ramble a little bit in various directions, folks. It's because of some pretty severe sleep deprivation right now. So so apologies for that. So we start there and then we spent about just a day then in Beijing meeting with some of the national institutions as well as the Beijing municipality to understand how they work. We looked not only at the national level, the miskelly level, but they went right down to the community level to try and understand how things actually operated in terms of case finding, contact tracing and also to speak to a lot of physicians, contact tracers, really to get a feel for what was working, what wasn't working, how things had evolved over the last last six or seven weeks.

From there, the team went in two different directions. One part of the team went to two down a province. And then that's a very large industrial province, you may know, just bordering Hong Kong. And then another part of the group went to sesh one and then from Sichuan, joined Quandong Group and then went to Wuhan, myself included, for a day and a half, just toward the end of the mission prior to the wrap up and then the press conference in Beijing.

So we actually covered a fair amount of territory in every place. We saw facilities, we saw contact tracing. We even saw markets in a couple of places. We saw the railway stations, the airports, the gospel. We see clinics. But we really it was quite an exhaustive and exhausting schedule. And as I as I go through this, I really want to pay tribute to the people in all of those places because we asked hundreds and hundreds of people, probably thousands of questions.

Often the same ones again and again from different directions to try and triangulate a lot of information or really understand how robust it was. And this is really important in a crises like this one, because I think you'll understand if it was only when I started there six weeks into this. So they'd been moving very, very fast. People were exhausted. Huge amounts of things have been done. Things were changing very, very fast. So trying to accurately build what had happened and how what it looked like took a fair amount of time.

I mean, I just want to pay tribute to the team.

Yes. But especially to the people who spent so much time in the middle of this doing it because they never really shattered and doing it and had the important lifesaving work of running a crisis response. I also want to clarify, by the way, this as we kick off and I'll get into the issues right now, promise. I'm speaking for the mission here as the team lead for a mission that was independent of W.H.O.. I'm actually not briefed Dr. Tedros.

He's actually not seen the report. This report is from the team and represents work done by the team together. The last three a couple of days was the Chinese. Our Chinese counterparts, internationals working very, very closely together in small groups of a lot of different issues to to nail a lot of this down. And so the reports just being submitted, I had to do some final edits. That's what took me late. Now just being submitted, integrate now.

So they run through those three big issues that I said. So the first was what did China what what have they actually done? And what what they've done is they as I mentioned in the press conference yesterday, they've approached a brand new virus, has never been seen before. That was, as you know, escalating and and quite frightening in January. And they have taken very standard in what some people think of as old fashioned public health tools, very basic public health tools, and apply these with a rigour and an innovation of approach on a scale that we've never seen in history.

Basically, they have taken case finding, contact tracing, social distancing, you know, movement restriction and used that approach to try and stop a new emerging respiratory borne pathogen, as most of you know, for, you know, flu planning, etc. Most of the you're thinking is buying enough time to get your vaccine rolled out to try and reduce morbidity mortality. And here there was no vaccine. There was no therapeutic. The Chinese do have a very pragmatic approach, and this time we are going to go after containment of this virus using that set of tools and a lot of people in the world that did it, myself included, and certainly a lot of people on the team would have been very cynical is the wrong word, but maybe concerned as to whether or not you can truly stop that kind of a pathogen because it runs counter to thinking a respiratory pathogen.

You could actually find the cases, isolate the cases, do the contact tracing and that and achieve that kind of an outcome. But what China did was they took a very as we dug into this and it took some time to understand it properly. They took a very systematic approach. And there were five key things that they did in applying this that were some of them different, but all of them impressive and critical to making it work. So the first thing they did was they took a differentiated approach because they realized immediately, if you try to do and where you think of China, people often think about the lockdown and move on.

Right. Which is a giant city of 50 million people. But that was just more hot in other parts of the country. The fundamentals were always the same. But then the degree of application was different and it was tailored to the context and setting the intensity of transmission, et cetera. So the first key thing was this differentiated approach. If there were zero cases, sporadic cases, clusters of cases or community transmission like they had in woo-woo had, the approach was differentiated.

And that was important because a lot of people say you can't do this at scale because you will exhaust your response. And I've heard that a number of time people say who we have to switch to another mitigation approach or whatever because you'll exhaust. But Chinese pragmatically said not if you tailor this properly. The second thing that they did was they mobilized a phenomenal collective action and cooperation by the people of China to this response. And the interesting thing is that people have commented on that and say, oh, that's easy.

And in a society or a political system like like China, it isn't. It's never easy to get the kind of passion, commitment, interest and an individual sense of duty that it's our duty to help stop this virus. We spoke to hundreds of people in hotels or trains and planes who are quite outside the system and they all share this sense of responsibility, accountability to be part of this. And the most stunning demonstration of it was when we pulled into the train station at night in and it was a special train because right now and me, it's the saddest thing in Rouhani.

The trains roar right through the station. I mean, continually now for a month. The big inner city trains. They were a road trip with the blinds down. And if you're living in the buildings surrounding or watching them and people accept that there.

But but, you know, we're we're the only train that stopped so that 6 of us could get off that train and be part of this. And as I got off, by the way, another group got off and I thought, well, hang on. And I thought we were the only people on how to get off in Rouhani. And this was a group of heavy little jackets on the flag. It was a medical team coming in from Wandong to be part of the 40000 health care workers from other parts of China that have come in, many of whom volunteered to go in to move on and help with the response.

But the level of collective action and the striking part when you pull in is you pull into the city of skyscrapers and massive boulevards. And it's just this is not a village. The city of 50 million people, a modern city. And as you as you drive into this city in the dead of night with the lights on, it's a ghost town. But behind every window and every skyscraper, there are people cooperating with this response.

And, you know, people say, yeah, but, you know, there's a big presence forcing them. There isn't invisible. It's it's it's it's staggering.

And every person you talk to there has a sense that they're mobilized. Like in a war against this virus and they're organized. So that's the second big thing, this collective action. The third big thing is they've repurposed the machinery of government. And I often hear people talk about all of government approach. And I never know what that means. But then when you see and you hear from China, they have repurposed transportation does this. They promise the trains is way too many of the roads that way as part of the response to toll booths and the checkpoints that the the agriculture does this the the force, you folks do that.

But everyone has. A role and it's been repurposed to fit into this machinery, and it worked through a prevention and control task force and answers straight to the state council and president to run the whole machinery of government in support. The third thing that was really a fourth thing pardon me was it's a technology and a straight turbo charged response. They are using big data in a in places. I guess people that have got a sense in China, nobody uses money.

I can pay for it. I took money out and it is difficult to pay because everybody pays with with WeChat on their phones. They use to pay for everything. And life is lived online. Big chunks of it. And from a distance, I hadn't appreciated that. But what they've done is when it came to the response, they had to manage these massive amounts of data, massive numbers of contacts, because remember, they're trying to find every case, trace every contact of seventy thousand cases across vast areas and know where they were.

Follow that up. So you manage all of that data and then you've got to be able to map that link to to to other sources of data, etc. So that was one piece of it. But the second thing they had to do was because of the sheer numbers. You had to take whole hospitals and take them out of general service and make them basically response hospitals for COVA 19 cases, which means you've taken major hospitals in inner city and repurpose them multiple ones for this response because there are so many cases and and people would that would ask them, well, what about all the right your patients?

So they have some designated patient hospital. Obviously for regular services. They delayed a lot of things like elective surgeries, etc. But then a full shot of work and someone in one place that 50 percent of their consultations are now done online, they just moved a whole bunch. What was normally done physically online to be able to keep the regular health services going, prescriptions turned over, etc. in a very orderly manner. And then the final piece, of course was just everyday life.

You have to feed 50 million people. You've got to keep the food moving, all gone through deliveries, all made online, etc.. Little I talked to some people saying, well, how's that work? And they said, well, every now and again, something missing from a package. But you know, we're around. I'm lost anyway. That's what Chantix me said to me. One of the people I asked and in one of the moon.

And then the last piece of this, which was was equally impressive, was how science driven the responses there as well. Because remember, we've known it called it and it sounds like we we've been living this forever. But this is eight weeks. We're eight weeks into this. And the science has evolved so fast that China has had it issued. While we were there, they issued the sixth set of clinical guidance, how to take care of the cases.

And imagine that. I mean, you know how long it takes for W.H.O. to generate a guide, right then to try and get it out and get people using these things the same in every country. Here they had turned over the national guidelines, how to take care of these severely sick patients six times by six weeks. Every single one of the places we went, we asked him how to managing patients. Recently, the six guidelines, I mean, how is that?

It came out yesterday. But until there's a speed of turnover to try and stay on top of the of the learnings on this. So it's a science driven, very agile response as well at a phenomenal scale. So what they did, again, it sounds so easy, right? Oh, the economy case finding and contact tracing. While they did this in an extraordinary way with an extraordinary rigour of application and discipline and differentiate your approach, incredible collective action, repurpose the machinery of government to make it work technologically powered and science driven.

And they applied that then to what was an escalating remember the exponential growth of the disease that we were seeing in places that they remember. Every place it's hitting these days, you're seeing exponential growth again. Right. And so and most people you keep hearing the debate on TV about and everywhere, which fascinates me, you know, is this a pandemic or not? Folks, this is a rapidly escalating epidemic in different places that we've got to tackle super fast to prevent a pandemic.

It's it's actually what China demonstrates is where this goes is within the control of our decisions to apply this kind of rigour and approach to to to this disease and its outbreak. And you saw yesterday some of you have seen this. Again today, because we get to the second question then. OK. OK, great. We understand the risky approach now and that took some time to understand it and understand it. How does it actually work? As you know, each level.

And that was another big learning. I'm interested in the differentiation of power. But what was interesting is as they went through this was that there was a lot of latitude, like the big rules of the game were in place. But provinces, counties, you know, towns, they could adapted as they needed to be able to make it work for them. And so as you went from one to another, the fundamentals role was to say, you know, you're tracing contacts, not.

Right. I mean, the fundamentals are the same, but they were adapted to be able to work for for for for that specific area. And by the way, someone asked me what once he said, OK, we've seen the big city. But what about the rural areas? What was happening there and what we're in Sichuan. We looked at that and this comes back to the technology part, went to the operations center. And that's what how is that working?

So they have teams out there all over the place that we're doing that case, find investigations, contact tracing. But well, that's great. But how do you know how it's working, et cetera? And they have standard indicators to trace all that stuff. But they and they said, well, we made a decision in Chengdu right at the beginning. The governor explained this to me that as we rolled out our 5G platform, we were not going to prioritize Chengdu.

We were going to use this to make the connectivity with the rural areas work. So with the run, the Povey response basically in real time. And so we were in one of these places. We went to the operations center and they'd had a new cluster and they had mapped out it so they won't be springing on a wall that had transmission chain mapped out. And there was a problem with. And I asked something about that. And they said, we can speak to them.

And they pulled up on the other side. The operations center in this county. And so we talked to them about what they're finding, an arrest, which took a while. And then again, there was a question. So they said, well, hang on a minute. And then they pulled up another train. And there was the team that was out in the field actually trying to do this. But the whole thing is linked up and they're in constant contact trying to make sure that together they solve the problems of trying to sort out the transmission.

So so the question then was, OK, well, what's the the the impact of this? Because cancer has been obviously this is happening elsewhere in this exponential growth.

And as I said yesterday, it's it's the unanimous assessment of the team that they have changed the course of this outbreak. What was it? You know, a rapidly escalating outbreak has plateaued and they come down faster than one would have expected if we had looked at the natural dynamics of an outbreak like this. And and that's that's striking. And so what I want to show yesterday was with this graphic here, which I think is really helpful, because what you can see here, you know, it's not the same as the reporting site here.

But when we're looking at here, if you know what you want to call it, is, you know, exponential growth. Right. Growth right here at the beginning of this curve going up like that. And if you look at this side, you can see it's actually coming down more slowly, because what happens in normal, what would happen in the next day of growth is would go up and up and up like that. And then you would see a normal distribution and it would come down with that.

But that's in a normal. And you've seen the normal distribution. Right. That's what would happen if it runs through community. But when you start doing all of this, which are the interventions, then you can, you know, ideally try and change the shape of back. And that's what China has actually done, to my surprise.

As far as. It was one of those things that, you know, we spent 20, 30 years in this business. It's like seriously going to try and change that with those tactics. And yes, and it was successful or it is being successful because look where the cases are driven right now. And what are the things we look at? OK, well, that curve would go like that. You know, big question mark. How many cases have been prevented or at least delayed as a result of this action?

And, you know, rough back of the envelope. You know, we look at it, it's hundreds of thousands of people in China did not get Cauvin 19 because of this aggressive response. And any time you pull down the force of infection from the epicenter and an outbreak like that, you are going to reduce the probability of it going elsewhere as well. That was the other big thing we heard again and again from anyone in China was it's our responsibility to do this for the world, not just for.

For them, we heard that quite a number of times. So the question then became OK. And because we we heard before getting there, of course, are the. Is this real? And, you know, one of the comments I made yesterday was we know the numbers have bounced around as as they've fallen down. People ask questions. What's going on today? How come the numbers have gone off, etc. And you know what we as epidemiologists are interested in is not the exact number on an exact day.

We're interested in the trend. And you want to know, is that trend real? Is just going down? Is it stable or is it going up because there were questions about things are being shared, etc. And so when we dug into that, we looked at, you know, multiple different there's multiple different ways you can try and get a sense of where the trend is going. And one thing you can do is you can talk to doctors who are seeing patients who are running these massive hospitals.

And, you know, everywhere you were hearing the same thing that, you know, we have open beds. It was like we had open beds. We can get people out of, you know, isolation centers into a proper hospital bed. Were able to you know, the system is opening up because the number of cases are going down. You know, one indication another when we looked at was they establish what they call fever clinics. And these are places where if you have a fever, you go and they assess you and they do a C.T.

scan very quickly. They do that to see whether or not you've got the tell. MARK COLVIN 19 disease and which is amazing story. And so but. And then and then at these hospitals and a decision is made, they do the test whether or not you need tests and then they do the test and then whether you need to be isolated in a facility, etc. So be it. Nothing we looked at, well, how many people are getting tested?

Because what's happened is, as people have you know, this mobilization of the community has happened. There have been more and more people who want to be tested, quite frankly. And so they've been going and getting tested. The numbers have been going up and coming up in terms of people getting tested initially. At one point it peaked at about forty six thousand people were being tested almost daily across the country. Huge numbers and then is down. When we looked at about a week and half were down to 13000 is going down like that.

And when we went talk to the people at the fever clinic, you know, they were sitting there not scanning people or not testing people. When they said, you know, this is change. We had lines and they aren't there anymore. That's a second indicator that that is real. It's coming down. And then a third indicator, which was interesting, I spoke to and again, I mentioned this yesterday, so sorry to be redundant, a fantastic researcher man called Joe Biden who is running around.

Isn't your trial severe and mild cases in Rouhani? And it's being done. Rouhani's course does. That's where he has the highest number of cases. You get the fastest enrollment and we try and get an answer on this very interesting drive as quickly as possible. And so when I'm talking to him myself. So how is Roman going? And he said it's a challenge. It's slowing down. It has slowed down because there are not enough new patients that we can actually recruit into the trial.

So, you know, this all comes back to that question of, is this real? Is what I described, you know, this extraordinary mobilization to implement fundamental public health principles and approach in the absence of a vaccine or a or drugs, you know, in the presence of a respiratory disease. And this bring this down and it can. And that's the core message right where we're we're getting new reports today of new outbreaks in new areas and people a sense of, oh, we can't do anything.

People arguing isn't a pandemic or not. Sorry. Why don't you go look at have you got 100 beds where you can isolate people if you have to? And you got a room at the hospital that you're going to close off? Have you got 30 ventilators? Because you're going to have to help keep the severe cases alive for, you know, they'll recover, but they're going to need to be ventilated for four or five days or a week. You know, do you have those visas?

Do you know who your thousand case contacts racers are? There's really practical things you can do to be ready to be able to respond to this. And that's where the focus will need to be. So we looked at this and said, OK, the first question I thought about what was done. The second, what was the impact and the impact it was was striking away. I showed yesterday another graphic which might be useful for people. In some ways, this is more striking than the national one.

So what you see here, this is the same as when you just saw me do the data from China. Right. So going out fast, that fast, like that abrupt plateau and then this skewing as it goes down rather than up like that about her and down. This. But then if you look at it and you can see this is this is who I'm right here, which is really driving the main shape of that, then these are the other areas of Roubaix.

And this is China outside of Hubei. And remember, there's a lot more people who live outside of the province of Roubaix than live in. Hey, so this is a much smaller firm, number one. The other thing. The shape it's a very flat curve as well. Part of it's a scale.

But this is not the shape of a normal epidemic. And that happens when you do something to try and change. Which is what China has managed to do. And what's striking is how far down they thought. If I remember yesterday, someone told me, I've heard so many figures. I think I've heard more figures than there are people in China over the last two weeks. But I think one of the figures I heard yesterday was that the zero out of twenty three twenty four provinces had reported zero cases for a day.

And that's remember there were 31 provinces infected only, only three weeks ago. Again, the evidence and all of these are as big as any one of the countries that have been in the news recently with their outbreaks. And that's a very hopeful thing. Which brings us to the third thing that we're looking at is, OK, where do you go next with China? Where do you go next? With the with this in terms of the global response.

And one thing I mentioned first is that, you know, China, we're not acting from scratch. China had had the SA's epidemic, an outbreak, rather, remember in 2003. And they realized they had to set up surveillance for a typical Amalia's and other surveillance systems that they needed to be able to do. Case finding and contact tracing, you know, at a much larger scale, etc.. So they had had time and experience to build a system.

But in terms of where they go next in China and you know, having seen so much of what they had done, it was a little bit humbling to be asked for opinions. Okay. Where we go next. And a lot of it was really reinforcing what China is already doing. And the first piece of it is, you know, the vigilance cases are down, but they're not zero. There is still a lot of disease in the country that that's got to be dealt with.

And remember, the people who get sick, they remain in hospital or in an isolation center for anywhere from two to six weeks. So it's a long period of time. So if you have all of these people that got, you know, let's use it to get all of these people. Let's go back a few weeks. If we go back two or three weeks. Right. So you're back here. You had all of these people that were sick at that time and you got they had some of the ones who were sick because that's just who were sick on that day or that week, remember?

So then you got to have the ones before. So an awful lot of those people are still in hospital or a holding center, except for Bernie being in isolation center. So right now, the number, if I remember correctly yesterday was it was just over 50000 thousand people are still recovering from cold, the 19 across across China. But one of the other things we learned, though, is the spectrum of the disease. Those have been a lot of question about, OK.

What is really the spectrum of disease that this causes? What's the natural history of that? We have a lot of information there because of just the sheer numbers now and as the epidemic or the outbreak goes forward and they start to get control this time to analyze a lot of that information more clearly. So now they can generate. And this I take absolutely no credit for it was this passerbys work. But this was done by the Center for New Control for the report.

And what they've done here is try to help people be able to visualize, well, what proportion are mild or farman when when they're when they're found. What proportion are severe? What proportion are critical? Critically ill patients. I think you have a sense now that the mild cases may just have a fever and a cough. And and just by the time we get to the common, they usually have a pneumonia or that sicker. But frankly, they're still mobile and in bad shape.

The severe are the ones by the census way to say that is the next step as they usually have respiratory insufficiency of some sort of either oxygen saturation is going down and their breathing rate is going up, et cetera. And then the critical usually have by then often multi-organ failure.

And what we we are able to see from this is, okay, what proportion fall into each group? The 80 percent are mild. And of those and a really important insight from GIGN as well, how many of those will go on to severe disease or even death? And you can see from the miles in the comments, very small proportion. This is really mild pneumonia with severe alarger and the worst outcomes, of course, in the critical. But now we're getting to the sheer weight of numbers that help us understand that that's really important because you've got to plan.

How many beds might you need, how long you're going to need him for, what the outcome is going to be like? How many are going to become severe and you're going to need possibly ventilation, et cetera. These are really important things to be able to plan that. Also, if you want to plan a clinical trial, you need to understand, well, would they get worse without the drug or not? Would they go for it? So you need this kind of information is is so important in China right now are the only ones who have been able to generate the kind of numbers to be able to help us understand that.

But what it means is they still have 50000 cases we mentioned. The thing is, any new cases now, they generally know where they come from. They can link epidemiologically or link them to a contact. And that's when, you know, as you heard from a Ebola, that that's when, you know, you're getting control of the situation. You're not getting cases from out of the blue and you can't link them back, which is is what's sometimes so concerning.

So that's the first thing. The second big thing, which is a really important message from China, is every governor we talk to, you know, most of them. They had an epidemic curve that was going down like that. And what were they doing in response? Building hospital beds, buying ventilators and being prepared. That's what they were doing. They were saying, OK, look, we just repurposed hospitals that should be giving general care if these cases go back up again.

And that was always what they came back to. We don't know this virus. People are talking about SaaS or they're talking about flu. And as soon as we get stuck with those two binary approaches and ways of thinking, we're not preparing for the novel coronavirus. We're comparing preparing for that or preparing for this. But we're not using all the evidence that we have. And one of their key points they made again and again was we don't know what's going to happen next.

In China, we've got it right down like this. We think we can manage. There will not be another route. We know how to manage this disease now in all the parts of the country, if we went to zero disappeared, that'd be great. But that's not what the plan for. What they're planning for is. This could remain for some time, maybe some time to lose a vaccine. So we will have the capacities to be able to manage it and run society and economy and everything else the way we need to and not lock people down and try and and and manage this.

This is second big thing to do. It's a good message for the world. Right. How many countries are you planning? Hospital beds, planning, ventilators, planning. You know, O2 supplies and the large capacity to be able to manage this. The third thing that we read, we said and asked of China, at this point, the world needs the experience of China. China has dealt with the most disease in the world. 31 provinces have managed this.

Everyone we spoke to, they knew what they were doing and they communicate, managed huge numbers of cases now. And one of the points you heard me mentioned yesterday is countries are building barriers between themselves and China and new barriers are going up in the last days at a time when the cases and the risk from China are going down. And you need access to that expertise that much more.

You also need China and it's it's gaining its productivity, going as you've heard. They're getting out. They're doing a phased restart of everything. So they're getting the you the factories going. Then eventually they'll they'll get the school going and then they'll but they're taking a phased approach to try and manage the the. This start up now as they go forward. So for China, a number of suggestions about how to move forward. And a lot of it was reinforcing some things that were already happening.

But then for the rest of the world that were those were the bigger things that you heard me speak about yesterday, perhaps. But the first thing in the response is there has to be a shift in mindsets again around the world. People are thinking, oh, gosh, how do we live with this and manage all this disaster, et cetera, instead of, gosh, this virus is to come. It's going to show up in our country. We're going to find it within the first week.

We're going to find every. Case, we're going to go after every contact, we are going to make sure that we can isolate them and keep these people alive so they survive the case. This is the way we've got to be thing. Are real shift in mindset. And it's not a preparedness mindset we're using thinks about how you prepare for eventual disasters. This is going to come soon. Potentially, you've got to be shifting to a readiness, rapid response thinking.

And in China, one of the interesting things was not only did they designate a whole hospital. These are big modern facilities, these hundreds of beds as OK. That was going to manage it when he wasn't thinking. How do you actually do that in practice? How do you keep it safe? So you go to a ward, you know, if you go to a year or two tour, I'm sure most of you have unfortunately had to visit one of those patients.

You know, you've got your own wards, right, with some doors at the beginning of the war. So what what China's done, rather than have some beds that are isolation beds is at the start of that ward. They built a wall with a window on it. They sealed the whole thing and set the whole ward. Oh, that whole 40 beds under beds is now an isolation unit. Imagine everything at scale very, very fast. They've taken a stadium which which I off.

They put a thousand beds up 72 hours. You know, it's it's you've seen these hospitals being built over a week, but they went from they would convert a training center or a stadium in between 24 and 72 hours. That was the timeframe they took the Muharrem to increase by a thousand. Their capacity and it was it was such a disciplined approach to put that in place. But again, a good lesson. It's OK. Were going to try and not have to deal with two hands, obviously.

But you may have to deal with sporadic cases. Definitely. We're seeing that in many places they get sporadic cases. We're also seeing clusters of cases. And as soon as you start seeing that in places, you have to be ready to manage this at a larger scale. You have to be ready, you know, in your mind to stop the transmission change, have to be thinking that way. And so there has to be the mindset shift. Number one.

And there's got to be the readiness planning and capacity building. And it has to be done fast. So yesterday when I said, you know, second base conclusion for the world is it's simply not raining. But it can get ready very fast. But the big shift is got to be in the mindset about what we're going to how we're going to manage the disease. The third big thing, you know, the rest of the world and probably this is the first one, is you've got to get your population ready and bring your population with you and your populations.

Yes, they should be washing their hands now. They should be proper. They're hiking now. Those things that we should be doing anyway should be at scale in countries because they will make a difference to the spread of a respiratory borne disease. But you've got to bring your population with you and your population you want to bring with you early because things are going to change rapidly and they are going to have a trust in a way and machinery to keep people up to date.

Yes, we said that we have new information. Now, we do it this way because we have known this virus for seven weeks. So we are going to have to adapt as we get the the the strategy rolled out. And, you know, the fourth thing I would say is if we look at, OK, the rest of the world would be access the expertise of China and the you know, they've done this at scale. They know what they're doing.

And they're really, really good at it. And they're really keen to help, even though they are still working in their own areas. And this was another message that you heard all the time in China. It was a fantastic story of the human side. It was all was about the people and the individuals. Everywhere you went front row from any anyone you spoke to. And there was a sense of responsibility and silence, a sense of collective action and just war footing and to to get things done.

But being the the other thing that was striking was the solidarity between provinces. Because remember, every province in in China has been hit by an unknown pathogen that started to do this in the province. Their response was to get on top with no provinces but to send medical teams, PPE, everything into war. And, you know, when I met with the governors, they said, yeah, we just sent two thousand people into Suhan and two to two to work and wonder how does that aid work?

Right. So you go to the same thing. How does that work? And, you know, one of the physicians said, well, I'm from and from from now on or one or wherever it was. And he says, if we run that, you know, that one I told you that was boarded off. We run that one. They just bring a whole team and run the whole thing and they bring all their own PPE. Clinton they pull it out of that product.

And remember what we're seeing in the rest of the world. We'd better build up our stocks and keep it over here. Oh, we better keep this year. We better keep our know, whatever. But there's a sense of you get the resources where they're needed. It's in our common interest to get this down. And you saw all the provinces offer you that way. And it was really fascinating. So those are the big findings. You know what China did?

The real impact that it had. The implications are you can actually affect the course of this disease. You can change the shape of this. But it takes a very aggressive and tough program. It. It was a striking thing to see. As you know, in 30 years of doing this business, I have not seen this before and nor was I sure it would work. So we did we saw a bunch of other things. Well, as I mentioned, there were a number of technical things that we learned about disease severity, the natural history of disease, how it's transmitted, by the way.

Even so, the work being done on the animal awards is very interesting. But then also operationally, how do you run a response? Right. So talking that through with top leaders, how do you set up a stadium in 72 hours and walk through you do both to three forum make sense and then and then how you run these kind of containment measures at this scale. So a lot of really good learnings that will inform other parts of what we're trying to do with this with this response.

I would say at one point you don't know the questions and then I'll stay as long as we need to try and help with any of those.

But one of the big questions that we keep hearing about and you will have heard is about, you know, how much transmission is going on in communities. Right. And you keep hearing the tip of the iceberg and we can't see this thing. And, you know, a million people infected and all this kinda stuff. So we tried to look at those kind of questions as well.

And we again, you know, you're at war here and there's a huge fog in any war. And you're trying to find those little bits of information that can add up and give you some confidence in what you're saying. So we tried to look at what where was their sampling of people in the population that might give us a sense of how widely this virus was, what it was was spreading. And again, this is where it's great to look at these things in China because the numbers are so big.

But you've probably heard there's something called an influenza like illness surveillance system that runs around the world with many sentinel sites that collect like 20 samples every month and get them analyzed, et cetera. But this happens in multiple places in China. And what you could do is look at the data and they could show you here or a date or a sampling. Here's all this flu cases that were coming up in November, December of last year. They all went back to look, nobody.

Because then once we had called the 19 tests and went back to test all of these, nobody found it. It wasn't there. They found lots of flu. But then in January, they did find it. It comes up in January. The first couple of weeks of January. But outside of Hubei, very rare. One might be positive here or one there was like all these samples were were positive. Like there was a lot of it circulate.

And then another thing we did is in places that were heavily infected, more and more people were coming to fever clinics. They wanted to get tested, et cetera. And in one place in many Wandong, I think they had tested three hundred and twenty thousand samples for cold the cold virus. Three hundred twenty thousand. Right. Gonna give you some sense what's going on. And when they started sampling of those about four point forty nine, I think it was percent of them more positive.

So less than half a percent. And in the recent period, it's something like zero point zero two percent. So I know everybody's been out there saying, well, all of the all of this thing is spreading everywhere and we just can't see a tip of the iceberg. But the data that we do have don't support that. And what it supports is, sure, there may be a few asymptomatic cases. And that probably is a real issue, but there's not a huge transmission beyond what you can actually see clinically.

And that's really important, right? If you're in a war, you need to be able to see your enemy. You don't know what you're dealing with. Now, another important development in China, it's just a well, we were there. Was it just licensed a couple of zero assays. It will let them test antibodies in a whole bunch of people to try and get a sense of if they have anybody, but they won't say, you know, the virus was circulating.

So, you know, maybe I'll be sitting here next week is, hey, guess what, in those days in Dallas, a story these ones do, but that Sarah survey showed. Help us understand that and that'll be important. For example, you want to reopen your schools. We know that kids have not gotten very Sandra. Very few have had a lot of them get infected. I'm a part of the driver of this outbreak. It doesn't look like it looks like the main driver is not widespread community infection.

Looks like it's household level infection. That may be part of the reason that China strategy. Find the case because of close contacts or family is usually known and you're going to be able to find them and be more successful. And remember, you don't find every single one. You never will want to find enough to break the. This a primary rodeo circuit for the Reuters Life Service. This is a primary audio segment for the Reuters Life Service. This is a primary audio segment for the Reuters Life Service.

So what does that mean, change increases of? One. Not to mention. Because sometimes it's quite dangerous. Sorry. But first I to just what I. What was topic? There were a lot of change. These disease going to take a baby, possibly. I just feel fortunate. Thank you, sir. I would say subject. She sees him every day, so he basically said, I'm going to be the case to proceed. You know, said.

Produced a serious disease. Worst, I think that speaks of hurting these people. I think they're claiming they've been successful. Stop, stop, stop. I just bought it for one point sixty. Each individual. Need to start this story first before. Thank you very much. We've been trying to find your online style store 9, 10 or so using some of your the. One spreading the right. Right, you know, right in front of me right now, just take you're and talk to me.

Obviously, this morning. We're almost there. We're what we're fighting for. For Sports Illustrated, this means that there were some states. You want to keep the question of procedures. Great success for six years. Of course, to say right quick is the bottom line. What do you say to people who are saying that this the two to the ones you speak to slowly? Thank you. Why can't you be smart? You start reading. These are quite interesting.

Wait, wait, wait, wait, wait, wait. What's that says? These cases which want to play out words exactly. And I think these are. Right. Can I just I think we were searching or something. This bias is just. On. Actually working five hours the first time, right, to work for qualified to be president of the party right now. Certainly conducing for my age. Means. What's your feeling? I think she made.

Footage shows workers offering patients care workers temptations to sway supports your workers who take a outbreak. What's your name? Dr. Sanjay Gupta. What's the right? What's wrong? You're kidding. These are the stupidest things. What's this? Speak so forcefully. Swamp your computer games. Right. Right. Right. Right. So I think they were think this person goes back to this point. I think that's right. That's right. Well, it was a question about regime change in Syria, which supplies Sergeant Theplace 21.

SJT Were there may still be some time working out way? Which is what we're looking at. That's what we're saying in Germany. Stage six, Christine. Ouch, ouch, ouch, ouch, ouch, ouch. Your first time since scored remaining. It's. Thestars. It just doesn't seem right to treat different diseases. It was a profit from the GDP. Just. Fogerty's. What is the space that attracts you want to take this great place first against science?

Why you science? So we did go out there. Everything was OK. Good to see you. And now the price tag for these gains. You see the balance. Read it. Oh, there's so much for part of the Russian effort. Supporters wonder why they to watch. Shouldn't say. Quite sensational. Think it's. Frankly. It's. So it's working. Working. See? Fasten your seat. Thanks. Twenty years ago today. Tuesday.

It's been interesting. Thanks for sweeps, the clock remains. Wait, wait, wait. Six hours, six hours. All cards just give us. It's crazy. I just wanted it to do better because they keep switching to keep your sister. She's been sitting in solidarity with. See that beach volleyball team? Workers. Too much risk. 60 to 90 people it's. I agree. I have. Reaver, I could ask you right off the top why you're not wearing that right.

But I also ask you to go to what you you're saying about not finding lunch undetected, filed cases, but you were hoping that there would be more of the iceberg to be uncovered to drive down to very old 0 5 break. And I think you're suggesting that that's true. Sure. Yes, it's me. First. It's serious border agents working for the working class are. It makes a great story for you to talk to me because the story even.

Dr. Sample, 33, is sort of a sampling of the base from which going to. Right, for hospitals. There's a graceful exit, a very serious. The Barkers, because they are restricted strictly. C-SPAN2 six seats. Sorry, it makes people think they to walk. Everybody thinks they're going house to House District, which covers. That's a big part. He just wants to change the outcome of the speculations. For. Swiegers said he's been asking these partners for six months to do business.

Good to see you. Looks like research-based. We don't with. That's where I was working, folks. Call me a great pleasure to speak with you. Don't we our hands over 30 seconds before precious time because we almost make this work. This is where I work, of course, need to provide options for. So what we're doing. We're working with the CDC and was that they scripts you see your budget increase by 13 doctors, one plus one each self-invention, Tony, flights to work working on the report, be stable.

Time wasters appears to get. When you search for such things. PopEater sparkles. In part, this is basic. I just want to see. I want to play. Watch where these things it's different for each. Science and space change for interest. It's. Still to come to tell you, that was the question. You saw some horrible. She's getting more about your story d d d d d D Stouts Breakfast's. So they did it once before.

What do you remember is being watched by adults, every single one. What the report stated is saying criminal justice system. So I think worked out or your report just before he took office. He faced off with each. So what? What's causing this procrastination? Scrutiny. Stress. Sequestrations deflations occupant per se. It's actually. Suppress one wants to stay strong sometimes in that stronger fear obviously starts to explain. So doctors, obviously. Mortgage rates are also.

After all, these things are very simple, specifically for this single single-story. Well, what did some say, 80 percent of the trace plug it the it time to really get off the stage. Feinstein. It's. I was like, what was your response? I'll quote. Was pretty. We do your question was something 160000 reading. What is your response? Playing steam and debris removal, scar tissue. Just to. Just after they left. What about you?

I just couldn't say anything. In which these data points so many observations. I read everything. The state. That's a good sign. Also, please, thank you for your purchase. Me. Stands for. Which was just such a brisk business graced. 1840's seems to be pretty dark because whites are being stretched thin. Thanks so much. Great talking to you. It's. Tracy Morgan, it was all about what sparked my great results. They just sort of didn't respond to just any questions, scratch and I could try.

It was like I just quote, drive the books. I they were pretty useless, but. So basically for the first time, actually. Each one of these guarantees is. Britney Spears rocking this. Is bringing sexy first pictures up. Forty six point twenty five were doing the same damage. Palestinians say this is why there are so many changes. Stern's report did find it easier to see these things when they were being first shot, trying to understand these things.

But it touches you. You would think it would be good for my dog, but I think what's important. First, both groups, they started seeing things just like any corporate. So so first, why did they going to change them saying, I'm going to make calls? Lasted for several seconds. I think they weren't ready, right? They were. You saw of me. It looks like. What do you think? These are these numbers, so.

All right. Patrick White, Students for Inspirational Sports Stars and Purpose Driven Regret. Here's only 20 years ago. Rock star. Twenty three years. Thirty point sixty eight. You, of course. So what do you think? I don't think. Wait, you're. But I guess think were just repeating what I evening. Jennings. You're planning to. You need based on your. Gaurantee, it upsets me based on a company that claims the mysterious doctor that marketing should be motivated to participate immediately, just as expected.

Case was this big talk back amnesty for these people to continue to fight disease screen? Are you kidding me? If you want to rethink using these different groups, they just work and try to be writing machines that run. It would already be pretty nice, but I think it's great. In the past, we did some obvious ways to get people to be the for the fourth. First, do you know where you're going to see more research? The British Secret Correctives responds, it's great.

You're right. Wait, there's just so much for fans. I don't know what it is, but he intends to marry you. Howard Dean. Excuse me. Did you watch this? It was of forcing seniors. Correspondent for The New York Times, you all right? My question, anybody? People like. What strategy or question or change? Protesters. Some passports leaving. Oh, thank you are usually. Pretty cool about. Kaniewski ocracy. Let's do it.

What do you want? Furniture. What did you say? What kind of. Cars have been circulating there? Some areas because they already caught putting. You start to think about opening your machines in the spring. Also possibly things. The Justice Department has to work in schools. It's. This box of concrete examples are exactly what scientists understand during the. So you're looking at a low carb version of the carrier waiting for his disease cases first, which they have exhausted.

I want to say the reality is that you want to purchase Spanish DNA, which is. But still, a lot of stock market experts say it's like what you're saying is M.A.S.H. You're out. The answer? Just for three days, we've seen a quantity of. Things will. Why? It's. Side effects. So was each week they are stricter for free, precipitously, according to a speech occupational. Are coming in to make. Artificially acquired brain territory.

Almost any sale. You start here, start again. So what's the matter? Well, expressivity and ask for your first here's. Same with Reagan's personal Secretary Rice making it work. Barclays. Hypertension is one of those forcing to. You into your brain dance. Distance between two individuals, 30 seconds remaining. Discovery. I think it's going to be two Major League Baseball games with the support. Worry over it like. According to the. Well, what we're saying is this it's.

Excuse me. What's. Walker this school. It's one thing. They say. Thank you. It's like it's like. It was a decision based participation. That you. This was a heart wrenching clinical resources. Great choice. You for. She's received reports maybe just state. Last question. So sweet, sweet. Very nice subject for the papers fortunes towards. So I grant you. Right. Thanks for starting your first question. These are challenges you face to face to face.

This happens in to try and bring in Richard Quest series face to face arguments. Costing. That's why we're saying the same thing. No person wants to study. So many artists are optimistic. Why wouldn't you say? Three days taken January based on an interesting case difference is with the. Now let's put it on our website. I wonder why I had. We always look for graduations, resulting a. Just change. What's your. You want to use agency coordination to reduce.

What's worth trying for 25 years to China's space to make things better for white, I. I graduated high speed six years ever decided to buck the White House, so. It's based on a percentage rate, which the group thinks that so it's much easier to watch version of the party, maybe state once watch. It was. Sort of a does that. You know, why do you prefer not to hurt? Winston That's. I can make points.

I think you're right. Sorry, forget it. And what what? Upstairs, right? Right. Of course that. Right. I heard what you saw. I wasn't expecting the person to screen any change or any or because that's their record. They promised to. What changed? What are you going to. Thanks for sticking out between. It has to be is that it wants maintaining that operating if you want to walk. Of course. With.

Again, this just seems like you are desperate to do something insane than, say, China. You know what? That's right. You want to forfeit. That's a great place. Great, see you. Because people stopped by. Question for three. We'll be watching to see what he wants before each day. What I think this report said there were three twenty six people on the defensive end to stop auditing. It was at least possible that people missing something.

It's interesting fascination with these groups, the groups. Just. Excuse me. Prajapati changes in Egypt today. The artists report what inspires such. My first tortuously. Workers will be charged already. To create the permanent expert site. Pacer's. To change your appearance came from the worst reached. It seems they are increasing their spirits. It's still. Disturbing images. If get bored. People seem to think these things when you're saying things, when you're depressed, you want to take a break.

That's a discussion. I think he's got to break the habit of talking to you for the psychological support for Judgment Day. Just one thing. So what's what's it called? Right. Is there anything? Are we ready to do this? Which one? And your tax rate is. Back to the point. Groups such as he puts his face on the far right side. These statistics gives me. Yes. So we better say. I'm seeing a price range, this arguably is such a case.

Average citizen tips to what the Boston Police Department of these days. So this is a recipe for Outerbridge. Anything anything secret for people to that this thing is breaking. You think you. I just wanted to say the was over again and expecting us to. I'm certain point. It's just. Joining us. Requestioning feistiest just for France, possibly anti-spyware, back in August, they reckon I be reading right now your friends. It just seems like your daily right at your front and you're writing.

Group. First things. Theservices there is a sprinkling of various states services that you can was to. face-plates. Hello, everybody. Thank you for joining us today. My name is Kendra Bar.