Webinar: Weekly COVID-19 Pandemic Briefing

Emma Ross

Welcome back to those of you who’ve joined us for earlier webinars and welcome to those joining for the first time. This is the Chatham House weekly COVID-19 webinar with Chatham House distinguished Fellow, David Heymann. The theme we’ll be discussing this week is Strategies for Transitioning out of Lockdown, after an initial discussion of what’s new, in terms of our scientific understanding in the last week? For the Q&A part of the session, you don’t have to confine yourself to the questions on the theme, it can be on whatever you want. I’m very pleased to be here with Professor Heymann, one of the most experienced authorities out there on epidemic control. He has unparalleled insight into this pandemic, not only because he led the global containment of SARS, but also, because he’s extremely plugged into what’s going on with COVID-19 through his Chairmanship of WHO’s Strategic and Technical Advisory Group on Infectious Hazards, which is advising the agency on the response to the crisis.

Let’s start with talking about new developments this week. Everybody, I’m sure, is keen to know your thoughts on President Trump’s announcing yesterday the suspension of funding for WHO. What are your thoughts on that development this week?

Professor David Heymann CBE

Well, the US gives two types of funding to WHO and it’s not clear to me which type they’re cutting. One type is their assessed contribution and all countries are required to be a member of WHO, to provide an assessed contribution, which is based on a formula that the UN developed just after the Second World War, when the UN was setup. And actually, that formula ends up, because it was based on GDP at that time, ends up by having the most regular budget funding, through assessed contributions come in through the United States.

At the same time, the Unite States also is very generous in giving funding to specific programmes within WHO, which cannot be used for other activities than those programmes. An example is polio eradication, for which they provide quite a large sum of money each year. Also, to tuberculosis programmes, to the AIDS programmes, and various other programmes within WHO. So, the first thing that has to be understood is if one or both of those sources of funding is being cut and, if so, which one is being cut. The regular budget fund keeps WHO going, the assessed contributions keep WHO going, and the US additional funding provides funding for specific programmes. So, that’s the first question to ask, and I wonder, Emma, if you know which funding has been cut?

Emma Ross

No, it doesn’t seem to be clear. I was also wondering, suspension of funding, does the US pay one lump sum once a year, so they would be due to pay maybe in January or some other date, or is it an ongoing thing, like suddenly it will cut and that’s one thing? And I also wondered, does the US contribute to the emergencies programme that is running this response?

Professor David Heymann CBE

Yeah, and CDC in the past has contributed to the emergencies programme, and I’m not sure what they do now. But remember, the US contribution is also in seconded staff to the World Health Organization, who are placed in various positions at WHO, at the expense of the US Government and this includes programmes such as the polio eradication programme and others. So, US have been very implicated in WHO, both in its extra budgetary funding and in its core funding, those assessed contributions.

Emma Ross

And in kind, secondments, I guess. There was no mention of that, but who knows whether that’s included or not. Is that a significant contribution of manpower?

Professor David Heymann CBE

You know, I can’t tell you what the secondment rate is at present, but it has been, in the past, quite significant in providing key people in various programmes.

Emma Ross

Okay, so what – after this announcement came out, what was your thinking on what that means for WHO’s ability to fight this pandemic?

Professor David Heymann CBE

Well, WHO has done an incredibly good job, in my view, of bringing together scientific and public health experts to discuss this outbreak in various fora. They have informal fora of experts in clinical medicine, in virology, in public health, in epidemiology, who are discussing and presenting their data regularly to WHO. And then, WHO takes this data, along with information that it gets from its advisory groups, its independent advisory groups, and makes guidance for countries. I, myself, am Chairing a group at WHO, the Independent Advisory Group to the emergencies programme, which is dealing with the COVID outbreak, and yesterday, for example, in our meeting, we had a presentation from China, from the China CDC, in which they presented their latest information, that they were providing to WHO. And last week we had experts from Hong Kong, Singapore, Germany, and other countries, providing their information, and on Friday, we’ll have information from – presented from Iran.

So, WHO brings in all this information, analyses it, and then uses it to make recommendations to countries, that countries then use when they do their own risk assessment and design of their own programmes.

Emma Ross

But is this suspension of funding going to hurt? The ability…

Professor David Heymann CBE

The suspension of funding will – these activities will continue, despite the funding, because they’re funded by many of the regular budget activities and the extra budgetary activities of the emergencies programme, which are heavily funded – which is heavily funded by countries, such as the UK, Germany and other countries.

Emma Ross

So, is this really not a big impact, if WHO loses this funding?

Professor David Heymann CBE

Well, as I said, I don’t know where the funding will be cut or has been cut, so I can’t say. If the funding has been cut for polio eradication, for example, it will have a big impact on how that programme continued to work forward. If the programme – the emergency programme is receiving funding, and that would be cut, then the programme would be required to make some changes in what they’re doing, but they certainly wouldn’t stop this exchange of information and provision of guidelines, because that’s the core responsibility of WHO.

Emma Ross

And has – have countries before done this, cut off funding in this way for this kind of reason? Has this ever happened before?

Professor David Heymann CBE

You know, I don’t know, I can’t answer that question. I know that if countries don’t provide their budget, their assessed budget, their assessed contribution, that they can be, after a period of time of being advanced in their payments, can be excluded from discussions that develop consensus in the World Health Assembly, but I don’t think WHO enforces that rule.

Emma Ross

So, are you saying that if you don’t pay, you don’t get access to the information?

Professor David Heymann CBE

No, what I’m saying is that if you don’t pay, you don’t get a possibility of discussing major decision points in what the World Health Organization does in its governance. This is in the governance body, it’s not in the technical bodies.

Emma Ross

What about technical influence and technical contributions, is there a requirement for that?

Professor David Heymann CBE

Sorry, say again.

Emma Ross

Contributions to the technical knowledge, understanding and recommendations.

Professor David Heymann CBE

The US has been providing its information, as have other countries around the world, to WHO, through its advisory groups and through other groups, and that information is being used to better understand this current outbreak. And it’s quite impressive to see the rapidity with which understanding has been gained. There are a couple of areas still, though, where information is lacking and that information is lacking because we just don’t understand enough about such things as the immune response in humans and other active – other responses that humans make to this virus.

Emma Ross

So, bottom line, I’m not going to go on and on about this, but is this a catastrophic development for WHO? Is this a disaster? Is this a blip? Is this, we don’t know what the impact? I mean, what are we to make of this, as far as how serious a blow this is to the pandemic control?

Professor David Heymann CBE

Well, being an American, I’m very unhappy that W – that the United States would not be providing funding to a multilateral organisation as important as WHO. That’s my own personal view, I’m very disappointed if that does occur. But I know that WHO will continue to function, as it has in the past, but certain programmes will be cut in funding and this could threaten things such as polio eradication, as I said, which is a major interest to the United States and its funding.

Emma Ross

Okay, thanks for that. Let’s move…

Professor David Heymann CBE

You know, Emma, the US has been a powerful example to the rest of the world in how to work in multilateral organisations and to work multilaterally. And what we’re seeing now is a change in that stance, in the US, and in many other countries, and it’s really unfortunate for the globalisation that we’re in and the need to work together, because, as we all know, a disease in one country is important to all.

Emma Ross

And the US have shown quite a lot of leadership in global health and supporting multilateral global health activities. If they retreat from that, does that open up a vacuum that other powers could move into? And do you expect them to do that?

Professor David Heymann CBE

Well, I don’t know what the geopolitical balance will be after this, if this really is taken through, and I don’t think anybody can predict that. But I think that we all have to understand the importance of multilateral organisations and how they are benefitting humanity in general. And I just, again, take a look at the polio eradication programme, which is heavily resourced, not only by the US, but by Rotary International and many other organisations, and that programme could be in jeopardy, if the funding is cut.

Emma Ross

And do we need leadership from countries to make this work, to bring along other countries to support these activities, or as long as everyone’s contributing a little bit, there doesn’t need to be a dominant leader to make this work?

Professor David Heymann CBE

Well, actually, I’m a Mentor in an executive leadership programme out of the London School of Hygiene & Tropical Medicine, and recently, I was asked to give a webinar to the Fellows in this programme, who are in their own countries, on COVID. And one of the comments coming from one of the participants from a developing country was, “We’re really now not knowing where to look because before we looked to Europe and North America for examples and now we see that they can’t deal with this outbreak and we don’t know where to turn.” So, there is leadership from Europe and from North America, from many industrialised countries, that countries are expecting and hoping to continue to have.

Emma Ross

Okay, so let’s go onto the update from what we’ve learned, in the last week, in terms of advancing our understanding of the virus and what these new insights mean for how to tackle the pandemic. So, how have we moved on this week?

Professor David Heymann CBE

Well, what we’re seeing this week is that countries are beginning to talk about unlocking their lockdowns and they want to be able to do that using evidence that they have, such as which sectors in the economy are most at risk of transmission of this infection. And so, we’re seeing that countries are doing serological surveys, looking at the antibody levels in blood, in people who have been examined in surveys, to determine whether or not in the past they’ve had this coronavirus infection. So, what they’re looking for is antibody in the blood of people in communities to see if they’ve been infected with this virus during the past three months.

The difficulty is that no-one yet completely understands the antibodies. We know from the Chinese that they have very few people who really have developed solid antibodies in some areas of the country and this is a question, whether or not it’s because the virus in milder infections is not producing antibody or just because it isn’t transmitting as easily as was – has been thought in the past. And we begin to see data coming from other countries, but we just don’t understand the antibody in the blood, what it’s indicating. And that’s very important, not only to know if people are immune, but also, to know if a vaccine eventually could be developed.

There are actually two types of immunity. There’s what’s called immunity in serological immunity, antibody in the blood, and then there’s also T-cell, or immunity from cells, that has nothing to do with the antibody in the blood and which may be attacking this virus and we just can’t detect that, because we’re looking at antibody. So, it’s very difficult, at this point, to understand what these serological surveys are showing and these were thought to be a very important part of the unlocking strategy.

Emma Ross

Okay, so for these countries that have done initial lockdowns, I know there are some countries that haven’t done them yet, that are thinking of doing them, or countries that didn’t do them that are now starting with, you know, resurgence to make some restrictions, but for the countries that have done the initial so-called lockdowns, hopefully, they’ve taken the pressure out of the outbreak, with tremendous social and economic sacrifices, but what now? This seems to be a really dangerous time, in terms of expectations and vigilance. I mean, it’s not over at this point, is it?

Professor David Heymann CBE

No, the outbreak isn’t over and we don’t know the destiny of this virus, whether it will remain with us long-term or not, we just don’t know that yet. But it’s been very interesting to see how countries in Asia began with a target of decreasing transmission and keeping it below the reproductive level of one, in other words keeping it from flaring up as a major outbreak in the countries. And so, they attacked it in this way, with this as a target, and they didn’t lockdown all sectors. For example, Singapore didn’t lockdown its schools, Hong Kong didn’t lockdown many of the nightlife centres that they have in Hong Kong, and other countries in Asia tried to continue with business as usual, as much as they could.

They’ve been able to maintain a low level of transmission, but now they’re finding that they have to lockdown some sectors. And so, Singapore has just locked down its school sector, which had been open until now, and Hong Kong has locked down its amusement centres where there is nightlife in Hong Kong, at least for the next two weeks. And so, we’re seeing that Asia has kept the transmission low and is now locking down to continue to keep it low, whereas in Europe, initially, countries like the UK and Germany started by trying to decrease the reproductive number and keep transmission low, but they found all of a sudden that they were overwhelmed with a massive influx of patients, which came from other parts of Europe and which then put a major blow onto the health systems and those health systems were overwhelmed, in many instances, and countries that weren’t yet overwhelmed, tried to flatten the curve by locking down, as you’ve said.

Emma Ross

So, with Asian countries sort of now starting to put in some restrictions, if they were managing to test and isolate and contact trace and keep it – transmission, you know, under control, why aren’t they anymore? Have they slacked off on that or what’s changed?

Professor David Heymann CBE

No, they’re still doing outbreak control, as is China. They’re taking – they’re quarantining people who come in from outside for a period of two weeks. They’re doing many activities to make sure that they’re tracing contacts, identifying contacts, isolating infected contacts, a whole series of things that continue, while the lockdown is going on. They weren’t overwhelmed with a huge amount of patients, as has occurred in many countries in Europe, as had – as occurred in China, when they had their break of the New Year, when people travelled all over China, there was spread in China. The same thing happened in Europe when skiers began to come back from the Alps into the countries and came back, having been – having a social life where they were in mass gatherings, mass social gatherings, becoming infected, taking it back. And then, in Europe, there’s a special factor in some countries in that they are very many elderly people who live in the same households as young, especially in countries like Italy, and therefore, the young took the infection to the elderly and they’re the ones who are at most risk of serious illness.

Emma Ross

Okay, so we can’t replace lockdown with nothing, that seems to be clear advice, but I want to focus on capabilities rather than forecasted dates, I think people have moved on from forecasted dates. The discussion seems to be around, well, how might you do it? But if I could kind 0f turn that towards the capabilities that need to be in place before you can consider to do it, the conventional wisdom seems to be that certain conditions have to be in place, in order to unlock safely. We’ve heard an ideal situation, well, what seems to be an ideal situation from the WHO, there have been other experts that have put out formulas for things that need to be in place. In your opinion, what are the must haves and then what’s the ideal for the capabilities that need to be in place before countries start thinking about unlocking?

Professor David Heymann CBE

When countries – before they begin to unlock and while they’re unlocking, they need to be able to do a thorough risk assessment and that risk assessment means that they need to have in place a system to monitor what’s going on in the outbreak, what’s going on in communities, what’s going on in health facilities and hospitals. So, that’s an essential. Countries that have had a target of flattening the curve, now need to make sure that that curve remains flat by having in place a system which can monitor that.

At the same time, they need to understand, as they unlock sectors, what is going on in those sectors before they unlock them. For example, is there a lot of transmission in schools? If there is, then schools would be a sector that might be unlocked later than a sector where there’s less transmission. And so, all of these things are really epidemiological, information must be gained by detective work by Epidemiologists, by public health experts in countries, to feed into a risk assessment.

The most important thing though, Emma, is for the population to understand how they can participate in control, and that includes physical distancing from people, making sure that if persons are sick, they isolate themselves, that they wear a mask, if they’re dealing with elderly and can’t physically distance, and that they must continue to wash their hands and stay away from large crowds of people. These are things that have to be inborne and understood by all people, as they are in many Asian countries, that we have a responsibility as citizens in these countries to help the government contain this outbreak.

Emma Ross

Okay, I’m going to go – I’m going to seize on the masks thing. This doesn’t seem to be going away. It’s been third, fourth week we’ve been talking about this. You said wear a mask when they’re looking after sick people. With the Czech Republic, Austria and other countries making it mandatory for people to wear masks when out in public, the US recommending face coverings, we had David Nabarro, this week, who is the Special Envoy for this outbreak for WHO, saying, “It’s likely to become the norm post-lockdown.” Martin McKee, a Professor of European Health at the London School of Hygiene & Tropical Medicine saying, “It’s going to become quite widespread, because of this evidence about pre-symptomatic or asymptomatic transmission.” Do you now think that masks by the general public are going to become part of the unlock strategy out there, you know, regardless of whether it protects you from infection, but given that we don’t know who is infected, unless you’re testing everybody all the time, that that is going to become a reality?

Professor David Heymann CBE

Well, you know, there will be many different strategies developed by different countries, I would expect, and this requires some innovation as well. You know, what we know now is that people over 70 are at greatest risk, and other people who have co-morbidities are also at great risk. And so, you know, maybe a country would decide, well, what we’re going to do is make an hour, between 10:00 and 11:00 every morning, when we will ask everybody to physically distance from the elderly and let the elderly go out and do their shopping, do their marketing, do what they need to do and then return back to maintain reasonable isolation from others. There are many different ways that countries may approach this, but the facts about the masks are clear. WHO has reviewed this many times, and those facts are that masks are not effective in preventing an individual from getting infected walking in the community with a mask.

Masks are very important for health workers, they’re essential for health workers, who are dealing with COVID, especially N95 filter masks, along with eye protection, and other personal protective equipment, indispensable for health workers dealing with COVID. Masks are also important for people who are sick, who are coughing and sneezing in a household, and trying to maintain physical distancing from others in that household. Whenever they’re in the household and they can’t maintain that two metres, or when they’re working in the kitchen or other places, they would be – it would be important to wear a mask to prevent the droplets that they make when they cough or sneeze or even sneeze or speak from contaminating others in the household. This would be especially true for carers of the elderly, who may be infected and not know it. If they’re wearing a mask, they will prevent droplets or a cough, hazard cough or a sneeze from infecting others. In the general population, if the general population really wanted to be protected, they would need to do what health workers are doing, because the eyes must be shielded as well. Eyes are an entry point for this virus, as eyes are for many other infectious diseases. Mucus membranes are where the virus can land in droplets and then infect.

So, protection in the community, using masks in the community to protect yourself is not valid. It’s not yet been shown to be effective, there will be studies, clearly, to see if it is. What we do know is that in Singapore, in one study, and this is what the US has based their policy on, in one study, 6% of people who have been infected appear to have been infected by people who got sick a day or two after they were exposed to those people. So, that 6% is important to take into the risk assessment that countries do, and what the US has decided with their risk assessment is that people, when they go in public, should cover their nose and mouth, so they don’t spread droplets from themselves to others, if they can, when they go out. I don’t know why Austria and other countries have made these mask decisions. It would be important to understand that and gradually, I think people will come to understand what evidence they’ve used to make – to have people wear masks in public. It may be this reason.

Emma Ross

Okay, before I go onto the questions, I just want to ask one thing that’s come up big time this week, and that’s the use of technology for contact tracing, well, of the announcement from Google and Apple this week, collaboration of contact tracing apps. My main question on that is, given the scale of the manpower heavy contact tracing that many say is necessary, I mean, WHO says, “Every contact of every case,” is some of this going to have to involve technology, such as these proximity apps on mobile phones, or can we do it without that, with an army of contact tracers in the traditional way? Do you think we’re going to have to adopt some of these technologies and, if so, what are the limitations of these apps? I mean, are they really that effective or is it just that we have it and we should try it?

Professor David Heymann CBE

Yeah, well, I think that innovation is extremely important in this outbreak because it’s changing the way we will live, at least in the immediate term, until we understand what is going on with this virus and what its destiny is. So, we will need to have innovation and I think this is a wonderful innovation that if I were in contact with someone who later became infected and was known to be infected, and I were notified by SMS that I should be tested, I would be very grateful for that, because then, if I were positive, I wouldn’t spread the infection to others. So, I think that the public will – there will be public acceptance and public non-acceptance of this and I’m sure there will be a sign in – an option to sign in, if you wish to do this, but myself, I would be very pleased to know if I’d been in close proximity to someone who’s infected, so that I could do the proper thing and make sure that I don’t infect others.

Emma Ross

Okay, but…

Professor David Heymann CBE

So, I think in a – go ahead.

Emma Ross

No, no, go – I just thought won’t it create quite a bit of noise? I mean, if it’s using – apparently, it’s using Bluetooth and it seems like they can flag many of my neighbours, who I have no contact with, but they’re on Bluetooth range on my phone, which is way more than two metres distance, and if a lot of people are asymptomatic, the apps aren’t going to pick them up, are they? I mean, is it not a bit theoretical?

Professor David Heymann CBE

My understanding is that the app will pick up people who have been in close proximity to someone who’s known to be infected. That person, who’s known to be infected, would have to then, on their app, say that they’re infected. So, I think it’s an opt-in situation, as I understand it, and I encourage, as most people do, any innovation using up to date technologies to see if they can add value to what we’re doing now. It would be wrong not to do that.

Emma Ross

Okay.

Professor David Heymann CBE

But there needs to be appropriate assessment and appropriate respect of human rights and dignity and privacy.

Emma Ross

Got it. Onto the questions now, the most upvoted question at the moment is on air travel and it’s from David Craig at British Airways, “Given the confined nature of air travel, what measures might sufficiently reassure travellers and governments to allow a return to international travel?” And I have rather a cheeky addition to that, in the way our lives might change, could there be an argument that airline seats have to be better spaced out now? That cooping us up like that is really not going to be sustainable, going forward, with this around.

Professor David Heymann CBE

Thanks, Emma. You know, making precautionary measures, which this would be, is many times based on past experience, if there’s not enough evidence at present. And in this case there isn’t any evidence at present on transmissibility of this particular virus in an aeroplane, but there is evidence, from the SARS outbreak, that people might have been infected either in close proximity in a waiting space, or after they boarded a flight, that went on from one place where there was SARS coronavirus outbreaks, to another. Now, what was found in this was that most people who were on this one particular flight, were infected either in the rows – were sitting either in the row before or behind the person who was infected. It wasn’t randomly distributed throughout the aeroplane, but was concentrated in this area. But then, there were some outliers, some people who were sitting in different parts of the airplane who were also infected and it was never clear whether they were infected in the aeroplane or in the waiting space before boarding that aeroplane.

So, the general understanding is, if the risk on an aeroplane, and this is also for tuberculosis and other infections, is immediately in front of or in back of or aside a person who is infected. So, the precautionary measure would be – there would be many ways that you could do this. I don’t know exactly how airlines will approach it, but, you know, people should be honest with people and, when they board an aeroplane, they should say if they believe they are infected, you know? but I can’t say what the future will be, things will have changed, and I can’t say anything at this point about that, because there’s no evidence.

Emma Ross

Should people who are infected be allowed to fly?

Professor David Heymann CBE

Well, this virus also is transmitted in a different way than the SARS coronavirus. SARS was an infection, which was low in the lungs and it came up as people coughed with a deep cough or with a pulmonary hygiene that was done by health workers, then there were aerosols where this virus was transmitted. But then it was transmitted fairly easily between people in a household. This virus is spread from higher area in the respiratory system, it’s higher in the lungs, it’s high in the respiratory system, in the throat area, and therefore, it can be possibly transmitted in a different way and easier. It’s not yet clear.

Emma Ross

Okay, I’m going to go onto a Journalist question, Ashleigh Furlong from POLITICO, “Can David provide any specific examples of where we might have seen the US leadership in the coronavirus response that we didn’t?”

Professor David Heymann CBE

Well, the US has been sharing its information, especially NIH in the clinical trials that are going on in the world. NIH is a very important part in WHO’s clinical trials groups that develops standard proposals, standard protocols for study of disease. The US FDA is very important in discussions, also. They’ve been important in the past and I believe are important right now in discussions. And many people from CDC are contributing to WHO’s knowledge base, on surveillance because CDC is one of the world’s renowned institutions in surveillance and in outbreak containment and response. So, there is a flow of information, I know there’s a flow directly to the Director General, through advisory groups that he has, and others, from US participants in the outbreak response. So, yes, there is free sharing of information from the US in what’s going on in this outbreak.

Emma Ross

Here’s another hugely upvoted question, and this is from Annelise Wilder-Smith, this is about delay in declaring the emergency, “One of the accusations by the US is that WHO was too late in declaring the public health emergency and also too late in declaring the pandemic. Do you think WHO should have been more forceful in order to manage to wake up the US and Europe already in mid-January to enhance preparedness?”

Professor David Heymann CBE

Well, I think, first of all, it’s a country responsibility to prepare itself. WHO has clearly stated that and provided guidelines about how countries prepare for outbreaks. I think most countries were aware that there were outbreaks going on in China, that there was an outbreak that was occurring in many other countries in Asia, and that this outbreak was threatening the world. I think all governments were aware of that. I can’t make a judgement on WHO, I’m not a part of their emergency committee groups. I understand that at the first emergency committee, which was – is made up usually of 12 people who have been named by countries on a roster that WHO calls on for emergency committees, that that emergency committee was divided in what recommendations should be made and they requested more information. They then met, I believe, two weeks later and made a declaration of a public health emergency. I can’t say any more than that because I’m not a part of that system.

So, you know, it’s easy to shift blame from one to another and that often occurs. It occurred early in AIDS as well, but the important thing is that we have to look forward. We’ve now got a pandemic in the world and we’ve got to do our best to stop it and to work together. There will be plenty of time afterwards, after this pandemic is under control, to go back and look and see what some of the mistakes were. But it would be wrong to try to discredit anybody at this point in time about the importance of working together to move this outbreak forward and to begin to stop it. So, I can’t answer Annelise’s question completely, all I can say is that it’s much more important now to have solidarity within the world and to move forward, rather than to try to shift blame at this point in time.

Emma Ross

Okay, another upvoted question on Sweden, from Marta Edible, “Sweden’s death cases are accelerating, five times higher, compared to Norway and ten times higher, compared to Finland. Yesterday, 22 Swedish health experts announced their lack of trust in the Swedish policy. Last week, you mentioned that you believe the Swedish leadership is on top of it,” her words, “is this still the case, in your estimation?”

Professor David Heymann CBE

Well, I don’t know what’s going on. I haven’t heard – had a report recently. This is the first I’ve heard that deaths have increased. I haven’t looked at today’s signal from WHO. But what I understand is that Sweden has tried to deal with this in the most appropriate way and they will now, I’m sure, be doing another risk assessment, especially if there are 22 experts who are advising that that be done, and they will maybe make modifications to the strategy that they adapted. I think what we need to do, again, is look forward and not backwards, and if we’re in a position today that is seeing an increase in deaths, in a country, remembering that these deaths are a result of what happened two or three weeks ago, not what’s going on at present, we should then, in fact, do another risk assessment in the country and make a decision on whether or not the strategy is proving to do what it was shown to do.

You know, if that strategy has decreased transmission in communities in Sweden, we can’t tell that yet from the deaths occurring in the hospital, because generally, deaths occur two or three weeks after infection has occurred. So, what we’re seeing is a reflection of what was happening two or three weeks ago, I would like to have more information about what’s happening today, as far as admissions to the hospital, before I would make any judgement.

Emma Ross

But this is a question from the Atlantic, Prashant Raul, “With China and, to a lesser extent, countries such as Iran, how much of a problem is poor quality data or improperly collated data, in terms of the impacts on other countries’ models and planning when it comes to COVID response? Is there any way to overcome this challenge, beyond encouraging transparency in data reporting?”

Professor David Heymann CBE

Well, it’s interesting, what’s happening is countries are reporting the number of cases they have, based on the number of tests they do and they each have different testing strategies. For example, the UK only reports infections from people who are seriously ill, admitted to hospitals, that’s who they test, and so that’s who they report the number of infections for. Other countries report the number of infections being contacts who have become infected, people who are asymptomatic, but infected, a whole series – or not asymptomatic, well, asymptomatic or mildly ill, who are tested and are reported. So, in general, there’s apples and oranges being reported in the world and these aren’t the same things reported from any one country.

So, what we need to do is better understand what these countries are reporting rather than saying they’re not reporting enough. I know for a fact that Iran will be providing information on its outbreak to WHO this coming Friday, in an advise – Independent Advisory Group meeting, and WHO will be able to use that information, as will the external experts, to determine what is really going on in Iran at that time. So, countries do freely share with WHO, I can’t say whether they’re reporting enough or not, because I can’t say that until after I hear on Friday, what Iran will have to report to WHO. Not a very clear answer, but it’s the best I can do.

Emma Ross

Okay, we’ve got a lot of questions on developing countries, but I’m going to pick one that seems to cross over a few. This is from Barnaby Briggs, “I’m interested in Sub-Saharan Africa, where I work, any updated views on why so few cases overall seem to be reported, is this just a lack of data or something to do with the disease?”

Professor David Heymann CBE

Well, you know, it’s really difficult at this point to say what’s going on in Sub-Saharan Africa. What we do know is that the population in Sub-Saharan Africa is much younger in populations than in many other parts of the world. We know that there are deaths occurring regularly and that if there are COVID deaths, they may not be detected, because of other deaths that are occurring and it’s not recognised. But what I think we can be fairly sure of is that there haven’t been, at least at present, these clusters of death, which would signify that there is a major outbreak going on in any one country. But, again, the clusters of death would occur three weeks after the infection occurred, so we don’t know what’s going on at present. We know what might be – have gone on three weeks previously.

There are other hypotheses that people are making. For example, do the Africans have coronavirus infections regularly? There are four human coronaviruses, and are these viruses, for some reason, causing cross-immunity, which protects these people from the COVID-causing coronavirus? Many questions being asked, but nothing really understood at present, except that it doesn’t appear that there have been the explosive demands on hospitals for people who have serious illnesses there have been in other countries. But, again, this is only hypotheses and we have to just wait unfortunately and see. I know the Africa CDC and WHO regional offices are working together to make sure that training has been done for diagnosis and that countries are strengthening their surveillance systems.

Emma Ross

Another highly upvoted question from James Tudor-White, on exit strategy, “The report published by Imperial College in early March suggested that there could be a second peak epidemic, once measures are released and the more effective the suppression measures, the worse the second peak would be. With the situation being so fluid, does the report still provide an accurate model? If so, is there any possible exit strategy, which can minimise the rate of infections, without having a vaccine programme for the foreseeable future? Or does the country need to accept a social shielding mechanism, where the most vulnerable isolate, whilst the rest of the population return to so-called normal, albeit practising some social distancing measures?”

Professor David Heymann CBE

Yeah, well, I think it’s – I’m not sure if Imperial has redone their model, based on currently available information or not, but I know that Modellers constantly are watching for information and will take this information and use it in their models. It would be great if we had reliable community surveys, which showed exactly how many people have been infected in the previous weeks, so that we could begin to understand how transmissible this virus is. But, as we talked earlier, the antibody studies that are being done are not clearly indicative of what’s going on, at least we don’t believe that, because we don’t understand what antibodies really represent at this point in time.

So, Modellers will be taking information, as they get it, and be updating their models. I can’t answer whether Imperial has done that or not, and I can’t speculate on what strategies may be. But I did say earlier that there will have to be innovation and I believe that’s very true, that there will be – have to be means in which the elderly are shielded from this infection, either by times when they’re out and nobody else – and everybody else social distances, and in general, people should remember to social distance, as long as we have this virus around, because they risk becoming infected and taking it onto others.

Emma Ross

I wanted to make a distinction between exiting from lockdown and exiting from the pandemic, so, kind of short-term/long-term. A lot of experts have said that ultimately, we need a vaccine as our way out, but I wanted to ask you, is a vaccine essential to end this or will an effective drug be okay, or is a drug an interim step and a vaccine really necessary? I’m thinking how we live with HIV today, there is no vaccine, it’s managed with drugs, is a vaccine going to be crucial or a nice-to-have, what are your thoughts on long-term management of this disease?

Professor David Heymann CBE

Well, vaccines are certainly an important prevention strategy. The question is, can there be an effective vaccine – can research and development make an effective vaccine? We know that there are many vaccines being developed, many different models for those vaccines, whether it’s virus, whether it’s particles that look like the virus, and whether it’s hooked onto other backbones of other vaccines, we know the research is underway.

What we don’t know is if those vaccines can be effective in preventing infection and if they do prevent infection, how long will that be effective? Will they need to be modified periodically, as the influenza vaccine, because the virus slightly mutates, or will there need to be boosters, frequent boosters, nobody understands these issues. So, it’s wrong to put stock in a vaccine. We need to do the best today with what we have today, and that includes understanding the importance of physical distancing, of social distancing, and of keeping hands clean, and making sure that surfaces are clean in areas where there might be transmission, which is in communities in general.

At the same time, we need to shield those populations, which are at greatest risk and we need to begin having healthy lifestyles, so we don’t develop the co-morbidities, which have caused difficulty to people who have had those morbidities, such as obesity or diabetes or diseases or issues which are preventable by better public health. So, we need to invest in public health, as we move forward, and make sure that people live healthy lifestyles, no smoking, moderate drinking, various things that will make sure that they’re healthy in the long-term.

So, we’ll see a modification in the way we approach life after this, as long as that virus is around. We can’t depend on a vaccine, but we might be able to depend on some drugs. There are many clinical trials going on. Hopefully, some of them will show up effective drugs.

Emma Ross

Well, that’s a great way to end, to bring it round. Thank you for that. I just want to add that for everybody, a full recording of this video will be on the Chatham House website this afternoon and for Journalists, who are still on the line, who may want to follow-up with David, he will make himself available for an hour after this. If you want to speak to him, please only go through the Press Office to book an interview and they will send him the schedule with your names. The slots are for about 15 minutes and the email address is [email protected]. So, that being said, we’ve run out of time. I’ve gone over three minutes, sorry, but thank you, David, again, for enormous insight on an ongoing basis into this, and I look forward to a redo next week. So, thank you very much for being with us and thank you all for joining us, and if you came on late, please do look out for the full recording on the Chatham House website.