Webinar: Weekly COVID-19 Pandemic Briefing – The Role of International Collaboration

Emma Ross

Welcome to the weekly series of ‘In Conversation’ interactive webinars with Chatham House sitting with Fellow David Heymann. The theme we’ll be discussing this week is International Co-operation, 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 questions on theme, you can ask about whatever you want.

So, I’m very pleased to have back with us today Professor David Heymann, a veteran outbreak control expert. Also relevant to today’s discussion, he chairs the WHO’s Strategic and Technical Advisory Group on Infectious Hazards, which is advising the WHO Emergency Department on the response to this pandemic. I know I’ve said this before, and he’ll be bashful about me saying it again, but it is true, he really is one of the most credible sources of information on what we really know about the virus and how to combat it and equally important, what we still don’t know. So, thanks, David for being with us again today. To start with, could you update us all on what new we have learned in the last week, in terms of advancing our understanding of this virus and what these new insights mean for the control of the pandemic?

Professor David Heymann CBE

Well, I think what we’ve learned is based on what WHO has been able to facilitate in discussions among experts from around the world, and we’ve learned some new things about testing, some new things about how we would transition out of a lockdown, and also, we’ve learned a lot about, in general, how to wear masks and how not to wear masks. So, maybe I’d start with the masks. WHO reviewed some evidence from Singapore that has shown that maybe up to 6% of people in their contact tracing, have been able to transmit infection just a day or so before they actually developed signs and symptoms. So, this means that there could be some transmission from asymptomatic people, who then go on to develop symptoms, which would be consistent with the fact that they might have a higher level of virus in their blood, just before they develop symptoms, or in their nasal passages.

At the same time, WHO reviewed some information from MIT, it was a laboratory test on how far droplets might be able to spread in the force of a cough, and all that information was used, and WHO has mainly stuck to its previous recommendations, which I feel are right, as well, which is masks are useful to protect others from infection if you’re coughing, if you’re sneezing, or if you’re taking care of an elderly person, for example, and unable to distance yourself, to maintain that physical distance. Then a mask is certainly important to wear. But if you’re wearing it commonly, casually in the community to prevent yourself from getting infected, it won’t work. What will work is social and physical distancing, washing hands and coughing and sneezing into your elbow, things that we know about personal hygiene.

Masks, on the other hand, are very important for health workers, especially those with the N95 filter, but they must be worn in conjunction with eye protection, because the eyes are also a source of infection. So, briefly, again, WHO recommendations, and no scarf will – no mask will protect you from infection and neither will a scarf in front of your face. But a scarf in the community may protect others, if they’re not social distancing or physically distancing, but it certainly doesn’t replace the need to physical distance. At the same time, masks are helpful in protecting others from getting infected, should you be sick or think that you might have been exposed to the virus.

Looking at what WHO is doing on testing, first of all, there’s two types of testing, PCR testing, which is antigen detection, looking to see if someone’s sick at the time that they have signs and symptoms, or if they’ve been in contact with someone with infection. That test tells you whether you’re infected or not and it permits health authorities to either isolate you in a hospital, if you require hospitalisation, or require – or asked to remain in your home, should you be infected and be able to self-isolate, and not seriously ill.

At the same time, there’s antibody testing, and this is being rolled out in many countries, including in the UK, through Public Health England, looking at communities and what people have as antibody that could indicate that they’ve been infected with this virus, during the past few months. That information will be very important to determine which age people and which people might be more infected than others, and it might help in devising a strategy to decrease the requirement on lockdowns and forced physical distancing, to depending on populations to physical distance themselves. So, that information will be very important.

There are some rapid tests that are on the market that could be used by individuals, like a pregnancy test is used, to determine whether they have antibody or not, but those tests are not yet validated and they may pick up other types of coronavirus infection as well, and Sir John Bell at Oxford is managing a group, which is validating these tests as well. So, for now, we don’t have a self-test and if we did have a self-test, it’s not clear what the results would mean to individuals, because we don’t yet understand whether those antibodies are the antibodies that can protect against future infection with this virus or not. We know that other coronaviruses do not provide an immunity, which prevents against re-infection. So, a lot to be learned.

And then, finally, on lockdown and un-lockdown transition strategies, WHO’s recommending that countries continue to look at the objective of their lockdowns and then see if that objective has been met. If it has been met, then they should consider the evidence that they have from community surveys and other parts, to do a risk assessment to see if there are sectors of their economy that they want to release, as long as they have measures in place to monitor what goes on after that, and a mechanism to rapidly respond, should they need to.

So, those were the updates of what’s going on at WHO and internationally at this point, Emma, so back to you.

Emma Ross

Thanks, David, for that. There are a couple of other things that I’ve been picking up in the last week that I wanted to ask you about. One is on alcohol gel. Looking at the WHO guidance, I looked at the mask, the new mask guidance, and they seem now to be saying that alcohol rub gel, if your hands are not visibly dirty, soap and water if they’re visibly dirty. I seem to remember, unless I was wrong, that it used to be soap and water and then alcohol gel if you can’t get to soap and water. So, has there been a change there in understanding, or is that a change in recommendation, or did I get that wrong?

Professor David Heymann CBE

Yeah, no, I think that what is common sense is common sense. What’s important to understand is that hand washing with soap and water, physically can remove any virus or bacteria, if the hand washing is done properly and for long enough. There are supplements that you can use if you can’t get to water, which is one area, then you would want to use an alcohol-based gel, or if your hands are not particularly dirty and you’re concerned, you should use an alcohol gel as well. It’s up to people to understand that whatever they use, they must use it in the right way, whether it’s hand washing or a gel, and they must use it whenever they come indoors and may have touched a surface outdoors or on a public transport or wherever, that could have been contaminated with droplets from someone who’s infected. So, it’s not a change, it’s just a reiteration of a policy, which is just really common sense. The basic understanding must be that hand washing with soap and water is equally as good, if it’s done properly, as is alcohol gel.

Emma Ross

But is there a risk that hand washing may not be done properly ‘cause the 20 seconds and the, you know, all the rigmarole you have to go through to do it properly, could it be that alcohol gel is easier to use and therefore more effective, if you’re not washing your hands properly?

Professor David Heymann CBE

Well, you know, protection and prevention are really in the hands of the population and they should understand that if they aren’t willing to wash their hands for 20 minute – 20 seconds and wash them properly, then they might be at risk of infection and they’re old enough, most populations are old enough or understand enough, so that they can decide whether or not they’re able to wash their hands properly. If not, then surely they should use gels and it’s not a bad idea to carry a gel with them if they want to, if they can’t get to a place where they can wash their hands with soap and water. Again, the decision must be in the people who are empowered to understand what they can do themselves.

Emma Ross

Okay, is there any more evidence about how far the virus can reach in a cough or a sneeze?

Professor David Heymann CBE

The general recommendation is, in a naturally occurring cough or sneeze, that people should stay away at least one and a half to two metres away from others, because that’s the distance that most of these heavier droplets can travel. There has been some MIT research, which shows that they can maybe travel further. That they can maybe travel further if they’re propelled in a way that a cough maybe doesn’t always propel them, but the rules that stand are still one and a half to two metres and that’s what I respect and that’s what I think most people respect and should respect and WHO would agree with that.

Emma Ross

So, does that mean a lot of this talk about travelling further is really forced in a lab, not really in a real situation where people are actually coughing?

Professor David Heymann CBE

That’s right, this was in a laboratory at MIT and now it remains to be shown in the public whether or not this occurs, and, believe me, there are all kinds of studies going on, looking at masks, looking at many different things in the public, and, as with all new information and new diseases, there will be a whole body of new information that occurs. But, for now, the recommendations of WHO are based on most valid and most available evidence that comes from previous research or present research.

Emma Ross

What are the key things that we still do not know, that are really important, but we don’t know it?

Professor David Heymann CBE

We still don’t understand the extent of transmission in communities in Europe. We understand that very well in Asia. They’ve been able to keep transmission in communities to a low level by continuing with routine outbreak containment measures, which include identifying patients, isolating patients, identifying their contacts, testing them, if they’re positive isolating those contacts. And they’ve been able to maintain their R0, the reproductive number, less than one, which is the magic number that shows that community transmission is at a very low level.

In Europe, there wasn’t an opportunity to jump on these cases. There was initially, and countries did jump on cases, but then there was a massive infusion of cases across open borders in Europe, which, in the end, caused major outbreaks in many, many countries, and as well, it included a huge burden on hospitals, which were not really prepared for such a surge of patients. So, instead of trying to decrease community transmission as a primary goal in Europe, the goal has been to decrease and flatten the curve that’s occurring of patients. Flattening the curve of patients, so that hospitals are not overwhelmed. So, there’s been a difference in strategies, and Europe continues on this strategy, as does North America, to try to flatten the curve of an outbreak that’s already transmitting fairly well in many different communities.

Emma Ross

You were just on a panel right before this webinar with colleagues of yours from Hong Kong, Singapore and South Korea, can you share with us what you think was the most important insight that you learned from those colleagues, as to what’s going on in their area?

Professor David Heymann CBE

You know, I think, and Emma you listened, so you could tell me if you – your own views, but I think the major message that came out of that was, the hands of control – that the control of this pandemic is in the hands of people and if people understand how to protect themselves and protect others if they’re sick, that’s already a major step forward in controlling community transmission. Then the government can step in with measures that are routinely used for outbreak containment and control and make sure that they have their hospitals functioning as a top priority. So, Emma, you might want to add some other observations from that as well.

Emma Ross

Well, there is something I wanted to follow-up and ask that I heard on that, that I was looking for a bit more clarity. Gabriel Leung from Hong Kong University, was saying – seemed to be saying there’s some early evidence suggesting that not everybody has the same type of antibody response. That I think he said that those who got the disease mildly, or the young, tended not to mount as robust an antibody response. Is that so and, if so, what are the implications of that? What is that really telling us?

Professor David Heymann CBE

Well, first of all, it’s important to remember that we don’t know if the antibody produced by this organism protects, and if it does protect, how long it protects. There’s some evidence coming out from some countries that there may be reinfection or a recrudescence of infection after people have been considered well by two PCR tests, that have shown they don’t longer – any longer carry the virus. What Gabriel is talking about is a common understanding of all infections, that the lower the inoculation of virus in the human organism, the lower the antibody response may be if that organism doesn’t amplify its transmission within the human, which seems to occur in this coronavirus.

So, people who don’t become symptomatic have a lower level of virus in their body and therefore, their immune response may make a lower level of antibody than someone who has a very high level of virus and has an immune system, which attacks it very vigorously and does create much, much more antibody. But, again, it’s early days. This is an organism, which is used to living in animals and all of a sudden, finds itself in humans and human systems, as we all know, are different from animal systems and the reactions may be being different than they were in animals and that they were – that they are in other organisms, which have been adapted to human presence for a long period of time.

Emma Ross

I want to move on now, before we take questions, to our theme for today, which is International Co-operation, starting with Tom Frieden, the former US CDC Director, this week called the pandemic World War C, it’s humans against the coronavirus, and we’ve heard repeatedly from WHO that we’re all in this together and we have to fight this together. But even in the most robust health systems, they’re really struggling and it’s expected that when this escalates in countries with comparatively weak health systems, it’ll be absolutely devastating, despite the efforts of WHO and others are making right now to strengthen capacities there. I mean, for instance, according to the World Bank, in Europe there’s one Doctor for 300 people; meanwhile in many countries in Africa, there’s one Doctor per 77,000 people. And we’ve heard this morning that confirmed cases in Africa have now passed 10,000 and then, infections have grown exponentially in the last few weeks.

Seriously, what is it likely to look like? What kind of response can they really mount? What can we expect to see, when this starts escalating in countries with comparatively weak health systems?

Professor David Heymann CBE

Well, Africa, fortunately, has a very strong network of community workers, traditional leaders and a whole group of people who, if they’re mobilised, can help the community members understand how they can physically distance and prevent themselves from getting infected and prevent others from getting infected. So, that’s a bonus in Africa. In addition, there’s the Africa Centre for Disease Control and many strong institutions across Africa, which didn’t exist even ten years ago. This is the Nigeria Centre for Disease Control, the Institute Pasteur in Dakar, under new leadership, a whole series of institutions around Africa, which are strong and which can contribute to the fight and which have learned how to contribute to fights against outbreaks during the Ebola outbreaks that have occurred recently.

So, Africa is much better prepared than it was at one time. Africa also may have an advantage in that it has a younger population than does Europe and maybe we’re just not seeing as many deaths in sub-Saharan Africa, because the elderly people are not available to be infected. They’ve already passed on or there are not so many elderly people, as there are in other societies. But it’s still early to determine what will really happen in Africa and Latin America and also in parts of Asia. But what we do know from the Ebola outbreaks is that weak health systems collapse rapidly and then people really suffer and can’t obtain the help they need for common diseases, such as malaria, diarrhoeal disease, in addition to the COVID infection.

Emma Ross

So, are you saying that it’s not necessarily going to be devastating?

Professor David Heymann CBE

I’m saying we don’t know yet what will happen in Africa. I can’t say it won’t be devastating. I can say that Africa has a younger population than in Europe, for example, overall, and hopefully, that younger population will not be as seriously ill as are the elderly in many other countries. But that remains to be seen and I just can confirm that I believe Africa is in very good hands with the institutions, the public health institutions around Africa, the World Health Organization Regional Office, and the Africa-wide Centre for Disease Control.

Emma Ross

In the scramble for supplies, poorer countries are likely to be left out, left behind, unless there’s an effort to intervene. Instead of this cutthroat competition where countries are outbidding each other, do you think we should have a globally co-ordinated production and distribution of supplies, so that it’s needs based, or is it enough that the World Bank and other multilateral agencies take care of countries that won’t be able to compete as well for the resources or to make their own? It’s something Gordon Brown, former UK Prime Minister, seemed to be suggesting yesterday, when he said, “There’s a need for a global co-ordination of money to increase capacity for supplies, such as testing equipment, masks and ventilators.”

Professor David Heymann CBE

Yes, I think Gordon Brown may have been quoting what the G20 said last week, under the Presidency of Saudi Arabia. At their meeting, which was a virtual meeting, they made a recommendation that there be a central co-ordination of distribution and more equitable distribution of supplies. Not necessarily a commandeering of production, but of distribution of supplies and an increase in production of those supplies, not only during pandemics or epidemics, but before those epidemics occur as a means of preparedness. And, in fact, the G20 asked WHO to develop a new framework that could ensure more equitable distribution of products and goods during a pandemic, but also, as a preparedness phase, and stop this helping countries by saying, “We will develop a mechanism to help you stop the outbreak,” these countries need to stand on their own feet and do it themselves.

So, all weekend, in fact, I worked with a small group, with the Director General at WHO, developing a concept paper, which has now been provided to the G20, at their request, which shows how this central co-ordination might occur in the future. And the G20 has agreed, last week, that they would consider something from the World Health Organization and begin to provide funding for that, understanding that preparedness is much less expensive than the response that we’re going through right now.

Emma Ross

What about global co-ordination of the whole thing? I mean, in a similar vein, David Nabarro, who, as you know, is a Special Envoy to the WHO Director General on COVID-19, in the last week called for, “The establishment now of a high level Pandemic Emergency Co-ordination Council to shape the global response.” He seemed to say the focus, he said, “Should be on enabling protection of health workers, ensuring equitable access to protective material, and managing the adverse societal effects of lockdown.” Co-ordinating strategy and implementation seems to be the whole lot. What do you think of the wisdom of doing something like this and the practicality and the prospects of that actually happening?

Professor David Heymann CBE

Well, it’s clear that the G20 has asked WHO to develop some kind of a framework and they clearly did not want a new organisation to be setup. The UN has a habit of setting up new organisations, as was in their view, and that these organisations may not be required, what’s required is better support of existing organisations. And so, the World Health Organization has taken this seriously, the request from the G20, developed a concept note, which has been provided now to the G2o, and that specifically indicates that there would not be a new organisation setup at this point in time.

Now, maybe David Nabarro was not talking about a new organisation, a Council, I’m not clear how that would be run, but there are many different groups that are already working to try to co-ordinate activities, and we’ve seen that it didn’t work so well in the West Africa Ebola outbreak, when the UN tried to setup an additional mechanism that was to work with the UN overall. And when it went back into the hands of WHO and WHO became more interested in dealing with this outbreak, it was the final solution.

Emma Ross

Okay, I’m going to move on to questions right now. The first question is from Deborah Haynes of Sky News, and actually, it echoes a few other questions, “If you could please address President Trump’s comments he made yesterday about” – specifically she’s asking about the WHO being biased towards China and did this affect its response to the crisis, as claimed by President Trump yesterday? And, as a follow-on, “Do you believe the WHO is facing a crisis of confidence over its handling of the pandemic, with allegations that it was too slow to respond?”

Professor David Heymann CBE

Well, you know, I don’t have all the evidence and I can’t make a judgement on what anyone says about China and the WHO relationship. I don’t have any evidence that can – I can use to give an evidence-based answer, which is what I like to do. But I can say that despite many geopolitical tensions in the world, between countries, between the UN and countries, despite these tensions that are high level, technical people from around the world have continued to work together and have made us understand right now all the different aspects of the outbreak that we understand. That’s because WHO has acted as a facilitator in bringing people together, as have other organisations, bringing people together in conferences, such as this today, and letting everybody speak, trying to address the issues of how the disease is transmitted, the transmissibility, the natural history of infection, a whole series of issues that we now understand much better, because of technical co-operation that’s gone on, despite geopolitical tensions.

If WHO should lose its funding, it will continue to work. It will continue to work in this way, but it will be – it’s already on a shoestring budget, and it would be a shame to see that budget become even smaller.

Emma Ross

I’m going to move to the most upvoted question now, that there are more on WHO, but I’ll get back to that, I’m going to move to most upvoted, so we don’t run out of time. This is about social distancing outdoors, from Fernando Herero, regarding Sweden’s policy to allow, even encourage, people to socialise outside, “What’s the idea and, if any, research support behind this thinking? Will we be expecting an acceleration of growing cases also in Sweden?” Oh, sorry, that was anonymous, and also, about Sweden from Fernando, “Do you agree with the Swedish response to COCID-19? Is it a good idea to have open schools for the children of key workers? Aren’t these children potential transmitters?”

Professor David Heymann CBE

Well, the Swedish Government has taken the approach that it has mature people in its population and those people understand how to physically distance, why social distancing is important, why hand washing is important, and they understand how to protect others by wearing masks, if they’re coughing or sneezing, and if they’re not – unable to physically distance. That’s their philosophy. They have agreed – and to do that, they’ve agreed that they will put the outbreak control in the hands of the people, and continue providing transparent information to the govern – to people through the government and trust on people to use this knowledge to help them decrease the outbreak transmission in communities.

The jury is still out as to whether this is an effective strategy or not, as the jury is out in most countries. We’ve seen in Asia that they’ve been able to convince people to physically distance and to socially distance and to be a part of the response to the outbreak, initially with very minimal lockdown. Recently, some of those countries have decided to cancel schools, for example, or to make sure that other sectors that might be transmitting infection more freely are shutdown. But, you know, Sweden has decided that it’s in the hands of the people and let’s see what happens in Sweden. They have a mature population and they have a good set of Advisors to their government and this is what those Advisors have recommended.

Emma Ross

Here’s another upvoted question from Richard Koch, who I know you know, “We have missed the window of opportunity to eliminate this virus and we are in it for the long haul, should we not be communicating this publicly? It took 200 years to eliminate smallpox after a vaccine and 100 years for rinderpest, we should be honest on the likelihood of this virus becoming endemic and the timeframe for control elimination, etc., what is your and WHO’s position on elimination? The cost for this will be huge, but perhaps justified.”

Professor David Heymann CBE

Well, you know, it was tried to interrupt transmission of this virus in China through their severe lockdown measures. They still have a few cases. It’s not clear what the community transmission level was, they’re looking at that now, but they haven’t eliminated it. Despite their extreme measures, they still have a little bit, but I think they had nine cases in one day recently, whereas in imported cases, they’ve had over 100 or 200 a day of cases being imported in Chinese coming back, etc. So, it would be nice if this could be eliminated, but it looks like, and we’re watching very closely what’s happening in China, it looks like it hasn’t been eliminated from China.

If that’s the case under these severe lockdown measures, then it may be that it can’t be eliminated as it is now. But, as Richard knows very well, and as we all know, we can’t really predict the destiny of a new and emerging infection at present. We can only say that it’s in populations now and that it looks like it’s on a trajectory to continue transmitting for a time. But we just don’t know what will happen in the long-term. We know that some influenza viruses enter human populations and transmit quite significantly and then they disappear.

So, you know, it’s not really clear that this virus will become endemic, as did HIV, as does some seasonal influenza, but, you know, every day the chances are more and more that it may at least linger longer than we hope and it may linger for a longer period and it may, as Richard predicts, may linger indefinitely, but I can’t say that because I don’t have any evidence yet that that would occur. We have to just wait and see and do our best to control it, as we can now. And what’s happened is, in Europe there’s widespread community transmission in some areas, it’s believed, and therefore, it would take extreme measures to really stop this virus from transmitting in communities at present. But it’s not off the table, I’m sure.

Emma Ross

Here’s another Journalist question from Arielle Busetto from JAPAN Forward, “What do you think of the recent studies possibly linking heavily polluted areas with the spread of the virus?”

Professor David Heymann CBE

I don’t think that there’s any relationship between transmission of the virus and pollution direct, there’s no direct link. But certainly, pollution, in many societies, causes asthma in people, for example, damaging the lungs, causing other problems in the lungs, and people with lung disease are known to be more susceptible to severe disease, because when they get infected, their lungs are already in a different state than the lungs of healthy people. So, it’s clear that pollution may indirectly affect a person’s susceptibility to severe infection, but that’s only some basic hypotheses that exist at present, based on some information.

There’s also some suggestion, though no proof, that people who smoke, and especially smoke heavily, might also be more susceptible to serious infection than those who have never smoked. But, again, this is speculation hypothesis, but it’s a hypothesis that’s been generated because in many societies, men smoke more than women and in those same societies, men seem to have a more higher rate of symptomatic infection than do women.

Emma Ross

Okay, here’s another most upvoted question, it’s on statistics, “How accurate are the reported COVID-19 global cases? How can the international community ensure that cases from China and African countries are accurately reported?” From Mustafa Coroma.

Professor David Heymann CBE

Well, cases are only as good as the data behind them and what countries are reporting is people who have positive COVID-19 tests, PCR or antigen detection tests. Those people are the surface or on the tip of what really is occurring underneath about those people who are infected and not symptomatic, or others in the community who have less serious infections and who have disease that expresses itself as a common cold.

So, the reported number of cases is an indication of people who have signs and symptoms and have been tested, or people who have been tested during the contact tracing phase of outbreak containment, who have a positive test and are therefore, reported. They are in no way representative of what’s going on in communities, that’s why the antibody test, the serosurveys, which are beginning in countries such as the United Kingdom and in China, are very important to tell what’s going on actually in the communities, and that will be much more accurate in understanding how many people are being infected, than will be the statistics now, which are a reflection more on people who are sick.

Emma Ross

Here’s one on immunity, it’s anonymous, if people could please say who they are, that would be really helpful. We’ve got a lot of anonymous here, I’m not sure why. “Could Dr Heymann please confirm, I heard him say that other coronaviruses do not provide immunity, is that categorical, or is it that others do not provide permanent immunity, i.e., is there any reason, based on other coronaviruses, to think that some immunity may be provided by infection?”

Professor David Heymann CBE

Yes, these coronaviruses, other than this coronavirus, do provide some level of protection, but you can be infected with a coronavirus this season and have a common cold and be infected in the next season with that same virus. There are some very interesting studies going on right now in South Korea that are looking at people who have been certified as free of virus by two PCR tests, after their recovery. They’ve then been a period of two to three weeks and then, again, become positive with a PCR test. There’s an attempt to isolate virus from those people who have positive PCR tests before and after, in other words, during their illness, and then two or three weeks after, to get them sequenced genetically to see if there’s any difference in those viruses, which might indicate that they’ve come from two different sources, meaning that, yes, people were re-infected if that virus is different.

We don’t have that data yet, we should have that data in the next few weeks, as South Korea and others work towards a better understanding of this infection. So, for now, the feeling is that there are antibodies produced, that some of these antibodies may be protective, but to say that you’re protected and then go out into the population and expose yourself to someone who’s infected might not be a wise idea, because we don’t fully understand the level of protection from these antibodies.

Emma Ross

A question here from Alex Warner, looking for advice you have on retrieving packages from the doorstep and the use of UV lights to clean the house?

Professor David Heymann CBE

Well, everyone has to use their own methods. What WHO recommends is, within the house, if there’s a possibility that people have been sick and coughing, or if there’s a possibility that people are sick, surfaces should be kept clean and rubbed down periodically. That includes surfaces where people who are self-isolating might have spoken over or coughed onto, they should then be wiped down and kept clean. At the same time, different practices for different people, depending on their own level of risk tolerance, are developing. Some people I know are leaving their post for two days before touching it, because they’ve read studies that the virus can persist in – on plastic, for example, for up to 72 days, if it’s kept moist in droplets.

So, there are all kinds of theories about what’s out there and there’s really no general recommendation, except to keep surfaces clean within the household, and to be careful with goods that are delivered to the household. And I think most deliveries are now occurring with services that provide masks to the workers who are delivering and hand protection to them, so that if they do speak or cause droplets to occur onto deliveries, that if they are infected, they will be prevented from contaminating those goods. So, everybody has to make their own decisions. Ultraviolet light is certainly a way of cleaning surfaces, soap and water is also another way, and common detergents or common antiseptics are also another way.

Emma Ross

I just want to clarify on the 72 hours, not 72 days.

Professor David Heymann CBE

Sorry, it’s 72 hours, my mistake. Thanks, Emma. The studies have shown that it can last up to 72 hours on plastic in droplets. Thank you, Emma.

Emma Ross

Okay, one, another upvoted one, re-infection and child transmission. This is from Brian Negwatu, “Do we have a better sense of what a) re-infection, and b) mother to child transmission rates are in the countries that have registered large patient cohorts?”

Professor David Heymann CBE

We don’t fully understand mother to child transmission. We do know that there have been children who have been born to mothers who were PCR positive that did become PCR positive possibly during delivery or possibly intrauterine. It’s not yet known, but there are registries being set up that will follow through on this and those answers will be available in the next months, I’m fairly certain.

Emma Ross

Another Journalist question, Camilla Hodgson from the Financial Times, “How important is it for countries to start rolling out widespread antibody testing to try to understand population level, infection and immunity? Should we be doing that now or would that be premature?” That’s presuming that the tests are available, validated and reliable.

Professor David Heymann CBE

If there’s a validated test in a laboratory in the country, that test should be used now to determine the prevalence of people who have been infected in communities. It’s very important in continuing risk assessment, in continuing epidemiological modelling. The UK, under Public Health England, has rolled out surveys, they’re being co-ordinated by the laboratory at Porton Down, the public health library at Porton, where the specimens are handled in the right way and it’s known that the antibody testing is specific and validated.

On home diagnostic tests or diagnostic tests that are coming on the market, that are more easy to use, antibody tests that can be used in the home, such as a pregnancy test, for example, are now being validated in the UK by a group headed by Sir John Bell out of Oxford, and that group will be working over the next two to three weeks and hopefully, will be able to validate some of the tests, which are now becoming available commercially, so that people can use them with confidence and they will be able to say whether or not they’ve had infection in the past. That doesn’t necessarily permit them then, to go out and expose themselves to people who might be infected, because we just don’t understand enough about the protection that those antibodies offer.

There may also be antibody tests, which can determine acute illness with an antibody, the IGM antibody, which is developed while a person is still acutely ill, and those tests are also now being validated.

Emma Ross

A question – another upvoted question, hopefully this will be second to last, not the last question, “What advice do you have for developing countries where physical distancing remains a challenge? A large section of the population lives hand to mouth; if they do not work, they cannot sustain themselves.” That’s from Vivien Iowesi.

Professor David Heymann CBE

Well, Vivien maybe is – understands what goes on in developing countries, and it’s very difficult to physically lockdown a developing country. But if the traditional system, and if the government can facilitate that, of helping communities understand how they can protect themselves, that is probably one of the most important issues that could be addressed in developing countries, as well as in industrialised countries. Everybody must work together in solidarity to use protective measures to protect themselves and protect others and that will be the final solution when everybody understands. This may mean a major change in the way we live today, at least for a time until we understand more about this infection, and unfortunately, that will have to be – that message will have to be taken on and people will have to begin doing these activities of physical distancing, avoiding crowds, if they want really to succeed in prevention of future transmission.

Emma Ross

We have time for one last one. I’m going to take it from Lois Rogers, who’s a Freelance Journalist, “What is the WHO view, and if you could add your view, in case that’s different, of the reinfection of 51 COVID patients in Korea?”

Professor David Heymann CBE

Well, we just talked about that. This is right – quite interesting and important and, as I said, South Korea is now trying to determine whether this is reinfection or recrudescence, a reoccurrence of the same infection. To do that, they’re looking at the virus under a PC – under a genetic sequencing analysis, to see if the virus that occurred two weeks or three weeks after PCR testing became negative in those persons, is the same virus which has reappeared, which was hiding from the immune system previously, or which that virus is it, or whether that virus is a new virus. And that’s the beauty of international collaboration, despite all the geopolitical tensions, Scientists and Technicians are working together to figure this outbreak out and the medical journals are rapidly reviewing, peer reviewing articles that come out, letting the Academics doing the research get credit for that, and putting that information out for the general public, in front of their paywall on the World Wide Web. So, we’re seeing a new way of working, rapidly getting answers to questions, such as this one.

Emma Ross

Okay, I’m going to do one more question, since we kind of answered that one already first time round. So, one from Hiromishi Nakahara, “Health Secretary, Matt Hancock, UK Health Secretary, referred to immunity certificates, what conditions are necessary to realise immunity certificates, is this a practical way to end a lockdown?”

Professor David Heymann CBE

It would be nice if it is the way to end a lockdown, to give somebody a certificate if they have immunity. But there are many other considerations that have to be taken in addition to that. First, we don’t know the length of protection, if there is protection from the antibody. Second, it would certainly be wrong for people to say, “Well, I think I’ll go expose myself to infection, because I probably won’t get a serious illness, and therefore, I will get antibody and can go out in the public,” and that would be a wrong assumption to be made. And so, many different considerations are going into a decision of whether a certificate would be useful, and that will come, as time goes on, as experts continue to debate this issue. WHO is just now trying to understand what the antibody status does mean and once that’s understood, that will be a great step forward to determining whether such a strategy would be effective and useful.

Emma Ross

Okay, thank you for all that, David, that was great. As usual, we’ve run out of time now. I’ve gone two minutes over, so hopefully, I won’t be in trouble for that, but thank you everybody for joining us and hopefully, you can join us next week. And if you do have questions in the interim that you think you already want to pose to David, please do email them to us, because we do collect those. Likewise, if there’s a theme you’re particularly passionate about, feel free to mention that too. So, thank you all for joining us and hopefully, see you next week.