In time of crisis we need real and trustworthy leaders and experts

Most of you have heard for sure about this prediction made in 1994: "I see little commercial potential for the internet for the next 10 years.". His author was Bill Gates. But his prediction capacity seemed to get better and in 2015 in a TED Talks presentation that has been very commented these days and I watched yesterday again he said: “If anything kills over 10 million people in the next few decades, it’s most likely to be a highly infectious virus rather than a war”. And he added: “We’re not ready for the next epidemic.”.

Although I really hope he was wrong with the numbers, it’s really incredible how he describes a situation that is very familiar these days. In case of the Ebola, he gave 3 reasons why it didn’t spread more: the heroic work of health workers, the nature of the virus and the fact it didn’t get into big urban areas. This third aspect is clearly the main difference with COVID-19. During the presentation, Gates presented some of the key missing pieces that in his opinion would make us not to be ready for the next pandemic. And he added “The WHO was founded to monitor epidemics but not to do these things.”.

And this reminded me a video I watched some days ago from the WHO (World Health Organization). An organization that has received numerous criticisms from people thinking they have not done a great job for alerting the rest of the world when the virus was only in China. It’s not my intention now to discuss on their work and decisions, but to share some thoughts and recommendations from the person who is today the Executive Director of the WHO Health Emergencies Programme, Dr Michael J Ryan. 

I knew about him in LinkedIn, when someone shared a short video during his intervention in one of the WHO daily media briefings. You can disagree on some of his comments, but nobody can discuss he has a proven experience. He provides some insightful information that can help to understand some of the key challenges and risks we are facing. Based on his experience on the field during more than 20 years fighting pandemics like Ebola, his opinions are worth listening and I think put some light to understand some of the decisions taken from different authorities and governments.

In time of a crisis like this, we need experienced and trustworthy leaders and experts. And these days, this is a real a challenge, since this is the first global pandemic with powerful forces such as the social media that help the population to be better and faster informed but that represent also a risk when a lot of people just share information or opinions that are not fact based. More than ever, we need the advice of real experts.

Below I summarize some of his comments and recommendations on certain topics in response to journalists from different countries during three of these briefings. In invite you to listen the whole videos. For your convenience, I indicate the start and end of each intervention. You can also activate the subtitles in English in YouTube.

Personally, this is of course the most difficult situation I've ever seen in my whole life as a society. I have 3 kids, and I sometimes look at them wishing this ends as soon as possible so we can start building a new and brighter planet for them. Things won't be the same again and it's really difficult that we all agree on the decisions taken, especially when some of us are paying a high cost, such it is the death of a loved person. But I firmly think we will overcome this situation. Together. 

March, 13. Watch full video here.

Social distancing (13:20 – 16:27)

Social distancing is a tried and tested method in slowing down the pace of epidemic spread. It is based on a principle that you don’t know who’s infected and you’re putting social distance between everyone. This is not always however needed, for example in situations where the disease is recognizable, cases can be detected, contacts can be identified and quarantined. These measures can result however in very costly interventions in terms of societal acceptance and economic impact, so they have to be used in a time-limited fashion with a specific purpose of slowing down infection enough to protect the health system.

But we must be clear saying that the social distancing measures are not a panacea. Social distancing won’t stop this epidemic.

Countries must work at national and subnational level to do more tests, trace contacts, isolate infected people and quarantine them while we gain time to produce a vaccine.

Social stigma and exclusion (22:12 – 23:28) 

It’s very important we avoid stigma associated with the disease and the resulting potential social exclusion. We cannot forget those more vulnerable communities such as migrants, undocumented workers, prisoners in prisons.

We must leave no one behind because the only way to beat this is to leave no one behind.

Importance of global cooperation and funding for vaccines (28:45 – 30:06)

An intensive joint work is being done by countries and scientific institutions who are putting together a global platform for being able to carry out medicine trials together and sharing data to increase opportunities to identify effective therapies.

However, there is a clear funding gap to develop vaccines.

The recently launched Solidarity Response Fund will try to mitigate this.

Main lessons from Ebola outbreak in Congo (30:36 – 32:15)

You need to react quickly, stop the chains of transmission, engage with communities very deeply, be coordinated and coherent. You need to look at the other social impacts, schools and security, economics... If you need right before you move, you will never win. Perfection is the enemy of the good when it comes to an emergency management. Speed trumps perfection. The problem we have in society at the moment is everyone is afraid of making a mistake. Everyone is afraid of the consequence of error, but the greatest error is not to move.

The greatest error is to be paralyzed by the fear of failure.

Importance of working as a team (33:55 – 34:44)

We are not seeking to identify those who do well or not. We’re trying to identify the best lessons we can all use. We share all the errors together so we will share failure in the same way we will share success. So, if one person makes an error in a team you blame the person or the team. Are we a team at global level? We are. And we are a team at national level we should be. Are we a team at community level? We should be.

No one has done perfectly, and no one has made all the mistakes.

March 25. Watch full video here.

North must move to protect vulnerable countries (12:00 – 13:15)

It’s a challenging situation for all countries in Africa. Africa, other countries in the South and lower middle-income countries need support.

The North must protect these countries while dealing with their own internal crisis because nobody is safe until we are all safe.

The power of innovation and IT (29:43 – 33:24)

This is the first epidemic of the 21st century in which the full power of information technology, social media, artificial intelligence is being applied to almost every aspect of this response. Public and private agencies are working together and supporting WHO and its partners during this crisis in order to provide better data and communicate better to the people.

Countries like Korea, China and other countries have also developed apps for faster cases detection, contacts tracing and many other things. WHO has also deployed a platform for contact tracing and follow-up and linking to labs results over 50 countries now. Other applications such as for epidemic intelligence from multiple sources that have been built up during the last five years that tracks electronic information from all over the world using AI engines. Innovation and ideas are coming from people as young as 14 or 50 from individuals, from small startup companies, from huge globally based companies.

It’s being the major level of support and collaboration I've seen in my career.

Our Supply Chain is not ready for a pandemic (43:25 – 46:34)

The simple issue today is demand because our current production of protecting products was pretty adequate to meet global demand before this event began. The world is not ready for a pandemic and so we are not ready to put in place those resources in order to scale up our capacity to protect our frontline health workers.

As Gates explained in his presentation, we don’t simply have a system in place.

March 27. Watch full video here.

The spectrum of the disease (21:50 – 23:26)

The elderly and those under lying conditions have been affected much more than other age groups, but it is affecting other age groups. In Korea 20% of the deaths were people under 60 years old, In Italy up to 15% of people in intensive care were under 50. In other countries like Germany and others we will see people under 50 with moderate to severe infection that may not progress into critical condition.

For most young people this will be a mild infection but for a significant minority of people between the age of 20 and 60 this is a significant infection.

How long is going to last? (28:06 – 31:15)

At this point no one can predict how long this epidemic is going to last and so how long the measures are going to last. We are moving into an uncertain future. The real trick for countries is to look at the national situation, to look at the subnational situation, to see if you know where the virus is. If you know where the virus is, you can break the chain. If you know who has the virus, if you know who the contacts are, you can break the chain.

All measures used for public health must be adapted to the maximum control of the disease but to the minimum impact on the economy and social life.

In order to do that countries simply have to have in place a system to detect, isolate, contact trace and quarantine as well as to continue appropriate hygiene and physical distancing measures. And do this in different parts of the country, at different times and with the capacity to re-implement these measures should the situation deteriorates.

Reward countries for looking. Analyze the right data (33:55 – 35:34) 

We should not punish countries for getting larger numbers. We should reward countries and governments for looking.

We need to look at rates of things. We compare wrong numbers.

We must look to number of cases as a proportion of the total population or the positivity of tests (how many tests are positive as a proportion of all made tests). When we look at these numbers raising, part of that raise in numbers is increased detection due to better testing.

Having a larger number means I know where the virus is better.

About Africa (37:46-40:52)

Numbers still low but the risks are growing. We must try and avoid the risks of lockdowns, so we minimize the necessity of measures like that which will have a very hard impact on people’s life. Africa is a relatively young continent and that may be an advantage now.

Africa has demonstrated with polio to have capacity to respond epidemics, the resilience to live through epidemics and to recover from them.

At this point we must say quite plainly that there are no proven effective therapies or drugs in the fight to COVID-19.

Give a gift to society (46:00 – 48-46)

This answer came after a question in regard to surveillance measures, the need to identify infected people and even removing them from their communities and how this could set precedence in some countries using them for other purposes.

When we talk about a public health system the gathering of information about individuals, their movements must be done with the consent of the community and in many cases of the individual themselves. In a crisis like this it’s important that individuals are prepared to offer a little piece of individual sovereignty in order to support the community. But that must be a temporary and explicit gift that must not be taken for granted. A gift of the individual to the society. WHO will work very closely with organizations like UNICEF, the Red Cross and other NGOs to ensure we avoid the worst outcomes of this disease and any abuses of human rights that may emerge as the world fights the COVID-19.

#covid19 #stayathome #flattenthecurve #quedateencasa