Special Briefing Via Telephone
Dr. Nancy knight, deputy incident manager for global covid-19 and dr. Heather burke, regional program director division of global migration and quarantine
April 21, 2020
Moderator: Greetings to everyone from the U.S. Department of State London Media Hub. I would like to welcome our participants who have dialed in from the United States and across the region. This is an on-the-record briefing with two Centers for Disease Control officials: Dr. Nancy Knight, Deputy Incident Manager for Global COVID-19; and Dr. Heather Burke, Regional Program Director Division of Global Migration and Quarantine.
We will begin with opening remarks and then turn to questions from participating journalists. We are pleased to offer this call with simultaneous interpretation in Arabic, and request that everyone keep that in mind and speak slowly.
I will turn it over now to Dr. Knight and Dr. Burke.
Dr. Knight: Thank you, Mr. James. This is Dr. Knight. I will go ahead and begin and then turn over to Dr. Burke.
First of all, thank you to everyone on the line for joining us today. COVID-19 is an unprecedented global health challenge. As of April 19th, the World Health Organization has reported a global total of 2,241,778 confirmed COVID-19 cases and 152,551 deaths. This includes 130,153 confirmed cases and 6,223 deaths in the countries that are represented on this regional call today.
We can’t forget that there’s a person behind every one of those numbers. CDC’s top priority in our work in the United States and around the world is to prevent illness and loss of life. We’ve been working with global partners for 70 years and have more than 50 international offices where we work side by side with host countries to address pressing public health issues, like measles, polio, HIV, and now, COVID-19. We’ve partnered with ministries of health to provide technical assistance for public health programs, improved disease surveillance and response, build laboratory capacity, and assist with workforce development.
Some places are facing special challenges in fighting COVID-19 due to resource constraints. WHO and CDC guidance may be difficult to implement in global low-resource settings. CDC is working to address these challenges. We are identifying safe hand-washing alternatives when access to soap and water or alcohol-based hand rub is not available. For communities where people cannot self-isolate, we are also recommending that these communities practice some physical distancing and cancel large gatherings. CDC is also developing guidance for safe and dignified burials. Practicing preventative measures is still the best way to avoid getting this virus.
I’ll turn the call over now to Dr. Heather Burke, who can provide some additional information about CDC’s work in the region. Dr. Burke.
Dr. Burke: Thank you, Dr. Knight. The CDC has been working in the Middle East/North Africa region for more than 20 years. CDC provides financial and technical assistance to field epidemiology network partners working in the region in support of core training and applied epidemiology. We’ve also formed partnerships with ministries of health, key UN agencies such as WHO and IOM, local partners, and other U.S. Government agencies with the goal of reducing the impact of emerging diseases; building capacity in laboratory systems and epidemiology; supporting public health through safe migration; responding to health emergencies; and conducting disease surveillance, surveys, and studies.
In the more than two decades that CDC has been engaged in the Middle East and North Africa, the region has faced a number of major health challenges, including avian influenza, or bird flu, pandemic influenza, MERS, and now, COVID-19. We bring the same dedication and service to every public health emergency as we seek to save lives and help countries help themselves.
We’re proud of our work and strong partnerships in the Middle East and North Africa. As part of our ongoing commitment to our work in the region, we look forward to opening our new Middle East/North Africa regional office in Muscat, Oman. This office is one of four regional platforms CDC began to establish in 2019 with other offices covering South America, Eastern Europe and Central Asia, and Southeast Asia. These regional offices will advance global health security and maintain a sustainable global presence. The approach will strengthen CDC’s ability to meet its mission by responding more rapidly, efficiently, and effectively to help threats wherever they occur.
CDC remains committed to working closely with our partner governments throughout the region to support them as they work diligently to reduce the risks of COVID-19.
Dr. Knight and I will now open the lines up for questions.
Operator: Thank you. One moment, please, for our first question.
Moderator: All right. Our first question comes from Raji Unnikrishnan.
Question: Hello? Can you hear me?
Dr. Burke: I can hear you.
Question: Yes, this is Raji from the Gulf Daily News based in Bahrain.
Dr. Burke: Please go ahead and ask your question.
Question: Hello? All right.
Moderator: Yes, we hear you. Go ahead and ask your question.
Question: All right. So I would like to ask you – I would like to ask you about the GCC region and in particular about Bahrain. How does the CDC assess the situation in the region in terms of the number of cases, the number of deaths, and the rate of recovery? In what phase of the pandemic do you think that the countries are – are the countries in and what do you suggest, that more should be done? Is there more to be done?
Dr. Burke: Sure. Dr. Knight, do you want me to take this question?
Dr. Knight: Sure. That sounds great, Dr. Burke.
Dr. Burke: So the Gulf countries – I think it’s important to recognize that all of the countries in the Gulf, the approaches are diverse and I think all of the countries are trying to assess the guidelines being put forth, primarily by WHO, and to figure out how to make those work in the national context. And I think in Bahrain the usual activities – the activities that we want to be – we want to see happening are happening: looking at trying to scale up testing and to do more around contact tracing. The contact tracing piece is really important in this region right now, especially while we’re – many of these countries are in very strict lockdowns where folks are not able to leave their homes. And so I think the ability to do contact tracing right now is really important in order to get a handle on the situation.
And then also looking at some of the surveillance systems that are at play, particularly around hospitalizations and some of the surveillance systems that were established during – for flu preparedness. Those are really important for Bahrain as well. I don’t know specifically how much the – how big of an issue the hospitalizations are in Bahrain in terms of recovery. I’d have to look a little bit more into those data. But I think the focus in the region, I think folks are working really hard to address this in a national context, and I think we can – we will continue to support that work.
Dr. Knight: Thanks. Dr. Burke, maybe I’ll just add one additional point. I think you’ve covered the question really well, but there is one thing that everyone as individuals must keep in mind whether it’s in Bahrain or other countries in the region, and Dr. Burke talked about many of those public health efforts that are ongoing. As individuals in those communities, we all have to also think about how we protect ourselves and our family members and other community members. So some of those key public health activities that you can do in addition to staying at home are making sure that if you develop symptoms that you contact your health care providers and your public health department so that you can make them aware of the symptoms that you have.
I think it’s also been really important to recognize the critical impact of social distancing, and that’s when we talk about staying at least six feet away from other people, or a couple of meters away from other people in order to try to decrease that spread, as well as the importance of hand washing with soap and water or with alcohol-based hand sanitizers so that we can continue as individuals to decrease the spread as well.
Back over to you for our next question.
Moderator: Great. Our next question comes from Hespress. “How do you assess the status of the spread of COVID-19 in Morocco? Are the current government measures sufficient to stop the spread of this virus in the country? Are African countries going to face a dangerous threat?”
Dr. Knight: Thanks. Dr. Burke, do you want me to go ahead and start with this one and then you can chime in?
So I’ll go ahead and respond. So for Morocco specifically, I don’t know the specifics of the situation in Morocco, but I’ll approach this from a more country – a general country approach. So for every country, it’s very important for their public health department to be – to have the systems in place to be able to identify when there are individuals with the novel coronavirus, or COVID-19, and to be able to then effectively diagnose.
So these are some of the important, core public health systems, and what I mean by that is something like surveillance systems – excuse me – so that when an individual in a community has symptoms, the information is able to be shared from that community up to the national system, national public health department through surveillance systems. And once you’ve identified someone who may have symptoms, you also have to then be able to diagnose, so ensuring that there’s a strong laboratory system with the diagnostic capacity to be able to test for and confirm whether someone has coronavirus.
And then there are the measures of being able to protect those individuals, so having a strong system for the supportive healthcare that is needed as well as to support the community through identifying close contacts of those individuals, which Dr. Burke talked about in the first question – the contact tracing. So having epidemiologists or people who are disease detectives that are on the ground that can respond to those investigations that need to be done on the ground.
We do know that in Morocco they have a field epidemiology training program, which are those disease detectives that have graduated from the program that can be engaged in that contact tracing within the country.
And then having a national response system is also very critical. So ensuring that all of the key components of national governments as well as local governments are able to communicate through an emergency operations or emergency response system, and so that they know what’s happening on a daily basis and can adjust the response based on the number of cases that they’re seeing, based on those outbreaks that might be occurring in a specific community so that they can contain them to the best of those abilities.
Moderator: All right. The next question we’ll take is from Nazenin Ansari from Kayhan London.
Operator: Nazenin, your line is open.
Question: Excuse me, I was on mute. Hello. Good afternoon and thank you very much for this briefing today.
My question is in regards to the data of World Health Organization that you are dealing with, specifically in relation to the countries in the Middle East and North Africa. Some of the data are being provided – for example, in the case of Iran – by the government and it is not accurate. And we know that there is migration as well across borders. How are you can going to deal in such a situation when the data is not there and that there is constant travel and migration? Thank you.
Dr. Burke: Dr. Knight, do you want to – do you want me to start or do you want to? I’m happy to talk a little bit about the migration piece because I think the migration piece – it’s important to understand that, I think, close to 80 percent of countries in this region either have closed borders or partially closed borders. So right now, while there is limited in-country travel for some of these countries, cross-border travel is extremely limited right now and I don’t anticipate that that’s going to be changing anytime in the near future. Although there are discussions about loosening up on a country level, the border issues are still – are still not on the radar in terms of next steps.
I think the data piece, we – it’s a good question and I think it’s – we work with what we have, and I think WHO has done a very good job at being able to support countries in the region and being able to get data through various surveillance systems and through direct reporting for those cases that are identified. I think this is a collaboration and where countries are – I think we all recognize it’s in everybody’s best interest to be transparent about the situation in countries so that the support and the resources can be directed to the benefit of that country and the people in that country. So I think WHO has really been doing a good job in terms of providing support to the countries in this region as well as possible.
Dr. Knight: Thanks. Yeah, I think, Dr. Burke, you’re absolutely right. And another thing that has made the data I would say a little bit more challenging, and we’re seeing this in a number of countries, is as this pandemic has progressed we’ve seen that now there are a number of cases that have been asymptomatic cases. So that also makes it a bit more challenging to be able to get a handle on the data if someone is asymptomatic and hasn’t – therefore hasn’t identified themselves as having the disease, but then is tested or is found to have evidence of it. Then we also have to take a look at that and what sort of a relationship do those asymptomatic cases have on the data and the numbers that we are counting. And this is something that not only countries in your region but countries around the world are looking at, and how the data might need to be adjusted to accommodate for asymptomatic cases that may not have been counted. Over.
Moderator: All right. Our next question comes from Bander Alwarthan.
Question: Yes, hello, everyone. Just my quick question is – and I come from a newspaper in Saudi Arabia – people here are curious to know from your perspective, what do you think or how do you evaluate all the methods and procedures we have done here in Saudi Arabia in dealing with this global pandemic? And also, we know that the two – the leaders of the two countries, Saudi Arabia and America, are always in touch regarding how to deal with global pandemics. So what do you think should be highlighting these efforts and cooperation? That’s it. Thank you.
Dr. Knight: Hi, thanks so much for your question. This is Dr. Knight, I’ll go ahead and start off that response. You’re right, the U.S. Government and the U.S. CDC specifically has worked with the Kingdom of Saudi Arabia for many years, for more than 20 years. We have partnerships there with the ministry of health, with WHO located in country, with other local partners, with our State Department colleagues and other U.S. Government agencies that are working there, in order to help reduce the impact of emerging diseases such as COVID-19. We have also partnered with the Kingdom of Saudi Arabia on technical capacity-building in areas such as laboratory systems and in epidemiology – those are like the disease detectives that I mentioned earlier – in responding to public health emergencies, looking at the surveillance systems and helping to conduct surveillance and surveys in the country. These collaborations that we’ve had, these technical collaborations that we’ve had over this 20-year history, can certainly be utilized and adapted for Saudi Arabia’s response to COVID-19.
Currently, we have a CDC employee who sits in Saudi Arabia and works side by side with our government counterparts, our Saudi Arabia government counterparts, and particularly focused on the field epidemiology training program. That was established in 1989, and the program there has graduated more than 130 medical epidemiologists. So now those medical epidemiologists are there and working across the country to help with identifying, through the surveillance systems and the diagnostics that are happening in the laboratories, identify where outbreaks like COVID-19 might be occurring so that they can investigate those outbreaks and help to contain them. Thank you.
Moderator: All right. Our next question comes from Al-Ittihad newspaper. “When do you expect the vaccine to be developed? And why is the recovery rate between COVID-19 patients in the U.S. less than 20 percent compared to other parts of the world, such as Germany at 60 percent?”
Dr. Burke: Dr. Knight, do you want to talk about the vaccine or do we want to —
Dr. Knight: Yeah, I can touch a little bit on vaccine development. I think the question that you have asked about development of a vaccine and timeline for development of a vaccine, that’s certainly one that’s being asked around the world. Research is underway at many sites. However, currently, there is no vaccine that is available. We know that it takes some time to develop a vaccine, and we’ve heard the experts here such as our colleagues from NIH talk about this, and making sure that while vaccine development is fast-tracked that it still has to go through – that development still has to go through some very important steps in order for us to ensure that a vaccine that gets developed is going to be effective and safe.
Until a vaccine is developed, there are still important tools that we all have to help to prevent and to mitigate the impact of COVID-19. These include community-based interventions such as closings, for example, of schools; some of the temporary closings that we’ve seen of businesses; options to telework so that people can still work but from a safe environment; options for educating remotely where that’s feasible; as well as postponing or canceling large events; and as we talked about earlier, ensuring that we’re all practicing physical distancing when we have to go out for essential services in order to help slow that spread.
I think I’ll go ahead and stop there and recognize that we all look forward to a time when a vaccine will be available, and continue, though, to not forget about these other, very important public health measures that we have to, both at a community level and an individual level, to be able to decrease the spread of the novel coronavirus.
Moderator: All right. The next question we have is from Lisa Barrington of Reuters news.
Question: Hello, hi. I am in the UAE and we notice that across the Emirates and the UAE there are very different measures being put in place, like in Dubai we’re under complete lockdown but the other Emirates are not. Do you have any input into why in one country we have such different measures? We’ve not been told which Emirate has the most outbreaks, so maybe I don’t know if you have visibility on that either. Thanks.
Dr. Burke: Right, this is – this is Heather Burke. I think it’s an interesting and important question that you’re asking, and I’m not sure we do have clarity on why different Emirates would have different – what the situation is across the UAE. I think the implementation of different sort of models of lockdown and different levels of restrictions is going to be something we’ll be looking at in the future to better understand sort of what pieces worked, but I think it’s really important to understand that there isn’t a one-size-fits-all in this region. I think there are different capacities and different areas have to do – make restrictions based on what their specific country needs are.
So for example, in Jordan where most of the food is brought in from other countries, while they have extremely perhaps some of the strictest restrictions in country in terms of movement, they do need to allow trade across – coming in from Saudi and some of the other – the countries that we border in order to bring in essential supplies. And so based on that, we’ve been doing testing at the border for those truck drivers to make sure that that is done in a safe manner.
I think it’s the local context – the local context is really important in assessing the different approaches that are being taken throughout this region, and I think it’s hard to fully assess at this point – at this point in the outbreak exactly where the – what has worked and what hasn’t worked, although we – I think we all feel quite confident that the importance of staying put, not moving around, and physically distancing and monitoring numbers of people in – at events, those things are all really, really important in terms of controlling the spread of this disease.
Moderator: All right, we have time for one final question. It comes from LBCI TV. “How do you evaluate the measures taken in Lebanon to address coronavirus, especially that in the past 24 hours there have been zero new cases?”
Dr. Burke: Dr. Knight, do you want me to talk about Lebanon a little bit or —
Dr. Knight: Sure, that sounds good, Dr. Burke.
Dr. Burke: Yeah. So Lebanon has actually been focusing on increasing their testing and at the same time have been enforcing pretty strict measures around physical distancing and staying indoors, and I think the number – Lebanon is not altogether different from Jordan. I think it’s a complex country in terms of the diversity of populations and some of the issues around crowding in that country, but I think they’ve really strengthened the lab capacity for doing the testing. I think they’ve been very much focused on trying to increase the number of tests that are being done, and my understanding is that there are almost – they’re going to be tripling the testing in that country in the next couple of days.
And then I think they’re also trying to do – engage in some of the WHO special investigations, which are actually doing some sampling in certain areas of the country that potentially may be more at risk, and also engaging in seroprevalence surveys in order to get a better understanding of what’s actually happening at the community level. Because when folks are indoors to the degree that they have been in many of the Levant countries, it’s become challenging to really understand the transmission dynamics at the community level, and so I think Lebanon is focusing on that in the next couple days and taking some strong measures. I think the testing will definitely need to continue to scale up, but I think they’re on track in terms of their focus and trying to align their activities along the WHO guidance and priorities. Over.
Moderator: With that, that is all the time we have for questions. Dr. Knight and Dr. Burke, if you’d like to make any final comments.
Dr. Knight: Hi, and thank you. I think just in closing, I would like to thank everyone for joining us this morning and to thank the countries in the region as well for the work that we’ve been doing together, particularly through ministries of health and the public – our public health counterparts around the region. We recognize that with this pandemic outbreak of COVID-19, there are still a lot of unanswered questions with it being a novel or new pathogen for us all, and it’s really through working together, through implementing our core public health approaches at the individual level, at the community level, and at a country level, that we are going to be able to work through this pandemic and find answers to some of the questions that we don’t yet know about this novel pathogen so that we can best address it together.
So thank you all very much.
Dr. Burke: Hi. Yes, I want to also echo what Dr. Knight said. It’s wonderful that you guys are engaged in these discussions, and I think this region is exciting, and while we would not wish this pandemic at any time, I think we’re learning a lot in the various regions and we’re also recognizing how many of the resources and investments that were put in place in the past in terms of strengthened surveillance and workforce development and laboratory capacity. All of these really key public health components that CDC has been supporting in the region are starting – we’re really recognizing the value in that work and being able to build on that work moving forward in this very difficult situation.
So thank you.
Moderator: Thank you, and thank you again to all our callers for participating. If you have any questions about today’s call, you may contact the London Media Hub at [email protected] Information on how to access the English recording of this call will be provided by AT&T shortly. Thank you and have a good day.