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“We Must Not Forget the Health Workers at the Outbreak Epicenter”

Feb 11 , 2020
  • James Chau

    Host, The China Current with James Chau

COVID19.jpg

Interview with Dr. Bernhard Schwartländer,

Chef de Cabinet and Assistant Director-General

of the World Health Organization,

on the outbreak of novel coronavirus (2019-nCoV)

An audio recording of the following transcript is available here.

James Chau:I'm James Chau. This is The China Current. And welcome to our special coverage on the novel coronavirus outbreak. Dr. Bernard Schwartländer is the Chief of Staff and Assistant Director-General of the World Health Organization. An epidemiologist, he was trained in Germany, and at the US Centers for Disease Control and Prevention. His connection to 'people' comes from his early work in the fight against AIDS, one of the most fatal epidemics of our times, and now he's a key figure in the response to the coronavirus outbreak that's taken hold in Wuhan, using his years of experience working in China itself. I called him in Geneva ways just seen-off his colleagues. They are at the core a WHO-led international mission to China. I asked him, where will they head first? And what's their goal on the ground? 

Dr. Bernhard Schwartländer:This evening, we set-off our pre-team to go to Beijing, to discuss with our colleagues in Beijing, in the National Health Commission and the Centers for Disease Control, to prepare for a larger mission, which will be a joint China-WHO mission. Constituting of about 10 experts on each side, which are the best experts internationally, the best experts from China, to review the data that we have on the coronavirus outbreak, and to decide where we need more research, where we need to get more information to really understand what the virus does and how it behaves, and how we can of course stop the outbreak in China to start with. But also how we can protect other countries and people living elsewhere from a potential outbreak. 

James Chau:The team is being led by Dr. Bruce Aylward, who we all remember was very much at the key of the Ebola response a couple of years ago. Is there any duplicate from that response to this? 

Dr. Bernhard Schwartländer:Of course, the coronavirus is very different from the Ebola virus. The way it transmits is very different, the way... what it does in the body is very different. Ebola virus is a very deadly virus. As it seems right now, the coronavirus is much less deadly in a sense. It spreads much easier of course, that's the point with the coronavirus that is worrisome that we need to understand better. Now what is important for a team leader to lead central mission is not necessarily to be a specialist of a given virus. It is the sound understanding of public health principles, it's the sound understanding of epidemiology, what the data tells us, and also how we can organize a public health response. And there of course, you can then learn many lessons from an outbreak, a massive outbreak that we had with Ebola in Africa, to a very significant outbreak that we now see in Wuhan, in Hubei province, and from there actually going into the world. 

James Chau:One question that I want to ask is, will the mission be eventually in Wuhan itself, in the epicenter? One question that other people are asking is, why didn't the mission head-off to China much earlier? 

Dr. Bernhard Schwartländer:One, we may well go to Wuhan. The decision where to go exactly to study the virus, the outbreak, and the measures taken will depend also where is the greatest chance we get all of this information. Now, obviously, going right into the epicenter, but gives you a lot of information, but also we need to consider that that is the place where every energy, that they have the people working day and night to keep other patients in life to make sure that not more infections happening. 

So we have to be careful that the mission is not a distraction to their work right now, and you have to see the other in other places, then maybe the audience is not quite as severe, we may get the same information we need to find answers to our questions without really having such an impact on the work on the ground, of the people in the hospitals, of the communities. And those decisions will be taken over the next three days, which will then define where the mission, the larger mission, actually will go to do its investigations. 

James Chau:As for whether WHO should have gone to China much earlier in the outbreak response? What do you say to that in terms of a team because of course, you went there with Dr. Tedros a couple of weeks ago to have the political meetings. But as a team, as a field mission, should it have gone earlier? 

Dr. Bernhard Schwartländer:But you can always say it would have been better to go a few days earlier. We had discussions with the Chinese less than two weeks ago, when we met with the Minister of Health, with the Foreign Minister, and also with the President personally. So it's not a very long time to set-up a strong team, to find the right people who can go, and discuss with our colleagues on the ground in China about the terms of reference and the objectives. So yes, maybe a few days earlier might have been better. But on the other hand, preparing well for such a mission is also a key to success. 

James Chau:Without wanting to oversimplify a very complex and evolving situation here. Is there any indication of when a peak may be arriving? And also, I think what everybody else wants to ask is, how long could this outbreak last based on the evidence that you currently have? 

Dr. Bernhard Schwartländer:This is a question which is of course very important, but also very difficult to answer. We do see some signs that the number of new diagnosis of the corona infection are stabilizing or even going down. Equally very encouraging, we don't see massive expansion of infections in places outside Wuhan within China. And we also have to remember that the number of infections outside China is still very, very small on a global scale. So there clearly is hope that we can contain the outbreak at its source, that it won't spread much further, but we really also have to admit that we don't know enough about the virus, the way it transmits. Are there for example "super-spreaders" as we call them, that means people who have the virus infection, and who can spread it more easily than others. And why is that the case? I mean, these are things that for example, we saw with SARS, that some people spread the virus much easier, or passed on the virus much easier than others. What are the factors for that? 

We also don't have enough information about the severity of the disease. What proportion of all people who become infected actually develop very severe disease? All these are questions that they need to understand better to have a good judgement. What the impact of the of the outbreak may be, and how quickly we may be able to bring it under control. But one thing I want to say is that, the measures taken in China are impressive, they're very dedicated, I have no doubt they have been able to contribute to keeping the world safe, in the sense that very few infections up to now have actually been observed in countries outside China. So we must congratulate our colleagues in China, having done an enormous job. And we have to continue to do that. We have a window of opportunity to contain the outbreak, we have to grab it, but we also have to prepare for the worst. 

James Chau:There seems to be a gap of understanding on that. Because many in the science and health community have said that they see where that praise is coming from. Others outside of the immediate community, who are not immediately involved in the response, have been puzzled, at best let's say, by the praise and by the level of praise. Is there a gap of understanding somewhere that we're not getting? 

Dr. Bernhard Schwartländer:I think we need to really give  praise where praise is deserved. And we also need to be very clear where we see gaps in the response or gaps into science and talk about that as well. There are always discussions whether there's more good things happening or bad things happening. People focus on different things. But there's no doubt that there was a very committed response leveraged in China. 

What they have done by bringing people into Wuhan, into the epicenter, to help stop the epidemic right there is exactly the right thing to do. They have built hospitals in eight days, which nobody has ever seen before. All of these are things that we have to really talk about and praise, but you also have to now work together to complete the understanding of the virus, and make sure that we can even further improve our measures. Not only in China, but in particular also... convey that learning, and that message, and that experience, outside to the world to keep the world safe. 

James Chau:This WHO-led international mission is an indication that China is working well with the international community. But the public health emergency of international concern was declared for one of the many reasons... but one of the key reasons is that WHO can engage and monitor with its member states to make sure that the world is working together. In this particular case, are member states working well with China, which is of course the epicenter in terms of a country of this outbreak? 

Dr. Bernhard Schwartländer:You're absolutely right, James. The reason to declare a health emergency of international concern really started to come forward after we actually came... after we went to China, and also discussed with the authorities there, including the President. When we saw the first infections happening outside of China, in this case in Germany, where a single case of a traveller, a business person, going to another country, participating in a meeting not in very close, familiar contacts. 

And despite that, situation infections were happening. Now, what has happened is that the person travelling back to China on the way back started to feel ill. She was diagnosed immediately upon her return in Shanghai, and the Shanghai authorities did exactly the right thing. They picked up the phone, they called their colleagues in Germany. The German colleagues could immediately follow-up, identify the contacts, identify the infections that had happened. 

Everybody is well, they're in hospital, no further infections happened after that. And by doing that, and by communicating very well with each other, between countries, between authorities, a further spread of the virus could be stopped right at the roots. That is an example, on the one hand that shows how well the cooperation is working with China and other countries. But it also showed us that we have to be on high alert, and all countries need to be on high alert to be able to react like the way we have seen in Germany. That was one of the reasons. That is one of the reasons why we call public health emergencies globally, to make sure that everybody understands, that information can flow, and that they can prepare systems to be ready in case an infection is imported into their territories. 

James Chau:The world has been listening from the World Health Organization every day. There's lots of information coming from the press briefings and also the social media updates. But it's key for us also to listen to you, as Chief of Staff, as Assistant Director-General, but because you bring that wealth of experience, especially from the earliest years of the national in your case and global AIDS response. One of the most fatal diseases of modern times. Is there anything that we can learn from that then, and quickly apply to it now, in what you're seeing in the evidence, in the science? 

Dr. Bernhard Schwartländer:One thing that we have seen in all outbreak type situations or in situations where a virus or bacteria actually passed from one person to another. We can only succeed if we include the communities in the response. This is something that we have seen in HIV and AIDS. This is something we have seen very painfully in Ebola, but this is also something we see now in fighting the coronavirus outbreak. Only if you engage the communities, only if you work with them, and make sure that they understand what is happening and how they can contribute through their own behaviour, to support those who are infected, to support the medical staff, but also to change their own behaviour to protect them, do we have a chance to really succeed. 

James Chau:Looking ahead, one of the problems that AIDS has, was, and is very much, of course... is stigma and discrimination. That seems to be coming through the way that this has been portrayed, not only in the media, but between people, between non-media on WhatsApp, on Facebook, on Twitter. How much of this is a war on a virus, versus a war on misinformation? 

Dr. Bernhard Schwartländer:James, you're raising a very important point here. I think stigma has shown again and again that it is the worst enemy in fighting disease. We are also starting to see similar trends here with the coronavirus, where we are very, very sad to see how populations like when Chinese are travelling, people get nervous, they don't want to talk to them, they stay away, so that a whole country almost gets stigmatized with the disease outbreak, despite them themselves actually dealing in an enormous way with the issue. 

We can learn so much from them. We have to be very clear with information and be factual, look at what the virus does, how we can respond to it. And also be very clear that has nothing to do with being of a certain nationality. That virus can appear anywhere in the world. That virus can infect anybody in the world. So only if you act together, only if you understand each other and learn from each other, can we stand a chance collectively to end this outbreak. 

James Chau:You talked about where praise is due, you give praise, and one of the big turnarounds has been the way WHO has worked with major social media platforms. I think one of your staff reached out to Pinterest first, and that's rolled out. There's a collaboration now with Google, with Facebook, with Twitter, where they help guide their users to sources of credible and accurate and timely information, not just WHO, even local health authorities where the people searching are searching from. Could this offer a template on how we deal with misinformation as a whole in all contexts? 

Dr. Bernhard Schwartländer:I think that is a very good way to deal with misinformation. We have learned so often, especially in social media, it is not the right way to go back to a wrong piece of information and say this is wrong, because that in a sense highlights the wrong information above any other information. The best ways whenever people look for information, whenever there's information out there, we help people to find the right information rather than trying to diffuse the wrong information. 

And that is what we're doing in collaboration with Google, with Facebook, with Baidu, and other major social media platforms. They are working with us, because they recognize that nothing is more important than health. Health is important for everybody, for every individual who's on social media, and they're interested in seeing the right information. So this is a benefit for the people who read, who engage in social media, but it's also of course in the benefit to the provider, because they are trusted providers, and the trusted providers will be more successful providers. 

James Chau:WHO has been very against travel restrictions in the context of this outbreak and outbreaks in general. And to other people who live in impacted areas, they'll say that speaks against logic. If you have a problem, you contain it by shutting down borders. Why doesn't that make sense to you? 

Dr. Bernhard Schwartländer:There's two reasons for that. One, it's virtually impossible to really shut down borders. So it's better to be prepared and to take measures, instead work with the people rather than against them. Secondly, what we have seen in some cases is that restrictions have been imposed on people where there's really no risk and no reason. I want to give you a few numbers: if in a place like Beijing, which has more than 20 million people living there, the size is larger than most of countries in other places, [where] you have 100 or less than 100 infections, the chances that these infections go out are absolutely minimal. How would that work? 

Unless you much larger numbers or you don't really take good measures, talking to the people understanding where they come from, and taking the proper risk assessment. So proper risk assessment by for example asking them, have you been in Wuhan at the epicenter? Or have you been living or in close contact with people who you know, or have been travelling to Wuhan, or you know have the infection? Those are the questions we should ask. You can take temperature checks to make sure that people are healthy when they travel. These are the measures that are much more helpful and unless you and less damaging to societies, to the economy, which in the end will hurt everybody. 

James Chau:Dr. Schwartländer, you're fighting a war on multiple fronts. To end up with, you're fighting that war on health. You're fighting the war on misinformation, and you're really facing a war against people's fixed ideas, and sometimes this growing public anxiety, which does come out of genuine concern in many cases. What would you like to tell everybody? And what's important for them to remember and to act on now? 

Dr. Bernhard Schwartländer:I think the most important is that we really don't forget the enormous effort and the burden that people take right now [by] fighting the outbreak at the epicenter. It's the heroic efforts of health workers who've work and disclose that they can't properly breathe, they have to stay there for hours. The healthcare workers who go out to the families to see how they can help those who are sick, so they don't have to go out on the road and on the streets and potentially exposing others to this. 

So those are the people who really deserve our thoughts and our support. Beyond that, I think this is the time we can show global solidarity. Where we all have to work together. Shutting down borders... it's not the time anymore. This is an interconnected world where we all work together, where we all live together and thrive together, and we also have together to solve problems like the coronavirus. We can solve it together. 

James Chau:I know it's well after midnight for you, and you've got hours of work ahead, and then the morning, Dr. Schwartländer, thank you very much for sharing some of those key insights right now. 

Dr. Bernhard Schwartländer:Thank you, James, for talking to me. 

 

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