As the world surpassed 100,000 COVID-19 infections, the United Nations announced on Friday that a critical round of climate negotiations among member states in Bonn, Germany will be postponed, while some of the sessions scheduled from 6 March to the end of April would be put on a virtual footing.  Africa Climate Week, a parallel policy event, which was supposed to take place 20-24 April in Kampala, Uganda was also put on hold.

WHO’s Director General Dr Tedros Adhanom Gheyebresus, however, sidestepped the question of whether the World Health Assembly (WHA), which brings thousands of people to Geneva for a week in late May, might be held remotely as well – in light of the COVID-19 crisis and the previously-announced World Bank decision to put its annual Spring Meetings on a virtual platform.

Speaking at Friday’s daily WHO press briefing, Dr Tedros said that WHO would have to do a risk assessment regarding the WHA, adding that he supported a broader approach to “virtual meetings”.

“On the Assembly, we still have time, so we will assess the situation. Based on the risk we will decide and let you know,” Dr Tedros said in response to a question by Health Policy Watch.

“Virtual meetings should actually be considered, not because of COVID now, but when there is no COVID,” he added, “We have to challenge all of our meetings, whether we really need to meet in person. In the middle of the COVID-9, now, we [also] have to do the risk assessment.”

Meanwhile, WHO is making contingency plans for how to continue its own operations at its Headquarters in Geneva, Switzerland, should the local outbreak accelerate.

Switzerland is now reporting 214 cases of COVID-19, largely as a spillover effect from the epidemic in Italy. That leaves the tiny mountain country of only 8.79 people among the top ten nations with the greatest burden of COVID-19 infections outside of China, in both absolute and per capita terms.

Said Emergency’s Head Mike Ryan, a key WHO concern will be how to maintain its Geneva global operations, which are badly needed now for COVID-19 emergency response:

“There is a big international community here in Geneva and we have been working with them (Swiss authorities) on how we deal with business continuity going forward. We have our own concerns about how to continue to run our operations in WHO, not only for our normal health programs but to be able to continue running our global operation here, our global nerve center.”

Ryan added that the Swiss were implementing national “preparedness plans” as well as trying to coordinate with other European authorities, but added, “I think that one of the challenges in Europe right now is coordinating across all of the nations of Europe with such open borders, and many having slightly different policies regarding mass gatherings, slightly different criteria regarding testing, and I think that’s caused a lot of people to question why there isn’t one standard approach in every country?

“But that is impossible to achieve,” he added, saying that: “What we need is each country is making its own risk assessment based on the risks it perceives, its openness, its exposure and its own vulnerabilities.”

As for the UN climate talks, the Bonn negotiating sessions were to be the lead-up for the planned COP26 Conference of Parties in Glasgow in November, a critical moment for the world to agree on a more aggressive plan of climate action. The Bonn sessions are important venues for countries to hammer out agreement on a wide range of technical issues that would underpin a stronger climate agreement on issues ranging from reductions pledges to carbon emissions counting and the financing of mitigation and adaptation measures.

Now these talks will be suspended indefiniely, or held virtually.

“I would like to inform Parties, observer States and Observer Organizations that after careful consideration and with considerable regret, the UNFCCC secretariat will not hold any physical meetings in Bonn and elsewhere between 6 March and end of April. This decision is in response to the Coronavirus disease (COVID-19) outbreak, and the evolving situation in Germany,” said the statement by the UN Framework Convention on Climate Change Secretariat (UNFCCC).

“This exceptional measure aims to contain the spread of COVID-19 and safeguard the health and safety of participants attending UNFCCC meetings in Bonn and elsewhere, as well as address the requisite duty of care of and by the secretariat in such circumstances. At the same time, it seeks to ensure that all mandated UNFCCC meetings and events have the necessary transparency and inclusiveness that our process requires.

“The secretariat is now working with the elected officials, members and registered observers of constituted bodies and other mandated events to find suitable alternative arrangements to meetings scheduled during March and April, such as virtual meetings, or postponement.”

Woman On Front Lines of COVID19 Battle – As World Marks International Women’s Day  

Although women health workers are on the front-lines of the battle to contain the infection — far fewer hold senior roles in the policy fora where key decisions on how to do that will be made.

Dr. Tedros made the remark ahead of International Women’s Day, which will be commemorated on Sunday, March 8. WHO also has declared 2020 to be the International year of the Nurse and the Midwife.

“International Women’s Day highlights the role women play in protecting and promoting the health of all people, noted Dr Tedros in his daily COVID-19 briefing, adding that. “Some 70% of the global health workforce are women, but women only hold 25% of senior roles.”

“We are on the verge of reaching 100,000 confirmed cases of COVID 19,” he added, speaking in the afternoon, shortly before that milestone was in fact reached. Still, he repeated his earlier calls for countries to “continue make containment” their key strategy, and to “detect, isolate, test and care for every case.

“Every day we slow the epidemic is another day hospitals can prepare for cases, governments can prepare, and every day we come closer to having vaccines and therapeutics available,” Dr Tedros said.

Around the world, 3793 new cases of COVID-19 were reported in the past 24 hours. The total number of global cases early Friday evening stood at 100,685. About a third of all new cases were reported in Iran, which saw an increase of 1234 new cases in the past 24 hours. There are now 4747 cases in Iran.  In South Korea, the total number of COVID-19 cases increased by 505 cases in the past 24 hours to 6593 total cases. Italy saw a 24-hr increase of 769 cases for a total of 3858 cases.

Case Fatality Rates Assessed From Multiple Perspectives

Among the global hotspots, South Korea has so far confirmed only 42 deaths – suggesting a below-average case-fatality of about 0.6%. That contrasts sharply with the updated global average mortality cited this week by WHO of 3.4%.

Experts quoted by Business Insider suggested that Korea’s low case-fatality may be driven by the country’s quick roll out of “drive through” diagnostic clinics. The diagnostic dragnet has greatly increased the country’s ability to quickly screen a large number of people, both swelling the numbers of reported infections, including mild cases, but also insuring that people get early treatment.

Another modelling study, released Friday, estimated that the true case-fatality for COVID-19 stood at 1.4%.  That would still be about 14 times higher than mortality for seasonal flu, but half as much as the curent WHO estimate.

Gabriel Leung, head of the University of Hong Kong’s School of Medicine and lead author of the study conducted in collaboration with Harvard University, told the South China Morning Press that the model was created based on data from China’s experience, but considers numbers of people with very mild symptomatic infections.

Still, Leung told reporters at a press briefing Friday that COVID-19 could still claim many lives, particularly among older people as well as those with preexisting conditions.

“We must not let [the virus] enter elderly care homes and centres, else the impact would be huge,” he said.

WHO’s Emergencies Head Mike Ryan echoed that, noting that even if average fatality rates prove to be somewhat lower, due to the identification of more mild cases, mortality rates could very well prove to be much higher than the average among older people and those with pre-existing conditions.

“Yes we could add in a whole bunch of younger people and children who may be getting infected but not getting sick and that’s important and the overall CFR (case fatality rate) may drop,” he said. “But that may not affect the experience of older people, and remember within this when you look at the data from China baed on the numbers reported, the actual age specific or condition specific mortality goes up with age and for those with underlyin conditions. So the actual age-specific or condition-specific mortality could be much higher than those numbers..

“Equally, we have the assumption that children may be getting infected or having milder symptoms. IN influenza outbreaks,  for children with low nutrition, in compromised refugee camp -type situations, the mortality rate in children is much higher, their mortality from many common diseases can be much higher, anyone who has worked in refugee camps we know how devasting viral disease can be in those situations. Of course we hope there is a lower overall case fatality…. But We have to look to those around you who are most vulnerable. ,look to people who are older, or have underlying conditions, look to our refugee populations look to those who are undernourished, look to those with long term infectious conditions, and that’s what we need to do  in order to put together the necessary approached to protect and save their lives,

WHO officials have also underlined that the rapidly changing dynamics of the outbreak mean that the case-fatality estimate will change over time – and the most accurate case-fatility rate will only be able to recorded after the outbreak is over.

Among COVID19 Therapies Under Review – Antibody Treatments Hold Most Immediate Promise 

Meanwhile, more than 200 different clinical trials are now underway in China and abroad, according to WHO. They run the gamut from vaccines, testing existing and new drugs, and traditional Chinese medicine as well.

But the first COVID-19 medications to reach patients are likely to be antibody treatments, many experts believe.

Antibodies are naturally produced by people’s immune systems to combat viruses, usually by blocking the binding of the virus to host cells. They can be an effective treatment for infected patients,  as well as helping in prevention – although they cannot be described as a vaccine.

According to SixthTone, a Chinese media review of trending topics, WuXi Biologics, a Shanghai-based biotech company, is collaborating with Vir Biotechnology in California to produce such a  treatment. The two firms expect to begin clinical trials in about three to four months, according to Chris Chen, CEO of WuXi Biologics.

“Using neutralizing antibodies for viral infections is quite safe, because they bind to very specific targets that only exist on the intended viruses,” says Chen.

Another company working on a COVID-19 antibody treatment is Regeneron Pharmaceuticals, which previously developed and tested Ebola antibiodies at very short notice in respone to the 2013-2015 outbreak in West Africa. The New York-based firm is now trying to harvest antibodies by injecting the SARS-CoV-2 virus that causes COVID-19 into mice that are genetically modified to have human immune systems.

Once the right drugs are identified or developed, the next challenge will be making them available to the people who need them the most, said Ryan.

“We have to look beyond the issue of efficacy, of having an effective drug,” Ryan said. “We have to ensure that those who most need the drugs can get them. We have to absolutely focus now on equity and access – we cannot have a situation where people who need the drug don’t get it, and people who don’t need the drug do. We must find ways where we can ensure that, where we can scale up production of drugs that are effective, and that those drugs are distributed on the basis of need and on the basis of benefit. WHO is already working on this with our partners in the north and south.”

Image Credits: Twitter: @WHOEMRO, John's Hopkins CSSE.