WHO Director General Dr. Tedros Adhanom Ghebreyesus said on Monday that the relationship between WHO and the United States is “very good” and that, despite the recent maelstrom of criticism by President Donald Trump over WHO’s handling of the COVID-19 crisis, he hoped that funding from the USA will continue. 

“I hope the funding to WHO will continue. And the relationship we have is very good. And we hope that this will continue,” said Dr Tedros at a press briefing.

The WHO Director-General was responding after a rash of remarks late last week by Trump, other key White House figures and allies over the agency’s handling of the crisis, which Trump and some of his political allies have described as “China-centric.”  There have been suggestions, including from Trump, that the US might consider suspending its contributions to the organization, and Congressional Republicans have demanded more documentation about key exchanges between WHO and China over issues that arose in the early days of the outbreak, such as whether the virus could be transmitted, person-to-person. 

The USA is the biggest contributor of funding to the WHO and has provided US$ 400 million to the Organization in 2019, which was ten times more than China. 

Meanwhile, however, WHO received a big boost from another major donor country, the United Kingdom. The announcement of a contribution of £ 200 million came just after Prime Minister Boris Johnson was discharged from a hospital where he was treated in an intensive care unit for several days, crediting the British National Health Service (NHS) for “saving my life”. Dr. Tedros welcomed this “generous support” and urged other member countries to follow the UK’s initiative.

Countries Need To Be Wary of Lockdown “Exit Strategies” Even In Places Where Outbreak Has Stabilized 

Countries planning to lift their lockdowns must do so carefully and gradually, urged Mike Ryan, Executive Director of the WHO’s Health Emergencies Programme, at the press briefing. He underlined this as a key principle even as outbreaks have stabilized in a “pretty consistent way” for a number of European countries.

“Lockdowns can be lifted in certain strategic areas, maybe where there’s lower incidence. But it does have to happen slowly, it does have to happen in a very controlled manner. And it is important that the community understands this,” said Ryan. 

As countries begin to open up again, they must maintain aggressive surveillance, testing and community engagement to keep the outbreak at bay. “We need to have a much more stable exit strategy that allows us to move carefully and persistently away from lockdown. And the only way to do that is to have fully empowered communities and a fully activated public health architecture and to the strengthen health system”, said Mike Ryan.

It is also “really important” that the lifting of these measures doesn’t happen “all at once all over Europe”, added Maria Van Kerkhove, Technical Lead for the WHO’s Health Emergencies Programme, as this may trigger another outbreak wave.

Huge Unknowns About Coronavirus Contagion Period & Immunity Gained After Illness  

Scientists still don’t have a full picture of the immune response to COVID-19, and that is one of the other issues confounding policymakers as they try to make decisions about exit strategies.

People infected with COVID-19 produce antibodies, but it is unclear whether these antibodies confer immunity, and for how long, Ryan pointed out adding, “The data is quite limited.”

“Some individuals had a strong antibody response. Whether that antibody response actually means immunity is a separate question”, said  Kerkhove referring to a new study from Fudan University in Shanghai that has not been peer-reviewed yet. The study, which compared antibody responses of almost 200 patients, showed that some people infected with COVID-19 may not develop any antibodies at all.

Yet another big knowledge gap centers around the time during which people carrying the virus may transmit it to others, Kerkhove said.

Although most people infected with COVID-19 develop symptoms within five days, scientists do not know whether patients are contagious for several days or weeks. Polymerase Chain Reaction (PCR) tests, the lab-based gold standard for diagnostics, suggest that contagion could last several weeks. However, just because people with the mild disease test positive for several weeks does not necessarily mean that they are still contagious, said Kerkhove.

“We don’t have the full picture,” she said, “What we need is much more data from countries to actually be able to say, how long is someone contagious.” 

In light of limited testing capacity and unknowns about the length of time a person can be contagious, individuals in home isolation should stay at home until their symptoms resolve, and even continue isolating themselves for another two weeks after that as well, recommended Kerkhove.

“What we recommend right now is that those individuals are in home isolation, if they can’t be isolated in a medical facility, until their symptoms resolved, plus an additional 14 days”.

More data is also urgently needed to understand if the immune response is different between patients with mild and severe COVID-19, especially in those with severe infection that have recovered, added Kerkhove. Such studies will help researchers determine what type of immune response helps a patient clear SARS-CoV-2 safely and effectively from their body.

Many of the deaths associated with COVID-19 may also be due to an overreraction of the immune system, rather than the the virus itself, suggests a study published late last month. As part of the immune reaction, so-called “cytokine storms” can lead to an excess amount of immune cells piling up in the airways and blocking them off, leading to death.

WHO Softens Position on Masks 

As mask use in the general population has gained momentum in various countries, including not only Asia, but the USA, eastern Europe and Israel, the WHO officials at the briefing expressed a more positive line on the practice, saying that they could support public use of masks as part of a comprehensive strategy. Previously, WHO’s Emergencies team had said mask use in the general population was unnecessary, except among people who are symptomatically ill, or caring for other sick household members.  

“The WHO will support countries who wish to implement a more broad based strategy of mask use “as long as it’s part of a comprehensive strategy”, said Ryan.

“[The comprehensive strategy] includes physical distancing. It includes hand hygiene. It includes respiratory etiquette. It includes staying home if you’re unwell. It includes cases being isolated confirmed cases being isolated. It includes contacts being in quarantine, and it includes following the directives of the national government”, added Kerkhove.

WHO has also stressed that masks, when worn or used improperly, can still lead to transmission of the virus.  This is supported by a recent study that found large quantities of SARS-CoV-2 can accumulate on masks. The study, which was published last Friday, recommends adequate desinfection of masks before discarding them.

“There are issues around wearing those face coverings and disinfecting those face coverings and disposing of those face coverings or masks”, said Ryan. 

But for those who know that they are ill, masks are not an alternative to self-isolation, emphasized Ryan. “We don’t want people to think that putting a mask on is the same as staying home and reporting the fact that you’re sick to authorities”, he said.

The WHO’s policy on broad-based mask use has been tweaked amid growing recognition that social isolation is unrealistic in some settings and communities, especially those in developing countries with high population densities, said Kerkhove at the press briefing. In addition, in places where transmission of the virus is high, many people who are in fact ill and contagious may be unaware of their status, experts have said. 

Total cases of COVID-19 as of 10:20PM CET 8 April 2020, with active case distribution globally. Numbers change rapidly.

Image Credits: NIAID, Cross River State Primary Health Care, Nigeria .