WHO Press Conference COVID-19 Infections among healthcare workers 13 October 2020

Good afternoon to our colleagues from Geneva Press Corps.

Big thanks to Eunice for helping with the technical side of this.

We will have our press conference today regarding COVID-19 infections among healthcare workers.

As I have said in a previous press briefing, some information and some figures have been published the last evening in our weekly epidemiological update.

I hoped that I hope that you had some time to have a look at it so you get the key figures already assimilated.

But we will go a little bit more into what what this really means as well as other issues about about health workers and impact of COVID-19 on health workers and what WHO is doing to protect them.

So as we have announced in our media advisory, we have 3 guests with us.

We have Mr Jim Campbell, who is our Director for Health Workforce.

We have also Doctor Anna Peuchow, who is a epidemiologist here at WHO, and we have a Professor Benedetta Eleganzi, who is technically for Infection Prevention and Control hub.

So I think we will start first with Doctor Campbell, who will tell us a little bit of overview of the impact of COVID-19 to health workers.

Then we will go to Doctor Anne Perez Shaw who will explain us how we got these figures and and what these figures tell us.

And we will conclude opening remarks with Professor Alegansi, who will tell us about what what are the risk factors for infection of health workers and what who is doing to help health workers protect themselves.

Then we will open the floor for questions.

So I will give a floor now to Mr Jim Campbell, Director of Health Workforce here WHO.

[Other language spoken]

Good morning, good afternoon, Good evening.

[Other language spoken]

The obviously, I mean you have the latest update issued on the global epidemiological situation and we can see clearly a pattern across the world in The Who regions that we are continuing to see increases.

Healthcare systems and health and social care workers are faced with the challenge of responding to the pandemic, maintaining the delivery of essential health services and thinking forward to the potential availability of a vaccine and the preparation of the vaccine and immunisation options.

This is putting a significant demand on the capacity of our health and social care workers worldwide, the impact of which is extensive.

We're going to be talking today in particular about infections in healthcare workers, infections in both health and social care settings.

But some of the other impacts that we are following as WHO working with Member States is around the existing shortages in the health workforce.

Many, many countries already facing challenges in the number and the skill mix of workers available to provide primary healthcare, universal health coverage.

We're seeing the challenge of extensive redeployment of staff to manage the pandemic and the impact that has had on maintaining essential health services.

Nearly 100 member states reporting that essential health services are being disrupted because of this redeployment challenge.

We're seeing the impact of not necessarily with confirmed infection, but with possible infections, isolation and quarantine, which takes people away from the workforce, especially if testing is not available.

This is having a detrimental impact after nine months on mental health.

It's the burnout, the stress, the anxiety that we're seeing amongst our healthcare employees and how they have the motivation and the commitment and the dedication to continue in their work when they're faced with these many, many difficult challenges.

We're seeing around the world the manifestation of this into industrial action.

We're seeing labour disputes and even strikes among certain occupations.

We saw here recently in Geneva a similar manifestation around some of these issues from health workers in one of the main hospitals.

That's also then translating in the intention to leave many studies and quality of assessments coming out suggesting that people are so burnt out, so much stressed that they may be leaving the profession and that has consequence when we go into next year and the realities there.

We've seen that though the positives, we've seen applause and recognition and awareness of the role of health workers around the world from leaders, from the general public, through art, through film and through social media.

We're seeing respect and recognition of our healthcare professionals for their essential work in protecting the public managing disease, but we also have to be aware that applause without action is not good enough.

The respect and recognition without rights and reward and remuneration is also not going to lead to long term sustainable improvements in our healthcare settings.

We will hear in detail about the infections from my colleagues, but I think there's there's one key message that we we are seeing coming through the data that we've analysed and this is from the Member states reports.

It is clearly a continuing challenge and we need healthcare systems to respond to that challenge.

But overall, the trend is encouraging.

You know, where we have data, we're starting to see the impact of guidance training, supply chains and the improvements in clinical practise, but we still need to do more and my colleagues will expand upon that.

We heard in the Executive Board special session that was held last week, Member States reviewing and looking at the lessons learnt and the elements that can improve our response to the pandemic going further forward.

We had a recommendation from the Minister of Health in Turkey that we need to make 2021 an international year of health Workers in recognition of their efforts and that will that proposal from Turkey will continue to be a discussion amongst Member States.

But I think one of the key things we need to do now is to make sure that we do take positive action to address the multiple impacts upon health workers, as I said, their mental health, their stress, their anxiety, their rights, their rewards at the same time as managing infections and the pandemic.

Thank you very much.

Happy to take questions when we've finished the presentations.

[Other language spoken]

Now we will turn to Doctor Anne Rashow, who is working as epidemiologist here at WHO and in a surveillance unit.

So she will tell us more about the data that you have already seen published last evening.

[Other language spoken]

Yes, good afternoon.

I will first indicate the origin of the information we are sharing here and then go through the result of the analysis that were conducted.

So as early as January 2020, WHO set up global surveillance system.

So to collect minimum information to monitor the trend of the epidemic and also to describe and understand the epidemic pattern and transmission.

Then we use what we call a case report form with minimum information.

And as of 15 September, the case report from database contain as much as around 8 million forms which represent around 30% of all case recorded at date.

There is participation of more than 150 countries in the case report from surveillance and weekly surveillance together.

So we conducted analysis of health worker information over close at 300,000 health worker reported from 83 countries and this represent so data which are covering primary Europe and American countries estimate that around 40% of COVID case reported to the ratio identify as occurring in health workers.

There are large difference between countries, however, the overall mean estimate of infection among health worker illustrates an over representation of case given that the health worker represents less than 3% of the population globally and less than 8% in our region **** income countries.

So the data analyse indicate that there was a substantial decline in health worker infection over time since the start of the pandemic and in the last months we were showing that the proportion of Kaiserman health worker were closer to the share of the general population.

In terms of age and text, we observed the data show that the mean age was 40 years, which is lower than the mean age of non health workers which is 46 years.

Distribution of health workers in women 67% is proportional to the global share of women and men in the health workforce as usually reported.

Then for a selected number of countries with **** level quality data and completeness, meaning when we have a report on more than 70% of case reporting by the country and the information is completed for more than 75%.

We were able to compare the proportion of COVID-19 cases for comorbidities, hospitalisation and deaths by each category and sex.

And what we show is that 13% of health worker patient reported underlying condition and this proportion is lower than what is observed for non health worker in those countries.

Also 5% of health worker required hospitalisation and this proportion again is lower than the one observed for non worker reported in the country.

Overall 0.5% of health worker were fatal and this proportion once again is lower than expected for the other the population of non health care workers.

Difference are really pronounced for patient over 50 years of age and above.

We are now conducting more analysis to understand those differences and try to better describe the pattern of infection of health worker and the setting of infection of health workers.

Happy to take question after it over to you.

[Other language spoken]

Thank you, Anne, for these explanations On, on, on, on, on fears.

I will now give flow to a Professor LaGrange who will tell us more about risk factors for COVID-19 infection among healthcare workers and also what who is doing to, to, to to train and help health workers protect themselves.

Professor LaGrange.

[Other language spoken]

So WHO has worked with the University of Oregon to look at the available evidence and literature published on different coronaviruses and really focusing on COVID-19 in particular, to better understand this data and especially how health workers get exposed and infected.

This work has highlighted that infections can occur in both acute and long term care settings, also in outpatient settings and infections are transmitted from patients and residents to health workers, but also between health workers.

And this work has also shown that there are specific situations that are obviously at higher risk, in particular during care situations like involvement in intubation of patients, direct patient contact and and also contact with body fluids.

But also a very important risk factor is inconsistent or incorrect use of personal protective equipment, various types of these equipments.

Another element which is really important emerging from recent publications from different countries is the fact that it appears that health workers could get infected also in break rooms in during their social life, in common areas, within healthcare facilities as well as quite prominently in their households, so in the community.

So there are new studies emerging from the Netherlands, from the US, from Germany, documenting these situations I just mentioned.

On the other hand, very importantly, from this living systematic review and meta analysis, we know that appropriate personal protective equipment use, hand hygiene best practises policies and implementation of universal masking within healthcare facilities and appropriate and adequate infection prevention and control training are all measures and factors that significantly reduce healthcare workers infections.

So my colleagues has just talked about decreasing trends in health workers infections over time.

Fortunately, since the beginning of the pandemic.

We believe that this reflects a better approach and implementation over time of these measures by member states, by facilities, local governments and also it may reflect The Who actions in in this field.

So indeed we have obviously recommended that there are specific measures starting from having infection prevention and control programmes and occupational health programmes in place at the national, at the facility level has been very important, very important factor, especially when reflected in policies and implementation of standard operating procedures.

In particular, these procedures need to be related to screening, triage, early recognition for health workers, in particular, syndromic surveillance and testing in specific settings and according to a risk based approach and systems for managing exposures as well as infections.

There are other obviously measures, in particular the type of personal protective equipment to be used and also the behaviour to be taken during provision of care.

In particular, obviously using standard and transmission based precautions, but also continuously wearing a medical mask or a respirator depending on the situation, frequently performing hand hygiene, keeping physical distance as much as possible during activities.

And as I said, very importantly, refreshing IPC education.

Another aspect that my colleague Jim Campbell has highlighted, and it's very important is staffing levels.

Already in 2015, WHO recognised that having low staffing levels and **** workload was a risk factor for transmission and spread of outbreaks in healthcare facilities and therefore we recommend adequate levels of these.

So in all these fields, in conclusion, WHO has produced of course many guidance documents.

We have overall 16 guidance documents on infection prevention and control.

WHO has established A COVID-19 educational channel, which hosts nowadays 121 courses on COVID-19 and in 39 languages, and there have been until and of August more than 4 million participants in these courses.

And finally, WHO has established a supply chain system, which in a few months provided 172 countries with millions and millions of items of personal protective equipment and hand hygiene supplies.

And last but not least, of course, our regional offices and country offices continuously provide technical and operational support to all countries affected.

So this is what I wanted to explain and I'm very happy to provide more details later.

[Other language spoken]

Thank you very much, Professor Leganzi.

So we will now start with the questions.

First question is Jeremy Lounge from Radio France and Tenaciones.

Jeremy, yes, thank you.

Tarek just want to ask first.

[Other language spoken]

My question in French and maybe get an answer.

[Other language spoken]

I'm looking at Anne right now.

And yes, she says yes.

[Other language spoken]

The.

Jeremy Mr Campbell will answer in English and if needed I can I can translate Messi.

Jeremy, indeed, you heard from Benedetta here the the systematic reviews, live systematic reviews that are ongoing and in the surveillance updates we talk also about the necessity to have standardised reporting and measurement on some of these impacts.

We are seeing an increasing number of journalists and media reports and some studies by professional associations in some of the OECD countries where this intention to leave burnout.

Leadership responses to, you know, questions around what is their biggest concern in the next 12 months, all pointing to an increasing level of stress, anxiety, burnout in the workforce and professionals themselves and students indicating they are seriously considering leaving the profession.

We're under way with a much more structured review to identify this.

But these are publications, like I said, from journalists, media, peer reviewed literature, mainly from **** income countries and we're trying to ascertain better information around the world.

Thank you, Jim, Jamie, would that be OK with you?

I hope it will.

Otherwise we can we can organise something after the after the after the briefing and have something properly in in French.

[Other language spoken]

I would like to come back to Doctor Perusho numbers presentation because I had some difficulties to understand all the numbers and data she gave.

For example, she mentioned that the that what what I understood is that the your study took into considerations 300 three 100,000 health workers in 83 countries representing mostly Europe and America.

I would like to, for example, to understand in America you are meaning North America, Latin America or overall America.

And what about Asia?

Why not Asia or China?

Where the what's in the the 1st in this pandemic and maybe you could you could have more data in about what is what happened in that in this country.

[Other language spoken]

And also if she can repeat some of the comparisons she made on the infection of the representation cases and what she said about about the decline that we are witnessing, for example, in relation with infection in health workers and infection compared compared with infection in overall population.

And finally, if she can clarify also because she said that health workers requiring hospitalisation and the fatalities was less than in the in the general population, but she said also that the average age of health working infected is less.

So it could mean that they are younger.

So they have less mortality and less lethality, sorry, and less severe infection.

If she can please clarify all this data, because it's very important to understand very well this.

Thank you for all these questions is about.

Let's just try to to to answer some of them because I just see there's so many journalists online who are waiting to ask a question and.

[Other language spoken]

I will try to to make it short.

So regarding for the first question, which country are we talking about and who is reporting?

So as I mentioned, there is a overall system for global surveillance system that is requesting via the international IHR that has regulation that all countries report to WHO minimum set of information on all case that are reported at national level.

Countries are participating to the global surveillance according to different criteria and patterns.

What we observe is that many countries in Euro and PAHO are participating.

When I say PAHO, I say North and South and South America and we also have countries from Emerald 0 and Wipro.

I'm mentioning WHO original office here and but in a less extent.

So we can say that all that are represent mainly PAHO and Euro countries.

However, we also are presenting that are from Co and Wipro.

But as I say, not all countries are reporting to WHO.

Even if we, we, we are trying to make all effort so to get a comprehensive reporting from all countries.

And even if country is reporting, they might not all have the information on health worker at national level.

So country reporting all cases might not provide information on health workers just because I don't have it connected at the national level.

So they are sharing with us what they do have.

And so this is the cause of the differences we observe in the reporting of ex workers.

So we're talking about 83 countries reporting as care workers, but we know that majority of countries are in Eastern and in the euro and power regions.

So I hope this respond.

Now when we talk about the decline in health workers in proportion over all cases.

We are expressing here that what we observe in the first month of the pandemic, the proportion of health worker reported to the case report form where the information is the patient healthcare worker, yes or no is documented.

I show a decreasing trend over time.

So even in countries and in region where the number of kids has been increasing over time or has been, you know, as the trend, we know we observe a steady decrease in the reporting of healthcare worker in the proportion of healthcare worker reporting.

So this might be linked to awareness but also better protection of health workers.

Now to the last question, what we did and you can read it in the EPI bulletin is that we compare for countries with **** quality data the S Walker versus not head worker by age and sex.

This is to control to exactly what you said that maybe if they're younger they have less com mobilities.

What we observed is for all ages there is a lower proportion of S Walker reporting com mobilities than non healthcare workers and this is the same for hospitalisation and for theirs.

Meaning that health worker are less likely to be hospitalised at any age and for any for male and for female than non healthcare workers.

So is it healthy working effect?

Is it because they are capture earlier in the course of the disease or is it because of testing strategy that sometime capture positive case that are not expressing disease and will not develop the disease?

This is under investigation at the moment, so I hope I.

[Other language spoken]

I hope this covers at least some of the questions that Isabel has asked.

Next question is from Jamie Keaton from Associated Press.

[Other language spoken]

Thank you for taking my question.

I wanted to just try to get the, the numbers are kind of going everywhere and I want to just make sure that I understand the overall value judgement if that's possible on these numbers.

For example, it sounds like you're saying there's a significant decline or a considerable decline, if I understood you correctly, in terms of the numbers of health workers being infected.

So I just want to make sure, do you have a global percentage of health workers who are getting infected?

Is it going up or down?

And are these people who are getting infected getting infected at work?

And then a second question is just about in terms of now that masks are being recommended by everyone including WHO, are you seeing any shortages of PPE for healthcare workers, whether it be masks or gloves or anything like that?

What can you tell us?

[Other language spoken]

Jamie, I don't know who would like to to ask the first question, answer the first question.

And would you like Jim, would you like to take the first one?

And I think maybe the second one Benedetta can can deal with.

[Other language spoken]

So, so for the first one, the question of this worker.

So as mentioned earlier, information is what member State and countries are reporting to WHO on the base of of information for every patient that is collected.

And so the proportion of health worker that's is reported is decreasing with time.

So it's a proportion of the number of case report form with information completed is the patient healthcare worker yes or no.

And so this completeness of information is stable over time and is showing that the proportion of those that are reported assets workers is decreasing steadily with with epidemic going on.

So for your question, is there a decrease in health worker reported, Yes, as affected by COVID-19 for the data collected for the surveillance, yes, there is a decrease in the number of all the proportion, let's say the proportion of face worker reported among the case with the information, I hope I responded to no in the in the document.

[Other language spoken]

And for you, Jamie, you have on the on the on the on the next page of the of the you have a graph basically that shows the decrease of of proportion of health workers among infections.

[Other language spoken]

Thank you for the question.

So first of all, of course, WHO has always recommended medical masks and respirators depending on the situation since the beginning, since since January.

What has changed for WHO recommendations and also other organisations is that between May and June, we have started to recommend continuous use of masks within healthcare facilities, in particular in clinical areas by any health worker instead of only those who provide care.

So just a clarification on that point.

So it has been some months now that there is widespread use of masks in affected countries, in healthcare facilities in particular.

Over time, as you know, there have been shortages in in many countries including **** income countries just for due to production gaps basically because the entire world has has been cooked unprepared with the the demand of of PPS in general, but masks in particular, shortages may still happen.

But certainly the production has been scaled up immensely over the last six months or or more.

And in addition, as I said, in particular for low middle income countries which certainly have financial issues, procurement issues, WHO and other institutions have set up this supply chain system which efficiently works.

And I can inform you that as of end of August, there were 101.1 million medical masks and 18.2 million respirators shipped to different countries through this supply chain system.

So certainly there have been many efforts to mitigate this problem, but I think we need to be aware that this may happen again or be happening now in in specific local situations.

So there is an important aspect that needs to be continuously raised to countries, governments, procurement systems for them to be always alerted and continue to procure regularly good quality personal protective, protective equipment.

This is certainly very important.

And just to sorry maybe another piece of information, WHO as well as CDC and ECDC have issued documents about rational use of personal protective equipment where we give a number of suggestions to avoid to get into this situation.

In terms of shortages, there are many strategies that can be, can be put in place either to prevent or to cope with similar situations, not always optimal, but certainly now we have advanced a lot also for instance, in research that WHO has facilitated and funded in terms of methods to reuse safely reprocessed personal protective equipment in some cases, or research on extended use of masks, for instance, for multiple hours.

And these are all measures that should be put in place in very emergency situations where there is real shortage.

[Other language spoken]

Thank you, Benedetta.

Now we will go to next question.

That's Gabriela Sotomayor from Proceso, Mexico.

[Other language spoken]

Thank you for taking my question.

I have two questions or three, I don't know.

But one is who is going to held accountable for the deaths of health workers that the governments are failing to to provide a PPE because for example in Mexico is a scandal.

So that is another question.

If you can talk about Mexico situation and because in the in conflicts it's very clear what what are the rights of the health workers and all that, but who is going to protect them in this situation?

And I think that's it.

[Other language spoken]

Indeed, we've, we've been following the example that you mentioned in the media and the news and the information and the data with great interest.

We WHO very early in the pandemic this year issued guidance on the rights, roles and responsibilities of health workers and with a particular emphasis on Occupational Safety and health.

And that set out the normative work and the considerations, including reference to all the international standards and conventions around employment and labour and occupational illness.

An updated version of that guidance is currently going through the internal review process and we anticipate will be published in the next few weeks and that will provide that.

What we can do is ensure that we follow up with you, that you get a copy of that guidance as soon as it's published.

And I think many of the particular issues with that apply to within a jurisdiction.

Can be referenced in that guidance and normative work empathy obviously with any health worker that's been infected and those who have lost their lives.

And indeed there are employment legislation, occupational roles and responsibilities that do apply.

Thank you very much, Mr Campbell.

We will go now to John Zaracostas from Lancet.

[Other language spoken]

For this briefing.

[Other language spoken]

With reference to the number of healthcare workers that died, is that basically from the sample of five countries only and not necessarily from the data of 83 countries?

And my second question is how many countries from the Western Pacific are included in your survey with hard data?

Does that include Japan, South Korea, China and Australia for instance?

[Other language spoken]

Think this for me.

I'm not sure I I fully understood the first question.

Please can you repeat?

[Other language spoken]

Yes, the number of deaths, I think it's you mentioned 0.5% that have died, is that basically only from the selected sample of five developed countries and that's not necessarily from the global data set?

[Other language spoken]

We conducted precise analysis using zoos, the data from five countries where we have a good completeness in terms of number of people reported compared to the total number of kids that occur in the country and also a good completeness on the information healthcare worker yes, no and on the on Zeus parameter as presence of comorbidity, hospitalisation yes, no, ventilation yes, no and and what is what was the outcome.

So yes, we conducted this analysis over 5 countries located in Europe and and the America.

So this is for for the for the 1st and it was over 11 million of of patient reported with this with the correct information.

Now the second question is also we say yes without entering too much into details, but yes, countries such as the one you mentioned are sharing with us the information on and with case report form.

However, I cannot tell you now what is the proportion what, which one are reporting on healthcare worker and which one are not.

Because some as I mentioned before, some country might not have the information or sometime just either do not collect or do not share with WHO.

And so I will not tell you with this one yet from in this meeting, but this information is available.

But yes, we have the country, some of the country you mentioned are participating is a global surveillance and sharing information with us.

[Other language spoken]

Hi, thank you for taking my question.

I had a few questions actually.

I was wondering about just on the question of the number of people who've died is do you have an estimate globally sort of from your research about how many health workers have died?

I'm also wondering about the overall proportion that you were talking about 14% and that it's been declining.

Do you have sort of a proportion a few months ago and what the proportion is now?

Maybe I've missed it.

And also if you could say something, if you have any idea of the proportion of health workers who've been infected in health facilities and in home settings, that would be helpful.

Thank you very much.

[Other language spoken]

Maybe then Jim wants to add something.

[Other language spoken]

So I I can tell the total number of who died.

I think this information unfortunately is not available at WHO level.

At global level, I will say information might sometimes be available in the regions, but there is still some difficulties to to assess whose number mainly due to the difficulty to report on outcome.

This surveillance system is based on the rapid reporting of every case.

So for the ratio to be able to monitor the trends as you know outcome, I mean as if the patient died recover is you need some time to identify what is exact how the patient will evolve with time.

And so the completeness of the outcome is really poor in our database.

And we will not rely on on this database to provide a correct estimate of the overall burden of of I mean of the overall deaths among healthcare workers.

This database will not allow us to to be to be precise enough and this will necessitate further studies, specific studies besides some countries as we were able to show here that are sharing very **** level quality data.

So I think that's what I want to say now regarding the proportion of his worker that as an overall is 14% of reported cases we saw in the graph that is mentioned in the apability and that at the end in June and August, this proportion now is 5%.

So once again with huge variation between countries, we observe for all of them that if they started with 20% sometime or 15%, they are now below 5% of infection occurring among the workers.

[Other language spoken]

And just Nina, just start on the particular issue about the estimate globally.

We again, I emphasise the point that we're trying to do standardised measurement and reporting and we're following literature and peer reviewed publications as well as news and journalist as well as member state reporting.

One of the challenges clearly is that the difference is in reporting standards.

So where our numbers are, particularly where we've got consistency in reporting from member states to the same standard and we can give that figure.

We're aware of other estimates that have been published globally, but we we recognise the numbers are ****.

But what we're saying is and that we need to be taking action in response to reducing the level of infection and the risk to health workers no matter what.

But at this moment in time, some of the data that has been reported on global estimates is not necessarily following the same standard as WHO.

Thank you very much.

And again, there is a graph, Figure 9 in the epidemiological weekly update published yesterday that shows exactly this per month on percentage of healthcare workers infections among overall number of infections in selected countries.

[Other language spoken]

Hopefully we will be able to finish with those two.

Peter, thank you.

[Other language spoken]

At a press conference earlier this year, the Director General has asked a question from South Africa, which is the country ID reporting on, about PPE fraudulence and the results of it being tantamount to ******.

Do you have any research on the effects of PPE fraudulence in any countries, including South Africa and something that can be measured?

Peter, I don't think this is a question for our speakers here.

So what I what I would like is that you send us an e-mail and we will look for people who in house here who may have more on this topic.

And now I will call on Isabel to ask her last follow up question.

And this will be last question for today, Isabel.

Yes, thank you very much.

I would like to to, to know if you could give, I mean, after all this analysis that you made on the this all this huge, huge data.

If you can I give an advice, for example, on what is the maximum of patients that any health worker, wherever he he or she, he is can be take care of me.

What is there really not to stress and to avoid burnout or any kind of situation, even if the situation in different countries, we all know is different by the human being is human being everywhere.

So what would you say is really the the the threshold you know of of this?

[Other language spoken]

Isabel that's a a simple question but has a whole set of complex answers to it.

Clearly there is overwhelming evidence around safe staffing and its impact on patient safety, safe staffing numbers and the impact on workload, mental health, stress amongst the the health employees.

But these are across multiple settings in acute facilities, in different types of wards which provide triage in long term care etcetera, etcetera.

We have some documentation on the safe staffing elements which we can connect you to offline, but there isn't, we don't actually advise a simple X per X amount of health workers per why number of patients because of the complexity of the settings involved.

But the principle of safe staffing and the impact of the evidence on patient safety and health worker safety is overwhelming in favour and Member States, indeed we recommend that they continuously consider, update and revise their staffing guidelines accordingly.

Thank you very much Mr Campbell.

[Other language spoken]

So it's just like if it wasn't clear because I got a couple of messages.

So there is no proper press release and I think when we have a more comprehensive figures we will do one.

But for the time being, what we all these figures that have been presented have been published last evening in the weekly Epidemiological update that is posted every Monday evening on our website where we detail the number of COVID-19 infections.

Now every every Monday we have a focus on something.

So yesterday the focus was on health workers.

This is where we published the figures and This is why we wanted to give you opportunity to ask questions on this.

But this is on our website.

If you go to WHO website on COVID-19, click on situation reports and then you will have a weekly epidemiological review and just click on one that is dated October 12th.

That was that was yesterday.

I wish to thank our colleagues from Eunice for Technical Support on this and and big thanks to to Doctor Perez Shaw, Professor Elegancy and Mr Campbell for being with us.

For any follow up questions, don't hesitate to contact media team and then we will see you for the next WTO press briefing is tomorrow on tuberculosis at 2:00.

[Other language spoken]