Live Q&A on COVID-19 and Omicron sub-variant BA.2 with Dr Maria Van Kerkhove and Dr Abdi Mahamud – 8 February 2022

00:00:53

AK          Hello, good afternoon, good evening and good morning to everyone joining today’s Live Q&A or #AskWHO about COVID-19. We will answer your questions about the current situation and, in particular, about Omicron and what we know about its sub-lineage, BA.2. It has been there out of high interest.

My name is Aleksandra Kuzmanovic and I’m very pleased to be joined by Dr Maria Van Kerkhove, as usual, but we also have a new guest for the first time. He’s not a new colleague but is new in this conversation. Dr Abdi Mahamud, who is our Incident Manager. Good afternoon, Abdi.

AM         Good afternoon, Aleks.

00:01:34

AK          Thank you for your time to be with us today and maybe you can tell us a bit about your work and when we say Incident Manager, what does that mean in WHO? What is your job, exactly?

AM         That’s a tall order. Thanks, Aleksandra, for having me and Maria, for doing this for almost a third year into this and for your facilitating. In terms of when we have an event in WHO, we have what we call the Incident Management System, where we bring all the expertise across the house and we create different pillars, from the epidemiology, to the technical network that Maria is leading, in infection prevention, clinical management, to operations, logistics and supply, all aspects are blocked together, under the Incident Management Support. So, we have ten pillars plus one pillar, which is the research that oversees.

So, as the Incident Manager, I’m kind of making sure that everyone is coordinated, both the technical and overall management and operational aspects. We have the same at a regional level and then also at a country level, bringing all the expertise across within WHO.

00:02:41

AK          Thank you so much, Abdi. We are really pleased to have you here and I’m sure our viewers are happy to meet you as well if they haven’t seen you in other channels before. As usual, I would invite you to send us your questions using the hashtag, #AskWHO, if you’re watching us on Twitter. If you’re watching us on other platforms, please leave your questions in the comments section and I will pass them to Maria and Abdi.

Before we start receiving some questions, maybe Abdi you can take this question. We normally start with the epidemiological update. Normally, Maria does it but as we have an Incident Manager, who oversees all the operations, so maybe you can do it today. What’s the current situation with cases, with mortality rates, and where are the hotspots at the moment?

AM         Thanks, Aleks. Just to start, I hope one day we will see when epidemiology becomes boring again, so that we more life saved. In terms of where we are right now, in the last one week we have over 19 million cases reported and because of the change in tests different countries have adopted it’s very hard to make minutes of where those cases are. What is more important is the number of deaths reported last week, 68,000, and that has increased by 7%.

So, while we are paying close attention to the trend, I think what will be more important moving forward will be the number of hospitalisations in cases because this is becoming more difficult and challenging. In terms of if you’re dividing by the WHO regions, the main cases we are seeing now of the deaths are in the US and I will spend some time there.

00:04:26

Within the US, where we see trends going down in most of the places, other parts of America, particularly Southern America, have seen an increase, so there is variation. In terms of when you move to Africa region, where Omicron has started, it is going down.

Europe, the western side, the wave is going down but it is picking up in the eastern side of Europe and is really affecting places with low vaccination and a weak health system. So, Eastern Europe and Central Asia will be something.

Then, coming down through the East Mediterranean region, we see a big uptick in Gulf countries, countries that already had a vaccination but also countries like Afghanistan and Somalia with very low vaccine

Moving on to the Southeast region, SEARO, India and Thailand. We have seen the southern part but it is now slowly shifting to East Asia, Thailand. So, we’re seeing a mixed picture and WPR countries who have just celebrated the Lunar New Year, are seeing an uptick of cases.

South Korea and all these have successfully managed now. In comparison, when you’re reporting one million cases in other parts of the world, even 10,000 cases is a big number for them.

00:05:44

So, it’s a mixed number. Countries see an increasing trend, others steady, and others down, but unfortunately in the third year of this we’re having more deaths reported. DG has touched on Omicron since it was discovered, how many declared. Now, just look at the numbers, thanks to the EPI team, 130 million cases since Omicron was declared as a VOC and 500,000 deaths.

In the age of effective vaccine, half a million people dying is really something. I think if there is a word beyond tragic, it’s sad, and unfortunately out of that 500,000, 100,000 are in the US reported since Omicron. So, while everyone was saying Omicron is milder, I think we missed the point that half a million people have died since this was detected.

The US in the last 24 hours, I was just looking at the number, 3,400 and someone smarter than me made a comparison, saying that the Boeing 737 Max, two of them crashed in 2018-19, 346 people died. So, if you take the number of just the last 24 hours in the US, that’s 18 Boeing 737s crashing every day, so it’s beyond tragic that occurs in a country that has free vaccine.

So, we really need to vaccine people who have not been vaccinated and reach the 1.1 billion people in Africa but also the millions of people in the US who are still resisting vaccination. Thank you. It took me long but I just wanted to put it in a context.

AK          Thank you so much, Abdi. This was great. We haven’t done this session in a couple of weeks, so we really needed a more detail update. Maria, looking into this epidemiological situation and tragic situation, basically, where we lost half a million people since Omicron emerged and became a Variant of Concern.

00:07:48

So, at which stage of this pandemic are we? We have safe and effective vaccines that prevent severe disease and deaths, and we have other tools, and now we are seeing an increase in the number of deaths. So, where are we going and what is your advice on what we need to do urgently?

MK         Well, I think as Abdi has pointed out, it’s a very dynamic situation globally and the sheer number of cases are astounding with Omicron. The way that Omicron has replaced Delta around the world so quickly, the sharp peaks that we’ve seen, we literally have had to redraw the scale of the epidemic curve that we have been using and it makes the previous peaks look almost flat.

We know that those are underestimates of the true number of cases and one of the things that’s important to point out is where we are in this. We’re still in the middle of this pandemic. We’re getting closer to the end. I hope we’re getting closer to the end of it every single day but it’s up to us on how quickly we get there.

Many countries have not passed their peak of Omicron yet, so while some countries are seeing a decline in cases in Omicron, others have not yet reached that peak, so we will still continue to see a large number of cases.

00:09:00

The more concerning thing for me, and as Abdi has pointed out, is the number of deaths that are increasing for the fifth week in a row, half a million people that we know about have died. The number of people who have probably died from COVID is much higher than that because we don’t have adequate reporting systems around the world.

But, of the last five weeks, we’ve seen an increase in deaths and the fact that we are seeing an increase in deaths when we have safe and effective vaccines, when more than ten billion doses of vaccines have been administered to date, when we have diagnostics that work, when we can get patients into the clinical care pathway and save people’s lives, this is beyond tragic.

There’s a lot of emotions that I think all of us have on this but it’s about what we do with those emotions and how we actually turn that into action because we can save lives now. So, where we are in this pandemic, the virus is circulating at a very intense level.

We have the Omicron variant, which is the fifth Variant of Concern that WHO has classified as a Variant of Concern at the global level but you have to remember that this virus still continues to evolve. There are four sub-lineages of Omicron that we’re tracking. Let me say that again. There are four sub-lineages of Omicron that we are tracking. We have the BA.1, the BA.1.1, the BA.2, the BA.3. This is all Omicron, and it is all the Omicron Variant of Concern but we are watching this virus evolve in real time.

00:10:33

So, with good sequencing and good detection capacities around the world, we’re tracking what are the proportion of these sub-variants that are circulating. Now, we already know that Omicron has a growth advantage. It is more transmissible compared to other Variants of Concern. It also has properties of immune escape.

But, we know some of the sub-lineages, BA.2, has a growth advantage even over BA.1, which means that as this virus continues to circulate, we will now see an increase in BA.2 with this increased growth advantage over BA.1. So, for the person out there, everybody that’s out there that’s watching this, what is important for you to know is that this virus continues to be dangerous. This virus transmits very efficiently between people but there’s a lot that you can do.

At a global level and as an organisation, what we’re doing is working with governments, we’re working with our partners to do two major things. One is to increase vaccination coverage among those who are most at risk in all counties, not just some countries, and making sure we reach that 70% target by June 2022.

But, we’re also trying to do everything that we can to support the reduction in transmission. We will not be able to prevent all transmissions. That’s not the goal. To prevent all infection and all transmission, that’s not attainable at this point but we need to drive transmission down because if we don’t, we will not only see more cases, more hospitalisations, more deaths, we will see more people suffering from post-COVID condition, long COVID, and we will see more opportunities for variants to emerge.

00:12:07

So, it’s a very dangerous situation that we’re in, three years in. I know everybody that’s watching doesn’t want to hear about this anymore and wants this to be over. We do too. We would give nothing for this pandemic to be over and for us to be able to move on and to get back to our normal lives, but we’re still very much in this and we still need people to be careful.

So, where you live, still take measures to reduce your risk and your exposure to the virus. Wear a mask. Physical distance. Wear a well-fitting mask, please, over your nose and mouth. Wearing a mask under your chin, off of your ear is useless. Wear a well-fitting mask, the best mask you can get a hold of, over your nose and mouth with clean hands. Physical distance. Improving ventilation. Avoiding crowds for now.

We will not be in this situation forever. That’s my last point. We will not be in this situation forever and the pandemic will end but how quickly we get there is really up to us.

AK          Thank you so much, Maria. We have received a lot of questions on this BA.2 sub-lineage but I’m also seeing some comments that our sound is okay but not perfect for everyone. So, please give us a minute or maybe even less. We will go on slide and our AV team behind the scenes is going to fix the sound and you can hear us even better. So, stay with us, please.

00:14:07

Thank you so much for staying with us. Chris, Mark and Jill, behind the scenes, have fixed the problem and I really hope you hear us even better now. Maria, a lot of questions on BA.2. How serious the variant is? What are the symptoms? And, also, as Abdi explained and yourself, that we have a significant increase in deaths, are these deaths linked to this sub-lineage?

MK         This sub-lineage of BA.2 is Omicron. What we are able to do with good sequencing is to determine which sub-lineage is circulating. We’re really in a good position to track this virus globally. We’re working with partners around the world to increase testing, increase surveillance, increase sequencing. That needs to continue to improve because we need better geographic sequencing around the world. So, I thank all of our partners who are working so hard on this to improve sequencing capacities around the world.

BA.2 is Omicron, so it’s a Variant of Concern. It’s already classified as a Variant of Concern. Our understanding of Omicron, as a whole, and we have researchers around the world that are doing different types of testing, different types of studies, different types of experimental study on BA.1 compared to BA.2, but for the general public out there what is important is to talk about Omicron as a whole.

Our understanding of Omicron is that people who are infected with Omicron can have a range of symptoms. They can have no symptoms at all and be completely asymptomatic or they can develop severe disease and people are also dying from Omicron. On average, we know that there is lesser risk of needing hospitalisation if you are infected with Omicron compared to Delta, but that does not mean that it is a mild disease.

00:15:56

There’s a lot of narrative that’s out there that suggests that Omicron is a mild disease. That is not true. It can be mild for some individuals, as can the other variants, but we need to make sure that people protect themselves about getting infected because everybody is at risk of developing severe disease.

With Omicron, we know people with underlying conditions are at an increased risk of severe disease, people of older age. Risk of severe disease increases with age and risk of severe disease increases if you’re not vaccinated. One of the most important things people can do to keep themselves safe is to get vaccinated.

The vaccines are designed to prevent severe disease and death and they are incredibly effective, even against Omicron. We are seeing a slight reduction in efficacy but they still protect people from developing severe disease and dying and that’s important. So, when it is your turn, please get vaccinated. This is one of most important things that can do and this is why WHO and partners are working so hard to make sure that there is access to vaccines for people around the world, not just in some countries.

But, in terms of what we understand of BA.2 compared to BA.1, BA.2 is more transmissible than BA.1, so we expect to see BA.2 increasing in detection around the world. There isn’t any indication to suggest that there’s a difference in severity of BA.2 compared to BA.1 but it’s still very early days.

00:17:24

The studies are really just underway and, again, we’re working with so many people around the world and learning this information in real time. So, for the person out there watching this, please do what you can to get vaccinated when it is your turn, receive your full course and also take measures to reduce your exposure where and when you can.

AK          Thank you so much, Maria. Abdi, maybe I can pass this question to you, coming from Veronica Douglas, watching us on Facebook. Can someone be infected with more than one variant of COVID-19 at the same time?

AM         Thanks, Veronica. That’s an excellent question and maybe a billion dollar question that we are all trying to answer, but we go back to what we have learnt so far dealing with the other variants, we have the way of protecting ourself and that is the vaccine and getting vaccinated.

With other coronavirus and another variants, unfortunately it wins or escapes with time. So, the body, when you get an infection, you have an immediate defence that’s call natural innate immunity and then you develop what we call the B cells and the T cells. The B cells produce immunoglobulins. You maintain those immunoglobulins for a certain time and then they go down after three to six months.

This is just an average and the travel, the flows of the average. So, please take what’s true for the average may not be true for that individual, Veronica. So, mostly between six to 12 months there’s available data. When those immunity go down and you will get exposed, and that’s why we’ve been saying continue protecting because your immunoglobulins have gone down, your first line of defence have done down, you can get reinfected.

00:19:11

But, when you’re reinfected, because you already knew the virus or the variant, your body will kick in your second layer, your memory B cells, your T cells and you will not get severe disease. While you may get infection, a mild infection, these vaccines will protect you from getting hospitalised and from getting to an ICU and, sadly, to death.

Right now, the main question from everyone, if I got BA.1, can I get BA.2? We don’t know. We haven’t had time and, for WHO, we use 90 days between the two infections. So, we’re still just starting the period. So, if the question is related to if you got Omicron BA.1, can you get BA.2? We don’t know yet.

But, the two cousins, that’s what I wanted to say, Omicron BA.1, BA.2, these are all cousins. They share a common ancestor some time back. Hopefully, the body, and that’s hope, it’s not a strategy, but what we have learnt in all this Delta, Omicron, that the vaccine will protect you from getting hospitalised and from death.

MK         Can I add something to that because I think this is important, what Abdi was describing. When we look at reinfection, we look at this 90-day period and there’s not really enough time. Since Omicron was first reported at the end of November, we’re still in the early days of Omicron, even though we’ve seen this huge spike.

00:20:31

One of the thing we’re tracking on the epidemic curves and, of course, this is based on surveillance, we’re looking at how the curves go up and how the curves go down. One of the things we have our eye out on is on the decline. Countries are in very, very different situations based on how they’ve handled this virus since the beginning and the population level immunity, their capacity to respond, the tools that they have.

So, the decline in the latest peak will be different, based on different countries. Some countries saw a very sharp increase and a very sharp decrease. Now, that we see BA.2 increasing in prevalence in terms of how much is circulating, we have to see what that decline looks like.

If the epidemic curves go down sharply, if they continue to go down in the trends that they’re going down, then we won’t see this signal of reinfection, given that we don’t have the 90 days to be able to detect with sequencing.

So, what we’re looking for is the decline starting to slow? Is it a sharp decline or is it more of slow decline? And that’s based on a number of different factors. As Mike always says, coming down the mountain is quite bumpy and it takes a long time to get down.

You’ve actually heard us say that over several peaks ago but with BA.2, we’re trying to keep an eye out very closely to detect any signals that we may start to see an increase again. We don’t see that yet. So, that answer, as Abdi said, we don’t know yet and I think it’s really important for us, as we speak, we speak telling you what we know, telling what we don’t know and telling you what we’re doing to find out.

00:22:09

I have been a little bit concerned. If I could just take a moment to say, I’ve been a little bit concerned about some of the public comments that we are seeing out there with people speaking with such certainty. There’s still a huge amount of uncertainty.

We know a lot about this virus but we don’t know everything and, quite frankly, the variants are the wildcard. We are tracking this virus in real time as it mutates, as it changes and we have an excellent group of people around the world who are working with us to do that, but this virus has a lot of room to move.

Omicron is the latest Variant of Concern. It will not be the last Variant of Concern that WHO will speak about. The next one that will come, hopefully it will take some time to get there but with the level of intensity of spread, the possibility that we will have other variants is really high. So, we need to ensure that we, again, not only increase vaccination coverage but we also take measure to reduce the spread.

AK          Thanks so much to both of you. You also answered Dianne Tenney-Adams’ question about reinfection between Omicron and BA.2, so we got two questions answered at the same time.

Some people are asking about if we know the scale of infections in people who had three doses and those countries that have introduced, heavily, booster doses. Do we see any different epidemiological trends in those countries?

00:23:36

MK         Maybe, I could start. We do see a very significant difference in individuals who are vaccinated with one dose, two doses and some people have had three doses as the primary course of their series, a significant reduction in hospitalisations and deaths. This is from Omicron, from other Variants of Concern, and I think that’s one of the biggest factors that is really, really critical that people hear out there.

When it is your turn get vaccinated and fight, as much as you can, for vaccine equity around the world for others so that they receive their first and second doses. There are some differences in terms of the vaccines that are out there. There are several WHO Emergency Use Listing that we have approved and there are more that are being evaluated but whatever vaccine, if you are offered, please get vaccinated when it is your turn.

If you’re offered a booster, you’ve also heard us say take that booster but, again, fight for what you can to ensure that vaccines are reaching people around the world. We evaluate vaccine effectiveness several different ways and we are working with several different groups, our technical advisory groups who are assessing this information in real time with the manufacturers, as data comes out from the manufacturers, as well, and we try to summarise this each week on our website.

00:25:05

We have these very detailed tables that go out and actually describe each study and say this is the study that was done, this is how many people that were followed, this is what they were measuring and this what we see in terms of efficacy.

But, bottom line, people who have been vaccinated are significantly less likely. I don’t know the actual numbers, 20 to 97 times more likely not to need hospitalisation or die if they’re vaccinated compared to those who don’t. So, there’s a real importance that we still make sure that everybody receives their vaccines.

AK          Thank you so much, Maria. Abdi, please go ahead. Sorry.

AM         I just want to add on that because sometimes we mix between the individual protection and the population protection. If you look at the individual level, your saving account needs to go up and that’s by protection. How do you invest in that? Getting the first dose, the second dose and some other people a third dose.

Every time the body sees these foreign bodies, it says this is serious, let me think on it. It puts an investment to produce antibodies but after time it says I have thousands of other diseases that I need to worry, it goes down. Then, you get again a second dose, it says, wow, this is serious. Let me take it serious again. Then, when you expose it again to the third time, it’s like, wow, this is dangerous because I need to invest more, maintain a high level of quality antibodies, T cells, B cells because I’m exposed to that. So, at an individual level we talk about that.

00:26:45

Then, at population level and that’s where a lot of the discussion that is so hard to explain, talking about the epidemiology, about the severity, it really depends how much population. So, sometimes comparing one country to another country, it beats the whole purpose. When you have a young population who had three waves that was not mitigated and high level of a vaccination, like South Africa.

We’ve been saying South Africa may have a high population level. Because of South Africa, someone else starts complaining. Another country has an elderly population, not vaccinated well and they haven’t been exposed to the natural illness. So, it’s a complex interplay of you’re individual, the type of vaccine you get, the booster and the environment where you live and other measures you do.

So, in short, it’s very hard to make a comparison between one country to another because it’s very unique for that country and for its population. But, at individual level, absolutely, as Maria said, you need to get vaccinated. If you’re in a country that you are lucky unlike the three billion of the world where you don’t have the luxury of getting even the first dose, if you’re in those countries with the vaccine, please get as per the recommended things to protect yourself.

00:28:06

MK         It’s not related to the actual question but it relates to something Abdi said here. Countries are in very different situations in terms of what they are able to do right now and they’re looking to each other to say should I follow this model? Should I follow what the UK is doing, or the US is doing, or Denmark is doing, or South Africa is doing?

What we are asking countries to do is to really assess where they are. Where are they in this pandemic in terms of the amount of infection that has circulated, population level immunity, vaccination coverage and in particular vaccination coverage among those who are most at risk, not just the proportion of the population but is it really the right section of the population that is vulnerable and what is the plan?

What are their access to tools? What is the relationship that they have with their people in terms of trust, in terms of the society’s ability to follow and to be enabled to follow the recommendations that are being outlined. There is no one solution fits all out of this pandemic but we do know what works. We know the elements and the tools of what works.

The implementation is what will vary and I think that’s what we’re trying to think through into this year. We’re not looking at revamping the strategy for COVID-19. What we’re looking for is adjusting it and how do we take into consideration what needs to be done, what can be done given the massive economic livelihood toll and human toll that this pandemic and the fact that everybody is ready to be done with it.

00:29:44

Unfortunately, this virus is not done with us, so we have to really remain vigilant. That doesn’t mean lockdown, it doesn’t mean shutting down societies. What it means is applying the tools that countries have at their disposal to save people’s lives now.

At least 68,000 people died last week from COVID-19 that we know about. They don’t have the opportunity to move on, nor do the 5.7 million people who have died so far. Let’s turn the tide. Let’s change the trajectory of this with the tools that we have.

Now, we may not be able to prevent all infections but we can prevent people dying right now. So, this is what we are asking. What the Director-General has been asking for is a recommitment to this while we balance the response. Increase vaccination coverage, get people into the clinical care pathway, protect our health workers, while at the same time reducing the opportunity for this virus to thrive, not even to spread but to thrive.

We are still allowing this virus to circulate, in some situations, unchecked and that’s dangerous and we shouldn’t be doing this three years into this pandemic. Now is not the time to raise the white flag. Now, is the time to use these tools more effectively and for governments to support people in being able to keep them and their loved ones safe.

AK          Thanks, so much Maria. We have a question from Sara Downs. Do we expect masks to still work against this transmissible virus?

00:31:13

MK         Short answer, yes, we do, but masks need to be work properly. We have advised on the use of masks, a three-layer mask with the right types of materials that has the right filtration, the right breathability. Just a piece of fabric is one barrier but if you have a three-layered piece of fabric, with the right filtration, with the right breathability that is fit properly over your nose and mouth, that offers more protection.

We know that respirators offer more protection, which is why health workers are wear respirators when they’re caring for suspected or confirmed cases of COVID-19, and they still do work against Omicron.

Omicron is incredibly effective at transmitting between people but these tools work. So, this is also why we are recommending to continue to wear masks, particularly when you’re in close proximity with other people but especially when you’re indoors, and even if you’re vaccinated because vaccines are incredibly protective against preventing severe disease and death but they don’t prevent all infection, so they don’t prevent all transmission.

Even though they are effective at doing that, they’re not 100% effective in that case. So, please continue to wear you mask and make sure you have clean hands when you put it on and take it off.

AK          Thank you so much, Maria. Abdi, maybe this one you can take. Ella O’Neal Belch is asking what are the best precautions to take if you can’t have a vaccination?

AM         If you can’t?

AK          If you can’t have a vaccine.

00:32:41

AM         That’s a tough one. I think there are multiple. In the first two years we didn’t have vaccine and we were able to beat this virus, so the measures at the individual level, at the community level, the family, there’s a lot of things that you can do and the loved ones can do.

We have not a good proportion but a certain proportion of the population that for the underlying reason, whether it is congenital, that may not be able or allergic. So, what I would recommend first is discussion with your physician because your local physician will really know your profile and what kind of medication they can give.

The good news right now, we have good, good medication that came down, from the monoclonal antibody, to the oral antiviruses, a lot of things that we can offer you and the vaccine platform is changing so much. Our advice is continue protecting yourself. As Maria says, masks do work. Avoid those risky settings, we say crowded places, reducing that risk and then discussing with your local clinician, out of the monoclonal antibody, the new therapeutics, which one.

I think even among the severe immunocompromised patients have been given vaccines, unless you are allergic to it. So, vaccine will be the best shot for it but it’s a unique situation and I recommend to discuss with your local physician about other measures. But, the preventive measures we applied for 1.5 years before we had a widespread use of vaccine worked and saved lives, so continue doing that.

00:34:24

AK          Thank you so much, Abdi. We have a next question from Ria Deshpande, asking, and she’s not the only one actually, about the effect of Omicron on other body organs and long COVID after Omicron, if you have any new findings from research.

MK         There’s a lot of work underway of better understanding Omicron and the diseases that are caused. We haven’t seen a change in disease profile in terms of the type of science and symptoms and, as I said, on average the risk of hospitalisation is less compared to Delta, but we still see the full spectrum of disease.

There are many clinical studies that are underway and we encourage countries to continue to use the clinical platform that we have established which collects standardised data, so that we can actually look at this in a real robust way.

There’s a lot of questions that we receive every day on long COVID, post-COVID condition. Again, Omicron has only really been circulating for a short amount of time. It takes some time for people to be infected, to go through the full disease and then what we’re looking at when we look at post-COVID condition, that’s usually around 90 days after symptoms resolve, where people are seeing a lot of longer-term effects.

00:35:41

There really isn’t any indication to suggest that we would see a difference in the percentage of people that may suffer from long COVID but we don’t have a full understanding of long COVID yet. There are people that are around the world that are looking at how SARS-CoV-2, this virus, and all of the different variants affect the body and the different organs of the body.

We are learning that people who are suffering from post-COVID condition, it affects all organs of the body, different organs of the body, not all organs at the same time, and range in severity from people not able to catch their breath, not able to exercise anymore.

We’ve seen some studies come out look at cardiac effects a year out but this data is coming online and we need to make sure that we have good cohorts of studies, these studies of individuals who are suffering from post-COVID condition or may be suffering from post-COVID condition around the world, not just in high-income countries but in countries all over, but we don’t have a full picture of this yet.

I do think that people are starting to pay attention more to post-COVID condition. This is something that we, as WHO, have been working since the first six months of the pandemic and we’re very grateful for the groups that reached out to us who said, look, we need people to recognise that this is real.

We need good research on this. We need good care, clinical care of dealing with the short-term and the long-term effects and we need to make sure that there is good rehab. This is something WHO is committed to with our Clinical Management Pillar under Dr Janet Diaz. We’ve had a lot of seminars, we’ve had research studies established but it’s a work in progress. We do not have the full picture of this yet.

00:37:23

This is another reason why we want people and governments and everyone to focus on prevention of getting infected in the first place because that is better in terms of any effect, short-term and long-term, but we don’t have the full picture of this yet. We don’t know everything yet on post-COVID condition.

AK          Thank you so much, Maria. Abdi, please.

AM         I just wanted to add that most of the time when people talk about COVID you think is the upper respiratory disease. Unfortunately, COVID is a systemic disease and that nuance a clinician can understand, someone checking. For the public, it looks like because you just presented with sneezing or a cough, it affected there. Unfortunately, it affects almost every part has been documented a complication. Whether it is the virus, itself, or our immune system starts misfiring, we really don’t know. There’s a lot of research going on.

The progression of those complications, Maria just alluded to this excellent paper that was published in Nature. Literally, it was affecting every part of the cardiovascular system one year down and later. So, the risk and complication from COVID, when we see it is not as a respiratory pathogen. Of course, that’s the way of entry, but it’s affecting every part of your body because of the vessels. It can cause vasculitis. The virus is so complicated, that’s why we say the only way you can do it is get vaccinated and continue preventing it yourself, preventing it yourself with those public health measures.

00:38:58

MK         What we have to look at is people who are infected and have COVID-19, people who are suffering from longer-term affects that we are just learning about but those long-term effects could be a few weeks, they could be a few months, they could be a few years. We don’t know what that is yet.

So, as an organisation, as WHO, with governments we need to plan for the longer-term. So, it’s not just now and, again, we’re thinking into 2022 and how we end the emergency of this pandemic, but we have to plan and we are planning for the longer-term and how we deal with the effects of this.

And, we have to think not just COVID but mental health effects and effects for people who have not received other vaccines for vaccine-preventable diseases, people who didn’t get the care that they need for cancer or for other treatments.

So, this is obviously quite a complex situation that the world is in, that countries are in but this is all the more reason why we need to end this emergency of COVID-19 and we have to end it as quickly as possible. It’s in our hands and we need everyone out there.

Some people may think what can I do to help? You can get vaccinated, if you have access to the vaccine. You can also take measures to prevent you from getting infected because it’s not just even about you and we want to protect you but we also want you to protect your family.

00:40:20

We also want you to alleviate pressure on the health systems because if you get infected and you need clinical care, you take up that bed, as you deserve to take up that bed, but you take that bed from somebody else who may need it for another reason. It has a domino effect and this is why it’s so critical that we really work to end this emergency this year.

AK          Thank you both. Speaking of prevention and protection individuals but also protecting populations and as Abdi explained that COVID is a systemic disease, way more complex than we think as individuals. Last week we had some social media posts published that Omicron is not a common cold, so our viewers are asking if it is not a cold, why do we have countries saying that they are going to treat COVID like a cold and from middle of February they are going to release all restrictions including wearing masks?

MK         This is a complicated question. I think it was the Wordle.

AK          Yes.

MK         I am probably the only person on the planet that doesn’t know what that is. I apologise to my family. They keep sending me things but SARS-CoV-2 is a coronavirus and the common cold viruses are coronaviruses, so there are people that are out there that think that this virus may become more like the common cold in years from now. And, that may very well be true but we’re not in that situation yet.

00:41:50

SARS-CoV-2, Omicron, the latest Variant of Concern, is not the common cold. It still causes severe disease in many individuals and with the huge number of cases that we’ve seen, we still too large of a proportion of people needing hospitalisation and dying from this. So, it is not the common cold. I forgot the second part of your question.

AK          We are seeing some countries lift all restrictions.

MK         I think countries are taking decisions based on the situation that they’re in and countries are in very different situations. They are looking at the population level immunity that they have from infection and from vaccination. They’re looking at the capacities that they have to respond, to detect, to impose measures, to lift measures.

They are looking at that adjustment and they’re looking at different ways in which they can apply tools. We are recommending that countries be cautious and to continue to use measures. I am not meaning lockdown, where you shut down society, where you lock people away, that is not what we are talking about, but to use tools to continue to drive transmission down.

Countries have to take those decisions. We issue guidance but the policies that countries take are up to the countries themselves. We are working with them to ensure that they protect their own people but, again, COVID-19 is a global problem. It’s a pandemic and it needs a global solution. So, what we look at is, on the whole, what tools need to be applied and we’re working with countries how they best implement them.

00:43:25

But, we are asking countries to continue to be cautious and individuals to continue to be cautious as we go forward. Again, it will not be forever. You will not need to wear a mask forever. We will not need to physically distance forever but, for now, it’s really important that we be careful.

AK          Sorry, Abdi.

AM         Thanks. I just want to add why some countries can take those measures. There’s a competition between our immune system and the virus and unfortunately the virus, the way it is mutating, they say RNA virus, it has a good RNA enzymes that proofreads them.

Unfortunately, Omicron has shown that whatever our wishful thinking, it is always, so humility is required when predicting the future because nobody knows what is going to happen and the next variant is going to happen.

Yes, we want to build our protection, build the population immunity to a certain level that even the next variant will not land and not cause damage. So, it’s the key unlock, as I just alluded earlier on.

The variant will come and unlock and get a smarter key. You have to start and design the lock again and then lock. But, if you put fire extinguishers, and that’s what a lot of the countries are doing. They have built every floor of their houses in the community they have fire extinguishers. Once the variant comes and it starts, they will be able to switch.

00:44:48

But, unfortunately, it is a copycat because what certain countries have done, you don’t have any fire extinguishers, you don’t have a health system, you don’t have anything but because of the pressure you are seeing you want to take that. So, what we are calling that, still at individual level, a country can decide but at the end of the day it’s your individual risk that is going to matter.

Population and policy, later they will be balancing public health, socioeconomic, all that into consideration. So, you continue at an individual level with your measures so that you protect your loved ones, and getting the necessary vaccination because we really don’t know what is going to happen. I wish we knew what variant is going to come but Omicron showed us that nature will always beat us, so we just need to build that defence.

AK          Thank you, Abdi. Maybe you can take this question from Arsela Kuriskova. How to treat Omicron? Just stay at home and take paracetamol and wait if it gets worse or better?

AM         For WHO we issued several guidance. We have our Clinical Management and we also have Home Care but I would really encourage her to get contact with her, because we have seen a lot of young people who are healthy quickly deteriorating. So, being in touch with your healthcare provider. It can be managed safely at home care level by a lot of things we have in our guidance but the first thing is to be in touch with your healthcare provider and that’s who will guide you when you need referral because the assumption because you are young and healthy, you can beat it, Omicron is a systemic disease that requires close management by a physician.

00:46:30

MK         It’s important what Abdi has just said because a lot of people ask us for individual-level advice and it’s very difficult for us to sit here to give individual-level advice because people are different. They have their age, their underlying conditions, whatever it may be.

So, I just want to emphasise what Abdi has just said, to speak to your physician. We issue, as he said, clinical guidance that works with ministries of health and hospitals to outline what is the best course of clinical care based on what people have, if they’re pregnant, if they’re not, if they have underlying conditions.

I get a lot of text messages from friends and family that says I have a family member or a cousin that’s having this. Always, my advice is to speak to your doctor because we don’t know the full situation. So, I just wanted to highlight that we cannot give individual-level advice in a setting like this but please to talk to your doctor because every situation is different.

AK          Thank you both. We’re coming slowly to an end and I have maybe a question or two before we close. We received, actually, several questions today about Omicron and children. What are the trends? What do we know? Then, there was a question in particular, as you touched upon long COVID. What do we know about long COVID in children? Is it possible and how often does it happen?

MK         In general?

AK          Long COVID in children.

00:47:56

MK         With regards to what we’re learning about Omicron, again, we’re still learning every day something new about this. We know that children can be infected with SARS-CoV-2 virus whatever variant is circulating and this is certainly also the case of Omicron, as well.

What we tend to see, when we see a new Variant of Concern circulating, we tend to see trends in different groups based on social mixing patterns. We saw this with Alpha, we saw it with Beta, we saw it with Gamma, we saw it with Delta, and we see it with Omicron.

So, the groups that are out and mixing will have higher rates of infection, just for the sheer fact that they’re in contact with each other. We do see this among school-age children because children are back at school. Children overall, and including with Omicron, tend to have less severe disease compared to adults. That’s certainly the case.

More often they have asymptomatic infection, meaning that they don’t have any symptoms at all. Those trends still continue but we do see children requiring hospitalisations and there have been some instances where we’ve seen hospitalisations increase in paediatric populations, under five.

But, as we have seen Omicron circulate, we are also seeing other respiratory pathogens circulate, so it complicates the picture. We see RSV that is circulating, which tends to be a respiratory virus that infects young children or younger children, and influenza is back.

00:49:23

Through our GISRS, through our Global Influenza Surveillance and Response System, we are tracking influenza, as we have been for decades, and in 2020/2021 influenza circulation was minimal if not wiped out but we are now starting to see increasing trends again.

So, this will complicate pictures and speaking as a mom of two young boys who always seem to have something, a runny nose or something, not COVID-19 because we have access to tests here. We are very fortunate for that. Maybe not RSV, maybe something else.

So, it does complicate the picture in terms of what is circulating. I mention that particularly because of kids, because kids tend to mix and it’s very difficult for children to wear masks and keep them on, although we are seeing that they can. I’m not saying that they can’t. To keep their physical distance is also quite challenging.

But, we’ve seen many, many schools around the world and I do want to emphasise how important it is for children to be in school, for their education, for their safety, for their wellbeing, and many around the world have shown how they can open schools and keep schools open by taken measures of having good surveillance in schools, having good environmental controls, of disinfection, of improving ventilation, wearing masks, making sure that the staff are vaccinated and, as well, keeping transmission down in the communities. So, that there is a lot that we are learning.

00:50:46

On long COVID, we do know that children can get long COVID. Again, we don’t have a good estimate of what proportion of children will have these longer-term effects. We know that it is possible. That’s not to scare parents out there but, again, it’s just to re-emphasise that we need to do what we can to reduce the spread. Abdi?

AM         Maria, you covered it very well. In some countries vaccination is recommended, so if it is recommended please get the vaccine because the complication of COVID, it is far much outweighed by the vaccine that you get. So, vaccines in those countries that is recommended, please vaccinate children.

Children do get COVID. Unfortunately and sadly, some of them tragically have died. The death of one child is sad for everybody, for the whole community. So, where those countries have recommended these are safe and effective, they have been studied, and children are receiving all the immunisation, as I say, please get vaccinated to protect your loved ones.

However young they are, they can get it and the lottery of how the body immune system is going to react, nobody can tell. We have seen almost 800 children I think in the US who died suddenly. So, children can get infected, they can get hospitalised, can get severe like anyone of us. Luckily, the vast majority of them don’t end up dead but that 0.1 in a big population is a big number, so please, please vaccinate your children where those countries recommend it.

00:52:21

For us, we have our criteria as WHO, with 194 countries who want to vaccinate their 3.1 billion people and others who are the highest risk, the healthcare workers, but in some countries in the world, it is not the same situation. So, if you’re in a country where vaccination for children is offered, please vaccinate your kids.

AK          Thank you both for very insightful answers today and to all our viewers for their great questions. I will summarise the last one. It kind of came from different people, so I will put it in one. What’s the way forward? Has Omicron reached its peak? And, will we be freer once the spring comes? Would you like to start with that one?

AM         Yes, we can be freer if we build population immunity and solidarity. Unfortunately, what we have seen again and again is the community and brothers and everyone going with politicisation and the nationalism has not helped that. If the ten billion that has been equally distributed and everyone, there was march, this hostility against this vaccine would have been different.

So, the virus will continue. We can’t predict with the virus. Viruses will continue doing what they do but it is the human behaviour that can change the trajectory. I’m a firm believer in the objective. Recently, I saw a Japanese proverb someone shared. What happens when you sit on a rock for three years? It eventually gets warm.

So, we need to sit tight. It will get better but it’s not the time to relax. We need to get ready and improve that. So, three years, that’s what the Japanese said. Maybe I am misquoting there but we will get there and we will come there and we will talk about the days of Omicron and the days of Delta, the five movies we watch after winning the series maybe, but the only way out is we need to have a high level of population immunity and that is only way I can see forward.

00:54:26

AK          Thank you, Abdi. Thank you for joining us today. It was really great to have you with us. Maria, your thoughts for the end?

MK         I think we certainly can be in a better place in the spring, Northern Hemisphere spring, but it is up to us. We’re looking at several different scenarios going forward. In one of the scenarios, not mutually exclusive, but what we expect to see is that this virus, the transmission will significantly reduce. With the tools that we have, we can significantly reduce transmission, and this virus is well on its way to becoming endemic at a global level. We’re not there yet, but it’s well on its way.

We expect to continue to see flare-ups in populations who are not well-protected, whether they haven’t had the vaccine, they refuse the vaccine, and we will still see outbreaks of people who are not well-protected.

We could go forward and start to see seasonal patterns with SARS-CoV-2. It’s a respiratory pathogen, so we eventually expect to see some kind of seasonal pattern similar to what we see with influenza but, again, we’re not there yet. The virus is taking opportunities to spread and to thrive and we are providing it plenty of opportunities to do so.

00:55:37

But, this may mean we will need some more vaccines in the future and there are a lot of vaccines that are still in development and underway and that research needs to continue, but the big wildcard right now are the variants, and that is what makes us so uncertain about the future.

Having said that, we have incredible hope and you hear us always speak about this hope. We have to use the tools at hand and we have them at hand. What we need to make sure is that we have the solidarity around the world to get the tools in the hands of everyone, not just in what we call the haves versus the have-nots. The divergence in which people around the world have access to tools and those who have not is getting bigger and we need to close that gap and that is up to us.

So, two sides of the equation. Increase vaccination coverage among those who are most at risk in all countries, not just in some countries. Use the vaccines that we have effective, appropriately, morally correct, ethically correct and that will have a massive impact as we go into this year.

As we continue to go into this year, we can take the death and disease out of COVID-19 and by the spring we could see a significant reduction in that, tangible, saving people’s lives now. But, we also, on the other side of that equation have to drive transmission down.

If we don’t, we will continue to see variants and the next one could be more severe. There’s no guarantee that variants that will continue to emerge will be less severe. They may but we can’t really sit back and just wait for that happen. It is up to us. It continues to be up to us.

00:57:13

So, we are cautious, we are hopeful, we are nervous but it’s up to what we do and every single person out there has a role to play. I’m a broken record on this and I will continue to be because what we also want people to feel is to be empowered, to be empowered to do something about your life and the life of your loved ones.

Get vaccinated when it’s your turn. Continue to adhere to measures to reduce your exposure. And, we do need governments to have policies that make sense in their countries and we are there to support governments in implementing those and adjusting those as we enter this third year of the pandemic.

AK          Thank you so much, Maria. It was really a great pleasure to have you both today and I really thank all our viewers for great questions, I think it was a great variety, and for watching us from Kenya, Cameroon, DRC, Chile, Iran, India, Nigeria, South Africa, Luxembourg, Zambia, Poland, Canada, US, Turkey and many others. Please, stay safe, feel empowered. There’s a lot that each of us can do and, until next week, please follow us on our social media channels or website for any further updates on COVID and its Variants of Concern, including Omicron and its sub-lineage, BA.2. Goodbye.

00:58:34