Must Read : WHO Covid19 expert Aylward speaks on how to break down the pandemic

  • Senior advisor to the Director-General of the World Health Organization (WHO) Bruce Aylward talks testing and how to break the COVID-19 transmission chain.
  • Lockdowns will likely last more than two weeks.
  • To hold off a second wave, governments must rapidly find and test suspect cases, isolate and treat confirmed cases, and quarantine others.

The COVID-19 pandemic is surging around the world and China is preparing itself for a second wave of infections. World Health Organization Director-General Tedros Adhanom Ghebreyesus told G20 leaders this week, “The pandemic is accelerating at an exponential rate.”

Bruce Aylward, senior advisor to the WHO Director-General, says governments must keep their populations under lockdown while chasing down every suspect case for testing, and treating and isolating those who test positive.

Below is an edited transcript of my conversation with Bruce Aylward, which you can listen to in full here. Subscribe to our World vs Virus podcast here.

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Many of the people listening to this are in some form of lockdown and will want to know how long will it last.

Well, probably the best indicator of how long this might last comes from China, because it’s the only country that has truly taken a rapidly escalating COVID-19 outbreak and really turned the corner and brought it down.

And if you look across China, across the 31 provinces, all of which were affected at one point or another, the longest and most difficult, of course, was Wuhan, which remains locked down. It will be nearly 10 weeks by the time they will have lifted there – all of February, March, and much of April. Now, there are many other provinces, however, that were able to manage this with a much shorter shutdown period, that ranged anywhere from a month to two months. It really depends on the context how well control measures bite or take the heat out of this outbreak. But it will be more than a couple of weeks anywhere, almost definitely.

That doesn’t sound too long. I guess the risk we’re all worried about is a second wave. People keep quoting the Spanish flu pandemic from a century ago.

There’s really two scenarios you could think of. What countries have done with all these slowdowns and shutdowns in workplaces and educational institutions and in society is they really slowed down the rate of increase of the COVID outbreaks. But they actually haven’t broken the transmission chain. That really requires finding every single case, testing every suspect case, confirming them, isolating the suspect cases, quarantining the others. And you really have to do those transmission chain-level measures as well as the big shutdowns and slowdowns and lockdowns if you want this thing really to turn around.

So, when I give an optimistic timeline, it’s if you were doing all of that. Now, most countries are scrambling just to get the big measures in place just to treat the most severe patients. And that’s what worries me a little bit in the West, that it might take a little bit longer to take the heat out of this thing. But I always want to be careful because we’re dealing with a biologic process that’s happening in the context of changes in seasons and other factors that just make some of this, frankly, unpredictable. The key thing right now is doing as much as you can to save lives, it means training people. But it also means trying to slow down that outbreak at the same time.

On the testing issue, there seem to be different interpretations around the world of what should be happening. What is the World Health Organization’s recommendation for testing? Is it test everyone you can? What is the recommendation?

Well, that’s a really good question because there’s a lot of interpretation even of our recommendation. So, let’s try and set that record straight. What you do in a situation like this is always test the suspect cases. You don’t want to test everybody because, number one, it will waste a lot of resources because a lot of people won’t be infected. The other thing is it gives a lot of people a false sense of security. They’ll think, ‘Oh, the test was negative. So, I’m safe.’ And you have to take any tests like that in the context of the risk.

If you test a whole bunch of people who aren’t safe the test will tell you, usually, that they’re not safe, but then you can have false positives, false negatives, all sorts of problems. So, what you really want – for the reasons of issues around the test itself, but also issues around the amount of resource available – is to test the suspect cases.

What our recommendation is: test, test, test. But test the suspect cases because it’s like that old story – my family’s getting sick of hearing this one – but, you know, they once asked that famous bank robber, Willie, ‘Why do you rob banks?’ And he says, ‘Well, that’s where the money is.’ And so, why do you test suspect cases? Because that’s where most of the COVID virus is. So, you find those and if we test everyone else, we’ll have a lot of other problems, frankly.

And if we don’t test in the way you’re suggesting, that will increase the risk of a second wave?

Well, what’s going to happen is that people are getting advice that says if you feel unwell or you think you might have caught it, stay home until you feel better. Now, the reality is they may well have COVID. If they stay home, first of all, and they’re not sure they have COVID, they won’t take the incredible precautions necessary not to infect the rest of their family if they live with people. But the bigger problem is that within two or three or four or five days, they’re going to feel a lot better and they’re going to say to themselves, ‘Gosh, I heard COVID was a terrible disease. So, I must have just had a cold or something.’ And I’ll wander back out there into society and supermarkets and other forums. And what’s going to happen, though, is they can still infect people because even though you feel better, you can still be infectious for up to 14 days and possibly even longer after you’ve recovered from the disease. So, for that reason, we really want people to know their status because it just helps them be better citizens and take better care of themselves and their families.

We saw that Spain’s death rate, following Italy’s, overtook that of China’s. Is there any way of saying why those two countries are getting it so heavily? Or is it just the way of these things and many other countries will be going down that route in a week’s time or so?

Well, there’s a combination of factors. When we look at a country like Italy or Spain and we think, ‘Well, why did they get so badly hit?’ Part of it is just temporal. But by that, I mean timing. They got hit earlier than some of the others. And then some of the high death rates that we’re seeing, etc. can be associated with multiple factors. We hear about this in the news all the time. Italy is the second oldest population in the world after Japan, of course. It can also be the fact that we’re mainly seeing the severe cases that are hitting the hospitals and not all the mild cases are getting tested. So, we have a falsely high death rate and there’s other factors that can be at play as well.

What I always remind people is all of that is happening against a background of biologic processes in large populations that we don’t fully understand. We’ve known this disease for 12 weeks. Even diseases that we’ve known for decades, we still don’t know everything about why they express themselves in different ways and different populations. But what we have learned is this virus has the propensity to cause severe disease, societal disruption, massive outbreaks, economic disruption in any environment. We’ve seen it now in the Middle East. We’ve seen it in Asia. We’ve seen it in Europe. And what it tells us everywhere is: be prepared, be ready, take every step you possibly can to try and prevent the explosive outbreaks we’re seeing in places like Spain and Italy.

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