Coronavirus COVID-19 - Global Health Emergency #4

[dixiegirl1035]

I knew if they found a vaccine right away that this was a bio attack on china. I believe they had a vaccine all along before releasing virus in China. I am not a conspiracy theorist but that's what I thought last week when thinking about it. I'd like to see who has stock in that co.

Heck, when I heard that they (not this company, others did) had sequenced the virus in a week I was flabbergasted. But I guess that is where technology is these days... I can't fathom it yet that's where technology is today. Unreal to me.. but it is what it is.

Partners and collaborators include ApolloBio Corporation, AstraZeneca, The Bill & Melinda Gates Foundation, Coalition for Epidemic Preparedness Innovations (CEPI), Defense Advanced Research Projects Agency, GeneOne Life Science, HIV Vaccines Trial Network, Medical CBRN Defense Consortium (MCDC), National Cancer Institute, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Regeneron, Roche/Genentech, University of Pennsylvania, Walter Reed Army Institute of Research, and The Wistar Institute. For more information, visit www.inovio.com.

ETA-Sorry, I see your question was who are stockholders... not savvy enough to know difference between partners and/or how to know who stockholders are. But their stock has gone UP

 

[Medstudies]

@dixiegirl1035

according to GCP Guidelines: (Good Clinical Practice -as part of the Declaration of Helsinki)

https://www.who.int/medicines/areas/quality_safety/safety_efficacy/gcp1.pdf
Basic principals:
respect for the individual
right to self-determination and the right to make informed decisions regarding participation in research, both initially and during the course of the research.
The investigator's duty is solely to the patient or volunteer , and while there is always a need for research, the subject's welfare must always take precedence over the interests of science and society and ethical considerations must always take precedence over laws and regulation”


“Research should be based on a thorough knowledge of the scientific background , a careful assessment of risks and benefits , have a reasonable likelihood of benefit to the population studied and be conducted by suitably trained investigators using approved protocols, subject to independent ethical review and oversight by a properly convened committee .
 Information regarding the study should be publicly available.
 Experimental investigations should always be compared against the best methods, but under certain circumstances a placebo or no treatment group may be utilised .
 The interests of the subject after the study is completed should be part of the overall ethical assessment, including assuring their access to the best proven care . Wherever possible unproven methods should be tested in the context of research where there is reasonable belief of possible benefit

 a final rule was issued on April 28, 2008 replacing...”

- the Belmont Report is also worth a read...
Regulations

(I posted all of this in previous threads.. ) will try to find)




http://www.jirb.org.tw/DB/File/Download/970127-03_History and Principles of Good Clinical PracticeTaipei_Christine Maure.pdf

 

[dixiegirl1035]

@dixiegirl1035

according to GCP Guidelines: (Good Clinical Practice -as part of the Declaration of Helsinki)

https://www.who.int/medicines/areas/quality_safety/safety_efficacy/gcp1.pdf
Basic principals:
respect for the individual
right to self-determination and the right to make informed decisions regarding participation in research, both initially and during the course of the research.
The investigator's duty is solely to the patient or volunteer , and while there is always a need for research, the subject's welfare must always take precedence over the interests of science and society and ethical considerations must always take precedence over laws and regulation”


“Research should be based on a thorough knowledge of the scientific background , a careful assessment of risks and benefits , have a reasonable likelihood of benefit to the population studied and be conducted by suitably trained investigators using approved protocols, subject to independent ethical review and oversight by a properly convened committee .
 Information regarding the study should be publicly available.
 Experimental investigations should always be compared against the best methods, but under certain circumstances a placebo or no treatment group may be utilised .
 The interests of the subject after the study is completed should be part of the overall ethical assessment, including assuring their access to the best proven care . Wherever possible unproven methods should be tested in the context of research where there is reasonable belief of possible benefit

 a final rule was issued on April 28, 2008 replacing...”

- the Belmont Report is also worth a read...
Regulations

(I posted all of this in previous threads.. ) will try to find)




http://www.jirb.org.tw/DB/File/Download/970127-03_History and Principles of Good Clinical PracticeTaipei_Christine Maure.pdf

Thanks for this. In the upcoming future, as the WHO is trying (with the exception of answering why china has changed definition/reporting patterns 3-4 days ago) to be transparent... they will have to tell the world if they are going to do vaccine studies with some folks getting a placebo? We'll see how this is handled as I cannot recall at all how they did this with the Ebola disease.

Time will tell, and so much new.

WHO presser to start in 5 minutes, unless delayed for the 3rd time today.

ETA - The WHO sit rep is not out for today yet, Novel Coronavirus (2019-nCoV) situation reports guess they are waiting until after the press briefing.

The live feed is now live.... looks like they have moved to an lecture hall media room type setting

 

[Medstudies]

Thanks for this. In the upcoming future, as the WHO is trying (with the exception of answering why china has changed definition/reporting patterns 3-4 days ago) to be transparent... they will have to tell the world if they are going to do vaccine studies with some folks getting a placebo? We'll see how this is handled as I cannot recall at all how they did this with the Ebola disease.

Time will tell, and so much new.

WHO presser to start in 5 minutes, unless delayed for the 3rd time today.

ETA - The WHO sit rep is not out for today yet, Novel Coronavirus (2019-nCoV) situation reports guess they are waiting until after the press briefing.

The live feed is now live.... looks like they have moved to an lecture hall media room type setting

Anytime! When you have time...

Experimental Ebola Vaccine Trial - Full Text View - ClinicalTrials.gov

phase1


Phase 1 Trial of Ebola Vaccine in Mali - Full Text View - ClinicalTrials.gov
And

For the first time, clinical trial data show Ebola drugs improve survival rates


“The announcement marks the first time a clinical trial has successfully shown that an Ebola therapy improves survival in people who have been infected.

Two other therapies used in the clinical trial performed less well and will be discontinued.

The therapies that have improved survival rates are REGN-EB3, a cocktail of three monoclonal Ebola antibodies made by Regeneron Pharmaceuticals, and mAb114, a single monoclonal antibody developed by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health. The clinical trial will continue comparing these two drugs in Ebola .’

Enrollment for trials began in 2003 ...

 

[dixiegirl1035]

Anytime! When you have time...

Experimental Ebola Vaccine Trial - Full Text View - ClinicalTrials.gov

phase1


Phase 1 Trial of Ebola Vaccine in Mali - Full Text View - ClinicalTrials.gov
And

For the first time, clinical trial data show Ebola drugs improve survival rates


“The announcement marks the first time a clinical trial has successfully shown that an Ebola therapy improves survival in people who have been infected.

Two other therapies used in the clinical trial performed less well and will be discontinued.

The therapies that have improved survival rates are REGN-EB3, a cocktail of three monoclonal Ebola antibodies made by Regeneron Pharmaceuticals, and mAb114, a single monoclonal antibody developed by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health. The clinical trial will continue comparing these two drugs in Ebola .’

Enrollment for trials began in 2003 ...

Interesting. So the first stage was to inject new novel vaccine into 27 volunteers just to see if antibodies are developed and safe.. for up to 52 weeks following. I get it now. The study doesn't inject and expose them.. they monitor the success with monitoring their serum for antibodies on healthy folks that aren't going to be near a contagious person. Thanks for the education on how this works and the opportunity for learning more.

 

[gregjrichards]

First coronavirus case 'is confirmed in London as Chinese national tests positive'

First coronavirus case 'is confirmed in London as Chinese national tests positive' | Daily Mail Online

 

[dixiegirl1035]

Per WHO presser (ETA's to follow)

• Cambodia has agreed to accept the cruise ship Westerdam. Will arrive tomorrow.
• 2 day meeting has concluded
• working on easy to apply diagnostics, treatment, vaccine candidates, and how to address infodemic
• WHO working on master plan for clinical trials
• Advance team is working on it's scope of it's work.. we'll review later
• We see risk of resurgence and complacency..
  
• I see 2 dark clouds on horizon 1-continued aggression on health teams 2-lacking more support. Therefore we maintain before 3 months we will reconvene and perhaps end public health emergency.

Q&A time....

• re will we reach peak this month or April? We would love to be able to predict, we need to be cautious. Numbers in last few days are optimistic. We see that the behaviour of virus outside of Wuhan is not as aggressive or accelerated and gives us opportunity to contain. We must slow, and prepare for arrival in other places. We would hope to come under control. Task is to contain, treat. Way to early to predict end of epidemic.
• re past two days, what do you think of chinese participation. A. We wanted Chinese to participate, they know local research, we were pleased that they could participate in the meeting. Lead up to meeting, we have had working groups that have Chinese participants. We are pleased about that... Having them involved grounded the discussion... stop the outbreak and save lives. Point of care diagnostics, immediate protection, and treatment guidelines set a clear goal for the other scientists.
• re priorities, and $$ A. Chinese were able to determine top priorities, simple diagnostics for primary settings that doesn't require labs such as PCR test does. Second, optimal treatment for hospital patients and treatment protocols and standard forms to collect data on what is working best. Also, transmission is needed to be studied.. age/underlying conditions/environmental and impact of interventions e.g. isolation.. we have a lot to learn. Medium priorities are vaccines and thearapeutics. Likely one or two vaccines will go into trial in 3-4 months.
• A number of therapeutics being discussed, we will do clinical trials with protocols.
• What is going on with current trials in china. A. Protocols need to be done to same standards. There was discussion of massive protocol. Currently, dosed quite a number on combo of Lupin Aviv (???????????????) was used in HIV... we don't know results and are waiting. Soon more with Resmidir (same one used in Washington e.d.) We will have to wait a few weeks for results.
• re reporting of Chinese A. Management of crisis by Chinese, under international health folks.. they notified us immediately through normal surveillance. This was picked up through surveillance. Picking up 41 of 23 million during flu was like needle in haystack. I would argue that given the huge population similar to flu, amazing it was picked up. Now is the time to fight the virus not incrimination. We all do after action review later to learn from crisis and mistakes. The test is how you react.
• What do we know about transmission chains outside china? A. 22% reflect localized transmission. Only 8 cases overall we could not find explanation of the infection. There could be other transmission chains but we feel we have a grip on.
• Singapore is testing all respiratory infections. They are going above and beyond. No overwhelming evidence it has spread as they have found none. We have a window of opportunity as was said before .
• There is no zero risk for mass gatherings... food poisoning, terrorism, ... WHO is not arbiter of decisions. We can give algorithms to help if risk of gatherings (e.d. OLYMPICS!). We believe most can continue if risks are managed and steps are applied. Risk depends on setting/type of participants/ length of meetings etc. We have to look at each setting and work with the organizers. They should link with local health organizers also.
• re case count stabilizing, but death count is rising, how do you explain. A. Through the work with so many patients and illness is quite long.. many are reflecting cases that were 2 weeks ago. EOL is now showing. So many sick, and end of their cycle.
• Please explain why no cases in south America or Africa. Could it be due to heat? A. Amount of travelers were looked at from china to those places. Statistically.. we looked at where they went. The air traffic decreased, so now pattern we see now is different than beginning . That doesn't mean we will not see cases there.. just perhaps delayed. (sorry, bad transcription)
• RE china redefinition!! of cases (e.d. NOTE: HE NEVER ANSWERED!!!!! ) A. Why we recognize what china is doing. pathogen they immediately shared sequence. that helped other countries develop diagnostic tools to help other countries to prevent it from growing so it's not missed as to transmission. add to this we appreciate.. there was a Chinese lady who visited Germany and went to shanghai and was positive. shanghai contacted to German to take action. and Germany took action and that is why under control in Germany. you would agree with me that an individual qualified. but i don't know why..... most all board members praised china. china took action at the epicenter. that helped preventing cases from being exported to the rest of the world. we had a board member said this is heroic as this had consequences. (he goes on and on and on about china etc.. but question is never answered!!) We have seen many good things to slow the virus, the facts speak for themselves. In the rest of the world, less than 400 and less than one death. Let the truth speak for itself. If the rest of the world had more cases, they would not hide it... but the rest of the world is in better shape. (He is going on and on and not answering the question..) I know there will be weaknesses, we will ask and address in future. Not now is the time for stigmatizing them, but fight against this common threat because we are one. We need to unite and attack this virus. Solidarity, solidarity, solidarity...let's not waste our time in pointing fingers...
• re Beging and case definition. Not abnormal in cases to adapt case definition as it's unfolding. Like fishing for big fish, one type of net. small fish, different fish. Like this.. few cases, specific case definition... when evolving change case definition. (Need to go back as couldn't follow sylvie here... I'm sure MSM will get this quote). This will widen the net (e.d. huh??? no it's not MOO)

I'll leave this now to @JerseyGirl and others for MSM/twitter stuff.

The end.

 

[LaborDayRN]

U.S. officials worried about Chinese control of American drug supply

“key ingredients and raw material, U.S. hospitals and military hospitals and clinics would cease to function within months, if not days," said Rosemary Gibson, author of a book on the subject, "China Rx."”

“The last penicillin plant in the United States closed in 2004."...

“Basically we've outsourced our entire industry to China," retired Brig. Gen. John Adams told NBC News. "That is a strategic vulnerability."

U.S. Dependence on Pharmaceutical Products From China
(council on foreign relations)
“97 percent of all antibiotics in the United States came from China. “If you’re the Chinese and you want to really just destroy us, just stop sending us antibiotics,” he said.”


https://www.google.com/amp/s/nypost...dden-perils-of-drugs-imported-from-china/amp/
US factories no longer make generic antibiotics. So, if US-China tensions worsen, China could cut off antibiotic exports, throwing our hospitals into turmoil, warns Hastings Center health expert Rosemary Gibson.

This practice of outsourcing nearly ALL of our vital medications to another country really puts our country at risk, both medically and politically. (not talking about politics as in political party politics, but from a global view.) Honestly, I had no idea the percentage was so high.

 

[LaborDayRN]

Praying this is true!

Me too Kali! And if it turns out to be an effective vaccine, a big shout out of congratulations to my neighbor to the south (San Diego)!!

 

[asyousay]

First coronavirus case 'is confirmed in London as Chinese national tests positive'

First coronavirus case 'is confirmed in London as Chinese national tests positive' | Daily Mail Online

For gods sake it had to hit in London

 

[LaborDayRN]

Per WHO presser (ETA's to follow)

• Cambodia has agreed to accept the cruise ship Westerdam. Will arrive tomorrow.
• 2 day meeting has concluded
• working on easy to apply diagnostics, treatment, vaccine candidates, and how to address infodemic
• WHO working on master plan for clinical trials
• Advance team is working on it's scope of it's work.. we'll review later
• We see risk of resurgence and complacency..
  
• I see 2 dark clouds on horizon 1-continued aggression on health teams 2-lacking more support. Therefore we maintain before 3 months we will reconvene and perhaps end public health emergency.

Q&A time....

• re will we reach peak this month or April? We would love to be able to predict, we need to be cautious. Numbers in last few days are optimistic. We see that the behaviour of virus outside of Wuhan is not as aggressive or accelerated and gives us opportunity to contain. We must slow, and prepare for arrival in other places. We would hope to come under control. Task is to contain, treat. Way to early to predict end of epidemic.
• re past two days, what do you think of chinese participation. A. We wanted Chinese to participate, they know local research, we were pleased that they could participate in the meeting. Lead up to meeting, we have had working groups that have Chinese participants. We are pleased about that... Having them involved grounded the discussion... stop the outbreak and save lives. Point of care diagnostics, immediate protection, and treatment guidelines set a clear goal for the other scientists.

Well Bless Cambodia! Someone is rescuing these poor people!

 

[Wicked Strong]

San Diego lab discovers COVID-19 vaccine in 3 hours
Inovio Pharmaceuticals created a vaccine for coronavirus that is going through pre-clinical trials.

Author: Neda Iranpour (Reporter)
Published: 2:17 AM EST February 12, 2020
Updated: 8:24 AM EST February 12, 2020
SAN DIEGO — In a race against the clock, a San Diego lab is scrambling to get a COVID-19 vaccine out and on the market. As the days go by, Inovio Pharmaceuticals is getting closer to releasing the desperately needed vaccine against the deadly virus.

Inovio Pharmaceuticals, which is located in Sorrento Valley, has also created a vaccine for the Zika virus, the Middle East Respiratory Syndrome (MERS), and the vaccine for Ebola.

Dr. Trevor Smith, who is the director of research and development at Inovio, said, "It's something we are trained to do, and the infrastructure is here and the expertise is in house."

When Chinese scientists released the genetic sequence on Jan. 9, Inovio researchers got to work immediately and within 3 hours they had a vaccine for coronavirus, or COVID-19 as it is now being referred to.

"We have an algorithm which we designed, and we put the DNA sequence into our algorithm and came up with the vaccine in that short amount of time," said Dr. Smith.

The vaccine has been tested on mice and guinea pigs. It will next be tried on a group of human patients.

California lab discovers coronavirus vaccine in 3 hours

Sadly, since MSM hasn't announced "breaking news" in the US, nor did the WHO talk about this, I think it's just a rush to get news out for Inovio Pharmaceutical. They are probably working on it, but I've read that other countries are also, including the UK.

One other thought, why can't they admit that the cruise ship in Japan is simply spreading the disease daily among the rest of the passengers and crew. They need to be quarantined off the ship.

MOO

 

[asyousay]

I don’t get what the WHO is even doing here as the numbers are lower because they have changed the way they are counting cases. So how exactly does that help anybody?

IMO

 

[gregjrichards]

Stop hugging and kissing to halt the coronavirus': Avoiding close contact with 'British standoffishness' is the best way to beat the contagious illness, virologist claims

'Avoid hugging and kissing on Valentine's Day to prevent the spread of coronavirus', scientists say | Daily Mail Online

 

[gregjrichards]

All 83 people being held in Wirral 'Camp Corona' are free of coronavirus and will be allowed to leave isolation unit tomorrow morning

All 83 people being held in Wirral 'Camp Corona' are free of coronavirus | Daily Mail Online

 

[Medstudies]

This practice of outsourcing nearly ALL of our vital medications to another country really puts our country at risk, both medically and politically. (not talking about politics as in political party politics, but from a global view.) Honestly, I had no idea the percentage was so high.

it’s incredibly unwise. I’m not sure if anyone here was (or knows someone ) affected by the shortage (and up pricing of levothyroxine/synthroid) 2 years ago?

manufacturing in Puerto Rico issues following hurricanes. (Took me three months to get a partial refill, for a person with no thyroid, it wreaked me)

There’s a Nationwide Shortage of Levothyroxine. This is Why - GoodRx


and here’s where you can check current drug shortages, —- its long...

Current Drug Shortages List - Drugs.com

 

[Amonet]

Yep, the declaration by WHO, then the US of an emergency cleared it all for "compassionate use" exemptions. When they do move to trials.. would hate to be the person who had the placebo if this works. Not sure how long they let placebo folks go until giving them the real stuff. We only have seen ONE iirc treatment of the Washington guy who improved with the compassionate exemption treatment off label with Resmidivir (spelling? I forgot the name) but with a vaccine... lot's longer to know in human trials if a vaccine works. I wonder how they determine such in real life as they can't purposefully vaccinate someone then expose them on purpose?

Will be interesting to follow as this is breaking so many barriers and novel science with this. As they say.. the science is moving faster than the laws etc.

Was interesting to read that they tested on mice and guinea pigs as I didn't know that they were susceptible from what I had read?

I imagine they might follow the protocols set up for Ebola vaccines when there was a serious outbreak of that virus in West Africa?

IIRC for the Ebola vaccines they did voluntary trials in close contacts of confirmed Ebola patients, and used that as some of their human testing.

The name of that R drug sounds like it's an antiviral similar to Tamiflu, so that would likely already have permission to be used in something like the flu, and using it on a patient with Covid-19 would come under compassionate use? That's because the drug has already been tested in humans and even though they don't know if it will help against Covid-19 they have good reason to believe that it won't do more harm than good.

One of the Dr Seheult videos covered the subject of using antivirals that have been previously been tested and accepted for general use with viruses like flu or HIV. I think I caught the drug name for Tamiflu (which is the brand name) in his video, though he didn't use the brand name, and he said that it is being used in some patients in China.

As those type of medicines wouldn't cover a global outbreak, I imagine they would be more likely to be used in higher risk patients who enter a hospital with breathing difficulties rather than in every case.

 

[Amonet]

Heck, when I heard that they (not this company, others did) had sequenced the virus in a week I was flabbergasted. But I guess that is where technology is these days... I can't fathom it yet that's where technology is today. Unreal to me.. but it is what it is.

Partners and collaborators include ApolloBio Corporation, AstraZeneca, The Bill & Melinda Gates Foundation, Coalition for Epidemic Preparedness Innovations (CEPI), Defense Advanced Research Projects Agency, GeneOne Life Science, HIV Vaccines Trial Network, Medical CBRN Defense Consortium (MCDC), National Cancer Institute, National Institutes of Health, National Institute of Allergy and Infectious Diseases, Regeneron, Roche/Genentech, University of Pennsylvania, Walter Reed Army Institute of Research, and The Wistar Institute. For more information, visit www.inovio.com.

ETA-Sorry, I see your question was who are stockholders... not savvy enough to know difference between partners and/or how to know who stockholders are. But their stock has gone UP

I watched a video on YouTube last night about the advances in genetic code printing, and how it's got so much cheaper than it was during the SARS outbreak. Also the samples of the genetic code for COVID-19 were released from China months earlier than was the genetic code for SARS.

Then add in the experience that some labs have gained over the past 20 years with doing urgent work on vaccines for things like SARS, Ebola, Swine Flu. I think it's just all come together to enable them to develop and ramp up production so much faster than they could have done twenty or thirty years ago when they were mostly working on infections that had been around for hundreds of years like measles, etc and no one thought it was even possible to develop a vaccine for the fast-mutating and multiple-strain influenzas.

 

[dixiegirl1035]

I don’t get what the WHO is even doing here as the numbers are lower because they have changed the way they are counting cases. So how exactly does that help anybody?

IMO

He did about 8 minutes dancing around that question for sure. I was so lost I couldn't transcribe! The transcription should be out tomorrow am. Yep, never answered although he was giving kudos to chinese for helping the rest of the world, then went to the lady ??? who talked about Bejing and blah blah. Pretty much said that don't worry about it... they are containing. ummmm... ummmm.. ummmm. Ask it again and again please media as we want those numbers!

 

[coastal]

Per WHO presser (ETA's to follow)

• Cambodia has agreed to accept the cruise ship Westerdam. Will arrive tomorrow.
• 2 day meeting has concluded
• working on easy to apply diagnostics, treatment, vaccine candidates, and how to address infodemic
• WHO working on master plan for clinical trials
• Advance team is working on it's scope of it's work.. we'll review later
• We see risk of resurgence and complacency..
  
• I see 2 dark clouds on horizon 1-continued aggression on health teams 2-lacking more support. Therefore we maintain before 3 months we will reconvene and perhaps end public health emergency.

Q&A time....

• re will we reach peak this month or April? We would love to be able to predict, we need to be cautious. Numbers in last few days are optimistic. We see that the behaviour of virus outside of Wuhan is not as aggressive or accelerated and gives us opportunity to contain. We must slow, and prepare for arrival in other places. We would hope to come under control. Task is to contain, treat. Way to early to predict end of epidemic.
• re past two days, what do you think of chinese participation. A. We wanted Chinese to participate, they know local research, we were pleased that they could participate in the meeting. Lead up to meeting, we have had working groups that have Chinese participants. We are pleased about that... Having them involved grounded the discussion... stop the outbreak and save lives. Point of care diagnostics, immediate protection, and treatment guidelines set a clear goal for the other scientists.
• re priorities, and $$ A. Chinese were able to determine top priorities, simple diagnostics for primary settings that doesn't require labs such as PCR test does. Second, optimal treatment for hospital patients and treatment protocols and standard forms to collect data on what is working best. Also, transmission is needed to be studied.. age/underlying conditions/environmental and impact of interventions e.g. isolation.. we have a lot to learn. Medium priorities are vaccines and thearapeutics. Likely one or two vaccines will go into trial in 3-4 months.
• A number of therapeutics being discussed, we will do clinical trials with protocols.
• What is going on with current trials in china. A. Protocols need to be done to same standards. There was discussion of massive protocol. Currently, dosed quite a number on combo of Lupin Aviv (???????????????) was used in HIV... we don't know results and are waiting. Soon more with Resmidir (same one used in Washington e.d.) We will have to wait a few weeks for results.
• re reporting of Chinese A. Management of crisis by Chinese, under international health folks.. they notified us immediately through normal surveillance. This was picked up through surveillance. Picking up 41 of 23 million during flu was like needle in haystack. I would argue that given the huge population similar to flu, amazing it was picked up. Now is the time to fight the virus not incrimination. We all do after action review later to learn from crisis and mistakes. The test is how you react.
• What do we know about transmission chains outside china? A. 22% reflect localized transmission. Only 8 cases overall we could not find explanation of the infection. There could be other transmission chains but we feel we have a grip on.
• Singapore is testing all respiratory infections. They are going above and beyond. No overwhelming evidence it has spread as they have found none. We have a window of opportunity as was said before .
• There is no zero risk for mass gatherings... food poisoning, terrorism, ... WHO is not arbiter of decisions. We can give algorithms to help if risk of gatherings (e.d. OLYMPICS!). We believe most can continue if risks are managed and steps are applied. Risk depends on setting/type of participants/ length of meetings etc. We have to look at each setting and work with the organizers. They should link with local health organizers also.
• re case count stabilizing, but death count is rising, how do you explain. A. Through the work with so many patients and illness is quite long.. many are reflecting cases that were 2 weeks ago. EOL is now showing. So many sick, and end of their cycle.
• Please explain why no cases in south America or Africa. Could it be due to heat? A. Amount of travelers were looked at from china to those places. Statistically.. we looked at where they went. The air traffic decreased, so now pattern we see now is different than beginning . That doesn't mean we will not see cases there.. just perhaps delayed. (sorry, bad transcription)
• RE china redefinition!! of cases (e.d. NOTE: HE NEVER ANSWERED!!!!! ) A. Why we recognize what china is doing. pathogen they immediately shared sequence. that helped other countries develop diagnostic tools to help other countries to prevent it from growing so it's not missed as to transmission. add to this we appreciate.. there was a Chinese lady who visited Germany and went to shanghai and was positive. shanghai contacted to German to take action. and Germany took action and that is why under control in Germany. you would agree with me that an individual qualified. but i don't know why..... most all board members praised china. china took action at the epicenter. that helped preventing cases from being exported to the rest of the world. we had a board member said this is heroic as this had consequences. (he goes on and on and on about china etc.. but question is never answered!!) We have seen many good things to slow the virus, the facts speak for themselves. In the rest of the world, less than 400 and less than one death. Let the truth speak for itself. If the rest of the world had more cases, they would not hide it... but the rest of the world is in better shape. (He is going on and on and not answering the question..) I know there will be weaknesses, we will ask and address in future. Not now is the time for stigmatizing them, but fight against this common threat because we are one. We need to unite and attack this virus. Solidarity, solidarity, solidarity...let's not waste our time in pointing fingers...
• re Beging and case definition. Not abnormal in cases to adapt case definition as it's unfolding. Like fishing for big fish, one type of net. small fish, different fish. Like this.. few cases, specific case definition... when evolving change case definition. (Need to go back as couldn't follow sylvie here... I'm sure MSM will get this quote). This will widen the net (e.d. huh??? no it's not MOO)

I'll leave this now to @JerseyGirl and others for MSM/twitter stuff.

The end.

Thank you!