Everyone my name is Christopher Black. I work in the Communications Department at Geneva and here we are live again at the World Health Assembly. Number 72 in the beautiful United Nations Paladino unlucky enough to be here with General Diaz who works in our emergencies program Janet. If you could tell us a little bit about yourself and your work that you do okay great thank you I am very happy to be here. My name is Doctor Janis I'm the clinical lead for the Ebola clinical response for this current outbreak in the C One of the exhibits that are Assembly That's beginning in the most attention is what is right next to us here and this is what's called a cube which I believe is short for the bio secure emergency care unit for outbreaks It was developed by one of the gorn global blanket Alert and Response Network partners a Lima and this is right now being used in the city and you're just back from the Democratic Republic of the Congo Could you tell us a little bit about? How this what we called cubes are used in the field Sure I'm Happy To do so, so yeah, I just returned from the city and I have been back and forth in the since the beginning of this outbreak last last August So I've seen the evolution of a Lima which is our clinical partner that is using these cubes in their treatment centers in both Benny and currently also in So as you can see this, Cube is a single patient isolation an isolation room However, it has many benefits to the usual types of treatment centers we had in the past and I think one of the first things you see is that the care provider can be outside of the cube and provide care as our colleague here from Illinois Doing directly to the patient inside so that means you don't have to be in full P e every time you want to do something to examine the patient or to adjust medications of the patient. You can do it from the outside in a totally complete bio secure fashion One of the other things that I think if we can just look at this table here is the highlight of being able to do intensive care in this cube. So that means if you have an infusion pump where you can have to give continuous infusions of varying doses Drugs that you can manipulate the dose of drugs from the outside this connects into the cube and connects into the patient So That's a really great advancement cuz. We can give individualized patient supportive care that is you know can change and these patients sometimes they're very sick in the first 24 to 48 hours with a lot of dehydration a lot of diarrhea a lot of fluids that needs to be given another medicine and antibiotics and that can be done quickly and safely from the outside one of the other things Monitor So we know to provide good care it's important to monitor and give surveillance of the patient on a frequent basis So these monitors this is you know a newer type monitor where you can get Bluetooth information from the patient like their blood pressure like their temperature like their oxygen saturation And we can see it from the outside again allowing the nurses and the doctors to have more frequent vital sign monitoring to adjust therapies And finally you can see here Our colleague from Alabama, where she's able to go inside actually in the cube underneath the protective gear of the Cube and also manipulate put a monitoring device on or manipulate the ivy or the an intervention for the patients So in that regard from the clinical perspective, this cube technology has helped us provide individualized patient care supportive care intensive care like you would call it in our like we see Their types of hospitals that care for severely ill patients Doctor Diaz you mentioned before in the past the health workers would have to be wearing P will be called personal protective equipment which was Quite a long process for them to put on and take on and off every day and it But now that the health workers can access from the outside directly so it's important for health workers How about for families before could families Couldn't interact directly with with patients but now can have a possibility to talk to their loved ones from outside of this cube So yeah, so I think the patient perspective is probably the second or probably maybe the most important thing of this cube as well before if we have any patients in a big tent and the Red zone was clearly demarcated the marketed away from where patients are where people without P could be then you could have very little interaction with the patient either direct Families are from the clinicians so now if You're the family member the way the units are set up if You're a family member then you can actually your paint. Your loved one can be inside and you can interact and speak through this directly without having to wear Pjs So so That's a huge and you can spend a long time at the Patient's bedside without having to be inside with P speaking of insight, I think we're actually gonna go into the cube this is this is actually not a demonstration cube. This is a real Cuban. This is exactly like it would be sad In the field I think there's 25 of these now in Benny and Catala How were they transported to places like the Democratic Republic of Congo So they are transported in I would have to ask our logistics they're transported in a You know in a in a compartmentalized, I think it weighs about 400 kilos. They compartmentalize a meter cubed package And so we're going into the Cube right now. So just to remember to remind everyone when you are in the cube and a real C or treatment unit once you go in you're wearing Pjs okay so you're wearing a bola specific personal protective equipment so you would not be in there like we are right now. This is just purely for demonstration as well demonstrating being the patient. Thank you. Juan. Thank you Melanie on the outside Thank you for your help today so some of the benefits from the inside as you can see is that the patients can get Hear from providers that are outside the cube and get their blood pressure monitor put on get their infusions adjusted again These are a lot of these newer devices are Bluetooth or directly communicating with our monitors outside the same thing, the patient can interact with their family if the families outside and have a communication with the family and as you saw there is one way to enter So this would be coming from the Green zone, the classic zone where there's not where you can be without P But as soon as you go To the first open the first door you come in with P you close both and this creates actually a negative chamber room. So this is these cubes are very good for the viral hemorrhagic fevers, which included Bola but also could be considered to be used for some of the severe acute respiratory infections such as mercy Corona virus cuz. It does provide negative pressure airborne precautions as well as important. That means if there's a break in the Cube The bacteria the virus will stay inside. Yes, exactly That's So then there is one exit here and usually the exit here is for the patient if they want to go into the Red zone exit into the toilet areas. If they're able to get up and use the toilet, the toilet would be placed back here Why so so much precaution with a bonus. Why do why do you have to be so careful let's tell our viewers a bit about the magic figure so so a bola is is a viral hemorrhagic fever it is transmitted by bodily contact with my contact with bodily fluids so through diarrhea through contact with blood and those sorts of things these patients when they are very sick with Ebola, they can have large amounts of diarrhea and vomiting and severe dehydration so any contact Protected Contact with those fluids can lead to catching the Bowl of virus disease So the PG e that we recommend we use complete avoidance of touching those unprotected which means we have strict personal protective equipment that healthcare workers must wear Thank you Thank you. Doctor Diaz so if You're just joining us, this is a Facebook live something a little bit different for us we're not only live at the World Health Assembly in Geneva at the we're actually coming to you live from the inside of what we call the Cube, which is which is a device That we use That's been used right now in Democratic Republic of Congo and the response to Ebola to trade pick treat patients How important is that in the response being able to treat patients effectively quickly in the communities where they affected So I think this has been a major breakthrough in the in this response. this has been a complicated responses. Everyone knows but in the area of clinical case management and treating patients with Ebola virus disease We've made tremendous advancements. A lot of this has been facilitated by this type of cube technology so Said before emphasis on severe dehydration and shock being one of the causes of death in patients with Ebola. But they also suffer from severe hypoglycemia and so with this cube technology, as you just saw you can also check the glucose level quickly. And then, if the glucose level is low you can give glucose infusions so I'm looking for your girl cometer So so that has been one of the benefits It's It's supportive care, its treatment of hypoglycemia, it's treatment of other electrolyte abnormalities such as low potassium levels We can measure that now with point of care testing that are available in all the treatment units and replace potassium in a timely fashion. And we know that if you don't have enough potassium testings very low, you can have cardiac abnormalities and that could lead to death so so That's the advanced That we have made in supportive care for this outbreak In addition to the implementation of two protocols for the use of investigational therapeutics one under monitored controlled use compassionate use protocol and the other one a randomized control trial Thank you doctor We actually be taking your questions. So if you have any questions just put them in the comment box, tell us where you're watching from and We'll try to get Doctor Diaz and to answer them right away We've got one question From Kendrick province linky what is effective preventive measures for a bonus okay. So for prevention of Ebola I think the most important thing is infection, prevention and control So that is what we try to teach to prevent the spread of Ebola would for be for early recognition of disease. So if you find the patients who had suspected Ebola disease you would then implement strict infection prevention and control measures to prevent that the spread of the disease from that suspect patient to others, so that would mean isolation Which means taking the patient away from the other patients in the health care facility and starting a diet rapid sampling and testing to either diagnosed Ebola or you know or exclude Ebola so that would be number one as early rapid identification And then this outbreak. We've also used a vaccine a bola vaccine as a preventative strategy in terms of working with communities is it is it relatively hard or easy to train local health workers to be part of the response in something like this so It's a Question so this outbreak the majority of health care workers that are working in the treatment units are from the local communities. We have used workers from the local hospitals of each community, for example, in bending or potable or cotton They come from those health the hospitals and then they come to work with partners with W O with Lima or F or C samaritan's purse and we train them to work under this, in this kind of situation with the infection prevention Troll with bio security measures about the therapeutics so so it's possible We've done it and the majority of workers are from the local community and in terms of interaction between family members. I remember I was deployed all of responses quite a few years ago and there was this big separation between between the family members in their patients that they could either they couldn't visit them in the isolation Ward when they were little bit better off better healthy more healthy They were in a kind of separated area so something like this like we said before the family members can really interact directly with with the patient Yeah, so I think when Very sick usually when patients are in the cube is when they're in the most severe part of their illness So so it is good. I think for their family to also be able to be with the patient during that severe time so and they can directly communicate as you can see outside once they get better. We tend to move patients to more of a convalescent type of open 10 to area where they can still have interactions with the family at a distance so It's quite hot in here on one would normally is their air conditioning. How does that work for something in this collision was a negative push so It's enough flow So it's more comfortable when we are on the field and there is a tent with a shot net euh de euh de mettre un hum hum Guess what this one here is traveling isn't after seven inches going in thank you very much Thank you for melanoma who's. Also pretending to be our patient today and as Doctor Diaz mentioned normally, we wouldn't be in this structure without wearing P That's correct Yes, this is good for our demonstration let's have some more questions somehow make it back to you on how expensive is something something like this structure is it and how how affordable is it to provide cubes to affected patients? So how does something like that work in the field Joe has a response a response asking for funds for an appointment like this and then we work closely with partners and that is that maybe we can talk a little bit about how maybe you can talk about the the cost and all that actually we the cube cost is 15 thousand euros siehst du also You save the cost of the because you use the reusable and for example, get out. 2014. Wheels lot of people and It's a 1000 Europe lot of lot of I think that you know to a cost for the you know the actual cost and maybe some day to day savings that we can have. But I think some of the things that we need to further explores has you know? Will this impact on better outcomes of patients? And what is this impact for they were more cost effectiveness analysis of the impact on patients on patients living healthier lives or longer lives because they were able to get more supportive care in a cube and That's something that we need to further consider we do not have the cubes at all the treatment Center so we have them at the treatment centers cuz. A Lima is the you know has been the pioneer In the Cube technology and we have supported it because We've seen some of the potential that the many benefits it seems like so supportive of this cube technology and so other donors that are funding a Lima in order to do this for other partners that have other treatment units. I think we're all cutting towards being able to provide more individualized patient care so that you can see the patients there's other ways that you can consider constructing cs not just with the cube but also to facilitate That's That interaction so so far, We've seen a limo with the cubes other partners haven't yet installed cubes. But we are We know we are open in order to provide the best patient care. If this is a good technology then we will go forward with this PC is French for all our treatment Center treatment units very good. Thank you maybe if you just answer a question for us on partners in general So the response to Ebola is really a wide response to Beach is working with many partners Can you talk a little bit In terms of who are keep keep players and how important that is responsible, it is an extremely important so W tow in the Ministry. you know the response is led by the Ministry and supports the Ministry but for clinical operations of management of Ebola patients. we heavily rely and work together. Collaborate with partners and so a Lima is a partner and myself has been a strong partner samaritan's purse and I am see if I'm not forgetting Are the other major partners that work in Ebola treatment units so that is most important. most recently, the W T O has had to take a bigger role in the operations of clinical care due to the insecurity of the area. So so We've had to supply are now currently supporting the Ministry and the running of one treatment unit in Bonn tempo because of the security issues But I think their emphasis is that we like to work with other clinic with clinical operation partners to do the treatment The direct care thank you so much So again where this is the Facebook Live coming to you direct from the World Health Assembly in Geneva we're in the will do at the beautiful with Doctor Diaz from the Bureau and our colleagues Melanie Anton from Alabama and one I was being a patient and Melanie is playing the health worker from outside thank you, Melanie for help today I would next question from Delong Simon Dot com What are the what measures we take to ensure the integrity of the Cubs when It's in the field What keeps them safe so that nothing for the equipment club ah concrete slab we put thanks ah ah for the for protection against the the rain mmm How long can we run them for what's the lifetime of was the life span of one year on the field Yes It's impressive opportunity one to we have some people asking us. Do we have enough cubes Is there enough Do we have the resources that we need in the field right now and the Democratic Do you do you actually know the supply chain of cubes? How many cubes that are since beginning of the purchase 45 cubes we can put this, 10 cube in six week tout un j'espère de de l'étang Different standards at different Cds, there were different standards in West Africa compared to those that got transported to the United States or Europe So in this outbreak, We've tried to even the playing field If I could say it that way, so that all patients get equal access to supportive care So regarding efficacy you know there's a lot of different factors that go into patients surviving one of those big ones as early diagnosis. So if you come in very late in a very late stage of disease, It's it's hard to to save that Person's Life so earlier presentation gives better outcomes and so we're working very hard to do that as well in the field But from this we, we have some data that we presented over a month ago that shows if you make it to a treatment unit and you get supportive care and an investigational therapeutic your odds of surviving or betweens. you know like six or seven out of 10 so 70 percent survival right an average and that's from some of our data You know review of some of our data from this outbreak, so That's That's pretty good We will see at the end of the outbreak. How similar technology like this used for lab diagnosis in the field as well now we're not really now that how is that done So no lap diagnosis is still at large. Has you know buy security? lab in one of the treatment units? we have used the glove box which is similar to that where you can be outside of the lab. That's holding the fluids but be working from the outside inside the glove box so that we have used I think we'd look a little bit more. If you could tell us give it so part of the response is is treatment part of the written responses prevention in terms of the work we do with communities and social Organization and their responses vaccine you touched on this very briefly Could you talk a little bit how it vaccines are being vaccination campaigns are being used in Concord right now I will I will discuss a little bit about that and leave it to my vaccine colleagues but we're using the the approach of vaccinating contacts and context of context and we Been I Can't tell you actually don't know the numbers of patients we vaccinated but also with the recent analysis that was released a few weeks ago It shows that the vaccine is highly effective so it doesn't prevent all cases of Ebola. We know that as well so but if you get vaccinated and on Ford and if you also unfortunately developed Ebola your risk of death is very low so your survival is up to about 90 percent and so we know it is preventing some disease You get it also preventing severe disease Thank you so much doctor so we'll probably start wrapping up a little bit. My name is Chris Black I've we're coming to you live from inside of a cube here at the museum at the World Health Assembly in Geneva Switzerland, with Doctor Janet Diez I'm Fun from Lima Malia Marina Melanie from Lima and We've been so lucky to be joined from viewers from all over the world. Just a few for a few countries where people are watching us live right now Pakistan, Egypt, Japan, Sudan, Brazil, Mexico, Afghanistan, Angola Nigeria, India Dominican Republic Jordan, Bahamas, Australia, Italy, France, South Africa Kenya Nepal Vietnam Portugal, Iran and Greece As mentioned before I leave my ear you're based in front You're we're about in and and those in Paris and New York and Doctor Diaz. Your base your base in Geneva, normally, but You've been how many times have you been to the last six months Based in Geneva, but I've been there, probably six times excellent so let's do We also mention to our viewers that normally if we were in this keeping their in a real response in the field, we would be wearing personal protective equipment will be called P but for the sake of the demonstration today were not But this is a real cube and this one is heading off to the right after the Assembly. I believe So why do we just wrap that up? He probably won't get to all the questions. So if you continue to leave your questions in the comment box our experts will get back to you and then we're gonna. Have more Facebook Live and other live events here from the World Health Assembly Soon Doctor Diaz thank you so much for your time today you really explain things beautifully and we really do appreciate your help and all your work. You've been doing on this response on our friends from Alibaba and everyone who's involved in the response in the field. Thank you so much thank you for being you can learn more on www. Dot t So this is Chris Black for the Communications Department and join us danke