The World Health Organization (WHO) today pushed back against accusations that it ignored an early email from Taiwan and that it didn’t warn countries early about the threat of human-to-human spread; meanwhile, countries with Muslim populations brace for the impact of COVID-19 on Ramadan, and outbreaks escalated in newly hit areas.The global total today rose to 2,463,357 cases from 185 countries, and the fatality count climbed to 169,794, according to the Johns Hopkins online dashboard.Groups seize on WHO-Taiwan tensionsTension between the WHO and Taiwan have been simmering since the outbreak began. Taiwan was one of the earliest-hit areas, and its public health system has been widely praised for a response that quickly contained its outbreak. However, Taiwan has pressed the WHO to recognize it as a sovereign state.Throughout the pandemic, the WHO has made its technical advice and experts available to Taiwan and has included its health officials on WHO expert groups, such as one on research and development. Taiwan is not a WHO member, because China says it owns the island and that it doesn’t have a right to membership in international organizations.The group has repeated several times that it does not have the power to recognize Taiwan as a sovereign state and that the decision rests with the World Health Assembly, the group—made up of 194 member states—that governs the WHO.Earlier this month, tensions bubbled over when WHO Director-General Tedros Adhanom Ghebreyesus, PhD, airing concerns about countries politicizing the pandemic, said he has fielded personal attacks and deaths threats, including some from groups in Taiwan.In an escalation of the tensions, the Taiwan health officials publicized an email it sent the WHO on Dec 31—about the same time ProMED Mail, media outlets, and infectious disease blogs carried reports of a mysterious pneumonia cluster in Wuhan. In the email, Taiwanese officials sought more information about the event.Taiwan’s health minister said the WHO’s stance on its membership has deprived it of timely information and that the WHO ignored its communications, Reuters reported on Apr 11. Critics of the WHO, including US President Donald Trump and some of his supporters, have seized on Taiwan’s accusations against the WHO, especially the one about the email.At a media telebriefing today, Mike Ryan, MD, head of the WHO’s health emergencies program, said Taiwan’s email didn’t reference anything other than what was already known about the outbreak and that Taiwan, like other countries, was asking for clarification in its email. He added that the WHO appreciated the emails it received about the outbreak from Taiwan and other sources. WHO officials today said there was no mention of human-to-human transmission in Taiwan’s email.Ryan said on Jan 1, the WHO asked China for more information, according to International Health Regulation protocols that require countries to respond within 24 to 48 hours. He said the WHO sent its first Tweet about the outbreak on Jan 4, and on Jan 5 it communicated detailed information to its focal point system, which includes Taiwan. Also on Jan 5, it posted its first public outbreak notice on the Wuhan cluster.WHO pushes back on transparencyAlso, some in the United States, including President Trump, have accused the WHO of keeping the country in the dark about the outbreak threat. At today’s briefing, Ryan said about 15 US officials are embedded in its operations in Geneva, two on a permanent basis—one on flu preparedness and the other in emergency readiness. “Many US government employees work with us in the frontlines, across all our expert networks, and we are hugely grateful,” he said.Maria Van Kerkhove, PhD, technical COVID-19 lead, said the WHO has close partnerships with scientists at the US Centers for Disease Control and Prevention (CDC) and the National Institutes of Health, including those who have worked on SARS and MERS-CoV, and were utilized quickly with the COVID-19 response.Tedros said nothing was hidden from the United States from day one. “That comes naturally for the WHO. It’s open. We don’t hide anything,” he said, adding that the group wants all countries to get the same message so that they can prepare well and quickly. Confidential information would be dangerous, Tedros said. “There are no secrets at WHO, because it’s about lives.”Ramadan rituals face COVID-19 changesAhead of Ramadan, which starts this week, religious officials in the United Arab Emirates (UAE) said health workers treating COVID-19 patients are exempt from fasting and that Muslims shouldn’t congregate for prayers during the holy months, Reuters reported.Indonesia’s religious affairs ministry issued guidelines earlier this month advising people to have pre- and post-fast meals individually or with family. Prayers at the end of the month, typically held in large gatherings, were cancelled, Anadolu News reported.Iran has been the Middle East’s main COVID-19 hot spot, but cases have been steadily rising in other countries in the region, including Saudi Arabia, the UAE, and Qatar.Several countries have religious observances this time of year. The WHO has posted information on safe practices, including guidance published Apr 15 on Ramadan.Singapore cases surge; New Zealand scales back distancingIn other international developments, Singapore’s cases jumped by 1,426 cases today, though 1,369 are related to a large cluster of infections in foreign worker dormitories. The health ministry said the number of cases is high, because workers are staying in their dorm rooms, where health officials are doing extensive testing, picking up many more cases. Most people who test positive have mild illness and are being monitored in isolation facilities or in hospitals.In Japan, cases are still climbing, and health officials said today the total has reached 10,751 cases, including 361 reported today. A health ministry official last night announced that the government has arranged for 210,000 hotel rooms across the nation to isolate those with mild symptoms and those who are asymptomatic, Kyodo News reported.New Zealand’s Prime Minister, Jacinda Ardern, said today that the country will ease back on its lockdown measures starting on Apr 27, about 1 month after they went into effect, Reuters reported. Its health minister has said there is currently no widespread undetected community transmission.A concert and comedy event called “One World: Together at Home,” which was televised and streamed online on Apr 18, raised nearly $128 million for the global COVID-19 response, its organizer, Global Citizen, announced yesterday.