World Health Organization (WHO) Coronavirus Q&A Transcript July 29

Dr Maria Van Kerkhove: (00:00) Events that happened beyond COVID, so we have many teams that are looking out for what those events may be and then the rest of the day is a series of meetings that we have with partners, with our international networks of technicians and scientists and public health professionals. We can meet in lots of different groups and we meet virtually through either teleconferences or video conferences. So, a series of meetings and then in between there we read, we write, we review, we try to have some lunch in there if we can and have a little coffee, a little food, but every day is very dynamic. It's very interactive with not only people within WHO, in headquarters, but in our regions, but also globally. So we are very, very fortunate that we work with incredible partners globally and we bring them all together through different types of teleconferences. Alex: (00:56) Thank you, Maria. You mentioned that on daily basis, you're in touch with network of scientists and technicians and experts. I remember last week towards the end, we received a question that we didn't address. Alex: (01:08) How can we better communicate science and slow nature of scientific processes, rapidly to adopt them into policies and behaviors that we need public to take now during the pandemic? Dr Maria Van Kerkhove: (01:22) That's a great question and sorry we didn't get to it the last time. I actually think that the science in this pandemic and for this pathogen is happening incredibly fast and remarkably fast, if you think about it. We're seven months into a new virus, a new pathogen, we knew nothing about before and the entire global community of researchers and frontline workers have come together to conduct studies, which help us better understand how this virus behaves, who it infects, how it's transmitted diseases that it causes, what types of interventions can be used. We try to consolidate, bring together, all of the science through our teleconferences, where we bring people speaking directly to one another, which is faster than any peer reviewed publication can happen. It's faster than any report that can be generated and then we work with our teams and with our international networks to consolidate that into guidance. Dr Maria Van Kerkhove: (02:24) So our first package of guidance was issued on January 10th, 11th, and 12th. So that was 10 days, 11 days, 12 days within two weeks of when we first heard about this cluster. So, that was incredibly fast and we've been working ever since to incorporate new guidance into that. But it's really been remarkable of how fast all of this has happened. Dr Maria Van Kerkhove: (02:43) Mike and I, and the director general and our chief scientists and many people across our regions, try to communicate what we know about it through press conferences, through these Facebook Lives, through different Q and A's. We try to do that as often as we can, but not only what we know, but the uncertainty around what we know. I know that can be confusing to some people but we're really working hard to even push everybody to work even faster and do really high quality research so that can inform our guidance. Alex: (03:15) Thank you, Maria and for explaining as well, all the efforts that you, Doctor Mike, Ryan and director general and other experts are putting as well to inform public timely of on everything we know, and we still need to learn about. So, Doctor Mike Ryan, how does your day look like as WHO Chief of Emergencies. Doctor Mike Ryan: (03:36) What she said. No, it's obviously the same kind of diversity. I think so many of our staff have been working seven days a week for seven months. So it is, there is the day you plan and then there's the day you have. I think we all know that one, right? Doctor Mike Ryan: (03:57) So today it'd be a fairly typical day starting with the morning meetings, but then I would have gone in to meet the [Walley 00:04:08] the OB doctor, Ambassador from Jordan, and then straight into a global teleconference on the Solidarity Fund, because we've received over $215 million through the Solidarity Fund for COVID-19. Thank you all. Doctor Mike Ryan: (04:25) Many of you out there have made contributions to that, both the individual citizens and private sector donors and it's made a huge difference and that's allowed us to invest in research. It's allowed us to invest in protecting refugees through HCR. It's allowed us to invest in research and development. It's allowed us to invest in training and so many other things and it's really added value. We meet every week to go through how those projects are going, how the money is being spent, just to ensure that we're getting good value for money for all of you who took out your precious dollars, and yen, and won, the euros and shillings and everything else to support this. Doctor Mike Ryan: (05:12) But then I think that's probably the biggest challenges to shifting your brain between things. It's a bit like those you were watching were in secondary school. It's like going from geography class to maths class, to English class, and then religion class or whatever else it is and your brain is, by the mid afternoon, you don't know where you are. Doctor Mike Ryan: (05:35) I went straight in after that to a global meeting on contact tracing and how we work on that and I am also the chair of the UN Crisis Management Teams. We have 23 UN organizations working together. We meet again on a weekly basis. I chair that and today we were discussing the access to COVID tools accelerator. We were discussing the policies from the UN agencies on schools reopening and we were discussing the preparations for the next G20 meeting on global preparedness. Doctor Mike Ryan: (06:07) Then into a meeting, preparing for the IHR Emergency Committee, which is happening on Friday and then another teleconference with some logistics experts from around the world, looking at how we're going to be able to scale up our supply chain in the coming months because we're going from supplying millions of diagnostic kits to potentially hundreds of millions of diagnostic kits. We're going from having no COVID vaccine to potentially having two or 3 billion doses of vaccine. We've got to be able to buy that, ship it, move it safely and we need to start planning for that now. Doctor Mike Ryan: (06:44) So, that was my day and I'm here now. Alex: (06:48) Thank you very much for your time. I would just like to stress that COVID is not the only emergency that you're overseeing and the WHO is responding to. We still have Ebola in DRC and other humanitarian crisis. So I'm sure you have a lot more meetings on these emergencies as well. Doctor Mike Ryan: (07:06) I was just giving you the COVID ones. We can do the Libya one and we can do the Syria one and the Yemen one and I think that's a, it's a very good point, Alex. We cannot forget that there are literally hundreds of millions of people around the world who are already suffering huge issues of food insecurity, conflict, lack of access to health services and we have to keep our eye on ensuring that we continue to serve them. Alex: (07:33) Thank you, Mike. You also mentioned, IHR, International Health Regulations and the Emergency Committee that meets on Friday. But tomorrow we are marking six months since we declared public health emergency of international concern. That's the highest alarm that WHO can raise for emergency? How do we raise that alarm? And why does it matter? Doctor Mike Ryan: (07:59) The International Health Regulations is, in the sense, the international law around epidemics of emergencies and it was entirely revised in 2005. Took three years and governments from are all around the world and people would say that the WHO and IHR are the same one. Doctor Mike Ryan: (08:17) Well, in fact, the IHR was negotiated by our member states. 194 countries came together and they said, "How are we going to manage epidemics together? And what are the rules going to be?" They spent three years negotiating that. Came into force in 2007 and it's been 13 years that we've had this new and revised IHR. We've only declared four public health emergencies, global public health emergencies, in that time. Doctor Mike Ryan: (08:42) So it shows you that WHO doesn't declare global public health emergencies every day. Where we have, right now today, we have 33 emergencies around the world but they're operational emergencies, things that are bad and they require us to respond, but they're not considered by the global community as global public health emergencies that require this collective action at global level. Doctor Mike Ryan: (09:08) The first one that met those criteria was the pandemic of 2009. I think that's the essence of the IHR, is when the IHR Emergency Committee gets together and that is selected from a whole series of representatives that are suggested by our member states. They get together. We brief them on the existing emergency. They come to a determination of whether that event meets the criteria that represents a global public health emergency and they advise the director general of that. Doctor Mike Ryan: (09:40) On the 30th of January, they declared, they advised the DG that this was a global public health emergency. In that sense, that's a call to action because that's essentially saying to the world, this was an emergency, but now we are giving this a completely different status. We are saying collectively, globally, this represents a threat to the world. In that sense, it should generate and it has in the past, generated a massive response. Doctor Mike Ryan: (10:12) I think in this case, we did see a response to the declaration in January 30th, but I'd have to say that the overall response to that massive alert was less than it should have been overall. I think we all need to look at that. Why did the world react strongly enough to that declaration on January the 30th? Did we lose time in scaling up the response at that moment? Doctor Mike Ryan: (10:42) At that time, I think we had a hundred cases, less than a hundred cases outside China and no death. Can you imagine if I say we've less than a hundred cases outside China and no deaths and then where we are now? Doctor Mike Ryan: (10:55) So we really do have to look at the opportunities that were lost potentially in suppressing the disease over time and we all have to look at that very carefully. But the IHR itself is an important instrument. It's an important way for countries to agree. Doctor Mike Ryan: (11:11) The other thing I think in the IHR is that a lot of the International Health Regulations is about preparedness and about getting countries ready and within the IHR, there are commitments from each country to say how they're going to improve their system. Doctor Mike Ryan: (11:25) I think another lesson from this pandemic is that not all countries were ready. In fact, very few countries were really ready to deal with this scale of an emergency. So when this is over and I'm sure it will be over, we're going to have to sit down and not only look at how do we work together internationally in coordinating response but how do governments prepare? I've said this before, we spend a lot of time protecting our borders from invading armies. Maybe we need to spend a bit more time learning how to prepare our health systems and others for epidemics. Doctor Mike Ryan: (12:02) ... health systems and others for epidemics. Dr Maria Van Kerkhove: (12:04) Can I say something? And it's just to say that, I think that in the beginning, especially with this declaration of this public health emergency of international concern, which is the highest alert we can raise under international law, as Mike has said, we did see some countries... I agree, we need to really strongly look at how countries have responded to that, and how they responded to this pandemic. But I do think that in some countries, the ones that I think had direct experience with SARS, the first SARS, countries that had experience with avian influenza outbreaks, countries that had experienced with MERS, and even countries across Africa that have experience with other infectious disease outbreaks, they were in a better state of readiness for something like COVID than many other countries, including high income countries. Dr Maria Van Kerkhove: (12:49) And I think that the countries that had that experience, almost that trauma of dealing with something like SARS in 2003, knew how serious this was immediately. And so, those that acted really fast, acted really aggressively, took a really serious look in approach to it, fared better in the beginning. But again, there's a lot to learn. I get a lot of questions right now on the six months, seven months, in. The biggest question that I have is, are we going to learn enough? Is the world going to learn enough to make changes? And I'm really hopeful that countries will use this as an opportunity to build back better and be better prepared and ready for when, and if, this happens again. Alex: (13:34) Thank you very much. I think this was very helpful for all our viewers to explain how the IHR works and how we can declare a global emergency. I think it's worth as well repeating, as we've been consistent in our recommendations, what all of us can do to stop the spread of this virus. So, I think it's worth mentioning as well, what are the measures on individual level that we can also take to support the response? Dr Maria Van Kerkhove: (14:01) Yeah. So, I think there's a lot that people can do. And I think everyone really needs to understand that they have a role to play. I say this a lot and I will continue to say this, because we need everyone on the planet to understand that you have a role to play. Whether you are an adult, whether you are a child, regardless of where you live and whatever type of situation that you're in, you have a role to play. It starts with the basics. It starts with the hand hygiene, clean your hands, where you can, when you can, with soap and water, with whatever means you have, with alcohol-based rub. Physical distancing, so at least a meter apart, and this is at least three and a half feet for those of you who don't use the metric system. To practice respiratory etiquette, so that means cough or sneeze into your elbow, it means wearing a mask where appropriate, there are specific settings where we encourage the use of a mask, where you cannot do physical distancing, where the virus is present. Dr Maria Van Kerkhove: (14:55) It includes, staying home if you're unwell. Contacting the hotline, contacting your medical provider, to ask what should you do, should I get a test? It means adhering to the recommendations where you live. So, in situations, in certain countries, you're asked to wear a mask, you're asked to stay home, you're asked to follow certain rules, please do so because that will help break chains of transmission. And it means get involved, find different creative ways in which you can support the response by helping... Checking in on a loved one, checking in on someone. Keep yourself physically distanced, but just checking on people. We have to acknowledge that this not only has an impact on our physical health, but it also has an impact on our mental health. And there are many people that are feeling alone, there are many people that are feeling scared, so there's ways we can be kind to one another and help. And then there's a whole slew of activities that governments need to do and leaders need to do, and I think we've outlined those before. But individuals, really, please be informed, be alert, be aware, find good sources of information. Alex: (16:03) Thank you very much, Maria. There's a lot of questions coming in from our viewers and we are very grateful. I'll start with this one from Twitter, although many are taking precautions like mask wearing, and physical distance, and also the lockdown measures, still the virus is spreading, why? Dr Maria Van Kerkhove: (16:19) Well, there's lots of reasons. I think that the virus is spreading, but the virus likes people, it needs people to pass between. And so, where we see transmission occurring, it's between people who are in close contact with one another. In many countries that have had success in bringing the outbreaks under control, they're starting to see some resurgence, they're starting to see some outbreaks. And many of these outbreaks are happening in specific settings. So, for example, we've seen some outbreaks occurring in nightclubs, we've seen some outbreaks occurring... Related to bars and restaurants, in terms of long-term living facilities. So, if the virus has an opportunity to enter those types of situations, where you have people coming into very close contact with one another, not practicing the hygiene measures and the physical distancing measures and the mass wearing measures that are needed, it will pass between each other. It... We should not allow this virus to transmit between people, and we have some control over that. Alex: (17:20) Thank you, Maria. Here's another question coming from a Facebook viewer, why does some health, national health, agencies recommend for people to be six feet apart? We just mentioned WHO recommends at least a meter or 3.5 feet. Dr Maria Van Kerkhove: (17:35) So, we recommend at least one meter, which is the three and a half, and it says, at least. So, the longer, the further, the better, if that could be done. What we've done is, we've been working with a number of scientists across the globe on looking at the distance, looking at how far these droplets will come out of an individual's mouth. We know that physical distancing works. And in situations where you can't do physical distancing, we recommend the use of a fabric mask. And just, I should take an opportunity to say that these fabric masks, not all of them are the same. We recommend fabric masks that have at least three layers and have this filtration layer in between, an absorbent layer in the beginning and a repelling layer on the outside. So it's a combination of factors that we need. Physical distancing alone, doesn't work. Masks alone, don't work. All of these measures need to be used at once. Alex: (18:25) Thank you very much, Maria. Mike, we are receiving a lot of questions about hydroxychloroquine and its use in treating COVID-19 patients, what do we know about its effects? Doctor Mike Ryan: (18:40) Well, I think the... Many drugs have been tried in this case, and there's been a lot of repurposing of a number of different therapeutic agents from users and others. And in fact, we've had hydroxychloroquine as part of our solidarity trials as have other big trials around the world. What is clear is that, while there have been some observations in smaller studies and observational studies that indicated some positive impact, all of the large studies that have been done so far are the ones that have been controlled randomized trials, have not demonstrated a positive outcome or an improvement in using hydroxychloroquine in ill patients, in terms of improving their outcome. And what's still under study, is the use of hydroxychloroquine as a prophylactic, as a drug to potentially reduce the chances of you getting sick if you've been exposed or if you've got mild infection, and we're still waiting for final results on that. Doctor Mike Ryan: (19:42) But I think it is clear that the overwhelming medical evidence is that hydroxychloroquine, based on the science and based on the published evidence, does not show a significant impact in improving the outcomes for patients with confirmed COVID-19. But we continue to look, we've seen dexamethasone and other drugs show some positive effect, and we will continue to keep an open mind. But, we... What we do have to do, is to do the biggest studies we can in the most controlled way and give the best information that we can to people, and many independent agencies around the world have come to that same conclusion. Doctor Mike Ryan: (20:22) And the other thing we need to be careful with is like with all drugs or most drugs, they can have side effects, and certainly hydroxychloroquine is associated with potentially significant side effects and should only ever be taken, especially in the context of COVID-19, under medical supervision. And it is still the, obviously, the life of any physician to prescribe a drug for, an indicator drug, for their patient according to national laws and national guidance. All we can say is that at this stage, it does not appear that hydroxychloroquine has a benefit in the treatment of sick patients with COVID- 19. Dr Maria Van Kerkhove: (21:01) That goes to your first question that you asked about the science and the speed of the science. I mean, what Mike was describing, these are randomized control trials that are happening in the context of a pandemic. And it's really incredible that these high quality studies are being done and that these results are being available so quickly, because we can answer questions. This one may not have the positive outcome that we would hope for, but still, I mean, the science is happening incredibly fast, and it's just an example of the speed at which these results are coming out. Alex: (21:31) This was a great one. I'll take another question from our viewer, I think on Facebook, how long a COVID patient remain contagious, any difference between mild-moderate patients and severe critical patients in terms of duration of transmission? Dr Maria Van Kerkhove: (21:46) That's a fantastic question- Doctor Mike Ryan: (21:47) [crosstalk 00:21:47]. Dr Maria Van Kerkhove: (21:47) ... and it's a fantastic question. So, yes, there... We are... This is an area of active research, because we know that people can test positive for COVID-19 using these molecular tests, PCR tests, for quite a long period of time. But that doesn't necessarily mean that they're infectious, that they can transmit the virus to others. From the data that we have seen, there is a difference between mild patients and severe patients, the data is very limited right now. We're working with a number of labs who are testing patients systematically, so regularly testing patients over time, which will allow us to not only see if they're PCR positive, but if they can actually grow virus, which means there's viable virus to transmit to others. What we know so far is, for mild patients, there are three or four studies that have shown that someone can transmit the virus to others for up to eight days, maybe nine days, but they don't identify live virus after nine days or so. Dr Maria Van Kerkhove: (22:50) There is a difference between severe patients. There's one study, it's in a preprint, and the lab shared these results with us through one of our international networks and teleconferences, there's actually two, saying that someone who's more ill, someone who's really severe, we can find live virus from them up to three weeks, but those individuals are in hospital and they're isolated. So, there is a difference between mild and severe patients. But we're using this information to help us understand how long someone needs to be isolated for contact purposes, to prevent passing it to others. Dr Maria Van Kerkhove: (23:29) But it's really important that... Part of this package that we recommend to countries, which we have from the beginning, is that all cases are isolated. We would like cases to be isolated in a medical facility or a special facility so that they don't have the opportunity to pass to others. There are situations where people who are mild, who don't have underlying risk factors, who are under six years old, who can be cared for at home if they're infected. But again, if the virus is in the home, then we have to make sure that they don't pass it to other people. So, it's really important that all cases are identified. Dr Maria Van Kerkhove: (24:03) ... the other people. So it's really, really important that all cases are identified, even asymptomatic cases because they can also pass the virus to others. Alex: (24:09) Thank you very much, Maria. Here is the next question coming from LinkedIn. How will I know that I'm COVID negative after I was positive? Dr Maria Van Kerkhove: (24:19) You mean after- Alex: (24:21) Do patients repeat their tests or how do- Dr Maria Van Kerkhove: (24:25) That's also a very, very good question. So it's linked to the first question that I just answered. Doctor Mike Ryan: (24:30) Keep the questions coming. Dr Maria Van Kerkhove: (24:31) Yeah. Keep them going [crosstalk 00:24:34]. You're challenging us. And these are some of the most critical questions right now because all of these recommendations... I will answer the question, but all of these recommendations that we make have implications on how countries manage this. They have implications for where patients are treated, where they are isolated. And they all have not only a health impact, but an economic impact as well. Dr Maria Van Kerkhove: (24:58) In terms of when someone is negative. In the beginning of this pandemic, we recommended repeated testing. And if somebody had to test negative twice and they had to have two negative tests, at least 24 hours apart. What we've recently done is use the data that I just described to give other recommendations that are not testing based to say when someone can be released and is no longer infectious. So what we recommend now is for symptomatic patients, they need to be isolated for at least 10 days from the time that they develop symptoms, plus an additional three days after symptoms resolve. Dr Maria Van Kerkhove: (25:40) If you are asymptomatic, it's 10 days from the time you test positive. We have guidance on this and we have a visual that's coming out, but it does link back to when someone is infectious. But again, we're still learning. We're still learning a lot about this virus. As new data becomes available, we will incorporate that into our guidance. Alex: (25:59) Thank you very much, Maria. A few of our viewers on Facebook are asking, is this possible to infect it again with COVID-19 once you already suffered it or not? Dr Maria Van Kerkhove: (26:08) Another very good question. So what we expect is, and what we are seeing is that people who are infected with the SARS-CoV2 virus, this is the virus that causes COVID-19. They develop a response, an antibody response, which is something that naturally happens after any infection. What we're trying to understand is what this antibody response means in terms of immunity, in terms of protecting them against another infection, how strong that antibody response is, and for how long it lasts. We don't have a full picture of this yet. We do expect that people will have some protection for some time, but again, we don't know how long that will last. Alex: (26:50) Thank you, Maria. Here's the next question- Dr Maria Van Kerkhove: (26:52) We have one for Dr. Mike Ryan here. Alex: (26:54) There is one [crosstalk 00:26:57]. Doctor Mike Ryan: (26:55) This is good. Keep going. You're on a roll, Maria. Alex: (27:00) Facebook [inaudible 00:27:02] says by name, Dr. Ryan, I am concerned about the concept of herd immunity. Some people believe it is better option. What are your thoughts on this? Doctor Mike Ryan: (27:12) Yeah. Herd immunity is a term that's generally reserved for people to work on vaccination. And because we wanted to try and understand when we're designing or developing vaccines, what proportion of the population do we have to vaccinate in order to stop the disease moving? You don't need to vaccinate everybody. And in that sense, I think everyone gets that. If we're sitting in a room and I'm in the middle of the room and everyone around me is vaccinated, then I'm in some senses protected by a wall of people. And if the next person who has the disease is far away from me, then it's going to take a lot for that disease to move towards me. And that's the concept of herd immunity. What proportion of the population do you need to vaccinate in order for that effect? Doctor Mike Ryan: (28:02) And that's what it's called the herd immunity effect. It means in the sense that you don't have to be perfect in your vaccination campaign in order to achieve disease control. You get an advantage. And for different diseases, that's different percentages. So in general for viral diseases is probably somewhere between 60%, 70%, 80%. For measles, it's higher because it's very infectious. It spreads very easily. And then you need a much higher number of people. So herd immunity is essentially the number of people in the population who are immune to the disease. And that's usually achieved by vaccination. This has been somewhat taken into the COVID world where without the vaccine people say, well, the number of people who are positive in the community is 5% or 10%. How many people need to be positive in order for us to reach herd immunity? Well, it's a debate. We don't know what that number is. Most scientists will agree that it's somewhere between 60% and 80%. Others would think that it could be lower. And I won't go into the epidemiologic and mathematical details of it, but there are certainly arguments that it could be a little lower. But whatever that number is, we're nowhere close to it, which means this virus has a long way to burn in our communities before we ever reached that. So the idea that we would have herd immunity as an objective, in some senses, it goes against controlling the disease. Because if you were to say, well, we need to have a herd immunity of 70%. We should let the virus spread until we get 70%. We've seen what happens. Hospitals get overwhelmed. A lot of people die. Doctor Mike Ryan: (29:49) And again, what we don't realize or we don't understand fully yet. And I think there's something we need to understand a lot better. And I say this to younger people online. There is this perception and it's true that the vast majority of younger people have a milder version of this disease, but we've seen significant longterm impacts. Yes, they don't die, but we don't fully understand the longterm impacts of this disease. And anyone who's looked at patients who are severe with COVID realize that this is a very severe multiorgan disease that stresses many systems in the body, the cardiovascular system, the neurologic system. And we will have to assume that in milder cases, that similar process may be happening at a milder level. And we don't know what the longterm impacts of that are going to be on people's longterm health. We've seen perfectly healthy young people go to hospital, have a moderate disease, and then come out and find 10, 15 weeks later, they still can't run. They can't exercise. They're out of breath. They're getting coughing fits. Doctor Mike Ryan: (30:54) Who wants or needs that? So I think we really have to come to grips with, yes, COVID might kill me, but COVID could debilitate you for a significant period of time. And therefore, we have to take it seriously. We have to take protecting ourselves and protecting others seriously. I said that, I think last week, at some level we have the right to potentially risk harm to ourselves. We have no right to risk harm to others. And I think we need to look at this very, very carefully as well. Alex: (31:26) Thank you, Mike very much. You mentioned now that COVID may prevent some people or disable some people to go gym and do some sports for some time. We are receiving a lot of questions from several viewers across platforms about going to gym at the moment. Is it safe to go to gyms and exercise? Some countries are reopening gym. So what is your opinion on that? Doctor Mike Ryan: (31:50) I think it's very similar to the arguments that have come up around opening schools or opening other venues. When people mix, as Maria said, the virus likes people. You put people together in closed environment, particularly where they engage in strenuous activity that may involve them producing droplets, heavy breathing, shouting, whatever else. And in that sense, gyms and have been shown in this outbreak to be associated with higher levels of transmission, both. And I say both because if there's no disease in the community, then the gym is safe. So everything about these environments like gyms or bars or nightclubs or anything else, the risk of those environments depends entirely on what is the risk in the community at large. And if you work together and if the community have worked together with the government and transmission in the community has been suppressed to very low levels, then going back to the gym is fine. Doctor Mike Ryan: (32:55) And I think when those risks are low, they still need to be managed. And I believe for example, many, many people who run gyms have a lot of knowledge. They're very, very good at managing safety. Gyms are inherently risky places. You're dealing with heavy weights. You're dealing with people who are exercising and stressing their bodies. So people who run and manage gyms are smart people. They know how to manage risk. They manage the environment they're in. They make that environment as safe as possible for their clients. And adding in COVID management is just another safety measure. I do though think in areas with intense community transmission, gyms are probably... If I was in that situation, I would probably keep gyms closed. The issue is when communities open up, gyms should open up in the same way, but in a planned and sequential way. But gyms are no more dangerous in a sense than any other environment in which we gather and unmask together and they need to be managed carefully. But again, I believe with proper professionalism and compliance from people who use gyms, that can be made safe. Dr Maria Van Kerkhove: (34:00) I think what we're asking, Alex, is for people to take responsibility themselves for the decisions that they make and the actions that they take forward. So as Mike has said, if the virus is not circulating in an area, things are safer to do. If the virus is circulating in an area, then people need to make a decision... And they remain open, individuals need to make a decision. Do I need to go to that nightclub? Do I need to go to that bar? Do I need to go to that gym? And that needs to be an individual level decision. If the virus is circulating, if there aren't proper measures in place, then perhaps you should skip. There are other ways that you can exercise. It's really important to stay physically fit. And so, there's different things that people can do. They can run outside, or they can do an exercise class in their homes and in different ways to keep physically fit. Dr Maria Van Kerkhove: (34:48) But not only do the owners of these establishments need to take precautions, those who are attending these establishments also need to take responsibility because it's not only a matter of protecting themselves. It's a matter of if I go to that gym, if I go to that nightclub and I happened to get infected, whether it's at the nightclub or it's on the public transport, or however it is that you got there, you could bring that virus home. And if it doesn't have an impact on you in terms of a severe disease, you could infect a loved one at home and they could be a parent. They could be a grandparent. They could be somebody who has an underlying condition and that can have a much stronger and more severe effect on them. So we need people to really take responsibility and know what their individual risk is. Alex: (35:32) Thank you very much, both. This reminds me as well that later this week, Muslim populations will gather to celebrate Eid. What is that mutual recommendation for such religious and social gatherings? Dr Maria Van Kerkhove: (35:47) So this is a great question. And so Friday, people will come together and celebrate Eid, which is wonderful. What we do for all events is we recommend that a risk based approach is taken, which means you ask a number of questions in terms of how the event is held- Dr Maria Van Kerkhove: (36:03) Which means you ask a number of questions in terms of how the event is held. Is it held indoors? Can it be held outdoors? Can it be held virtually? I know many people who are having celebrations, family celebrations, religious celebrations, have been doing these over Zoom, over different types of different platforms, if that's available. They've been having them outside. Dr Maria Van Kerkhove: (36:22) There's some fundamentals that need to be taken into account. It's physical distancing, limiting the size, limiting the duration of the event. If they are decided to take place, making sure that there's good hand hygiene, appropriate food preparation and food safety that's taken into consideration. There's really no reason that people cannot continue to celebrate religious events and family events. We just need them to be done in a safe manner, and there's ways in which that can be done. Dr Maria Van Kerkhove: (36:53) Again, this is a challenging time for many people, but we are finding people be very creative in the ways that they continue to socialize with one another. So, we do have guidance out specifically on Eid, and we're grateful for our colleagues in EMRO who've led that. But Eid is a celebration that will continue, and we've just outlined some different ways in which that could be done safely. Alex: (37:16) Thank you very much, Maria. Before we close, because we are running out of time for today, Dr. Mike, here is a question as well for you, coming from several viewers, about the second wave of this pandemic in countries or communities that have success in suppressing this virus. Doctor Mike Ryan: (37:35) Yeah. There's a lot of talk at the moment. People are saying second wave, second peak, and because there has been this perception that this disease would behave a little bit like influenza, and it would have a natural peak and then it would disappear for a while, and then it would come back in the Northern hemisphere in the autumn. Doctor Mike Ryan: (37:53) I think we've always said that we didn't know that. And I think what's become clear is that when we move to suppress this virus, we put pressure on the virus it's like, for those of you who swim, if you take a ball and you push a ball under water, if you release pressure from the ball, it jumps up. And I think this virus is behaving like this. It's like a spring. When we pushed the virus down, we suppress transmission, release the pressure, it bounces back up. Doctor Mike Ryan: (38:23) Now, you can call that a second peak, a second wave. You can call it what you like. What it means to me is this virus requires sustained pressure to reduce transmission, and requires a sustained commitment to reduce exposure. And I think they're the two things we need to do. The government and the authorities need to work to suppress transmission, stop cases, detect cases, test cases, quarantine contacts. Do all of that work, right? And communities and individuals need to do everything they can to reduce their exposure to the virus. Doctor Mike Ryan: (38:53) And in countries where we've seen well-managed efforts of the part of government to suppress transmission and where we've seen communities empowered to reduce their exposure, we see success. And we need to see that partnership in countries really improve and really grow. So, I would say that there is no second wave, as such. What we're seeing is the virus naturally reemerging when we take pressure off. Doctor Mike Ryan: (39:19) And when people move around and countries who have done well have opened up their borders, and people start to move, then you start to see a flare ups, we could call them flare ups. Now, the real question is, how fast do we react to them? And I said this in previous pressers, please don't judge countries and declare failure when all of a sudden there's two or three clusters in the country after great success. That happens. And that is not a failure on behalf of the country. Doctor Mike Ryan: (39:46) But please look to what countries do in response to those clusters, and if countries react quickly to the cluster, if they investigate the clusters, if they do localized control measures. And if you can see countries reacting in an agile and rapid and systematic way to new clusters of disease, then I think we're going to get into control again. Doctor Mike Ryan: (40:06) If you see countries ignoring clusters and allowing the disease to get out of control again, then I think we're going to be into what your viewer has said is a second wave. I mean, all we really mean by a second wave is lots more cases, and we want to avoid that. I believe it is avoidable, and there are countries demonstrating that you can put this virus back in the box again and again and again, but it takes a huge and sustained effort. And nobody understands more than us how exhausting that is for everybody. Doctor Mike Ryan: (40:36) I think this is something, after seven months, we do need to take into account. Everyone was tired. People are just tired of not having their normal lives. People are afraid because now at six months, my kids aren't in school, and how long is my unemployment going to last? Or will my employer still keep me on? So a second wave of anxiety, too, as people look at the longterm potential for this virus to stick around. Doctor Mike Ryan: (41:04) I do think, and this is where I think in a crisis, you can either fold and accept your fate, and say, "Well, there's nothing we can do." Or you can redouble your efforts and say, "Look, we can do things. We need to take control. We need to take action." Doctor Mike Ryan: (41:23) And I think we need every single individual, every single community. And I would love to see young people do this. I challenge young people out there, take control, take action. This is your world. This is your future. You have the power. We have the knowledge, we know what to do. I know it sounds simple, but it's hard to achieve. Doctor Mike Ryan: (41:46) I really would say we can avoid the second waves. We can avoid this disease going back up and destroying our economies again and overflooding our hospitals again. But it's going to require each and every person to take control, take action, know your risk, manage your risk, be smart and make a difference. Never before have we needed the young people of the world to take notice of that and take action. Alex: (42:17) I thank you very much. Dr. Mike Ryan, Dr. Maria Van Kerkhove, and we thank all our viewers from the UK, France, Canada, Israel, Philippines, Serbia, Paraguay, the USA, Spain, Denmark, India, Nepal, Pakistan, Vietnam, South Africa, Ghana, Ireland, et cetera, et cetera. Numerous years from all parts of the world. We will be here back next Wednesday to respond more of your questions. Meanwhile, either visit our website for more information or follow our social media channels, where we will be posting regular updates. Thank you, and have a good day, and stay safe. Alex: (42:51) (silence)