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Maria Van Kerkhove: (23:52)
So, thanks for this. I can start. And maybe Mike would like to add here. In terms of all of these questions, specific to a ski season or specific to travel or specific to any activity, what WHO advises is a risk-based approach in terms of what can be done, how it can be done, if it can be postponed and if it can’t be postponed, how it could be done safely. Skiing is no different. There are different countries that are looking at whether to keep it open or to close it, whether they can keep it open in a safe manner. But what WHO has outlined are ways in which people can reduce the opportunities for them to be infected. If the virus is circulating in an area and if people are in close contact in that area, the virus can spread. It’s as simple as that. And so, what are the measures that need to be taken to be able to minimize that risk, minimize that opportunity for spread?
(24:49)
So, there are ways in which different activities can be held safely or in a more safe manner, but right now there is no zero risk. And while we are definitely seeing some improvements in case incidents in many countries across Europe, it has come at some high costs due to the stay-at-home measures and the other restrictive measures that have been put in place. We really need to remain vigilant in terms of everything that we could do to prevent that spread.
(25:16)
So, it needs to be a risk-based approach in looking at what policies, decision-makers need to be put in place, taking into account the circulation of the virus, the measures that could be put in place to keep people physically distant from one another, to make sure that we don’t give the virus an opportunity to spread further.
Michael Ryan: (25:37)
Yeah, I agree with Maria. This really has to be a risk-managed approach. And the risk in this is not necessarily skiing itself. I suspect many people won’t be infected while barreling down the slopes on their skis. The real issues are going to come at airports, on buses taking people to and from ski resorts, ski lifts and places where [inaudible 00:26:08] pinch points in the skiing sort of experience, where people come together in large numbers and there are pinch points in that. Not to mention the apres ski that so many people seem to enjoy is another issue. So, here you’re dealing with issues of airline transport, bus transport, the opening or closing of bars. It’s not just about skiing; it’s a much broader issue. So, I don’t think we should be reducing this down to skiing or ski season.
(26:34)
What every government needs to be looking at is all forms of gatherings that lead to people congregating or moving en masse, and how they’re going to derisk those processes. If they don’t believe those processes can be derisked enough, then curtailing, postponing or managing it in that way. And I think rather than targeting the ski season, the next thing it’ll be spring season and the hiking season, and then we will be… We had the previous issue in summer and holiday. So, I think rather than targeting the actual activity, it’s important for governments now to look at the risk management, end to end of this process.
(27:11)
So, governments who potentially don’t have skiing as part of their economic activity may be sending lots of people to go skiing, who may return with the risk. So, it’s not just the places in which skiing occurred; it’s the risk that’s exchanged between locations based on the movement of people. It’s not that they went skiing or they’re going skiing. That’s not the issue. The issue is any activity that involves large numbers of people, moving into a concentrated space and then using public and other transport to get there and back needs to be managed carefully and it needs to be managed, as Maria said, with very much a risk-management approach.
(27:51)
We don’t hold a position on whether something should be canceled or not canceled because the circumstances change in each and every jurisdiction. So, we would advise that all countries look at their ski season and other…
(28:03)
… that all countries look at their ski season and other reasons for mass gathering, be they sports or recreation or religious, and looks very, very carefully at the end-to-end risks associated with that. We are in the middle of a deep moment of transmission. We’ve seen great progress made, certainly in Europe, over the last number of weeks, as the DG said, with the application of measures, however difficult, have reduced in the turning around of that. We want to maintain that progress.
(28:36)
As we say, there are travels that are needed. People may need to travel for all kinds of different reasons. The question is whether travel is considered to be essential or necessary, and in that, I think countries are going to have to look at mass recreation and see whether or not that can be managed within their current risk management framework.
Margarita: (29:01)
Thank you very much Dr. Ryan and Dr. Van Kerkhove. I think we’re now move from snow to tropical regional Brazil because we have Bianca from Globo. Bianca, please, unmute yourself and ask your question.
Bianca: (29:19)
Hi, Margaret. Can you hear me?
Margarita: (29:21)
Very well, Bianca. Please, go ahead.
Bianca: (29:24)
Thanks a lot. Yeah, here, Bianca Rothier. I’m a correspondent in Switzerland for Globo, the largest TV network in Brazil. My question is again on Brazil. Brazil clearly sees an increasing the number of cases and deaths. My question is probably to Mike and Maria. What is your main concern with Brazil at this point in time, and technically, does [inaudible 00:29:54] see it as a second wave or is Brazil still facing the first wave? Thanks.
Michael Ryan: (30:05)
I think we spoke pretty extensively about this on Friday. I think, as I said then, it’s not a specific concern related to Brazil. It’s a general concern related to Central and South America where many countries have fought very hard to get their numbers down. The numbers have not returned to extremely low levels, so many countries are still moving along with reasonable, but they’re not low numbers, and the difficulty now is, in some countries, as they begin to see a rising number of cases, they need to look at that at a national and sub-national level, so even in the case of Brazil, the disease numbers are going down in a number of states but rising in others, so I think it’s about looking at the problem now and being very, very clear and very, very directed.
Michael Ryan: (30:55)
Where are cases jumping back? What’s driving that raising cases? What can be done at that sub-national level to deal with that, very much like the first waves. Whether you call this a second wave or a surge within the first wave, we can have those pedantics all night. The fact remains that the numbers are increasing again in a number of countries, and that must be addressed, but that increase is very unlikely to be everywhere at the same time.
(31:24)
It’s very likely, as it happened in Europe, to be occurring in specific zones, and we need to look at those zones and see whether or not we can act fast and implement measures that will be aimed at suppressing the numbers of disease so that the health system stays intact as it did before. Again, the healthcare workers of Brazil did a fantastic job during the previous peak in maintaining basic capacity of the health system to deliver across the country. That was a gargantuan task.
(31:55)
Again, my advice would be look at the sub-national level, look at where the increases are occurring, ensure that we have rapid action in those areas both to contain the disease and support the health system. We all know the complexities of responding to COVID, particularly in countries that have both deeply rural and very, very urbanized settings, and within those urban settings, a very different profile in the population from the very wealthy to people living in slums and who have little access to services.
(32:29)
It’s a very diverse situation, no one-size-fits-all, but we want to avoid the health system coming under huge pressure, and we want to take action as quickly as possible in the areas where we see the disease jumping back up. That advice is not just for Brazil. That really is for any country facing a rebound in its cases. You’ll see in the case of Europe how countries that reacted quickly to the new numbers seem to have done pretty well in suppressing those numbers and protecting their health system.
(33:04)
Now, hopefully with the continued follow-through, we would like to see that follow-through in Europe to follow through with low numbers of cases, and then begin to introduce vaccines. If we have followed through a low numbers of cases, then other health services can continue to recover. Meg is here to speak about that from the perspective of HIV. We need that. We need the system to be able to not just survive COVID, it’s got to deliver other services, and it’s got to recover that capacity to deliver a full service to everybody. That’s, will be the same in Brazil or anywhere else.
(33:39)
We’re not just trying to get the COVID numbers down for the sake of getting COVID numbers down. We’re trying to get the COVID numbers down so the health system can get back to what it’s supposed to be doing, which is preventing and treating other diseases at the same time. The advice goes for Brazil as it goes for everyone else. I don’t know, Maria or Meg, if you want to add.
Maria Van Kerkhove: (23:52)
So, thanks for this. I can start. And maybe Mike would like to add here. In terms of all of these questions, specific to a ski season or specific to travel or specific to any activity, what WHO advises is a risk-based approach in terms of what can be done, how it can be done, if it can be postponed and if it can’t be postponed, how it could be done safely. Skiing is no different. There are different countries that are looking at whether to keep it open or to close it, whether they can keep it open in a safe manner. But what WHO has outlined are ways in which people can reduce the opportunities for them to be infected. If the virus is circulating in an area and if people are in close contact in that area, the virus can spread. It’s as simple as that. And so, what are the measures that need to be taken to be able to minimize that risk, minimize that opportunity for spread?
(24:49)
So, there are ways in which different activities can be held safely or in a more safe manner, but right now there is no zero risk. And while we are definitely seeing some improvements in case incidents in many countries across Europe, it has come at some high costs due to the stay-at-home measures and the other restrictive measures that have been put in place. We really need to remain vigilant in terms of everything that we could do to prevent that spread.
(25:16)
So, it needs to be a risk-based approach in looking at what policies, decision-makers need to be put in place, taking into account the circulation of the virus, the measures that could be put in place to keep people physically distant from one another, to make sure that we don’t give the virus an opportunity to spread further.
Michael Ryan: (25:37)
Yeah, I agree with Maria. This really has to be a risk-managed approach. And the risk in this is not necessarily skiing itself. I suspect many people won’t be infected while barreling down the slopes on their skis. The real issues are going to come at airports, on buses taking people to and from ski resorts, ski lifts and places where [inaudible 00:26:08] pinch points in the skiing sort of experience, where people come together in large numbers and there are pinch points in that. Not to mention the apres ski that so many people seem to enjoy is another issue. So, here you’re dealing with issues of airline transport, bus transport, the opening or closing of bars. It’s not just about skiing; it’s a much broader issue. So, I don’t think we should be reducing this down to skiing or ski season.
(26:34)
What every government needs to be looking at is all forms of gatherings that lead to people congregating or moving en masse, and how they’re going to derisk those processes. If they don’t believe those processes can be derisked enough, then curtailing, postponing or managing it in that way. And I think rather than targeting the ski season, the next thing it’ll be spring season and the hiking season, and then we will be… We had the previous issue in summer and holiday. So, I think rather than targeting the actual activity, it’s important for governments now to look at the risk management, end to end of this process.
(27:11)
So, governments who potentially don’t have skiing as part of their economic activity may be sending lots of people to go skiing, who may return with the risk. So, it’s not just the places in which skiing occurred; it’s the risk that’s exchanged between locations based on the movement of people. It’s not that they went skiing or they’re going skiing. That’s not the issue. The issue is any activity that involves large numbers of people, moving into a concentrated space and then using public and other transport to get there and back needs to be managed carefully and it needs to be managed, as Maria said, with very much a risk-management approach.
(27:51)
We don’t hold a position on whether something should be canceled or not canceled because the circumstances change in each and every jurisdiction. So, we would advise that all countries look at their ski season and other…
(28:03)
… that all countries look at their ski season and other reasons for mass gathering, be they sports or recreation or religious, and looks very, very carefully at the end-to-end risks associated with that. We are in the middle of a deep moment of transmission. We’ve seen great progress made, certainly in Europe, over the last number of weeks, as the DG said, with the application of measures, however difficult, have reduced in the turning around of that. We want to maintain that progress.
(28:36)
As we say, there are travels that are needed. People may need to travel for all kinds of different reasons. The question is whether travel is considered to be essential or necessary, and in that, I think countries are going to have to look at mass recreation and see whether or not that can be managed within their current risk management framework.
Margarita: (29:01)
Thank you very much Dr. Ryan and Dr. Van Kerkhove. I think we’re now move from snow to tropical regional Brazil because we have Bianca from Globo. Bianca, please, unmute yourself and ask your question.
Bianca: (29:19)
Hi, Margaret. Can you hear me?
Margarita: (29:21)
Very well, Bianca. Please, go ahead.
Bianca: (29:24)
Thanks a lot. Yeah, here, Bianca Rothier. I’m a correspondent in Switzerland for Globo, the largest TV network in Brazil. My question is again on Brazil. Brazil clearly sees an increasing the number of cases and deaths. My question is probably to Mike and Maria. What is your main concern with Brazil at this point in time, and technically, does [inaudible 00:29:54] see it as a second wave or is Brazil still facing the first wave? Thanks.
Michael Ryan: (30:05)
I think we spoke pretty extensively about this on Friday. I think, as I said then, it’s not a specific concern related to Brazil. It’s a general concern related to Central and South America where many countries have fought very hard to get their numbers down. The numbers have not returned to extremely low levels, so many countries are still moving along with reasonable, but they’re not low numbers, and the difficulty now is, in some countries, as they begin to see a rising number of cases, they need to look at that at a national and sub-national level, so even in the case of Brazil, the disease numbers are going down in a number of states but rising in others, so I think it’s about looking at the problem now and being very, very clear and very, very directed.
Michael Ryan: (30:55)
Where are cases jumping back? What’s driving that raising cases? What can be done at that sub-national level to deal with that, very much like the first waves. Whether you call this a second wave or a surge within the first wave, we can have those pedantics all night. The fact remains that the numbers are increasing again in a number of countries, and that must be addressed, but that increase is very unlikely to be everywhere at the same time.
(31:24)
It’s very likely, as it happened in Europe, to be occurring in specific zones, and we need to look at those zones and see whether or not we can act fast and implement measures that will be aimed at suppressing the numbers of disease so that the health system stays intact as it did before. Again, the healthcare workers of Brazil did a fantastic job during the previous peak in maintaining basic capacity of the health system to deliver across the country. That was a gargantuan task.
(31:55)
Again, my advice would be look at the sub-national level, look at where the increases are occurring, ensure that we have rapid action in those areas both to contain the disease and support the health system. We all know the complexities of responding to COVID, particularly in countries that have both deeply rural and very, very urbanized settings, and within those urban settings, a very different profile in the population from the very wealthy to people living in slums and who have little access to services.
(32:29)
It’s a very diverse situation, no one-size-fits-all, but we want to avoid the health system coming under huge pressure, and we want to take action as quickly as possible in the areas where we see the disease jumping back up. That advice is not just for Brazil. That really is for any country facing a rebound in its cases. You’ll see in the case of Europe how countries that reacted quickly to the new numbers seem to have done pretty well in suppressing those numbers and protecting their health system.
(33:04)
Now, hopefully with the continued follow-through, we would like to see that follow-through in Europe to follow through with low numbers of cases, and then begin to introduce vaccines. If we have followed through a low numbers of cases, then other health services can continue to recover. Meg is here to speak about that from the perspective of HIV. We need that. We need the system to be able to not just survive COVID, it’s got to deliver other services, and it’s got to recover that capacity to deliver a full service to everybody. That’s, will be the same in Brazil or anywhere else.
(33:39)
We’re not just trying to get the COVID numbers down for the sake of getting COVID numbers down. We’re trying to get the COVID numbers down so the health system can get back to what it’s supposed to be doing, which is preventing and treating other diseases at the same time. The advice goes for Brazil as it goes for everyone else. I don’t know, Maria or Meg, if you want to add.
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