As the city moves toward reopening, Toronto's top doctor continues to urge residents to practice physical distancing as most of the new COVID-19 cases in the past few weeks were close contacts of confirmed cases.
"And most often that happens in the household because you spend a lot of time with people that you live with, but it also happens with those in the workplace," Dr. Eileen de Villa, the city's medical officer of health, said during an interview with CP24.
"Physical distancing continues to be really important."
Toronto Public Health reported 86 new COVID-19 cases on Wednesday, bringing the city's total to 13,588. Of those cases, 998 have died, while 11,397 have recovered.
De Villa also answered COVID-19 questions from viewers.
CP24: What are your thoughts on the COVID-19 recommendations released by medical experts from SickKids Hospital?
De Villa: Well, I haven't had the chance to see the guidelines. It sounds like they as well have looked to the experiences of other jurisdictions, which, of course, is a smart thing to do. We're still learning a lot about this virus. It sounds like there's recognition of that, but that we're using the evidence that we have right now to best inform our decisions to come up with what makes the best sense for all aspects COVID-19 and also knowing that schools have a lot of other benefits, health benefits for kids. It is an evolving situation. And I think you make the best decisions with the information that you have at the time, but good professional practice says that we have to change our practice as the evidence and the information and situation changes.
CP24: Wellington-Dufferin-Guelph Public Health is mandating the use of masks in commercial settings. Would you consider making the same move when Toronto enters Stage 2 of reopening?
De Villa: Well, we're certainly keeping an eye on all the different practices that are happening elsewhere. When it comes to those indoor settings, physical distancing is one of the most evidence-informed practices that we can take to protect ourselves and our community from COVID-19. Don't forget washing your hands, not touching your face and staying home when you're sick. But we know that these are the important elements, and we are increasingly understanding more and more about masks.Stores or other businesses that have members of the public come in are well within their rights to require people to use a cloth mask in order to access that business. Good professional practise means that you have to examine the evidence, examine new information and change the practice should the situation require that.
CP24: Are you worried that social circles may lead to an uptick in COVID-19 cases?
De Villa: I am very encouraged by the direction in which our numbers are going all good signs. We are seeing new cases declining. We're seeing hospitalizations go down. I do think that having social circles is really important. Again, we can't over-focus on any one single element. And when we're doing our monitoring and trying to understand and assess how we're doing on our COVID-19 objectives, it's not just on one particular aspect. I think we have to look at all the many aspects of health, including having access to our social networks and our support networks. I'm in support of social circles as a method by which we can balance out all the health needs that we have -- controlling COVID-19 transmission and at the same time, ensuring that we have our support networks and our social networks available to us.
CP24: Is it okay to go into somebody's house, for example, to use the bathroom, even if they're not in your social circle, but you're at a social gathering of 10 people?
De Villa: What we're trying to do is limit the potential contact. So, quickly going in to use a washroom, for example, is no different than say, for example, using a washroom in one of our parks. To my mind, if you're quick about it and not exposing yourself, we're not talking about long periods of time with people outside of your social circle. Not lengthy exposure to other people and not going beyond that social circle, that's reasonably safe. Being outdoors also helps. When it comes to social gatherings, I will remind the viewers that if you're talking about people outside of your social circle, you'll remember that maintaining physical distancing is important. And again, having that social gathering occur in the outdoor environment, where transmission of the virus is less likely, also helps to support controlling COVID-19.
CP24: A viewer asks, my immediate family consists of three children, myself and my husband, which comes to five people. Some of my friends have even larger families. Would my whole family, since we have been together through it all, be considered one out of a group?
De Villa: We're all busy learning about COVID-19. When it comes to a family of five, that's five out of the 10 in that social circle. I have full sympathy with that. I'm also a household of five, and I realized that it does limit how many other families can join that social circle. But if we continue to practice those good public health measures, continue to main physical distancing with those outside of our social circles, stay home when we're sick and wash our hands, I know that will progress faster, and hopefully, we'll get to larger social circles so that those of us that have those larger families can congregate in larger groups sooner, rather than later,
CP24: Many couples, boyfriends, and girlfriends and partners are finding it increasingly difficult to social distance from one another. If they are not currently living in the same household, what are your suggestions to those who are continuing to break these social distancing rules with those who live outside of their homes?
De Villa: I'd like to think that with the announcement of social circles, which has allowed for that expansion, that hopefully there's some togetherness and reuniting that's happening there between those couples because that's clearly allowed now.
If you're actually expanding your social circle to someone who lives in another household, all those people in that household should also be part of that 10. The total number of people in the social circle should be no more than 10. And they have to consistently stay at that 10. When we're talking about people going outside into the workplace, we are talking about people who should be maintaining physical distancing to the greatest extent possible. And so, you should still be able to protect that social circle effectively with really good practice and all the good advice that we've provided.
CP24: When do you see these social circles expand to more than 10?
DeVilla: That will all depend on how we see things progress within our communities, and this is certainly within something that's within the power of the provincial government. They're the ones who are setting the social circles, and it was their choice to go with 10. And I think they were trying to achieve that appropriate balance, trying to provide people with some access to a broader social network than what exists in their homes while at the same time, not having numbers that are so big, that if one of those individuals becomes sick with COVID-19, that you have a large number of people who've been exposed. It's a question of trying to achieve balance, but with a new virus, there isn't a single answer. We're learning from lots of other jurisdictions. And I've seen places go from 10 to say 20. But I don't know that there is a single right answer.
CP24: Is the city preparing behind the scenes for an eventual second wave in the fall? Is there a plan in place, and is a second wave inevitable?
De Villa: We're still in the middle of the first one. There's certainly a lot of activity continuing to respond to the current level of activity, but we are preparing for a second wave. There has never been a pandemic before without a second wave, but what we're used to seeing are pandemics of influenza. This is a new coronavirus. I don't know what will happen. I don't think anyone can say that they know with certainty what will happen in the future. But I think it's appropriate for us as good public health professionals to prepare for a second wave and take a good stock of all the lessons we've learned from the last several weeks as we've responded to this new virus.
CP24: A viewer asks, at home, should everyone have their hand towel for drawing washed hands?
De Villa: I think that's a reasonable precaution to take in terms of having individual hand towels. It does make for a little more laundry for sure. And I suppose one has to remember whose towel is whose, but if you can do that and that's within your household's capacity, I don't see why you wouldn't. I think that's a very good choice.
CP24: A viewer asks, I have respiratory issues, and I'm in the higher risk category. Masks are suggested only when physical distancing cannot be maintained. However, because of my situation, should I wear one every day?
De Villa: I would say that still try to limit outings wherever possible. And if you are going to go outside, best to be in the outdoors and in open-air spaces, where a likelihood of encountering virus or getting a virus from others is significantly reduced. However, for those who are in high-risk categories, whether it's because they have pre-existing medical conditions or they're above a certain age above age 70, these people are at higher risk and should be more cautious and more careful in general, around limiting exposure and ensuring that they're doing the good practices like hand hygiene washing hands using alcohol-based hand sanitizer, not touching your face, and certainly staying away from people who are sick and are showing symptoms.
CP24: Is there any advice in terms of what the most recommended mask is?
De Villa: I think there are lots of good masks out there that are available, and I would encourage viewers not to use medical-grade masks. Let's save those medical-grade masks for those situations where they're recalled for. Um, and we're talking about health care settings for health-care workers. There are still many challenges around the world with getting access to that supply. It's really important that we reserve that for those situations that need it the most for the rest of us, for the general public, her out and about and wish to protect others from our germs, a cloth or nonmedical mask will suffice. There is information on the Public Health Agency of Canada's website about different options that you can follow to make your mask. But if you're going to buy one, something that's a double-layered cloth, tightly woven cloth is best and double layer to help control the spread of what comes from your nose and mouth outside and going to others. Those are the basics.
CP24: Would weather shields, i.e. the plastic covers used for rain for strollers, help minimize the risk of exposure if I need to be out with my five-month-old in a public space, for example, in a store or a mall or a doctor's office?
De Villa: That's an interesting question. I hadn't thought about the plastic cover as being a virus protector. I was thinking with the stroller you're most often outdoors, where there is less of a concern. We know that virus doesn't transmit quite as well outdoors because you've got lots of airspace and lots of air movement. But it sounds like we're talking about going into indoor spaces and I think that that might create something like a face shield except it's a stroller cover.
I suppose that's a reasonable thought, probably not well studied, but it sounds like it has some merit as an idea. The important thing is that if you are indoors, you still try to maintain that physical distancing wherever possible. And if you're just passing by people, quickly going by with your stroller, the likelihood of transmission is pretty low.
This interview has been edited.