Ahead of the Thanksgiving long weekend, Toronto's top public health official is repeating her message to avoid large gatherings and limit celebrations with those within the immediate household.
During the city's COVID-19 briefing, Dr. Eileen de Villa warned that Toronto could see more infections in the next few weeks than it did during the peak of the first wave.
Without stricter restrictions to curb the spread of the virus, de Villa said things could get "much worse" this winter.
The doctor said that Torontonians aren't "passive observers" and do not need to wait to protect themselves and others around them.
"Your actions – the choices you make – play a significant part in arresting and even reversing the spread of COVID-19," de Villa said.
"The virus will find it a lot harder to spread if you aren't doing things that help it spread. That's why it is vital to think of your plans as a choice between things you need to do and things you want to do."
For those who live alone, de Villa urges them to connect with others virtually.
Some people with serious mental health needs who need to connect in person with risks, de Villa advises them to meet outside, keep a distance of at least six feet, and wear a mask.
"Believe me, I know – I really do know – that this is a huge ask. No one wants to imagine the worst could happen as a result of a family holiday. But I imagine many of the people in Toronto thought something similar before they began the frightening, and sometimes harrowing experience of battling this illness," she said.
On Wednesday, Toronto Public Health reported 187 new infections, bringing the city's total to 21,315. Of those cases, 1,308 have died while 17,700 have recovered.
De Villa joined CP24 on Wednesday afternoon to address concerns about the pandemic and answer coronavirus-related questions.
CP24: Last week, you announced that your re-prioritizing contact tracing as the city continues to see an increase of COVID-19 cases. How long is the strategic shift going to be lasting? And when will these additional 200 contact traces from the province come in, to hopefully help ease that burden and get you back to where you were?
De Villa: We have 700 people working on case and contact management at Toronto Public Health right now. And the province has very generously offered to provide us with some support with 200 additional people who will be doing contact calling, which is a little different from case management. Case managers actually interview the individuals who have a COVID-19 diagnosis and get into a pretty lengthy history and help understand what might have happened, where do you think you might have acquired this, as well as trying to figure out who they might have been in contact with when they were possibly infectious and who might be the next generation of infection.
We had to change our plan. We had to change our strategy because of the high case counts. And it simply just gets overwhelmed. Any system has that, and this is a very standard practice in public health. We move to a more focused case and contact management process. We're hoping to get back to that. Although the best way to determine the timing or the factor that will determine when we can get back to our regular kind of case and contact management will be when the case count starts to drop to a more manageable level. That we know is on all of us.
CP24: Is there any chance that more people, perhaps for the city or for public health, could be transferred into this sort of lower-level function here to try to increase the ability to contact trace? The understanding most of us have here is without contact tracing, you can't really have a good handle on where COVID is hitting the city or where it's going.
De Villa: We're certainly bringing in more people as we have been doing right from the beginning of this when we first started this whole COVID-19 response. We had about 50 people working in the case and contact management. And we've continued to build up our resources to where we are now -- 700 case and contact managers at Toronto Public Health that's larger than most other public health departments across the province. And I would dare say, across the country. It is a pretty significant number of people that we've brought on board.
Plus, we've introduced technologies and information systems to make us more efficient with respect to our work. But we know that this is a situation that actually impacts all local public health units across Ontario, and certainly in other provinces. We're bringing on more people using technology where possible, using additional resources for those areas that are easier to train new people. But at the end of the day, we still need to deploy other tools in the public health toolbox, if you will, to bring case counts down. Those are things like those broader public health measures. And of course, asking people as much as possible, use the self-protection measures that we know work -- watching your distance as much as possible, wearing your mask and washing your hands. I know people are tired of that. We've said it quite a bit. But I really can't say enough how very important that is towards controlling COVID-19.
CP24: Public health officials have been urging residents to stick with their immediate household this Thanksgiving. I want to see my grandkids, and I'm kind of holding off on it because they don't live me. How will gatherings with those outside their household affect our fight against the pandemic?
De Villa: She says she's said no and is not mixing with her grandchildren at this point because she knows they are at school. My advice to the residents of Toronto around Thanksgiving is a tough one. It's not easy advice to give. But it is the best advice. The best course of action that we can take in our city right now. Please, spend Thanksgiving, celebrate Thanksgiving, exclusively with those you live with regularly. This is the safest thing, the safest option for us to celebrate Thanksgiving so that we can control COVID-19 in our community. I know it's not what we want to do. And I know people want to connect with their extended family members, their grandchildren and beyond. The best thing to do if you want to connect with others you don't regularly live with is to try to do that virtually. That's really the best thing that we can do.
It is it's not an easy thing to do. But at this point in time, it's the safest option for us. And it gives us the best chance at it continuing to keep our community safe, to keep our residents and long-term care safe and to keep our schools operating as safely as possible. And we know that this is really important.
CP24: How do you deal with anti-maskers, anti-pandemic people, pandemic deniers that are gaining a lot of steam and being fueled by social media?
De Villa: That's a very interesting question and one that we are constantly managing in the realm of public health. There's always a lot of information and there's a lot of misinformation that's out there. First and foremost, let's talk about masks. With masks, we know that it actually helps to protect all of us by restricting the ability for the droplets that come out of our nose and mouth to spread to others. We protect others around us. And increasingly, there is evidence that we're protecting ourselves by wearing that non-medical mask or face covering. And the more of us that wear it, the more protection we afford to the entire community. When it comes to hospitalizations, I don't think we should look at that gift horse in the mouth. Right now, hospitals are managing okay. We're not seeing a great deal of hospitalizations. We are seeing an increase, but it's not a huge one. Not like what we saw earlier in the first component of this outbreak.
But the issue with hospitalizations is it's one of those factors that rises a little while after we see a rise in case activity. It's not something that comes at the same time as those increases in COVID-19 cases. First, you see an increase in COVID-19 cases, and it's a couple have weeks later before you really start to see the impact on hospitals. We may not have seen the full impact on hospitals yet. And the reality is that our data are always a little bit behind because it takes that time from when you actually get exposed to COVID-19 until such time as you get symptoms, get a test and then get a diagnosis. Our data are always a little bit behind. By the time your hospital data start to shoot up, it's too late. Let's not go there. Let's not let ourselves get into that bad situation that we've seen in places like New York City or Italy, where their hospitals were completely overrun. I just asked people to really engage in self-protection measures, keep themselves safe, keep our community safe.
CP24: The provincial government continues not to heed your request when it comes to shutting down indoor dining and gyms to ensure that we keep the lid on the spread of COVID. What is your reaction when you see no change at the provincial level?
De Villa: There is an ongoing conversation. I've made my case, and I have put my advice out there. And first and foremost, my main concern, my main job is to make sure that I'm offering the best advice and doing the best that I can on behalf of the residents of Toronto. I completely understand that my provincial counterparts have a slightly different perspective. They need to consider all of Ontario. And yes, Toronto is a significant component of that, but it is quite different from the rest of the province. I do appreciate those concerns. And I do appreciate the kinds of considerations that they need to give to a much broader, broader geography and different populations. Suffice it to say that at this point, we're continuing to have a conversation. I'm continuing to make the case. And in the meantime, there is a lot that can be done at the community level by each of us limiting our social interactions as much as possible to those with whom we live, and limiting the risk of spread by avoiding close contact with others, especially if we're without a mask and in an enclosed space. We know that closed spaces with close contact without a mask -- these are the conditions that give rise to COVID-19 spread.
CP24: A viewer asks, my university son tested positive for COVID-19. A few weeks ago, he completed his quarantine period and has been asymptomatic throughout. However, his roommate just tested positive for COVID-19. How safe is it to bring him home for Thanksgiving weekend if my husband and I are both in our 50s, and it's not possible to completely isolate him within our home? Is it possible he could get reinfected by his roommate?
De Villa: I wish there were really simple answers on this one. It would be helpful to know what the exact time frame is. But if you've got someone who's already recovered and completed their entire isolation period for COVID-19 infection, the likelihood that they're going to get reinfected in the very near future is relatively small. We have heard reports of reinfection. But it is one of the questions that is still really to be fully understood by science. I wish I had a simple answer. I don't know how long immunity lasts; we know that there is some degree of immunity. But, as I said, there are some reports of reinfection. At this point, you know, depending on what the circumstances are at home, who's in the place, and as long as we've got enough of that isolation period, I would say that it's likely okay for your son to come back. But I would say in general, we're asking people this Thanksgiving, keep your celebrations to those who you regularly live with under the same roof. Because the risk of transmission is very high, especially when we're talking about close contact in an indoor space. Being in a crowded room full of people you don't live with is not the circumstance that we want to see this Thanksgiving.
CP24: A taxi driver wants to know if it is safe for him to pick up people at hospitals or clinics that have been testing for COVID-19?
De Villa: There is no 100 per cent guarantee. I know that's not an answer people want to hear. But there are things that can be done to make it safer. Having passengers wear a mask and wearing a mask yourself will absolutely reduce the risk, and opening windows to create good ventilation. These are the kinds of things that can be done to reduce the risk. There is, unfortunately, no zero-risk scenario. But I think that can be said anywhere, and it's really a question for us to try to reduce the risk as much as possible.
CP24: Ontario is experiencing a shortage of contact tracers. If a person is interested in applying to help, what are the criteria necessary to do so? I'm a retired high school teacher who does not want to go back into the classroom or work in a virtual teaching situation. But I'm curious about the role/job of contact tracing.
De Villa: It is a very interesting job to do case and contact management. But unfortunately, it's not one that we can readily take on other people from the outside. And let me explain to you why. When we're talking about case management, in particular, we're actually talking to patients who have a COVID-19 infection, helping them understand the nature of the illness, and then doing some pretty deep investigation work to understand two major things. One, where they might have acquired that infection? How did they get the infection in the first place, and to whom might they have spread it on to when they were with an infection and could pass it on but didn't know that they actually had it? This takes a lot of detailed work and often gets into areas around medical advice and gets into some pretty personal health information. It does have some sensitivity. I really do appreciate people's interest. But I think the best thing that people can do is to really be very careful about their choices, focus on those activities that you need to do rather than the ones that you want to do. And of course, watch your distance, wear your mask, wash your hands, and stay home when you're sick.
CP24: A school bus driver says they are asked to open windows for air circulation. When it rains, we have to close the windows. What will we do when temperatures drop?
De Villa: That might be a question that's better directed towards my school board colleagues. I know that they have been working very hard on many aspects of the return to school and how that can be done in a safe way as possible. We know that having air circulation helps. That is a huge benefit in terms of reducing the risk of transmission. We also know that keeping distance from other people to the extent that that can be done also helps reduce the risk of transmission. And finally, making sure that people are wearing masks and wearing a mask oneself is also a huge benefit. I think I would be remiss if I didn't mention that making sure that we're not sending kids to school when they're sick also makes for a safe bus environment. So I think these are the most important steps to creating as safe a bus environment as possible.
CP24: How is your staff holding up amid this increase case of COVID-19 cases?
De Villa: I have the most incredible staff at Toronto Public Health. They are amazing. They are tired, but they continue to inspire and amaze me because every challenge that has come in front of us, they just rise and surpass it.
This interview has been edited.
