While cases of COVID-19 are declining in Toronto as a result of lockdown measures, Toronto’s top public health official said Wednesday it is better to delay reopening the city as variants of concern posed a threat to the progress made by Torontonians.
Dr. Eileen de Villa, the city’s medical officer of health, reported during the city’s COVID-19 briefing that there are now 56 confirmed cases of COVID-19 variants, a number she said is the tip of an iceberg.
“The variants of concern mean we face a deceptively dangerous situation,” de Villa said.
“By the time the confirmed case counts are big enough to shock us, it will be too late to do anything – we will be in the third wave as bad as anything we’ve been through thus far.”
De Villa and Dr. Lawrence Loh, Peel Region’s medical officer of health, wrote to Ontario’s chief medical officer of health, Dr. David Williams, and asked for the province to delay their region’s return to the colour-coded framework.
The stay-at-home order is expected to be lifted in the four remaining hot spots next week.
“While there is a downward trend in many key indicators, warning lights are flashing, too,” de Villa said.
“Mobility data show that people in Toronto are starting to spend more time out of home again, raising the inevitability of increase spread.”
The good news, de Villa said, is that public health measures are effective against variants.
“I would love to be able to tell you that we are at a point where restrictions can substantially lift. I look forward to that day,” she said.
“Better to wait until we know more than to put everyone through the yo-yo of opening, closing, reopening and close again and again.”
Dr. de Villa joined CP24 to talk more about her recommendation and answer COVID-related questions.
CP24: During today's COVID-briefing, you asked for the reopening of the city to be delayed, writing a letter to the province to ask for an extension of the stay-at-home order for at least two more weeks. You also said you have never been as concerned about the threat of COVID-19 to health as you are right now. What are you so worried about?
De Villa: That's not an easy message for any physician to have to deliver to their patient to say that you're at this level of concern. And this is a message I've been trying to bring now, for a number of days, talking about variants of concern. This is a different phase of the pandemic. And we have to really pay very careful attention to that which we've seen from other jurisdictions that have experienced these variants of concern ahead of us and have some a few weeks ahead of us. They understand how it's changed the pandemic and what it's meant for them. And what we're talking about here is a variant, a form of the virus that is more transmissible, and that gave rise to huge numbers of cases, whether we're looking at the UK, Ireland, Denmark, and most recently, now in Germany. They went from a certain high-level number of cases and then just saw a real explosion as a result of exponential growth and all that came with it, including increased illness and increased death associated with those cases.
CP24: What if the premier does not take your advice and does not extend the stay-at-home order? Would you invoke a Section 22 order?
De Villa: We've been having good productive conversations with our provincial counterparts. I remain hopeful that those conversations will continue to be productive and that we'll be able to find a reasonable place where we can land, and that actually provides the protection that I think we need here in Toronto, given what we know, about these variants of concern. We'll cross the bridge when we get there. If there's something different that needs to be done, I'm prepared to do as I have throughout the pandemic. I've always acted in the best interest of the residents of Toronto. I will continue to do that, applying the best available data and the best available evidence to protect and promote the health of people who live in the city.
CP24: We spoke to York Region's medical officer of health earlier. He is encouraging provincial officials to let York region reopen in the red zone next week. On the other hand, you and your counterpart in Peel want your regions to stay in lockdown until at least March 9. What's different about Toronto that the city needs to stay so locked down compared to the region north of Steeles where they're comfortable going to red?
De Villa: I can't really speak to the circumstances north of Steeles. I expect that Dr. Kurji is looking at his circumstances and making the best decisions he can, based on what he understands is happening in his circumstances. To my mind, my job is to be responsible for that which is happening in Toronto. I'm looking at our circumstances here and my understanding of the evidence as it's been presented. I would remind the viewers that the provincial science advisory table just presented on this issue last week. Those individuals came to the same conclusion as I did that there is a significant risk here. We know that we're talking about variants of concern that have demonstrated this capacity for greater transmission, greater ability to spread from person to person. And the current data would suggest that if we are not careful if we don't take the necessary steps in order to limit the spread of the virus, that we will see a third wave that may be just as big and just as bad if not worse than what we've seen before.
CP24: How worried are you about potential region-hopping?
De Villa: I think we've seen throughout the pandemic that there has been some propensity for people to move from jurisdiction to jurisdiction. But I've also noted throughout the course of this pandemic that people have been able to appreciate risk when it's been communicated in this fashion and have also been able to take the necessary action in order to reduce that risk. My plea to people, both of Toronto and those who live in jurisdictions around Toronto is to really stick to your home front as much as possible. I think that continues to be the best advice at this point in time, particularly as we face variants of concern and their increased transmissibility. The more we're able to stay home as much as possible and really limit our interactions with other people, people that we don't live with, the better off we will all be not just in Toronto, but frankly, this is for the whole province.
CP24: A viewer asks if you're concerned that we are on the same path as the UK when it comes to variants, why our case counts going down, even with a variant representing a growing percentage of positive cases? Shouldn't the counts be going in the opposite direction like in the UK?
De Villa: It's an excellent question. In fact, the situation in the UK is that their counts were going down for some time and then as the variants came to really exert their full impact, that's when they saw the explosion in cases. And that's the real challenge with something that grows in what we call an exponential fashion. It grows along at what appears to be a rate that you're not really noticing, and then all of a sudden, cases and counts increase dramatically. By the time you realize it's happening to you, it's too late. The numbers have gone way out of control. And then you really need to impose some very, very strict measures. This is exactly what we're seeing in the UK, in Ireland, in Denmark. It's what they're experiencing now in Germany. And I think there are many other jurisdictions that are actually on the precipice of this as well. It's a good question and an important one, but that's the challenge with something that grows at an exponential rate. There is a period of growth that looks like things are kind of steady or plateau, and then all of a sudden, you see this really rapid increase.
CP24: Why are we not putting teachers on the high priority list when their exposure is dangerous, as they have overcrowded classes? The viewer says her child's teacher has 29 students in her class.
De Villa: Wow. That's a large class. I can certainly appreciate the concern of a mother for their own child. I think we all have that experience, or many of us have the privilege of having that experience of concern for our own children, including adult children. When it comes to the prioritization as to who gets the vaccine and what phases, this is actually being done under the guidance of the province. With respect to how they make their decisions, the questions really are best directed towards my provincial counterparts. But what I can say at the local level is that as vaccine supply becomes more available, which we hope will be very soon, we will do everything in our power to make sure that vaccine is moved as quickly as possible that we can go through the phases of the provincial prioritization and distribution plan as quickly as we possibly can so that we can get as many people as possible who are interested in taking a vaccine as it is a very important tool in our response to COVID-19. We're hoping that's a lot. We're hoping it's most people.
READ MORE: Ontario officials provide update on who will be next in line to receive COVID-19 vaccine
CP24: Are we supposed to be wearing two masks now? Should we also be wearing a face shield when out getting essentials, especially with these new variants?
De Villa: The science is constantly developing and evolving. That's why the advice does change from time to time when it comes to what are the best protective measures. The one thing that hasn't changed is distance, distance and distance. So, the more you're able to stick at home and apart from others, save and exclude when it's absolutely essential, the better protected you are. When it comes to masks, we have heard studies from the United States, the Centers for Disease Control, in particular, and they talked about the potential of using a second mask. And the reason why they were talking about that was around fit. The current advice in Canada is to use a well-fitting mask to try to minimize the gaps around the face so as to really keep the droplets to yourself as much as possible. That's the importance of fit. The study from the CDC found that putting that second mask, a non-medical mask, over a medical mask really made for a good fit and created the best protection in preventing droplets from spreading. And if we all wear our masks, we're protecting each other as a community.
READ MORE: CDC study finds two masks are better than one vs. COVID-19
CP24: Will there be any changes to the policy where workplaces in Toronto do not require masks if people can remain six feet apart now that we know more about how COVID spreads?
De Villa: when it comes to workplaces there, there are all kinds of nuances there. And each workplace is a slightly different set of circumstances. What actually is required within the context of given workplaces is under the purview of occupational health and safety. And therefore, it is something that is focused on the Ministry of Labour. That's their area of expertise. But we know for a fact that the more you are able to wear your mask, especially when you're outside your home, the more protection you're providing both for yourself and others around you. So that's why the advice is if you can work from home, do that as much as possible. For those who can't, who perform essential work that cannot be done remotely, then the expectation is that certain provisions are provided under the law from your employer. But as much as possible, when you're out and about, wear your mask and keep your distance as best you can.
CP24: Ford announced that public health units will have an emergency brake option to close things down if they see a concerning situation. Given that you see major concerns now, why not pre-declare an emergency brake now versus waiting until Monday?
De Villa: By raising the requests that I've made to the province through the Chief Medical Officer of Health, one could see that as effectively as an emergency brake, whether you call it an emergency brake, or whether you call it approaching our current situation with appropriate caution. That's exactly what I'm calling for. I do think we need to not move into reopening too quickly. And the reason why I would suggest that is not only because we're worried about variants of concern and the impact that it would have on case counts and illness and hospitalizations and deaths, but also thinking about what it means for our society to open and close or reopen somewhat only to have to close again. That strikes me as a not a very good scenario for any of us and, in particular, for businesses.
CP24: Are you clear on the parameters for when an emergency brake may be applied to a public health unit?
De Villa: I think that's really a tool that's been offered or suggested by my provincial counterparts, so they're probably the best people to make that determination. I think the point is to try to get at some method by which concerns can be identified. But the challenge, of course, with variants of concern, is that because we're talking about something that grows exponentially, what happens is, as we've seen in other jurisdictions, is that cases kind of grow at a low level and then all of a sudden you get very explosive growth. So, by the time you recognize that you're in a dangerous situation, where there is that incredible exponential growth, it's late. It's awfully late to be calling the brake.
CP24: Do you know of any of the long-term side effects, if there are any, of the COVID vaccines? How are we supposed to trust a vaccine that's been rushed without knowing any of the long-term consequences?
De Villa: I recognize that there are some very real and legitimate concerns that people raise about a treatment that's relatively new, like a new vaccine. But I think it's really important that people recognize that all of the safety issues and all of the regulatory processes for every vaccine have been followed with these new COVID-19 vaccines. So yes, they are new vaccines, but every safety mechanism, all the regulatory processes have been followed in respect of these vaccines. I think, in fact, when I look at this issue, I think about what an amazing accomplishment it is that we are able to have these vaccines available, and they're demonstrating effectiveness right now. Millions of doses have been given to people all over the world, and we're actually seeing the benefit of the vaccines. So that tells me that this is one of those miracles of modern science, for which I'm incredibly grateful.
CP24: If you get an extension of the stay-at-home order, what should people take away from it?
De Villa: I would say that we, you know, we've done this before. We've been successful at pushing COVID-19 down through the use of self-protection measures. Please keep doing that, and we will get there.
This interview has been edited.
