While she is open to some outdoor activities being allowed in the grey zone, Toronto's top doctor urges residents to remain vigilant and practice public health measures as COVID-19 is still a threat.

Dr. Eileen de Villa, the city's medical officer of health, said Wednesday discussions are ongoing with her provincial counterpart about the possibility of tweaking restrictions in the lockdown category to allow some outdoor activities.

"We know that as spring arrives, people will be to spend more time outdoors. What I've described for you today represents a change that can be tried, given our current circumstances," de Villa said during the city's weekly COVID-19 briefing.

"But these are incremental changes. And they are cautious and can be reversed if circumstances demand."

However, she reminds Torontonians that her recommendation does not mean that the pandemic is ending. De Villa noted that variant cases in the city are growing steadily, which is cause for concern.

"Even small steps forward, permitting additional outdoor activities, do not signal that the threat has been reduced to an extent that we can let our guard down when it comes to self-protection. In fact, each step forward is a reminder that we've got to up our game," she said.

"We are increasingly moving around. And we have to do it, masked and at a distance, with every other practical consideration, we can make to prevent the spread of COVID 19 and lower the risk of becoming infected with it. The more we can reduce the spread of COVID 19 through distance and masking, the more effective our vaccination efforts will be."

Dr. de Villa joined CP24 to answer more questions about COVID-19, vaccines, and the possibility of a third wave.

CP24: It has been a year since the first state of emergency was declared in the province. Looking back, what were you feeling a year ago?

De Villa: It's interesting to reflect over time. And certainly, we were all concerned at this point last year. We are still concerned now. But I would say that we're also that much more tired. We're a year into this now. The whole team at Toronto Public Health and I would say public health units all over the province have really been working very hard over the course of the last year. So, just a shout out and thanks to them for their continued efforts and just keeping on in the face of some very difficult challenges.

CP24: Did things felt frightening for you at some point? Do you feel a bit more assured now, given the information you have now?

De Villa: I think that it's fair to say that we knew a lot less a year ago about COVID-19 and the virus that causes it. And we've certainly learned a lot over the course of the last year. I would also say that having vaccines as part of our toolkit also provides a great deal of assurance. Knowing how effective those vaccines also provide a great deal of assurance over and above the knowledge we've gained over the last year. So certainly, you know, feeling more optimistic, especially now that we've got vaccines in our toolkit.

CP24: Toronto has been in lockdown since November. What will it take for the city to open hair salons and other personal care services and gyms? What will it take for Toronto to move to the red zone?

De Villa: What we really need to see in order for us to get back to life that looks a lot more like what we call normal, we really want to see disease rates coming down. And unfortunately, in the last little while, we've seen COVID-19 activity increasing. We're seeing all the indicators suggesting that our outbreak is, unfortunately, expanding at this point in time. We're seeing hospitalizations. What we need to see is for those numbers to start to come down. We want to see more vaccines and arms actually having the impact that they will have. We know that vaccines are really effective in those places that have received vaccines, whether we're talking about our long-term care homes or retirement homes. We've seen a dramatic decrease when it comes to COVID-19 activity in those settings. That's what we want for everybody and the vaccines will have their best effect the more we're able to bring case rates and disease activity down. We can really get the full impact of those vaccines. So, when we get the combination of those two things happening, you'll see us start to move more and more towards safer reopening activities and more like normal life. There's a number of things that need to be looked at. It's not a defined number, per se. It's the combination because you've got to look at vaccines as well.

CP24: Let's talk about your recommendation to modify restrictions in the grey zone to allow outdoor activities.

De Villa: I think we need to take into consideration all the different circumstances that we see in front of us. And unfortunately, we know we've got variants of concern in our environment and we know we have indicators that are unfortunately going in the wrong direction, including hospitalizations. Our health care system, we do want to protect. We want to make sure that it's there for when we need it. And we will all need our health care system for many things -- COVID-19 for some of us, and for others, it's just all the other medical reasons for which you need a hospital, or you need health care. I think we have to really make sure we're doing the best we can to reduce disease in our community, but still, recognize that we've got warmer weather coming and an opportunity for us to get little pieces of life back but in a safer way. Having those outdoor activities, I think, gives us that opportunity to help bring cases down, let vaccines come in and do their work and at the same time, get a little bit have our mental health back and our well-being restored through having more activities available to us.


CP24: The province has said that they are listening to local medical officers of health. Who makes the final call whether the grey zone could be tweaked?

De Villa: We engage in conversation and that has been happening, you know, throughout the course of the pandemic, and certainly over the course of the last few days. But fundamentally, any kind of change that happens actually is something that is reflected in provincial regulations. So it is, in the end, a provincial decision to make. But you know, my expectation is it's a decision that's made in consultation with us and certainly having listened to us. And that's certainly the sense I've got as far. That we're being listened to that, we're having a good conversation and good discussion.

CP24: In Toronto, are the variants winning the race against vaccines or is it vice-versa?

De Villa: It's a tight race. But I would say this to the people of Toronto, it's actually up to us. We have a lot of power and we know what to do. We've gained a lot of knowledge over the course of the last year. We know what makes a difference in terms of controlling the spread of COVID-19. And that's maintaining distance as much as possible, not socializing with people with whom we don't live to the greatest extent possible and wearing our masks. If we do this and we let vaccines come into play, and we know that we've got more supply coming, then I think we'll see ourselves in very good stead, hopefully in the not-too-distant future. But this is entirely up to us.

CP24: Is Toronto in the third wave as the Ontario Science Table and the Ontario Hospital Association pointed out earlier this week?

De Villa: Some people call it a third wave. Some people have said, well, we've never really gotten out of the second wave. This is more of a bit of a resurgence as part of that. And again, I would say this is in our hands. This is in our hands. We know what it takes to actually control COVID-19. We've done it before, and we can do it again. I think we just need to really keep vigilant about those measures for self-protection. We know what works in terms of reducing transmission. And we know our vaccines are really effective. The more we're able to reduce that transmission and to reduce the spread of disease, that allows our vaccines to be as effective as possible. And the sooner we will get back to life, that's more like it was before.


CP24: How come all the Oxford/AstraZeneca vaccine is now available for people 65 years or older?

De Villa: This is a recommendation by the National Advisory Committee on Immunization. This is a federal group of public health experts and vaccine experts that provides advice to the entire country on the use of vaccines, how best to use them and who they should be used for. Their initial recommendation around AstraZeneca suggested that it was best to be used for those under 65 years of age, given that there wasn't a lot of studies and a lot of data around the use of the vaccine for those older than 65. There's now been a real-world experience. More study information coming forward. And so, they've changed their recommendation in accordance with the evidence that they've now had a chance to look at. But this is the committee that actually makes recommendations on the vaccine and it is what's followed when it comes to this vaccine in terms of advice and all other vaccines out in the Canadian market.


CP24: A 73-year-old viewer wants to know when will she get her COVID-19 vaccine dose?

De Villa: The short answer to the question is that we're following a prioritization framework that's been laid out by the province. And right now, the efforts are focused on those who are 80 years and older, a variety of health care workers, seniors who live in congregate settings, and some adults who have chronic home care needs. Members of our Indigenous communities are also included in that phase one. The plan, as I understand, is for the province to drop down through age groups slowly. And the expectation is that they'll probably drop from the 80+ category to the 70+ to the 70s. And as well, they're looking, as we move through the phases, to think about immunizing adults who have a variety of different health care conditions. The hope is that it won't be too long for the viewer before her turn comes up. It will depend on how things proceed as part of phase one right now. And it will ultimately be in the hands of the provincial government to decide.

CP24: A viewer says mass vaccination sites do not look like the best way to administer vaccines to people. They look like areas that could become super spreaders due to the number of people in an enclosed area for a long time.

De Villa: That's certainly not the intent. The mass immunization clinics are designed in a way that we're supposed to be able to allow for appropriate distancing, and certainly with appropriate personal protective equipment, including masking for all those who are there, whether we're talking about staff or we're talking about people who are visiting the clinic as clients. For us at the City of Toronto and Toronto Public Health, this was our first day with mass immunization clinics. I do expect that there'll be a few little bumps as you launch through. But my expectation is that we will continue to manage those clinics as smoothly as possible, making a safe environment as is possible for staff and for the clients certainly who go and use those facilities.

CP24: A viewer says, going outside riding bikes or playing sports will not help seniors. She says she does not understand why small hair salons, which followed all protocols, can't reopen their doors.

De Villa: There are lots of things that we're constantly looking at. I would say this, I completely appreciate and understand that we all want to get back to regular life and have all the activities and services we're used to having. That's not lost on me. We do need to make sure that it's being done in a safer way as is possible. And the idea is that we're constantly talking about these things, and of course, we're guided by the facts and the data. Anytime you put people in close contact with each other and bring people into indoor settings, the risk is always a little bit higher. I know that there are many measures that can be put into place. We're still having those conversations. My hope is that as we work together as a city to bring rates of the disease down and as we work together to get vaccines and arms that we will be at that point where people can visit the salon and visit all the other services and activities that they're used to having as soon as we can actually get there as soon as it's safe to do. That's my real desire to get people you know back to life but in a safe manner as possible.

CP24: A health care worker who already got her first dose says she is disappointed that she won't get her second dose until four months from now, especially since she is in close contact with patients.

De Villa: I can appreciate the viewer's disappointment, for sure. But this has been a decision that's been taken by the provincial government and, in fact, has been taken by a number of other jurisdictions around the world, particularly in light of challenges around vaccine supply in order to get as many people vaccinated as soon as possible. And the interesting thing is that when you look at the data that's available now, in respect of COVID-19 vaccination, while many of the vaccines that are available right now are two-dose vaccines, the greatest part of the effect does come from that first vaccine. There is a little extra protection that's provided by the second dose. But it is an effective protection thus far, as seen through studies, even with that first dose after a certain amount of time has passed. Depending on what happens to supply, we'll see what happens with the dosing interval and whether there are any changes such that that second dose can be given sooner. But in the meantime, I think it's comforting to know that having the vaccine, that first dose is quite effective in terms of providing protection.

CP24: A viewer asks, do you know if the other vaccines cause blood clots too?

De Villa: The side effects that are most commonly reported with vaccines tend to be those that are locally related. From Pfizer, Moderna or Johnson and Johnson, I've not heard of anything related to blood clots. I would say this, though. There is a significant activity that's called post-marketing surveillance. What it is, is watching over time as vaccines are used in practice to see whether there are any issues that are arising. There is a whole process by which negative unexpected events following immunization are reported. We have an established system for that here in the province and of course, the city participates in that so that all these data are collected so that we can understand on a go forward basis. Are we seeing any unusual side effects or adverse events following the receipt of a vaccine? Those can be assessed properly and determined whether there's a connection to the vaccine. Just because something happens after you get a vaccine doesn't necessarily mean that it's the vaccine that causes it. But I think people should be assured that there is a process for vaccine safety on an ongoing basis while it's being used. It is constantly being followed.

CP24: York Region has expanded its vaccine rollout to include more residents. Why is Toronto lagging behind vaccination?

De Villa: I'm not sure that that's actually true. Vaccination of populations that are part of that so-called phase one of the provincial prioritization framework is all done simultaneously. We have a number of 80-year-olds, thousands, in fact, that have already received vaccine here in the City of Toronto and as well thousands upon thousands of healthcare workers. I would just remind people that here in the City of Toronto, we actually have a significant proportion of all the health care workers that practice in the province of Ontario. For example, half of all practicing physicians in the province, or roughly half, actually practice right here in Toronto. We have some pretty significant populations in terms of numbers to cover. But we're very pleased to do that as more and more supplies of vaccine becomes available. We're happy to put as many needles as we can into as many arms.


CP24: Any final thoughts for this week?

De Villa: We've come so far. We're almost there. We really need the people of Toronto to continue keeping their distance as much as possible and wearing their masks. And when it is your turn to get the vaccine, please go and take it. I think between these two things, we'll find ourselves on the other side of this pandemic as soon as possible and goodness knows we all want that. I know we all want that so the more we can work together, the sooner we'll find ourselves there.