COVID-19 Q&A: Dr. de Villa on surging virus cases, another possible lockdown, vaccine rollout, school outbreaks

In the race between COVID-19 variants and vaccines, the former is winning by a mile, Toronto's top public health official said as she urged residents not to come together ahead of the upcoming holidays.

Dr. Eileen de Villa, the city's medical officer of health, said it may be tempting to gather and celebrate this week but warns it is not the time to do it. She advised

"The religious holidays to be celebrated over the next couple of weeks create tempting opportunities to come together, but this is a dangerous time when you look at the rapid growth in case counts," she said.

"If you gather, as usual, you are taking a great risk. It is just an invitation to COVID-19 variants to spread."

De Villa said more than 800 cases have screened positive for a variant since Monday, bringing the total to 8,570.

She noted that while variants are more transmissible and virulent, how a person gets infected has not changed at all. That's why, she said, it's important for people to continue practicing self-protection measures, including keeping distance and wearing masks.

"I don't want anyone to panic or to feel hopeless. I do want you to act you are and always have been your very best protection against COVID-19, and you are the best protection for everyone you care about," de Villa said.

She added that the vaccines are nowhere near close to providing widespread protection.

"Please do not gather with anyone you don't live with. The best treatment is always prevention. COVID-19 prevention is critical this year and never more than now."

Dr. de Villa joined CP24 to answer your COVID-19 questions.

CP24: The premier has hinted about an announcement on possible actions that his government may implement to control the surge of COVID-19 cases in Ontario. Would you recommend that Toronto shuts down like late last year?

De Villa: Those kinds of recommendations are never made very lightly. These have serious consequences. We are dealing with a really, really serious situation. We know that we have ICU admissions -- the highest they've ever been. We continue to have hospitalizations. We continue to see cases rise. And we know that many of these will result in deaths. We're talking about some really significant circumstances here with very serious consequences. So, I think what we need are actions that are commensurate with that, and those are the kinds of things that are going to really reduce risk, reduce harm, and keep as many of us as safe as humanly possible, during what is a very difficult time. Pandemics have lots of unpredictability to them, and we're exactly living that.

CP24: You mentioned that the head of the U.S. CDC is scared as cases south of the border are also climbing. On a scale of 1 to 10, how scared are you of the current COVID-19 situation in the city?

De Villa: A number of weeks ago, I talked about how I was very, very concerned and that I had never been more concerned as I was at that time because this was exactly what we were forecasting. This was the kind of thing the modelling showed us that variants of concern – if they really started to take off given their transmissibility and given what we saw at the time, more severe illnesses will result from them. And that's what we're seeing, unfortunately, right now. I share the concerns of the CDC director. I share the concerns of my health care partners all around the city and throughout the province. And I sincerely hope that our provincial counterparts are able to take actions that are significant enough to meet the risk of our current situation.

CP24: With more supplies of vaccines coming, could that mean that the interval between the two doses will be reduced in light of the variants currently ahead of the race?

De Villa: This is a very delicate balance, and there isn't a simple answer here. Here's the issue, what we're trying to do is provide the protection of the vaccine because we know these vaccines are really effective. We've seen that both here within our own setting and in countries all over the world, particularly those that are further ahead of us in terms of vaccination. We know it does make a difference. It is all about how we try to spread the available supply so that the protection is spread out to as many people as much as possible while at the same time making sure that you have good protection, particularly for those who would benefit from that extra boost of protection that's provided by the two doses. If we get enough supply to cover a good proportion of the population and can also get second doses, then obviously, we're going to do that, but it will all depend on the supply and what the circumstances are.

CP24: Given our past history in terms of celebrating holidays, do you think there should be an Eastern enforcement blitz at this time around to ensure that people are following COVID-19 protocols?

De Villa: It would be helpful to have greater restrictions for sure because it helps people stick to these rules for self-protection that will make a difference. But at the end of the day, it does come down to each and every one of us. We know what works. We know it makes a difference to keep that distance as much as possible and to wear your mask as much as possible. These are the things that have worked over the course of the pandemic. And I would just encourage everyone to continue to follow those self-protection measures, regardless of what specific restrictions are put into place or not put into place by the provincial government. It will make a difference. It protects you; it protects everyone around you. And of course, now that we have the vaccine, if you're eligible to get the vaccine, I would encourage people to go and take advantage of that. It's a very effective way of protecting yourself and everyone else around you.

CP24: We've heard from several doctors that the vaccination strategy in the province needs to change as more younger people are getting COVID-19. If you could rearrange how Toronto distributes vaccines, would you? Or are you happy with the current strategy?

De Villa: I think one strategy always has to be ready to adapt and shift with the changing circumstances. It's the hallmark of good professional practice. I can assure people that we're constantly assessing and reassessing. Yes, there is a provincial framework for the vaccine campaign, which we're all following. But there is some latitude as well, particularly for hotspot areas of the province of which we are one. We are adjusting in concert with our other vaccination partners, using the best available evidence, understanding what's actually happening on the ground, and then adjusting and adapting our strategies to fit so that we're able to get the most by way of benefit in terms of the vaccine. We want to reduce the likelihood of deaths and reduce significant illness and hospitalizations to the greatest extent possible.

CP24: Can you give us a quick example of how Toronto has tweaked or adjusted its strategy?

De Villa: Well, for example, we actually did use the vaccine in congregate settings early relative to what the provincial framework was. We've been vaccinating shelters in concert with our health care partners. It's been several weeks now. We saw that there was a risk, particularly in that community, so that's been an area that got accelerated in order to meet the circumstances that we were seeing on the ground.

CP24: A viewer says for past holidays, there have been exceptions made for people living alone where they were allowed to gather with one or another household. He says he hasn't heard anything about that for this coming holiday weekend. What is the guidance for people living alone?

De Villa: This is one of those difficult things, as is the case for every holiday. When it comes to actually disease transmission, when we're talking just about COVID-19 and the possibility for spread, the more you're able to limit your interactions, the better it is. But we're trying to balance out the various health needs and we know that it's difficult for people who live alone to spend those holidays alone. So, to the extent that you can avoid getting together with people outside of your household, that's still the best, but we have to leave some room for individuals to make some reasonable decisions within their own risk tolerance and also understanding what the circumstances are -- what their unique circumstances are to make good decisions around how they reduce the risk for themselves. But ultimately, distance is still the best protection until such time as we are all able to get vaccinated and get the protection that's afforded by vaccines.

CP24: Another viewer asks, do you think you are targeting the right groups for the vaccine? Do you think it's more important to give 65 to 75 years old who do not go to work, or should we lock down warehouses and factories and vaccinate teachers and other essential workers to stop the spread?

De Villa: When I looked at the goals that the province has laid out for the vaccination campaign, they were looking particularly to reduce deaths, which is why we started vaccination efforts within long-term care homes and retirement homes. We also know that the most serious outcomes associated with COVID-19 infections have tended to happen in that older population. So, the vast majority of deaths over the course of the pandemic have occurred to people who are over 70 years of age. They're very few below you know the older age category; hence we're looking at those populations. Of course, one must adapt and adjust strategies depending on what you're seeing on the ground. From a death perspective and a serious hospitalization or serious illness perspective, focusing on those older populations is still is quite valuable. But as we start to move through the population, we are moving into younger people and really thinking about how best we can use the vaccine to help us control the spread of disease and try to bring better control to the pandemic at this point in time. That's added to distance and masking and all those infection prevention and control measures which we know make a difference.

CP24: A viewer asks if there is a standby vaccine list in case people who have appointments don't show up.

De Villa: Each clinic has a slightly different version of doing this. Clearly, what you don't want to do is to waste doses and I can tell you that Toronto Public Health-run clinics, there is a really good protocol in place to minimize the potential for any wastage of doses of vaccine. At this point in time, there isn't a standby rush list. I know that other clinics vaccine clinics certainly around Toronto and I believe throughout the province have slightly different ways of doing this and I know that this is one of the issues that our own city-run Toronto Public Health clinics are looking at right now. So, stay tuned, but please know that doses are not being wasted. We are really very careful in the clinics recognizing how precious a resource this is. We're really being quite careful about it.--

CP24: A viewer wants to know how it is safer to shop at big box stores with so many people crammed in than in a small store with only a few customers at a time.

De Villa: I don't know that anyone can really talk about what the relative safety is of one store versus another other than to say this -- distance, distance, distance and indoor environments are always more dangerous than outdoor environments when it comes to transmission of COVID-19. I would encourage people, whether you're talking about a big box store or a small store, or any other indoor environment, to minimize the amount of time that you're there and to reduce your visits there where possible. And if you have to be there, wearing your mask. These are the kinds of things that you can do to protect yourself in terms of disease transmission. We know that indoor environments with close contact or higher risk for sure. And outdoor environments are not zero risks, but they're definitely lower risk than indoor environments. At this point, it's the measures for self-protection -- keeping your distance, wearing your mask, washing your hands. Knowing that we've got vaccines available, when your turn comes up, please go out and get that vaccine as soon as you can. It's the combination of these two sets of protective measures that will do the best for all of us in terms of reducing COVID-19 transmission, protecting ourselves and protecting those around us.

CP24: A viewer says she was on a TTC bus full of people, standing shoulder to shoulder, and sitting on seats with restricted signage. How can I be safe on the TTC?

De Villa: I'm sorry to hear that's the experience. I know that my colleagues at the TTC try to run the system in a way that's as safe as possible, recognizing that many of us rely on public transit, particularly essential workers in our community. I'm certainly happy to raise that with my colleagues at the TTC.

Obviously, the best things to do, as I've just said in my earlier response, maintaining distance to the greatest extent possible, wearing a well-fitting mask, especially when you're out and about, and washing your hands remain important elements of self-protection. And where possible, depending on what your circumstances are if you have the flexibility of adjusting the time in which you're in public transit. If there's some flexibility to schedules so that you're travelling at less busy times, that would be another aid towards protecting oneself. But it does come down to the measures for self-protection: distance to the greatest extent possible, wearing your well-fitting mask and washing your hands.

CP24: A viewer wants an update on the success of TPH's contact tracing efforts and is the city or province looking at using a QR code tracing app?

De Villa: There's no question that case and contact management are mainstays of public health follow-up when it comes to infectious diseases. They are most effective when the number of cases is actually at a more reasonable level. At the levels that we're at right now, case and contact is not quite as effective as it would be when you're talking about much lower numbers and you can really follow up very in a very timely fashion and a very thorough fashion because it is quite painstaking work. It is continuing on here in Toronto and public health departments all around the province. When it comes to QR codes, I know that there are a number of different tech agencies that are testing out different methods of using QR codes, thinking about the future and how we might actually inform ourselves or at least get notified if we're in a place where there might have been an exposure to a case. I don't know all the specifics of this, but I know that there are a number of different agencies and companies that are actually exploring that activity right now.

CP24: School boards are telling students to take their things home before the long weekend in case the province decides to move classes online. What do you think is going to happen when it comes to schools? What would your recommendation be?

De Villa: This is a really tough one because we know that, yes, there are concerns around COVID-19. We've heard the numbers, lots of disease activity in the community. And unfortunately, this reflects itself in our schools. We know that cases in schools go up when there's lots of cases in the community. And obviously, people are concerned for the welfare of their children, and of course, we're concerned for the welfare of the staff who teach within the schools and work within those schools. But we also know that there are lots of health advantages to having children in school. And we've also seen that when infection prevention and control measures are well-practiced and are really followed carefully within schools, they can be reasonable environments for children to learn in and still be safe. This is an unenviable task that rests at the feet of our colleagues at the Ministry of Education. I'm sure they're reflecting on it every day. Certainly, we're providing input to them and letting them know what we're seeing on the ground. Yes, there is more activity but what we've also seen is with really diligent practise of infection prevention and control measures, there is a way to operate schools reasonably safely, given that we are in the middle of a pandemic.