With the arrival of more vaccines and COVID-19 cases continue to decline, Toronto’s top doctor says the city is “on the cusp of taking a much-wanted step towards a little more flexibility in our daily lives.”

Dr. Eileen de Villa said the case counts at present call for a cautious approach, and that’s why she is recommending the city to move back to the grey zone in the province’s reopening framework.

“It comes down to our choices in our daily lives,” she said during the city’s COVID-19 briefing.

“Our ability to make the right choices is the reason a move in this direction is possible.

But de Villa is urging now more than ever that residents remain vigilant and continue practicing self-protection measures as COVID-19 variant cases in the city are up. The number of cases that screened positive for a variant doubled in a week, from 710 to 1,468.

There are 126 confirmed variant cases in Toronto.

“The variant figure is not what I want to see,” de Villa said.

“It is important we now act in ways that do not squander these hard-earned small steps forward.”

The doctor joined CP24 to answer viewer questions about the COVID-19 situation, including the city’s vaccine rollout.

CP24: Michael Garron Hospital decided to vaccinate some elder residents in the community because they have an extra supply. What's going on with the city's vaccine rollout? There seems to be a lot of confusion.

De Villa: If there's a lot of interest in vaccination for COVID-19. I think that's great. That's exactly what we want to see. So, there is a provincial framework and a prioritization framework for providing those vaccines. Those of us here at Toronto Public Health, our city partners, and our healthcare partners who are providing vaccines in the city are following that framework. What is at issue right now is that there isn't a lot of supply. So, the vaccine is coming in not in huge amounts yet. So, what's happening is that we, as vaccination partners here in the city, are working with the supply that we have following the provincial prioritization framework. Going through that in a very appropriate fashion in keeping with what's been provided by the province. When we have more vaccines, we'll be able to do this in a bigger way. Right now, we're doing things in accordance with the framework and in accordance with what is available in terms of supply. I'm pleased in East Toronto; it sounds like they were able to provide vaccines to certain older members of their community. That's fabulous. As more vaccine becomes available, we're going to do the same, not only older members of our population but over time to everybody who wants one.

CP24: How did it happen that Michael Guerin had this extra vaccine on hand to then phone out into the community to some seniors?

De Villa: Each different vaccination partner got a certain amount of vaccine directly from the provincial government. they're working through the list of that prioritization list. And for certain areas of the city and for certain hospitals, they just have a larger group of people, for example, health care workers, to get through. For our colleagues out at Michael Garron Hospital, they're following through with the framework. We're all trying to cover as much as we can as we're following that provincial framework and use the available doses to cover those eligible for a vaccine under the current phase one of the provincial framework. So, I'm really pleased to see that we are reaching more and more members of our community,

CP24: At today's city briefing, there was some cautious optimism as cases are declining. You were grateful for that. But what about the variants? Why are you recommending the move to the grey zone?

De Villa: When I look at our case counts, we're seeing improvement there. There's no question. The numbers are significantly down from some of the highs we saw earlier in the winter when we had really huge numbers. We've seen improvement, but we're not out of the woods yet. When we look overall, we see declining case counts, but we see increases in those cases that are screening positive for variants of concern. We know that variants of concern are more transmissible. And we know that our reproductive number dropped a few weeks ago to as low as point eight, and this is that number that we want below one and as far below one as we can get it. It crept up to around one, and we're still hovering in that range. So, remember, we want that number to be below one. If it's at one or bigger, it means that the outbreak still has the potential to continue. And if it's bigger than one, it has the potential to really grow. We really need people to continue to be vigilant as much as possible because we know that COVID-19 spreads when we get close to each other, when we interact with each other, especially with people we don't live with.

READ MORE: Toronto's top doctor asks for city to be placed in grey zone in move that would allow retail stores to reopen

CP24: We know that people are going to other regions to spend money, which means Toronto businesses are suffering. How does that all come into your decision to decide to go back into the grey zone?

De Villa: First and foremost, my concern and role is to do the best I can and provide the best advice to protect and promote the health of Torontonians. Above all, public health has to be my primary concern. However, we recognize that Toronto is not an island. It is part of a whole region. And people do move around the region quite a bit. We're quite mobile, a population. This obviously has to figure into the discussion, and it has to figure into the decision-making process. But for me, it's always about what does the science show is best for public health here in Toronto. What's best for the population's health here that's the top concern that I have. And we know that to the extent that people are able to limit their interactions, even now, as case counts get better, we know that the more we're able to really keep that distance as much as possible, the sooner we'll be able to get back to life that looks more like it did before COVID. And frankly, the more effective the vaccines will be as they become more available.

CP24: What worries you – the potential spread of COVID due to region hopping or variants?

De Villa: I don't know that you can separate those two. The issue around variants of concern and region hopping -- that's all wrapped up in this notion of people interacting with each other, particularly where that interaction isn't really necessary. Where we can bring it down to minimizing our interactions with other people, the sooner we'll be able to get back to life more like it used to be.

CP24: A viewer asks, why was there no announcement made today about the 300,000 AstraZeneca vaccines delivered to Toronto today? When, where and how will these be administered? Is there a trial being conducted to see if they are effective for over 65?

De Villa: First and foremost, when it comes to supply a vaccine, actually getting a vaccine into the country is the responsibility of the federal government. Bringing it into the province and then distributing it is the responsibility of the provincial government itself. We had heard in very high-level terms that we should be expecting the in the province AstraZeneca vaccine to come in the not-too-distant future, but without specific timelines, and how that will be allocated and where it will all go. Again, very high-level details, nothing really provided except to say that it's coming into the province. And the hope is that we will try to get that out as soon as possible. But I actually don't have specific details quite yet on that. Looking forward to hearing those and certainly, really looking forward to being able to participate actively as the City of Toronto and as Toronto Public Health, in particular, in vaccinating people as supply becomes more available.

READ MORE: Ontario residents aged 60 to 64 to receive newly approved Oxford-AstraZeneca shot

CP24: A viewer asks, why have you not been advocating for Toronto to get a larger portion of vaccines so small businesses can get open faster and stay open?

De Villa: We have certainly my team here at Toronto Public Health have been in regular conversations all the time with our provincial counterparts. And we have spoken about different ways of distributing and allocating vaccines in order to get us together collectively as a province to our desired outcome. One, limiting the negative impact of COVID-19 and two, really getting as much vaccine as possible into as many arms as possible. We have advocated for a greater proportion of doses to come to Toronto, given that we were so heavily impacted. And in fact, you might recall that Toronto was one of the earliest recipients of doses of vaccine, particularly for long-term care and retirement homes, so I think our advocacy did work.

CP24: A national panel of vaccine experts is recommending the delay of the second dose of the COVID-19 vaccine up to four months. What is your reaction to this, knowing that will mean more people will at least get their first round of the shot earlier?

De Villa: I think this is great news. Anything that helps us get more shots, more needles into arms, and provide that protection for more people in our communities. This is nothing but good news. I think it's, again, a testament to science. Hats off to the amazing science that has brought us this vaccine. And what great news it is that we're able to provide more vaccines and more coverage to a larger group of people faster.

READ MORE: Vaccine panel recommends going up to 4 months between COVID vaccine doses

CP24: Are you surprised at how the guidance has shifted so quickly, though from three or four weeks between shots, now to maybe four months? It seems remarkable to think that they've been able to establish that too.

De Villa: It is remarkable. And I think it is a sign, I would say, of the level of cooperation that is happening at a global level in order to respond to this pandemic. I think we're all trying to learn from each other, learn from our own experiences in the first instance. But as well to learn from the experiences of jurisdictions all around the world. We're all hitting different points of our respective outbreaks at slightly different times. And so that does afford the opportunity for expanded learning. And I think that's just responsible public health practice that we look at the best available evidence locally, but we should be looking at the best available evidence from all over the world to inform our practice.

CP24: When will other essential workers be a priority to get vaccinated? Grocery store cashiers are essential workers and have been continuously working since the pandemic started. Shouldn't they be a priority?

De Villa: There's no question that we owe much to the essential workers in our communities, who have provided all those services and goods that we need in order to survive. To my mind, we owe a great deal of thanks to these individuals. As I understand it, the provincial government is working on that next phase of their prioritization framework. And I'll just remind everybody that it is up to the provincial government to determine what is the sequence in which vaccine will be given and who's eligible for the vaccine. And that's actually what they are meant to do. My understanding is that we should be hearing soon from our provincial counterparts around who's coming up next in phase two and where essential workers might fit into that framework of theirs as more and more vaccine becomes available. Stay tuned.

CP24: A viewer asks, I am immunosuppressed due to medication and suffer from autoimmune disorders, diabetes. I've been advised by my specialist to take the Pfizer or Moderna vaccine. However, I'm not considered a priority group. Would you happen to know why we are not considered a priority group?

De Villa: As far as I know, that's something that is addressed in the provincial prioritization framework. Adults who have chronic medical conditions are part of one of the next phases, and I think we should be hearing more from our provincial counterparts in the next few days, in the next week or so, on what that looks like. Stay tuned on that one, as well as much information coming out soon.

CP24: Earlier this week, Toronto Public Health recommended the closure of a school in Scarborough due to variant cases. You've said that the school reflects the community. Do these cases concern you? Could we see more variant cases going forward?

De Villa: Yes, this is part of my concern around these new variants. Now, we also know that these variants are spreading in the community. I spoke earlier this afternoon, as I delivered some remarks at a press briefing, to talk about how the growth has actually been significant. We've got over 1,400 cases that have screened positive thus far. Last week, the number was 700. So, we should expect to see more and more of these cases. Now, it's in our control, to the extent that many of us in the community are able to work from home and to restrict our interactions with other people. That will significantly reduce the burden of disease within the community and therefore make our schools safer for our students and for the staff that work within the schools. I can't emphasize enough how important that is. We want our schools to continue to operate in person. The best thing we can all do together as a community is to really be vigilant around practicing physical distancing, staying home as much as possible, wearing our masks as much as possible. All those self-protection measures that we've talked about for many months now.

READ MORE: Public school in Scarborough closed until further notice after 6 test positive for COVID-19, including 4 variant cases

CP24: How long would you recommend to Dr. Williams the city stay in the grey zone before going to red?

De Villa: This is one of those things that's a constant discussion and interaction between ourselves and the Chief Medical Officer of Health. As I understand it, we're going to be constantly following the data together and having regular interactions and conversations around what we're seeing, and then making decisions as we should, based on what we actually see in the community. That's a constant monitoring job that we have. And you can be sure that we'll continue to do that, especially as we keep our eyes open for those variants of concern, making sure that we're controlling growth as much as possible.

CP24: Do you consider seniors over the age of 80 living in the community high risk or not? If we are, as the federal guidelines and scientific consensus indicate, why are we not included in phase one of the provincial framework? And why does Toronto Public Health not challenge this edict?

De Villa: In fact, 80-year-olds in the community are in phase one of the provincial framework. The provincial framework is, again, a provincial framework. They are the ones responsible for putting that together and trying to outline how best to provide vaccines. Our major challenge right now is one of vaccine supply. As supply becomes more available, you can expect that all the vaccinating partners in Toronto will be seeking to provide vaccines as quickly as possible to all those who are eligible under phase one, including adults who are 80 years of age and older, regardless of where they live. As we get through those populations, we move on to phase two because what we want to do is see as many people vaccinated as quickly as possible.

CP24: A viewer asks, do you support putting those who have been ticketed with breaking COVID rules be put at the back of the vaccine delivery? It's a good idea and could prevent further rule breakers.

De Villa: I can appreciate that we're all perhaps irritated or a little angry at people who might have broken the COVID rules. But look, as far as I'm concerned, the more people who get vaccines faster, the better it is. And I don't think we need to think about where we put people or sending people to the back of the line. I want as many people who are interested in getting the vaccine to come forward as quickly as possible in accordance with the prioritization framework laid out by the province. And I can assure you that every vaccination partner in the city will do their very best to get through all the people who want to get the vaccine as soon as possible because that's how we will best protect our community and start to resume life more like it was before, which I think we can all agree on.

CP24: Any final thoughts this week?

De Villa: I would just ask people to really stay vigilant. We're almost there. Vaccines are coming. Continue to practice those self-protection measures. Get your vaccine when you get your turn. And soon, we'll be on the other side of this.

This interview has been edited.