In her weekly segment with CP24, Dr. Eileen de Villa, Toronto's medical officer of health, answers viewer questions about COVID-19, including vaccines, variants and the latest public health measures.

CP24: Two days from now, on July 16, Ontario will enter Step 3 of its reopening plan. Is Toronto prepared?

De Villa: It is for sure a big step. And I think one that we are all excited about. I mean, this is a moment that I think many of us have been waiting for. It's what we have really held on for. It's what we've sacrificed for. And so, to my mind, I think that we should celebrate that, recognizing that our indicators are generally moving in the right direction. But by the same token, I would just ask the people to exercise a little caution. We have come a long way. Let's not forget all those lessons that we've learned over the course of the last year and a half or so. Let's enjoy life fully and get out and do more of the things that we've been missing for so long now. But I would just advise a little caution. We've learned a lot about what promotes the transmission of COVID-19. So, I would ask that people continue to exercise some caution, recognizing that transmission can still happen. COVID-19 is still here. We have more transmissible variants. So, in addition to just being extra cautious on personal protection measures, if you haven't gotten your vaccine, go get that vaccine. It is safe. It's effective, and it's what will protect you and allow all of us to enjoy this newfound freedom.

CP24: What indicators are you looking at? Do you look at case counts? Do you look at testing? Positivity rate? Vaccination rates? What are the indicators that you are most keenly attuned to now?

De Villa: We have not been at this lower level in respect of daily new cases since basically August, September of last year. So, this is certainly a move in the right direction. So, you asked about a number of indicators. The ones that we're following are on our monitoring dashboard. And I would encourage residents of Toronto to follow along with us. But not only are we watching what's happening locally, I also think it is important to understand what's happening in other communities, particularly those that have been a little bit ahead of us on their COVID-19 trajectory. So, we've watched what's happened in England and in Europe. They've always been a few weeks ahead of us. So, it's very, I think, important for us to keep an eye on what's happening there as it offers some insight. It's not a perfect analogy. They're not in exactly the same situation as we are, but it offers us valuable insight and lessons that we can take and then apply to our own circumstances to keep things moving in the right direction. But of course, I would be remiss if I didn't talk about how important vaccination coverage is to all of this -- the more we are vaccinated, the better opportunity and the better chance we have at getting to the other side of this pandemic sooner rather than later.

CP24: In the past few days, there have been talks about vaccination passports. What are your thoughts on this issue?

De Villa: I think it's reasonable, especially understanding what we are hearing about the ability to move around and particularly to move around internationally, that there would be some process by which to verify what is your vaccination status. And this will be important as we move into the fall season when we're not able to enjoy the outdoors quite as much when we do congregate a little bit more indoors and as life starts to resume something a little bit more like what we were used to seeing before there was a COVID-19. You expect as people move around indoors and interact with each other that we'll see more case activity, especially in group settings -- workplaces, schools, and universities, places like this. And clearly being able to identify who's fully vaccinated, who's partially vaccinated and who's unvaccinated becomes important in terms of helping to manage through cases and exposures and understanding who is at greatest risk and who's at lesser risk. But I think overall, it's never a simple conversation. But I would say this from a local public health perspective, and I would argue from a provincial public health perspective as well to the extent I can speak for them, they're always going to look, and we will certainly look for what measures actually really make a difference in terms of increasing vaccine coverage and vaccine confidence. So, I think we should be looking at all options that actually advanced those goals of vaccine coverage and vaccine confidence. We shouldn't close the door on anything quite yet. These are all new concepts to us, and I think we need to keep an open mind.

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CP24: Earlier this week, there was some confusion on mixing and matching doses after remarks from a representative of the World Health Organization. It was largely taken out of context and required a lot of communication from science experts and medical officials in the city and beyond to correct or to put people's minds at ease. In Peel Region, there have been cases where people walk away because they are not getting the shot they want. Have you seen similar incidents in the city?

De Villa: I think we are seeing manifestations of that for sure. Certainly, I've heard some concerns expressed not only here in Toronto but throughout the province. And it is unfortunate. These things do happen. It's unfortunate that these comments made by a World Health Organization official were taken out of context. She was speaking about booster doses and people apparently making some choices on their own around getting additional doses of vaccine without any kind of medical advice. So, it wasn't about the kind of practice that we have here around using mRNA vaccines in an interchangeable fashion. So, as I've mentioned before, in both on this show and through other opportunities I've had with the press, we follow the advice of the National Advisory Committee on Immunization. We know that it is reasonable, and there is an established practice in interchanging vaccines that are effectively similar. And we know from studies right now that there is some safety and effectiveness associated with the practice as we are using vaccines here in Canada. I, myself, have had a Pfizer (as the first dose) and a Moderna (as the second dose), and I feel quite confident that I am protected. So, I would encourage people to, you know, make sure that they're looking at comments in context and that they're listening to the public health experts in the advice that we've been providing here in Canada and in Ontario specifically.

READ MORE: Canadian health officials defend mix and match COVID-19 vaccine strategy after WHO comments

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CP24: The Toronto FC has been allowed to return to BMO Field, and they will play on Saturday in front of 7,000 fans. We are still awaiting information on the Blue Jays. Do you have any insight as to how those conversations are going, given that you are the medical officer of health? Can you say as to whether the federal government is leaning one way or another? When can we expect some news ahead of maybe a return to play at the end of the month?

De Villa: I'm really fortunate to work with a wonderful group of colleagues who I'm going to give a little shout out right now. My colleague, Dr. Vinita Dubey, and others who work in Toronto Public Health have been looking at all the protocols. They have opportunities to review from a Toronto perspective. We recognize we're not the only player here, but we participate in the discussions. We look at things from the local public health point of view. But I know that our provincial counterparts, and in this case, our federal counterparts have their own concerns to think about. So, I don't have any further insight to lend. But I can say that look, our situation here in Toronto is certainly improving. It's not something we should take for granted. I think there are a number of precautions that are still in place to try to allow for the enjoyment of sports and sporting events while at the same time making sure that we're protecting public health and being mindful of COVID-19 and (the) delta (variant) in particular, recognizing that it is here, and it does pose some risk.

READ MORE: Toronto FC gets green light to play at home in front of 7,000 fans on Saturday

CP24: Would you be only allowing the Blue Jays to play if the dome stays open?

De Villa: The big open-air environments are much safer. We've known that and we've learned that over the course of the pandemic that to the extent that we can increase airspace and ventilation, we reduce the risks associated with transmission. So, I think there are a number of safety measures that are in place and protocols that are there to allow for safe enjoyment of these activities once they get the green light from our colleagues at the federal government.

CP24: A viewer says, "I choose not to be vaccinated due to numerous allergies to medications and having horrible reactions to other vaccines. I'm being held back from travelling all kinds of things, but there's no direction for unvaccinated people. It feels more of a discrimination because I have a personal choice not to take the shots." How do you respond to that?

De Villa: First of all, I think with the situation like the viewer's, I'm sorry to hear that she has so many allergies and has had some challenges with vaccines in the past. However, I would suggest that this is something we're talking about COVID-19, a new disease that has certainly wreaked havoc for the last 18 months. I think this situation warrants a conversation with a trusted health-care provider, whether that be a family physician or perhaps she has an allergist involved in her care. I think this is something worth discussing and not to write it off completely without actually having engaged with some specific expert advice who understands her unique circumstances. We have found that in general that even for people who have indicated that they have a number of allergies or those that have indicated that they've had difficult experiences with other vaccines, we know a number of these individuals who have proceeded and gotten COVID-19 vaccine, recognizing how important it is just given the circumstances around COVID, new variants, and its transmissibility and all the negative impacts associated with a COVID-19 infection. And they've done so successfully. So, I would encourage the viewer; please have a conversation with a trusted health-care provider. Discuss your unique circumstances and see what might be done because I think that it will be good for her, good for protecting those around her, and may actually allow for greater latitude in terms of what activity she can participate in in the future.

CP24: Another viewer says, "To attend public school, my mother had to present an immunization card proving I was vaccinated against certain communicable diseases. However, we never had to show that card to enter a mall, restaurant or to travel. I've never had to show proof of a flu shot against the yearly flu virus, which sickens and kills many every year. When measles made a resurgence a few years ago, no one demanded proof of vaccination. Why is COVID being given the special treatment?"

De Villa: I think there are lots of questions and special treatment as it were that has been accorded to COVID just because of the impact it has had on us as a city, the province, the country, and the entire world. I mean, this has been the most significant public health event of the last 100 years. So, I think we can appreciate why COVID is being treated differently from a number of other conditions and a number of other situations. That being said, I would say this from a public health perspective, what we're interested in and what I'm certainly interested in is figuring out what measures actually make a difference in terms of supporting increased vaccine coverage and increased vaccine confidence because we have seen through our own experiences here locally, and experiences all around the world, the vaccines that we have available to us against COVID-19 are safe and they are effective. So, to the extent that we can use measures to help increase vaccine coverage and get that protection to as many people as possible, I think that's really the direction we should be heading in. And you can appreciate that having some sense as to proof of vaccination is an idea that people are speaking about to see whether that, in fact, helps us drive up vaccine coverage and therefore drive up protection and the opportunity for us to enjoy all the activities that we've been missing for the last several months now.

CP24: A viewer wants to know if you have any advice for parents who have school children who are not eligible for the vaccine as the province is leaning towards a return to in-person learning in the fall.

De Villa: Education is something that is largely under provincial purview. But I think we can all agree that we've learned quite a bit over the course of this pandemic. First and foremost, what I would say is that in our observation and in our experience, what happens within the context of schools is a reflection of what is happening in our communities. So, to the extent that we are able to do everything we can to reduce transmission all over our community, including adults, that will reduce what happens in schools, it will reduce the likelihood of transmission of COVID-19 within schools. So, good public health practice, good self-protection measures and, of course, vaccination become really key. Now, good public health measures can also extend to schools. And we've learned a lot over the course of the past several months. Using masks actually does make a difference. Having some degree of cohorting, where possible, limits the different exposures in contacts, and handwashing, staying home when you're sick. Following all the good advice that we've been providing over the past several months on how to reduce your own risk for COVID-19 will serve us all well in the future as we wait hopefully for vaccines to become available for the younger population. And the hope is that that will come in the months to come. I know that it's being worked on right now. The vaccine manufacturers are actually doing studies on vaccines for younger members of our population, and hopefully, they'll soon be able to have that protective benefit.

CP24: A viewer says, "I understand people have the right to refuse having a vaccine. Do people in long-term care or their families have the right to refuse care from a staff member who's not vaccinated? Do those rights go both ways?"

De Villa: When it comes to the issue of rights, that's probably a question that's better directed towards somebody from the legal profession. But here's what I can say. I know that we are working very hard, whether we're talking about ensuring vaccination coverage is high throughout the community. We're certainly working on that. But we recognize that there are certain workgroups, there are certain areas of employment, certain workers who, by virtue of their work, deal with more sensitive populations so people who are health-care workers, people who work in long-term care or acute care. We recognize that they deal with patients in a very close fashion and therefore present a risk if they are not fully vaccinated. So, there are lots of efforts underway to make sure that people within those sectors who work in more sensitive occupations are afforded every opportunity to get vaccinated as much as possible because we know again, the higher we drive up vaccination coverage, the better off we will all be as a community, and certainly, the protection is afforded to that individual as well, who seeks out and gets vaccinated fully.

CP24: Final thoughts this week?

De Villa: Knowing that we're coming into Step 3, we're at this opportunity where we're going to be able to do more and live more fully. So, I would ask people to absolutely enjoy that hard-earned, do found opportunity, but not to forget the lessons of the last 18 months. Still practice good public health measures and if you haven't gotten vaccinated, please do so and encourage all those around you to do the same.