Dr. de Villa, Toronto's medical officer of health, answers your questions about the pandemic, vaccines and other COVID-related issues.

CP24: What's your advice to people who are making plans for the Victoria Day long weekend?

De Villa: I really do appreciate that people want to get together. And that the Victoria Day long weekend is traditionally the start of summer festivities, which involves getting together with friends and family. Right now, though, we are still under a stay-at-home order. And we're seeing good things in terms of our numbers. But we don't want to lose that. We don't want to lose the progress that we've made. So, my advice to people is that as much as possible, stick to the terms of the stay-at-home order for now. Try to keep it really to your household to the greatest extent possible. If you have to connect with other people, do so outside where it's much safer, keep your distance to the greatest extent possible. And the final thing I would say is, of course, if you haven't already gotten vaccinated, do get vaccinated. The more we're able to do this all together, the sooner we will get back to all those activities and gatherings and festivities that we so desperately have missed over the last year and a half. We just don't want to lose the progress we've made so far.

CP24: A viewer asks if I'm walking and someone not wearing a mask is coming towards me or running past me and I'm walking in space recently vacated by them, is it risky for me?

De Villa: In the outdoor space, the risk of transmission is definitely reduced. And certainly, just that transient passing of somebody is not likely to generate the transmission of an infection from one person to the next. That being said, I would strongly encourage people, look, if you're running along a path or walking along, try and give each other some space. Keep your distance to the greatest extent that's possible. And if you find yourself in a situation outdoors where you cannot maintain that distance, then that's really a time to put on your mask. It's a question of reducing the risk to the greatest extent possible. We know the outdoors plays a big part in that. But the longer you are in contact with each other and the closer you're in contact with each other, even outdoors, there is the risk of transmission. If you find yourself in that close contact kind of situation, even if it's outdoors, I would recommend using your mask just to add that extra layer of protection.

CP24: There are reports that the province could announce tomorrow the lifting of some outdoor restrictions as early as May 26. Have you heard anything about a possible announcement?

De Villa: I haven't heard anything specific about this. And I can certainly appreciate that we all want to be able to get out there to enjoy the warm weather while it's here. It's all too brief, our summer. We want people to be able to enjoy the outdoors to get physical activity not only for their physical health, but for their mental health as well. As far as I'm concerned, the more we are able to support people in using the outdoor space because it's safer, the better it is. But the same caveats that I've just mentioned earlier still apply to the greatest extent possible. Do try to keep your distance, particularly from those people that you don't live with. And if you can't maintain that distance, it is safer to wear a mask to reduce the likelihood of any kind of transmission of disease from yourself to others. You've heard me talk about those self-protection measures for so many months and weeks now. There's still important right now. Cases are still up in our city. They're definitely reduced from where they were at their peak. But there are still a number of infections, and we still need to be mindful of those measures to protect ourselves and those around us.

CP24: New York City is now reopening. Not long ago, it was the epicentre of the pandemic. What do you think of this development?

De Villa: I'm pleased for New York that they've gotten to that state. That's in our future too, but it's in our hands. How soon we get, there are really in our hands. The more we're able to stick to those measures for self-protection now because that's what's driving our case counts and COVID-19 activity in our city down. That combined with people going out and taking advantage of the vaccine and its protective benefits. It's these two things together that will get us to that moment where we too can have that collective exhale and really started to enjoy life and the many things that we used to enjoy before there was such a thing as COVID-19 in our vocabulary.

CP24: A grandmother says she lives in a multigenerational home with seven people ranging from 12 to 70. She says her 18-year-old grandson and girlfriend went to an anti-mask rally last weekend. She says she is upset that her grandson did it without a thought. She wants to know if it is wrong to ask him to leave and stay at his girlfriend's house for 10 days.

De Villa: It's very difficult. And I know that there have been disputes and disagreements within families over COVID-19 and people's approaches and beliefs around it. It is a significant issue. COVID-19 is a significant risk to all of us in this city still at this point. What can I say but I think it's important to have an open and honest discussion to try to understand where her grandson is coming from with respect to these points of view. I don't think that we solve problems by berating people necessarily. I think you have to protect yourself. I think that's quite reasonable, especially as an older individual. You're at higher risk for a severe illness or a severe outcome associated with a COVID-19 infection. So, I appreciate and understand why the viewer, in this case, took the action that she did. But I do think that bringing people onside into a better understanding actually requires conversation. Blaming or berating people isn't a very good way of doing that. So, I would encourage the viewer, in this case, to keep lines of communication open and really just try to explain her perspective and why it's so important to her, and why she's concerned around COVID-19.

CP24: Another viewer wants to know if it will be safe to visit and hug her grandkids when she gets her second dose, even though the parents and the children only have had one shot.

De Villa: This is a question that many of us are still trying to piece our way through. There are increasing guidance and guidance documents that are being put forward by different jurisdictions. At this point in Canada, we don't have a lot of the specifics worked out yet but looking at that which are our colleagues down in the United States have put forward, this is the Centers for Disease Control, they're putting forward guidance on those who are fully vaccinated and what they might be able to do together. The kinds of gatherings that should be in our not-too-distant future. I hope to be able to share very specific guidance with our population. This is not something that will happen at a local level. It should be something that at the very least happens at a provincial level, possibly even at a national level. I would just say stay tuned. We're all looking forward to that opportunity where we can gather again and start to hug our loved ones. But in the first instance, I think we're going to be seeing outdoor gatherings first as a safer place and then hopefully, not too long after that, if we can all do our part, we can start to see more indoor gatherings and gatherings more like we're used to.

CP24: Toronto Public Health released the number of opioid overdose fatalities in 2020. What can you tell us about this report?

De Villa: This is just yet another tragedy on top of the tragedies that we have suffered through COVID-19. And I cannot tell you enough how disheartened I am and how concerned I was to see the numbers in respect of opioid overdose-related deaths. Prior to COVID-19, you will have heard me speak on several occasions on the significance of the health crisis that is the opioid poisoning crisis that's affecting our city and so many other places around the world. It is very much still a concern in our minds. Obviously, addressing it has been made more challenging as a result of the number of measures that had to be put in place in order to manage the COVID-19 pandemic. But despite that, we have worked hard over the last year and a half and we'll continue to do so with our healthcare partners and our community partners to ensure that we're taking a true health-based approach to this issue, rather than one that's founded in criminal approaches or legalistic or justice-system oriented approaches. So, lots of work for us to do on this front. And we know that mental health challenges add further to this. We have no shortage of work to do on this front. But there's lots of partnership, harm reduction processes, safer supply initiatives, work that we're doing with our healthcare partners, in order to address the significant crisis.

CP24: Is there any message of warning you can give out right now about this?

De Villa: I think at this point, I don't know that it's a warning, per se, but it is a message to all those in our community. There are many people who are suffering and hurting very badly. There were mental health and addiction challenges that existed before COVID-19. And they continue to exist. In many situations, they've become amplified as a result of the many stressors of COVID-19. I would just ask that people reach out to others in the community. If you know of somebody who is suffering, I would ask that you help them get access to the many resources that are available - harm reduction supplies, safer supply initiatives, treatment initiatives that are out there to the extent that we can help each other and connect people to resources. I think that's at least one step that we can take together in addressing this crisis. But there's much, much more to do. And I can assure you that we're working with our community partners and healthcare partners on the many solutions that need to come to the fore.

CP24: A viewer wants to know when can people who got their first dose of the AstraZeneca vaccine receive their second shot? He says he is worried that they cannot get fully vaccinated.

De Villa: This is very much a question of interest to many, many people, as I'm sure you can understand. And I can tell you that there are active discussions happening at the provincial government to come up with a very specific plan. I expect that there should be communications to people soon about what the path forward is. But there are many studies happening on this, with respect to second doses and mixing and matching first vaccines and second vaccines. Having different vaccines given for first and second doses, we know that that's safe and actually providing an effective immune response. I think that we'll get messaging soon from our provincial counterparts and know that there's lots of study on this issue and lots of interest, not just here, but all over the world.

CP24: A viewer who had the AstraZeneca first dose wants to know more about receiving another vaccine for a second dose.

De Villa: The specifics of what will happen here will be shared, I expect soon, by our provincial counterparts. I know that they're actively discussing this very issue pretty much on a daily basis. But what I can also say is that there are studies going on elsewhere in the world, looking at that mix and match approach, having one particular vaccine as a first dose and a different vaccine as the second dose. Thus far, these studies are quite promising there. They're suggesting, look, this is a safe approach. And it does appear so far in the studies to be providing an effective immune response. I think much more that we're still learning about this. And all of us are, I think, eagerly awaiting what will be the specific plan here in Ontario, which I know will be coming in the not-too-distant future. So, stay tuned. More to come and certainly the research is quite promising.

CP24: A viewer wants to know if you have any advice for couples planning their wedding for 2021. Do you have any specific timeline on when wedding celebrations could finally happen? She says she postponed her wedding five times last year, and she is struggling to pick a date.

De Villa: I'm so sorry that that's happened to you. That must be incredibly frustrating. And so, I can appreciate why you might want to have some certainty around that. Here's the thing, I don't know that I can give you 100 per cent certainty. I'm not even sure I can give you 90 per cent certainty. But here's what I think I can offer, if we all continue to do our part, I think we have an opportunity to enjoy the later part of the summer that's a little bit more like what we're used to enjoying. But I think in order to be safe, trying to focus down on a relatively small group of people. The more outdoors it can be, the safer it is. And with people being vaccinated, you have a better chance at success on a go-forward basis. So, what the timing will look like, I can't be certain. But perhaps I can offer her this: outdoors, small, with vaccinated people, I think you have a really good chance. And then maybe you save a bigger celebration for a little bit further down the road when the crystal ball is a heck of a lot clearer and a little less fuzzy in terms of prediction. Maybe that's the best we can do for now.

CP24: A viewer wants to know why camping is included in the ban on outdoor amenities if it is all outdoors and very low risk of COVID-19 spread as continuously promoted by doctors and provincial leaders.

De Villa: I think this is one of those very challenging questions to answer. Let me see what I can do to explain. There's no question, outdoor activities, definitely safer. I think we can all agree. You're talking about big open airspace and, therefore, less opportunity for transmission to occur, especially if there's distance. This is a provincial regulation. The challenge is that there's the activity itself, the actual whether it's playing tennis or whether it's camping, and then there's all the activity that goes on around it. When you're on the tennis court, no question, the risk is definitely (low). You've got one person on one side of the court, the other one several feet away, with big distance between them. That in and on of itself isn't all that risky. But how do the people get there? What do they do afterwards? Is there a gathering of sorts afterwards? Are they carpooling to get to wherever it is that they're going? And does it promote people actually moving around from one place to the next? And does that create the opportunity for gathering and socializing, particularly amongst people who don't share the same household? That's really where the risk starts to come into play. I think that's what underpins some of the guidance and the current regulations that we're seeing right now. But the more we're able to continue to practice our measures for self-protection. And the more we are getting vaccinated, hopefully, the sooner we get to the point where we are able to enjoy a broader range of outdoor activities.