As parents prepare to send their children back to school, Toronto's public health official is reminding them that it is important to help kids understand that school will be different this year.

In her weekly briefing, Dr. Eileen de Villa, Toronto's medical officer of health, said parents should teach their kids how to wash their hands, practice physical distancing, and wear their mask.

De Villa said it is will also help if parents create a routine to screen their child for symptoms of the virus before school each day.

"It's also important to watch for signs of stress or anxiety in your child," de Villa said. "They

may have a lot on their mind, and they may or may not talk about it."

While it is essential to remind children to think about COVID-19 and their actions when they are at school, de Villa said parents should also let their children know that this is temporary.

"Ask them about their day so they can share their feelings. For example, they may be worried that a friend got too close, or that someone wasn't wearing their mask the right way," she said.

Dr. de Villa joined CP24 on Wednesday to answer more coronavirus-related questions.

CP24: I know you're predicting that there is going to be a second wave. What would the second wave depend upon? And how do you think the second wave will be compared to the first wave that we had mid-March when we were in total lockdown?

De Villa: You might have noticed that as I delivered my remarks this week and talked about future COVID-19 activity, I use terms like resurgence or future COVID-19 activity rather than a second wave. And that's because I think when we talk about a second wave, you think about a single peak, a single big wave of activity that then subsides. And that is one potential scenario for future COVID-19 activity. But when we look at the potential projections what future COVID-19 activity might look like, it could be that large wave, but it could also be a series of small outbreaks that are just kind of a low level of activity that's constant and just keeps us moving with COVID-19 cases. I think what we can say is this, we don't have effective treatments, and we don't have a vaccine, and we know that most people, the vast majority of people in our city, are still susceptible to COVID-19 infection, so we should expect to see more activity. What it's going to look like is actually in our hands.

Following this advice will control the amount of activity that we have. It will not be zero. We know that as more of us mix and interact with each other, especially as we have to move indoors as it gets colder, we should expect to see activity. How much we see, how big the waves will be, it's all up to us.

CP24: Does the city and does Toronto Public Health have different sorts of plans of attack, depending on what we do end up seeing?

De Villa: I think different situations and different scenarios will call for different kinds of actions. Indeed, if we see a lot of activity, we have to think about what kinds of limitations might be necessary to control further spread. That's exactly what we've seen in other jurisdictions. Everywhere from Australia to Korea to parts of Europe, you'll notice that we're trying to keep activity to as low a level as possible to as controllable a level as possible so that we don't need to rely on those kinds of limitations and restrictions as we had to put into place earlier this year. Again, it's up to each and every one of us we need to keep doing our part when it comes to washing our hands, watching our distance, wearing our mask and avoiding close contact with people outside of our bubbles, especially when we're talking about indoor spaces.

CP24: We've seen pictures this week of some Toronto District School Board classrooms where desks aren't effectively spaced out. In other scenarios, windows just simply don't open in the school. How concerned are you when you see pictures like that? As a public health officer, what goes through your mind when you hear and see that?

De Villa: I think we're all concerned about what we can do to limit spread within schools. But I think we all need to be very clear about this. We should expect to see cases in schools. The question is, can we keep it down to a low enough level that we can manage it and ensure that kids can stay in school? Because it's really important for them to be there. There are so many benefits. It's not just about education and academics, which is already important in and of itself, but there are so many other health benefits to having our children in school. We need to do everything we can to make it as successful as possible. And physical distancing and using masks and all the public health practices adapted for a school environment will be very important. But the other critical component, for our schools to continue to run successfully, is for us to keep the community levels of COVID-19 as low as possible. And that's not just on our kids or staff at schools. That's on all of us. So again, I keep going back to what we need to do as a community in order to be successful. It's also what we need to do as a community to ensure that our schools can continue to run in the safest possible while we're living with this virus in our community.

CP24: I think one of the other concerns we're hearing from parents, in particular, is kids are going to be so excited. They're going back to school for the first time in six months now. I've seen children playing together. It is difficult for children to physical distance. Is that why, or is that part of the reason why you expect to see some spikes? Or is it just because they're going to be more people congregating in more places post-Labour Day, maybe more people coming back to work?

De Villa: I think it's a little bit of both. I completely understand the excitement of kids. I'm sure they're dying to get back to seeing their friends and being back into that social setting. And so I would encourage people, including our children, to take advantage of the outdoors while the weather is still good. It's not to say that you can't transmit virus out, but the risk is certainly significantly reduced just because of the large air volume and air movement when we're socializing or mixing outside. But certainly, within a school setting within any setting where we have more interest

reaction between people, there is just a higher risk of COVID-19 transmission. The best thing we can do is minimize the amount of disease transmitted in our community by keeping up our public health measures, by definition, that will reduce the risk within our schools.

CP24: Please advise families on facilitating visits home from university or college students who are living in residence during the pandemic.

De Villa: What we're trying to do in these circumstances is to minimize the social contact that happens with large groups of people, and I know that's difficult within a residential setting. Here's what I would suggest. Physical distancing, physical distancing, physical distancing. Wash your hands, wear your mask as much as possible. I know it is challenging for university students because I know so much of the university experience, particularly when you're at the start, is around the socializing is around getting to know other people. And it's not that we want to discourage people from getting to know each other. That's an important part of the university experience. But to the extent that the large parties in closed spaces without masks can be avoided for now. I think that'll go a long way towards protecting yourself as a university student and towards protecting your family when you're going home, particularly if your family members include those who have chronic medical conditions or weaker immune systems, or for those who have grandparents or older relatives who are part of their household. We have to keep in mind that some people within our community are at higher risk, and we need to protect them as much as possible.

CP24: With kids heading off to university, will positive test results be recorded or attributed to the health unit of their home location, or the health unit of their school location?

De Villa: It depends on how they're characterizing their home address. So generally, it's where your home address is. Suppose you list your home address when you have your test as your university residence location or apartment. In that case, that's how things will be managed through that particular local public health department. It all depends on what you list as your address. That's how we determine how things are assigned to local public health units.

CP24: What is the number to make an anonymous call to report a person who flew in from the U.S. and isn't self-isolating?

De Villa: I know that people have reported that there are some times and situations where they get knowledge of someone who's recently travelled and isn't abiding by the quarantine rules. Here's what I would suggest. You can call our Toronto Public Health hotline. We would be one source. You can certainly call the city at 311. We can direct the call appropriately. But to be clear, quarantine and the isolation that's being asked of travellers as they come into Canada is something under the federal government's responsibility. And they also have some numbers that are available on their website. But certainly, calling the City of Toronto, whether through 311 or Toronto Public Health, would be a reasonable place to start. And it's my sense that we're not going to say so and so reported you, by the way, if we follow up on a situation that needs some follow up.

CP24: There is that sentiment from some people who suggest, I'm doing everything I'm going by the rules, all the bubbles, that sort of thing. And then, when some people see people who they think are some flagrantly abusing, ignoring the rules, there is that divide among some people among our community, isn't there?

De Villa: There is that divide, which is why what I'm doing is asking members of our public look, we're all tired. We're tired of physical distancing. We're tired of wearing our masks, and I get that because it is a change. And we like to get back to being with our families and with our friends unfettered by all these restrictions and limitations. It's not that we don't understand. But the issue is that we're trying to protect our community, protect you and your health, and protect others around us. And, of course, to protect our economy and all the other social impacts that COVID-19 has brought. And the best thing that we can do is for each of us to do our part. I've been encouraging people just when you're feeling weak when you're thinking, 'you know what, just this once, I'm going not to follow the rules,' how likely is it that something bad will happen? Just stop yourself for that second and think something terrible can happen, and all it takes is a small incident, one small lapse, and we've seen this in other cases and jurisdictions. As difficult as it is, to the extent that we all want to get back to socializing in ways that we're used to doing so that we can actually enjoy ourselves in those large groups again, please follow the public health measures. It is eventually we will get past this. But we need to do this for now to protect our city, our community, ourselves and those we love around us as much as possible.

CP24: How low does the number of new COVID-19 cases has to go to drop some COVID-19 health measures?

De Villa: Until we get to that time where we have effective treatments that are broadly available, and a durable immunity through such things as effective, safe vaccines, we are going to be in the circumstances where we're going to be practicing these public health measures. And hopefully, we keep those to as limited as we can. There is no desire to impose public health measures or ask people to do public health measures unnecessarily. This is not an interest of public health officials. We try to make sure that we're putting the appropriate level of controls for the situation as it's warranted. But that's why I'm encouraging people to continue to do your part. The more we're able to do our part, the better we can control the spread of the virus now. We buy ourselves a little bit more time until those treatments and vaccines are available and can be used and deployed across a broad enough swath of our population. We can then think about starting to resume those activities that we've been used to doing and that we've so enjoyed in the past.

CP24: Do you know anything about underlying conditions that people may have after having COVID-19?

De Villa: That's an excellent question. We're still learning the full extent of the answer. As I've told people, many times, this is still a new virus. This is a virus that was only sequenced in January of this year, and we are just into September. We are watching people recover. Now, because it's a new virus, we don't have any experience to tell from the past what do the long-term consequences of a COVID-19 infection look like. We are learning actively, and science is seeking to develop and understand what those long-term consequences are. Some people seem to have recovered without difficulty, while others have had long term consequences, which we're still learning about.

CP24: Last week, long-term care homes announced that residents could leave the home and return without isolation. How do we know they won't pick up the virus and bring it into the home? It doesn't seem like the right time as we embark on the second wave.

De Villa: With these kinds of situations, it still comes down to practicing public health measures, watching that distance, washing hands, wearing a mask, especially when that distance can't be maintained. And practice good infection prevention and control is going to be fundamental in long term care homes to protect everyone there.

CP24: The masks with air vents in them, are they any good? People say they're good for people with glasses because they don't fog up, but in reality, are they safe to wear?

De Villa: What we have recommended in respect of mask for regular use is that it ideally should be made of cotton, multiple layers, good fit, covering the nose, the mouth and the chin. With respect to the valves, I think they're doing a less good job in preventing the spread of your germs out to others. Cloth mask that is made out of the right material, tightly woven, good fit, no gapping covering your nose, mouth and chin, these are the fundamental pieces of a good mask and using it properly is very important as well making sure you wash it.