In her weekly segment with CP24, Dr. Eileen de Villa, Toronto's medical officer of health, answers viewer questions about COVID-19. She also tackles topics related to the pandemic, including vaccines, variants and the latest public health measures.
CP24: The province announced an updated second dose strategy with a focus on Delta hot spots. However, it does not include the allocation of more shots to high-risk communities. What do you think of this move?
De Villa: Basically, what I see is that the science says that in respect of that new Delta variant, the one that has caused a lot of illness in India and is creating some troubles now in the United Kingdom, what you do really need in order to get good protection is that second dose of vaccine. So, I do think it's a good step forward in that eligibility is being accelerated for second doses for those areas of the province where there has been some documented Delta activity and where it's the highest. Obviously, the more we are able to push out first and second doses all across the province, the better off we will be in terms of COVID-19. So, certainly, as one of the beneficiary public health units, we're looking forward to being able to put out vaccines there. And please know that we're doing everything we can to make sure that first and second doses are happening, especially in those areas where there is transmission and where there is the Delta variant.
READ MORE: Ontario moves up second doses for many residents in Delta hot spot regions
CP24: Is Toronto pushing second doses to hot spot neighbourhoods?
De Villa: Well, you'll notice that we've been doing that now for several weeks here in Toronto. We have pop-ups and mobile clinics, specifically in those hotspot areas -- in those areas where we know there is more COVID-19 transmission. It's exactly to get to those places. We're trying to really control transmission, and the best thing that we can do is to then give vaccines exactly to those areas where transmission is happening.
CP24: The province at this time is not shortening the 12-week interval for those who received the AstraZeneca vaccine. What are your thoughts on people who got AstraZeneca who still, despite the Delta variant, whether they live in a hotspot or work there, have to wait 12 weeks?
De Villa: This is a decision that I know that the province has taken. And my understanding is that they're continuing to look at this and assess and reassess the available science on this issue. I understand that the reason why they have taken this position at this point is because the available science suggests that the protection is best at that 12-week interval. But I understand they're looking at it. I'll expect to hear more from the clinical guidance group that is actually working on this issue.
CP24: Earlier this week, Mayor John Tory spoke about the staff at vaccination clinics being subjected to abuse by people seeking to get their second doses. Have you experienced abuse in your job throughout the pandemic?
De Villa: I'll be quite upfront. Yes, I have received some negative emails or calls and have been the recipient of some negative emotions. And I understand. This has been a really, really challenging period for all of us. I think sometimes people feel that they need an outlet or a place to direct their anger. I would ask the public, though, not to direct it towards the people working really hard around the clock to try to provide that service. I'm willing to hear complaints and certainly willing to take criticism, in respect of what has been done, and certainly open to having a discussion, but I would just ask that people do so in that spirit of real constructive criticism and seeking to improve rather than in the ways in which we've heard, people have been speaking to our staff at our clinics, resorting to racist or sexist remarks. There's no place for that. And it's not constructive at all. It has nothing to do with the service that people are working so hard to provide.
CP24: A viewer asks, why can't you immediately allow gyms to reopen with capacity limits for fully vaccinated clients?
De Villa: The reopening plan that the province has put forth, I think, is a careful and cautious one. I think it's one that takes into consideration the science. So, what we know is that the risk of COVID-19 transmission is definitely much higher in those indoor settings, and gyms would be one of those. I do recognize that vaccination is another protective feature and an important one that we're seeking to really push out there and make sure that people are able to take advantage of. But I think that when you look overall at reopening plans the world over that they are cautious, the best ones anyway, are cautious and slow and take into account the science. So, you start off first, particularly at this time of year, focused first on outdoor activities and then as more and more people get vaccinated, particularly with second doses and having sufficient time after that second dose and enough of the population getting there, you can then start to move towards more and more activities that are increasingly indoors. But again, I would encourage people, we need to be careful. The rates are definitely moving in the right direction. And the way to continue that is to be a little cautious, not necessarily to kind of go wild, as things start to open. And, of course, to get the vaccine if you haven't already done so. Get that first vaccine, and then get that second one when the time is right.
CP24: A viewer is seeking some clarification. She wants to know what it means to have a gathering of 10 outside. Should it still be distanced and people wearing masks? Or can you sit, chat, have a drink and let kids play?
De Villa: The general advice, of course, particularly if you're not vaccinated, you still want to be very careful even for those of us who are vaccinated. You're going to want to exercise a little caution. The outdoors is definitely safer. It does mean that you can have people in your backyard. Best to try to keep distance as much as possible. But I recognize that that's not always achievable. Outdoors is a much safer environment. The risk of transmission is significantly reduced just because of the large air pace. But it does mean that you can actually get together and have that social connection that I know we've all been craving for so many months. And the weather's lovely to boot. So, all in all, it looks like a great opportunity to start to restore some of those activities that we've missed for so long.
CP24: A viewer says she tested positive for COVID-19 in May but is now good to go back out. Public health recommends that she doesn't get a test for 90 days because they say she will likely get a positive result. She asks, if it's there in me, how am I not giving it to others?
De Villa: The issue isn't so much about being infectious. It's that actually, we may be able to detect remnants of the virus that are not infectious but would still be recognized as COVID-19. So that's why the recommendation is not to test again for the next 90 days because the issue is that you may get a positive test and then inadvertently be seen as having COVID when of course, you don't. So it may just, in fact, be remnants of the COVID virus that aren't really infectious. But here's one thing I would say to the viewer -- having now recovered from a COVID-19 infection and it sounds like it was uneventful and I'm glad to hear that, it is still worth getting a COVID vaccine. Once you finish your isolation period and as long as you're not having symptoms, it is still worth getting the COVID vaccine even after you've had an infection. And I would encourage that in this case for sure.
CP24: While you are waiting for the second dose, you suddenly develop a cold and a little cough. Do you still suggest that people go and tested? Or could it just be a summer cold? How do you know the difference?
De Villa: The only way you know the difference is to get tested. I know that people don't want to hear that, and it does mean going to get a test. But it is the safest thing to do right now. We shouldn't take our good numbers and the improving conditions for granted. There is still a COVID-19 out there. It is possible to acquire that infection, especially when you're not fully protected with the vaccine. So absolutely, that's the circumstance in which to get tested.
CP24: A viewer says Toronto Public Health did a great job setting up clinics at seniors' buildings during the first dose rollout. Many did not have to venture out to vaccination sites. She asks why it hasn't been done for the second dose?
De Villa: Without knowing the specifics of the building, it's difficult for me to comment in a very informed way. But what I can say in general is that there is a team of vaccination partners. As you can well imagine, there are hundreds and hundreds of buildings all over the city where we do have a significant proportion of seniors and where we do want to make sure that they're absolutely getting that protection. So, with the resources that are available across all the vaccination partners, I can assure people that we're working as quickly as we possibly can. We take into consideration where the building is, who's there, how much at risk the residents are given their profile. Obviously, older individuals are at higher risk of more serious outcomes associated with COVID-19. So, all I can suggest is that we are absolutely doing our very best with our partners. We will get to places as soon as we possibly can. And our ultimate goal is to get everybody vaccinated in the city as quickly as possible because it does afford really effective protection for those who received the vaccine and ultimately for the entire community.
CP24: Could Toronto achieve a two-dose summer?
De Villa: I think that the capacity is there. We are just looking for the supply. And as long as there's supply, I can tell you, there's no shortage of willingness on the part of the vaccination partners to do everything we can to get doses out there. I would also just ask for the people of Toronto to help us out by helping people that they know who haven't yet gotten vaccinated to get there. If it's a question of reluctance, have a conversation with them about what might be holding them back. Let's try to point them to some really good information sources. There are so many out there. Toronto Public Health and our website being only one. But I would encourage you to have that conversation, make sure that people in your network are aware of the opportunities to get vaccinated. And if they need help, give them that help. I think that's something that we can all do together as a community to get back to the things we've all missed so very much for so long.
CP24: Some jurisdictions are shortening the interval between AstraZeneca vaccines to eight weeks. Why can't Ontario do that?
De Villa: People do look at the science and there is a product monograph that goes with this and there is some latitude around what the interval should be. My understanding is that the decision that's been taken here in this province is really premised on the science that they've looked at. And the science on AstraZeneca suggests that a 12-week interval is an interval that actually gives you a higher level of protection relative to shorter intervals -- nine to 12 weeks versus 12 weeks. But again, I know that there is a constant assessment and reassessment. I think we should continue to wait to hear whether there's any reconsideration from the province. But in the meantime, we know what works. I would get that first dose of the vaccine. While you're waiting for that interval, continue to practice those measures for self-protection, wear your mass, and keep your distance. And before you know it, we will hopefully all have that second dose on board and really start to move towards life more like it was before there was a COVID-19.
CP24: A viewer asks, how effective is mixing Pfizer and AstraZeneca vaccines against the Delta variant?
De Villa: There is still a lot yet to be understood around a mix and match approach. But I would tell the viewer this if you have specific questions in your unique circumstance, really best to speak to your physician about this. They know the most about you. But the best vaccine is the one that's in your arm and the best vaccine course is the completed one. So please do get that vaccine as soon as you can.
