As many parents in the city decide whether to allow their children back to school next month amid the COVID-19 pandemic, Toronto's top public health official says she will be sending her kids to school.

"I think that's the best thing that we can do," Dr. Eileen de Villa, Toronto's medical officer of health, said in an interview with CP24 Wednesday afternoon.

She said schools provide a lot of health benefits for children. De Villa has three children: one is going back to university for his second year while the other two are in high school.

"We're trying to balance out COVID-19 transmission risk, but we recognize that school has lots of benefits for children. And it's not just about the academics and the education, although that's clearly the primary role of schools, but particularly for younger kids, schools provide all that necessary sort of social development", she said.

"Hence, we're trying to create the circumstances that allow for kids to go back in a safe way and to make the environment safe for teachers and the other staff at schools as well."

Toronto Public Health reported 33 new COVID-19 cases on Wednesday, bringing the city's total to 15,866. Of those cases, 1,167 have died, while 14,401 have recovered.

During the city's COVID-19 briefing, de Villa said it is just "not feasible" to expect the number of COVID-19 cases to go down to zero.

De Villa joined CP24 to answer your questions about school reopening and other COVID-19 issues.

CP24: My question is, what is your professional opinion of the maximum classroom size for the best safety for our children?

De Villa: I think the interesting thing is that it all depends on the class size. I wish I could say that there was a singular answer. But we know that we're looking at the space, it depends on ventilation. It depends on how sizable the actual classroom itself is. So, what we also know is that what makes a difference in trying to reduce risk has to do with physical distancing. We know that masks work in terms of preventing the spread of droplets from one person to the next. So, there are a number of different factors that are involved.

That being said, I think that when we're looking at what has been the experience of other jurisdictions, keeping things down to the size of 15 to 20 or less in that range has clearly been shown to be a more beneficial size and one in which one you reduce the risk, particularly if you keep distance and two, should there be a case, you have a relatively small number of people to follow up on so that public health can do its work and minimize transmission as much as possible.

CP24: There maybe 70 children on a school bus. How is that going to work? How can one ensure that kids can go to class safely? Also, how are we going to ensure the safety of the bus driver? Any thoughts on how we can make school transportation safe?

De Villa: I think we should all be concerned about the safety of our students, the staff and this includes the bus drivers and those who are managing transportation systems. What's interesting is it again, the advice is still the same around making sure that there's as much distance maintained as possible and as much airflow as possible. We know that if you are in an outdoor airspace, the risk is significantly reduced. I'm not going to say it's zero. There's no such thing as zero risk. Our goal here is to lower risk as much as possible in a practical way. What can be done with respect to the bus, certainly trying to maintain distance as much as possible and wearing masks to prevent the spread of droplets from one person to the next. And of course, where possible, keeping windows open so that you get that kind of airflow. That being said, for those kids who live within walking or biking distance from school, over and above the protection from COVID-19, taking active transportation routes to school has additional benefits of physical activity. You get the exercise benefits, and as well there's mental health benefits to being physically active. For those for whom that's a possibility, I would strongly encourage either walking or biking to school, using methods of active transportation, not only from a COVID-19 perspective, from a physical health perspective. The physical activity that derives from going back to and from school on a bike or by walking and the mental health benefits of that physical activity.

CP24: How about when the weather changes, and it will be cold and snowy? How do you tackle transportation at that point?

De Villa: I think we should take advantage of the fall weather and the nice weather while it's here because those options are more readily available. That being said, you still have the option to try to maintain distance as much as possible. And my understanding is that our education partners are working as best as possible to maintain distancing and keep people into cohorts so that if there is any degree of closeness, it's amongst a set group of people. There is still the benefit that is derived from wearing a mask. If we're all wearing masks, we're protecting each other in those circumstances where we're in close spaces and can't maintain that distance to the best extent that we can.

It's important to remember that if you're sick, stay home. That's the other thing that we can all do to help protect each other. And to make sure that schools are able to function for the students and for all of us because we know that parents in order to be able to work need to be able to safely and happily send their kids off to school.

CP24: With back to school so soon and the talk of keeping kids home if they're showing symptoms, my question is, what does that mean? My kids all through fall and winter often have a runny nose and cough as most kids do. Does this mean my kids cannot go to school at all?

De Villa: Well, hopefully, not. And I think we have to try to use our best judgment as parents and hopefully in consultation with our health care providers. So for example, when we're talking about symptoms like a runny nose and if you have known allergies and your symptoms are typical of what your allergy profile looks like, you're not worsening, and when you're away from the allergen your symptoms improve, I think what you have is a case of your allergies. And certainly, if you respond to anti-allergy medication, you have yet more evidence that suggests that you're talking about a runny nose related to allergies.

Each of these situations is unique to the individual. It's something that I think that individuals should discuss with their healthcare providers so that you can make the best determination in that particular circumstance. This is not easy. I completely appreciate this. But it is part and parcel of learning how to live successfully with this virus. We have some time ahead of us that we're going to have to continue to do this. We each need to put our best efforts forward, work with our healthcare providers and try to find that reasonable balance to resume activities as much as possible and minimize the risk of COVID-19 spread in our community.

CP24: Are you worried at all though if parents you know, do send their kids to school that there may either be potential shaming from other parents or maybe even repercussions from the school if send your child to school and they are a little bit sick?

De Villa: I think that this is where the conversation becomes very important and clear communication between parents and the schools, their teachers, those involved in the care of the child will be fundamental to this. And I think we have to give each other a little bit of latitude and some understanding. These are challenging circumstances. We have come through this together.

We've made a lot of progress together as a community. And the reason why we were able to do that is that we all did our very best. We continue to practice public health measures. And now I think we have to add to that better communication, communicating with others and giving each other the understanding that's needed as we try to live successfully with this virus. I am not going to pretend that this is going to be easy. It will be challenging, but the more we communicate openly and honestly with each other, the more that we demonstrate that we are together, practicing public health measures, washing our hands, wearing our masks, watching our distance, I think this is the best thing that we can do to safely live with this virus in our community.

CP24: The top medical officer of health in the province talked about looking was looking into the idea of maybe expanding bubbles or expanding social circles. I wonder where the city of Toronto is potentially allowing groups of bigger than tend to be involved in bubbles or having multiple groups available to interact with?

De Villa: It is one that actually rests with our provincial colleagues. So right now, the current advice is to keep the social bubble to 10 people or less. And really what this speaks to is what we understand about virus transmission. We know that the likelihood of spreading COVID-19 increases when we're talking about socializing or mixing together within closed spaces, with close contact with lots of people. The idea here is that to try to limit the opportunities for that to happen, while at the same time allowing people to have that very necessary social contact because that's fundamental to our health and well-being.

I think that what we're trying to do is create that right balance. Right now, we know that when we keep things at a social bubble of 10 or less, we're able to mitigate the risk, we reduce the spread of COVID-19. This is part of successfully living with COVID-19 until we get effective treatments and a vaccine. We're going to continue that conversation. But I would encourage people again, limit the amount of social contact, and fully enjoy your social bubble. These are people with whom you can have, you know, direct interaction and physical contact. And this is part of how we're going to continue to live successfully with COVID-19 until we get a vaccine.

CP24: I have never taken a flu shot in the past. Do you recommend taking the flu shot in preparation for a COVID second wave? Or is there a connection?

De Villa: I recommend taking the flu shot every year as it is one of the best things that you can do to protect yourself from influenza. And while you know, influenza is a virus that we're familiar with. We certainly hear about it every single year. It should not be underestimated. It is the cause of a significant amount of illness, which can lead to hospitalization and does lead to a significant number of deaths every single year. The flu vaccine is one of the best things that we can do to protect ourselves. Of course, things like handwashing, staying home when you're sick, covering your cough, and sneezing properly. These public health measures that we've been communicating for the last several months now are also part and parcel of that. But yes, I do strongly recommend getting your flu shot this fall.

CP24: Is it guaranteed that we are going to see a second wave this fall?

De Villa: I don't know if I would characterize it necessarily as a second wave per se, but I do think we should expect to see more COVID-19 activity. This is exactly the experience that we're seeing in other jurisdictions. Even those jurisdictions where they've had COVID-19 case counts dropped down fairly low. At a later point, we see that some of those jurisdictions are now experiencing more COVID-19 activity. As we see more people mixing, we should expect to see COVID-19 activity. School reopening is one of those examples where we will have more people mingling with each other. Whether it comes as a second wave per se, whether it comes as a series of small waves, whether it comesas increased activity at a sort of low level, we should expect to see more COVID-19 activity until we have effective treatments more readily available, and ideally, a vaccine against COVID-19 to protect all of us.

CP24: Do you feel it is safe to take my two children aged eight and four to an Ontario resort for a couple of nights. They provided all the protocols in place, but I just wanted your views on it.

De Villa: I think that this all depends on one's individual risk tolerance and understanding of whether there are pre-existing conditions amongst any of the family members. I think getting away, being in the outdoors certainly reduces risk. Keeping distance from other people outside of your bubble as much as possible is another element. So, I think that there are lots of things that people can continue to enjoy the last days of summer.

And I think that it is a reasonable thing. But of course, it all depends on the individual circumstances. Who are the people that we're talking about? What are their pre-existing conditions? How capable are they of maintaining distance and keeping up with public health measures? And to the extent that they can keep up with public health measures, maintain distance, and stay outdoors as much as possible, I think it is possible to enjoy the last days of summer. I would encourage people to enjoy the great outdoors to the extent that that's available to them.

CP24: I recently started to wear my glasses more often. I also wear a nonmedical mask when I'm in public. And I have noticed that my glasses get fogged up, and it reduces my ability to see clearly. Dr. de Villa, do you have any tips on reducing the fog buildup on glasses when wearing a mask? Or am I just wearing my mask incorrectly?

De Villa: I think this is a very common concern. And yes, I sympathize with it for sure. I think there are a couple of things that do work. One, depending on the fit of the mask, try to make sure that the mask is well fitted and has that wire above the nose. That does limit the amount of exhalation that then comes up and fogs up your glasses. But I do think there are some circumstances where it's just tougher like if you've come out from an air-conditioned space, you're going to get a certain amount of fogging.

But, what I will say is that it's great to see that you're wearing your mask. It is one of the best things that we can do to take care of each other and continue the progress that we've had to reduce the virus spread in our city. So, I would ask you to persevere. Sometimes, mouth breathing a little bit helps. We're all trying to figure our way through this and to live as safely as possible with COVID-19 in our midst.