Toronto’s top public health official said Toronto is in an “uncertain phase” of the pandemic due to the emergence of highly contagious coronavirus variants.

Dr. Eileen de Villa, the city’s medical officer of health, said 14 cases of the COVID-19 variant first detected in the United Kingdom have been found in the city. The B.1.1.7 variant is known to be more transmissible.

“I’ve often said there is so much we don’t know about COVID-19,” de Villa said.

“We’re at one of those points now, and as new variants with new risks surface and the medical and scientific communities move to understand them.”

Toronto Public Health reported 502 new cases and 11 more deaths on Wednesday. De Villa said Wednesday’s numbers are nothing to celebrate.

“Not many weeks ago, we would have undoubtedly considered 500 confirmed cases to be grim news,” she said.

“It still is. There is no guarantee of how the illness will progress in the people who make up these cases.”

Dr. de Villa joined CP24 to answer questions about the pandemic.

CP24: How concerned are you about the situation involving COVID-19 variants for the City of Toronto and beyond?

De Villa: I think that the emergence of these new variants and what we have seen in terms of their increased transmissibility are our reason for concern for us, certainly in Toronto, and I would argue throughout the province. We've seen the experiences from other jurisdictions, where there have been declines in case counts and declines in COVID-19 activity and then the variant gets introduced into the mix. Perhaps people get a little lax with respect to self-protection measures, or restrictions start to loosen a little bit because of declining case counts, the new variant comes in, and then all of a sudden, you experience another surge. This is exactly what we wish to avoid, and we're now equipped with this knowledge. I think it's really important for us to act with that knowledge at this point to protect ourselves.

CP24: There have been talks about shutting down regions due to the variants. Do you start going regional to keep the variants from spreading?

De Villa: I think what we've seen is that first and foremost, we're trying to understand where exactly we are, so how much spread is there in the community. And then I think we can start to take on some of the very specific actions. In Toronto, what we've done is we've communicated with places -- congregate settings, long term care homes, retirement homes, places where people do gather in larger groups, especially if they live together -- to make sure that they're really doing the very best they can. They're reviewing their current Infection Prevention and Control practices. They're actually auditing what's happening, and they're being very careful around sticking to the best Infection Prevention and Control practice. That's what I think we can do in terms of those types of settings. It is really up to each of us to really practice those self-protection measures, limiting our interactions outside the home as much as possible. We can bring down the spread of COVID-19, and as vaccines become increasingly available, we will be in a better position to add that tool to our fight against COVID-19.

CP24: We've learned that a long-term care resident has tested positive for COVID-19 three weeks after getting the first dose of the Moderna vaccine. Is this cause for concern?

De Villa: I think every case in long term care is a cause for concern. And it means that we need to really be vigilant around our Infection Prevention and Control activities. A new vaccine, still learning a lot about you know how it's effective, and we know that really what's optimal in terms of the vaccine is for people to get both doses of the vaccine. So that's what we're pushing for now. We're starting the second dose of vaccine administration in long-term care homes and retirement homes in Toronto tomorrow. So hopefully, as we start to implement that, we'll have better protection for those populations, which I think is a sign for optimism.

These are new vaccines, but there are studies available around these vaccines. And what they have seen is that there is some degree of protection that's provided after the first dose, especially as the time proceeds after the first dose. The body needs time to actually produce the antibodies. The immune system needs its opportunity to react. But the more fulsome protection and the reports that we've heard around 95% efficacy, that doesn't happen until you have that second dose on board and the appropriate amount of time thereafter for the body to actually again boosts that immune response.

CP24: There are fears that a vaccine shortage would lead to more deaths. Are you concerned about the vaccine delays Canada is facing?

De Villa: I think there's no question that everybody's interest is in really making sure that we use our available vaccines and direct them towards those who are most vulnerable. That's why the focus on long-term care home residents and our retirement home residents. You have a highly vulnerable population because of age. We know that they've had the most significant outcomes, and they've experienced the greatest death as a result of the pandemic. And as well, they are in environments that it's frankly just easier for a disease like COVID-19 to spread. This makes good sense. What we want, of course, is to make sure that as many people are covered as possible in the population, and as soon as possible. But in the meantime, our best defence until that point is to continue to practice those self-protection measures, and the most important of which is around keeping distance, not interacting with people to the greatest extent possible, except for those with whom you live.

CP24: But while the numbers are coming down, you really are reiterating the point that we need to keep our guard up, especially with the variant.

De Villa: I think what we're seeing in the numbers right now is that when we do practice self-protection measures when we do try to minimize to the greatest extent possible, or interactions with people outside our home, it does have an impact in terms of reducing the spread of COVID-19. But when you introduce a variant of the virus that is more transmissible, then we need to be extra vigilant and extra careful around our practice of those self-protection measures in order to keep the spread down and to reduce the likelihood of us becoming ill or spreading illness to those around us.

CP24: There hasn't been a ton of people vaccinated in Canada up to this point. What is going to be the timeline for the next phase of vaccination?

De Villa: We're very much beholden on the news that we receive from our provincial counterparts, and they, in turn, receive the information from the federal government. So actually, getting vaccine supply into Canada is the responsibility of the federal government. They then distribute to the province, and the province distributes them locally. We are waiting to hear about what the supplies look like in the future. My understanding at this point, without getting into the specific details, because I'm not as familiar with those, is that supply becomes more available. We start to get larger amounts of vaccines coming into Canada after the end of March. Right now, supplies a little tight in the province. My understanding is that we should start to see a pickup in the latter half of February and into March. But larger volumes of vaccine supply, we understand, will be available in April, May, June and beyond. We're asking people to stay tuned and to just be ready to roll up their sleeves when we get that vaccine supply because we're going to try to get that out as quickly as possible. Once we have more available supply in Canada, in Ontario, and specifically here in Toronto.

CP24: 250 people have tested positive for COVID-19 at a Canada Post facility in Mississauga. What does that setting tell you about what's going on in the community?

De Villa: I don't know that we can necessarily extrapolate from one particular facility to what's happening in the community. There are a lot of communities spread. And we do know that certain work environments are such that, you know, have conditions, which actually make it relatively easy for the virus to spread. Sometimes it's about the nature of the work and the workspace and how people have to interact with each other in the workplace. Sometimes, it's about the opportunities to let one's guard down, during breaks, during lunchtime or other mealtimes. One really has to do a fulsome investigation of any particular outbreak to understand what are the circumstances that drove that outbreak or gave rise to the spread of disease in that facility.

These investigations do take some time. it's important that they look at the circumstances and understand where there are opportunities for improvement. I would imagine that with as with many other workplace situations, there's an opportunity to actually implement some areas for improvement in terms of infection prevention and control.

CP24: A viewer asks, why isn't there more focus on COVID long haulers? She's been suffering symptoms since last March. And she said all she hears in the news is the number of new cases and the number of recovered cases, but what about the thousands of people like me who are not recovering? Our family doctors don't have answers either. And so, we don't know where to turn for help.

De Villa: First and foremost, I'm so sorry to hear that you're continuing to experience symptoms, and I feel terribly for anybody who has suffered as a result of this disease. Death is certainly one outcome that many have experienced, and so many of us have lost family members and friends to this disease. Those who have survived, a number of them go on to have symptoms that last for weeks. And as we've heard, in this case, months now. This is one of the many challenges that COVID-19 has placed in front of us. It is a new virus. We are still very much in the learning phase when it comes to COVID-19 long haulers -- those who are experiencing symptoms long after they've recovered from the acute infection. And I think we're still very much in the learning phase around what treatments actually work. We're working. I think this is part of what medical science does, and it's part of what the medical community does. I wish there were simple answers, but for now, it's to learn and try to figure things out based on actual practice and what we're seeing in real life.

CP24: A teacher says there's lots of concern for teachers, students, families, obviously around the return to school, given that the provincial government hasn't put in place any more safeguards in schools. He asks, is there a concern about returning to school? What is your recommendation on that, seeing that COVID case numbers have gone down since schools have been closed?

De Villa: We're interested in protecting our children and all the staff who work within schools, including teachers, from the spread of COVID-19. This is very important. We know that schools are important in terms of the lives of children, and they have a very significant positive health impact, particularly in-person learning. So, the challenge is, how do you create the best balance here? How do we ensure that we're doing the best in terms of the overall health of children and our communities by facilitating in-person learning while at the same time minimizing the risk of COVID-19? Many discussions are still ongoing right now with respect to the many measures that can be put in place to make schools as safe as possible for children and staff within the schools. I would ask that you stay tuned. These are very active discussions. Lots of measures and safeguards are the focus of those discussions because I think we all have that shared goal in mind.

CP24: A concerned mother says she is struggling with the decision of whether to send my three-year-old to daycare. I thought perhaps with the dip in the daily numbers, this might be a good time to restart daycare, but with a variant upon us, should I continue to keep him home? What's the bigger risk, my three-year-old going stir crazy or catching COVID or one of the variants at daycare or school?

De Villa: It gets at that same very difficult balance that we're trying to strike here. Safety and safe environments in respect of COVID-19 spread but recognizing that our experience of health is not just about avoiding COVID-19. There are so many other aspects of health that are so important. So when it comes to these individual decisions, as much as I would like to be able to offer the best advice to each and every single person, at the individual level, it's actually around what are your unique circumstances? What makes the best sense for your child in terms of their own personal development? What is the circumstance within your own childcare facility? And as a parent, what can you do in terms of working from home or being off work? And can you manage all the responsibilities? I know how very challenging that is. But those kinds of decisions are truly made best within the context of your own unique circumstances.

CP24: What are the different symptoms for this new variant of COVID-19?

De Villa: Same symptoms. If you're going to get symptoms, it could be anything from a runny nose to abdominal pain to, you know, a cough, headache, fever—all of the same symptoms.

CP24: A gout drug is being looked at as a possible medication to treat COVID-19. Any word on the drug?

De Villa: I've also heard a little bit about this. I admit I haven't had the opportunity to really look into the details, but certainly, I'm very interested in anything that helps treat this disease.

This interview has been edited.