'I need everybody to pitch in:' Toronto's top doctor answers COVID-19 questions
Published Wednesday, October 21, 2020 8:07PM EDT
Just like everybody else in Toronto, the city’s medical officer of health admitted Wednesday that she too is tired of living with COVID-19 restrictions.
However, Dr. Eileen de Villa said she is not giving up on controlling the spread of the virus.
“I know I’m out here urging you forward, asking for your patience, trying to strengthen your resolve, but actually I’m just like you: I am as tired of living like this as everyone else,” de Villa said during the city’s COVID-19 briefing.
“But it’s my job not to be, so I’m not giving up on getting this right, and I’m not giving up on you.”
The doctor also expressed her concerns about the steep rise of Toronto’s COVID-19 positivity rate is not over.
Standing at 4.4 per cent, the city’s positivity figure is now nearly double the “high alert” threshold previously cited by the province.
“The figure could yet change because we can find data for the most recent week can be incomplete, but I feel comfortable saying I have no basis to expect it will fall 1.3 per cent and that I am concerned that its upward climb is not over, especially when I look at COVID-19’s renewed eruption in other countries,” de Villa said.
The doctor noted that she is worried about the tightening of restrictions in other countries experiencing soaring infections.
“There is nothing to prevent COVID-19 from catching here except the choices we make,” she said.
De Villa is urging Torontonians to follow self-protection measures because if the virus had the capacity to want, she said it would want people to be tired, frustrated, impatient and worn out.
“We’re not going to let this get out of control, not if I can help it, but I need everyone to pitch in – especially on the days when you don’t want to.”
De Villa joined CP24 on Wednesday afternoon to answer coronavirus-related questions.
CP24: What are your thoughts on restaurants putting up dining 'bubbles'? Do you have any concerns about these?
De Villa: It's a question that we're going to need to have answered by our provincial colleagues as the regulations around indoor dining and where what things can happen are actually under provincial legislation. I think the technicalities are all about what the regulations say and whether they fit under the terms of the existing regulations. But fundamentally, what we're looking about here is a risk. And what do we need to do as members of our community to reduce the risk of COVID-19. It still comes down to limiting your outings as much as possible, trying to maintain your close contact only with those with whom you live, watching your distance, wearing your mask, washing your hands.
What we know about COVID-19 is that the main root of transmission is from those droplets that spread from somebody who actually has the infection to others around them. It's more around the breathing and the talking and the expelling of the virus from somebody who actually has a COVID-19 infection, more so than it is about surfaces that you might touch. I think it's really good that restaurant owners are interested in maintaining a clean environment. But at the end of the day, it is still about how do we limit interactions between people, especially limit our interactions with others with whom we don't live.
CP24: During your COVID-19 briefing earlier today, you talked about Toronto's positivity rate now at 4.4 per cent. This sounds like it is cause for alarm and deep concern to you.
De Villa: I think we're constantly watching the numbers. I think it's really important that we pay attention to what's happening, that we understand how the virus spreads, and what seems to be happening in our community that either advances virus spread or actually limits it from happening. Our overall monitoring dashboard suggests that our overall status is red. And you're quite right. I did talk about a pretty significant jump up day over day and hospitalizations. And I realize it's only one day, but taken all together with the other indicators on our monitoring chain dashboard, and taken as well, in the context of what's happening elsewhere in the world, that's what's given rise to my concern. Hence, I was calling on the people of Toronto to double down and commit themselves to self-protection measures to make the choices that we know we need to make to best protect our health and the health of our whole city.
Ireland, Wales, Spain, Italy, they're all moving to increase restrictions, some of which are as severe as complete lockdown, and really limiting the movement of people to within five kilometres of their home, save and exclude for some very essential services. In Paris and nine other cities in France, we're talking about curfews where people must stay at home between nine at night until six in the morning to limit interactions between people. This is not the way we want to go. Hence, I'm asking Torontonians let's do what we need to do. Let's make sure that we're protecting ourselves and our community. Let's not go that way. We can avoid that.
CP24: Are you looking at the percentage of positivity at the hospitalizations to make that determination? If you saw a 4.4% over an extended few days or anything above 2.5, that concerning threshold, when could we see us go into lockdown territory?
De Villa: It never rests on one single indicator. You have to look at the whole picture as I'm sure they did in Ireland and Wales and Paris, and all the other places in the world that went towards that. We're looking at the complete and total monitoring dashboard. We want to make sure that we're preserving healthcare so that our hospitals and our health care system are available for all of us, whether we need it for COVID-19 or any other medical condition. It's much more than just one single indicator. But when you start to see indicators moving in the wrong direction, that's when I feel I have a responsibility to let the people of Toronto know, look, these things aren't moving in the right direction. Let's work together. We've done it before; we can do it again.
CP24: A viewer asks, do you think if we close down everything completely for one month, we can control this virus? Because obviously, what we've been doing for the last eight months or so is not working.
De Villa: I think we have seen some success. We were able to flatten the curve, as it were earlier in the spring. We did have some good success when we were able to really limit our interactions. And we had a pretty good run in the summer, right. But it is very much trying to strike that balance. We had spoken about as we were reopening the various activities and services that are part of normal life. One of the things that I did emphasize over and over again was that as more and more people are out there, the expectation is that more and more people would interact with each other. It gives rise to more opportunities for the virus to spread from one person to the next. The issue is, how do we live safely with this virus. How do we manage ourselves? How do we conduct ourselves as a community so that we're able to achieve this very delicate balance? I think we can do it. We've seen other places do it. I don't see any reason why Toronto can't, and I have every confidence in the people of Toronto.
CP24: A Toronto chef asks, as we approach the 14-day mark of indoor dining closer in Toronto, and we see no drop in infection rates, is it fair to say the decision to close indoor dining was premature and with no data to back it, as it has shown, restaurants weren't the issue, to begin with considering indoor dining at restaurants was open for over two months with no significant spike in cases? And would you be willing to request the provincial government to cut the 28-day closure short if this is proven correct?
De Villa: I will say there isn't a single one of us in the public health sector who doesn't really feel for members of the hospitality sector. This is a very challenging thing to do. We certainly appreciate the impacts that it has on those businesses and the livelihoods of the people who are involved in those businesses. And we know that that's an important part of health. But the thing is that we know that when we don't get COVID-19 under control, we've seen this in other jurisdictions, it actually leads to more significant restrictions for a longer period of time, which is even worse for the businesses. That's been the experience thus far. And I admit, a new virus only discovered in January, so many of these things are very much learning opportunities for all of us. We are all trying our very best. But what we know about the virus and what we know about case numbers is that it does take some time before the actions you take are actually reflected in case counts. I would ask our hospitality sector to hang on. We are actually observing, and we should be seeing in the next couple of weeks or so the impacts of the measures that have been taken today.
CP24: When gyms in Toronto reopen, will mask use be mandatory at all times when exercising? As a gym user, I find it incredibly frustrating and dangerous that people are exercising heavily and spraying droplets everywhere with no masks.
De Villa: I don't know what the regulations hold in the future. And again, this is perhaps worth asking our colleagues in the province as they are the ones for forming the regulations under the Reopening Ontario Act. But I appreciate and understand the concerns because we understand about how COVID-19 is spread. And as we know, it is spread by the droplets that are put out by somebody who has a COVID-19 infection when they breathe or talk or exercise. With heavy breathing, more droplets will come out. But here's the issue. Again, that's why we're asking people when you're sick, you know, make sure you stay home, watch your distance as much as possible. But by the same token, we have to recognize that it is difficult to engage in certain physical activity, exercise at a gym, for example, with a mask on. This is one of those examples of trying to find a balance of how we live with COVID-19 in our community, and at the same time, keep ourselves safe. Part of the learning journey that I think we're all on, and I think we're figuring it out as best as we can with the best available scientific evidence. I'll look forward to hearing what our provincial colleagues do and what science ultimately tells us about this.
CP24: Do you not have the powers as a public health officer for Toronto to bring in regulations like masking in gyms or having a close look at those dining domes? Or is everything effectively on the shoulders and responsibility of the province?
De Villa: When it comes to changes to the regulations under the Reopening Ontario Act, that is squarely within the provincial jurisdiction. When it comes to very specific communicable disease risks that present themselves here in the city of Toronto, that's when I have some latitude in power and authority to protect and to do what's necessary to protect the health of those who live in Toronto.
CP24: Why don't you use stronger language to tell the people of Ontario that it is their fault restaurants and businesses have to close? We are the ones to blame, not the government, not the health system because you told us what we have to do. Now is the time to get tough.
De Villa: I've tried to explain things as much as possible. And today, I painted a picture of concern and clearly articulated some worry, recognizing where we are, and recognizing that if we don't change our behaviours, if we don't commit to more and better practice of self-protection measures, we may find ourselves in a circumstance similar to what we're seeing in different parts of Europe. We've talked about France and Spain and Italy and the things that they're having to do. But in general, we find that to encourage people to move in a certain direction or change their behaviour, blaming people doesn't generally work all that well. But encouraging and trying to make it easier for people to do the right thing seems to be a more successful method of changing behaviour. It's a little bit of balance again, as we've been talking through all this. How do we balance out what's an appropriate amount of understanding and encouraging, versus recognizing this hasn't been done well, let's commit to doing better? It's an interesting balance that we're trying to strike.
CP24: Do you have any updates or news about ongoing vaccine trials? When can we hear more about vaccines?
De Villa: I think there's a lot of hope around what is coming through the pipelines on the COVID-19 vaccine. Now your viewer was asking a question about vaccines that were talked about earlier in the summer from Russia. And I admit I am not up to speed on Russian vaccines. However, I am a little better informed about the vaccines that the Canadian government has ordered for use here. They have ordered six different vaccines, five of which are in fairly advanced clinical trials. There's quite a bit of hope around when we might anticipate seeing these vaccines in use. And clearly, we're hoping some point in early 2021, but no specific date quite yet. But lots of hope, and certainly lots of interest in that subject. Lots of planning is going on upfront.
CP24: Is the lockdown in the Toronto area not driving people from those areas to neighbouring ones, and hence increasing the spread in densely populated areas nearby? Should the lockdown be extended?
De Villa: When the province moved a number of jurisdictions throughout Ontario into the so-called modified stage two, one of the recommendations and one of the pleas that were made to those who live in Toronto, Peel, Ottawa and York were to limit your outings as much as possible. Keep close contact, as much as possible limited to those with whom you live. And part of that means not venturing out far and into other parts of the province. That's what we can do to try to limit spread as much as possible. You've heard me talk a number of times about how COVID-19 is spread from person to person. And frankly, the virus needs us and to behave in certain ways in order for it to spread. To the extent that we can deny the virus that opportunity, we will be able to better control this, not only in those in modified stage two but also throughout the rest of the province.
CP24: If you see numbers improving in the next nine days, is there any possibility that you may be able to reconsider the advice of trick or treating in the city of Toronto? Could it perhaps be encouraged the kids go out if they follow proper guidelines?
De Villa: This was a tough recommendation to come to, especially because we know how much people really look forward to Halloween. I completely get that. And it was just another ask on top of a series of asks of the people of Toronto, to say nothing of the other jurisdictions that are affected by this recommendation that was put forth by the Chief Medical Officer of Health and which we support given our current circumstances. I think what we don't want to do is slip back. We know how the virus spreads and what conditions give rise to it. And we know that Halloween creates those opportunities for people to get together because they're having fun as you want to on Halloween, get into close contact with each other, let their guards down. These are the kinds of circumstances that give rise to COVID-19 spread, to say nothing of the fact that about half of Torontonians live in buildings that are five storeys or more. For many people, Halloween isn't an outdoor activity. It's an indoor activity, especially when the weather isn't so great. That is a recipe for the COVID-19 transmission disaster. I think that's why the recommendation is what it is.
CP24: Some people are suggesting that that piece of advice may sort of tip the scales, and some people may sort of stop listening to medical advice because, on the one hand, kids can be in school for five to six hours a day, but on the other hand, they can't trick or treat maybe 50 per cent of them that is outside. Any concerns that you may lose the audience there based on that kind of guidance?
De Villa: I hope people understand why we're giving this guidance, recognizing that school has lots of benefits and Halloween and trick or treating as fun as it is, isn't really an essential activity. We will be back again with future Halloweens, where we can have fun.
This interview has been edited.