'I wish I had the crystal ball': Toronto's top doctor answers COVID-19 questions
Web Staff, CP24.com
Published Friday, May 29, 2020 7:07PM EDT
The city is moving in the right direction when it comes to the fight against COVID-19, Toronto’s top doctor said Friday after Ontario Health Minister Christine Elliott said the province is now in the post-peak phase of the pandemic.
“Well a post-peak on any outbreak is good news. It means you’re on the downside of the outbreak, which is where we want to be,” Dr. Eileen de Villa, Toronto’s medical officer of health said during an interview with CP24.
“It means that the efforts that people have put into the public health measures have had success and that we’re moving in the right direction.”
Toronto reported 175 new cases of COVID-19 on Friday, bringing the city’s total to 10, 901. Of those cases, 810 have died, while 8,086 have recovered.
De Villa joined CP24 Friday afternoon to answer COVID-19 questions from viewers.
CP24: We have a question for you about self-isolating in this new environment, and it’s also dealing with testing. Are people who have tested negative for COVID-19 required to still quarantine for 14 days?
De Villa: I think what you have to look at is what are the circumstances. Some people are getting tests and who may not have a real known exposure to COVID-19. If you have a negative test, then you can continue with your regular activities. There may be some particular circumstances where even with a negative test, you may be at risk for developing COVID-19. For example, if you were exposed to somebody, close contact with somebody who has a COVID-19 infection, and you have a test, but it’s very shortly after that exposure, it may be that that test was done too early.
Hopefully, that’s not the case. But it might be the case. And if that’s the situation, you’re going to want to follow the advice of the people who’ve done the test, and that may require a little more isolation just to be sure that you’re not exposing people to the risk of you having a COVID-19 infection.
CP24: Do you have confidence outside of that parameter in a negative test? Is a negative, a negative?
De Villa: There is no such thing as a perfect test. There are better times to do a test than others. That’s why each situation has to be done on its own and assessed on its own. There is always the possibility of a false negative that does exist. That’s why testing actually should be done in concert with a health-care provider that you tell a complete story to so that they can best make the appropriate determination on what the test results mean.
CP24: Toronto Public Health released a map of COVID-19 hot spots in the city. When you saw this map come together at first, what was your impression? Was it something you expected? Were you surprised by anything when you saw this map?
De Villa: I think we knew here at the city because we have been keeping track of these data right from the beginning. Understanding our cases, not necessarily mapping them, but understanding what our cases are and who they are and who was most affected. I know that at the very start of the outbreak, travel was a more significant risk factor. And we saw those neighbourhoods in our city that are of higher-income status, actually having more cases because they were more likely to travel. Over the course of the outbreak, as we got more into communities spread, we started to see a change in who was most impacted.
We’ve seen there are parts of the city -- more to the northwest and the northeast -- that are showing the most by way of cases of COVID-19. And this is a reflection of a number of things. It’s not about the risk of being in that neighbourhood. Where people live isn’t necessarily where they get their infection from, but it does tell us a little about who those people in that neighbourhood are, what kind of work they do, and a bit of their housing circumstances, all of which we need to work on together as a city to improve health and to manage COVID-19.
CP24: Will masks really protect someone from COVID-19?
De Villa: I would say that washing your hands and maintaining that physical distance of at least six feet or two meters from other people are the most important steps. We recognize, though, that that can’t always be achieved, not sustainably, not reliably. And in those circumstances when we’re talking about the general public, we’re strongly recommending, especially if you’re in an indoor public space where you cannot keep six feet distance, that it’s a good idea strongly recommended to wear a cloth mask or a face covering. But remember that the protection that that affords is for other people from the germs that you might spread, not necessarily to protect yourself from what other people might have or might be spreading by way of germs.
CP24: After coming into contact with a positive COVID-19 case, how soon can you be tested for reliable test results? How many days would you say are a good number of days to wait and then get tested?
De Villa: That is an excellent question, and in fact, it’s not even entirely clear in science. Is there an optimal time or a day? Because each one of us actually has a different course of infection, and we manifest our symptoms differently. Some people develop symptoms after exposure to COVID-19 within a couple of days. Most people take about five or six days before they start to develop symptoms if they’re going to develop symptoms.
And we know that some people take as long as 14 days. That’s why so much of our advice is around a 14-day time window. There isn’t an exact answer. What we would recommend to people is that if you are exposed to COVID-19 to monitor yourself very carefully for signs and symptoms of COVID-19 and to do your best to maintain that six-foot distance from other people to limit the spread. And if you get those symptoms, go and get tested right away.
CP24: You’ve been saying since the beginning that this is a new virus. And you’ve been learning something probably every day about the virus. Are there any new additions to the list of possible symptoms for COVID-19?
De Villa: It was quite a list that I’ve been providing, in terms of COVID-19 symptoms. At the outset of the outbreak, we were focused a lot on fever, coughing and difficulty breathing. But we know that that list of symptoms has expanded into a sore throat, runny nose that doesn’t fit with allergies. Some nausea, vomiting, abdominal pain, and for some people, different skin conditions, particularly in younger people. There is quite a list.
I would encourage people to go look at the COVID-19 website, toronto.ca/COVID-19. Lots of really good information there. Of course, the province has also got a self-assessment tool for people concerned that they might have a COVID-19 infection. I would encourage taking that self-assessment tool to help you determine what is it that you have, and might it be COVID-19.
CP24: Can a person who tests positive to COVID be asymptomatic and still spread the virus?
De Villa: This is one of those things that we have learned over the course of our time living with COVID-19 that there are asymptomatic infections. They’re not infrequent, and people can spread their infection even though they may not be showing signs and symptoms. That’s why that message around physical distancing is really important because if you maintain that physical distance, even if you have an asymptomatic infection, the likelihood that you’re going to be able to transmit it is lowered significantly.
CP24: Is this why you were so concerned about what you saw at Trinity Bellwoods Park last Saturday?
De Villa: Absolutely. It’s that direct, close, face-to-face conversation, especially if you’re doing things like speaking loudly to make yourself heard. Now the issue is that the likelihood of that spread, and transmission with close contact, the spread of infection from one person to the other is lessened when you are in an outdoor environment. But if you have that close face to face conversation, particularly in a loud voice, having to project over the sounds of lots of other people, then even in the outdoors, there is the chance that you would be able to transmit that infection. But generally, we would say that outdoor settings are lower risk than indoor setting simply because you’ve got lots of airspace around you.
CP24: Why are medical staff wearing their uniforms outside of workplaces, like in public transportation, grocery stores, and other public places? Aren’t they supposed to change to their regular clothes before going out?
De Villa: I think that’s a very good practice for hospital staff to follow and all health-care staff to follow if you’re involved in that kind of direct patient care, where you run the risk of exposure. Now, some people who do work in the hospital environment don’t have a lot of direct contact with patients but wear those hospital uniforms the same cause they’re comfortable. My understanding is that most hospitals have policies around the appropriate change in and out of clothes to minimize the likelihood of infection. And I think the other thing that’s really important here, as we learn more about this virus, is that the most significant risk factor is that direct contact with somebody who’s infected and the respiratory droplets, more so than surfaces and the stuff that they might carry on their clothes. It’s not to say that that doesn’t happen, but from what we can see in the literature right now, the biggest risk factor is close contact with somebody who has a COVID-19 infection.
CP24: Can my child swim with one friend in our outdoor private swimming pool that allows for enough physical distancing measures?
De Villa: We’re all looking forward to being able to enjoy our pools right at our outdoor spaces because we have a limited number of months for which we can do that. Right now, we’re asking people to stay within their household bubble for now. We’re hoping that we’re going to be able to expand that as we progressed for our outbreak and as we bring our case counts down and get better control over the virus in our community. But for now, we’re still asking people to stay within their household bubble.
Hopefully, as that expands, we’ll be able to encourage people to enjoy their space with one other family or two other families, as we’ve seen in other jurisdictions. But of course, that physical distancing is the most important thing.
CP24: Do you have a timeline of how soon those public health measures will be lifted?
De Villa: I wish I had the crystal ball that would tell us that. I think many of us would love to be able to be more precise around the dates. All I can say to the people of Toronto is stick with physical distancing measures for now. I know how very difficult this is, but the more we can stay with it now, the sooner we will be able to go back to something that’s more like what we’re used to—having that ability to enjoy our spaces with our friends and family in person rather than always on his screen.
CP24: Many condos have switched on their central air conditioning units due to the intense heatwave in Toronto. Is it safe to use central air conditioning units, and is there a risk of transmission of COVID-19 through central air conditioning?
De Villa: That’s an interesting question that I think many of us are still trying to figure out. Let’s face it that our experience with COVID-19 thus far has been in rather cold weather. We’ve only had a couple of nice days of warm weather. We haven’t had the chance to see what it’s like to have a COVID-19 outbreak with the use of air conditioning. I think my understanding is that this is theoretically possible, but to my mind, the important thing here is maintaining physical distancing from people with a COVID-19 infection.
When I’ve looked at what science is available, and there is a limited amount available because this is a new virus. When we look at what’s available in the literature, it focuses on the major root of spread being direct contact within that six-foot distance, direct contact with the respiratory droplets of somebody who has COVID-19 might’ve seen that continue. We’ll continue to learn. We’ll continue to observe what we see in the literature, but for now, our understanding is that the major risk is really around direct contact with somebody who has a COVID-19 infection.
CP24: Many brides are very worried about their upcoming weddings this year. Do you have any information on what type of restrictions will be needed at weddings this fall or how many people we may be allowed to have at a wedding?
De Villa: Again, to go back to the point that I’ve been making, it’s all-around physical distancing and weddings, by definition, are group events, and it’s just really challenging to create that physical distancing particularly in indoor environments. There is currently a provincial order as well that prohibits public gatherings of more than five people. Where we will be in the fall? I’m not sure. I don’t know what the province’s plans are on that. I think all I can advise people with wedding plans upcoming is keep watching, keep observing what’s happening at the provincial level and their orders. And think small. I wish I had something better to offer.
This interview has been edited.