Should you get the vaccine if you've already had COVID-19? Q&A with Toronto's top doctor
Dr. Eileen de Villa is seen in this undated photo.
Published Wednesday, February 24, 2021 7:05PM EST
Toronto’s top doctor repeated her call for vigilance as she reported a rise in cases of variants of concern and revealed that the pandemic is growing again in the city.
Dr. Eileen de Villa, the city’s medical officer of health, confirmed during the city’s COVID-19 briefing that there are 72 variant cases in Toronto and 710 more cases that have screened positive for a mutation.
That’s an increase of nearly 200 possible cases of variants in two days.
“The only trend I am prepared to cite at this point is that the screened positive total marches upward daily – and that should be a matter of concern to all of us,” de Villa said.
“The variants are something to worry about – easily transmitted and in all likelihood capable of causing more severe illness – but they can be countered if we take the steps for self-protection, we all know.”
De Villa also reported that the city’s reproductive number is at 1.1., meaning each new case of COVID-19 is giving rise to more than one new case.
“This is not where we want to be,” she said. “The good news is that much of this is actually within our hands. It’s within our control.”
“That’s why I remind all of us, as always, to continue with vigilance in those measures for self-protection: staying at home, limiting your interaction with those outside your home, wearing a well-fitting mas as much as you can, especially when you are out in public, keeping your physical distance as much from others, people you don’t live with, and to please wash your hands regularly.”
Dr. de Villa joined CP24 to answer your questions about vaccines, variants, and other COVID-related inquiries.
CP24: Mississauga Mayor Bonnie Crombie said she is pushing for her city to enter the red zone when the stay-at-home order is lifted. Does that suggest that perhaps we could see divisions within Toronto? Would you be looking at potential areas of hotspots and keep those areas locked down while reopening parts of Toronto? Could that happen here?
De Villa: I would say at this point, it's a little early to say what's going to happen, and I'm quite careful. I think it was once said that it's difficult to make predictions, especially about the future. And we know that when it comes to this COVID-19 pandemic, things change on a dime. So, my plea would be to continue to observe and to ask people all over the city and, indeed, throughout the Greater Toronto and Hamilton area to continue to be vigilant around self-protection measures because that's very important. And overall, I would say that we have preferred to look at things as a city rather than trying to divvy things up into subsidy regions. That's just a very complicated business to get into. I think it is better, in general, to look at things city-wide. But really, the focus is to continue to be vigilant. Variants of concern are still very much top of mind and still continued to pose a threat to the progress we've made in the pandemic at this point.
CP24: There appears to be plenty of confusion over the emergency brake. This week, it appeared that the provincial government was talking and speaking as if the emergency brake has already been pulled here in Toronto based on the extension of the stay-at-home order. Is that your understanding of the situation?
De Villa: I would say that the emergency brake is a concept that was developed or created by provincial counterparts, so they're probably the better people to speak to what they mean by the emergency brake. To my mind, what's happened over the course of the pandemic, though, is that there's been an active conversation between ourselves here at the City of Toronto and Toronto Public Health in particular, and with folks at the province, notably the Office of the Chief Medical Officer of Health. I think that that's a productive relationship. And we have good discussions around, look, what are the conditions as we're seeing them here in the City of Toronto, and what therefore seems to make the most sense, in terms of reopening or what measures should be put in place to best control COVID-19, all with a mind to reducing the impact of the disease on our population. So, whether you call that deployment of the emergency brake, or whether you call that good public health practice, I think that's neither here nor there. To my mind, my job is to do the best I can to protect the health of the residents of Toronto. I've done that throughout the entire pandemic and the people of Toronto can count on me to do that on a go forward.
CP24: During this afternoon's city briefing, it looks like the numbers are still not going in the right direction. You said it's disheartening. What do you think is going on?
De Villa: We had been seeing for the last couple of weeks this trend towards improvements and all of our indicators, whether you were talking about the seven-day moving average on new COVID-19 cases or hospitalizations and outbreaks, percent positivity, all the indicators that you see on our dashboard. Generally, those were all moving in the right direction over the past few weeks. This last week, we've seen a little bit of a shift. Unfortunately, that seven-day moving average on new COVID-19 cases ticked up a little bit. It wasn't a huge increase, but it was the wrong direction. And so that gives rise to concern. We are continuing to see some improvements in many other aspects, whether we're talking about percent positivity on tests and with outbreaks, we're seeing great improvement, particularly in long-term care in retirement homes where vaccine has been deployed, which is fantastic news. That's really great news. But that seven-day moving average on cases and variants of concern and the numbers that we're seeing on the screen-positive cases, that gives us pause, and it should give us all pause to make sure that we're doing the best we can to control that spread.
CP24: The mayor also announced some in-person events in the city like the Pride Parade and Canada Day celebrations are cancelled.
De Villa: We should expect to see a certain amount of COVID-19 transmission until we were able to use our self-protection measures to really push the transmission down. And that will be aided and abetted by vaccines as they become more available, and this is supply issue gets resolved. How much we can expect in terms of vaccine supply, how quickly we can get things going, how much protection we can get as a result of the vaccine, and therefore how that changes disease transmission, we don't really know yet. We've not done this before. This is the first time we're really undertaking. This is our first go at vaccine with this particular disease. So, as the mayor mentioned in his remarks today, many of these people planning these kinds of events need that far in advance notification. And so, I think that was a very reasonable and prudent thing to do so as not to leave people in a lurch with big responsibilities and with big obligations that they just wouldn't be able to make good on because of COVID-19. But I am hoping by the end of the year, hopefully, we'll be in a better position and perhaps starting to resume life a little bit more, unlike what we used to do before there was such a thing as COVID-19.
CP24: Toronto and Peel have been the hotspots in the province remaining in lockdown. But we do not seem to get priority with vaccines. Can you explain why?
De Villa: When it comes to the vaccine and its distribution, that actually really does sit at the higher level with the provincial government. They're responsible for prioritizing who gets the vaccine, and they're also doing the allocation. The province makes a decision around how much will come to Toronto, how much will come to Peel, and how much will go to all the jurisdictions around the province. So, once we get the supplies, we're working really hard here with all of our partners to make sure that we're ready to go and to inject vaccine as quickly as possible into as many arms as possible with whatever supply we get from the province. But the distribution is firmly in the province's area of responsibility.
CP24: A viewer asks, my mother lives with me, and she is over 90. It makes no medical sense for my mother to get the COVID vaccine and not me because I'm with her 24 hours a day. What can I do to solve this issue, as I'm sure it applies to many others?
De Villa: Here's what I think is going to happen. And again, here I'm now predicting a little bit and we know how complicated an endeavour that is. But when it comes to older people living in the community, that's clearly one of the nearer priorities. We know that those who are of older age are in the higher risk population, which means they have a higher risk for more severe outcomes associated with COVID-19 infection. There has also been an effort to make sure that those who take care of people who are at higher risk are appropriately covered as quickly as possible. That's been the case with long-term care homes and with retirement homes, where the residents have been vaccinated but still have staff and essential caregivers. As vaccine supply becomes more plentiful and as we start getting out into the community, as the vaccinating partners get out into the community, that kind of situation will be resolved fairly quickly. We will be able to provide vaccines sooner rather than later, both to the viewer's mother and the viewer herself.
CP24: A viewer asks, our 22-year-old daughter has asthma but is otherwise healthy. Do you think she will be included in the phase two vaccine rollout?
De Villa: I believe in phase two, there is some provision for adults who have chronic conditions. How they're going to divvy that up, again, the prioritization and the sequencing is something that's being determined by my provincial counterparts. I don't have specific information on this at this time. But I'm certainly pleased to hear that a young person, albeit with a chronic condition, is interested in getting the vaccine. And I would simply encourage that person and all others in that situation to be ready to take up the vaccine when their turn comes up, which hopefully will be sooner rather than later.
CP24: Do you provide any insight to the vaccine task force when they are deciding on the prioritization? Or is that strictly handled by the task force?
De Villa: The decision actually does rest with tables at the provincial level. However, there are participants from local public health, and some of those tables do include representation from Toronto Public Health, as part of the informing process so that they're getting the perspective of people all over the province, including those from local public health as they make their decisions.
CP24: A viewer asks, when can probation officers expect to be vaccinated? Just like frontline workers, we work with populations experiencing homelessness and those who reside in shelters. And it feels like we're being overlooked.
De Villa: I completely understand. There's a lot of interest in getting the vaccine. And I do think that the sense that people might be missing something or the sense of being overlooked is a common one. While that is challenging, and I think so many of us just want to get beyond this pandemic and see getting the vaccine as one of the first steps to getting to the other side, the issue is the supply is the challenge. As supply gets resolved, as there is more and more vaccine that's available, it will become much, much easier for people to get access. I know that many of us in the field, local public health units all over the province, are working really hard to make sure that once vaccine supplies are available, we're going to work hard to make sure that with our partners, we're going to give vaccines as quickly as we can to as many people who are willing to take that vaccine. And we're hoping that it'll be a significant proportion of our population. Where everybody will fit in, not easy to say at this point, but I would just encourage people to stay tuned and to be ready to get the vaccine when their turn comes. We'll make sure that we're putting out as much communication along with our provincial partners so that people know when it's their turn to go.
CP24: Why don't we, Canada, say accept either the U.S. vaccine approvals? They accept ours, and we all just accelerate everything. Aren't we wasting a lot of resources and time redoing each other's work?
De Villa: I don't know that I would say that it's a waste of time. I think it's important that we look at the research for ourselves and satisfy that ourselves as Canada that we're doing the right thing where our approval requirements are met appropriately. I would say that we should continue on with the current process for now. And I'll leave that to my federal counterparts, who do a good job of doing that.
CP24: What is your thought on the first dose vaccination being given to the wider Toronto population, and then a follow-up second dose is given when we have more supply later on?
De Villa: There's certainly been more and more research available on this, as other countries who are a little bit ahead of us in respect of their vaccination campaigns are able to provide us with information. We are seeing the benefits of even that first dose of vaccine. That being said, the vaccines that are licensed for use in Canada are still approved as two-dose vaccine regimes. And so that is something that we should continue to promote. But here's my sincere hope, as interested as I am in that potential to focus on first doses for now until such time as vaccine supplies become more available. My hope is, and my understanding is that the vaccine supply should be coming in the not-too-distant future. This may not be a concern for us, here in Ontario and specifically in Toronto. However, if there continued to be some supply challenges, I think that's something that's worth pursuing and thinking about, given the expanding knowledge on this particular issue.
CP24: How long should a person wait after having COVID to get vaccinated? Do you need to get vaccinated after you've had COVID?
De Villa: This is an interesting question that I think is one of those that we're still also just learning about. COVID or SARS coronavirus two is a new virus and still very much in the learning phase. It is recommended that you can get you're a COVID vaccine, even if you've had a COVID infection. We're not really sure how long the immunity lasts associated with a COVID infection. And in fact, we are still trying to understand the long-term duration of immunity after receiving a COVID vaccine. While I can tell you that we're seeing great results from the vaccines thus far, whether we're talking about our own experience here in long-term care homes or we're looking at the experiences in other countries, so far, the vaccine appears to be quite effective in terms of reducing things like hospitalization and illnesses and more significant impacts associated with COVID-19. How long that protection lasts? We're not totally sure yet. So, we're continuing to study, as best as we can, whether we're talking about people who have their immunity from infection or talking about people who've got immunity after receiving the vaccine. This is one of those things we're going to have to stay tuned for.
CP24: Most sports activities in Toronto have been closed for about a year. Many parents believe the lack of sports is affecting their kids' mental and physical health. What is your position?
De Villa: My position is I'd love to get us back to sports as soon as possible. But to my mind, in-person learning is really first and foremost in the overall health of our children. Let's get that successfully underway. Let's get disease rates in our community lower, let's get vaccine rates up. And then slowly but surely what we've seen in the research is that reopening and moving back towards activities like they are normally if you will, it's something that should be done very gradually and very cautiously in order to protect ourselves and our community as fast as possible.
CP24: Any final thoughts for this week?
De Villa: I'm looking forward really to hearing about more vaccine supply coming and I'm looking forward to working with my team and all our partners around the city to actually getting the vaccine in arms. I do think that this is a real beacon of hope for all of us in the city and that I'm really looking forward to.
This interview has been edited.