In her weekly segment with CP24, Dr. Eileen de Villa, Toronto's medical officer of health, answers viewer questions about COVID-19, including vaccines, variants and the latest public health measures.
CP24: Patios in the city have been filled in the past few weeks as many soccer fans watched the Euro 2020 matches. What are your thoughts when you see these crowds?
De Villa: One, we need joy. There's no question that the more joy we have in our lives, and goodness knows, we could use a little bit of joy at this point. And soccer has that way of bringing joy to many people's lives, particularly when your team is doing well. So, there's a healthy element to that to be able to enjoy a fun event and to celebrate with other people, something we've missed for so long. But we do know that yelling moistly and in close proximity to each other is one of these transmission risks associated with COVID-19. And we know that this is especially important in light of delta -- the Delta variant that is more transmissible, certainly indoors, but yes, even outdoors. It is more transmissible than the previous forms of COVID-19 we've been used to. It speaks to a couple of things—one, minimizing risk to the greatest extent possible. Where you can be in larger open air outdoor spaces, that's a good place to express joy with others and to celebrate with others to reduce the risk. Again, it's not a zero-risk, but it is significantly reduced in outdoor environments, especially where you can maintain some distance. And of course, the second piece is going to be around getting fully vaccinated, having the two doses on board and with that two-week time for the body to fully develop immunity. That's really what we're looking for in order to allow us to be as successful as possible in getting to that post-pandemic period, which I know we're all craving.
CP24: Can you talk about the decision to allow walk-ins at one of the city's mass vaccination clinics, which was announced today?
De Villa: It means that for the Toronto Congress Centre that there will be a walk-in component. There are still scheduled appointments there for sure because for some people, that's the way they prefer to access their health care. And in this case, that means vaccine. But as you just pointed out, for some folks, it's not part of their routine. It's not part of how they do. So being able to walk in during certain hours and just show up and get vaccinated just makes it that much easier. We're at the point in the vaccination campaign now where we have an adequate supply of vaccines. There are lots of vaccines that are now available, and more and more are coming in week after week. So, we are now able to run mass immunization clinics with appointments, to have other community-based vaccine opportunities and to offer walk ins in a way that opens as many channels and as many avenues as possible to make it as easy as possible for people to get that first dose and then that second dose of vaccine to appreciate the benefits of full protection from the vaccine. That's all we're trying to do. And I think the more we can do that, the better it is, and the sooner we'll be able to get to those really high levels of coverage that we want in order to protect us from delta and any other variant that should emerge.
CP24: The province's chief medical officer of health previously said that Ontario would not be moving to the next step of reopening ahead of schedule. Are you happy with that measured approach?
De Villa: I think that when we look at the experiences from around the world and look at the data that they have generated, it tells us that a low and slow approach, a cautious approach to reopening, is actually what's warranted given what we know about the transmissibility of the delta variant. So. we've seen in other jurisdictions that even with high rates of vaccination, you still need to be cautious. I would urge caution so that we can be successful in the longer term. The last thing we want to see is anyone having to go back -- to open only to have to retract again or to go backwards. This is exactly what we don't want to see. I think that would be devastating for us, for our psyche and frankly, from a business perspective. So, low and slow is that is the best approach based on the experiences of other jurisdictions that are a little bit ahead of us and that's the best data that we have at this point in time -- that along with vaccination. I can't emphasize enough the benefit of vaccine coverage and the protection that's afforded by getting fully vaccinated.
CP24: A viewer says she has two doses of the AstraZeneca vaccine. She wanted to ask if it was possible or beneficial to get a booster shot of an mRNA vaccine. She says she is really worried, and she would feel so much safer if she could do a top-up that would give me a much higher percentage of safety.
De Villa: That's an excellent question and one for which there isn't yet a definitive answer. So right now, when you've got two doses of AstraZeneca on board, good move. Very glad to hear. You're now considered fully vaccinated. But on a go-forward basis, there is still some discussion around if we are all going to need boosters in the future. Are some going to need boosters sooner than others? This is still one of those things that are part of the learning that's happening on an ongoing basis. This is a new disease, new vaccines on established technology and proving to be effective in terms of reducing serious outcomes -- hospitalizations and that kind of thing. However, we still don't know exactly how long the duration of protection is and when would be the right time if there is a right time for boosters. So, I would just ask this viewer to stay tuned. We will keep the information coming as we learn more and more about the protection afforded by the vaccines and the length of that protection and whether boosters are needed. We will be messaging out in concert with all of our partners. This is not something that will be done at the local level. It will need clearly higher levels of government and significant levels of study so that we can provide good advice to everybody around the province.
CP24: A viewer wants to know if people who recovered from COVID-19 need to get a vaccine.
De Villa: The current advice at this point is that even if you've had a confirmed COVID-19 infection, there is a benefit to getting vaccinated against COVID-19. The reason for that is that we don't know exactly how long is the immunity that you get as a result of natural infection and for some of the new variants that are emerging. We're seeing some evidence that while you may have had a COVID-19 infection with a particular variant of COVID, as new variants emerge, you may still get reinfected with those. So, there is a protective benefit for yourself and for those around you to actually get the COVID vaccine, even after you've had an infection. The key point here is to make sure that you do that isolation period that's required when you have the infection and to wait until such time as you've completed that 14-day isolation and you have no more symptoms, you're fully recovered. That's when you then go and can get a COVID-19 vaccine to get fulsome protection, more fulsome protection than that which would be provided by natural immunity.
CP24: Can you get tested for COVID-19 antibodies?
De Villa: At this point, my understanding is that that's not readily available outside of particular studies. So, the best thing to do is look if you know you have been diagnosed with a COVID-19 infection, do your isolation period, and follow the medical advice. And then, as you've recovered and no longer symptomatic, that's the time to go then and get the COVID-19 vaccine.
CP24: A viewer says the use of hand sanitizers has increased significantly over the pandemic. He asks, is it possible people may be relying on sanitizers too much to the point where our bodies may not be able to create a natural immunity to basic germs?
De Villa: I think hand hygiene is really important. We know that it makes a difference in respect of the transmission of infectious diseases, particularly respiratory diseases that we run into. COVID is one of them, but certainly, influenza and the other respiratory diseases that cause flu and cold-like illnesses. So, hand hygiene first and foremost, where possible, hand washing is what we're all aiming for—handwashing with soap and water. Hand sanitizers are meant to be a substitute when handwashing facilities like soap and water are not readily available. So when used in that way, they certainly do augment our ability to maintain clean hands and to try to reduce the transmission of disease associated with droplets and things that can accumulate on our hands. So, I think if we actually follow good hand hygiene principles -- not coughing or sneezing into our hands, doing so into our sleeve or elbow, hand washing when you can with soap and water as much as possible and then using hand sanitizer when handwashing facilities aren't available, this I think is the way we can manage hand hygiene as best as possible. The main problem that I see with hand sanitizers is actually the dryness and the cracking that it costs to the skin. That's one of the major complaints. I think good hand hygiene -- hand washing or hand sanitizer when it's not available, cough into a tissue or into your elbow or sleeve. These are the things I think that together are good principles for all of us to follow.
CP24: A viewer cites a study from Israel that found the Delta variant is being transmitted between fully vaccinated people. He says new guidance allows us to unmask indoors with others who are fully vaccinated. He asks, do you think that will need to change?
De Villa: We don't totally know yet. This is a new variant that's emerging, and we are absolutely learning as we go. That's the thing with a new variant of a new virus. But here's the thing, as I've said, just because we can do something doesn't mean that we have to do something. So yes, there are lifting of certain restrictions and there is an opportunity to not wear masks, particularly outdoors. But this doesn't mean that you have to stop wearing your mask. And in fact, I would strongly recommend that people continue to use masks, especially where you can't maintain physical distance, even if you are fully vaccinated. It's just another layer of protection. And we do this with lots of other aspects of our lives -- multiple levels of safety, multiple levels of protection to augment our safety and make sure that we're keeping ourselves as safe as possible and those around us as safe as possible. So, for those who have any concerns, I would strongly recommend by all means continue to wear your mask. It is just an added layer of protection, but the vaccine is beneficial. We are seeing that it is still providing a high level of protection. It's not 100 per cent perfect. You will see Delta cases even amongst those who are fully vaccinated, but it is definitely much better protection than being partially vaccinated or not vaccinated at all.
CP24: A viewer says, "We are very concerned about a group of our family members who are refusing vaccinations because of conspiracy theories they are reading and believing. How can this group be encouraged to believe in science and medicine? We are not successful, unfortunately. and wondering if you have resources or suggestions to help dispel these false theories."
De Villa: This is a challenge that many of us encounter. There is a lot of misinformation out there. There's lots of information, but there's also lots of misinformation. And the misinformation is often packaged in a way that it is seen as more credible, and people really do believe these things. First and foremost, what I tell people is to go to reliable sources of information. And these are going to be things like the Toronto Public Health website --toronto.ca/COVID-19 -- Public Health Ontario, the Public Health Agency of Canada, the Centers for Disease Control and Prevention. These are the kinds of sites that actually provide you with solid, science-based information in and around COVID-19 and around the vaccines as well. So, those are good sources of information. And we also have some information to help people answer questions. We have frequently asked questions on our website. I think that many of those questions are exactly the kinds of questions that people ask around the disease itself and around the vaccine. So, these are good sources of information. But what I would do as an individual with family members or friends who are expressing some reluctance, I think the important thing is to encourage conversation, rather than shutting it down. So, don't berate people for their beliefs or for perhaps misunderstanding what information is out there. It would be, to my mind, good to have a conversation around what's driving the concern. What is the basis of the concern? I think people who've had experiences with vaccination should talk about their good experiences with vaccination and explain that they had a good experience with the vaccine. That helps to build confidence and trust in the whole vaccine process. But really, it's around having a conversation and directing them towards more reliable sources of information, whether it's a trusted primary care provider, family doctor, nurse practitioner, who can talk in a very knowledgeable way around the science. But keep the door open. Keep the conversation happening because it's when it shuts down that you know that it's over. You're not going to be able to convince anybody if they're shutting the door.
