Dr. Eileen de Villa, like most Torontonians, is eager to move beyond COVID-19.

But as the three-year anniversary of the city’s first confirmed case of the virus approaches, de Villa admits that the pandemic that upended life in the city, while resulting in thousands of deaths, isn’t in the “rear view mirror” just yet.

She says that while it “thankfully doesn’t cause the same anxiety and fear” that it once did, it remains a daily challenge from a public health perspective and could still ultimately produce another “curveball.”

Ahead of the holidays, CP24.com sat down with de Villa to talk about the changing nature of COVID-19, the need for humility when it comes to making any predictions and her one message to Torontonians for 2023.

CP24: So this time last year we were sort of seeing the rapid spread of the Omicron variant of COVID-19 and bracing for more shutdowns and closures. One year later it feels like much of that fear that many felt during the holiday season in 2022 has faded. Are we at a point in the pandemic where we can at least count on a little more certainty going forward?

de Villa: I don’t know if I would characterize it as certainty, personally. My observation over the last almost three years now is that COVID-19 as a virus has always thrown us a curveball, right? You know, when you think you are in a more settled place and getting to a place of greater certainty it just always seems to throw a curveball. Omicron was certainly one of those. It came late November, early December and it just hit very, very hard. This fall what we have seen is a rather complex situation because we have seen COVID-19 continuing to circulate but unlike the past couple years, what we also saw was the circulation and activity of other viruses that frankly have been quiet for the last couple years. Influenza and RSV, these are viruses we had not seen much of in the last couple years and they made their presence much more known this past fall.

CP24: What do you think has been driving the sort of resurgence we have seen with those two respiratory viruses, RSV and influenza?

de Villa: I don't know that we have a complete answer. I think many people have hypotheses around it or theories. But these viruses are always around during this time of year. I would say that many kids, the youngest in particular, are getting exposed to these viruses for the first time (following COVID-19 lockdowns), and it is a large group (with infections) because we have had more than one birth group or age cohort getting some experience in being exposed to these viruses, RSV in particular. So that has certainly been part of it. But I think at this point there's also a certain amount of humility that's required as we're dealing with these viruses and trying to understand what is happening. We've never been in this situation before. You know, emerging from COVID-19 with RSV and influenza (circulating). So there is lots that we are observing but we just don’t have a complete understanding.

CP24: Pediatric hospitals in particular have really struggled with this uptick and they have struggled despite relatively low levels of COVID compared to what we may have seen earlier in the pandemic. Do you worry about the possibility of perhaps another wave of COVID being layered on top of all this other viral activity this winter? I know Dr. Moore (Chief Medical Officer of Health) said last week that he envisions another wave as soon as January.

de Villa: You certainly have to hold out for that possibility, right? I would caution against predicting but based on the knowledge we have it is not unreasonable to expect that there may be more COVID activity and another surge coming in the New Year. For me fundamentally the important part is that we use the knowledge and the tools we have. So that does mean vaccination and getting that booster dose that is now available for everyone as young as five years of age and as we gather with friends and family over the holiday season we need to make sure we are engaging in good practices and that is all the other layers of protection, including masking when you are indoor public spaces. I know people are tired and would like to be beyond the pandemic but we are not quite there yet and this is actually a very reasonable step that can be done, along with staying home when you are sick, washing your hands and opening windows when you can if you are indoor spaces with other people with whom you don’t live.

CP24: You mentioned masking and of course this was the year we went from mandatory orders to this idea that it can be a personal choice. So much of your job is communication. Has this more nuanced message been a tough one to convey to Torontonians?

de Villa: Yeah. I think the challenge really stems from the fact that frankly people are exhausted. I think that's a fair statement to make. And, you know, I don't think there is a single one of us who wouldn't like to see, you know, the pandemic in the rear view mirror. We all want it to be behind us. Unfortunately, we're not quite there yet. So that, that to me is the real challenge. Encouraging people to continue on with what are good behaviours and using the tools that we have in our basket in order to protect ourselves, the people around us and our healthcare system so that it is available for all the things we need it for. We can do these things together. But it takes a concentrated effort and it is challenging for people to keep up that level of energy after almost three long years of COVID.

CP24: On the topic of vaccination, Toronto Public Health is still involved in some very concentrated efforts to boost COVID vaccination rates, whether that is through the use of community ambassador teams or pop-up clinics in malls, subway stations and other high-traffic locations. Will we get to a point where COVID-19 vaccination can look a lot more like the flu vaccine, with a more seasonal push rather than this sort of all-out effort?

de Villa: That is certainly the hope. It is so difficult to make predictions but what I can say is that pandemics do end. When we look back over the course of history all pandemics come to an end. There isn’t necessarily a storybook ending and it is hard to predict how it is going to look or when it is going to come. We're certainly, you know, emerging from the pandemic at this point and the reality is you can identify the end to a pandemic when it is actually in the rear view mirror.

CP24: Are you still having success getting people who may have been hesitant to get their first dose of COVID-19 vaccine. It seems hard to believe that those people would change their minds now, after years of advocacy.

de Villa: Some people are taking up first vaccines (still). For some it may be people who are relatively newly arrived in the country who may not have had opportunities in their home country or in jurisdictions where they were before to actually get access to vaccines. We're quite fortunate in this country to be able to provide that COVID-19 vaccine at no charge to the recipient. That's not the case in every jurisdiction around the world. So for some people that's the reason why they're picking up their first dose at this time.

CP24: 2022 brought a lot of division over things like vaccination requirements and that sort of culminated with the ‘Freedom Convoy’ movement in Ottawa. There was also a lot of abuse directed at public health officials, as tensions sort of boiled over in some places. Are you hopeful that as we move out of the sort of acute phase of the pandemic, that division will lessen?

de Villa: I certainly hope we are moving beyond that. At the end of the day, every action that we take and every piece of advice that I proffer is actually, you know, in the spirit of advancing healthier, safer communities, whether it's in respect of COVID, or influenza or any other conditions that may impact on the health of the community. Yes, there are some very significant downsides to a pandemic. We've actually all witnessed that over the course of the last three years. But really, at the end of the day, that's about the virus and not about the actions that we took to control it and to support community health. It's the virus that has wreaked havoc.

CP24: What’s your one message to Torontonians as we head into 2023 and approach the three-year anniversary of the city’s first confirmed case of COVID-19 in January?

de Villa: I think first and foremost it is sympathy that ‘Yes, we are all exhausted. It has been an exhausting three years no question.’ But our ability to put this behind us sooner rather than later means that to the extent that we can we need to continue to use the tools of protection that have served us and will continue to serve us well as we seek to emerge successfully from this pandemic. I think the final thing I would say is just recognize that we're all exhausted so be kind to each other and try to be patient with each other because it has been a challenging three years.