Toronto's top doctor is warning residents that January could be 'extremely difficult' for the city if people do not heed the advice of health officials and continue to gather and celebrate the holidays with people outside their household.

"It's hard to break with tradition even once, but the best and safest decision for those we love is to break with it, just this once," Dr. Eileen de Villa said during the city's COVID-19 briefing.

"In protecting ourselves, we also protect the people who matter the most."

While the daily case counts in the city seem to be settling two weeks after Toronto was moved to lockdown, de Villa said case counts in the mid-500s or into the 600s "are in no way a good thing."

Toronto Public Health reported 553 new COVID-19 cases on Wednesday.

De Villa revealed that the percent positivity for the week of Nov. 22 is highest among those aged 14 to 17 at 11.6 percent. The second highest positivity rate was recorded among the 18 to 23 age group at 9 per cent.

"For now, and for the foreseeable future, we have to live with what we do know that COVID-19 is spreading widely in Toronto while we are in the holiday season," de Villa said.

"These levels of infection clearly indicate that we must be on high alert and that we are best to follow the provincial guidance and celebrate this month just with the people we live with."

With the announcement of the approval of a vaccine in Canada, de Villa said this is encouraging news. However, she noted that COVID-19 remains a threat to many, urging residents to stay vigilant.

"The momentum is finally, but slowly, beginning to favour us and not the virus. But there is a long way to go," she said.

"We must not lose sight of the current risk and threat of COVID-19 infection. Vaccines are emerging as part of the solution – but they are still months from providing the solution."

Dr. de Villa joined CP24 on Wednesday to answer questions about COVID-19.

CP24: How significant of an accomplishment is this that there is a COVID-19 vaccine that has been approved by Health Canada?

De Villa: This is indeed a remarkable achievement. And it is a real testament to science and how quickly it can progress in the right circumstances. But I think that with the approval of the vaccine, what we know is that it's passed the exacting standards of Health Canada in terms of safety and efficacy. But the real value of the vaccine comes as its implemented and actually used in the population to provide protection against COVID-19.

READ MORE: 'This is a momentous occasion': Health Canada approves Pfizer's COVID-19 vaccine

CP24: What do you know about when Toronto might expect the arrival of the vaccine? Should frontline workers be getting ready?

De Villa: It's limited in terms of what we can say at this point. And as has been remarked on several times, it is something that is changing quite literally on an hour-by-hour basis. Things are rapidly moving in this scenario. While I think that there will be some people who hopefully will be getting the vaccine in the not-too-distant future, as you've already heard through the many reports, most of us will have to wait a little bit longer before we actually get our turn to roll up our sleeve. In the meantime, we're continuing to ask people to continue to practice measures of self-protection in order to keep the spread of COVID-19 down.

CP24: Teachers have written an open letter to Toronto Public Health and provincial officials calling for an extended break after the holidays because of the COVID-19 situation in the city. They want to move all Toronto schools to online learning starting Jan. 4, for at least the first two weeks after New Year's Day to ensure schools don't contribute to the spread of COVID in the post-holiday period and in order to be ready to conduct regular ongoing school-based voluntary asymptomatic testing of students. What is your reaction to this? Would you approve of this sort of move, especially as you noted today in your brief briefing that concern about the spread and the younger demographic?

De Villa: I think that it's clear that there were many of us in the City of Toronto that are concerned about the spread of COVID-19, and that would include teachers who are working at schools all over the city. I do think we need to be concerned about what behaviours are going to look like over the course of the holiday season and how that might contribute to the ongoing spread of COVID-19 and, in fact, worsening of COVID-19 spread in January if people aren't actually careful and if they don't choose to do differently in terms of what they do over the course of the holidays.

However, I will say this. It is still very much in our hands. If people actually do follow the best and the safest advice, which is to limit their interactions, as much as possible, really keep those gatherings down to only those people with whom they live and for people who live alone, to extend that gathering to one other household, the more we're able to do that the more we're able to practice those good self-protection measures, then the safer it will be and the more reduced the spread of COVID-19 in the community will be. That, I think, is fundamentally where we need to be. Testing is helpful in certain circumstances. But the best thing that we can do is to prevent COVID-19 from spreading in the first place. And that's done by limiting our interactions with others with whom we don't live.

READ MORE: TDSB teachers, education workers call for two-week school closure, more asymptomatic testing

CP24: You mentioned that the highest positivity rate for the week of Nov. 22 was among those aged 14 to 17. Several schools in the Thorncliffe Park community have closed due to outbreaks. There's also the COVID-19 fatigue factor.

De Villa: There is absolutely the COVID fatigue factor. But when we look at what is happening in our schools and what's happening amongst kids, it is a reflection of what's happening in the community writ large. And if I were to look at it from another perspective, I would say this -- we have seen what can happen when people actually commit to staying home as much as possible. It's not not to have celebrations but to have celebrations with the people you live with and to celebrate virtually as much as possible with others from outside your household. It's one year and I know it is tough to break with tradition. But that is the best and the safest thing that we can do, so that we can get back to our regular traditions and back to our daily lives more like we knew them before there was a COVID sooner rather than later.

These kinds of decisions are complicated. They're not left alone to Toronto Public Health. Education decisions clearly need to involve the school boards and the Ministry of Education. But I think we should be willing to consider options and consider a broad range of options. But first and foremost, prevention first, and that's in our hands.

CP24: How soon are people able to get back to work after the vaccine? How soon is Toronto going to be opened up and be back to normal?

De Villa: That's the million-dollar question. If you think about it, there are lots of people who are already and who've continued working all throughout the pandemic because of the nature of their work. There are many people in our city for whom remote work is simply just not doable, given the nature of their work. I think that we are just starting to learn about vaccines. We're hearing that there may be more available on a broader basis by the spring, and there is a sincere hope that we will have the vast majority of the population immunized by the end of the year. That's the story we're hearing now, but it is a rapidly evolving situation. The information is coming in fast and furious. It's very difficult to predict. We're all with fingers crossed along because we'd like to get back to life as it was or a little closer to like it was as soon as possible.

CP24: We've heard that the vaccine might not be available for little children. Is that true?

De Villa: The vaccine was developed very quickly, and at this point, the testing has been done in adults. What we know about the vaccine and its safety and its efficacy thus far is with adults. There is, as I understand it, testing that is now going on in younger populations. We'll eagerly await the information as it comes in on that front. This is, again, one of those areas in which we're constantly evolving our information and our understanding.

CP24: A viewer asks, there are many who will refuse the vaccine. Should those who refuse the vaccine for no viable reason be warned of ramifications, such as contracting the virus and being refused a hospital bed? Why should we pay for their blatant irresponsibility?

De Villa: That's an interesting question and it's one that I think has a lot of different elements to it. But the core of it is that we know that the vaccine has been approved by Health Canada, so there are certainly safety standards, and we understand that it is an efficacious vaccine. The real effectiveness of that vaccine depends on it being actually administered and used across a large swath of the population to provide that protection. I expect that there might be some people who cannot take the vaccine for a variety of medical reasons. That exists with almost every other vaccine as well, despite the safety record and the approval from Health Canada. There may be some circumstances that they may not be able to participate in. For example, there may be certain types of work or certain environments where it would be simply too dangerous for people who are unamortized and may present a COVID-19 risk to be involved with. But I think these are some of the questions for which we don't have definitive answers yet. I think that this is another reason why we have to really make sure that we're out there. And that's one of the things that I think you'll find over time will be happening more and more as we learn more about the vaccine and as the vaccine becomes more available. That we provide education and information for people so that they can make the best choices for themselves and their families and in their own unique circumstances.

CP24: Can you deny those who refuse to take the vaccine medical care?

De Villa: We that's not how things work within the context of our medical practice. We don't blame people for becoming sick, even when we know that there are certain risk factors and clear behavioural risk factors for becoming ill. For example, smokers are still treated for their heart disease, although we know that that is a known risk factor. This would be no different.

CP24: When a person gets vaccinated, will he or she still be required to wear a mask?

De Villa: At this point in time, what we're understanding is that while the vaccine is just starting to roll out and even as people become immunized, for now, the expectation is that the measures for self-protection will be in place for some time. We don't have all the answers yet again. We haven't even started with vaccines yet here in this country. But you can well imagine that we will be constantly studying as we have throughout the pandemic so that we can offer the best advice around what protective measures are needed in order to control the spread of COVID-19 even as the vaccine becomes more and more administered to more and more people.

CP24: How will people be advised of when and where they should go for their vaccine? Do they have to call for an appointment? Will they have to stand in a long line or wait in a crowded waiting room? Can a couple arrange to go together? Who will decide if someone is more at risk?

De Villa: All excellent questions to which answers are still being developed. Do stay tuned. There is a lot that is still underway in terms of planning. The provincial government is leading the charge on this and is providing us with information at the municipal level once it becomes available. When we have that information, we'll then be able to describe a more fulsome plan and make sure that we're putting out information in a way that all the different communities across Toronto, regardless of where they live and how they interact, whether it's online, or they prefer something a little more traditional in terms of communication. We're going to have to cover all those channels. It is quite the undertaking. Do stay tuned. As information becomes available, we'll make sure that it's put out there.

CP24: Where are the cases in the city coming from?

De Villa: I wish it were that easy to sort of demarcate very simply that this is where it comes from, or it's that location or this place. But in fact, what it's about is the nature of the interaction between people. We know that the vast majority of cases, as we have them, are caused or come from close contact with somebody who has a COVID-19 infection. Sometimes this happens within the context of the home, one family member to another. Sometimes it happens within the context of a friendship, and yes, that might be a social gathering. And other times, it happens within the context of a workplace. It may be about the work, or it may be about the socializing that sometimes occurs in a workplace. But we do know that close contact is the major risk factor that exists right now.

It's actually about the behaviours more so than it is about the location. It's close contact with people that you don't live with that really gives rise to the risk. The people you live with, well, they're the people you live with. You're going to have close interaction with them. To the extent that you can limit your close contact with those people, that's how you can reduce your risk of COVID-19, and we can reduce the risk of transmission throughout the entire community by doing this all together.

CP24: A viewer who lives in an apartment building says they have two elevators, and it is difficult to get onto one because most residents do not wear masks. Why is the bylaw for apartment buildings and condos not being enforced?

De Villa: We have found in general that most Torontonians are actually participating quite nicely and are really wearing their masks. That's certainly been my experience. But I imagine that that's not the case everywhere. If there are specific challenges, probably the best thing to do is to contact the city at 311. We can see what our enforcement people can do to help reinforce bylaws throughout buildings, particularly around mask use in multi-unit dwellings. I think that would be my advice for now. I think we have to recognize that for some people, mask use just isn't doable for medical reasons. That may be part of the reason as well. It's a little bit of give and take on everyone's part as is just being a good neighbour.

CP24: You talked about celebrating holidays with only those in one's household. Hanukkah is starting this week. What more do you have to say about that to people who are observing Hanukkah?

De Villa: Whether it's Hanukkah that you observe or any other one of the major celebrations that happens within the month of December, what we're asking people to do is to do differently this year. I know it's really difficult to break with tradition. But this year, we're asking people for just this once to celebrate smaller. Stick to your household. Don't gather together with others outside of your household because the safest and the best thing to do for yourself, your family and your community is to stick to your household to the greatest extent possible.

CP24: A viewer asks, with a young child currently in kindergarten, she is becoming increasingly concerned with the amount of hand sanitizer they use on a daily basis. Even after sending her with her own personal aloe plus sanitizer, she often comes home with hands that look so red it looks more like chemical burns rather than just dry hands. I have the same issue with my son. Any advice as to how to avoid that?

De Villa: There's a little bit of advice that I can offer. To the greatest extent possible, using soap and water where soap and water are available is better. But I do think that some hand sanitizers are a little bit gentler on the hands, and certainly using lotion in advance and trying to keep the hands as soft as possible and as protected as possible are probably the best things you can do.

This interview has been edited.