Toronto’s top public health official says she is concerned about the rising pressures on the city’s hospitals as COVID-19 cases continue to climb.

“As able as the health care system is, it is delivering care under enormous struggle as COVID-19 cases surge, and there is little reason to expect that case counts will decline anytime soon,” Dr. Eileen de Villa, the city’s medical officer of health, said during Wednesday’s COVID-19 briefing.

The city reported 837 new infections. There are 406 people in hospital, which de Villa said is a worrying number. Eighty-nine people are in the ICU.

A 23-year-old person is the youngest among those newly hospitalized.

“I understand from discussions with my hospital colleagues that admission of younger people are reaching noticeable levels,” de Villa said.

Early data appears to suggest that many Torontonians didn’t heed the advice of health officials not to gather during the holidays.

“The outcome of those decisions will emerge over the next days and weeks,” de Villa said.

“If they manifest as COVID-19 cases, the implications are plain to see.”

Dr. de Villa joined CP24 to answer COVID-related questions from viewers.

CP24: Are you concerned about the rising hospitalizations in the city? Are you worried that we are reaching a precarious breaking point in the city when it comes to COVID-19?

De Villa: Absolutely. When we’ve got case counts at this level, and when we’ve got hospitalizations and ICU admissions happening at this pace, it’s very concerning. We want our health care system to be available for all of us, whether for COVID-19 related issues or for all the other medical conditions that may affect us at some point in our lives. We really need our health care system to be available, and when it’s under this much stress because of COVID-19 infections and when we’re talking about infections that are preventable, I think it’s really on all of us to do our part to stay healthy and to stay apart as much as possible.

READ MORE: Nearly a third of people who later tested positive for COVID-19 attended gatherings over the holidays: survey

CP24: Do you have a date circled in the calendar when we could see the brutal impact of surging COVID-19 cases?

De Villa: I don’t know that there is any specific date, but certainly, as we look after the holidays, and we have some sense based on the data that we have collected from those who’ve become infected with COVID-19. We’ve asked them some specific questions around what might be risk factors. Did they gather with other people? And we did start to note that people were gathering more in the holiday period than they were in the weeks leading up to the holidays. If that’s really the case, we can expect that there may yet be more cases coming forward, more demands placed on the health care system.

But I think the really important point here is it’s not too late to change. We can absolutely still change our behaviour. Perhaps if you got together with other family members, people from outside of your household over the holidays, okay, that’s not the right thing to do. It is not consistent with public health advice, but there’s still what you can do now and from here on in. I would just ask for people to really focus on what they can do to protect their own health and the health of our whole community.

CP24: Quebec just announced that it would be imposing a curfew for four weeks starting Saturday – from 8 p.m. to 5 a.m. What do you think about this measure? Would it be appropriate to apply in Toronto?

De Villa: Those kinds of measures are always taken, in my experience, only after great consideration and very, very careful deliberation. My expectation is that our provincial counterparts would be doing the same thing. These are those in terms of the deliberation and careful thought and looking at the numbers and understanding what can be done at this point, in order to reduce interactions between people. We know that’s what makes a difference in terms of controlling the spread of COVID-19. So, what tools do they have available to them? These are the kinds of tools that are best deployed by the provincial government. They have more significant powers in this regard. But certainly, I have concerns that we need to really reduce the amount of interaction that’s happening between people, certainly here in Toronto, arguably through other parts of the province as well. So those are conversations that are happening and that I’m contributing to as much as I can.

READ MORE: 'Electroshock': Quebec to impose 8 p.m. provincewide curfew until Feb. 8

CP24: According to data from your team, it suggests that between that critical period of December 22 and the beginning of this month, more than 30 per cent of people admitted that they gathered inside a home with other people outside of their household. Given where we’re at in this pandemic, we’re inching towards a year of people being bombarded with these public health reminders in terms of their behaviour. What is that number say to you about the effectiveness of restrictions that are in place now or any stricter restrictions that could come into play if people just, even at a critical time, like over Christmas, aren’t following the rules?

De Villa: I think it certainly speaks to a couple of things. First and foremost, it’s our natural desire to want to connect with our friends and family, particularly over the holidays. I think we all understand that natural desire to do so, but our hope is that at this point, when people actually see this can result, and it does result in increased infections, which in turn causes greater hospitalizations and ICU admissions. And unfortunately, it also leads to deaths. I’m hoping that people will actually take a look at those numbers and recognize that this is within their power. They have it entirely within their hands, not everybody does, but many of us actually have that luxury of being able to work from home, not going outside to attend the workplace and certainly, we can all limit our interactions outside the home to that which is most essential. If we actually cut down the amount of interaction we have with other people, that’s how we can best reduce the spread of COVID-19. And as vaccines become more available, that’s just another tool that helps us again in terms of reducing the spread of COVID-19 over time. It’s that recognition that we have power, and the hope of the vaccines combined, that I’m hoping will really start to change behaviour.

CP24: We heard from the premier today, suggesting that we’ll learn more about what happens with elementary school kids in the next couple of days. Do you think that schools should reopen? Or do you think kids should learn from home or remotely for a little bit longer?

De Villa: With respect to schools, this is a very difficult balance to strike. You’ve heard me talk about this before. Of course, we’re worried about COVID-19 spread throughout our community that that includes schools, but we’re also concerned about the fact that having kids learning online or not having in-person learning actually has a detrimental effect on their health for a variety of reasons, whether it’s access to social programs, access to healthy nutrition for a number of kids in our city actually comes through school, and also reducing social isolation and all the negative health impacts associated with that. There are lots of reasons why we want kids to be in school in person. But of course, there’s COVID-19 spread that we have to balance that out with. We know that with really high rates of COVID-19 in our community, that’s a risk for kids in our schools and for all the staff that work there. I’ve registered my concerns. I certainly have some concerns around return to school, and I have some concerns around how we protect our children and our families as best as possible. We’re continuing to have those discussions with our provincial counterparts. But I am firmly focused on how we maximize the health and safety of children and their families.

I certainly have concerns around COVID-19 spread and what a return to school looks like. But I also have concerns around the mental health impacts of prolonging online schooling or school closures, however you wish to look at that. Those concerns have to be registered, I think, with our provincial counterparts, so that they can take those into consideration as they make their decisions.

CP24: How do doctors and experts expect people to follow a lockdown where we can’t see our parents, but I can work in a school of 500 plus students if they open schools back up on Monday?

De Villa: I know this is one of those difficult things that seems that doesn’t fit. I know, a lot of people have talked about that and really, what it comes down to is a couple of things. One, we know that when we’re looking at health, we’re not just looking at COVID-19 spread. We have to look at health writ large. And we know that there are a number of advantages for children to be attending school in person and it’s not just about the education, it’s also about all the other benefits to health that it provides, whether it’s mental health, physical health by access to healthy foods. It’s just overall health for kids. There is a real advantage to having kids attend school in person. I think that’s one of the major considerations as we talk about schools and whether they should operate and whether they should operate in person.

CP24: Can you explain why families are allowed to meet up at a City of Toronto-run skate programs. But the messaging from city officials is that we shouldn’t be meeting up. What is the city doing to prevent this from happening? I am seeing this happen a lot across the city’s programs.

De Villa: I know this is one of those challenging issues, as so many are in COVID-19. This is about trying to make sure that people have opportunities to get physical activity, both for their physical health and their mental health. And optimally, what would happen is that people engage in those activities -- physical activity outdoors, where it’s safer, the risk of COVID-19 transmission is certainly reduced in big open-air spaces, but of course, maintaining distance is still the best policy. When we’re talking about those kinds of activities, ideally, we’re hoping that people still stick as much as possible, like really focus, on limiting your close contact with only those people with whom you live. That’s really what’s most important. Now, certainly, the risk is reduced in outdoor settings, but first and foremost, focusing your social interactions as much as possible only with those people with whom you live is the best way to prevent the spread. The one exception, of course, is for those who live alone. We want them to be able to have social interaction with others, and the best thing to do in those circumstances is for them to connect with one other household and really stick only to that one other household so that they can get the balance of minimizing the risk of COVID-19 spread, but also still have that social connection for their mental health.

CP24: Can you please explain how a professional hockey team (Toronto Maple Leafs) gets to practice and potentially play a season when I have two young boys who keep asking me what the difference is if they continue to play ice hockey with their team?

De Villa: This one will take a lot of explanation if I was to give you all the details. But the short version of the story is that there are a lot of significant infection prevention and control measures that are put into place in order to allow for those professional teams to continue playing. There is regular testing, and it is very, very regular. There are very rigorous protocols, and it’s a very detailed plan that has been put into place and is constantly being assessed and reassessed and evaluated in order to ensure that it is safe both for the players, the staff that support the hockey team, and the rest of society around them.

CP24: So, you’re comfortable with the NHL having a Canadian Division where Canadian teams just travelled on this side of the border?

De Villa: With the protocols, the very, very rigorous protocols that have been put in place and assessed and reviewed by public health officials from across the affected jurisdictions, yes, I think it’s a good plan, and it is constantly being assessed and reviewed.

CP24: It seems as though lockdown is not working to slow down the spread of COVID-19. Do you believe that greater enforcement of the lockdown and stiffer penalties to those who disobey would make a difference?

De Villa: I think that’s a debate that is constantly in play when it comes to changing behaviour, whether it’s a question of education versus enforcement or how much education you do versus enforcement. I don’t know that there are easy answers to this. What I would say is that when there have been violations of important legislation and requirements, that those things when they’re brought to the attention of enforcement agents, the enforcement partners that are engaged in this are following up and enforcing as the law allows them to do. But at the end of the day, it still all comes down to what we do, and there is so much power for each and every one of us to actually do the right thing in order to protect our own health, the health of our loved ones and the health of our entire community. It comes down to reducing social interactions and reducing our interactions so that we’re only really having close contact with those we live with and wearing your mask when you’re outside of your home as much as possible, whenever possible. We know that distance is the enemy of COVID-19. The combination of distance, vaccine, the other enemy of COVID-19, and we can actually work to get COVID-19 levels down in our community and start to imagine life a little bit more like what we were used to before COVID-19 came along.

CP24: Should joggers and people who are exercising outside be wearing masks? How safe is it to have an unmasked jogger run by me?

De Villa: We know that virus likes cold, dry air, and it transmits better in those circumstances. But we also know that when you’re in the big open-air outdoor spaces that it is more difficult to transmit simply because of the volume of air. It’s like a diluted effect, if you will, of a virus. But the best advice is really this: to keep your distance as much as possible and when you are outside, as much as you can, wear your mask. That’s actually the safest thing to do in terms of protecting yourself and protecting others from an infection you may not even know that you have. But if you’re outside and somebody passes by you even as they’re jogging, I mean again, the risk is lower, but I can’t say that it’s zero. There’s no such thing as zero risks. The best thing to do is to maintain distance.

CP24: How do you feel about where this vaccination rollout is and this province’s new plan?

De Villa: I think that we’re getting vaccine into arms as quickly as possible. I’m really pleased to see that we’ve got almost a third of our long-term care homes covered now.

This interview has been edited.