‘We’re at a crucial time’: Dr. de Villa on stay-at-home order, third wave, COVID-19 vaccines

Toronto’s top doctor says the city does not have enough time nor enough COVID-19 shots to vaccinate its way out of the third wave, and that’s why she urges residents to follow the stay-at-home order announced Wednesday.

“I support any and all solutions that achieve the objective of measurably weakening the disruption that COVID-19 is forcing in all our communities. Our job now is to respect and follow those measures,” said Dr. Eileen de Villa, Toronto’s medical officer of health.

The stay-at-home order will take effect at 12:01 a.m. on Thursday, April 8, and will be accompanied by Ontario’s third state of emergency declaration since the beginning of the pandemic.

De Villa noted that in the past seven days Toronto recorded 7,000 new cases of COVID-19. More than 10,000 cases have screened positive for a variant of concern so far, she added.

“The extent of the resurgence and persistence of these high case counts compel us to determine what ways will best outsmart the spread of the virus and the variants,” de Villa said.

“So, please abide by the stay-at-home order. Practice self-protection measures, get your vaccine as soon as you are eligible. In so doing, everyone in Toronto will be better protected, safer, and ultimately healthier.”

Dr. de Villa joined CP24 to answer your questions about the third wave, the stay-at-home order, vaccines and other COVID-related issues.

CP24: The province has announced another stay-at-home order. Do you think it’s too little too late, or do you think there is anything missing?

De Villa: I think that any step and solutions that take us closer to measures that bring us reduce transmission of COVID-19 are steps in the right direction. I’m certainly supportive of the measures that are taken. And at the end of the day, those measures are only going to be as good as we make them. We still have to participate actively as a community. We need to stay at home as much as possible and continue to practice those measures of self-protection. I know you’ve heard me say them so many times before, but they are so important now. We know what’s happening in our community. We see this overwhelming wave of COVID-19 cases, and we’re seeing significant impacts in our hospitals, whether we’re talking about admissions on the general floors or into our intensive care units. It really is beholden on us to keep our distance as much as possible, stay home as much as possible, wear our masks, wash our hands, stay home when we’re sick, and of course, get the vaccine as soon as our turn comes up.

CP24: The Ford government also announced its plan to vaccinate teachers and education workers in high-risk neighbourhoods in Toronto and Peel Region during the spring break. It comes a day after you ordered the closure of schools for at least two weeks. What does this announcement mean for schools in the city?

De Villa: There’s no question that we want is vaccinate as many people as possible as quickly as possible because we know that it provides protection for those individuals and it provides protection to all those around them. We focused very significantly on a data-driven and evidence-informed response, so we know that focusing on age and geography become very important factors as you look at vaccination. So certainly, focusing vaccines on hotspots is a smart move because that’s where the disease risk is and that’s where the benefit can be derived, particularly for prevention for future waves of COVID-19 activity. With respect to schools, we’re going to see what happens over the course of the next several days, hoping that what really will make a difference right now isn’t so much vaccine, but it’s about the measures that have been put into place and how well we together follow those measures. That’s what’s going to bring community transmission down in the shorter term, really try to blunt this current wave. And then it allows for vaccines which happen now and, in the weeks, to come to have their benefit. But that benefit won’t be felt for at least a few weeks down the road.

CP24: How quickly can the city now pivot its vaccination program to start moving those mobile clinics into those hot zone areas and moving up anybody 18+ in those areas? Is that going to be easy to do? Or is that going to take some time?

De Villa: First and foremost, our health-care partners have been out there doing mobile clinics for many weeks now, so certainly, we know we have our vaccination partners to help in that regard. And my understanding was that those involved in planning the details of our immunization efforts had plans to really start moving towards mobile clinics as early as next week. Lots of planning going on. And certainly, with these new details just arriving, you could well imagine there’s lots of logistics that need to be done and lots of conversation, so it’ll be a busy next few days and weeks ahead of us as vaccination partners in the city of Toronto.

CP24: Do you think the stay-at-home order should have been done sooner?

De Villa: I don’t think there’s much point in talking about what could have or should have been. We are where we are now. Good measures have been taken. And I would suggest that it’s actually up to us. It is all in our hands now, as it often has been throughout the course of this pandemic. The more we are able to abide by those measures and really honour what they intend to achieve — keep our distance wear our masks — this we know really makes a difference in terms of transmission and is the most important thing we can do right now to bend this curve, to have an impact on the cases. Subsequent to that, there are vaccines. So, I would, of course, encourage people, as their turn comes up, to please go and get vaccinated. These two things combined good self-protection measures and adhering to the public health measures that have been put into place, getting the vaccine as soon as you’re eligible — it’s these two things that will see us through to the other side of this pandemic in the fastest time possible.

CP24: Do you have the number of how many hospital staff have been vaccinated? Are they taking advantage of the vaccines? We are hearing that staff in health-care facilities are not getting inoculated.

De Villa: I think we’ve heard some stories through the news and the media around efforts that have been put forward to get health-care workers vaccinated. And I know that we’ve had a significant proportion of our health care workers vaccinated, and I admit I don’t have the numbers in front of me. I think what has worked in our favour, however, is that as more and more health-care workers get vaccinated and as more people in our community get vaccinated, it serves as a bit of a peer pressure is one way to describe it. If you have any concerns around any ill effects but you see others around you getting vaccinated and not suffering ill effects and in certain cases exposed to COVID-19 and being protected from COVID-19, I think that gives extra confidence.

So, we’ve certainly seen within long-term care homes a massive improvement in terms of the COVID-19 picture there. We’ve got residents well vaccinated and a goodly proportion of staff vaccinated, and we just haven’t seen that this wave of COVID-19 having that same impact as it has had in the past. And we’re really grateful for that. I would encourage people to look at that, look at the experiences of other countries that have done well and have a significant proportion of their populations vaccinated. See the reduced rates of disease, it is effective and it’s the best protection we have other than our self-protection measures.

CP24: A viewer asks, with the stay-at-home order, is the rule the same as the last one? If you live alone, can you connect with another home?

De Villa: To be honest, I haven’t actually had a chance to really look at the details of this stay-at-home order. I’ll look forward to seeing those details. I do think that from just a general public health point of view and a general overall health point of view, I think if you can safely manage to limit your contacts, that’s the best thing to do. That’s really the best we want to limit the contacts and get vaccine on board as soon as possible. For now, that would be my advice. And we recognize that there are mental health challenges associated with not having contact. Certainly, being outdoors and still maintaining distance is one way to reduce the risk and still have some connection with people so that you can protect your mental health as best as possible.

CP24: Another viewer wants to know why are we “not creating a waitlist or first-come, first-serve for open appointments for COVID-19 vaccines? With our numbers skyrocketing, shouldn’t it be a priority to get as many doses in arms regardless of age?

De Villa: I certainly understand the nature of this line of questioning. Here’s the thing right now of the current provincial booking system that we’re using in our city clinics doesn’t really allow for a waitlist or standby provision, which is unfortunate. That’s hampered us, although the system has actually served as well overall. In this one area, it has been a challenge. With the new announcements made today, my sense is that we will be seeing less and less availability in terms of the clinics. And there’s no question whether you’re talking about the city clinics or the clinics that are run by health-care partners, fixed clinics, mobile clinics, all of us absolutely want to get as much vaccine out, particularly to high-risk areas, but to everyone in the city as quickly as possible so that we can all enjoy the protection that are that’s afforded by vaccines.

CP24: A viewer says everything has been tried to control the outbreak. She asks why not imposed a curfew as it seems to do the trick in other countries. Also, why is the airport still open, she asks.

De Villa: Those are questions that are probably better directed to my provincial counterparts or federal counterparts. These are aspects that are more under their jurisdiction. I think there’s some concern around the challenges of enforcing curfews. And with respect to the airport, again, that’s under federal jurisdiction. I would say this, though, that regardless of what measures are taken, regardless of what policies are passed — whether it’s by the provincial government or the federal level of government — it does fundamentally come down to each and every one of us. We need to abide by those rules and stick by the measures, which are all aimed at having each and every one of us keep our distance to the greatest extent possible. That’s why the focus is on stay at home as much as possible—getting outside only for those essential activities, which of course, include exercise and grocery shopping, etc. But the more we can keep our distance, that’s what reduces transmission. We’ve seen this time and time again, here at home and in countries all around the world. Regardless of what governments do in terms of policy, we need to abide by the measures and the self-protection steps that we know actually make a difference until such time as vaccines can have their full effect and help get us to the other side of this pandemic.

CP24: Have you ever considered your powers as the medical officer of health to enforce a curfew?

De Villa: This one is a much more challenging circumstance to implement on a citywide basis. It’s not a specific environment. And it would be very difficult to speak about a specific instance of communicable disease. As it turns out, the powers that exist for medical officers of health under the legislation are really meant to be reactive to specific instances of communicable disease risk within particular settings rather than something that blankets the entire city. It would certainly be challenging to try to do that, and it really is better affected at the higher level of government. The provincial level of government is they have greater powers to do that kind of policymaking.

CP24: A viewer says he got the AstraZeneca vaccine at a pharmacy four weeks ago. He says he is unsure if it is safe to get the second shot due to fears of developing blood clots. He wants to know if he is at risk of developing blood clots after getting his first shot.

De Villa: Let me say this, this has been really well-reviewed. And I believe the European Medicines Agency has put out a review, and fundamentally, the key message that came out was that the vaccine confers greater benefits than any risk. The risk of COVID-19 and all the ill that comes with it is far greater than any risk of very rare side effects that tend to occur within two weeks after that first vaccination. It sounds like in this situation, the likelihood of any ill effect is quite low, as it is in any instance. And the benefits of receiving the vaccine far outweigh any risk whatsoever. I would encourage this individual to get that second dose to ensure the full protection of the vaccine and I’m glad to hear that he went and made that choice to get the vaccine. It was a good choice. And it’s certainly a key step in terms of getting us all to the other side of this pandemic.

CP24: A viewer asks who makes the decision about the age restrictions for the AstraZeneca vaccine.

De Villa: There isn’t really a decision per se around who gets what vaccine. In this case, we’re talking about AstraZeneca. What has happened is that the National Advisory Committee on Immunization has recommended for now that the vaccine be used in those 55 years of age and older. Reserved for use that age group as the situation in Europe this rare side effect that was seen or this association that was noticed was being investigated. At the end of the day, as I’ve always said, the best vaccine is the vaccine that’s in your arm. So, at this point, I don’t know the viewer’s specific circumstances, but there is an opportunity for her to get the vaccine depending on where she is. It sounds like she will soon have a range of options available to her. If you’re in one of the hotspot communities, there will be vaccines available at many different venues. AstraZeneca is what’s available within the context of pharmacies. We know that Pfizer and Madonna are the offerings within the city clinics and the hospital clinics. Lots of options available. But I would encourage anyone and everyone who is eligible for a vaccine, please get that vaccine. All of them are really effective in terms of preventing the most serious outcomes associated with COVID-19 infection, namely hospitalization and death. And the best vaccine is the one that’s in your arm, so please get that vaccine.

CP24: Another viewer asks, “if I’m only willing to get the Moderna or the Pfizer vaccine, how can you find out without booking an appointment? I do not want to book an appointment. If it’s not the vaccine that I want, I will never get the AstraZeneca shot despite what the doctors say. No disrespect to you.”

De Villa: Right now, AstraZeneca is only available through pharmacies and certain select primary care providers. When it comes to the other vaccine channels that are currently available, whether their city or Toronto Public Health-run or run by our health-care partners, they’re either providing Pfizer or Moderna. So, I think that makes his choice relatively simple.

CP24: “What is the government doing to improve the containment of those people infected with new variants? They need to be more aggressive on testing and containment while watching for the vaccines. They need to keep monitoring those people that are in self-isolation to ensure effective containment,” a viewer says.

De Villa: That’s exactly the work of public health. I think the interesting thing, of course, is that in Toronto now, the majority of cases are variants of concern. And that’s why we’re seeing so many cases at this point in time. We’re doing everything we can with case management and contact follow-up. But of course, we rely on the public as well. And it’s really important for people to really stick to the rules, to isolate appropriately when you’ve been identified as a case, and for contacts to really follow up and follow themselves for symptoms and abide by the guidance that’s being provided. That, maintaining distance, doing all the things that you’ve heard me say so many times, those measures for self-protection and then ultimately getting the vaccine. These are the measures that really do count for now and for the future as well.

CP24: Have you or your team at Toronto Public Health encountered a surprising case of the variants of concern?

De Villa: I don’t know if I would say that there have been total surprises. But I will say this. We have seen that fundamentally what it comes down to is people gathering. And we have seen that when it comes to these variants of concern, we have been just amazed — not in a good way — how quickly it can transmit in certain settings. When people have that close contact, it really does go through households. And yes, we have seen spread even with people as they are trying to keep distance outside. If they get close together, we have actually seen transmission there as well. That’s just a reminder that transmission outdoors is definitely a lower risk, but it’s not no risk. Distance, distance and distance become really important as just wearing your mask as much as possible.

CP24: Final thoughts for this week?

De Villa: I would just ask that we’re at a crucial time. So, I would ask everyone to please abide by the stay-at home-order, keep your distance from others as much as possible, check in on those who are alone virtually or by phone, get your vaccine as soon as possible. And if we do this all together, we will ultimately be a safer and healthier city.