As new cases of COVID-19 continue to grow in Toronto and the rest of Ontario, Toronto's top doctor is urging the provincial government to take immediate action to help stop further spread of the virus.

According to a release from the city, Toronto's Medical Officer of Health Dr. Eileen de Villa wrote to the province's chief medical officer of health today with strong recommendations for stricter public health measures, including prohibiting indoor dining and discontinuing all indoor group classes in gyms and indoor sports team activities. 

"We have seen in other places what happens when COVID-19 gains the upper hand. Without quick action to implement further public health measures, there is an acute risk the virus will continue to spread widely, causing serious illness, stressing the health care system and further straining Toronto's economy," said Dr. de Villa in a statement. 

"It is my duty as medical officer of health to do what it takes to break the dangerous chain of transmission and so I have asked the province to support us through legislation or by granting me further authority to act."

Other jurisdictions who have experienced a resurgence have taken action that has stopped the virus, while jurisdictions that have failed to act early, have faced months of rising cases.

— City of Toronto (@cityoftoronto) October 2, 2020

Dr. de Villa has already moved to introduce new restrictions for bars and restaurants as a result of rising case numbers, but the ability to introduce the new recommendations falls under provincial jurisdiction. 

On indoor dining, the city says they explored two alternatives to the restriction of prohibiting all indoor dining, including requiring individuals to only dine in with members of their household or restricting indoor dining in areas of Toronto where case counts are highest.

But Dr. de Villa said such measures will be neither enforceable nor effective.

In addition to restaurants and gyms, Dr. de Villa is also recommending that individuals only leave their homes for essential trips, as was advised during the province's first wave.

Work, education, exercise and fitness, healthcare appointments and the purchase of food would all be considered essential reasons for leaving the house, and the city says up to two individuals from outside a household would also be permitted to provide social support if an individual lives alone.

Additionally, Dr. de Villa is also recommending that large venues be required to submit a plan to Toronto Public Health demonstrating how they will comply with public health measures, such as seating that ensures physical distancing and a method to collect individual contact information.

Public health measure recommendations for the following were made to the Province today:
1. Restaurants and Bars
2. General Public
3. Recreation, Sports and Gyms
4. Managing Public Health Measures in Large Venues
More: https://t.co/VaeJR6ItmO

— City of Toronto (@cityoftoronto) October 2, 2020

"Dr. de Villa has concerns about exposures and outbreaks in large venues, some of which can have a capacity of more than 100," reads the city release. "She also expressed concerns about the current regulations that allow for 30 per cent capacity in these venues."

According to the city, the seven-day moving average of COVID-19 cases on Sept. 1 was 40, and it rose to 84 on Sept. 17. On Sept. 29, it grew again to 236 — an almost six-fold increase.

There are also currently 169 active outbreaks in the community in Toronto, as well as in congregate settings such as schools, childcare, workplaces and long-term care homes. In the last three weeks alone, outbreaks in long-term care homes have increased from two to nine.

"Between September 20 and 26, there were 45 active community outbreaks," notes the release. "Of these outbreaks, 44 per cent were in restaurants, bars and entertainment venues. Socializing in bars and restaurants is contributing to significant exposures and outbreaks."

Due to Dr. de Villa's limited authority under Section 22 of the Health Protection and Promotion Act, she has requested that Chief Medical Officer of Health Dr. David Williams use his legislative powers to either enact these changes himself or consider making the necessary changes to provide her with the authority to take these actions as quickly as possible.

"Throughout this pandemic, we have followed Dr. de Villa's advice to keep our residents safe and help businesses reopen. Toronto Public Health has made additional recommendations to the Province about how we can stop the spread of COVID-19 now," said Mayor John Tory in a statement. 

"These are tough recommendations, but I believe they are necessary in order to protect seniors in our long-term care homes and students in our schools. I will be fighting relentlessly to secure federal support for restaurants and other businesses. We need all residents and businesses to follow public health advice right now in order to stop this virus as quickly as possible and to avoid much tougher and much longer public health measures."