Dr. Eileen de Villa, medical officer of health, is the eye of Toronto’s public health hurricane.

“I have no idea how she manages to lead in the face of this storm, with the hours that she’s putting in, at all times remaining calm,” says health board chair Coun. Joe Cressy. “It’s remarkable — from our first morning call to our final call around 11 p.m., that empathetic, steady demeanour she exudes in the press conferences never wavers.” We got a few of de Villa’s precious minutes to check up on the doctor.

What does an average day look like for a physician leading Toronto’s fight to contain COVID-19?

De Villa: I get up around five-ish and do the usual sorts of getting ready for the day. Coffee is clearly involved. Right? I have to review what’s come in overnight, catch up on all the different reports and emails, and we have our first (conference) call at 7 a.m. The city partners, including Toronto Public Health, review all the issues that need to be addressed over the course of the day. Then many meetings, conversations and phone calls to understand what are the most important issues that need to be addressed, that require my attention. The heavy lifting of the response is done by my team at Toronto Public Health. My day usually ends around midnight-ish with a review of what’s happened over the course of the day. I often find that’s the quiet point in the day when I can actually catch up on that reading.

When did you realize COVID-19 was going to be a major challenge for Toronto?

De Villa: When the Chinese authorities first reported this new pneumonialike illness on Dec. 31 (and) the World Health Organization, that was my first “uh, I wonder what’s happening there.” We had no sense as to the size or scope of their outbreak. But given what we know about Toronto — a very diverse and a mobile population, lots of travel internationally, including to many parts of China, I certainly had my first suspicion there. By Jan. 7 we were putting out statements to our public saying, “We’re aware that there’s something happening, reports of illness, we’re watching this.” Then we moved into an incident management structure, which is a standard emergency response to organize the work.

The late Dr. Sheela Basrur was in your position during the SARS epidemic of 2003. Do you ever think of her while leading the fight against this virus?

De Villa: I’ve thought about her legacy quite a bit going through this COVID-19 response myself 17 years later. I do have very distinct memories of Sheela. I was a resident physician at the time and had the opportunity to work with Sheela directly, just before SARS actually. What I think about most as we’re going through the situation with COVID-19 are the characteristics and qualities I most admired about Sheela Basrur, the transparency with which she addressed the issue, her clarity of communication and her honesty with the public, all the while using the best available science and evidence to inform the decisions that she took — and the messaging that she provided to the people of Toronto through that very, very difficult time. I think to myself “If I can emulate that as best as possible, then I know I will be doing right by the people of this city.”

You’ve tackled issues including student nutrition and opioid treatment. Did you ever imagine you would be fighting a global pandemic that’s killing thousands of people?

De Villa: I was in practice in the late stages of my training during SARS, but not here in the city of Toronto. I am a veteran of the 2009 influenza pandemic and certainly have dealt with more than my share of outbreaks over the course of my career. I’m not sure that any of us had really anticipated that this would happen — these are truly unprecedented circumstances. It is quite the challenge, but with our preparation as public health and preventive medicine specialists we are well suited to meeting the challenges.

Your husband is a physician and you have three teenage kids. How do you have a family life amid marathon all-consuming days?

De Villa: It’s not easy. People talk about work-life balance, and frankly, just given the circumstances, and given my responsibilities to the city, it’s not a balanced situation. My family is always an important concern to me but my primary focus for now has to be on serving the city. While that is my professional obligation, given that I am a resident of Toronto, fundamentally I’m serving my family as well... They are extremely skilled at using all technological devices. So there is FaceTime, phone calls, they send me texts, memes they find funny, just to keep me entertained. I’ve never doubted for a second that I have the full support of my family and they know that. Even when I’m not there, I’ll send them a little quick note, just to say that I’m thinking of them.

You have massive responsibility on your shoulders, how do you handle stress? Can you unwind?

De Villa: Time to unwind time is hard to come by. But I’m a very, very fortunate individual. I have a fabulous network of people on whom I can lean for support at any time: folks here at Toronto Public Health, colleagues throughout the city, provincial counterparts, my family, a really fabulous network of friends. I get texts pretty regularly and messages of support from that very valuable support network. Of course, I try to provide that same support to others.

How do you warn Torontonians about the dangers of COVID-19 without scaring them into paralysis?

De Villa: Over the last three years that I’ve had the privilege of holding this position, I’ve spent quite a bit of time trying to establish a connection, a relationship. I do see the 3 million residents of this city as my patient — every last one of them. I find what makes for the best relationship, to be able to deliver important information in a productive and effective manner is straight communication that’s clear, transparent and honest. And full of empathy, right? I think the people of Toronto need to know how very much we do care about their health status and how much we feel the professional and ethical obligation to serve them well.

What keeps you up at night? Or are you so exhausted that’s not a problem?

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De Villa: The 3 million people of this city are my patients — I have a very strong feeling of obligation and commitment to them. People are getting sick and dying from this disease, and we know health-care systems in other parts of the world and other cities are being overwhelmed. I think about the social and economic disruption. At the end of the day, this is all about people. My focus is obviously Toronto, but of course I care about the rest of the province as well. Every single one of those numbers actually connects back to a person and a member of our community — somebody’s family member, somebody’s friend, somebody’s neighbour. Making sure we’re doing everything we can to reduce that loss of life and to minimize and mitigate the impact on health care ... those are the kinds of things that keep me up at night. But at a certain point you have to let the brain sort of shut down and get some rest so you can come back with a clear mind and focus on the task at hand.

Last year you were part of a successful fight to reverse deep cuts to provincial funding for public health in Toronto. Where would we be now if those cuts had proceeded?

De Villa: I am grateful to our provincial counterparts for the support that they’ve given us, collaboration and resources to deal with COVID-19 effectively. I think what will be interesting on a go-forward basis, once this outbreak is in the history books, is how we work together as a broad system, given that public health objectives are to improve health status, reduce disparities, and prepare for and respond effectively to outbreaks in emergencies.

Your scarves — have you always worn them? Why do you like them so much?

De Villa: Probably in the last 10 years, I’ve been a regular wearer of scarves. I think it makes for a great accessory. It also happens to be incredibly practical. I work in various office locations and the temperature is variable. A scarf makes it easy to manage all kinds of environmental conditions. The scarves also hold a memory for me. Many have been given as gifts over the years so when I wear those scarves it brings back happy memories of the person who gifted it to me. Sometimes scarves I’ve picked up are mementos of vacations and travel, memories that I have. Each scarf actually holds a special memory for me. And that’s a nice piece too, a little boost to have, as part of each and every day.

This interview was edited and condensed for clarity.