Eileen de Villa is not freaking out

Eileen de Villa Is Not Freaking Out

How Toronto’s medical officer of health got us to flatten the curve

By Katrina Onstad| Photography by Katherine Holland
| May 19, 2020

The first time Eileen de Villa, Toronto’s medical officer of health, heard about a viral outbreak in China, she, like the rest of the world, figured it was likely nothing to worry about. It was the morning of December 31, and a report had come across her phone. She was drinking coffee in the kitchen of her house in the west end, near Old Mill, planning for a quiet New Year’s at home with her husband and whichever of her three teenage boys—15-year-old Ryan, 17-year-old Nicholas and 18-year-old Aidan—was around.

The news of the outbreak triggered a few thoughts: the end of December is cold-and-flu season, and doctors are often on vacation, so emergency rooms tend to get more flu presentations; maybe this was just a flu strain. The next thought was more concerning: if it was something serious, it could carry. But de Villa is nothing if not rational, and a viral Christmas outbreak was the more likely scenario. She filed it away and went about her day.

But by mid-January, the number of cases was growing in China. When there’s a forest fire, the first response is to contain it, and that was the initial approach to the new virus: track down everyone who had been in contact with an infected person—this is called contact tracing—and isolate them. Still, the numbers kept growing, and when Hubei province went on lockdown, de Villa was forced to imagine the unimaginable for the first time. “Cordoning off an entire jurisdiction with a population larger than our country’s—it was unfathomable,” says de Villa. “You naturally think: how might we do that here? Could we even do that?”

At the city, it was time to initiate the Incident Management System. It sounds like something shouted on the deck of a spaceship, but incident management is a standard emergency preparedness response that cities unleash when facing major crises. Training and simulations for a pandemic were common in Toronto, and everyone involved already knew what their role would be. The Covid Strategic Command Team met every morning at 8 a.m. in Committee Room 1, a vast chamber at city hall—later, they’d be purposely seated far apart, dotting the room like a poorly attended church service. At the top of the incident management system were Mayor John Tory and City Manager Chris Murray; beneath them, de Villa and Fire Chief Matthew Pegg, who was named incident commander, leading the Planning and Response Team. Because this particular emergency wasn’t a hurricane or a flood but a public health crisis, de Villa was the axis point around which everyone orbited; all roles were about her role. Everyone was there to translate and implement her advice and recommendations. “We all look to her,” says Pegg. “She sets the tone.”

Eileen de Villa is not freaking out
De Villa, shown here with Ontario’s chief medical officer, David Williams, and associate medical officer of health Barbara Yaffe, gave regular press briefings in the early days of the pandemic

On January 25, de Villa’s office got a call from a physician at Sunnybrook; the hospital had just logged the first Toronto patient with the novel coronavirus. De Villa caught her breath. Now the disease had a human face. Patient Zero, a Toronto man in his 50s, had returned from Wuhan on China Southern Airlines flight CZ311, flying into Pearson on January 22. Toronto Public Health put a team of detectives on the case to do the contact trace, mostly nurses and later medical students. From cubicles at TPH headquarters, they phoned passengers who had been in Patient Zero’s radius, asking about their temperature and whether or not they had a cough or other symptoms, followed by an order to self-isolate. The detectives would go on to gather detailed information: who the person had been in contact with, plus credit card statements and TTC passes—details to track movements and build a picture of each person’s web of contact. They were essentially doing what homicide detectives do: gathering forensic evidence to anticipate where the murderer would go next, potentially preventing transmission. De Villa’s job was to stop the carnage before it started.

During lockdown, I’ve found myself oddly compelled by de Villa’s daily press conferences. Perhaps it’s the scarf that rotated reliably every day. Perhaps it’s the unflinching scientific explanation of calamitous news, the soothing way she delivers her sensible pleas to physically distance and shelter at home, like a patient language teacher leaving a pause for each student to mentally translate… before… moving… on. That nerdy, radiant patience is not just a counterintuitive response to the chaos, but something inborn.

A medical health officer is an unlikely celebrity, but this is an unlikely moment. Covid-19 has exalted the nerds. Nurses and doctors, lab researchers sprinting toward a vaccine, scientists repurposing vacuum cleaners into ventilators—these are the people engendering trust and awe. There’s no room for frivolity right now; a star-studded video rendition of “Imagine” is gratuitous, if not contemptible. Instead, we’ve projected our collective affection onto those whose concrete skills are our only hope of survival. In Canada, leadership throughout the Covid crisis has been driven by science, and polls suggest that Canadians approve of this approach, distinguishing us from our disordered southern neighbours. Hence the sudden folk-hero status of wonky scientists like de Villa, whose name appears on a charity T-shirt alongside other Covid doctor celebrities, including Theresa Tam, chief public health officer of Canada, and British Columbia’s beloved provincial health officer, Bonnie Henry (who has a shoe name after her, designed by John Fluevog). It isn’t usually like this. Public health is, by definition, a bland project: it’s working best when no one is talking about it. There’s never been a headline that reads: “Area Man Goes Out to Dinner, Does Not Get Salmonella.”

De Villa took the top position at Toronto Public Health three years ago. It’s a gig that’s equal parts extremely important and extremely unglamorous. Her job is to persuade us that our lives are worth saving. Before Covid-19, she was in non-stop PSA mode, imparting the dangers of smoking, the need for vaccinations, the scourge of opioid-related deaths. Her drumbeat was steady: health status has little to do with health care and more to do with social determinants like education, housing, poverty. Councillor Joe Cressy, chair of the city’s board of health, describes her as a rock. “But a human rock,” he clarifies. “Calm, steady, deeply compassionate. That said, science is what drives her policy recommendations.” But years of proselytizing isn’t what got her name on a T-shirt. Her 2018 TEDx Talk on opioids (titled, now ironically, “The Defining Health Crisis of Our Time”) has only 4,300 views on YouTube.

Her low profile ended when the pandemic hit. She’s appeared on our screens almost daily, seated behind a blue-skirted table next to Tory, in front of a row of flags, delivering alarming numbers about how many Torontonians are sick and dying. After reciting the numbers, she gently—very gently—asks us to do better, to be personally vigilant for the greater good. Clarity is her brand. Fine. We’ll take it. No flash required. The calm is comforting; we hope that it’s infectious. The calm is why it’s charming and incongruous to see her doing live FaceTime chats with Serge Ibaka, or starring in a mystery Twitter account called “Dr. de Villa’s Scarf” that tracks her daily scarf habit (@de_scarf).

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Meanwhile, de Villa’s private existence has been upended. Most days, she works from 5:30 a.m. to midnight, and sleeps in a room at the Sheraton, across from Nathan Phillips Square, away from her three teenage boys to avoid spreading infection. Her husband, Richard Choi, is a cardiologist at St. Joseph’s Health Centre who volunteered to join the ICU during the pandemic, treating Covid patients. He could have taken a pass, but he and de Villa didn’t have to talk about it long. “I’m trying to follow Eileen’s lead, where if you’re called to action, you do whatever you can to help, even in ways that you may not have imagined,” says Choi. “When the call comes, you have a choice to make. And you put your fears aside.” He has set up a system: when he comes home from the hospital, he strips at the door, beelines to the washing machine and drops his clothes directly in without touching anyone or anything.

The two younger boys’ school has transitioned to online learning, and de Villa tries to help out over the phone. The eldest, who was finishing his first year at Waterloo, is now home—Choi picked him up in March in a rented van. De Villa sends texts about dinner (mostly takeout) and frequently reminds “her men,” as she calls them, to wash their hands. They FaceTime or Google Duo every day, and Choi has taken over the cooking and grocery shopping, while the boys have been assigned dishes, laundry and vacuuming. “There has been redeployment at home,” he says. “It’s all hands on deck. Like most families, there is pushback as to who is cleaning the washrooms until it gets to the point of no return.” De Villa’s mother, Maria Antonina—she goes by Nenette—lives in Etobicoke, a 10-minute drive from de Villa’s family, and has been self-isolating due to her age. De Villa hasn’t seen her in person for months. Her sons regularly leave takeout on their grandmother’s porch.

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De Villa and I met on the phone and via Skype in early April, obeying social-distancing protocol. During this time, the Covid death toll was mounting, and emotions, mine and the city’s, were high. My home had become a makeshift school while I tried to work. A friend lost her grandfather to Covid. I could feel my community, locked down for a month, unravelling around me. On the sidewalk, neighbours shouted at one another, incredulous at both the constraints and those who refused to follow them. A viral video montage of mayors in Italy, losing it as citizens continued to disobey quarantine measures, seemed to embody how all public officials were probably feeling, wanting to gesticulate with their hands and scream in all-caps Italian: “YOU NEED TO STAY AT HOME! PEOPLE ARE DYING! DON’T YOU GET IT?”

At 51, de Villa is inexplicably youthful. Even over the phone and Skype, her serenity was palpable, and kind of comforting. But surely de Villa, too, felt crazed, splintered. Surely this pandemic was as terrifying for her as it was for the rest of us. In almost every interview, she says that she considers the three million people of this city her patients, so what did it feel like to learn that thousands of your patients might die?

“You cannot be a good doctor if you don’t feel,” she says simply. But I realized I didn’t want to know the details of those feelings. The whole city was overwhelmed with feelings. I was grateful that the medical officer of health was keeping hers to herself. Her calm was a necessity and a salve.

Standing on the deck of an outdoor pool when she was about two, Eileen de Villa rushed past her older brother, Joey, who was nervously considering his next move, and jumped in. What was weird was that she didn’t know how to swim at all.

De Villa has always been adventurous and extroverted—a person who feeds off the energy of other people. Her parents were both physicians; their training took them to Boston, where she was born, then back to their home in Manila, where she lived between the ages of three and five. A family headed by two doctors is wealthy by Filipino standards. “In the Philippines, you either have servants or you are a servant,” says Joey, and their family was on the have side. But the de Villas were not ostentatious, and her father was especially vigilant about reminding Eileen and Joey of their good fortune, pointing out how other people lived: that garbage cart is pulled by a water buffalo. Those corrugated tin huts are people’s homes. Not everyone has a car.

In the Philippines, de Villa’s sensors became highly tuned to the random gaps that separated people. The family wanted to stay, but decided to flee the escalating violence of the Marcos dictatorship, landing in Toronto in 1975. They first lived in a tower in High Park with other immigrant families, where de Villa befriended newcomers from Korea, Guatemala and Japan, many of whom were in limbo, waiting for their credentials before they could get established in Canada. De Villa’s father had a position as an ob-gyn at Wellesley Hospital, and the family later moved to a house in Etobicoke. The precariousness of the lives she encountered as a kid, in those High Park towers and in the Philippines, stayed with her.

The family was very close, and exceptionally accomplished. De Villa’s mother, Nenette, became the first female cardiologist at St. Joseph’s Health Centre. De Villa’s father, Guillermo de Villa, who died in 2006, was a community leader who helped establish the Filipino Centre on Parliament Street. For years, he was the only Filipino ob-gyn in Toronto, which gave him a built-in clientele: a generation of Filipino-Canadian babies were born in his delivery room. De Villa remembers sitting in the waiting room at Wellesley Hospital, happily chatting with the nurses while her father delivered babies.

Eileen de Villa is not freaking out
A medical officer of health is an unlikely celebrity. But this is an unlikely moment. Covid-19 has elevated the nerds

As a teen, de Villa adopted dark clothes and music (Joy Division, Dead or Alive) but not necessarily the adjacent attitude. Joey is a computer programmer who lives in Tampa, and also plays accordion, as documented on his blog, the Accordion Guy. “You know how there’s mopey goth and perky goth?” he says. “She was a perky goth.” De Villa thrived at Havergal, where she played tennis and volleyball and served as president of the Political Affairs Club. There were only a handful of Filipino students at the school, but she never felt out of place. “I did notice that my house”—she’s speaking in the Hogwarts sense of the word—“was rather blonde.” Nonetheless, she was elected house captain. On weekends, she and her friends would drive into Toronto in her dad’s car to eat at the Bloor Street Diner and go dancing at Nuts and Bolts, a nightclub downtown that now, as de Villa point out, houses the offices of Toronto Public Health.

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Still wearing black, de Villa got her BSc in psychology from McGill, minoring in women’s studies. With her eye on a career that could bring about social change, she took an internship with the UN, helping to establish basic pharmaceutical industries in countries without their own supplies, and later working with the UN Population Fund to create sexual health clinics in developing countries. The work took her to Vienna and New York and left her with a refined sweet tooth; she is known for bringing gourmet chocolates from her travels into the office, and dropping boxes on colleagues’ desks.

De Villa’s focus at the UN was community health. Her parents never directly pressured her to go into medicine—in fact, they were convinced she wouldn’t—but her time at the UN helped her realize she’d be better positioned to persuade people toward positive behaviours if she were a physician as well as a public health professional. So she enrolled at U of T med school and planned to join the family business.

During rotations at Wellesley Hospital, de Villa saw a parade of low-income patients suffering from substance abuse and mental illness. At Toronto East, where she also had a practice, her patients were largely young new Canadians. It wasn’t uncommon for a pregnant woman to walk into the hospital having just arrived in Canada the day before, with elevated blood pressure from the stress of the journey. De Villa is an astute listener—a nodder, an mmm-er, a “Yes, Katrina”-er—and bonded with her patients. Years later, she was often invited to birthday parties of babies she delivered (she would say no but always sent a gift).

While training at St. Michael’s Hospital, de Villa met Choi, who had come from B.C. for medical school. He was immediately taken with her warmth, friendliness and poise. “For me, it was love at first sight,” he says. When I Skyped with de Villa on Good Friday, she told me it was the 22nd anniversary of their first date, and she was hoping to get home in person for socially distanced Korean takeout with her family. Also, she desperately needed to do laundry.

While doing her residency, she did a stint at Toronto Public Health, where she met Sheela Basrur, then Toronto’s medical officer of health, best known for presiding over the 2003 SARS outbreak that killed 44 Canadians, which was then considered a shocking number. Basrur was the alpha medical celebrity for Toronto, appearing daily on TV for weeks, guiding the city through collective panic over an unknown virus from China. De Villa and Basrur share a hyper-articulate self-possession, and de Villa remembers watching her closely as she assuaged a city’s anxiety during SARS. “It was all about her communication style. She was the model for me as a young woman and as a person of colour. She looked different than everybody else,” says de Villa. “There are lots of articles now about public health women, but it wasn’t always like that.” On her desk at work, she has a card with an encouraging message that Basrur sent shortly before she died of cancer in 2008, at age 51. “I keep that to remind myself that she thought I had a bright future in front of me,” says de Villa.

SARS seized Toronto in 2003 at a rare moment when de Villa wasn’t working; instead, she was recovering from major surgery. In December 2002, her retina detached due to a congenital condition. The back of her eye had essentially peeled away and needed to be sewn back down. She was 20 weeks pregnant with her second son, and faced with the very real possibility of losing her vision in one eye. On Christmas Eve, de Villa went in for surgery—awake, because the pregnancy prevented her from receiving general anaesthetic. She was scared, but on the upside, the anaesthesiologist was a friend, and they chatted throughout the procedure. “What can you do?” says de Villa about this horrific surgery and the months that followed, when she was stuck at home with two kids she wasn’t allowed to pick up, her eyes so sensitive to light that it hurt to go outside. “You put one foot in front of the other and just get on with it.”

Uh, not always. To someone whose feet tend to stop in a crisis, who seethes at injustice when put on hold for more than 10 minutes, de Villa’s consistent unflappability is both admirable and perplexing. Refusing high drama is a family trait, according to de Villa’s brother. “There’s no freaking out,” Joey says. “I get annoyed when people lose their minds in a tough situation without trying to collect themselves first. She feels the same way. Any time she’s faced with a problem, she first takes everything in and goes, ‘What do we know about this? Let’s get another perspective on the situation.’ ”

He is describing the professional approach of both a good doctor and a good bureaucrat—which is, in effect, the job of the medical officer of health.

The pandemic has made strange bedfellows. Doug Ford, who called TPH “a bunch of lefties” a year ago and tried to cut $1 billion of their funding, now publicly lauds health officials as heroes. Yet, united front aside, the needs of Toronto differ hugely from the needs of rural Ontario. The virus hit here first but remained an abstraction in the rest of the province until much later, which may have slowed the adoption of measures that would have helped Toronto lock down sooner and reduce the virus’s spread. Just before spring break, Ford announced: “Go away, have a good time, enjoy yourselves.” At that time, de Villa was ramping up the messaging on social distancing and sheltering in place. Almost absurdly, in a city of three million people, the chief medical officer can only make recommendations; the province makes the orders. De Villa advised closing restaurants and bars in early March, but that actually happened only when Ford declared a state of emergency. “We pushed,” says de Villa. “We had conversations all the way through. And I can appreciate it from the provincial perspective. The actions we were promoting in Toronto—try explaining those to the folks up in North Bay who were seeing nothing. And that’s the problem. That’s the provincial purview.”

Even at the height of the fight over cuts to TPH, de Villa never publicly said a bad word about the provincial government. She won’t admit her political affiliations. That even-handedness seems baked into her DNA, the privileged public figure who empathizes with the less privileged.

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Still, like someone dancing around in front of a Beefeater, I was determined to get de Villa to break, to get her to admit how frustrating it is to navigate political minefields and clueless citizens who won’t behave in their own best interests. When she was advising people to shelter in place, as cases were multiplying and hospitals were running short of PPE, many Torontonians were strolling through High Park, hosting parties and drinking on blankets in Trinity Bellwoods Park. Don’t you just hate that? “I’m not sure berating people gets the kind of action you want. It’s all about communication. People are more likely to do the right thing if they know why,” she said mildly.

I asked some of her colleagues who had spent the past weeks in her presence if they ever saw her punching holes in the wall. “She will throw up her hands sometimes,” said Tory. “I’ve seen a little frustration. But then she just gets back to it.”

Then I asked one of de Villa’s closest friends, the Toronto Star wine writer Carolyn Evans Hammond, if de Villa ever panics or melts down. “I’ve never seen her lose her cool in 10 years.” She told me how once, when she was sick, de Villa came by with soup and sat at her bedside until she fell asleep.

Finally, I asked de Villa’s husband what makes her angry, and he paused for a very long time. “I can’t really think of anything,” Choi said. When she was on TV reminding people to social distance, he mentioned, he and his sons recognized that voice from home, like when she’s trying to convince them to pick up around the house.

In March, Mubarak Popat, a 77 year-old grocery worker in Little India, fell ill after visiting the United Kingdom. Per federal recommendations, he had self-isolated upon return, but he eventually ended up in hospital, testing positive for Covid-19. His son-in-law posted on Facebook about the staggering speed of his descent: one day, his father-in-law was dropping off food for seniors; a week later, he was on a ventilator. He died on March 21—Toronto’s first death from Covid-19.

By this point, de Villa’s command team was often pulling 18-hour days. Sometimes, to break the tension, someone would forward a jokey email, like the video clip of Samuel L. Jackson reading Stay the F**K at Home. At night, de Villa and Pegg, who were staying at the same hotel, would order Uber Eats and have dinner together in a boardroom, at opposite ends of the table, combing through data, adjusting the plan.

On the last Saturday in March, de Villa stood in front of a small group of city officials. She turned on a PowerPoint presentation. After a month or so of recommended measures, people were still getting sick, and faster. Toronto had experienced a 500 per cent growth in cases in two weeks, with more than 600 confirmed cases and 19 deaths. The evening before, de Villa had received the new Covid-19 modelling from the provincial medical officer of health, projecting the deaths of between 3,000 and 15,000 Torontonians if they didn’t take further action.

Eileen de Villa is not freaking out
On the Covid command team, de Villa is the axis around whom everyone else orbits. “She sets the tone,” says Fire Chief Matthew Pegg

Tory was seated near de Villa. He noticed that as those figures appeared on the screen, people’s jaws dropped. Tory thought of World War II, the last time he had heard of Torontonians dying together in the thousands. Cressy noticed a flicker of emotion beneath de Villa’s usually unflappable demeanour, something that resembled fear. After the meeting, he went to the bathroom to weep.

To protect the health of Toronto’s citizens, de Villa told her colleagues, Toronto must shut down for the next 12 weeks. There was no more wiggle room. There could be no more “voluntary” lockdown, or more people would die. She clicked to the next slide, which outlined a plan: non-essential businesses must close; isolation for people over 70; even people who were not ill and had not travelled recently should stay home.

Tory expressed some hesitation, leading a chorus of questions. How would this work, even? How do you force three million people to stay inside? Shutter the biggest economy in Canada? “You’re telling me an awful lot about how I can conduct myself. It goes against our way of life,” he recalls saying. De Villa progressed through her argument like a human PowerPoint, addressing every question with a data-backed response. In South Korea, forceful distancing measures were flattening the curve, while in New York, a city that hesitated, refrigerated trucks were being used as makeshift morgues. It was time to administer the city’s maximum powers and shut down Toronto.

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De Villa wouldn’t engage in any argument that pitted personal freedoms against public health. If freedom of movement wasn’t controlled, the virus would spread, without question, and there would be even greater individual restrictions later. “We recognized right then and there that she was our leader in that room that day,” Tory says. “She’s never going to give you a bad steer. When she told me that six feet in parks mattered, for example, I was comfortable signing something that’s out of sync with how we normally live.” Four days later, after the city’s lawyers cleared the plan, Torontonians were on lockdown.

In the hotel boardroom with Pegg, late at night, de Villa would wonder out loud how best to get the word out about preventative measures, to persuade people to do the right thing. “She kept asking, ‘Is my message okay? Am I communicating clearly?’ ” Pegg says. “She was always wanting to do more, and better.”

De Villa reached a massive segment of Toronto almost by accident. As is well known, she loves scarves, each one a memento of a place she’s travelled, or a gift. (Everyone in her family has a sartorial “thing.” Joey’s is Hawaiian shirts.) Serge Ibaka, a scarf aficionado himself, took notice on Twitter (“Art”, he wrote above her picture), so de Villa’s team conscripted him. In an episode of his video series, How Bored Are You?, he sits by his fireplace while de Villa and colleagues are spaced far apart in a bleak, fluorescent-lit room at TPH headquarters. Ibaka reiterates the importance of staying at home and washing hands, and wraps a scarf around his face, stiffly delivering a punchline: “This is more than art. Health is always important.” The video got almost 200,000 hits.

While her public profile was growing, de Villa’s private life was in the kind of disarray that many Torontonians were facing all through March and April. The toughest part, de Villa says, was being separated from her family. But she was quick to add that it’s a sacrifice she’s willing to make. “I take this obligation seriously. People put power and authority and expectation upon us as local medical officers of health. And that’s significant trust. It’s deeply felt.”

De Villa, Bonnie Henry and Theresa Tam all speak and text frequently. In a memorable moment early in the pandemic, Henry, reporting on a surge of deaths, stood in front of the cameras and broke into tears. De Villa sent her a text. “Just saying, we’re here with you. I know how painful it is.”

In mid-April, a shimmer of light appeared. New provincial modelling suggested that the strict health measures were working. They may, in fact, have averted hundreds of thousands of Covid cases. De Villa was optimistic, but she told me she was concerned for what came next. Toronto will have many citizens with permanent health issues from the virus, and it will take a long time for the city to recover from the psychic toll of these strange, mad months. We will all be much changed.

The press conference, though, was a victory. The numbers were good. The curve was flattening. Next to her, Mayor Tory and Fire Chief Pegg sat silently as she spoke, watching closely as she expressed, slowly, some tentative optimism. She had been proven right. She had forced us to do better for ourselves, and it worked. She wore a pink and green flowered scarf, the quietest hint of spring.


This story originally appeared in the June 2020 issue of Toronto Life magazine. To subscribe, for just $29.95 a year, click here.

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Correction
May 20, 2020

A previous version of this story incorrectly stated that de Villa met Sheela Bakur during her MBA.

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