Of the 9,496 excess deaths reported in BC between the start of the pandemic and October 2021, less than a quarter were attributed to COVID-19. Could a cascading tragedy that combines the pandemic, the opioid crisis, and climate change explain the rest?
Excess mortality in British Columbia overshadowed all other Canadian provinces during the first year of the COVID-19 pandemic, according to a new study.
The peer-reviewed report, published Monday in the Canadian Medical Association Journal, used public data to see how many excess deaths occurred in each of Canada’s provinces from March 2020, the beginning of the pandemic, to in October 2021, for a year and a half later.
Excess mortality measures how many deaths actually occurred compared to what was expected under normal circumstances. It is a way in which researchers have been able to find out the actual number of lives lost due to COVID-19. But what emerged from the investigation was a large gap in the number of unexpected deaths that each province recorded in a period just before the arrival of the Omicron variant.
“I think we all know that there have been deaths related to VOCID. But to see the differences, at least in these estimates? … It was amazing,” said study author Kimberlyn McGrail, a professor at the study. School of Population and Public Health, University of British Columbia.
In its analysis, McGrail used data from Statistics Canada to track the observed number of deaths. He then compared these figures to a model that estimated how many deaths would have occurred if the pandemic had never happened.
It found that during the first year of the COVID-19 pandemic, Canada saw an increase of about five per cent in excess mortality. This is higher than many countries, but less so than the United Kingdom, which saw an 18% increase in excess deaths, or the United States, which saw the excess mortality increase to 22% in early 2021.
In Canada, McGrail calculated mortality rates per 100,000 population. In this way, you could directly compare provinces with different populations. The researcher avoided analyzing the excess deaths in all three Canadian territories due to the small number of pre-Omicron COVID-19 cases reported there.
In the end, McGrail found that excess mortality was lower in the eastern provinces of Canada, even falling below what was expected on Prince Edward Island and Nova Scotia.
Quebec had the highest COVID-19 mortality rate in Canada. But while there were times during the pandemic when excess deaths outweighed reported deaths, at other times there were “substantial periods during which mortality rates were lower than expected. “, even going below zero.
Ontario appeared to have the smallest gap between reported COVID-19 deaths and excess mortality, suggesting that the province was the best at tracking pandemic deaths.
With a 4.5-fold difference between reported COVID-19 deaths and excess mortality, BC outperformed all other provinces in the number of unreported excess deaths. Only Alberta and Saskatchewan came close to the westernmost province of Canada.
Determining how people died during the pandemic has challenged health officials and vital statistics agencies worldwide. To date, nearly 6.3 million people have officially died from COVID-19 worldwide. But some have estimated that the actual death toll from COVID-19 could be three times higher.
As the gap in BC makes clear, the virus was not the only factor that pushed mortality rates to unexpected highs.
The dome of heat causes the highest weekly excess mortality rates in Canada
During the heatwave of 2021 in late June, the excess of deaths per 100,000 people in BC literally came out of the graph, rising to 90 deaths per 100,000 people. This is higher than the excess weekly mortality anywhere in Canada at any time during the pandemic.
“Alberta, BC and Saskatchewan stand out for having excessive mortality rates almost twice as high (or higher) than in other provinces,” McGrail wrote.
McGrail says “remarkably diverse” mortality patterns in Canada probably have several explanations. He noted that limited probation, deaths in the community rather than a hospital, and various public health reporting practices were likely to play an important role in deciding whether or not to classify a person. cause of death as related to COVID-19.
“These provincial variations suggest to me that the first thing to understand is how different approaches to testing, contact tracking, and coding, identifying COVID-related deaths, can vary across provinces,” he said.
Another wildcard factor that could have affected how many people died in the first year of the pandemic: delayed or canceled surgeries, diagnostic tests, or doctor appointments.
To better understand which province actually had a “COVID-19 problem,” McGrail says differences in public health reporting practices must first be ruled out as a cause.
In places and times where mortality rates fell below expectations, McGrail points to a pandemic decrease in car accidents due to fewer people on the road and a reduction in flu-related deaths. Statistics Canada, he said, currently does not count the deaths avoided as a result of COVID-19 measures.
Other factors to consider include how pandemic policies and border closures affected an unsafe supply of drugs, prompting more people to use or overdose only opioids, McGrail said in his report.
An increase in unexpected deaths in BC
BC reported an excess of 9,496 deaths in October 2021, more than double that of Quebec and almost as many as Ontario, a province with a much larger population.
Of these deaths, only 2,109, or 22%, were attributed to COVID-19. It is unclear to what extent the June 2021 opioid crisis and heat wave in the other 2021 caused the other nearly 7,400 unexpected deaths. But during that same period, the BC Coroners Service reported that 3,416 people died from overdoses of illicit drugs, rather than suicides, murders and motor vehicle accidents together. The heat wave is believed to have killed about 600 people.
Even if these two causes of death were eliminated, this still leaves about 3,000 dead without counting under normal conditions.
Pointing out the SARS-CoV-2 virus collision, public policy and climate change, McGrail pointed to a possible cascading effect that leads the most vulnerable to face a double or even triple crisis.
McGrail cited a Human Rights Watch report published in October 2021 that concluded that an inadequate response from British Columbia authorities worsened heat-related deaths in the province. But because these deaths were “highly associated with social and material deprivation,” COVID-19 and the accompanying poverty may have paved the way for the most vulnerable to suffer the worst effects of extreme heat.
“If you think about the implications of COVID, they would have had some impact on the deaths of the heat dome because it would have affected the political response,” McGrail said, noting the public health measures that pushed people, particularly the British old age, to isolate.
McGrail called on all provinces and territories to come together and conduct a forensic analysis of how mortality has developed during the pandemic. To that end, he has shared his work with the health authorities of the federal government and British Columbia and plans to go further now that his work is public.
Reform of the death tracking system could not come too soon. An international analysis by The Economist found that Canada is three to four months behind its peers when it comes to reporting deaths.
“Even the basic record of mortality, we are very slow in Canada. That surely could and should be fixed,” McGrail said.
But it is not just the government that is trying to convince.
On a second front, McGrail says more work needs to be done to involve the public in responding to public health crises.
“When we have another of these events … part of our response will be to be able to bring together community organizations, community groups and the general public very quickly,” he said.
“And that requires information. That requires trust.”