Jul 26, 2021, 20:05 pm
Published: June 29, 2021
Canada may have undercounted more than 5,700 COVID-19 deaths during the first 10 months of the pandemic — and even more since then, says a new report from the Royal Society of Canada.
More than 26,000 people have died from COVID-19, so far, according to official data from the Public Health Agency of Canada. By Nov. 14, 2020, the country had recorded 11,009 deaths.
But the newly released study, which examined data between Feb. 1, 2020 and Nov. 28, 2020, found evidence that Canada has vastly undercounted COVID deaths. The report, completed by a team of five researchers, found that if Canada continued to miscount fatalities past last November “the pandemic mortality burden may be two times higher than reported.”
Based on previous estimates, Canada is believed to have experienced 80 per cent of its COVID-19 deaths among people in long-term care, the report says. This is roughly double the average of 40 per cent among equivalent countries in the Organisation for Economic Co-operation and Development.
However the report, released Tuesday morning, suggests that these uncounted deaths occurred primarily in Canadians older than 45 who were not living in long-term care homes. The team found that up to two-thirds of deaths that occurred outside of long-term care homes are missing from Canada’s total.
If that’s the case, the percentage of Canadian COVID deaths in long-term care would fall to between 40 per cent and 45 per cent of total deaths — a figure more in line with comparator nations.
The data analyzed by the researchers suggest these deaths often happened in low-income, high-density and racialized communities.
“It strongly suggests that while the novel coronavirus was devastating the long-term care sector in two successive waves in 2020, it was also devastating communities outside long-term care,” the report says.
The report reaches its conclusion by applying a different formula than the one the government uses to a phenomenon called “excess all-cause mortality.” This is “extra deaths due to any cause that occurred beyond the number of deaths expected in a normal year.”
The standard method of analyzing these deaths — used by Statistics Canada — looks at week-by-week fatalities compared to the data from previous years, but, crucially, it includes negative figures.
In other words, if there were fewer deaths one week in 2020 than in 2019, it calculates a negative figure for that week, and this drags down the total sum of excess deaths. For example, in Ontario, two per cent of long-term care residents can be expected to die in a given month. If a patient died of COVID-19 in the first week of March, that death would be recorded then, and not, say, in the first week of June when they may have otherwise died. That would bring down the total number of deaths recorded in the first week of June.
As well, the researchers say, this practice of using negative numbers does not account for the protective effects of COVID-19 public-health measures and the reduction in other methods of death, such as accidents, violent crime and other common causes of excess death, such as influenza.
Statistics Canada says there were 13,798 “excess deaths” from January to December 2020. The StatCan method, the researchers say, “is useful for finding how many people died during the COVID-19 epidemic, who would not have died in the same period…. However, it is not as useful for estimating how many COVID-19 deaths have occurred in Canada.”
Instead, they used the method favored by the U.S. Centers for Disease Control and Prevention, which uses zeros instead of negative figures.
The researchers estimate that, in Canada, under this method, excess deaths between the start of the pandemic and Nov. 14, 2020, would have between between 19,680 and 24,441. The official COVID-19 death figures as of that date (11,009) account for between 56 per cent and 41 per cent of those excess deaths.
What could account for the other 8,671 to 13,432 deaths? One common explanation is toxic drugs. But the researchers say they accounted for this possibility, and subtracted the toxic drug deaths from their estimates.
As a result, the total number of excess deaths among those aged 45 to 84 in Canada was estimated to be 9,297 as of Nov. 28. The researchers said 3,531 of those can be attributed to COVID-19, based on the government’s official numbers, but that still leaves 5,766 excess deaths.
The report gives a number of reasons why they are likely more unaccounted COVID-19 deaths.
The researchers estimated that an additional 6,000 people aged 45 to 84 died of COVID-19 during the first 10 months of the pandemic.
Often, the missed cases would have to do with a lack of testing. Canada, compared to other wealthy countries, performed considerably fewer tests per positive COVID-19 case, at least up until May 2021.
The exception is Quebec, which, because of its testing and data practices, “was the only region in Canada where reported COVID-19 deaths largely accounted for all-cause excess mortality, and which appeared to be the province that came closest to accurately and completely measuring the full magnitude of its COVID-19 fatalities.”
While 87 per cent of COVID-19 fatalities officially reported across Canada were laboratory confirmed, deaths not accompanied by a positive test would be classified as a COVID-19 death only if the deaths were “clinically compatible” with COVID-19 and had been “closely epidemiologically linked” to a lab-confirmed case.
In other words, at the times when contact tracing was overwhelmed, these deaths wouldn’t be classified as COVID-19 deaths officially, unless there was a post-mortem test. That occurred inconsistently across Canada.
“We estimate that death certificates listing COVID-19 without naming it as the primary cause of death might have accounted for about 30 per cent of excess deaths unattributed to COVID-19 by the end of the first wave,” the report says.
The researchers say it’s possible they’ve over-estimated how many more deaths there are, but because of Canada’s out-of-date data system, “there is not enough data beyond June 27, 2020 to reach a concrete conclusion as to the full tally of missed deaths.”
https://www.healthing.ca/diseases-and-co...ths-report
Canada may have undercounted more than 5,700 COVID-19 deaths during the first 10 months of the pandemic — and even more since then, says a new report from the Royal Society of Canada.
More than 26,000 people have died from COVID-19, so far, according to official data from the Public Health Agency of Canada. By Nov. 14, 2020, the country had recorded 11,009 deaths.
But the newly released study, which examined data between Feb. 1, 2020 and Nov. 28, 2020, found evidence that Canada has vastly undercounted COVID deaths. The report, completed by a team of five researchers, found that if Canada continued to miscount fatalities past last November “the pandemic mortality burden may be two times higher than reported.”
Based on previous estimates, Canada is believed to have experienced 80 per cent of its COVID-19 deaths among people in long-term care, the report says. This is roughly double the average of 40 per cent among equivalent countries in the Organisation for Economic Co-operation and Development.
However the report, released Tuesday morning, suggests that these uncounted deaths occurred primarily in Canadians older than 45 who were not living in long-term care homes. The team found that up to two-thirds of deaths that occurred outside of long-term care homes are missing from Canada’s total.
If that’s the case, the percentage of Canadian COVID deaths in long-term care would fall to between 40 per cent and 45 per cent of total deaths — a figure more in line with comparator nations.
Quote:“So it’s not that we had a greater percentage of our deaths in long-term care than other countries, it’s that we missed the deaths outside long term care, and we missed a lot,” said Tara Moriarty, a professor at the University of Toronto and the chair of the study.
The data analyzed by the researchers suggest these deaths often happened in low-income, high-density and racialized communities.
“It strongly suggests that while the novel coronavirus was devastating the long-term care sector in two successive waves in 2020, it was also devastating communities outside long-term care,” the report says.
The report reaches its conclusion by applying a different formula than the one the government uses to a phenomenon called “excess all-cause mortality.” This is “extra deaths due to any cause that occurred beyond the number of deaths expected in a normal year.”
The standard method of analyzing these deaths — used by Statistics Canada — looks at week-by-week fatalities compared to the data from previous years, but, crucially, it includes negative figures.
In other words, if there were fewer deaths one week in 2020 than in 2019, it calculates a negative figure for that week, and this drags down the total sum of excess deaths. For example, in Ontario, two per cent of long-term care residents can be expected to die in a given month. If a patient died of COVID-19 in the first week of March, that death would be recorded then, and not, say, in the first week of June when they may have otherwise died. That would bring down the total number of deaths recorded in the first week of June.
As well, the researchers say, this practice of using negative numbers does not account for the protective effects of COVID-19 public-health measures and the reduction in other methods of death, such as accidents, violent crime and other common causes of excess death, such as influenza.
Statistics Canada says there were 13,798 “excess deaths” from January to December 2020. The StatCan method, the researchers say, “is useful for finding how many people died during the COVID-19 epidemic, who would not have died in the same period…. However, it is not as useful for estimating how many COVID-19 deaths have occurred in Canada.”
Instead, they used the method favored by the U.S. Centers for Disease Control and Prevention, which uses zeros instead of negative figures.
The researchers estimate that, in Canada, under this method, excess deaths between the start of the pandemic and Nov. 14, 2020, would have between between 19,680 and 24,441. The official COVID-19 death figures as of that date (11,009) account for between 56 per cent and 41 per cent of those excess deaths.
What could account for the other 8,671 to 13,432 deaths? One common explanation is toxic drugs. But the researchers say they accounted for this possibility, and subtracted the toxic drug deaths from their estimates.
As a result, the total number of excess deaths among those aged 45 to 84 in Canada was estimated to be 9,297 as of Nov. 28. The researchers said 3,531 of those can be attributed to COVID-19, based on the government’s official numbers, but that still leaves 5,766 excess deaths.
The report gives a number of reasons why they are likely more unaccounted COVID-19 deaths.
Quote:“We can never be absolutely certain … but what you do is you sort of triangulate, right, into different types of evidence, and you say based on what we know about how many people were infected, and it’s much higher than the number of cases that were actually detected,” explained Moriarty. “We know what percentage of those people should have died of COVID-19. And so from that we can say what what those numbers look like. And those numbers actually match really closely to what the the excess deaths were in 2020.”
The researchers estimated that an additional 6,000 people aged 45 to 84 died of COVID-19 during the first 10 months of the pandemic.
Often, the missed cases would have to do with a lack of testing. Canada, compared to other wealthy countries, performed considerably fewer tests per positive COVID-19 case, at least up until May 2021.
The exception is Quebec, which, because of its testing and data practices, “was the only region in Canada where reported COVID-19 deaths largely accounted for all-cause excess mortality, and which appeared to be the province that came closest to accurately and completely measuring the full magnitude of its COVID-19 fatalities.”
While 87 per cent of COVID-19 fatalities officially reported across Canada were laboratory confirmed, deaths not accompanied by a positive test would be classified as a COVID-19 death only if the deaths were “clinically compatible” with COVID-19 and had been “closely epidemiologically linked” to a lab-confirmed case.
In other words, at the times when contact tracing was overwhelmed, these deaths wouldn’t be classified as COVID-19 deaths officially, unless there was a post-mortem test. That occurred inconsistently across Canada.
“We estimate that death certificates listing COVID-19 without naming it as the primary cause of death might have accounted for about 30 per cent of excess deaths unattributed to COVID-19 by the end of the first wave,” the report says.
The researchers say it’s possible they’ve over-estimated how many more deaths there are, but because of Canada’s out-of-date data system, “there is not enough data beyond June 27, 2020 to reach a concrete conclusion as to the full tally of missed deaths.”
Quote:“It will never be possible to have perfect evidence unless you can actually go and somehow, you know, test people, months or years after they’ve actually died,” Moriarty said. “The evidence that we’ve shown is very much in line with what the evidence is that’s used in other countries that has supported the conclusion that almost all their excess deaths were COVID-19 as well.”
https://www.healthing.ca/diseases-and-co...ths-report