Of the 9,496 deaths reported in British Columbia between the start of the pandemic and October 2021, less than a quarter were blamed for COVID-19. Can a cascading tragedy combining pandemic, opioid crisis and climate change explain the rest?
Excessive mortality in British Columbia has surpassed all other provinces in Canada in the first year of the COVID-19 pandemic, a new study says.
A peer-reviewed report published in the Canadian Medical Association Journal on Monday used public data to see how many over-deaths occurred in each of Canada’s provinces from March 2020, at the start of the pandemic, to October 2021, in one year and half later.
Excess mortality measures how many deaths actually occurred compared to what was expected under normal circumstances. This is one of the ways in which researchers have been able to determine the true number of lives lost due to COVID-19. But what emerged from the study was a huge difference in the number of unexpected deaths in each province recorded just before the Omicron variant hit.
“I think we all know that there have been COVID-related deaths. But to see the differences, at least in these estimates? … It was surprising, “said study author Kimberlyn McGrail, a professor at the School of Population and Public Health at the University of British Columbia.
In his analysis, McGrail used Statistics Canada data to track the number of deaths. She then compares these numbers with a model that calculates how many deaths would have occurred if the pandemic had never occurred.
She found that in the first year of the COVID-19 pandemic, Canada saw an increase in over-mortality of about five percent. That’s higher than many countries, but less than the United Kingdom, which saw an 18 percent increase in over-deaths, or the United States, where over-deaths rose to 22 percent in early 2021.
In Canada, McGrail estimates mortality based on 100,000 people. In this way, it can directly compare provinces with different populations. The researcher avoids analyzing redundant deaths in three Canadian territories due to the small number of COVID-19 cases before Omicron reported there.
McGrail eventually found that the death rate was lowest in the eastern provinces of Canada – even falling below what was expected on Prince Edward Island and Nova Scotia.
Quebec had the highest reported mortality from COVID-19 in Canada. But while there were moments during the pandemic where over-deaths outpaced reported deaths, at other times there were “significant periods during which mortality rates were lower than expected,” even falling below zero.
Ontario seems to have the smallest difference between reported COVID-19 deaths and excessive mortality, suggesting that the province is the best at tracking pandemic deaths.
With a 4.5-fold difference between reported deaths from COVID-19 and over-deaths, British Columbia is ahead of all other provinces in the number of unreported deaths. Only Alberta and Saskatchewan came close to Canada’s westernmost province.
Determining how people died during the pandemic has challenged health officials and vital statistics agencies around the world. To date, nearly 6.3 million people have officially died from COVID-19 worldwide. But some believe that the actual number of deaths from COVID-19 could be three times higher.
As the difference in BC shows, the virus is not the only factor that increases mortality to unexpected highs.
The heat dome leads to the highest weekly levels of over-mortality in Canada
During the Thermal Dome in 2021 in late June, the excessive deaths of 100,000 people in British Columbia literally jumped off the chart, rising to 90 deaths per 100,000 people. This is higher than the weekly over-death rate anywhere in Canada at any time during the pandemic.
“Alberta, British Columbia and Saskatchewan stand out for having an excess mortality rate, almost double (or more) than in other provinces,” McGrail wrote.
McGrail says Canada’s “remarkably diverse” mortality patterns probably have a number of explanations. It notes limited testing capacity, deaths occurring in the community rather than in the hospital, and different public health reporting practices may have played a role in deciding whether to classify the cause of death as COVID-19-related.
“These provincial variations tell me that the first thing I need to understand is how different approaches to testing, contact tracking and coding – identifying COVID-related deaths – can vary from province to province,” she said.
Another factor that could affect the number of deaths in the first year of the pandemic: delayed or canceled operations, diagnostic tests or doctor’s appointments.
To better understand which province actually had a “problem with COVID-19,” McGrail said differences in public health reporting practices must first be ruled out.
In places and times where mortality rates have fallen below expectations, McGrail points to a pandemic decline in car accidents due to fewer people on the road and a reduction in flu-related deaths. Statistics Canada said it did not currently account for deaths avoided as a result of COVID-19 measures.
Other factors that need to be addressed include how pandemic policies and border closures have affected the dangerous supply of drugs, leading to more people using and overdosing on opioids alone, McGrail said in a report.
Increase in unexpected deaths in BC
British Columbia reported 9,496 deaths in more than October 2021, more than twice as many as Quebec and almost as many as Ontario, a much larger province.
Of these deaths, only 2,109 – or 22 percent – are due to COVID-19. It is unclear to what extent the opioid crisis and heat wave of June 2021 led to the remaining nearly 7,400 unexpected deaths. But during the same period, the BC Coroners Service reported that 3,416 people had died from illicit drug overdoses – more than suicides, homicides and motor vehicle accidents combined. The heat wave is estimated to have killed only 600 people.
Even if these two causes of death are eliminated, this still leaves about 3,000 deaths unknown under normal circumstances.
Citing the clash of the SARS-CoV-2 virus, public policy and climate change, McGrail noted a potential cascading effect, leading to the most vulnerable facing a double or even triple crisis.
McGrail cites a report by Human Rights Watch published in October 2021, which concluded that the inadequate response from the British Columbia authorities had exacerbated heat-related deaths in the province. But because these deaths are “strongly linked to social and material deprivation,” COVID-19 and the poverty that comes with it may have paved the way for the most vulnerable to suffer the worst effects of extreme heat.
“If you think about the effects of COVID, they would have some impact on the heat dome deaths because it would affect the policy response,” McGrail said, referring to public health measures that have prompted people, especially older British people. Colombians, to isolate.
McGrail called on all provinces and territories to come together and conduct a forensic analysis of how mortality developed during the pandemic. To that end, she has shared her work with the federal and government health authorities of British Columbia and plans to achieve more, now that her work is public.
The reform of the death tracking system cannot come too soon. An international analysis by The Economist found that Canada was three to four months behind its peers in reporting deaths.
“Even the main record of mortality, we are very slow in Canada. That can and must be fixed, “McGrail said.
But she is trying to convince not only the government.
On the second front, McGrail says more 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,” she said.
“And that requires information. That requires trust. “
Add Comment