COVID-19 continues to affect communities and families across the country, and many have lost family members and friends. Beyond deaths attributed to the disease itself, the pandemic procured indirect consequences that increased the number of deaths from various factors, including delayed medical procedures or increased substance use.
Measuring excess mortality, which occurs when there are more deaths during a period than what would be expected for that period, may be the best gauge the indirect consequences of the pandemic and pandemic response.
From January to mid-December 2020, there were an estimated 296,373 deaths in Canada, representing an excess of 13,798 deaths exceeding the expected range had there been no pandemic.
In the early months of the pandemic, Statistics Canada notes the number of excess deaths and deaths caused by COVID-19 were closely aligned and mainly affected older populations, suggesting COVID-19 itself was driving excess mortality in Canada.
From March to early June, there were 8,530 deaths where COVID-19 was the underlying cause, based on the medical certificate of cause of death, exceeding the number of excess deaths (8,496) by under 1 per cent over that period, the stats show.
Overall, during those first months of the pandemic, 86 per cent of excess deaths occurred among individuals aged 65 and older. Similarly, COVID-19 deaths also disproportionately occurred in older populations during the March-to-early-June period — approximately 94 per cent of the deaths caused by COVID-19 involved individuals aged 65 and older.
On the biggest lesson learnt from the federal government’s handling of COVID-19, Chief Public Health Officer Dr. Theresa Tam said, “we failed the most vulnerable.”
“I think the tragedy and the massive lesson learned for everyone in Canada is that we were at every level, not able to protect our seniors, particularly those in long-term care homes,” Tam said in an interview on CTV’s Question Period.
“Even worse is that in that second wave, as we warned of the resurgence, there was a repeat of the huge impact on that population.”
However, as provincial public health measures and lockdowns ramped up in the fall, the number of excess deaths exceeds the number of deaths directly due to COVID-19.
The cause of death has been reported for 94 per cent of the deaths during the first period of excess mortality in Canada — from March to June.
From September to November, 3,626 excess deaths were reported nationally. There were 1,835 deaths reported caused directly by COVID-19, with this number expected to rise as more deaths are reported by the provinces and territories, the stats show.
Younger people were more affected by excess deaths because 35 per cent of these deaths involved individuals under the age of 65, up from 14 per cent in the spring.
Failing to acknowledge the indirect consequences of the federal government’s COVID-19 response, she repeated her previous remarks as their failure to protect vulnerable Albertans “will be forever etched in our collective memory.”
“Not just seniors, racialized populations, women, and people in congregate… housing, so that is the biggest lesson learned, for sure,” she said.
The deaths related to the indirect consequences of COVID-19 predominantly affect younger populations, suggesting that other factors are now at play.
Like observations in the spring, about 95 per cent of the deaths directly caused by COVID-19 during the fall involved people aged 65 and older.
The number of deaths was 24 per cent higher than expected for men aged under 45, followed by women aged 45 to 64, who recorded 14 per cent more deaths than anticipated. By comparison, there were 6 per cent more deaths than expected among those aged 85 and older during the fall period.
As these shifts imply an increase in deaths not directly caused by COVID-19, it is essential to note that some deaths may be due to the pandemic’s indirect consequences, including increases in mortality due to overdoses.
For example, in British Columbia, the Chief Coroner’s Office reported increases in deaths due to overdoses since the start of the pandemic.
Similarly, Alberta Health Services reported decreases in both the provision and use of substance use treatment programs and increases in opioid-related emergency responses and deaths since the onset of the pandemic.
Overdose deaths disproportionately affect younger men.
For example, according to a report by Alberta Health, between January 1 and June 30, 2020, 79 per cent of apparent unintentional fentanyl overdoses were among men, with those aged 25 to 39 recording the highest proportions of such deaths.
Increased excess mortality in Alberta and British Columbia partly accounted for the shift.
In the fall, there were 12 per cent more deaths than expected in Alberta, up from 5 per cent more deaths than anticipated in the spring. Similarly, for British Columbia, there were 9 per cent more deaths than expected in the fall, compared with 6 per cent in the spring.
While overdose deaths across Canada appeared to decline in 2019 from highs in 2017 and 2018, there are early signs of an increase in 2020. For example, Alberta reported 220 deaths caused by overdoses from March to June 2020, compared with 170 overdose deaths during the same period in 2019.
The share of excess deaths for Ontario was relatively similar in the spring (39 per cent) and fall (40 per cent).
Based on data received to date, from March to June, the number of deaths from specific causes rose in several provinces compared with the same period in previous years. For example, the number of deaths caused by heart disease in Ontario increased from 4,125 in the spring of 2019 to 4,345 in the spring of 2020, higher than the spring of the previous five years.
Dhaliwal is a Western Standard reporter based in Edmonton
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