Pandemic has added significantly to Canada's overall death toll: Ontario study
There’s more evidence that COVID-19 has significantly added to the overall death toll in Canada, with a new study suggesting the pandemic boosted the number of fatalities in Ontario by up to a third in recent months.
It also pointed to unusual trends in how people died.
Not only did deaths in nursing homes soar compared to the number in previous years, but people died in their private homes at far higher rates than normal, the research concluded.
At least half, and probably more, of the thousands of excess deaths were due to COVID-19 itself. Many, though, were likely the result of delayed or avoided medical care and other reasons during the lockdown, the paper said.
The findings by scientists from the University of Toronto, Western University and Ontario’s chief coroner’s office are based on detailed provincial data for cremations. Those typically represent more than 70 per cent of the province’s deceased.
“It is important to provide people with the numbers, to say there was more death, there was a lot of COVID mortality. This is not influenza season,” said Laura Rosella, a University of Toronto epidemiology professor and one of the study’s lead authors.
“This is an impact to our health that we didn’t see in previous years. It is higher than we ever had … If we didn’t put those (lockdown) policies in place, we could see a lot more mortality.”
The paper was posted recently on a so-called “pre-print” site, meaning it has yet to be peer-reviewed, but is being submitted to a peer-reviewed journal.
The study is consistent with research in other parts of the world but is still important in cataloguing how COVID-19 has added to mortality, said Ronald Labonté, an epidemiology professor at the University Of Ottawa.
“The study findings, alongside other similar studies, should be a wake-up call to those who think it is a hoax, exaggerated or just a bad flu,” said Labonté, who was not involved in the paper.
Quebec also saw a similar, 35-per-cent increase in mortality in April compared to the average for the three previous years, according to preliminary provincial data.
In Ontario, COVID-19 has been blamed for 2,763 deaths, 65 per cent in nursing homes.
Though some other parts of the world have released mortality data almost in real time, official death numbers from Ontario’s vital-statistics office are not expected for another year or more.
So at the urging of the coroner’s office, the paper’s authors instead collated data on cremations. That was possible because coroners must approve and issue a certificate for every cremation that occurs, information the agency keeps in an electronic database.
The researchers looked at monthly numbers of cremations this year and the previous three, 2017-2019, the furthest back the electronic data reach.
They found relatively small increases in the overall number of deaths — 2.3 and 4.5 per cent — in January and February of 2020 versus the average for the previous three years, but much steeper spikes for the next three months.
The number of cremations rose from the earlier average by 8.4 per cent, or 517 deaths, in March; 32 per cent, 1,830 deaths, in April; and 20 per cent, 1,111 deaths, in May, the study found.
Reflecting the disastrous effect COVID-19 had on long-term care homes, the analysis found that the overall number of cremations for residents of the facilities exceeded the previous average by 89 per cent in April.
And there was a similar but slightly smaller jump in the total for people who died in private homes — over 60 per cent in April and May.
Rosella said the researchers can only speculate at this point about why so many more people were dying at home. But it could have related to their reluctance to seek help in hospitals perceived as contaminated by COVID-19, or even in small part to a surge in violence or self-harm, she said.
“That’s one of the most interesting parts of the study,” said Rosella. “There was a behaviour change there, in terms of people who would typically go to the hospital *.”*
Information in the coroner’s office database indicates that at least half of the excess cremations compared to the 2017-2019 period were people killed by the coronavirus. Some of the remaining 50 per cent were probably also COVID-19 cases, individuals who were not diagnosed or had false-negative tests, said Rosella.
But certainly many of them would have died from other causes, such as not getting the care they needed because they didn’t want to visit a hospital, or having treatment delayed, she said. Cardiovascular specialists have noted that the number of people reporting to hospital for heart attacks and strokes dropped during the pandemic.
Rosella said she does not blame officials who cancelled thousands of elective surgeries and other services and closed medical clinics in March, saying that it was likely the best response at the time to an uncertain and evolving threat.
But she said the system is already looking at ways of avoiding non-COVID harm if there’s a second wave, such as creating separate, coronavirus-free hospitals or parts of hospitals.
The researchers say it’s possible that some of the increase in cremations they found was the result of more people cremating rather than burying loved ones as the lockdown forced families to pare back funerals. But various indicators — such as the fact the cremation spikes paralleled the epidemic curve — suggest that phenomenon would have contributed little to the effect, said Rosella.
Is it also possible that those excess deaths were people who would have died within a few months, anyway, and that the numbers will in effect even out over coming months?
Time will tell, said Rosella, but it’s doubtful, requiring a drastic decline in deaths for the rest of 2020.