COVID Deaths : Correcting The Numbers

"[Right now Canadians only know about those people who have died from the novel coronavirus after being diagnosed with it]. But there may be people in the community -- in fact there likely are -- who are not being captured by this process."
"One of the cleanest ways of accounting for those 'missed' deaths is to compare the number of deaths now to the same time period in previous years." 
"We can get a sense as to how wrong or how right our existing models were -- and maybe improve them down the road."
Professor Raywat Deonandan, epidemiologist specializing in global health, University of Ottawa

"We have observed anecdotally people presenting late in the course of their cardiovascular illness."
"So instead of calling 911 after 20 or 30 minutes of pain, they're waiting a longer period of time."
"People can get the attention they need."
Dr.Rob Beanlands, head, division of cardiology, University of Ottawa Heart Institute

Healthcare workers do testing at a drive-thru COVID-19 assessment centre at Etobicoke General Hospital in Toronto on April 21, 2020. Because of massive data gaps, the coronavirus death toll likely is being underestimated.

There is a formal, declared death rate of COVID-19 in Canada collectively, and the provinces also deliver regular updates on deaths due to the novel coronavirus. But these numbers register those deaths where the presence of COVID has been diagnosed. There are many suspected instances of death where no diagnosis has taken place, where people have died at home or in hospital or in care homes and though COVID might have been involved in their deaths, without a test and diagnosis, the cause can be attributed to conditions outside of COVID.

Now Statistics Canada, the federal numbers-gathering agency, is preparing to identify the "extra" deaths taking place in Canada, over and above what is considered a normal rate, based on previous months and years on average. The agency has plans for the release of an analysis on "excess deaths", considered a measure of the number of deaths occurring beyond expectations in the country, aside from the numbers COVID-19 is seen to be directly responsible for.

Examining the total number of deaths from any cause and comparing that with historical averages, according to epidemiologists, can offer a more reliably complete idea of the impact of the pandemic, given that it can include people who have died from COVID-19, despite not having been diagnosed, or people who died while awaiting (postponed) surgery. Plans are for Statistics Canada to compare death rates in the first three months of 2020 with the rates in the first three months of the previous year.

The goal is to publish more timely information on deaths, working alongside provincial and territorial vital statistics offices. News of the planned data release has been welcomed by Canadian epidemiologists, as a means by which a deeper understanding of COVID-19's human toll can be achieved. Official figures released by authorities has the number of lives the disease has claimed as 4,567 throughout Canada. Epidemiologist David Fisman of University of Toronto views excess-death data as critical. "This is the ultimate metric of the impact of COVID-19, and whether we make it better with these very costly measures we've taken."

People who have died from what has been attributed to flu or stroke, but could be seen to be linked to COVID-19, and not ending up in the total count of COVID deaths reveals a real shortcoming in the system of data-gathering. As well, information on excess deaths is critical as well in assessing accuracy of pandemic models. A number of questions could be answered with an analysis of excess deaths in Canada:

• Are a significant number of undiagnosed people dying at home from COVID related issues?
• What is the effect of drop in the number of people seeking emergency help at hospitals?
• Has there been a rise in the mortality rate for other diseases?
• Has there been an increase in suicide rates?

In the city of Ottawa 13 percent more obituaries were published in April than in March (863 and 761 respectively). Montreal, hard-hit by COVID, saw a 45 percent increase in obituaries between March (606) and April (876), while also seeing a 38 percent jump on obituaries in April in comparison with 2019. Dr.Beanlands, head of University of Ottawa Heart Institute, notes emergency room visits have decreased by up to 50 percent during the pandemic, and people arriving at the hospital with major heart attacks decreased as well by up to 30 percent.

What is obvious is that people have been deterred from seeking timely medical attention. The concern at the heart institute is that people fear arriving at the hospital because of the fear of the perceived presence of COVID. Anyone with severe symptoms, Dr.Beanlands stressed, should call 911, and those concerned by their symptoms should contact their family doctor or specialist, many of whom offer virtual visits, while the heart institute itself has taken significant measures to protect against COVID-19.

In contrast to Canada's approach up to now, Europe published weekly mortality statistics, provided by 24 countries, analyzed by a network of epidemiologists, the network estimating that the pandemic has caused 149,447 excess deaths. In the United States, similar data is published by the Centers for Disease Control and Prevention. The death count surged to six times the normal number in New York City, according to an analysis undertaken by the New York Times.

Interestingly enough, and as has been seen in India with a dramatically plummeting traffic accident death rate, the lockdown has seen fewer traffic fatalities, since the bulk of the population is heeding the stricture to remain at home, and this trend should also be taken into account through analysis of excess-death numbers during the pandemic.

Royal Papworth Hospital in Cambridge, Britain

Neil Hall/Getty Images

"Definitely, if we are just counting COVID-confirmed deaths, we are underestimating the true death toll of COVID on Canadian society."
"There are a lot of things to take into consideration. That being said, it sounds like a lot of European countries and the U.S. have been able to produce this sort of data and publish it on a weekly, if not monthly, basis. Hopefully, COVID-19 will allow us to expedite the process here."
"On the end of the person filling out the paperwork, that usually has to be done in a prompt time. Depending on the province, it’s usually within 48 hours, or quicker if possible."
"Right now, the medical system is very focused on treating acute COVID. Sometimes if things are considered non-urgent, tests are being delayed , procedures and surgeries."
"What will the consequences be? It’s hard to know, but timely data about deaths will help doctors understand, and react."
"We may see an increase in breast cancer, colon cancer or cervical cancer."
"Having that all-cause mortality data would be important. So we see that maybe the number of strokes or heart attacks has significantly increased, so maybe it’s time for more public messaging to tell people: these are the signs and symptoms of a stroke or heart attack; do not ignore it, go to the hospital."
Dr.Jennifer Kwan, Burlington, Ontario