Increased Deaths in Canada During COVID Lockdown

"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 [merely] influenza season."

"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."

"That's one of the most interesting parts of the study. There was a behaviour change there, in terms of people who would typically go to the hospital."

Laura Rosella, epidemiology professor, University of Toronto

"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."

Ronald Labonte, epidemiology professor, University of Ottawa

A body is removed after several residents died of the coronavirus disease (COVID-19) at the Eatonville Care Centre in Toronto, Ontario, Canada April 14, 2020. Carlos Osorio / Reuters

According to a new study, deaths in nursing homes soared compared to the numbers of deaths in previous years, even while people died in their own homes in numbers during the first wave of the novel coronavirus, at much higher rates than would have normally occurred. Evidence has been unearthed that COVID-19 significantly increased the overall death rates in Canada.

Half at the very least and in all likelihood more, of the thousands of increased deaths were a result of COVID-19 onset. At the same time many other deaths were held to reflect delayed or avoided medical care and other factors related to the coronavirus lockdown, according to the recently released research paper. Scientists from the University of Toronto, Western University and Ontario's chief coroner's office were responsible for the findings, based on provincial data for cremations which typically represent over 70 percent of the province's deaths.

Studies released in other parts of the world reflect similar conclusions. A similar, 35 percent increase in mortality was seen as well in Quebec, in comparison to the average for the three previous years, based on preliminary provincial data. COVID-19 is seen to have been responsible for 2,763 deaths in Ontario, 65 percent of which took place in nursing, or long-term care homes. This, in the absence of official death statistics from Ontario's vital-statistics office.

A woman prays as she leaves flowers outside Residence Herron, a senior’s long-term care facility, following a number of deaths since the coronavirus disease (COVID-19) outbreak, in the suburb of Dorval in Montreal Quebec, Canada April 13, 2020. Christinne Muschi/Reuters

In studying monthly numbers of cremations for the past four years researchers found small increases in overall death numbers in January and February of 2020 as compared to the average for the previous three years, but steeper spikes were seen in the following three months, with the number of cremations rising from 517 in March to 1,830 in April. The analysis found the overall number of cremations for residents of long-term care facilities exceeded the average previously seen by 89 percent, in April.

A similar increase in the total deaths for individuals who passed away in their own homes came to over 60 percent in April and May. It is speculated that peoples' reluctance to seek medical help in hospitals for fear of contracting COVID-19 contributed to the situation where an  underlying illness led to infection and complications. The possibility of lockdown contributing to domestic violence or self-harm also saw speculation as to cause-and-effect.

The very fact that the COVID lockdown had an effect on people relating to difficulties in seeing medical personnel, in being admitted to hospitals gearing up for a flood-tide of COVID victims, leading to people not having the medical care required because of reluctance to visit a hospital, or delayed treatment or medical/surgical procedures delayed may all have played a role. It had been noted that cardiovascular specialists saw the numbers of people reporting to hospitals for heart attacks and strokes dropping wholesale during the lockdown; another contributing factor.

A man walks through a homeless camp where approximately 150 people are living at a parking lot on Port of Vancouver property adjacent to Crab Park, in Vancouver on June 10, 2020.. THE CANADIAN PRESS/Darryl Dyck

Crowded Long-Term Care Homes : Patients at High Risk for COVID 

"Too often, the building and the physical infrastructure gets forgotten in this conversation."
"[But] public health experts ... would know on face value that that's sort of infection-prevention 101: crowded rooms are bad."
Dr.Nathan Stall, geriatrician, Mt.Sinai Hospital, Toronto

"We saw the numbers -- then shared that information with government and said, 'We have a very large problem here'."
"We need to prepare today to look at alternate accommodations and solutions ... We have to move very quickly."
Donna Duncan, CEO, Ontario Long Term Care Association

Verla Pacey, 102, waves through a window at Stoneridge Manor Long Term Care Home in Carleton Place, Ont., where six residents died of COVID-19. Pacey survived the virus. (Supplied)

Some of the havoc caused by COVID-19 in nursing homes where the highest mortality rates in Canada were seen among the elderly, boosting Canada's death rate attributable to the effects of the novel coronavirus, had a quite simple explanation, according to a new study. Elderly and health-impaired residents kept in shared accommodation turned out to be a particularly lethal arrangement.

Close to 300 long-term care resident deaths in one province alone could have been prevented, had the residents been housed in two-bed, rather than the ward-like four-bed rooms, according to the research results. Ontario scientists from University of Toronto, McMaster University and Public Health Ontario highlighted a clear association in the degree of crowding in the homes -- the number of people sharing a room and lavatory -- and the spread of the hugely contagious COVID virus.

The elderly living in the most tightly packed of the facilities turned out to be twice as susceptible to being infected and to perish, in comparison to those living in the least-crowded homes, according to the paper. When the pandemic struck, one in every four long-term care residents was housed in four-bed rooms.

Ontario standards introduced in 1999 held that new facilities would plan for no more than two people for each room, while older homes, mostly for-profit enterprises, were encouraged to retrofit to the same standards. According to Dr.Stall however, few have committed to making those changes to meet the new standards of two people per room.

A new report by the Canadian Institute for Health Information underscores that nursing homes have seen about 80 percent of Canda's 8,500 deaths. The per-capita number of long-term-care deaths averages among like industrialized countries, according to the Institute report. Yet Canada's deaths exceed those of other Organization of Economic Co-opration and Development members.

OECD countries saw deaths in their long-term care homes averaging 42 percent, ranging from under ten percent in Slovenia and Hungary up to 55 percent in Spain. As a percentage of the nation's total COVID-19 death rate, deaths in Canada attributable to COVID, exceed the record of other OECD members.

The Ontario Long Term Care Association says that about ten percent of residents live in four-bed rooms and that converting them to two-bed accommodation at the present time would effectively remove 4,300 places from the system, at a time when waiting lists for nursing home places currently stands at 36,000.

In anticipating the arrival of a second pandmic, Ms.Duncan feels the province should consider the conversion of existing unused building space such as vacant hospitals, hotels or arenas, into long-term care housing. Facilities were ranked in the study on the density of housing ranging  from those with mostly single rooms to homes with only four-person rooms.

The infection spread was seen to be higher in crowded houses with 9.7 percent infected as opposed to 4.5 percent in the least crowded of the homes; deaths 2.7 percent and 1.3 percent respectively. Placing all residents who were in four-bed rooms into two-bed accommodations would have prevented 988 COVID-19 cases and 271 deaths.

Past surveys reveal that 80 percent of residents would select a private room over a shared one, according to the paper. Most four-bed rooms are located in older facilities, with high occupancy rooms having curtains to separate residents, but "curtains are no match for this" virus pointed out Ms.Duncan. Unsurprisingly, an earlier study found that outbreaks were significantly higher in for-profit homes.

People show support for staff and residents at Ottawa's Carlingview Manor long-term care home, a for-profit facility owned by Revera that has experienced 61 deaths due to COVID-19. (Francis Ferland/CBC)

Not All Cities Are COVID-Equal

"I think we can safely say that certain drivers, such as a dense way of living, as well as age structure, in particular, the share of the population living in nursing homes, will strongly continue to predict worse [COVID] outcomes."
"What we find is that large metropolis are vulnerable mainly for two reasons. First, they are places with a dense way of life. Second, in large urban areas it is very hard to create a disease-free bubble because there is always inflow and outflow."
"Any epidemiological model of infectious disease will tell you that one of the most important drivers of the spread of the disease is the infection rate. Obviously that infection rate depends on how many other people an infected individual bumps into every day [and] that'll be much larger if I use the metro than if I live on an isolated farm in the countryside."
"Taken together, being connected to many other people makes you vulnerable. Ironically, what is very beneficial in normal times for the economy, makes you vulnerable in these abnormal times."
Klaus Desmet, economist, Southern Methodist University, Texas

The Toronto skyline on June 2. Photo by Peter J. Thompson / National Post

According to new research, certain cities become susceptible to the novel coronavirus infection rate much in excess of others as a result of complicating circumstances. In view of expectations of potential second and even third waves in the near future as SARS-CoV-2 reasserts itself, this research may be a critical tool for planning on the part of public health officials. Experts have been busy tracking the inexorable path of the coronavirus in view of the dread toll it has taken in Italy where close to 35,000 people lost their lives from its dread effects.

Germany, on he other hand experienced a quarter of the deaths that hit Italy, while New York City suffered the agony of experiencing the absolute worst global outbreak even as Los Angeles' death toll came out one-sixth the size of New York's. The greater Toronto and Montreal areas in Canada have accounted for over 66,000 of the approximately 100,000 cases in the entire country. According to Dr. Desmet, Canada's largest two cities' plight could be attributable to the very same forces that struck New York City, leaving it with a massive death toll.

A patient is transferred from Elmhurst Hospital in New York, US, on April 25, 2020. Elmhurst Hospital Trauma Center In Queens Borough of New York City Continues Receiving Covid-19 Patients. (John Lamparski/NurPhoto via Getty Images)

A city's density represents a factor of huge proportions in the incidence of COVID transmission, with other factors such as population age, and distance to an international airport; all characteristics that the two economists posit are most likely to define the occurrence of future outbreaks. From their study it seems clear to them that waves of the disease will not necessarily hit all cities in an equal manner; leaving some cities to cope with persistent outbreaks and other will be left in a relatively unscathed state.

Should this hypothesis bear out with future incidences validating the proposed trend, health experts and municipal authorities will be able to aim their resources in those areas identified with the greatest susceptibility, confident that other areas will not become vulnerable in their turn to similar-sized outbreaks. Those areas less affected will have little need to impose stringent lockdowns and can confidently anticipate earlier reopenings without fear of overwhelming their health-care system.

Density levels come most readily to mind when weighing the susceptibility to infection of any city. Verified by a glance at the statistics identifying North America's most population-dense cities with heavy outbreaks of COVID-19. Several features of density were considered in the study; the share of individuals living in multi-unit housing structures, and the number of people representing each household, along with a breakdown of occupancy per square kilometre.

Multi-unit housing and the size of households are both recognized to be positively associated with cases and death levels; a primary feature of any future outbreak. Places with more people using public transit have worse COVID-19 outcomes, and more so in terms of the death rate. There was a clear correlation found in the United States between the distance of a city to the international airport serving it, and an early COVID-19 outbreak.

Higher infection rates were seen to be clustered around Toronto's international airport. Peel Region, home to Pearson International Airport, saw a rate of 328 cases each 100,000 population, representing one of the highest rates in Ontario, second to the city of Toronto itself, with 394 cases per100,000 people. In Calgary, where the airport remained open to international flights, infection rates were much higher than what Edmonton experienced, which has a considerably smaller airport located a further distance from the city, and not open to international travel.



Researchers discovered the more people over the age of 75 the more likely for fewer cases to emerge, the reasoning being that younger people are likelier to search out activities that tend to spread the virus, such as large social gatherings and events. In some situations, an older population, however, can lead to greater death numbers, when considering outbreaks at nursing homes where social isolation, an immune-hampered and chronic health-vulnerable population surrenders to a demonically dangerous virus.

And then there is the perennial issue of poverty, its associated poor health outcomes in indigent communities and unequal access to health services with their bearing on mortality rate for all reasons including COVID-19. Outbreaks were identified in Black and Indigenous and Hispanic communities with higher infectious rates. What the conclusion of the study seemed to point out is that many of the activities that make for a well-adjusted social community are those that now place people at an increased risk of diminished health and possibly death.


"This should come as no surprise: as with any other infectious disease, contact between susceptible and infected individuals is a key determinant of the spread of the disease."
"There is a randomness in locations that got the virus early. One important exception is the variable capturing distance to international airports with connections to the top five COVID incidence countries as of March 15."
"Places with a large share of retired individuals may feature fewer places [bars, stadiums] where the disease spreads rapidly."
"This finding [outbreaks at nursing homes with high death rates] is consistent with the idea that once a county is affected by the pandemic, its nursing homes can quickly become powder kegs, and account for larger shares of countrywide deaths."
"Overall, these results confirm concerns that the COVID-19 pandemic has a disparate effect on various racial groups."
Study Report: Economists Klaus Desmet and Romain Wacziarg, University of California, Los Angeles  Study on COVID numbers in large cities: Report

Seeking Out all Mechanical Vulnerabilities to the Transmission of COVID-19

"We want to save lives, let's cut right to the chase."
"There are so many, many buildings ... This affects absolutely everybody. Billions of people. If we are able to cut down the transmission rate by a percent, that's a lot of people."
"This has been on people's radar for quite a while. Somebody on a different floor sneezes ... The particle can stay airborne long enough to go all the way through the [air conditioning] system and then pop out in somebody else's office." 
"While it’s not the most powerful method of transmission, it’s certainly one that makes people worry because we have a difficult time controlling it."
"People are spending most of their time indoors these days. And for places with air pollution, it’s even more important because the clear air is indoors in these highly-polluted megacities."
Professor Brian Fleck, scientific study, University of Alberta

"It is  highly likely that the SARS-CoV-2 virus also spreads by air, [requiring] all possible [action in response, including modifications in ventilation systems]."
"The fact that there are no simple methods for detecting the virus in the air does not mean that the viruses do not travel in the air."
"We predict that ... failure to immediately recognize and acknowledge the importance of airborne transmission and to take adequate actions against it will result in additional cases."
Chinese and Australian air-quality experts

"[The effort represents a] non-pharmaceutical intervention [that, if successful, could avoid] 
extensive consequences. It’s just as valuable as vaccine research."
"Improving ventilation systems in high-occupancy structures could be a critical way to contain the pandemic… This work has the potential to impact millions of people living and working in these buildings."
"[The research will unfold in three parts: a systematic review of research on air circulation and viruses, determining an effective strategy and then testing out that strategy on buildings at the Edmonton campus] to create a real-world model of what should be done."
Lexuan Zhong, engineering professor, University of Alberta

An African restaurant is closed off along with other businesses in Guangzhou's Sanyuanli area, where a neighborhood is in lockdown after several people tested positive for the novel coronavirus disease (COVID-19), in Guangdong province, China April 13, 2020. - REUTERS/David Kirton

Engineering professor Lexuan Zhong is leading a project involving the university's civil engineers funded by the Canadian Institutes for Health Research at the University of Alberta, consisting of three phases; systematically reviewing literature on air circulation and viruses, determining the strategies that would be effective, and finally conducting a detailed audit of all buildings on the Edmonton campus with the intention of creating a real-world model of what should be done in response to their conclusions.

Their interest in the possible role that building HVAC systems (heating, ventilation and air conditioning) may play a role in the transmission of the novel coronavirus stemmed from a case in Guangzhou, China detailed in a U.S.Centers for Disease Control online journal. Researchers had reached the conclusion that flow from an air conditioner moved over three occupied tables in the restaurant, carrying virus droplets from an infected patron at the middle table to the far table, then back to diners closer to the air conditioner.

It was a puzzle at first how eight diners at the restaurant all were infected with the coronavirus. A visitor from Wuhan, the coronavirus epicentre, suspected of being the vector had travelled to the Guangzhou region and happened to enter the restaurant. A team of local scientists came to a conclusion that tiny particles of virus had floated around on currents created by the restaurant's air conditioning, despite the prevailing view that the coronavirus is transmitted solely by heavier 'droplets'.

Now, the civil engineers at the University of Alberta have taken up the intriguing concept, one they are familiar with, hearking back to Legionnaire's Disease, a bacterial pneumonia transmitted in a hotel setting through the air conditioning system. Engineers are well acquainted with building ventilation systems as efficient distributors of viruses and other pathogens. They have set out to prove that COVID-19 falls into the same category. What now consumes their interest is conceiving of practical ways to curb infection risk; a "non-pharmaceutical" intervention.

"The HVAC system in most non-medical buildings play only a small role in infectious disease transmission, including COVID-19", responded the American Society of Heating, Refrigerating, and Air-conditioning Engineers, in defence of their product and their livelihood. The smaller, lighter aerosol particles capable of spreading through a ventilation system is still questioned by some: "the truth is that we still don't really know if the (COVID-19) virus can be spread by aerosols", virus expert Matthew Miller at McMaster University responded.

However, in a paper published earlier in the month, Chinese and Australian air-quality experts basing their hypothesis partly on the SARS experience, argued in their own study that as droplets from an infected person begin evaporating, the resulting smaller particles indeed may become airborne; evidence that passengers confined to their cabins on cruise ships was cited such that they may have been infected through the air ducts of the vessels.

Canadian cases

CONFIRMED

50,015

(Today: +1,526)

DEATHS

2,859

(Today: +152)

RECOVERED

19,203

(Today: +922)

782,541 tests administered  (Today: +28,023)

Canada-China Relations

"Establishing fake civil society NGOs is an established modus operandi of the United Front [Works Department, a secretive arm of the Chinese Communist Party whose purpose is to convince ethnic Chinese groups overseas to collaborate in supporting the government of China]."
Charles Burton, professor, Brock University, former Canadian diplomat in Beijing

"[The group -- Vancouver-based United Association of Women and Children -- seems to have] all the hallmarks [of a front organization to further Beijing's interests]."
"All but a tiny handful of Canadians of Chinese heritage are here [in Canada as immigrants] because they do not wish to be ruled or controlled by the CCP."
Jonathan Manthorpe, author, Claws of the Panda

"I think China has lots of freedom of speech. The Chinese media in China, they have very much freedom, to talk and to criticize and to make suggestions."
"The Chinese people would like to keep the good relationship to expand the business with Canada."
"But this matter [the arrest and extradition of  Huawei CFO Meng Wanzhou] will damage that because people understand Canada is doing something for the benefit of America."
Chinese-Canadian lawyer Hong Guo, Vancouver

A Chinese security official stands guard in front of the Canadian embassy in Beijing, China, Jan. 15 2019.
EPA/ROMAN PILIPEY

In the news lately there has been notice of Chinese students studying in Canadian universities attempting to demoralize, harass and complain about Canadians of Uyghur and Tibetan heritage speaking on Canadian university campuses about their ethnic groups' trials and tribulations with the Chinese Peoples Republic, calling on the universities to see that such talks are not permitted since they are insulting to China's sterling reputation on human rights.

Now, news of another group representing Chinese immigrants to Canada invested in pursuing China's interests within Canadian politics and the rule of law has come to the attention of the news media. Chinese groups working surreptitiously to influence Canadian politics, raising funds for Liberal governments, federal and provincial, posing for photographs with Prime Minister Justin Trudeau while being connected to the Chinese political hierarchy.

Following Huawei's Meng Wanzhou's detention by Canadian authorities awaiting extradition to the U.S. on fraud charges, two Canadians were detained while doing business in China and charged with plotting against China; both are being held in prison, subjected to torture and interrogation while another Canadian whose prison sentence for smuggling drugs was updated to capital punishment for his crime, have the two countries at diplomatic loggerheads.

And into the fray enters Canada's Foreign Affairs Department. Even while one of their own diplomatic employees on temporary leave, Michael Kovrig languishes in a Chinese prison along with businessman Michael Spavor, both randomly picked up and charged as an obvious reciprocal challenge to Canada to release Ms. Wanzhou, here is the director-general of the north Asia bureau pitching for the Canada-China Scholarship Exchange Program at the Chinese Embassy in Ottawa.

"My department is proud to support the CCSEP and is eager to see a broader representation of Canadians from across the country at the university and college level [travel to China to study there]."
"[Strong] people-to-people connections have been the bedrock of our dynamic bilateral relationship [ and both countries view] education co-operation [as a strategic priority]."
"And that priority is easy to see. China is Canada's most important source of international students with more than 140,000 Chinese students on campuses of Canadian institutions."

"It sends the message to the Chinese that, no matter what we say, we want the relationship to continue as if nothing had happened. I simply can't see us holding such an event with any other country if they were holding two of our citizens hostage."
"[Canada's continued engagement with China on the education exchange is indicative of its] national myopia [relating to the People's Republic]."
David Mulroney, former Canadian ambassador to China

"These exchanges provide international academic experience to both Canadian and Chinese students and researchers -- and foster co-operation between our two countries."
"[Canada continues to call for the release of Kovrig and Spavor after their arbitrary detentions, but relations benefit from student exchanges]."
Adam Austen, spokesman, Foreign Affairs

And take note: even while the government of Canada continues to promote the exchange program where Canadian colleges and universities sweep up enormous tuition fees, the travel advisory for Canadians contemplating travel to China through the Government of Canada website reads:

China - Exercise a high degree of caution
Exercise a high degree of caution in China due to the risk of arbitrary enforcement of local laws; risk of arbitrary enforcement of local laws; Laws and culture - death penalty, penalties for drug-related offences

Exercise a high degree of caution
There are identifiable safety and security concerns or the safety and security situation could change with little notice. You should exercise a high degree of caution at all times, monitor local media and follow the instructions of local authorities.

Michael Kovrig (left) and Michael Spavor, the two Canadians detained in China, are shown in these 2018 images taken from video. Canadian diplomats have been granted consular access to one of two Canadians detained in China.  THE CANADIAN PRESS/AP