On Tuesday evening, the Public Health Agency of Canada’s official COVID-19 death tally topped 10,000, with 28 newly reported deaths in Quebec, Ontario, Manitoba and Alberta, bringing the total to 10,001.
The grim milestone comes as most of the country – with the exception of the Atlantic provinces and the Far North – grapples with a surge in infections that has claimed more lives recently than in the summer , when Canada has successfully suppressed the virus temporarily.
What do we know about the more than 10,000 Canadians who have died from COVID-19? And what can the first 10,000 deaths tell us about what lies ahead?
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Kill the old people, spare the young
Around the world, SARS-CoV-2, the virus that causes COVID-19, has been particularly cruel to the elderly. Canada is no exception. As of Tuesday, the Public Health Agency of Canada had received detailed reports from provinces and territories on 9,845 patients known to have died from COVID-19. Of these, 96.7% are over 60 years old; 71% are over 80 years old.
In contrast, the virus has killed very few young people. PHAC has two deaths from COVID-19 in those 19 and under, 11 deaths in 20-year-olds and 16 deaths in 30-year-olds. The counts, however, do not tell the full story of COVID-19. The disease has sent just over 300 Canadians under the age of 40 to intensive care units. Countless numbers of coronavirus survivors are also struggling with long-lasting COVID, a version of the disease where symptoms such as brain fog, body aches and deep fatigue persist for months.
Devastation in central Canada
The vast majority of Canadians killed by COVID-19 have died in Ontario or Quebec. Provinces which account for about two-thirds of the country’s population have so far recorded 93% of all deaths from the coronavirus.
Quebec stands out as particularly appalling. About 62 percent of all Canadian deaths from COVID-19 have occurred there. If Quebec were a country, its COVID-19 death rate (717 deaths per million people) would be among the highest in the world – worse, even, than the United States (683 deaths per million). In contrast, Ontario’s death rate stands at 210 per million. In the West, death rates per million were low in the first wave, but numbers started to rise in British Columbia, Alberta and Manitoba.
The national death rate from COVID-19 is now 262 per million. “This is double the rate for Germany. That’s the bad news, ”says Prabhat Jha, director of the Center for Global Health Research at St. Michael’s Hospital, part of Unity Health. “The good news is it’s about a third of the US rate. So overall, Canada has had a lower mortality trajectory than in many other settings. Yet some countries, such as Australia (36 deaths per million) and South Korea (nine per million), have shown that the coronavirus can be managed in ways that save many more lives.
Tragedy in institutions for the elderly
The story of the spring wave in Canada was one of the viruses that is rampant almost unchecked in institutions for the elderly, primarily in Ontario and Quebec. Sick and frightened workers fled the hardest hit homes, prompting governments to call on local hospitals and the military for help. The Public Health Agency of Canada said about 80% of those who died in the first wave were residents of nursing homes, retirement homes or assisted living facilities.
This figure of 80%. 100 splits in half: it shows that Canada failed to protect long-term care residents in the first wave, but managed to minimize the number of deaths among all the others.
An article by Toronto geriatricians and researchers Nathan Stall and Samir Sinha illustrates this dichotomy perfectly. Their study looked at deaths among residents of long-term care facilities in a dozen OECD countries, some of which weathered the first wave well (Germany, Denmark) and others (Spain, Italy).
Compared to the US and hardest-hit European countries, Canada’s long-term care death toll is not that bad. Canada actually had the fourth lowest COVID-19 death rate among residents of long-term care facilities in 12 countries, with 1,640 dying from the virus per 100,000 people living in facilities for the elderly in Canada – better than the average of 2,687 deaths in 12 countries per 100,000. Only Denmark, Germany and the Netherlands did better.
Where Canada really stood out was in the gap between the fortunes of seniors living in long-term care and those of seniors living at home. Canadians over 65 who lived at home had a lower per capita death rate from COVID-19 in the first wave than in all of the other countries in the study, even Denmark and Germany.
“It was an uneven response,” said Dr Stall. “The lockdown that was imposed really at the national level [in Canada] was effective, as it has in other jurisdictions… but they forgot about long term care.
Mortality in the second wave
From reporting its first COVID-19-related death on March 9 to the end of August, Canada has recorded 9,126 deaths from the virus. The first two months of Wave 2 have led to 875 deaths to date, significantly fewer than the deadliest two months of Wave 1, especially when measured against the number of confirmed infections. (Canada performed far fewer tests in the spring than today, which means the number of cases from the first wave is vastly underestimates.)
“In the current peak that we are seeing now, we have seen a much slower increase in deaths,” says Dr Jha. “And while nursing homes have been affected, it’s not at speed or scale that it was the first time.
Dr Stall, who has followed a worrying increase in recent deaths in long-term care in Ontario, says it is still too early to draw solid conclusions about the level of mortality in the second wave. Already October, with more than 600 deaths, was far deadlier than in September, when 175 deaths from COVID-19 were reported, according to PHAC data. When it comes to facilities for the elderly, “there’s no way the mortality and epidemics would be this bad this time around,” says Dr Stall. “But I still think they’re going to be bad.
Even with just eight months of deaths from COVID-19, the virus is already believed to be the sixth leading cause of death in Canada relative to causes of death in 2018, the last full calendar year for which Statistics Canada has released data.
“It is striking in itself to put the [COVID-19] data up to the end of October in the context of a full year of death data, ”said Owen Phillips, senior vital statistics analyst at Statscan. In Quebec, COVID-19 is on its way to being the third leading cause of death, behind cancer and heart disease.
With a report from The Canadian Press
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