Chris Hitchcock

With the transition of Canadian COVID-19 reporting to the combined respiratory virus dashboard, weekly COVID-19 deaths for Canada are no longer publicly reported by @GovCanHealth . According to the most recent report, participating provinces reported 971 hospitalizations and 131 deaths for the period from Aug 25-Sep 28/24. During the same period, Quebec, which accounts for 22% of the Canadian population, reported 4,691 hospitalizations and 256 deaths (current INSPQ data). If hospitalizations and deaths are similar in Quebec and the rest of Canada (likely), the national report for the Aug 25-Sep 28/24 period should include at least 21,323 hospitalizations and 1,164 deaths. Based on the most recent @CIHI_ICIS reporting of Quebec in-hospital COVID-19 deaths (Apr 1/22 to Mar 31/23), there were 1.28 times more documented COVID deaths in QC hospitals than were reported by INSPQ for the same period. However, CIHI captured only 84% of INSPQ-reported hospitalizations in QC for this period, meaning QC in-hospital deaths were likely ~1.52 times higher than deaths reported by INSPQ. About 70% of all deaths in QC occur in hospitals (StatsCan), meaning actual COVID deaths were likely ~2.17 times higher in QC than reported by INSPQ, at least from Apr 1/22 to Mar 31/23. Is QC reporting only "from" COVID deaths and excluding deaths of people who would have died anyway from other causes? To test this, we can compare excess mortality estimates from @StatCan_eng for the same period, after correcting them to remove excess mortality attributable to toxic drug deaths and excess cancer deaths (stand-in for potential excess mortality attributable to delays in access to healthcare and MAID). The StatsCan excess mortality program has been paused for the last 10 months, so estimates for QC are only available up to Sep 2/23, and are still incomplete for weeks before this date. However, weekly age-adjusted per capita all-cause mortality rates for QC and other provinces are still published every month, meaning weekly excess mortality can still be estimated by comparing weekly mortality rates in one year to mortality rates in the same week of the preceding year, and using these ratios to estimate current excess mortality values compared to previous years when estimates are more complete. From Apr 1/22 to Mar 31/23, there were 2.19 times more excess deaths in Quebec than reported COVID deaths, after adjusting for excess mortality attributable to toxic drugs and cancer. This is very close to the CIHI-based estimate of actual COVID-19 deaths (2.17 times higher than reported by INSPQ for Apr 1/22 to Mar 31/23). Taking the average of both methods for estimating under-reporting in QC, we know that for the year ending Mar 31/23, INSPQ reported 46% of "excess/from" COVID-19 deaths. If we assume the magnitude of under-reporting of COVID-19 deaths by Quebec was similar after Mar 31/23, then from Aug 25-Sep 28/24 there were likely 558 excess/from COVID-19 deaths in Quebec, and 2,537 COVID-19 deaths in Canada. Recall, the total number of COVID-19 deaths in Canada from Aug 25-Sep 28/24 reported on the new respiratory virus surveillance dashboard from PHAC: 131 So, it's likely that the new national COVID-19 dashboard is reporting, ~5% of "excess/from" COVID-19 deaths in Canada. However, reporting of COVID-19 deaths by Quebec has actually worsened since Mar 31/23. How do we know this? Because from Apr 1/23 to Jun 8/24 (the last date when age-adjusted all cause mortality rates are available from StatsCan), there were 6.37 excess deaths for every COVID-19 death reported by INSPQ, after adjusting for excess mortality attributable to toxic drugs and cancer. So, from April 1/23 onward, Quebec has likely been reporting only 16% of its COVID-19 deaths. If the under-reporting rate for Aug 25-Sep 28/24 was the same as for Apr 1/23 to Jun 8/24, then there were likely 1,630 "excess/from" COVID-19 deaths in Quebec from Aug 25-Sep 28/24, and 7,407 "excess/from" COVID-19 deaths in Canada during the same period. Recall, the total number of COVID-19 deaths in Canada from Aug 25-Sep 28/24 reported on the new respiratory virus surveillance dashboard from PHAC: 131 So, it's likely that the new national COVID-19 dashboard is reporting, fewer than 2% of "excess/from" COVID-19 deaths in Canada for the 2024 respiratory virus season to date. And no, Canada doesn't have exceptionally high COVID-19 mortality rates. From December 2021 to March 2023, the estimated median weekly COVID-19 infection fatality rate for Canada was 4% LOWER than the median infection fatality rate for the UK calculated from ONS infection estimates and confirmed COVID-19 deaths, even though Canada is slightly older than the UK and has had lower rates of fresh vaccine dose uptake than the UK from 2022 onward. What was the median weekly SARS-CoV-2 infection fatality rate for Canada during this period? 0.08747% What was it in the UK? 0.08824% Open access ref for UK IFRs: ncbi.nlm.nih.gov/pmc/article… Why are so few of Canada's COVID-19 deaths reported? It's likely that at least in part it's because many/most(?) provinces now only report deaths in people infected for the first time, as @sarperotto has confirmed for BC via official communications from BCCDC. From Dec 4/21 to date, the average person in Canada has had ~3.5 SARS-CoV-2 infections. Reporting only deaths associated with first time infections would reduce reporting by ~70%....meaning only ~30% of deaths would have been reported if this policy was in place in every province. On top of that, testing in Canada during Omicron has declined ten times more than the decrease in infection and fatality rates, meaning that a substantial number of deaths and hospitalizations simply wouldn't be detected because of under-testing. So, it's probably a combined issue of under-reporting and under-testing, but either way, it's an enormous problem. As the Office of Canada's Chief Science Advisor Dr. Mona Nemer @ChiefSciCan has pointed out, Canada currently has gaps in the effectiveness of our communication about COVID-19 vaccines. Fewer than 15% of people in Canada got fresh doses in the fall 2023 campaign. Perhaps if we started reporting more than 2% of actual COVID-19 deaths on our new national respiratory virus reporting dashboard people would better understand why getting a fresh vaccine is so important, and journalists would have real numbers they can use to help communicate about the issue. I don't know who else to copy in on this post--it's like shouting into the wind, and I don't know what it will take for Canada and ALL provinces to start improving actual COVID-19 deaths and hospitalizations. @picardonhealth @NightShiftMD @DrGorfinkel maybe you can help resurrect a national conversation on this topic.