British Columbia’s excess mortality rate dwarfed all other provinces in Canada during the first year of the COVID-19 pandemic, a new study says.
The peer-reviewed report, published in the Canadian Medical Association Journal Monday, used public data to look at how many excess deaths occurred in each of Canada’s provinces from March 2020, at the start of the pandemic, to October 2021, over a year and a half later.
Excess mortality measures how many deaths actually occurred compared to what was expected under normal circumstances. It’s one way researchers have been able to figure out the true number of lives lost due to COVID-19. But what emerged from the research was a huge gap in the number of unexpected deaths each province recorded in the period just before the Omicron variant hit.
“I think we all know that there have been deaths related to COVID. But to see the differences, at least in these estimates? …It was surprising,” said the study’s author, Kimberlyn McGrail, a professor at the University of British Columbia’s School of Population and Public Health.
In her analysis, McGrail used Statistics Canada data to track the observed number of deaths. She then compared those numbers with a model that estimated how many deaths would have occurred if the pandemic never happened.
She found that during the first year of the COVID-19 pandemic, Canada saw a roughly five per cent increase in excess mortality. That’s higher than many countries but fewer than the United Kingdom, which recorded an 18 per cent increase in excess deaths, or the United States, which saw excess mortality climb to 22 per cent into early 2021.
In Canada, McGrail calculated the mortality rates on a per 100,000 population basis. That way, she could directly compare provinces with different populations. The researcher avoided analyzing excess deaths in Canada’s three territories because of the small number of pre-Omicron COVID-19 cases reported there.
In the end, McGrail found excess mortality was lowest in Canada’s eastern provinces — even dropping below what was expected in Prince Edward Island and Nova Scotia.
Quebec had the highest reported COVID-19 mortality rate in Canada. But while there were moments during the pandemic where excess deaths outpaced reported deaths, at other times, there were “substantial periods during which mortality rates were lower than expected,” even dropping below zero.
Ontario appeared to have the smallest gap between reported COVID-19 deaths and excess mortality, something that suggested the province was the best at tracking pandemic deaths.
With a 4.5-fold gap between reported COVID-19 deaths and excess mortality, B.C. outstripped all other provinces in the number of excess deaths that went unreported. Only Alberta and Saskatchewan came close to Canada’s westernmost province.
Determining how people have died throughout the pandemic has challenged health officials and vital statistics agencies globally. To date, nearly 6.3 million people have officially died from COVID-19 across the world. But some have estimated the real COVID-19 death toll could be three times higher.
As the gap in B.C. makes clear, the virus wasn’t the only factor pushing up death rates to unexpected highs.
Heat dome drives highest weekly excess mortality rates in Canada
During the 2021 heat dome in late June, excess deaths per 100,000 people in B.C. literally spike off the chart, climbing to 90 deaths per 100,000 people. That’s higher than the weekly excess death rate anywhere in Canada at any time during the pandemic.
“Alberta, B.C. and Saskatchewan stand out for having had excess mortality rates nearly double (or more) those of other provinces,” wrote McGrail.
McGrail says the “remarkably diverse” mortality patterns across Canada likely have a number of explanations. She notes limited testing capacity, deaths occurring in the community rather than a hospital and different public health reporting practices all likely played a role in deciding whether or not to classify a cause of death as COVID-19-related.
“These provincial variations suggest to me that the very first thing to understand is how the different approaches to testing, contact tracing and encoding — identifying COVID-related deaths — might vary across the provinces,” she said.
Another wildcard factor that could have impacted how many people died in the first year of the pandemic: delayed or cancelled surgeries, diagnostic tests or doctor appointments.
To get a better understanding of which province actually had a “COVID-19 problem,” McGrail says differences in public health reporting practices need to be ruled out as a cause first.
In places and times where mortality rates dipped below what was expected, McGrail points to a pandemic decline in car accidents due to fewer people on the road, and a reduction in influenza-related deaths. The Statistics Canada data, she said, currently doesn’t count avoided deaths as a result of COVID-19 measures.
Other factors that need to be looked at include how pandemic policies and border shutdowns impacted an unsafe drug supply, leading to more people using and overdosing on opioids alone, said McGrail in her report.
A surge in unexpected deaths in B.C.
B.C. reported 9,496 excess deaths by October 2021, more than double that of Quebec and nearly as many as Ontario, a province with a much larger population.
Of those deaths, only 2,109 — or 22 per cent — were attributed to COVID-19. It’s not clear to what degree the opioid crisis and June 2021 heat wave drove the other nearly 7,400 unexpected deaths. But over that same period, the BC Coroners Service reported 3,416 people died overdosing on illicit drugs — more than suicides, murder and motor vehicle accidents combined. The heat wave is thought to have killed just shy of 600 people.
Even if those two causes of death were taken away, that still leaves roughly 3,000 deaths unaccounted for under normal conditions.
Pointing to the collision of the SARS-CoV-2 virus, public policy and climate change, McGrail noted a potential cascading effect leading to the most vulnerable facing a double or even triple crisis.
McGrail cited a Human Rights Watch report released in October 2021 that concluded an inadequate response from B.C. authorities made heat-related deaths worse in the province. But because those deaths were “highly associated with social and material deprivation,” COVID-19 and the poverty that came with it may well have set the stage for the most vulnerable to suffer the worst effects from extreme heat.
“If you think about the implications of COVID, they would have had some impact on the heat dome deaths because it would have affected the policy response,” McGrail said, pointing to public health measures that pushed people, in particular older British Columbians, to isolate.
McGrail called for all provinces and territories to come together and conduct a forensic analysis of how mortality has played out over the pandemic. To that end, she has shared her work with federal and B.C. government health authorities and plans to reach out to more now that her work is public.
Reforming the system tracking deaths could not come too soon. One international analysis from The Economist found that Canada is three to four months behind its peers in reporting deaths.
“Even the basic recording of mortality, we’re very slow in Canada. That surely could and should be fixed,” said McGrail.
But it’s not just the government she is trying to convince.
On a second front, McGrail says more work needs to be done to involve the public in responding to public health crises.
“When we have another one of these events… part of our response is going to be being able to rally community organizations, community groups and the public at large very quickly,” she said.
“And that requires information. That requires trust.”
Kingston, Ont., area health officials examining future of local vaccination efforts – Global News
More than 455,000 people in the Kingston region have been vaccinated against COVID-19.
Now health officials say they’re using the summer months, with low infection rates, to look ahead to what fall might bring, urging those who are still eligible to get vaccinated do so.
“Large, mass immunization clinics, mobile clinics, drive-thru clinics and small primary care clinics doing their own vaccine,” said Brian Larkin with KFL&A Public Health.
Infectious disease expert Dr. Gerald Evans says those who are still eligible for a third and fourth dose should take advantage and roll up their sleeves during the low-infection summer months.
“Now in 2022, although you still might get COVID, you’re probably not going to be very sick. You are less likely to transmit and ultimately that’s one of the ways we’re going to control the pandemic,” added Evans.
He expects another wave of COVID-19 to hit in late October to early November and that a booster may be made available for those younger than 60 who still aren’t eligible for a fourth dose.
“The best case scenario is a few more years of watching rises in cases, getting boosters to control things and ultimately getting out of it with this being just another coronavirus that just tends to cause a respiratory infection and worst-case scenario is a new variant where all the potential possibilities exist to have a big surge in cases and hopefully not a lot more serious illness,” said Evans.
Public Health says they’re still waiting for direction from the province on what’s to come this fall.
“We’re expecting that we would see more age groups and younger age groups be eligible for more doses or boosters but about when those ages start, we have yet to have that confirmed,” said Larkin.
The last 18 months of vaccines paving the way for the new normal could mean a yearly COVID booster alongside the annual flu shot.
© 2022 Global News, a division of Corus Entertainment Inc.
Monkeypox detected in Norfolk County | TheSpec.com – Hamilton Spectator
The monkeypox virus has found its way to Norfolk County.
The health unit announced on Friday that a Norfolk resident has tested positive and is currently isolating at home.
Contacts of the infected resident have been notified, according to a media release from the health unit.
“There is no increased risk of monkeypox to the general public stemming from this case,” acting medical officer of health Dr. Matt Strauss said in the release.
“Outside of an emergency situation, if you have symptoms of monkeypox, it is important to stay home and call your doctor to be assessed. When seeking medical care, you should wear a high-quality medical mask and cover up all lesions and open sores.”
Monkeypox is spread by direct physical contact, most often by touching a rash on an infected person’s skin but sometimes through “respiratory secretions” if in close proximity for a prolonged period, the health unit said.
“Most people infected with monkeypox will have mild symptoms and recover on their own without treatment,” said the release.
Symptoms lasting between two and four weeks can include fever, headache, swollen lymph nodes, low energy, muscle aches, skin rash or lesions, sometimes starting on the face or genitals and spreading elsewhere.
The health unit says symptoms usually start between six and 13 days of exposure to the virus.
The Halton region recorded its first confirmed case of monkeypox earlier this month.
Close contacts of monkeypox patients are eligible to receive the smallpox vaccine, which also provides protection against monkeypox.
Mass vaccination campaign against Monkeypox needed, experts say – Global News
As the World Health Organization calculates whether to declare monkeypox a global health emergency, infectious disease experts are urging health officials to be more proactive and start ramping up vaccinations and surveillance — especially in African nations where the virus is most prevalent.
The WHO convened its emergency committee Thursday to consider whether the spiralling outbreak of monkeypox should be declared a “public health emergency of international concern,” the WHO’s highest level of alert.
But the United Nations agency is facing criticism over its treatment of monkeypox — jumping into action only after the disease started to spread in rich western nations.
The viral disease that causes flu-like symptoms and skin lesions is endemic in parts of Africa, which means it is consistently present in certain regions. The continent has registered just over 1,500 suspected cases since the start of 2022, of which 70 have been fatal, according to the WHO.
By comparison, Canada has confirmed over 200 cases, the majority of which are in Quebec, and has had no deaths.
“There are more cases that occur in Africa on a yearly basis than have already been reported outside of Africa right now. And there are more deaths that have occurred in Africa from monkeypox than have occurred in the rest of the world,” said Dr. Sameer Elsayed, an infectious disease physician and professor of epidemiology and biostatistics at Western University.
That’s why he believes Africa should be getting the lion’s share of resources to deal with monkeypox — and that should include mass vaccinations, he says.
“I think Africa needs to be looked at with high, high priority,” he said.
“It needs to be a mass vaccination campaign for monkeypox with the newer vaccines for people in the African continent, especially in the high endemic areas.”
He’s not alone.
Dr. Monica Gandhi, a physician and infectious disease expert at the University of California, San Francisco, says she also believes more people living in regions where monkeypox is more prevalent should be vaccinated.
“That will actually stop it in endemic regions in this non-endemic outbreak.”
That the WHO is only now taking monkeypox seriously is “profoundly problematic,” Gandhi says, given that the disease has been spreading and killing people in Central and West Africa for years.
Monkeypox has about half of Canadians worried, but most confident with health response: poll
“It’s been circulating since 1958. There are increasing outbreaks — a severe one in Nigeria, for example in 2017 — and it’s only really essentially when this has affected high-income countries that the WHO is jumping on it.”
Experts who have worked on monkeypox in places like the Democratic Republic of Congo have long taken note of rising cases while population immunity to pox viruses has been decreasing, due to lack of vaccination. This is why the world shouldn’t be surprised at the current outbreaks, said Anne Rimoin, an epidemiology professor at UCLA in California, who has studied monkeypox for two decades.
The COVID-19 pandemic has demonstrated how quickly a deadly virus can spread across the globe when the right conditions are present, so health officials ought to learn from this and start being more proactive, she said.
“When it comes to infectious diseases, in particular those viruses that have the potential for global spread, it’s much easier to stay out of trouble than it is to have to get out of trouble.”
In addition to providing vaccines, health officials should also be ramping up resources to study this disease and do more surveillance to get a better understanding of monkeypox and learn why it is spreading in new and unusual ways, Rimoin said.
“We’ve given this virus a lot of runway to be able to spread. We have not been looking for it as vigilantly as we should be,” she said.
“I think we have to learn the lessons that we’ve learned with COVID-19 and that it is much better to invest ahead of time to get in front of these viruses, to do the kind of surveillance it’s necessary to be regularly updating our knowledge about viruses.”
Good disease surveillance is just as important in poorer countries as it is in “high-resource settings,” she added.
Like many countries around the world, Canada and the United States stopped vaccinating the general population against smallpox by around 1972, which means many on this continent are highly susceptible to pox viruses like monkeypox.
Given that scientists expect to see more emerging infectious diseases due to factors such as climate change, deforestation and globalization, the world should start getting better prepared for new outbreaks, Elsayed said.
This is why, in addition to calling for vaccinations and more resources to fight monkeypox in Africa, Elsayed believes governments in developed nations should also consider more options to protect citizens from pox viruses, including possibly re-introducing mass smallpox vaccinations.
“I believe that these vaccines should come on board again for the general population … but not (just) for monkeypox, but also to protect the world against perhaps a smallpox pandemic that can happen in the future, or even another virus that’s closely related to monkeypox but hasn’t reached humans,” Elsayed said.
He stressed this should only be considered after addressing the more pressing needs in Africa first.
WHO looks into reports of traces of monkeypox found in semen
Rimoin noted that when the world stopped vaccinating against smallpox, it opened a “gap of immunity” for populations to once again be vulnerable to it. And with the emergence of a number of new pox viruses in different parts of the globe, including mousepox, cowpox and camelpox, the world is not immune to new outbreaks, she said.
“We now have to really think about, How important is it for us to be able to keep pox viruses out of the population?” she said. “What are the stakes of allowing this virus to spread? And then acting accordingly.”
-With files from Global News reporter Reggie Checcini and Reuters.
© 2022 Global News, a division of Corus Entertainment Inc.
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