'It's really distressing': Study estimates B.C.'s COVID-19 death toll could be double what's reported

Vancouver -

Roughly twice as many British Columbians may have died from COVID-19 than what government is officially reporting as deaths from the disease, according to an in-depth analysis of pandemic fatalities in Canada.

The estimates in the just-published paper threaten the perception that Canada in general, and B.C. in particular, have been successful in weathering the COVID storm and have the provincial health officer on the defensive.

A group of researchers and university professors crunched the numbers and estimate that from Feb. 1 to Nov. 28 of 2020, 1,767 people died in B.C. above what would be expected for a typical year and there is no other explanation or data that would account for those excess deaths.

The formal COVID-19 death toll stands at 1,754 up to June 28, 2021, a 17-month reporting period.

In the policy briefing to the Royal Society of Canada titled “Excess All-Cause Mortality During the COVID-19 Epidemic in Canada,” the authors warn that there is “evidence that at least two-thirds of the deaths caused by COVID-19 in communities outside of the long-term care sector may have been missed.” 

POOR DATA COLLECTION TO BLAME?

They largely blame poor data collection, delayed data reporting, atypical COVID symptoms in seniors and inadequate recognition of the impact of the virus on low-income and racialized communities.

B.C. health officials have repeatedly pointed out the province does not collect race-based data.

“It looks like approximately 78 per cent of likely or quite likely COVID-19 deaths in B.C. were not reported or identified,” explained study co-author and University of Toronto associate professor, Tara Moriarty.

“It may well be that there’s something else — it looks like it’s COVID because of the seroprevalence data and other data — but it’s the most likely explanation.”

Moriarty points out the numbers are adjusted for opioid deaths and that in Quebec they found no other major cause of death in their excess mortality numbers except for COVID-19.

She says other high-income countries that’d recorded excess mortality numbers have attributed nearly all of their extra deaths to COVID based on testing.

The report notes that Canada has low testing rates and poor data collection and reporting compared to other comparable countries, suggesting that has contributed to a national under-counting that could see the number of COVID deaths double when full accounting and analysis is completed.

That process could easily take another year just for the deaths in 2020.

THE TOP DOCTOR’S THEORY ON UNCOUNTED DEATHS

B.C. has a considerably lower testing rate than the national average, and the authors note the province’s slow and patchy data collection.

“Without adequate situational awareness or surveillance testing, Canadian public health officials and policy makers may not have recognized the prevalence of COVID-19 cases and fatalities in the community, prior to and between the pandemic’s major waves,” notes the report.

The provincial health officer acknowledges that while some deaths were likely missed early on, she doesn’t believe there were many and that there’s another explanation.

“Not directly related to COVID, but more related to people who did not access hospital services when they needed to and we’ve seen that in the Emergency Department data, we’ve seen that in hospitalization data through that period of time,” said Dr. Bonnie Henry. “So I don’t agree with what that report has come out (with) yet and I think there are variations and they have made assumptions between what happened in Ontario, for example and what happened here.”

Henry’s response came shortly after an advisor to the World Health Organization reached out to CTV News when this story was first published.

Canadian doctor and Order of Canada recipient, Dr. Peter Singer, pointed out the WHO itself also believes COVID-19 deaths have been undercounted, with considerable variations around the world. 

Meanwhile, the country’s chief medical health officer encouraged the non-governmental analysis.

“I think this is (an) important report, and it also goes alongside some of the Statistics Canada work on excess mortality,” said Dr. Theresa Tam. “We do know that based on some of the ascertainment of cases and also deaths that some of these could indeed have been missed or delayed in reporting.”

The RSC analysis focused on deaths in those 45 and older (since they were most likely to die from COVID) from Feb. 1, 2020 up to Nov. 28, 2020. It adjusted for opioid deaths, which skyrocketed in B.C. during the pandemic.

Moriarty believes there will be many more uncounted deaths in the second and third waves, which unfolded after the cut-off.

URGENT CALLS TO SPEED UP DEATH REPORTING

The report makes several recommendations, including timely reporting of death data, which B.C. researchers are also urging government to prioritize as soon as possible.

“We cannot access timely death data in the province, I’m always surprised it takes forever to access this data,” said UBC PhD candidate in epidemiology, Mohammad Karamouzian, who has extensively studied B.C.’s opioid crisis and the slow trickle of data.

“We need to build beyond COVID -- while it’s going to be around for a long time, we have another public health emergency we’ve been dealing with for 5 years and we haven’t done a better job,” he pointed out. “There are structural issues here we need to be identifying with reports like this.” 

Karamouzian doesn’t believe officials have been trying to hide data and he emphasized how important it is to avoid laying blame, but he also pointed out that the pandemic response has not been equitable as far as marginalized, low-income and racialized British Columbians – and he fully agrees with the report’s authors that they’ve been disproportionately impacted.

“We could have predicted this and these are avoidable deaths, lets not forget that,” he said. “I think the tragedy isn’t just the lives lost, the tragedy is if we forget to do something about this and move on with this as businesses as usual and back to so-called ‘normal,’ I think that’s what concerns me.”

'COLLATERAL DAMAGE'

The researchers say they see no evidence that B.C. or any other province has made meaningful changes to reporting or interpretive practices to compensate for what they believe is undercounting in the first 10 months of the pandemic.

Moriarty and her co-authors made their calculations based on what they believed were direct COVID-19 deaths, rather than people who would’ve died from so-called “collateral damage,” where they did not seek or have access to medical care, which Henry believes is the predominant explanation.

In March, Statistics Canada released the latest information on the nation’s excess mortality in 2020, which is how many deaths there had been above what would’ve been expected had there been no pandemic. It found a five per cent increase, with 13,798 Canadians dying last year.

“For British Columbia, there were nine per cent more deaths than expected in the fall, compared with six per cent in the spring (of 2020),” reads a briefing from the agency.

In August of 2020, the agency had already hinted that more deaths than were confirmed with testing could be attributed to COVID-19.

“In British Columbia, there were 336 more deaths than expected from the middle of March to the end of April. This is 232 more than the 104 deaths reportedly attributed to COVID-19 over the same period," they wrote.

"Of particular consideration would be cases, especially early in the pandemic, where individuals may have died of COVID-19 prior to getting tested or treated.”

Henry insisted that the province, “had an arrangement with the coroner’s service, we worked together to make sure that any sudden unexpected deaths in the community were tested for COVID” and is confident there are few uncounted deaths due to the virus.

POST-MORTEM TESTING

Proving for a certainty who died from COVID-19 will only be possible with post-death analysis of the excess death figures.

With the people long-since deceased, testing is now impossible and Moriarty acknowledges that opportunity has passed and we’ll never know for certain based on testing.

The BC Coroner’s Service tells CTV News its mandate only includes the investigation of sudden, unnatural, institutional or children’s deaths and that as of Apr. 27 had “not identified any unusual increases in deaths reported.”

“Of 216 post-mortem COVID tests completed, 47 have returned positive. For all deaths that occur suddenly and unexpectedly where the decedent was not previously diagnosed with an underlying natural disease process sufficient to account for death, COVID testing is occurring,” wrote a spokesperson.

“It is possible that some individuals dying in the province of diagnosed underlying disease were also COVID-positive however, post-mortem COVID testing is not conducted for every death that occurs in B.C."

A LAST-RESORT WARNING SIGNAL

Moriarty believes people have been dying in plain sight, and that the data from StatCan backs her up. Nonetheless, she is prepared for shock, as well as a backlash and defensiveness in response to the report.

“I’m hoping that complacency can be shaken a little bit and we can realize that we’ve missed a lot of deaths in Canada — it’s really distressing how that could’ve happened, how so many people dying could’ve gone unnoticed is really disturbing,” she said.

“We’re a high income nation, this was a last-resort warning signal that we had in Canada, and it completely or largely didn’t work. We cannot let that happen again.”