Alberta has seen roughly 10,000 'excess' deaths since 2020, and COVID doesn't explain it all
COVID underreporting, health-system overcapacity, alcohol and poison drugs blamed
The number of Albertans who died over the last three years was significantly higher than what would be considered normal for that stretch of time, and not all of that increase is attributed to COVID-19 deaths, according to new data from Statistics Canada.
Weekly death estimates from the federal agency show there were 9,821 extra deaths over the course of the pandemic, from early 2020 to the first week of November 2022. That is, close to 10,000 more people died than what would normally be expected for the same time period. Researchers call this number excess deaths.
The official count of COVID deaths suggests the disease is responsible for a large proportion of excess deaths. Alberta Health data shows 5,277 people died of COVID-19 between January 2020 and early November 2022.
But experts say COVID-19 numbers miss the true loss of life that has occurred since 2020. They point to a variety of potential factors for the other deaths, including the province's toxic drugs crisis and an under-pressure medical system.
Others argue Alberta is undercounting COVID-19 deaths.
But regardless of how the deaths are counted, it's important to know what's happening so as to better address the root issues, according to a Calgary doctor who has spent countless hours with COVID patients.
"We get into semantics of dying with COVID, or dying of COVID," said University of Calgary public health researcher Dr. Gabriel Fabreau.
"And really, it's irrelevant from a health-systems perspective, or the health of a population perspective. Many more people are dying that shouldn't be dying."
Demographers say some excess deaths can be attributed to an aging, growing population. But the last three years saw a significant jump in overall deaths.
Not everyone agrees on the number of excess deaths in the province. There are varying methodologies for calculating this number. Estimates of excess deaths do vary.
Tara Moriarty, an infectious disease researcher and associate professor at the University of Toronto, pegs the number of excess deaths in Alberta at 10,232.
She believes underreporting is one reason for the elevated excess death numbers in most provinces, including Alberta.
In her latest report, Moriarty estimates that Alberta is missing thousands of deaths for the Omicron period (December 2021 to November 2022) of the pandemic.
She estimates the number of cases and deaths based on the infection rate of the population on a given date. That expected case and death ratio is based on jurisdictions with more detailed COVID testing and data sharing such as Quebec and the U.K. — jurisdictions where excess deaths more closely match COVID deaths, she says.
Alberta defines a COVID death as a person who died of COVID-19 or where the disease was a contributing factor and is confirmed through a lab test prior to death. But deaths in congregate care outbreaks where only a rapid test was done are also reported, according to Alberta Health.
When it is unclear whether COVID caused or contributed to a death, it is classified as "unknown" and is reviewed by health officials, including nurses, physicians and, in some cases, the medical examiner.
In Quebec, the definition includes lab confirmed cases. It also includes cases where someone who had symptoms of COVID dies with no other clinical explanation, after being exposed to a positive case in a close-contact environment, such as living under the same roof. A positive test result is not required in those cases.
According to her reporting, Moriarty says most Canadian provinces have been overemphasizing COVID deaths in the elderly and missing others.
"There is considerably more excess mortality in younger age groups, even after you adjust for toxic drug deaths, which are also themselves probably underreported," Moriarty told CBC News.
Before the arrival of pandemic, Alberta averaged roughly 40 to 75 drug poisonings per month. Once May 2020 arrived, that number dropped below 100 just once and has been as high as 175 deaths per month.
A separate Alberta study, based on weekly death estimates, looked at excess deaths between March 2020 and December 2021. It found nearly 55 per cent of the deaths were attributed to COVID-19. But it also observed an additional quarter of excess deaths were associated with drug poisoning.
"Although older adults are more likely to die of COVID-19, a massive increase in non-COVID-19-related mortality was observed among younger people," it said.
A spokesperson for Alberta Health said the excess death figures are not a result from underreporting.
In a statement, the spokesperson added the department is confident in the province's reporting of COVID deaths. It cites alcohol and drugs — particularly opioids — an aging population and a greater demand on the health-care system as reasons for the rise.
"The pandemic led to major deferrals of care between 2020 and 2022, which is also contributing to increased patient acuity that could be impacting excess death rate numbers," the statement said.
James Talbot, a former chief medical officer of health for Alberta, says underreporting could be one possible explanation for the excess deaths, adding the province records only test-positive deaths.
"So people who died at home, or in the ambulance, or in emergency before they could be tested, would be listed as excess deaths," he wrote in an email to CBC News.
But Talbot believes delays in getting medical attention for other conditions, toxic drugs and the overwhelmed medical system could also be causes.
Fabreau, the U of C public health researcher, agreed the strained health-care system is affecting patient outcomes.
He says a lot of research shows that over-capacity health services cause additional mortality, whether it's elevated ambulance or ER wait times, or reduced nurse staffing in hospital wards.
"This can lead to the dramatic increase in missed cancer diagnoses we have been seeing, which is due to collapse of primary care," he said.
Lack of adequate mental health care can lead to increased overdoses and alcohol-induced hepatitis from a surge in alcohol use during the pandemic, he said.
Fabreau also suggested the social and medical complications brought on by the arrival of the SARS-CoV-2 virus have led to the escalated deaths.
"There's a long litany of serious complications that come with COVID," he said.
"Strokes, heart attacks, blood clots, organ failures — those are mortality, those are deaths and morbidity that are probably not being captured as COVID but certainly are adding to the increase mortality burden."
Misinformation fills the void
When it comes to accounting for excess deaths, researchers like Moriarty believe it's critical information for the health system and citizens to have.
She said much of this data is available from the Canadian Institute for Health Information (CIHI) and Statistics Canada, but the delays in reporting from many provinces make painting a provincial or national picture difficult.
"When data are not made available or data are difficult to access, we've learned that in the daily age of misinformation [that] we'll fill in the gaps with garbage and confuse a population and make it harder for people to understand what's happening," he said.
Some reports of excess death numbers in other countries, like the United Kingdom and the United States, have fuelled false claims online that vaccines are to blame.
Fabreau, who is leading a national study on COVID vaccinations, says there's no evidence vaccination raises the risk of death, according to his reading of the literature.
"If anything, it is the exact opposite — it dramatically reduces your risk of death and serious illness," he said. "And I've seen way too many people die of COVID."
Almost 97 million doses of COVID-19 vaccine have been administered to date in Canada, and nearly 32 million Canadians have been vaccinated.
Health Canada data shows that of 400 post-vaccination deaths reported to the agency, its investigation determined/found only four were "consistent with causal association to immunization." One of those deaths occurred in Alberta.
More than 50,000 deaths have been associated with COVID-19 in Canada.
Fabreau says Alberta could, without too much work, provide more detailed and comprehensive data on hospital wait times, ambulance reporting and wait times, hospital capacity and major and minor surgical wait times, without jeopardizing patient privacy.
"We pay for these health systems," he said. "So we should have access to the data about them, and I think that improves accountability and it improves trust."