Excess deaths during COVID pandemic could exceed 10,000 in Alberta, says expert

During the COVID pandemic, more Albertans died over the last three years than expected, and not all of that increase is attributed to COVID, said Statistics Canada.

In June 2022, Statistics Canada released a report on the excess mortality among younger Canadians for January and noted that select provinces observed very high changes in death data.

The report found excess mortality rates for residents under 45 were over half (51.6%) in Alberta. For those 45 and older, the rate more than halved to 18.8%.

A spokesperson for Alberta Health said the excess death figures are not a result of underreporting.

In a statement, the department spokesperson said they are confident in the province's reporting of COVID deaths, citing 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," reads the statement.

However, not everyone agrees on the number of excess deaths in the province, citing different methodologies for calculating the number of excess deaths.

University of Toronto infectious disease researcher and associate professor Tara Moriarty pegs the number of excess deaths in Alberta at 10,232.

According to Alberta Health data, 5,277 residents died of COVID between January 2020 and early November 2022. 

Unlike Alberta Health, Moriarty claims underreporting is one reason for the high excess death numbers in the province.

She estimates, in her latest report, that Alberta is missing thousands of deaths from December 2021 to November 2022. 

Moriarty estimates the number of deaths based on the infection rate of the population through data sharing with Quebec and the UK — jurisdictions where excess deaths more closely match COVID deaths.

Alberta defines a COVID death as a person who died of COVID or where the disease was a contributing factor and is confirmed through a lab test before death. 

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.

According to Alberta government statistics, the province reported an unprecedented increase in ill-defined and unknown causes of death in 2021, snagging the first spot with 3,362, up from 1,464 in 2020 and 522 the previous year.

The unknown causes of death category only began appearing on the list in 2019 — no record of it ranking before then, dating back to 2001.

According to her reporting, Moriarty told the CBC that there is "considerably more excess mortality in younger age groups after adjusting for toxic drug deaths."  

Before the pandemic, Alberta averaged roughly 40 to 75 drug poisonings per month. After May 2020, that number reached as high as 175 deaths per month.

In 2019, the province reported 677 deaths due to overdoses, which it calls "accidental poisoning by and exposure to drugs and other biological substances." The number rose to 920 in 2020 but fell to 604 in 2021.

A separate Alberta study, based on weekly death estimates, looked at excess deaths between March 2020 and December 2021 and attributed nearly 55 percent of excess deaths to COVID. It also observed an additional quarter of excess deaths caused by drug poisoning.

"Although older adults are more likely to die of COVID, a massive increase in non-COVID-related mortality was observed among younger people," reads the study.

James Talbot, a former chief medical officer of health for Alberta, said underreporting could be one possible explanation for the excess deaths, adding the province records only test-positive deaths.

"So people who died at home, in the ambulance, or in an emergency before they could be tested, would be listed as excess deaths," he wrote in an email to the CBC.

But Talbot believes delays in receiving medical attention for other conditions, toxic drugs, and the overwhelmed medical system could also be causes.

The University of Calgary's public health researcher, Dr. Gabriel Fabreau, agreed that the province's strained health-care system affects patient outcomes.

He said that much research found that over-capacity health services caused additional mortality, whether elevated ambulance or ER wait times or staffing shortages in hospital wards.

"This can lead to the dramatic increase in missed cancer diagnoses we have been seeing, which is due to the collapse of primary care."

Fabreau also lambasted inadequate mental health care for the increased overdoses and alcohol-induced hepatitis from a surge in alcohol use during the pandemic, citing data from the Canadian Institute for Health Information (CIHI) and Statistics Canada.

However, he cited the delays in reporting from many provinces, making giving an adequate assessment in each province and nationwide difficult.

"When data is not made available, or data is difficult to access, we've learned that in the daily age of misinformation [that] we'll fill in the gaps with garbage and confuse the population and make it harder for people to understand what's happening," said Fabreau.

More than 50,000 deaths have been associated with COVID in Canada.

Weekly death estimates from the federal agency show 9,821 extra deaths from early 2020 to the first week of November 2022.

Fabreau claimed that Alberta could 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."