The Washington PostDemocracy Dies in Darkness

Opinion Canadians have been in the dark about covid-19 deaths in hospitals. We need more transparency.

A health-are worker from Humber River hospital's mobile vaccination team administers a coronavirus vaccine at the Church of Pentecost Canada in Toronto on May 4. (Carlos Osorio/Reuters)
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Nora Loreto is a Canadian freelance writer and author of “Take Back the Fight: Organizing Feminism in the Digital Age."

Canadians have been receiving daily covid-19 updates on the number of cases and deaths, but there are two figures that have been missing: How many Canadians contracted covid-19 in a hospital, and how many of them died?

That information has been mostly out of reach.

Journalists in Quebec received some of this data through information requests. There have been at least 743 deaths at 31 hospitals of people who contracted covid-19 through a hospital outbreak. The largest number of deaths occurred at Hôpital Maisonneuve-Rosemont, where 150 people died from covid-19 outbreaks.

We also know the data from Manitoba, as it has been consistently reported for the province. Fifty-seven people died there, and the largest number of deaths, 15, occurred at the Winnipeg Health Sciences Centre.

But aside from these two provinces, and a few public health units in Ontario, including in Ottawa and Toronto, Canadians have not been able to see the full scope of how covid-19 has propagated in hospitals, endangering vulnerable patients.

According to data gathered by the Canadian Institute for Health Information (CIHI), and recently released to me, there were 3,088 post-admission covid-19 infections reported at hospitals across Canada and 897 in-facility deaths, excluding Quebec. Quebec has its own reporting system; when that province’s death figures are added to this total, it rises to 1,640. Twenty-nine percent of covid-19 infections were acquired post-admission within a hospital, and outside of Quebec, ended up in death.

It’s critical for Canadians to understand how well hospitals controlled covid-19 infections, and not only for the families of the hundreds of Canadians who died as a result of becoming infected. The capacity of the public health system to control for infection has been headline news since February 2020. And yet, we still do not have national reporting on covid-19 infections and deaths within Canadian hospitals.

The CIHI data is presented in aggregate, making it impossible to know where the worst outbreaks were, which provinces had higher infection rates, or if there were larger clusters in a particular hospital. And of the data that is public, it’s fraught. For example, data from Ottawa’s public health unit is posted cumulatively, and it’s possible to verify the death rate at each institution. For Toronto, however, outbreaks and deaths appeared and disappeared from the outbreak list. The way Toronto posted this information, it was possible to miss a new outbreak within the same hospital, or to double-count.

The other problem is that each jurisdiction counts covid-19 deaths differently. Quebec is the only province that has considered most excess deaths (91 percent in the 85-plus age category) to be related to covid-19. That has meant that Quebec’s death count is higher than those of other jurisdictions in Canada in general because Quebec includes most of the province’s excess deaths (deaths in excess of where the death rate had been previous to the pandemic starting) as being related to covid-19. This is likely why Quebec’s death total is as high as it is.

In other provinces, even if someone died while infected, if their death was determined not to be explicitly caused by covid-19, there was discretion about whether to count the death as an official covid-19 death.

In British Columbia, where zero excess deaths were attributed to covid-19 in the over-85 age category, 77 hospital deaths were reported by local health authorities or journalists. But like other provinces, this reporting was not consistent, so there’s no total count for deaths from covid-19 acquired in hospital that hasn’t been cobbled together by media reports and limited public health reporting.

Similarly, in Alberta, there were 29 deaths reported. In Saskatchewan, only one death has been attributed to post-admission covid-19 infection. The data from CIHI is the first time that all deaths have been reported together, adding almost 300 previously unreported deaths to what has been publicly reported.

Death data is gathered from hospitals reporting to local public health units, or provincial bodies, and then fed into national databases that aren’t always available to the public. Any problems with how local units officially count a covid-19 death will also appear in how they count deaths related to hospital-acquired infection.

Canada’s hodgepodge covid-19 infection and death reporting has made comparing jurisdictions very difficult. Without consistent reporting protocols from province to province or even nationally, Canadians have not had a clear picture of what covid-19 outbreaks and deaths looked like among hospitalized individuals.

This lack of data is a massive problem. The reporting is clearly clumsy and slow. We will not get a full picture of how many people died in Canada for months after the last covid-19 death, thanks partly to how slow our agencies are to report death figures.

This means that during this pandemic, and God forbid the next one, policy decisions have to be made without consistent guidelines. Canadians rely on their institutions to keep them up to date on data trends, but when the data is unavailable, how can we know what measures are necessary?