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Family and friends of the over one hundred residents that died from COVID-19 related causes take part in a memorial in front of the Residence Angelica seniors home on July 23, 2020 in Montreal.Ryan Remiorz/The Canadian Press

On Tuesday evening, the Public Health Agency of Canada’s official count of COVID-19 deaths ticked past 10,000, with 28 newly reported deaths in Quebec, Ontario, Manitoba and Alberta pushing the tally to 10,001.

The bleak milestone comes as most of the country – save for the Atlantic provinces and the Far North – grapples with a resurgence in infections that has been killing more people recently than over the summer, when Canada succeeded in temporarily suppressing the virus.

What do we know about the more than 10,000 Canadians who have died of COVID-19? And what can the first 10,000 deaths tell us about what lies ahead?

COVID-19 news: Updates and essential resources about the pandemic

Is my city going back into lockdown? A guide to COVID-19 rules across Canada

Killing the elderly, sparing the young

All over the world, SARS-CoV-2, the virus that causes COVID-19, has been particularly cruel to the elderly. Canada is no exception. As of Tuesday, the Public Health Agency of Canada had received detailed reports from the provinces and territories on 9,845 patients known to have died of COVID-19. Of those, 96.7 per cent have been over the age of 60; 71 per cent have been older than 80.

By contrast, the virus has killed vanishingly few young people. PHAC counts two COVID-19 deaths among those 19 and younger, 11 deaths among people in their 20s and 16 deaths among thirtysomethings. Death counts, however, don’t tell the full story of COVID-19. The disease has sent just more than 300 Canadians under the age of 40 to intensive-care units. An untold number of coronavirus survivors are also struggling with long COVID, a version of the illness where symptoms such as brain fog, body aches and deep fatigue persist for months.

Devastation in Central Canada

The vast majority of the Canadians killed by COVID-19 died in Ontario or Quebec. The provinces that account for about two-thirds of the country’s population have so far recorded 93 per cent of all deaths from the coronavirus.

Quebec stands out as particularly abysmal. About 62 per cent of all Canadian COVID-19 deaths took place there. If Quebec were a country, its COVID-19 death rate (717 deaths for every million people) would be among the highest in the world – worse, even, than the United States (683 deaths per million.) By contrast, Ontario’s death rate sits at 210 per million. In the West, death rates per million were low through the first wave, but the tallies have begun to grow in British Columbia, Alberta and Manitoba.

The national COVID-19 death rate is now sitting at 262 per million. “That’s double the rate Germany had. That’s the bad news,” says Prabhat Jha, director of the Centre for Global Health Research at St. Michael’s Hospital, part of Unity Health. “The good news is that it’s about a third of the U.S. rate. So on the whole, Canada has had a lower death trajectory than many other settings.” Still, some countries, such as Australia (36 deaths per million) and South Korea (nine per million) have shown the coronavirus can be managed in a way that saves many more lives.

Tragedy in seniors' facilities

The story of the spring wave in Canada was one of the virus rampaging nearly unchecked through seniors' facilities, primarily in Ontario and Quebec. Sick and frightened workers fled the hardest-hit homes, prompting governments to call in local hospitals and the army for help. The Public Health Agency of Canada has said about 80 per cent of those who died in the first wave were residents of nursing homes, retirement homes or assisted-living facilities for seniors.

That 80 per cent figure cuts two ways: It shows that Canada failed to protect residents of long-term care in the first wave, but succeeded in minimizing deaths among everyone else.

A paper by the Toronto geriatricians and researchers Nathan Stall and Samir Sinha neatly captures this dichotomy. Their study looked at deaths among residents of long-term care in a dozen OECD countries, some of which rode out the first wave well (Germany, Denmark) and some of which didn’t (Spain, Italy.)

Compared with the U.S. and the hardest-hit European countries, Canada’s long-term care death toll doesn’t look so bad. Canada actually had the fourth-lowest COVID-19 mortality rate among long-term care dwellers in the 12 countries, with 1,640 dying of the virus for every 100,000 people living in Canadian seniors' facilities – better than the 12-country average of 2,687 deaths per 100,000. Only Denmark, Germany and the Netherlands fared better.

Where Canada truly stood out was in the gap between the fortunes of seniors living in long-term care and seniors living at home. Canadians over the age of 65 who lived at home had a lower per-capita COVID-19 death rate during the first wave than any of the other countries in the study, even Denmark and Germany.

“It was a lopsided response,” Dr. Stall said. “The lockdown that was imposed really nationally [in Canada] was effective, as it has been in other jurisdictions … but they forgot about long-term care.”

Mortality in the second wave

From the reporting of its first COVID-19 death on March 9 to the end of August, Canada recorded 9,126 deaths stemming from the virus. The first two months of the second wave have led to 875 deaths so far, significantly fewer than the two deadliest months of the first wave, especially if measured against the number of confirmed infections. (Canada conducted far fewer tests in the spring than it does now, meaning first wave case counts are vast underestimates.)

“In the current peak that we’re seeing now we have seen a much slower rise in deaths,” Dr. Jha says. “And although nursing homes have been affected, it’s not of the speed or scale that it was the first time.”

Dr. Stall, who has been tracking a disturbing rise in recent deaths in long-term care in Ontario, says it’s still too early to draw strong conclusions about how deadly the second wave will be. Already, October, with more than 600 deaths, has been far deadlier than September, when 175 COVID-19 deaths were reported, according to PHAC data. When it comes to seniors' facilities, “there’s no way that the mortality and outbreaks can be as bad this time," Dr. Stall says. "But I still think they’re going to be bad.”

Even with only eight months' worth of COVID-19 deaths counted, the virus would already be the sixth-leading cause of death in Canada compared with causes of death in 2018, the last full calendar year for which Statistics Canada has published data.

“It’s striking in and of itself just to put the [COVID-19] data until the end of October in context with a full year of death data," said Owen Phillips, a senior analyst in vital statistics at Statscan. In Quebec, COVID-19 is on track to be the third-leading cause of death, behind cancer and heart disease.

With a report from The Canadian Press

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