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A nurse attends to a patient in the COVID-19 Intensive Care Unit at Surrey Memorial Hospital in Surrey on June 4, 2021.JONATHAN HAYWARD/The Canadian Press

COVID-19 case counts are down dramatically from a year ago, according to federal data. Hospitalizations are higher than during the first two pandemic summers, but are hovering around their lowest point since December, 2021. And there are now fewer than 30 COVID-19 deaths reported across the country per week.

But owing to limited testing and COVID-19 deaths that are undetected or not yet reported, the real toll COVID-19 continues to take on Canadians is not yet known.

By a different measure, one that is trickier to interpret, more people than expected are dying in Canada for reasons that are not yet clear. Excess mortality, also known as excess deaths, is a calculation of how many more deaths occur than are predicted based on demographic factors, including the growth and aging of the country’s population.

Estimated excess mortality dipped in January and February, but the latest 2023 figures indicate it is about 15 per cent to 20 per cent higher than it was in 2020 and 2021, according to Tara Moriarty, an infectious-disease researcher and co-founder of the grassroots group COVID-19 Resources Canada. That’s considerably lower than in 2022, “which was a horrific, really, really bad year in Canada, but it’s still higher than the first few years of the pandemic,” she said.

What excess mortality says about the current state of the pandemic is uncertain, in part because of a slow, patchwork system of reporting deaths in Canada. Yet it shouldn’t be ignored, said Dr. Moriarty, who is also an associate professor at the University of Toronto.

“We absolutely need to know why we have historically high levels of death,” she said.

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Since the start of the pandemic until June, her group estimates there have been nearly 90,500 excess deaths in Canada, which is about double the number of Canadian deaths in the Second World War. That number is adjusted to subtract deaths from drug poisonings, suicides, mass homicide and a heat wave in B.C.

The total number of COVID-19 deaths that have been recorded since the start of the pandemic, however, stands at 53,216, according to Public Health Agency of Canada data.

In other countries such as Britain and France, which have timely death-reporting systems, almost all excess mortality can be explained by COVID-19 deaths, Dr. Moriarty said. The two numbers match up fairly closely to each other.

But in Canada, provinces lag in their reporting to the official Canadian Vital Statistics Database, which collects information, including cause of death, for all deaths in the country.

That reporting is not yet complete for the first year of the pandemic, Dr. Moriarty said. But so far, she said, most of the COVID-19 deaths that have been reported to the database for 2020 indicate about 90 per cent of excess deaths that year can probably be attributed to COVID-19.

In addition to those that are not yet reported, there are potentially many deaths caused by COVID-19 that are not detected or not officially attributed to the disease, she added. For example, if someone developed a serious health condition from an infection and died more than 28 days after testing positive, their death may not be considered a COVID-19 death in some jurisdictions.

Kim McGrail, a professor at the University of British Columbia’s Centre for Health Services and Policy Research, said she thinks of excess mortality as “an indication that there’s something happening that’s worth investigating,” but it doesn’t indicate what is actually happening or what to do about it.

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Similarly, in an e-mailed statement, Statistics Canada said unusual excess deaths don’t necessarily speak to COVID-19′s impact on Canada. Rather, they signal a need for deeper analysis.

Statistics Canada explained it uses a statistical model to estimate weekly expected deaths based on mortality trends from 2015-19 while considering changes in age, sex and total population.

Part of the problem, Dr. McGrail said, is there are many factors influencing mortality now that are different from before the pandemic. One wouldn’t try to predict deaths in 2023 based on looking at an average five-year period in the 1970s, for example, she said. To a similar but lesser extent, comparing mortality today with a model based on what it was before the pandemic is complicated by numerous factors, including the toxic drug crisis and other public-health crises, she said.

Beyond deaths directly caused by COVID-19, people can die from indirect or long-term effects of infection, or from the mental-health effects of the pandemic or because they had delays in getting medical treatment or surgeries for other kinds of illnesses, Dr. McGrail said.

But even if it turns out excess mortality is not being driven by COVID-19, Dr. Moriarty said the country still needs to address COVID-19, since it is not showing any signs it is going away, and will continue to limit people’s lifespans, put pressure on the health care system, potentially have long-term consequences for population health, including long COVID, and hurt economic productivity.

She added that Canada also needs to improve its death-reporting system to inform speedier responses to whatever crises may arise, whether it’s future pandemics or the effects of climate change.

Moreover, whatever is causing it, excess mortality is something the country should pay attention to, she said. “Because clearly there are a lot of people dying that wouldn’t normally have.”

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