Study struggles to explain why Quebec has a high number of COVID-19 deaths but a low excess of deaths

Researchers are struggling to explain why Quebec recorded the highest number of official COVID-19 deaths in the country despite a relatively low number of excess deaths between March 2020 and October 2021.

A new study published Monday by the Canadian Medical Association Journal attempted to answer that question, but failed.

“I would say at this point it’s something we need to understand,” Kimberlyn McGrail, a professor in the University of British Columbia’s School of Population and Public Health, said in an interview.

The study, titled Excess Mortality, COVID-19, and Health Systems in Canada, says Quebec recorded 4,033 excess deaths between March 2020 and October 2021, but reported 11,470 COVID-19-related deaths, nearly three times more.

This is the largest gap recorded in Canada during the pandemic. Excess deaths refer to the extent to which observed deaths exceed expected deaths based on modeling from previous years.

McGrail said he observed too many factors to offer a definitive answer.

“Quebec was an interesting case,” she says. “What we see is that in Quebec, you have these periods when there are high excess mortality, but you also have periods when the excess mortality is below zero, that is to say that there were fewer deaths during those weeks than expected.

Between February 2021 and July 2021, for example, the death rate in Quebec was lower than in pre-pandemic years, but authorities in the province were reporting up to 10 COVID-19 deaths per 100,000 people every day.

“I don’t have a definitive answer,” McGrail said. “That’s part of the reason I was interested in writing the article, because of the number of things that could play into this.”

One reason that could explain the discrepancy, she said, is that Quebec authorities were testing many people who — for reasons unrelated to COVID-19 — were already close to death.

“Quebec was doing more testing, especially with people who were clearly at the end of life,” McGrail said. “They were maybe picking up people with COVID-19 who were really going to die in the next few days or weeks, whatever.”

Legault says health measures have reduced the number of deaths

Earlier in May, the Quebec Statistical Institute released a report indicating that there had been 6,400 additional deaths between the start of the COVID-19 pandemic and March 12, 2022. The province had officially reported more than 15 000 deaths from COVID-19 during this period.

In response to the report, Premier François Legault said data from the Institute of Statistics of Quebec said the health orders his government had imposed had helped reduce the number of deaths in the province.

Quebec Premier François Legault, seen here at the Coalition Avenir Québec’s annual political conference, says his government’s health measures have averted deaths. (Jacques Boissinot/The Canadian Press)

“What that says is that the measures we have put in place over the past two years have had results,” he said at the time.

McGrail’s study indicated that Nova Scotia had the lowest proportion of COVID-19 deaths compared to excess deaths.

The province reported 98 deaths from COVID-19 in March 2020 and October 2021, but there were 217 fewer deaths during this period than expected based on previous years.

The statistical institute offers possible explanations

While McGrail was careful to give definitive answers to explain the discrepancy between Quebec’s excess death rate and its COVID-19 death rate, Frédéric Fleury-Payeur, of the province’s statistical institute, offered several theories.

One explanation, he said in an interview on Monday, is that older people stayed indoors more than usual between March 2020 and October 2021, which reduced the chances of injury.

“Falls in the elderly are still a fairly significant cause of death,” Fleury-Payeur said. “This results in a fracture of the hip or other bones, and as older people have been less mobile during times of isolation and curfew, this could have played a role.”

Another explanation, he said, is that doctors in Quebec included COVID-19 as a cause of death in medical reports more liberally than doctors in other provinces. He said it is known in the Canadian medical community that medical reports in Quebec are more detailed than in other provinces.

“We have known for quite a long time that there is more detail in the causes of death section in Quebec (medical reports) than in other provinces,” Fleury-Payeur said.

“At the start of the pandemic, were Quebec doctors, out of habit or tradition, more sensitive to identifying any suspicious death linked to COVID-19 and reporting it?

Fleury-Payeur said a full picture of the situation will be available when all coroners’ reports involving deaths during the pandemic are made public and investigated.

This story was produced with the financial assistance of Meta and the Canadian Press News Fellowship.

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