COVID Update: Pandemic to worsen before getting better

It has become a familiar story. Once again, Canada’s COVID-19 cases and deaths are rising faster than the U.S. In November, confirmed cases of COVID-19 in Canada increased by 61.2 per cent, versus 47.5 per cent in the U.S. Both increases exceeded the October rate and in Canada’s case represented almost a three-fold rise since the first of September. Over the same three months, cases in the U.S. merely doubled. And deaths in Canada, which lagged well behind the increase in the U.S. for September and October, rose by 19.7 per cent in November, compared with only 16.0 in the U.S.

Table 1: COVID-19 cases and deaths November 2020

Source: Worldometer

The upward trend in Canada was especially troubling in the final week of November as both case numbers and deaths were at the top of the range projected in modelling by the Public Health Agency of Canada. The PHAC projected a cumulative case range between 366,500 and 378,600 and deaths of from 11,800 to 12,120 to November 30. Cases of 378,120 came within a few hundred on the top of the range while deaths, at 12,184, exceeded it.

Just as  during the first wave, many of the deaths occurred in long-term care homes. There is not enough consistent reporting to enable month-by-month or province-by-province comparisons. In May, it was estimated that about 80 per cent – 5,325 of the 6,575 COVID-19 deaths to that point – were in long-term care and retirement residences. The PHAC reported last month that deaths in long-term care and residential residences stood at 7,339, which would indicate that, to the end of November, about 60 per cent of the victims of COVID are in long term care. And despite a second wave surge in infections among younger people, close to 90 per cent of all fatalities were 70 or older.

West hit hard

As was the case in  October, the virus hit the west the hardest last month. Led by an increase of more than 30,000 in Alberta, cases more than doubled in the Western Provinces and the Territories in November. Ontario and Quebec experienced a slightly lower rate of increase in November than in October, while the month-to-month rate of increase nearly doubled in the Atlantic Provinces.

Table 2: Change in COVID-19 cases by region

Source: health-infobase.canada.ca

Manitoba had by far the worst increase in deaths from COVID-19, as deaths rose from 67 at the end of October to 328 a month later. Combined, the four western provinces had a 99 per cent increase in deaths in November, compared with only 14 per cent in the rest of the country.

Projections grim

Despite some possible good news on a vaccine, the next few months look much like the last few, with Canada’s case and death rate continuing to climb faster than the U.S. This past week some news reports cited projections here from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington. As Globe and Mail and CBC pundit Andrew Coyne reported, citing IMHE, “the number of new infections in Canada each day will nearly triple between now and the first week of January, surpassing the U.S. in per ­capita terms some time in mid­-December. The death rate, meanwhile, is projected to more than quadruple.”

The Institute’s projections are updated regularly. Assuming there is no easing of restrictions, the Institute’s Dec. 4  projection had Canada’s death rate tripling, not quadrupling, to the end of March. That’s even with early rollout of a vaccine, but masking at 95 per cent lowers projected deaths to about 31,000. The table below presents the IHME’s projections to January 1.

Table 3: Projected deaths and infections to Jan. 1, 2021

Source: Institute for Health Metrics and Evaluation

We’ll check back in January to see how those projections fared. The IHME projections can change significantly from day to day. On Thursday, when Alberta’s pandemic plight topped the news, ISME projected 5,001 deaths to March 1 for that province, a ten-fold increase from Dec. 3. On Friday, the projection for Alberta was knocked down to 3,951 to the first of April.

Nova Scotia, the only Atlantic province tracked, was projected on Thursday with 72 deaths to March 1. On Friday, the projection jumped to 135 deaths by April 1, reduced to 119 with universal masking. The short term January 1 projection for Nova Scotia is 72 deaths and 45 to 54 daily infections, rising to 190 a day before beginning a decline in February. It’s possible those projections are too dire. But unless they are way off, they’re a strong reminder that we are far from being out of the woods.

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[1] IHME’s daily infections include both confirmed cases and suspected cases based on positivity rates and are thus higher than confirmed cases as reported by health authorities.