Relative Pandemic Severity in Canada and Four Peer Nations During the SARS-CoV-2 Pandemic

  1. Amy Peng
  2. Alison E. Simmons
  3. Afia Amoako
  4. Ashleigh R. Tuite
  5. David N. Fisman

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Abstract

Introduction

National responses to the SARS-CoV-2 pandemic have been highly variable, which may explain some of the heterogeneity in the pandemic’s health and economic impacts across the world. We sought to explore the effectiveness of the Canadian pandemic response relative to responses in four peer countries with similar political, economic and health systems, and with close historical and cultural ties to Canada (the United States, United Kingdom, France, and Australia) from March 2020 to May 2022.

Methods

We used reported age-specific mortality data to generate estimates of pandemic mortality standardized to the Canadian population. Age-specific case fatality, hospitalization, and intensive care admission probabilities for the Canadian province of Ontario were applied to estimated deaths in order to calculate hospitalizations and intensive care admissions averted by the Canadian response. The monetary value of averted hospitalizations was estimated using cost estimates from the Canadian Institute for Health Information. Age-specific quality-adjusted life-years (QALY) lost due to fatality were estimated using published estimates. QALY were monetized using a net expected benefit approach.

Results

Relative to the United States, United Kingdom, and France, the Canadian pandemic response was estimated to have averted 94,492, 64,306 and 13,641 deaths respectively, with more than 480,000 hospitalizations averted, and 1 million QALY saved, relative to the United States. A United States pandemic response applied to Canada would have resulted in more than $40 billion in economic losses due to healthcare expenditures and lost QALY; losses relative to the United Kingdom and France would have been $21 billion and $5 billion respectively. By contrast, an Australian pandemic response would have averted over 28,000 additional deaths and averted nearly $9 billion in costs in Canada.

Conclusions

Canada outperformed peer countries that aimed for mitigation, rather than elimination, of SARS-CoV-2 in the first two years of the pandemic, likely because of a more stringent public health response to disease transmission. This resulted in substantial numbers of lives saved and economic costs averted. However, comparison with Australia demonstrates that an elimination focus would have allowed Canada to save tens of thousands of lives, and would have saved substantial economic costs.

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  1. Version published to 10.1101/2021.03.23.21253873v2 on medRxiv
  2. ScreenIT

    SciScore for 10.1101/2021.03.23.21253873: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are three important limitations to our analysis: while we attribute improved outcomes in Canada to concrete public health actions, it is also possible that they reflect differences in structural, societal factors that have enhanced COVID-19 risk in the United States. Excess risk of COVID-19 and COVID-19 related death in the United States has been associated with lower income status and non-white ethnicity, but similar relationships have been observed in Canada as well (6, 7). A second key limitation of our analysis is our use of Ontario-specific case fatalities, and hospitalization and intensive care admission risks, to estimate outcomes averted at a national level; however, Ontario’s epidemiology is likely similar to that of Canada overall, both because of similarities in demographics and health systems across the country, and also because the population of Ontario represents approximately 40% of the Canadian population, and 35% of Canada’s COVID-19 case load, such that the Province’s epidemiology strongly influences that of Canada as a whole. Lastly, we assume that attribution of COVID-19 deaths in Canada and the United States occurs in a comparable manner; questions around over- and under-assignment of COVID-19 mortality have been raised in both countries (8).

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.03.23.21253873v1 on medRxiv