Covid-19 Cases and Deaths Comparison, within
North America (Up to the end of February 2022)
Recently, the governments of both Canada and the U.S. increased
Covid-related restrictions for persons crossing their borders, either
way. The reaction to this, from a large group of Canadians, was to
organize protests in Ottawa, which then spread to protests and
informal blockades at several border crossings. As these
restrictions fell particularly heavily on truck-drivers, the protests
became identified with that particular occupational group, though it
was embraced by a much broader assortment of people than that.
Eventually, this led to the Prime Minister instituting the
Emergencies Act, something which no P.M. had done in the 33 year
history of the act. This was followed by forceful removal of the
protesters, resulting in some injuries, though thankfully no deaths.
The purported reason for the enhanced restrictions at the border was,
of course, the fear of the spread of Covid-19, particularly in the
form of the Omicron variant. This variant is now known to be highly
transmissible, though causing severe disease and/or death in a much
smaller proportion of infections than the earlier variants, such as
Delta. The government was insisting that all drivers must be double
vaccinated and quarantine after crossing the border, which they
considered to be an undue and unnecessary burden, given that the
Omicron variant was well established in Canada by then, and most
spread was considered to be “community spread”.
This being the case, it seems like a good time to review the
situation of Covid-19 within North America. I will look at the
fundamental indicators, such as cases, ICU admissions and deaths,
within the three North American countries of Canada, the United
States and Mexico. This will include an overall trend, since the
beginning of the pandemic, with a focus on the most recent time
periods, since they are most relevant to the situation concerning the
border restrictions and the ensuing protests and government response
to those protests.
Looking at these facts should help provide context for assessing the
reasonableness (or lack thereof) of the actions of the Canadian and
U.S. governments, concerning this matter. Though Mexico is not
directly involved in the Canada-U.S. border situation, Covid-19
statistics from that country should help round-out the picture in
North America.
Note that if you want a quick summary, skip to the final section.
A
Note on Data
As many people have noted throughout the pandemic period, there have
always been some issues with regard to data reliability in the
Covid-19 reporting. Some of those issues include:
-
How were cases determined, and what proportion of infections were
actually reported as cases? Who was tested and how were the tests
done? How did that vary throughout the world? Were rolling random
samples tested, or were tests only initiated by medical visits? How
about water-treatment plant tests?
-
How were Covid-related hospitalizations counted? What proportion of
these hospitalizations were primarily due to Covid-19, and how many
were essentially incidental (for example, a person goes to the
hospital with a broken leg, but is then tested positive for Covid).
-
How were Covid-related deaths counted? As with hospitalizations,
how many Covid-related deaths were incidental, As an example, I
knew one person who died of cancer in hospital during the early days
of the pandemic, that was swabbed and tested within a half-hour of
his cancer-related death. It turned out that he tested negative,
but had he tested positive, by the protocols of the time he would
have been called a Covid-related death.
The rise of the Omicron variant has brought more transparency to
these issues. For example, in the December 30, 2021 issue of the
Toronto Globe and Mail (a very mainstream source) we can read
statements such as the following:
-
The scientific director of Ontario’s Covid-19 Science Advisory
Table, Peter Juni, estimates that the province’s daily count is
now capturing just one case out of every five to eight cases in the
province.
-
The daily measurement has always had flaws. For one, it almost
exclusively records cases that have been confirmed during lab-based
polymerase chain reaction (or PCR) testing. In the past, when the
demand for tests outstripped the capacity of labs, such as during
the virus’s deadly first wave, many people who suspected they were
infected couldn't get tested, causing government tallies to
under-count the spread of the virus.
-
In Ontario, even before Omicron came along, case counts only
captured about tow out of very five Covid-19 inflections according
to Dr. Juni – a ratio verified by mortality data and serological
testing.
Similar statements are coming out regarding incidental
hospitalizations and deaths. In my opinion, it is still useful to
look at trends, but the possibilities for over-counting and
under-counting should be kept in mind.
Aggregate Cases
and Deaths, up to end of Feb 2022
1 - Raw Numbers of Aggregate Cases and Deaths
The
graphs of aggregate case counts and deaths are shown in the first two
graphs below, for the three countries at different points in time
over the period of the pandemic, thus far. Note that these graphs
have not been normalized for population or any other relevant factors
- they just show the raw totals for cases and deaths. Further on,
graphs with these normalizations will be provided.
The graph of the case counts show
that cases in the U.S. far out-stripped those in Canada and Mexico.
Much of this is effect is due to the higher population in the U.S.
than in Canada and Mexico (334 million vs 38 million and 131 million
respectively).
The other striking feature of the
graph is the huge jump in cases during the final couple of time
intervals. U.S. case counts fairly leap up, while Mexico and Canada
also show very noticeable increases. That gives an indication of the
enhanced transmissibility of the Omicron variant.
As for Covid-related deaths, the
U.S. is still highest by far, though the gap between Mexico and
Canada has widened considerably. The slope of the lines also
increased somewhat during the final two time intervals, but much less
so than was the situation for cases. That is an indication that
Omicron tends to be less severe for those infected.
Just looking at the two graphs
already raises a question about differences in either data collection
practices or health outcomes – why are Canada and Mexico so close
in terms of cases but much further apart in terms of deaths?
Obviously, these comparisons,
interesting as they are, need to be normalized for population, which
I will do a little later on in this blog.
As always, it should be noted that there is a good deal of
uncertainty in these numbers, due to differences in reporting
standards and levels of economic development.
2 - Aggregate Cases and Deaths per Million Population
Case
and death counts alone don’t tell the whole story. Regions with
larger populations will experience higher case counts and deaths, all
things being equal. When an adjustment for population is made
(expressing the data as Cases per Million Population and Deaths per
Million Population), things are quite different.
The U.S. still has the highest level of Cases per Million, at about
250,000, by the end of Feb 2022. That would imply that about
one-quarter of Americans had Covid-19 at some point during the
pandemic period.. In addition, about 65,000 of those 250,000
occurred in the two month period of Jan-Feb 2022, showing just how
transmissible Omicron has been,
especially in the U.S..
Canada has had a much lower Cases per Million count, reaching about
85,000 by the end of the period. This might indicate some problem
with comparing case counts, as a difference of this magnitude between
the U.S. and Canada seems rather high. The same could be said of
Mexico, whose case count per million population, at about 50,000, is
only about one-fifth of the U.S..
In all cases, the Cases per Million jumped up quite substantially
during 2022, again demonstrating what we might call “the Omicron
effect”.
As for Deaths per Million population, those were quite close between
the U.S. and Mexico by Feb 2022, between about 2500 and 3000. Again,
this probably indicates a problem with case count comparisons, as it
implies a rather high case fatality rate for Mexico (that will be
shown more directly later). Canada’s Death per Million rate was
much lower than its North American neighbors, at about 1000.
Though the Deaths per Million rate did accelerate during the final
two periods of the data for all three countries, the rise was much
less steep than was seen for Cases per Million. This demonstrates
the other main feature of the “Omicron Effect”, namely that the
outcomes of cases tended to be much less severe than it was in
earlier phases of the pandemic (and thus earlier variants).
Case Count and Deaths by Time Periods up to End of 2021
3
- Raw Numbers per Time Interval
Here
are a couple of graphs, looking at raw numbers of case counts and
deaths during particular intervals. The intervals are mostly months,
though in the earlier period they are sometimes longer and the last
period is relatively short (in an effort to get more detail about
Omicron).
For
the Cases per Time Interval graph, the U.S. data dominates, so much
so that it is difficult to see much detail in the lines for the other
two countries. That said, one can see three main waves in the data:
late 2020-early 2021, late summer-autumn 2021 (Delta) and late
2021-early 2022 (Omicron). As with the aggregate data, Omicron shows
much higher case rates than the other waves. I should note that more
fine-grained data would make some of the other waves that were known
to occur more obvious.
More
detailed country comparisons can be seen in the Deaths per Interval
graph. This shows the correspondence in time of several waves.
Again, the count of deaths in the U.S. and Mexico are relatively
high, compared to Canada. This is mostly due to the populations
differences between the countries, though some differences between
the three countries health care systems (and thus case fatality
rates) likely play a role.
Deaths
were especially high during the late 2020-early 2021 wave. Deaths in
the U.S. remained relatively high for much of late 2021-early 2021,
though they dropped off substantially during the final period.
Deaths
were also quite high during the first waves, in early 2020,
something not so evident in the Cases per Interval graph. It may be
that the virus was more pathogenic at that time or it may simply
represent difficulties in testing and recognizing cases then,
relative to later time periods.
4
- Case Counts and Deaths per Day per Million Population per Time
Interval
As with the aggregate counts and deaths, normalizing the data for
population and number of days during each time interval helps with
inter-country comparisons. Since the time periods in the graph were
not equal in duration, the data has been converted to a “per day”
basis. Similarly, since the three counties are not equal in
population, they have been normalized to a “per million population”
basis. Combining the two normalizations gives a “per day, per
million population” figure. For purposes of comparison, this is
the preferred graph. That said, the usual caveats apply regarding
the uncertainties about consistency in such matters as differences in
defining and collecting data on cases and deaths in different
jurisdictions.
The graph of Cases per Day per Million Population (note that it could
also be described as Cases per Million Population per Day) continues
to show the U.S. higher than the other two countries, though the
differences are now reduced. Three main waves are once more visible,
and at times the lines for the three countries actually cross.
Nonetheless, the pandemic in the U.S. appears to be more severe than
in Canada and Mexico, when looking at this data.
Looking at the Deaths per Day per Million Population gives a
substantially different view of the pandemic, as experienced by these
three countries. In this view, Mexico and the U.S. show rather
similar profiles, during much of the pandemic. Both peak at about
the same level in late 202-early 2021 and in late summer-autumn 2021,
though the U.S. peak is much higher during the Omicron wave. Canada
was generally quite far below its North American neighbours, using
this measure.
5 - Case Fatality Rates, Aggregate Trend and by Time Periods
Of particular interest is the trajectory of the Case Fatality Rates
(CFR) for the three North American countries. I have defined this as
(Deaths/Cases). Deaths generally lag cases by about 2 weeks, as it
takes some time for the disease to progress to the end-point of
death; however at this scale it generally seems reasonable to ignore
the time lag.
That may differ for the final period, in mid to late February as that
was a fairly short interval, when cases were falling dramatically,
while deaths remained relatively high (as many of these were from
cases diagnosed during the previous time period). Thus, that could
artificially inflate the calculated Case Fatality Rate for that final
period.
The
data is shown in the two associated graphs. The first graph shows
the trend in the aggregated Case Fatality Rates for the three North
American countries over the two years of the pandemic. In other
words, at each time step all of the cases and all of the deaths up to
that point in time are used for the calculation. The second graph
shows the trend in the Case Fatality Rates for each time interval for
these countries over the two years of the pandemic. In other words,
at each time step all of the cases and all of the deaths that
occurred during that time interval are used for the calculation.
Several
observations stand out for the Aggregate Case Fatality Rate:
-
Perhaps the most striking observation about the graph is simply that
the aggregate Case Fatality Rate falls over time for all three
countries.
-
For the U.S. and Canada, the rate at the beginning of the pandemic
was over 5%, while by the end of the pandemic it was under 1%. So,
the Case Fatality rate fell by at least four-fifths, perhaps a bit
more.
-
Mexico’s drop in the CFR was less dramatic, but it still fell from
over 10% to somewhat above 5%. That was still a drop of over
one-half.
-
Also striking is the convergence between Canada and the U.S. in this
measure. By the mid-point of the pandemic, the CFR of the two
countries was essentially equal and it remained like that right up
until the end of the available data.
-
The difference between Mexico and the other two countries remained
high. This may reflect differences in the underlying pandemics or
it may be primarily an effect of reporting practices. It seems
likely that it is a combination of the two phenomenon.
The second graph,
showing Case Fatality Rates specific to the various time intervals
shows a lot more variation, but some trends are clear:
-
The Case
Fatality Rates were high in all three countries during the early
stages of the pandemic, at the beginning of 2020.
-
Rates fell
quite substantially after that time, in the U.S. and Canada, though
less so in Mexico.
-
Canada and
the U.S. show increases in the Case Fatality Rates during at least 4
(possibly 5) later waves.
-
These latter
waves generally track between about 1% and 2.5%, from trough to
peak.
-
There is
considerable correlation in time between Canada and the U.S. during
these peaks and troughs.
-
The data for
Mexico is much less closely aligned with these Canada-U.S. trends,
though Mexico does follow roughly similar waves.
-
There is an
uptick in Case Fatality Rates at the end of the series, though as
noted previously that is probably due to the lag time between a
person being infected and dying of the disease.
-
Given the
similarity in Case Fatality Rates between the U.S. and Canada, but
the much higher Cases and Deaths per Million Population in the U.S.,
it does seem reasonable to conclude that case numbers really were
much higher in the U.S. than Canada (i.e. it is not just some
reporting artifact).
Summary
Comments about the Emergency Act
Getting back to the implementation of the Emergency Act in Canada,
there are a few salient points that we can make from the data. I
will add a few points that are my own opinions, but I think they are
supported by the facts as displayed in the graphs:
Case Counts
-
Though Cases per Million Population were higher in the U.S. (about 1750 cases per million population per day) than in
Canada at the time that the Emergency was declared (mid-February),
Canada was already in the midst of the Omicron wave (with a rolling average of about 700 cases per million people per day). So, heightening restrictions at the border at that
time was essentially a case of closing the barn door after the horse
has left the barn.
-
From
that point of view, it is hardly surprising that truck drivers felt
that they were being singled out for no good reason. Thus, the
demonstrations and protests in Ottawa and other areas (“the
Honkening”).
-
Some
provinces had recently allowed unvaccinated nurses and other
hospital staff back to work, even to the point of having them work
with Covid patients. Cracking down on truck drivers at this time
seemed misguided, even gratuitous.
-
The
fact that both hospital workers and truck drivers had been lauded in
earlier stages of the pandemic for staying on the job, only
heightened the contradiction and likely led to a sense of alienation
by these typically working class truck drivers and their supporters.
Case Fatality Rates
-
Though the rise in cases was causing a rise in deaths, the Case
Fatality Rate was at its lowest
level ever by the time that the Emergency Act was implemented (well under 1%).
-
So, this latest Covid-19 variant
was actually turning out to be much less deadly than earlier
variants had been.
-
The rise in infections (thought to
be up to 10 times the rate of actually diagnosed cases) was
producing an increase in natural immunity.
-
This, in association with earlier
vaccination programs, seemed to really be putting Canada well on the
road to the long hoped-for “herd immunity”. So, it was quite
reasonable to think that further restrictions were not only
pointless, but they may have also been counter-productive.
-
Many countries and provinces within
countries were relaxing restrictions (or giving up on them
altogether) by that time. The
inconsistency of the heightened border restrictions with those facts
only further alienated people, leading to the demonstrations and
protests.
-
The fact that the federal
government revoked the Emergency Act only two days after insisting
on its necessity during the House of Commons debate only furthers
the sense that the policy was misguided and needlessly provocative.
Sources:
The Globe and Mail
https://www.worldometers.info/coronavirus/#countries
https://github.com/owid/covid-19-data/tree/master/public/data/vaccinations
Some earlier Covid-19 blogs:
https://dodecahedronbooks.blogspot.com/2021/07/covid-19-cases-and-deaths-by-continent.html
https://dodecahedronbooks.blogspot.com/2021/07/covid-19-cases-by-continent-jan-2000-to.html
https://dodecahedronbooks.blogspot.com/2021/03/covid-19-vaccines-how-successfully-are.html
https://dodecahedronbooks.blogspot.com/2020/12/covid-19-vaccines-comparison-of.html
https://dodecahedronbooks.blogspot.com/2020/09/covid-19-continues-to-travel-around.html
https://dodecahedronbooks.blogspot.com/2020/07/has-covid-19-become-less-deadly.html
https://dodecahedronbooks.blogspot.com/2020/07/july-2020-update-covid-19-death-rates.html
https://dodecahedronbooks.blogspot.com/2020/05/covid-19-death-rates-correlate-highly.html
https://dodecahedronbooks.blogspot.com/2020/06/covid-19-impact-on-employment-no-impact.html
https://dodecahedronbooks.blogspot.com/2020/04/is-there-model-that-can-predict-when-to.html
https://dodecahedronbooks.blogspot.com/2020/03/estimating-fatality-rate-of-coronavirus.html
=====================================================
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=======================================================
What
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=======================================================
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