View the full, updated COVID Misery Index hereDownload the data for the April 21 update here. For more information, including a full methodology and analysis of the initial COVID Misery Index, click here, and view the original, non-updated Misery Index here.

To find all the MLI products related to the COVID Misery Index, click here.

What’s Happened Over the Past Week?

Canada’s pace of vaccine roll-out is improving, but data reporting on excess deaths - perhaps the most important pandemic performance metric - is months behind almost every other country in our COVID Misery Index.

MLI COVID Misery Index Weekly Update (April 21, 2021): The Macdonald-Laurier Institute’s COVID Misery Index is updated each week as we follow the progress of 15 developed countries to preserve the health, well-being and prosperity of their citizens during the pandemic. There are three categories: Disease Misery, a measure of the impact of sickness and death from the disease, Response Misery, a ranking of how well governments are doing on measures such as the success of vaccine rollouts or having to rely on restrictive lockdown measures, and Economic Misery, which takes into account the impact on jobs, growth and government finances.

Although Canada’s COVID-19 rates are rising, they remain lower than in many European countries which have much higher rates of incidence, hospitalization and death than Canada. However, Canada’s “excess death” rate - perhaps the best measure of the pandemic’s impact - is higher than virtually every other country in the Index.  Excess deaths are measured as the change in mortality rate from the same week of the previous year; this metric captures deaths from COVID as well as increases in mortality from other causes.

Excess deaths truly capture the trade-offs facing our healthcare system.  As Canadian health care providers geared up for an onslaught of COVID-19-related admissions in successive waves of increased numbers of cases, routine and non-urgent health care services have been pushed to lower priority.  Instead of face-to-face visits, consultations and appointments are delivered online.  It’s likely that many older Canadians are missing routine care altogether.

As time has dragged on, the impact of this shifting of priorities is being felt in Canada with significantly elevated excess death rates. But this metric comes with a crucial caveat: Canada’s data has not been updated for some time and reporting on this metric lags well behind every other country in our comparison.  The best tool to fight a pandemic is information and Canada is failing in this respect.

As of April 21, Canada has moved up to 10th place in the Index, with some improvement in vaccination rates. However its performance in responding to the pandemic, and the severe economic fallout impacting Canadians, continues to earn it a C grade overall. (For more detail about the methodology and initial results, click here.)

Many Canadian provinces are re-instituting restrictive public health measures, with Ontario’s being particularly strict.  At the same time, the Atlantic Canada bubble is set to re-open allowing quarantine-free travel between these provinces in early May.

Canada does, however, have better news with improvements in its vaccine roll-out.  Most provinces have opted for a wide distribution approach, with the aim of getting first vaccinations to as many people as possible before proceeding with second jabs.  This course of action is not without some controversy as the evidence for the efficacy of the vaccination is based on doses being administered four weeks apart.  A longer time between doses has the potential of leaving the most vulnerable still at risk, albeit a lower one, for contracting COVID-19.  It is this most vulnerable cohort that has borne the brunt of the pandemic and they are being asked, yet again, to sacrifice for the broader community.

In Canada the rates of tests per case is falling, which is indicative of a growing caseload.   Faced with such an increase, we would want to see the surge capacity of testing rise to this challenge.  Instead, we are struggling to keep up, resulting in more spread of COVID-19.

Finally, and with the political response to the increasing caseload, Canada’s “Severity” score -- a metric based on the stringency of lockdown measures that affects a country’s Response Misery ranking -- is rising.  Of particular note are the very restrictive measures being implemented in Ontario.  Hopefully these restrictions will serve as an effective circuit breaker.  However, the province’s swift backtracking on the more ill-conceived measures and lack of clarity regarding some of the provisions is causing confusion and frustration which may hamper people’s willingness to adhere to the restrictions. 

Either way, misery in Ontario and elsewhere in Canada is rising due to both the spread of the disease and the harsh measures taken in an attempt to flatten the curve which are affecting liberty and prosperity. 

Looking Ahead

The current increase in cases is worrying and adds urgency to the need to distribute vaccinations as widely and as quickly as possible.  The light at the end of the tunnel may be further off than we hoped. In Canada, we remain particularly concerned with the elevated rates of excess deaths and the desperate need to improve access to health care for non-COVID-19-related reasons. We will be watching Canada’s “Severity” score as new restrictions are imposed and remain in place in Ontario, BC, Alberta and Quebec; this data will be included in our analysis for the next update. 

We continue to keep a close watch on the vaccine roll-out. We have some concern about the availability of vaccines across provinces, and whether hesitancy about some of the vaccines on offer is leading Canadians to choose not to get vaccinated even when supply is available, or waiting until they can get their preferred vaccine. We note that there are production concerns with the Moderna vaccine that could further disrupt the roll-out.

Richard Audas, Faculty of Medicine, Memorial University of Newfoundland­­­. Senior Fellow at the Macdonald-Laurier Institute.

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