Ontario cremation data suggests 1,800 more deaths than normal at peak of pandemic in April

During the height of the first wave of COVID-19 in Ontario, roughly 1,800 more people were cremated than normal and fewer of those people died in hospital than in previous years, according to a study of cremation data.

The April 2020 numbers also show an 89 per cent increase in the number of cremations from deaths that happened in long-term care and a 68 per cent increase in the number of cremations from deaths in personal residences compared to the same month in the previous three years. 

Public health experts decided to look at cremations statistics because most bodies are cremated in Ontario, and because the records involved are available in almost real time — unlike data on all deaths in the province and across Canada.

"There is a lag in the official reporting of deaths," said Laura Rosella, one of the authors of the study. "We thought this was a creative way to get an early look at the potential impacts [of COVID-19] on mortality." 

The associate professor of epidemiology at the Dalla Lana School of Public Health told CBC News the fact there were still excess deaths in the spring under strict public health measures shows how much worse deaths could have been without those restrictions. 

"Even though the population … were largely under lockdown, still seeing these excess deaths provides some additional evidence that the policy measures that are needed to protect especially certain individuals were appropriate," she said. 

Deaths related to impact of pandemic measures need further study

But the study also noted that those excess deaths during the lockdown point to an increase in deaths from other causes due to factors like delayed medical care, loss of employment and isolation. 

That discrepancy can be seen in the numbers for April. The study found that there were 1,839 more cremations in April than the average number of cremations that month for the previous three years, but COVID-19 was the official cause of death for only 867 of the April cremations.

That's one of the reasons Rosella says more work needs to be done to address some of the questions raised by the study's findings, such as  why there was an increase in deaths at home.

"Some of those [deaths] are not related to COVID, but might be related to the impacts of some of the measures that are in place," said Rosella.

"If we can better understand those, we can understand what other measures need to be in place to protect individuals that might be dying from unintended consequences." 

Right now, public health units and the Ontario government are tracking deaths from COVID-19 in real time, but not for other causes, because the way that death data is processed and verified in the province and across the country through the Vital Statistics Act can take up to a year.

Having time-sensitive, clean mortality data 'is critical'

That's a problem, Rosella says, because it means mortality trends that could be helping the government create better public health policy now might not be available for a year or so.

"I think having robust, time-sensitive and clean mortality data is critical and COVID is showing us that," she told CBC News.

"There's lots of questions we cannot answer, we should be able to know who's dying generally, what age and generally, causes and where."

In the absence of that kind of mortality data, Rosella says certificates for cremation from the Officer of the Chief Coroner can provide near real-time data on most deaths since 70 per cent of bodies are cremated in Ontario. 

However, that cremation data does come with the caveat that there could be a shift in cremation preferences contributing to the excess deaths. While that might have played a small role, Rosella doesn't think that led to significant change. 

"We have the information of all deaths in long-term care and we can calculate the proportion that were cremated versus not," said Rosella. "We saw no change over the study period in the proportion of deaths that resulted in cremation, or not cremation, in long-term care specifically."

In a statement, the Office of the Chief Coroner told CBC News the impact of the pandemic on the number of deaths in Ontario is currently unknown. 

"Cremation data does not represent all deaths in Ontario, and comparison may be limited if the COVID-19 outbreak disproportionately affected groups with higher or lower rates of cremation," said spokesperson Stephanie Rea.  

But she went on to say that while "analysis of cremation data is ongoing, early estimates are critical to understanding the impact of COVID-19."

Scandinavia and U.S. have timely mortality data

So are there other countries around the world that have been able to use real-time mortality data to respond to the pandemic? 

Rosella says Scandinavian countries are well known for having extensive administrative data systems that can provide real-time information. 

"They ensure that data can be linked, can be accessible, is clean, but not for a specific reason," said the University of Toronto professor. "But when a reason comes up like COVID, they're able to respond, access that data quickly and generate insights from it."

However, Rosella acknowledges that Ontario would have had to make a significant investment in that kind of data system years ago for it to be ready to help provide real-time information in the current pandemic. 

The province could look south of the border for another short term solution to compiling mortality data. 

Rosella says some U.S. states like New York have a system in place to provide provisional data from death certificates in real-time with a disclaimer that some of the numbers might change through the verification process.

"Those are some things I think we could do quite quickly," said Rosella. 

Overall, she says the first step to improving the process is making sure when deaths are recorded that the information makes its way into a digital database, because right now death certificates are still paper based. 

"There are a few of these ad hoc systems that are being put together for COVID in Ontario, and in other provinces, but it's not capturing everyone," said Rosella.

"It's not always containing all the information we need to understand where the death occurred and how COVID was related to the death."