Why COVID-19 deaths are likely underreported in Nova Scotia

The Nova Scotia government says there have been 421 COVID-19 deaths in the province since the pandemic began, but an infectious disease researcher says that number is likely understated by at least 200.

Tara Moriarty, an associate professor at the University of Toronto, called it "a conservative estimate" and cautioned the number will grow.

"A lot of the deaths from Omicron are going to start coming in," she said.

She said it's important to note that underreporting of COVID-19 deaths is "the norm" worldwide, even in high-income countries.

Moriarty is part of a team at the COVID-19 Resources Canada project doing modelling to help members of the public better understand the COVID-19 situation. It receives funding from the Public Health Agency of Canada for its work.

What is excess mortality?

Moriarty said to get an accurate picture of how many COVID-19 deaths are going unreported, one has to look at excess mortality, which is when more deaths happen than are expected.

Figures released Thursday by Statistics Canada estimate that from March 2020 to the middle of February 2022, there were an estimated 40,349 excess deaths in the country, or seven per cent more deaths than expected.

However, the situation got much worse beginning in January because of Omicron.

"Canada experienced a new period of significant excess mortality starting in January 2022," said a Statistics Canada report. "From the start to the end of January, there were 4,085 excess deaths observed nationally, or 13.2  per cent more deaths than expected if there were no pandemic."

Statistics Canada's data estimates that since the pandemic started, there have been 181 fewer deaths than expected in Nova Scotia. However, the data for Nova Scotia only goes up to Oct. 23, 2021, which is before the Omicron wave hit the province.

Roughly three-quarters of the official COVID-19 deaths in Nova Scotia have happened since December.

"There are many more deaths that are still going to come in from Nova Scotia because Nova Scotia just hasn't reported [that data]," said Moriarty.

Of the 21 COVID-19 deaths announced by the province during their weekly update on Thursday, officials said 19 of the deaths happened between April 25 and May 30.

How Nova Scotia classifies COVID-19 deaths

In Nova Scotia, deaths attributed to COVID-19 capture both people who died from infection with the coronavirus or when COVID was believed to be a contributing factor.

"When people have underlying conditions it becomes more complicated, but if COVID may have contributed to the death, we report it as a COVID-related death," Health and Wellness spokesperson Marla MacInnis said in a statement.

"In situations that are more complex, such as a person who dies with multiple contributing factors, the cases are reviewed by clinicians and/or public health to determine whether COVID-19 may have contributed."

In cases where the cause of death is unknown or a person is suspected to have had COVID-19, tests are carried out to find evidence of the disease.

Moriarty said deaths can still be missed.

"A lot of deaths in older people don't necessarily look like the way we typically think of COVID as a respiratory infection," she said. "A lot of older people, when they develop respiratory infections don't have obvious symptoms, until they can no longer breathe and they die."

Older Nova Scotians face higher death rates

Since Dec. 8, 2021, the median age of people who have died from COVID-19 in Nova Scotia is 81, according to the province. 

It said the risk of death from COVID-19 is 125 times higher for people 70 and older than it is for people under 50.

While Omicron has been billed as a mild strain of COVID-19, Moriarty said the reality is far more complicated. 

"What I want people to understand is that if you're eligible for fourth doses, get them immediately," she said.

"There's still a lot of Omicron out there. And every week that passes, the protection you have from vaccines, from your third dose, is falling and [you] indeed become more and more likely to be infected and potentially die if you're susceptible."

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