Cremations in Ontario rose by about 3,000 over normal levels in March and April, as the novel coronavirus took hold in the province, numbers released by the province’s coroner show.
However, only about half of those cremations were of people whose deaths were formally blamed on the pandemic.
The numbers offer a glimpse into ‘excess death’ linked to the pandemic: people whose deaths were in some way related to the coronavirus, but don’t appear in official totals.
Dirk Huyer, Ontario’s chief coroner, suggests three reasons for the discrepancy.
The first is people with serious medical issues like a heart attack, who normally would have gone to hospital but were afraid to, and died as a result.
“Maybe people were fearful about going to medical care, maybe people looked at their symptoms and said, ‘It’s not that bad that I need to go in,’ because they don’t want us to go into the emergency department. Maybe it was that, or there may be many others,” he says.
In London, England in April, hospitals reported a sharp increase in heart attack deaths at home, which they blamed on a reluctance to be treated in hospital.
(Doctors say people who need emergency care shouldn’t avoid hospitals.)
Other people, affected by job loss, social isolation or both, may have been pushed over some personal edge.
“Maybe it’s the fact that people are having troubles with the isolation, and troubles with not working, loss of job, mental health issues may be triggered by all of this,” Huyer says. “That may have had secondary impacts with substance-related deaths or other potential deaths may have arisen from really having struggles with all of this going on.”
Or, he explains, coronavirus deaths may just have been accounted for as due to other causes.
The use of cremation data is a workaround to get faster data on deaths than Ontario’s paper-based death registration system can easily provide. About three-quarters of the people who die in Ontario are cremated, Huyer says.
Data on all Ontario deaths in 2020 won’t be made public until January of 2022, officials told Global News in May.
However, all cremations in Ontario must be reported to the coroner’s office, and, Huyer says, “We have the data pretty real-time from the cremation forms.”
One limitation of the data is that it’s not clear how the pandemic has affected the choice between cremation and burial in Ontario, so it’s hard to tell the extent to which rising numbers of cremations reflect a rise in total deaths. Family members who normally would have chosen burial might have chosen cremation, but it’s hard to tell.
“One of the things we can’t control for is how many more people chose to do cremations because they couldn’t have funerals the traditional way, they weren’t able to get to the funeral home, they weren’t able to travel,” Huyer says.
“Say someone was a Nova Scotia resident and moved to Toronto, but all of his or her family were in Nova Scotia and couldn’t travel, maybe cremation is easier. They could send the ashes back to Nova Scotia.”
The greatest increases in cremations were in the 75-plus age group, which were up by 1,297 people, or 37 per cent. Broken down by location of death, deaths in long-term care homes rose the most (89 per cent over normal levels) and in private homes (68 per cent over normal levels.)
The study is an exercise in making do with the data available.
“Based on the information available, we don’t have the ability to answer (questions about the pandemic’s death toll) any more clearly.”