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COVID-19 could be one of the leading causes of death in Alberta in 2020

Pandemic Response Unit at the Peter Lougheed Hospital in Calgary on November 14, 2020. Leah Hennel, Government of Alberta

The first positive case of the novel coronavirus in Alberta was identified March 5, 2020. The first COVID-19 death in the province was reported March 19, 2020.

In the nine months since there have been over 72,000 cases in the province, and more than 640 people have lost their lives to the virus as of Dec. 8, 2020.

At a press conference Nov. 6, 2020 Premier Jason Kenney urged Albertans to “put this into perspective” saying “while we have to take the COVID-19 threat very seriously, it is currently projected to be the eleventh most common cause of death in Alberta this year.” As of that date, 352 deaths in the province had been attributed to COVID-19.

In just over a month, that number had jumped to 640 deaths, with 12 days out of 32 reporting COVID-19 daily death tolls in the double-digits in Alberta. Infectious disease experts confirm that COVID-19 will likely be in the top ten causes of deaths, and as numbers rise throughout December, it could be even higher.

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According to infectious disease specialist Dr. Lynora Saxinger, the mortality associated with this virus is significant.

“It’s really really unusual to have an epidemic infection actually even crack the top 10 of any kind of a death ranking,” Saxinger said.

Global News has sent a request to the premier’s office and the Ministry of Health for updated projections on the leading causes of death in Alberta and will update the story when we hear back. A previous request to Alberta Health Services was redirected to Service Alberta.

Projections by The Institute for Health Metrics and Evaluation (IHME) suggest Alberta is on track to see between 786 to 1,214 COVID-19 related deaths by the end of 2020.

Alberta COVID-19 mortality projections from the IMHE, as of Dec. 8, 2020. Institute for Health Metrics and Evaluation

Previous data on leading causes of death in Alberta

According to a spokesperson for Service Alberta (the ministry that manages vital statistics data in Alberta), as of Dec. 2, 2020, Statistics Canada had not released updated data for the leading causes of death in 2020.  However, data from previous years is publicly available.

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In the past decade, the leading causes of death in Alberta have been fairly consistent year-over-year since there have not been any significant cures for top-leading causes or widespread positive modifications to our behaviors that lead to ill health.

For the past 10 years, the top five leading causes of death were organic dementia, chronic ischemic heart disease, lung cancer, COPD and sudden or acute heart attacks — though the order varied from year to year.

For the past three years, the fifth leading cause of death in Alberta was sudden or acute heart attack (acute myocardial infarctions) with 1,061 people succumbing to this in 2019, 1,071 people in 2018 and 1,028 in 2017.

A list of the top nine leading causes of death in Alberta from 2017 to 2019. Global Calgary

According to public statistics, the sixth and seventh leading causes of death for the past three years have been either “atherosclerotic cardiovascular disease, so described” (more commonly known as artery blockages causing such things as strokes, angina and coronary artery disease) and “accidental poisoning by and exposure to drugs and other biological substances” (more commonly known as overdoses.)

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In the previous three years, deaths from these two causes, arterial blockages and overdoses were responsible for 817 and 810 deaths in 2017, 745 and 833 deaths respectively in 2018 and 678 and 677 deaths in 2019.

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Strokes and diabetes have alternated between the eighth and ninth leading causes of deaths for the previous three years, with 606 and 584 people dying from these diseases in 2017, 566 and 577 respectively in 2018 and 602 and 569 in 2019.

So where does COVID-19 fit?

Assuming data trends would be similar for 2020, and with 640 deaths attributed to the novel coronavirus currently, COVID-19 deaths would likely sit around the eighth leading cause of death in Alberta as of Dec. 8, and if mortality trends continue, COVID-19 is on track to be between the fourth to the seventh leading cause of death in 2020.

That does not adjust for the consideration this province was COVID-19 free until early March.

As of Dec. 8, 2020, 72,028 Albertans have tested positive for COVID-19, 654 are in the hospital –112 of whom are in the intensive care unit — and 640 people have died from the virus.

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Saxinger said COVID-19 is likely sitting as the third leading cause of death in countries like the United States and it “speaks to the fact that although people tend to focus on the fact that 99 per cent of people recover, the one per cent that do not recover is actually a tremendously large absolute number of people.”

Saxinger added, “That’s really something that does show up when you look at mortality statistics as being something that is incredibly different.”

Co-morbidities are often cited along with COVID-19 death statistics in Alberta, with diseases like dementia, high blood pressure, diabetes and heart and lung disease cited amount the top-known illnesses in those who have succumbed to this coronavirus.

A study on the Global Burden of Disease analyzing data from 204 countries was recently made public via The Lancet. The authors concluded some developed nations were not prepared for a crisis like this current pandemic because of rising cases of conditions like high blood pressure or diseases like diabetes.

Saxinger noted this pandemic has exposed a number of vulnerabilities in our society.

“This virus has exploited the chinks in our armour from the very beginning,” she said, touching on the way our society manages elder care, and congregate care as well as the way this crisis exaggerates disparities — which are also a cause of ill health.

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“So beyond the virus itself which is at least 10-times more lethal than influenza, all of those other pieces combine to make this something that really changes the shape of our population for a period of time.”

Demographics of COVID-19

Data from the Alberta Government shows the average age of a person who has died from the disease is 82, but as the Chief Medical Officer of Health Dr. Deena Hinshaw pointed out in her briefing on Dec. 8, all demographics are susceptible.

“Our youngest reported case was less than one year old, and our oldest was 108,” Hinshaw said.

To date, there have been very few fatalities in younger Albertans, something pediatric infectious disease specialist Dr. Jim Kellner said is another way COVID-19 differs from other viruses — although experts are still trying to understand why.

“We’re used to infectious diseases being predominantly a childhood thing that goes away in adulthood and comes back in later adulthood,” Kellner said.

Of the children who do end up with more severe outcomes from the novel coronavirus, Kellner said they tend to have similar health issues as the older demographic that does poorly with the disease, things like congenital problems.

He also noted he has observed more children with severe COVID-19 infections during this second wave.

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‘Echo pandemic’ and other effects of COVID-19

Beyond the obvious tragedy associated with the worst possible outcome of mortality from COVID-19, Kellner says there are other impacts caused by the virus.

“Getting COVID-19 is not a walk in park for many of those who contract the virus,” he said.

“For every person who dies from COVID-19 there are a least 20 who will be hospitalized.”

Kellner said many of those with COVID-19 see effects from the virus for months and potentially longer. The data just doesn’t exist to tell us the full story of what those long-term impacts might be.

“The way that COVID-19 infects the lungs is really unique compared to any other virus and certainly different than influenza,” he explained.

Kellner said this is part of the reason why some COVID-19 survivors are referred to as “long haulers,” noting the toll of the infection can leave patients very frail and requiring on-going support from family as well as the health system.

He did point out the majority of COVID-19 patients will not fall into this category, but urged this ramification not be overlooked.

According to Saxinger, another consideration is how non-COVID-19 patients are impacted by the so-called “echo pandemic.” Specifically, the need for a broader look at the ripple effects something like this can have on the overall physical and mental well-being of society.

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Saxinger believes it is important people understand how serious the COVID-19 situation is right now, especially in light of the pressure being put on our health care system.

“These next couple of months are going to be really really hard,” she said.

However, Saxinger also indicated there is reason for optimism with the vaccine expected to roll out in the next couple of months — which is something the infectious disease specialist believes will make a difference.

This is something Kellner alluded to as well.

“Infectious diseases as the fundamental cause of death in countries like Canada have become much less common,” he said, “thanks to vaccines, medications and our health care system.”

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