Is B.C.'s COVID-19 death rate really as low as official numbers show?

Ask the B.C. government if they've done a good job handling the pandemic, and you'll often hear a very specific answer.

"The data is overwhelmingly supportive," said Premier John Horgan last week.

"The next closest of the jurisdictions of our size, of five million people in North America, the next closest to the low mortality rate is Ontario, and their mortality rate is twice what ours is." 

Horgan, Health Minister Adrian Dix and government news releases have all mentioned B.C.'s official death count compared to other provinces, states and countries in western Europe with more than five million people.

That very specific answer is based on a very specific chart — one produced by CBC News since the beginning of the pandemic, measuring official death counts in highly populated jurisdictions that were hit by the first wave at approximately the same time. 

It's a rudimentary metric, and all countries have different ways of gathering data, but it shows a large gap between B.C. and dozens of other comparable places.

But what if those numbers didn't paint the full picture?

Excess deaths

A report published last week by the Royal Society of Canada compared the number of official COVID-19 deaths in each province between Feb. 1 and Nov. 28, 2020, with excess deaths — essentially the difference between the total number of deaths and the number that was expected based on past years.

The study, which adjusted for overdose fatalities, found B.C. had 1,767 more deaths that were unaccounted for in that time. 

"They happened outside of situations where you have professionals with a legal reporting requirement to alert [the province to] deaths and then have an official process for cause of determination. And you can imagine that means that a lot of these deaths were people who probably died very quickly in their homes," said Nora Loreto, a freelance journalist and one of the authors of the report. 

"Especially in the start of the pandemic, it would have been very easy to miss people dying from COVID."

If all of those were due to COVID-19, but not reported as such, it would still put B.C. below Quebec and Ontario, every major state and the vast majority of western European countries. But it wouldn't make B.C. such an outlier, or perhaps deserving of praise in international media.

"You can imagine that B.C. has a set of public health and political figures who are very proud of [its official deaths figures], even if the pandemic was quite bad," said Loreto.

"[But] for anybody who had someone die suddenly in the last 18 months, and thought that death could have been a COVID death, and they didn't get a test and they couldn't be sure, I imagine this would be very important to them." 

'Grain of salt'

The province, not surprisingly, took issue with the report. 

"We need to take the review with a grain of salt," said Provincial Health Officer Dr. Bonnie Henry. "I don't agree with what the report has come out with, and I think ... they have made assumptions."

While Dr. Henry said that any sudden, unexpected deaths were tested for COVID, contrary to Loreto's assertions, she also admitted that "undoubtedly there are some deaths we missed early on" because of low testing and initial low capacity to track cases in the first wave.

But she didn't provide more specifics, and Loreto said if B.C. wanted to accurately rebut the study, it should provide specific data on post-death COVID testing, and why excess death data is lagging from the province.

"We don't have the fullest picture possible," she said. 

"It's one thing for public health officials to say take this with a grain of salt, and it's another for us to look at the data and go … why is death reporting in this province so slow, when it's not this slow in other parts of the world?" 

What is beyond debate is B.C. lagged behind many other places in data transparency for much of the pandemic, which continues to fuel questions. And while the province did better in containing transmission than some jurisdictions, there is always room for improvement.

"Compared to other places around the world, like East Asia and so on, we're doing much more poorly. Compared to the places in Europe, we're doing better," said Dr. Srinivas Murthy, an infectious disease specialist at B.C. Children's Hospital.

"It's all a spectrum, and I think understanding why we're in the middle and what we could have done better would be a great conversation in the future."