Ontario officials point fingers over lack of data on pandemic deaths

No one knows how many Ontarians have died because of the coronavirus pandemic and instead of trying to find out, public officials are pointing fingers at each other.

On Monday, the province announced a total of 1,904 confirmed COVID-19 deaths in Ontario. And while Ontarians see figures on the rising death toll in daily news reports, those figures are artificially low. They only take into account the deaths that have been recorded into a central database and so are a day or more out of date. But more significantly, they only include confirmed cases — people who have tested positive for COVID-19.

Ontario hasn't been testing living people widely for COVID-19 — the province issued guidelines only last week for all people with potential COVID-19 symptoms to be tested. Prior to that most people with milder symptoms, outside of priority groups such as health-care workers, were told to self-isolate at home, instead of going to an assessment centre. The province still isn't testing people when they're dead, with very few exceptions.

And testing alone doesn't capture the cost beyond the virus itself, such as lives lost due to the surgeries that were postponed to clear out overcrowded hospitals to make room for coronavirus patients.

There are two ways Ontario could learn more about the virus's true death toll — widespread post-mortem testing and tracking excess deaths in the province compared to years prior.

It is doing neither.

But according to some experts, Ontario is blind to the realities of the pandemic without that information.

"We have a dangerous pathogen among us and we don't know who it kills, and we don't know why," said epidemiologist Colin Furness, an assistant professor at the Faculty of Information at the University of Toronto, on this week's episode of the QP Briefing podcast.

"We are staying blind and fortunately for us, other jurisdictions are doing that kind of surveillance, that kind of measurement," he said. "We are refusing to learn, refusing to exert a small amount of effort to learn."

Furness has been publicly calling for widespread post-mortem testing, which he says could help Ontario learn more about who COVID-19 is killing and how. The "who" could identify high numbers of deaths among certain occupations, for example. The "how" would allow Ontario to add to the research in other jurisdictions that have recently found, for example, that in many patients, the coronavirus coagulates the blood and causes catastrophic stroke.

In other jurisdictions, post-mortem testing has determined that the virus was circulating locally earlier in the year than officials had previously realized.

In a recent interview with QP Briefing, Ontario's chief coroner said neither widespread post-mortem testing nor the calculation of excess deaths is his responsibility.

Dr. Dirk Huyer said the responsibility for post-mortem testing doesn't fall to his office because COVID-19 deaths are considered natural and therefore don't fall under his aegis, according to provincial legislation. "We're not involved and we're not doing the testing, so the question doesn't come back to us, unfortunately," he said.

Early on in the pandemic, the coroner's office worked with public health to do autopsies on the province's first known COVID-19 victims to better understand the novel disease, he said.

"But we don't do those anymore because we now understand what the infection agent is, because the coronavirus is well-recognized as the cause of this, so we wouldn't be doing any other investigations right now, and any investigations are led by public health," said Huyer.

However, his office does have the authority to investigate deaths under certain criteria laid out in the legislation, including violence, and deaths in long-term care homes where the coroner believes an investigation is warranted. Based on those investigations, he can decide to call an inquest, which provides a broader examination of the circumstances of deaths.

Huyer said coroners are investigating some deaths in long-term care, but it is premature to say at this point if he will call an inquest.

Any broad investigations of the pandemic fall to public health, he said. "Public health leads the investigations, so public health are the ones that help to provide the direction and the work through what would occur when investigating an outbreak or pandemic situation," he said. "They're the ones who are most informed on the type of approaches, as far as testing goes, generally."

Responsibility for public health in Ontario falls to 34 local public health units, but the key person who has been advising the province's public health strategy during the pandemic has been the province's chief medical officer of health and public health, Dr. David Williams.

Asked last week about post-mortem testing, he pointed back at the chief coroner.

"We have been consulting all along with our chief coroner, Dr. Dirk Huyer, and they have their own methods of reviewing and their standards about which cases they require for post-mortem," he said at a press conference, adding that the coroner did some post-mortem testing earlier on.

"As we trust him, if he felt there was any need for any further aspects, besides looking at chart reviews and monitoring the certifications of death as well as charts to see if there's any concerns, but no, we haven't heard any recommendation from the chief coroner in that regard, for anything there, but he is involved and giving us advice and direction as he deems necessary," said Williams.

According to Furness, the premier and cabinet have been using the extraordinary powers they have under the Emergency Management and Civil Protection Act and could direct widespread post-mortem testing, and could do so on the advice of Williams. "I don't think anyone's accused our premier of being a health expert, but our chief medical officer is supposed to be, and we need leadership from that office."

Williams also suggested Huyer's office should take the lead on the calculation of excess mortality, saying "the chief coroner has full access to the data."

"It's there, and if it was informative the chief coroner would look at it and make decisions accordingly," said Williams.

Not so, according to Huyer.

The Office of the Registrar General, within the Ministry of Government and Consumer Services (MGCS), is responsible for death registrations and extracting information from medical certificates of death and submitting that to the national vital statistics group, he said.

"It does take time," he said. "We don't have a real-time electronic process for death certification in Ontario. It's a complex province with lots of people involved."

Until the pandemic, coroners were required to complete medical certificates of death in pen and ink — and the province has only temporarily allowed for electronic means. Still, only about 50 out of 300 coroners have that capability now, Huyer said. That relates only to the deaths coroners are involved with — usually about 17,000 deaths a year — as well as all deaths in long-term care during the pandemic, he said.

Last week, Statistics Canada gathered information from eight provinces and one territory that were able to provide up-to-date information on the number of deaths in their jurisdictions as of the end of March. Ontario was not among them. While that data, which mostly reflected the early phase of the pandemic in Canada didn't show evidence of excess mortality in provinces where the data was available, hundreds and thousands of excess deaths have been found in other countries.

Huyer said it's MGCS's responsibility to make the changes that would allow Ontario to collect the death data in a more timely manner.

"This is an initiative and an area I think the Ministry of Government and Consumer Services do want to pursue — I can't speak directly for them but I have been in discussions previously with them about this," he said, adding it's a "big challenge," involving thousands of people including doctors, funeral home directors and civil servants.

A spokesperson for MGCS wouldn't confirm or deny if any work on that challenge is underway saying only, "The Ministry of Government and Consumer Services is continually considering and evaluating solutions that will improve timely access to data."