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Jul 27, 2023

The worst-case free-for-all scenario estimated that 34 million Canadians would have got the virus had it been allowed to run free

OTTAWA — A new paper from scientists at the Public Health Agency of Canada, co-authored by Chief Public Health Officer, Dr. Theresa Tam, estimates that with absolutely no public health measures and no vaccines, 800,000 people would have died from COVID-19 in Canada.

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The paper was published in the Canada Communicable Disease Report, a peer-reviewed medical journal published by PHAC. The article, which appeared in the July/August edition, presents a series of several counterfactual scenarios, from an approach with no public health measures or vaccines to scenarios where public health measures, like lockdowns and masks, were simply lifted earlier.

According to the paper, which had several authors including Tam, the worst-case scenario would have seen 34 million Canadians get the virus had it been allowed to run free. Two million of those people would have ended up in hospital and 800,000 would have died.

The paper used information up to April of this year, by which point 150,000 people had been hospitalized and 38,783 had died, a number which rose over the summer and now sits at just over 45,000 deaths.

The modelling information is only estimates of what would have happened, but is based on what agency data about how easily the virus spreads, how fatal it can be and how many people have ended up in hospital.

"In the absence of public health measures and vaccinations, a very large initial wave far exceeded hospital capacity as did a subsequent large Delta-driven wave as immunity waned, and this resulted in a very high number of hospitalizations and deaths."

In all of the scenarios it looked at, hospitals were overwhelmed with far more patients than they could accommodate with beds. The researchers argue that without the measures the government took, many more people would have died.

"The simulations show that the combination of public health measures and vaccinations that occurred in Canada resulted in far fewer infections, hospitalizations and deaths," the researchers wrote. "The earlier measures were lifted, the worse were the outcomes in terms of hospitalizations and deaths."

The paper also looked at what would have happened if Canada had used public health measures, but not vaccines and found that would have resulted in roughly 360,000 deaths and close to a million hospitalizations. The estimates show that abandoning all public health measures and relying solely on vaccines would have produced roughly 325,000 deaths and 850,000 hospitalizations.

It also looked at other scenarios where public health measures were lifted earlier than they were starting in July 2020 after the first wave was over; that estimate suggested there would be 220,000 deaths and approximately 550,000 people in hospital.

If governments had abandoned all public health measures when vaccination was well underway in July 2021, the death count would have been just under 50,000 in April 2022, up about 20 per cent from where it was.

Isaac Bogoch, an infectious disease physician and researcher, said there is definitely evidence the pandemic could have been far worse, and the early days of the virus where it was poorly understood and ran rampant are a good indicator.

"You only need to look as far as places like Wuhan (China), Northern Italy, Iran, New York City to see how significant and impactful unchecked viral transmission was," he said.

However, he cautioned PHAC's numbers, while reasonable, are just estimates.

"It's a good exercise to do. We just have to obviously interpret the results with caution and in context."

The paper also compares Canada's approach to other countries like the United States, United Kingdom, France, Germany and Sweden, which adopted a model focused on preventing spread among only certain groups in society.

It found all of those countries had higher death rates than Canada. It found the only countries with lower death rates adopted so called "zero COVID" approaches, countries like New Zealand, and Singapore which had harsh lockdowns and virtually zero travellers.

The researchers also looked at the challenges COVID in particular presented. Canada had prepared for an influenza pandemic with plans to distribute antivirals and swiftly administer a newly formulated flu vaccine.

But when COVID emerged there were no effective antivirals and no quick prospect for vaccines, leaving public health measures as the only option.

Bogoch said Canada needs to take stock of how this pandemic was handled and figure out how it might respond to a future threat that could look very different.

"We have to think about how infections are imported and then circulate around Canada and obviously think about what would be acceptable to Canadians in the instance of a new emerging deadly infection and how we would respond to that."

He said as awful as this pandemic was, there are much worse viruses in nature.

"It's not nice to think about, but this might not be the big one in the sense that there are other emerging viruses that are far more lethal than COVID."

Twitter: RyanTumilty Email: [email protected]

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