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. 2023 May 1;49(5):197-205.
doi: 10.14745/ccdr.v49i05a05.

Relative pandemic severity in Canada and four peer nations during the SARS-CoV-2 pandemic

Amy Peng  1 , Alison Simmons  1 , Afia Amoako  1 , Ashleigh Tuite  1   2 , David Fisman  1
Affiliations

Relative pandemic severity in Canada and four peer nations during the SARS-CoV-2 pandemic

Amy Peng et al. Can Commun Dis Rep. .

Abstract

Background: National responses to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic have been highly variable. We sought to explore the effectiveness of the Canadian pandemic response up to May 2022 relative to responses in four peer countries with similar political, economic and health systems, and with close historical and cultural ties to Canada.

Methods: We used reported age-specific mortality data to generate estimates of pandemic mortality standardized to the Canadian population. Age-specific case fatality, hospitalization, and intensive care admission probabilities for the Canadian province of Ontario were applied to estimated deaths, to calculate hospitalizations and intensive care admissions averted by the Canadian response. Health impacts were valued in both monetary terms, and in terms of lost quality-adjusted life years.

Results: We estimated that the Canadian pandemic response averted 94,492, 64,306 and 13,641 deaths relative to the responses of the United States, United Kingdom and France, respectively, and more than 480,000 hospitalizations relative to the United States. The United States pandemic response, if applied to Canada, would have resulted in more than $40 billion in economic losses due to healthcare expenditures and lost quality-adjusted life years. In contrast, an Australian pandemic response applied to Canada would have averted over 28,000 additional deaths and averted nearly $9 billion in costs.

Conclusion: Canada outperformed several peer countries that aimed for mitigation rather than elimination of SARS-CoV-2 in the first two years of the pandemic, with substantial numbers of lives saved and economic costs averted. However, a comparison with Australia demonstrated that an elimination focus would have saved Canada tens of thousands of lives as well as substantial economic costs.

Keywords: Canada; SARS-CoV-2; health economics; pandemic severity; public health; standardization.

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Conflict of interest statement

Competing interests DNF has served on advisory boards related to influenza and SARS-CoV-2 vaccines for Seqirus, Pfizer, AstraZeneca and Sanofi-Pasteur Vaccines, and has served as a legal expert on issues related to COVID-19 epidemiology for the Elementary Teachers Federation of Ontario and the Registered Nurses Association of Ontario. ART was employed by the Public Health Agency of Canada when the research was conducted.

Figures

Figure 1
Figure 1
Cumulative proportion of COVID-19-attributable death by agea, March 2020 to May 2022 Abbreviation: COVID-19, coronavirus disease 2019 a Ages represent the midpoints of age categories. For the oldest age categories in Canada (80 years of age and over) and the United States (85 years of age and over) we assigned an age of 90 years
Figure 2
Figure 2
Cumulative proportion of COVID-19-attributable quality-adjusted life years loss, by agea, March 2020 to May 2022 Abbreviations: COVID-19, coronavirus disease 2019; QALY, quality-adjusted life years a Ages represent the midpoints of age categories. For the oldest age categories in Canada (80 years of age and over) and the United States and United Kingdom (85 years of age and over) we assigned an age of 90 years; for Australia and France, the highest age category (90 years of age and over) was assigned a value of 90 years
Figure A1
Figure A1
Oxford Pandemic Stringency Index by date, Canada and comparator peer countriesa Abbreviations: UK, United Kingdom; US, United States a Stringency values plotted to May 1, 2022. Higher values indicate more stringent control measures
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