Why in Ontario and in Canada, this became COVID’s deadliest year

And yet, in Canada in 2022, more people have died from COVID than in any other year of the pandemic. Eight provinces saw more COVID deaths this year than in any other year, including Ontario.

Nationwide, 19,035 people died of the disease in 2022 — up from 14,606 deaths in 2021 and 15,307 in 2020.

There were 5,613 people who had died of COVID in Ontario this year as of Dec. 17, according to the Public Health Agency of Canada. That’s 14 more than last year and 1,355 more than in 2020, before we had a full understanding of how the disease behaves.

What’s more, there were more hospitalizations from COVID in Ontario this year than in years past, according to Public Health Ontario. Hospitalizations were a third higher than in 2021 and nearly triple what they were in 2020.

To be sure, much of this can be attributed to the Omicron wave, which spiked in January and severely affected our hospitals and vulnerable populations. Both COVID deaths and hospitalizations peaked in mid-January in Ontario before dropping by more than 80 per cent in March. The balance of hospitalizations and deaths came throughout the year, not so much in spikes, but more as bumps following the spread of the BA.2 and BA.5 variants. Intensive care admissions have been on a downward trend since the beginning of the year.

Still, the majority of COVID deaths in Ontario in 2022 occurred after the massive January Omicron spike.

Ethicists and medical professionals point out that, as 2022 wore on, COVID seemed to join a long list of illnesses, such as influenza, respiratory syncytial virus (RSV) and rhinovirus, that society has learned to live with as long as the worst effects are confined to specific populations.

In COVID’s case, that’s the medically frail and the elderly.

“I think unless it’s in your house or your social circle, you kind of forget that these people need — deserve — our attention and care,” said Dr. Miriam Mottiar, an Ottawa anesthesiologist and palliative care physician, noting that in her practice she still takes care of people who are dying of COVID.

“It’s very sad for me and my colleagues, but it’s doubly sad, because it feels like if our society managed to mask, a lot of these deaths would be preventable, because we would have lower levels of COVID in the community. So I think there’s sadness, but there’s regret as well.”

Ninety-three per cent of all COVID deaths in Canada since the start of the pandemic have been people age 60 and older. COVID death rates in Ontario are currently highest, by a wide margin, in those 80 and older, followed by the 60-79 age group and those 40 to 59. The death rate in those younger than 40 is close to zero.

Research from the University of Toronto has shown that Omicron led COVID to become more deadly for Ontarians 60 and older than during the previous two waves combined, even as Ontario lifted capacity limits in public settings.

It’s not often we see a lot of medically frail, elderly people standing in line at our local hardware store or grocer. So perhaps it’s understandable why, no matter where you go these days, masking seems to be a rare thing, as does social distancing.

Maxwell Smith, a bioethicist and assistant professor at Western University, says part of society’s increasingly tepid response to COVID comes down to the adage: what is out of sight is out of mind.

“I think the general public is just less aware of the toll that the pandemic is continuing to have. At the beginning, on every news site, on every channel, you could see trackers of every case, every death. Right now, it’s hard to come by that information and, in some respects, it’s not even reported that frequently,” he said. “So I think if you’re just not aware or that’s not so prevalent, then you’re simply going to assume that things must not be as bad.”

He adds that a common pattern in the history of infectious disease is for severe outcomes to shift to marginalized or disadvantaged sectors of society, while those privileged enough to not experience the worst outcomes move on.

“Now that (COVID) is sitting in those populations and the most privileged among us don’t feel threatened anymore, there’s very little tolerance to have collective measures put in place,” Smith noted. “We sort of just say, ‘Well if those people are vulnerable, let them take care of themselves,’ knowing full well that this will continue to disadvantage those groups. I think that is at play here.”

Dr. Naheed Dosani, palliative care physician and health equity lead at Kensington Health in Toronto, agrees that the fact that those who are disproportionately affected are not directly visible in our communities is contributing to society’s response to the current COVID situation.

“You start to wonder if the lack of action to mitigate the spread of this virus and its impact is a form of ableism by way of policy,” he said. “It is really unfortunate to see that we know this virus is disproportionately impacting the frail and elderly and people who are immunocompromised and yet we don’t see policy actions to address that concern.”

Dosani says the public health messaging from the provincial government has also left the impression in many people’s minds that the pandemic is, for all intents and purposes, over.

“This is a failure of public communication around the current status of COVID-19 in our communities; it is a failure of communication around who is being most impacted; it’s a failure of communication around masking; it’s a failure of communication around the importance of vaccines,” he said.

“These superimposed layers of failure are what has led many people in our community to think that the pandemic is over, when in reality it is not. People are still suffering. People are still dying.”

In an email to the Star, Hannah Jensen, a spokesperson for Health Minister Sylvia Jones, said the ministry and the office of the chief medical officer of health continue “to work with public health units during respiratory illness season and monitor impacts on the health system. At the same time, we are investing in health-care staffing, and building capacity in health care to ensure Ontario patients receive the care they need when they need it.”

Her comments come against the backdrop of a health system in crisis, where patients are facing record-long emergency room wait times, sick children are being flown hundreds of kilometres for intensive care, and surgeries for kids are being cancelled.

COVID death rates of Ontarians age 60 and over have been declining in recent weeks, reflecting a downward trend of cases in the community, said Dr. Isaac Bogoch, infectious diseases specialist at University Health Network.

Bogoch points out that even though COVID continues to prey on Ontario’s most vulnerable individuals, hybrid immunity (from both vaccination and infection) has helped us avoid the same intensity of hospitalizations and deaths witnessed during the initial Omicron wave.

But he notes that it will not be surprising if we see a rise of COVID cases over the course of the holiday season as people gather indoors.

“There will probably be a corresponding bump in hospitalizations and, sadly, a corresponding bump in deaths,” he said, adding that the magnitude, however, is “unlikely to be anywhere near what we saw during the initial BA.1 wave because of our hybrid immunity that we have and our degree of vaccination and, I would say, reasonable uptake of booster vaccines among the most vulnerable. But there is still room for improvement on that front.”

University of Toronto bioethicist Kerry Bowman points out that, historically, pandemics tend to have a social end before they have a medical end.

“I think what’s really happened with the COVID-19 pandemic in Canada, and globally, is we’ve reached kind of a social end,” he said. “That does not mean for a minute that medically this is over. Epidemiologically, it’s not.”

Additionally, Bowman said that over the past three months, the arrival of other viruses, such as RSV and influenza, in large volumes, has led to confusion about what is COVID and what isn’t.

He says that as the general public begins to perceive the risk of a pandemic as something that’s not a direct threat to them individually, society will move on.

“It’s kind of a moral failure on our part in that we moved on even though the most vulnerable people in our society were really in harm’s way,” he said. “In the early days of the pandemic, we kept hearing that we’re all in this together … That was never really true.”