key: cord-0990934-qijyfn5r authors: Fisman, D.; Tuite, A. title: Estimated Deaths, Intensive Care Admissions and Hospitalizations Averted in Canada during the COVID-19 Pandemic date: 2021-03-26 journal: nan DOI: 10.1101/2021.03.23.21253873 sha: 3e4fc65782d69853621b9aa698e2dee9c02e7e0f doc_id: 990934 cord_uid: qijyfn5r Cross-border comparisons of healthcare structure and outcomes between Canada and the United States have yielded important insights into strengths and weaknesses of their respective health systems. Canada's approach to control of the SARS-CoV-2 pandemic was more successful than that of the United States in terms of mortality. We standardized US mortality risk to the Canadian population, in order to estimate hospitalizations, ICU admissions and deaths Canada averted by outperforming the United States in this regard. We estimate that Canada averted some 45,000 deaths, 185,000 hospital admissions and 38,000 intensive care admissions. Notably, the deaths averted were concentrated in adults in the 50-75 year age group. We estimated the number of excess deaths in Canada under a United States-like scenario using direct standardization. As Canadian and U.S. death data were reported using slightly different age groupings we reallocated Canadian deaths using death distributions by two-year age increments available for the province of Ontario (as of March 11, 2021). Observed deaths in Canada were divided by expected deaths based on U.S. mortality incidence to calculate standardized mortality ratios. Observed deaths were subtracted from expected deaths to calculate deaths averted (Table) . Lastly, we divided averted deaths by age-specific case-fatality estimates from Ontario to estimate averted cases. We applied age-specific risks of hospital admission and intensive care admission, derived from Ontario case data, to calculate hospital and intensive care admissions averted. We estimated that the more aggressive approach to pandemic suppression employed in Canada averted approximately 6 million counted cases, 45,000 deaths, 185,000 hospital admissions and 38,000 ICU admissions that would have been seen had the country's public health response been similar in stringency to that employed in the United States. Averted hospitalizations and intensive care unit admissions were concentrated in the 50-to-74 year age band. Data used for calculations are available online at https://figshare.com/articles/dataset/Estimated_Deaths_Intensive_Care_Admissions_and_Hospit alizations_Averted_in_Canada_during_the_COVID-19_Pandemic/14036549. The Canadian response to the COVID-19 pandemic has been less effective in limiting disease and death than that seen in other large federal democracies like Australia, though there has been . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 26, 2021. ; https://doi.org/10.1101/2021.03.23.21253873 doi: medRxiv preprint notable heterogeneity in the response to COVID-19 within Canada, with Atlantic provinces and Northern Territories having effectively achieved COVID-19 elimination, despite intermittent setbacks (5) . However, given cultural similarities, intertwined economies, and a long, undefended border, the natural comparator for Canada's COVID-19 response is the response in the United States. Here we show that application of U.S.-derived age-and disease-specific mortality for COVID-19 to Canada would result in a counterfactual in which deaths, hospitalizations, and intensive care admissions are markedly increased. In particular, Canada's response appears to have protected middle-aged adults against severe diseases from COVID-19 far more effectively than the public health response in the United States. There are three important limitations to our analysis: while we attribute improved outcomes in Canada to concrete public health actions, it is also possible that they reflect differences in structural, societal factors that have enhanced COVID-19 risk in the United States. Excess risk of COVID-19 and COVID-19 related death in the United States has been associated with lower income status and non-white ethnicity, but similar relationships have been observed in Canada as well (6, 7). A second key limitation of our analysis is our use of Ontario-specific case fatalities, and hospitalization and intensive care admission risks, to estimate outcomes averted at a national level; however, Ontario's epidemiology is likely similar to that of Canada overall, both because of similarities in demographics and health systems across the country, and also because the population of Ontario represents approximately 40% of the Canadian population, and 35% of Canada's COVID-19 case load, such that the Province's epidemiology strongly influences that of Canada as a whole. Lastly, we assume that attribution of COVID-19 deaths in Canada and the . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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