Here we are in August 2020 and the pandemic seems to be firmly attached to our short and medium term future. Many of us are holding out hope that vaccines will bring everything back to normal in short order. Yet questions remain. Will we see effective vaccines soon? Will they slow the spread of infections? Will they be safe? Will they be accessible?
Other questions–about the safety of returning to school, the risk of a second wave, and the long term impact on the economy add yet further uncertainty about our future.
The uncertainly may leave you feeling a bit depressed. But there are reasons to feel optimistic. While the future is uncertain, in Canada (and many other countries) there is growing evidence that this infection is manageable (masks, physical distancing and hygiene all seem to work), and returning to quasi-normal life could happen before an effective vaccine is widely available.
The purpose of this short essay is to make an argument that things could be much worse and that Canadians should take some satisfaction in the how we’ve handled the Covid-19 situation so far. I make this argument simply by drawing a comparison between Canada and our closest counterfactual: The United States of America.
Part 1. The epidemiological argument
In between March 1 and July 31st 2020, more than 150,000 Americans died from SARS-CoV-2 infection. During the same period, roughly 9,000 Canadians died from SARS-CoV-2. In per-capita terms, the US saw about twice the rate of death than Canada. This is widely known, and on the face of it suggests that Canada did something right that the US did not do. However, this difference is far more striking when viewed on a monthly basis. Take a look at the table below:
Looking at deaths per 100,000 for April, May and June, the ratio of rates hovers around 2 to 1 (the US has roughly twice the death rate of Canada). Who knows what accounts for this–is it access to health care? Population vulnerability? Environmental differences? It’s hard to say. What is clear is that in July, the ratio of the Covid-19 death rates changes dramatically: in the US, the rate is 7 times higher than in Canada. Such a short term change is almost certainly not due to some structural difference between the countries (like health care access or underlying health status), but due to short-term policy decisions and behaviours in the US that occurred in June and July. What specific decisions and behaviours, who can say. What is clear is that a country to country comparison strongly suggests that something right happened in Canada and/or something wrong happened in the US.
To make the difference tangible, I’ve also calculated attributable risk seen in the last two columns in the table above. The attributable deaths in the US are the deaths that occurred as a result of the excess mortality rate in the US. In simple terms, these are deaths that would not have occurred if the US had the same risk profile as Canada. In the last column these are deaths that would have happened if Canada had the US mortality rate. We can think of these as lives saved due to our decisions and behaviour that were different from those in the US.
Again, the July data are most striking. If Canadians had the same risk profile as the US, an additional 2336 people would have died in July alone. In the US, more than 20,000 people died in July that would not have died if the they had Canada’s risk profile.
Part 2. The economic argument
Some have suggested that the US made a calculated trade off. The argument is that unemployment causes death too. By shutting down economies people lose jobs, which will cause more death as a result of unemployment and economic desperation. By returning to normal faster, there was more Covid-19 death in the US, but less unemployment-related-death.
What do the unemployment numbers say? Take a look for yourself:
In total, the US has slightly fewer net job losses than Canada for 2020–by about half a percent. However, the data also show that the timing of job losses differ between these countries. In Canada, there was a rapid drop in employment and a slightly lagged recovery, but more job growth in June and July. Once the August numbers come out, Canada may yet end up better off overall. In any case, at the moment, the difference in Covid-19 related employment impacts between these two countries seems pretty small.
It’s hard to say definitively if the small difference in employment recovery makes up for the excess loss of life due to Covid-19. In the US, half a percent of the workforce corresponds to about 700,000 workers. This means that if the US had Canada’s employment profile, 700,000 fewer Americans would have a job at the end of July. Are 700,000 jobs a worthwhile trade-off in exchange for the lives of the 72,000 excess deaths due to Covid-19? It’s hard to judge. However, the relationship between unemployment and mortality risk does depend on time; short term unemployment is more weakly associated with increased mortality than long term unemployment. Many of the job losses thus far have been short lived. Moreover, the wealth transfers (the CERB in Canada and whatever they have in the US) would probably offset some of the trauma of losing a job. So it seems unlikely that unemployment due to Covid-19 will have lead to a spike in mortality similar to equivalent unemployment growth in ‘normal’ times.
Conclusion
The US and Canada are suitable for comparison because of the timing of infection, and the similarities in culture and population vulnerability. Comparisons between these two countries are more meaningful than comparisons between either of these countries and any other country in the world. In this comparison, Canada comes out clearly ahead.
Many countries have lower mortality than the US and Canada, though Canada’s mortality rate is (as of July) low by any standard of comparison. Lots of things went wrong in Canada, and maybe thousands of deaths could have been prevented. However, in comparison to the most natural alternative (the US) Canadians should be confident that some of the actions we took clearly saved lives, and that if we continue on this course, we can prevent many more unnecessary deaths.