Intended for healthcare professionals


Covid-19: Canada outperformed comparable nations in pandemic response, study reports

BMJ 2022; 377 doi: (Published 30 June 2022) Cite this as: BMJ 2022;377:o1615
  1. Owen Dyer
  1. Montreal

Canada performed better than the majority of G10 countries in its response to the first two years of the covid-19 pandemic, a study has concluded.

A paper published in the Canadian Medical Association Journal concluded that Canadians were better vaccinated than comparable western countries, with fewer infections, fewer covid deaths, and lower mortality from all causes.1

Researchers from the University of Toronto, some of whom are members of Ontario’s covid-19 science advisory board, linked the country’s lower death rate to the persistence of its social restrictions and the relative lack of antivaccine sentiment.

The study compared responses from the 11 countries in the G10, comprising Canada, Belgium, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland, the UK, and the US. Japan was an extreme outlier, with by far the fewest deaths and infections despite having the oldest population and imposing the mildest restrictions.

Canada was the next best in health outcomes, being the only country of the remaining 10 to record fewer than 100 000 infections per million population from the pandemic’s outset to February 2022. Canada saw 82 700 cases per million people, while the worst hit countries were France with 312 000 per million and the Netherlands with 313 000 per million. Japan reported only 27 600 cases per million.

Stringency index

Canada was also the only country other than Japan to see fewer than 1000 covid related deaths per million population. Canada had 919 covid deaths per million people up to February 2022. The country with the lowest losses was Japan, at 156 per million, while the US had the most, with 2750 deaths per million.

Excess deaths were a negative number in Japan, whose death rate from all causes fell by 143 deaths per million during the pandemic. Everywhere else overall mortality rose, but it rose the least in Canada, by 456 deaths per million. All cause mortality rose the most in Italy, by 2510 deaths per million, and in the US, by 2450 per million.

The researchers scored countries’ responses according to the Oxford Stringency Index, which weighs school, work, and transport closures, cancellation of public events, limits on gatherings, requirements to stay at home, internal and international border controls, and public information campaigns.

Italy imposed the strictest restraints, but the measures taken in Canada were stronger than average and varied little over time. The lead author, Fahad Razak, told the Canadian Broadcasting Corporation that other countries “would have periods with tight restrictions but quickly pull back. For Canada, it was really this high and persistent level almost entirely for the first two years.”

Canada closed its schools for longer than any other country except the US. The average Canadian child missed 51 weeks of in-person schooling, compared with 66 weeks in the US and only six weeks in Switzerland.

Canadian pandemic border controls were among the strictest in the G10. The closure of the US-Canada border upended thousands of lives, and later a border vaccination requirement sparked weeks of protests and blockades in Canadian cities.

But the authors argue that closing borders proved ineffective, noting that later testing showed that the omicron variant had already raced through Europe before the first case was even reported by South Africa.

Economic health

The authors acknowledged the limits of international comparisons, particularly given different testing regimes. While Canada probably did not undercount cases relative to its peers in the past, it currently faces a shortage of PCR tests amid widespread omicron infections.

More easily measured is the economic health of the G10 nations. Canada was among the heaviest relative borrowers during the pandemic, along with the UK and the US. Canada also saw the steepest decline in gross domestic product, although its performance on inflation and unemployment was middling.

“We had these very significant economic impacts,” said Razak. “We had very tight restrictions on our individual freedom which led to things like isolation. But we also had really among the best results in terms of controlling the impact of the virus. Was it worth it? That’s not a scientific question. That’s a values and morals and policies question.”

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