In a recent study published in the Canadian Medical Association Journal, researchers assessed how Canada performed on all coronavirus disease 2019 (COVID-19)-related metrics compared to the group of 10 (G10) peer countries: France, Germany, Italy, Belgium, the Netherlands, Sweden, Switzerland, Japan, the United Kingdom, and the United States (US).
Study: Canada’s response to the initial 2 years of the COVID-19 pandemic: a comparison with peer countries. Image Credit: Shark9208888 / Shutterstock
About the study
In the present study, the authors analyzed data from February 4, 2020, to February 8, 2022, from Our World in Data (OWID), the Organisation for Economic Co-operation and Development (OECD), the United Nations Educational, Scientific and Cultural Organization (UNESCO), and the International Monetary Fund.
They compared rates of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, vaccination rates, COVID-19–related and all-cause excess deaths, public restrictions, and economic impacts of the pandemic in Canada with the G10 countries.
The cumulative per-capita rate of COVID-19 cases in Canada was 82,700 per million. Most peer nations had at least two- to threefold higher rates than Canada (except Japan). As of February 2022, at 79.9%, Canada had the highest two-dose vaccination rates, ahead of Japan. At 63.9%, the US had the lowest number of vaccinated people because a quarter of their population is still modestly hesitant to outrightly hostile regarding vaccination.
All G 10 countries had over 1,000 per million COVID-19 death rate. However, at 919 and 2,730 per million, it was the second-lowest and the highest for Canada and the US, respectively.
Canada had among the most stringent public restriction policies; it was the only country in the G10 that sustained moderate to severe restrictions from spring 2020 onward. Canada closed its primary and secondary schools for around 51 weeks. Despite a notable increase in unemployment in Canada during the beginning of the COVID-19 pandemic, it had reverted to its previous unemployment rates. The increase in Canada's debt-to-gross domestic product (GDP) ratio was relatively high at 23.1% and closest to the US, having a 24.8% GDP ratio. In addition, at 2.6%, Canada was at the midpoint of countries with respect to the increase in the inflation rate.
The percentage of over 65 years elderly in Canada was 18.1% compared to 28.4% in Japan. In addition, Japan had a comparable proportion of the vaccinated population and the least strict public health measures. Yet, the study analysis could not adequately assess why within the G10, Japan emerged as an outlier, with low COVID-19 case rates and mortality.
Canada had the lowest direct burden of SARS-CoV-2 infection and the highest overall vaccination rate. If Canada had the US vaccination rate, around 5.9 million fewer Canadians would have received the vaccination. More importantly, if Canada had a COVID-19 death rate the same as the US, it would have claimed ~68,800 more lives. Moreover, Canada attained favorable outcomes despite low baseline hospital capacity relative to other nations, especially the US, and logistical challenges for care delivery.
Concerning mitigating strategies, such as restrictions on social gatherings, business, and school closures, Canada was relatively stringent compared with peer nations. Further, Canada was among the strictest countries in limiting international and domestic travel. However, these measures proved ineffective against a highly contagious pathogen like SARS-CoV-2. Since January 2022, Canada has had the second-lowest rate of reverse transcription-polymerase chain reaction (RT-PCR) testing per capita. This lack of testing impeded infection control; subsequently, more than 40% of the Canadian population became Omicron-infected. It emphasized the importance of adequate replacement for individual-level PCR testing for tracking new SARS-CoV-2 variants of concern.
Overall, it was difficult to draw firm conclusions regarding the relationship between COVID-19 interventions and outcomes while comparing Canada and the G10 nations. The risk of misinterpretations was also high due to ecological reasons. In addition, studies have shown that higher vaccination rates are not correlated to subsequent COVID-19 cases. In addition, excess and COVID-19–related mortality across Canadian states showed significant heterogeneity. Finally, COVID 19 cases and death surges do not occur similarly across countries; hence, it was difficult to draw conclusive inferences about causes and effects unless the pandemic completed its full course.
To conclude, Canada's COVID-19 response was comparable to all peer nations concerning broad health outcomes. However, the study also highlighted the adverse economic and social impact of the ongoing COVID-19 pandemic in Canada. Therefore, the Canadian leaders and policymakers should ensure continual data collection and analysis, making strategic adjustments to reinforce measures and modify strategies as needed.
Canada's response to the initial 2 years of the COVID-19 pandemic: a comparison with peer countries, Fahad Razak, Saeha Shin, C. David Naylor and Arthur S. Slutsky, CMAJ 2022, DOI: https://doi.org/10.1503/cmaj.220316, https://www.cmaj.ca/content/194/25/E870