Data mistakenly posted by Hamilton public health shows it has few details about those who died with COVID
Hamilton public health has almost no data on the income, race or first language of those who died with COVID.
The pandemic has magnified the effects of social determinants of health (SDOH) - that is, socioeconomic factors that can influence health outcomes - so information about those hardest hit is critical.
But data inadvertently released by the city shows almost nothing is known about these factors - and therefore potential inequities - in Hamilton's COVID deaths.
As of Thursday, 401 Hamilton residents with COVID have died since March 24, 2020. The information - briefly released and since removed from the city's website - includes 400 of those deaths.
The data provides never-before known details about Hamilton's pandemic deaths, but it's so incomplete that it's impossible to determine trends around social determinants of health.
Public health services does not have additional information," said a statement from public health Thursday when asked about data missing for roughly 84 per cent to 95 per cent of the deaths (depending on the category).
The Spectator's questions about the data resulted in the city shutting down its online COVID dashboard from July 23 to July 29.
As Hamilton Public Health Services staff were working on getting a new open data set containing de-identified line-level COVID-19 data, your questions identified a configuration problem with the COVID-19 dashboard that had prematurely shared this information," it said in the statement.
The new open data portal is expected to go online Aug. 9 to provide more detailed information about COVID in Hamilton.
But, at least for the deaths, little can be gleaned from the small amount of data available.
Hamilton didn't start collecting social determinants of health information until May 26, 2020, leaving a void of two and a half months.
It stopped gathering the data for another two months in January 2021 when public health became overwhelmed with record numbers of infections and didn't start again until March 1.
But those two gaps don't account for all of the sweeping information missing.
It's significant because social determinants of health have been repeatedly identified as increasing risk and severity of COVID infection, including by Public Health Ontario and the World Health Organization. It's important to pandemic response, decision-making and program development to understand these inequities.
Incorporating SDOH into risk considerations and assessments is crucial for supporting an equitable COVID-19 response," states Public Health Ontario on its website.
Yet household income is recorded for just 18 of the 400 Hamilton residents who died. A further 12 are listed as prefer not to answer" and 33 said they don't know.
Of those who provided data, six were in the lowest income bracket of $29,999 or less, while another four made $30,000 to $49,000 a year. Two earned $50,000 to $69,000 and four more made $70,000 to $99,000.
One was recorded as having a household income of $100,000 to $150,000 and one was over $150,000.
Slightly more information is known about race and first language but still not enough to draw reliable conclusions.
Of the 400 deaths, there is race data for just 63 of them.
When it comes to first language, there is information for only 65 of the 400 deaths.
The data also has significant gaps around vaccination status. Again, public health relied on the infected themselves to provide the information, says the statement.
Seven COVID deaths in Hamilton appear to be among those who had at least one shot of vaccine.
But it's impossible to tell how many of the seven had two shots versus one dose. It also doesn't show when they were vaccinated, so it's unknown if at least two weeks had elapsed to give them full protection. In addition, it's possible vaccine information is missing for some deaths.
Public health confirmed at the end of June that at least one fully vaccinated person with COVID died but wouldn't provide any other context - such as whether there were other underlying health conditions.
The extent COVID contributed to the seven deaths is also unknown.
All seven were age 70 and over and had an mRNA vaccine such as Pfizer or Moderna.
Ontario's chief medical officer of health, Dr. Kieran Moore, has said 90 per cent of the population needs to be vaccinated to achieve community immunity to decrease the risk of breakthrough infections among those who get less protection from the shot.
Hamilton is far from that target with about 66 per cent of those eligible fully vaccinated.
The data shows local COVID deaths are almost equally split between the sexes - 203 women and 197 men.
The vast majority - 85 per cent - were age 70 and older.
Five deaths have been among those under the age of 50. No Hamilton resident under age 30 has died with COVID.
More than twice as many have died in outbreaks - 281 compared to 119 outside of outbreaks.
Nearly half of the outbreak deaths lived in long-term-care homes - it jumps to over 60 per cent when retirement homes are added.
Hospitals account for almost 30 per cent of those who died in outbreaks.
No Hamilton health-care worker or seniors' home staff appears to have died during the pandemic, although this information could also be incomplete.
In addition, none of the deaths are linked to schools.
Potential workplaces listed as where people who died were infected include two at a manufacturing plant, one at a car dealership and one at a business.
Other locations of infection include a rooming house, a group home, five from community living facilities and one at a private residence.
Of the 119 deaths not linked to outbreaks, 56 are listed as close contacts of cases while 60 got the virus in the community, meaning it's unknown where they were infected. One got COVID while travelling, one is listed as pending and one is described as missing information."
Nearly 20 per cent of deaths were linked to a COVID variant. However, this could be under-reported as it takes time for Public Health Ontario to complete its analysis of cases.
Of the 78 variant deaths, 47 had B.1.1.7 - also known as Alpha, which was the dominant strain in Ontario before the more aggressive Delta took over.
One Hamilton resident who died was infected with the P.1 variant first identified in Brazil. The rest were listed only as screened positive."
Lastly, the data shows nearly 17 per cent of Hamilton residents who died with COVID were asymptomatic - meaning they had no signs of the virus - when their case was investigated by public health.
The importance of pandemic death data and its link to the social determinants of health was underlined in June by the Royal Society of Canada, which called for urgent and further investigation to properly understand the true scope and nature of the COVID-19 death toll in Canada."
Its in-depth analysis concluded thousands of COVID deaths may have been missed most likely in low-income, high-density, racialized neighbourhoods of essential workers and recent immigrants where most COVID-19 cases were concentrated. Among these communities it is likely that many cases were never identified, and the resulting deaths were never counted."
Joanna Frketich is a Hamilton-based reporter covering health for The Spectator. Reach her via email: jfrketich@thespec.com