Are Hamilton’s COVID deaths ‘overexaggerated?’

An associate medical officer of health says the number of COVID deaths in Hamilton have been inadvertently overexaggerated."

Dr. Bart Harvey says public health is reviewing all Hamilton COVID deaths with the aim of removing any that should not have been included because they have clearly died of another cause."

However, this explanation appears contrary to the definition of a COVID death posted on the city and province's websites. Both clearly state: Deaths are included whether or not COVID-19 was determined to be a contributing or underlying cause of death."

The change also raised flags with infection control epidemiologist Colin Furness.

Pretending the deaths didn't happen is a really, really big problem" said Furness, assistant professor at the University of Toronto. I don't think the public interest is served in any way shape or form by saying, They were sick with something else.'"

The issue came to light when the city removed - without any explanation - two deaths from an outbreak on a palliative unit at St. Peter's Hospital. Both were reported as COVID deaths Tuesday and withdrawn Thursday.

We're overexaggerating our numbers and we weren't doing it knowingly," said Harvey. We're trying to make them more accurate and more in line with what we understand our sister health units across the province are already doing."

The two were still included as cases in the outbreak on 3W at St Peter's with the tally climbing to nine patients and three staff. But no deaths were listed.

They should be on there absolutely," Furness said. I don't like backing those out of congregate settings where people are vulnerable because it means we're screwing up, it means we're not doing a good job and it means we're not protecting these people. If that gets covered up, that's a big problem."

It was new public health staff who raised questions about whether palliative patients should be included in COVID deaths, said Harvey. Palliative units provide care to dying patients in the final stages of their illness.

It's always nice having fresh eyes where people say, How does this make sense,'" said Harvey. For those of us who have been doing it back to March 11 of last year it's like, That's a great question.'"

Furness says the answer is that we should be counting them" to measure the burden of COVID in these settings.

If COVID is ripping its way through hospices and health-care facilities, that's a problem," said Furness. If we are not actually writing that down than we're not caring about it ... A whole bunch of deaths means there's been a serious lapse in care and these people deserve better than that."

All patients and staff on 3W had been tested for COVID when the outbreak was declared Oct. 27 at the east Hamilton hospital on Maplewood Avenue.

Both of them came up with positive tests," Harvey said about the two patients. Neither one of them had any symptoms ... They were active cases technically and they died."

Hamilton public health has always counted similar situations as COVID deaths.

St. Peter's has had two other outbreaks on 3W during the pandemic with six palliative patients with COVID dying in spring 2021 and one in spring 2020.

An outbreak on St. Peter's other palliative-care unit - 3E - saw three more deaths in spring 2021.

In addition, two seniors with COVID died in an outbreak at Emmanuel House Hospice in April 2020.

Because of the question that people rightfully raised ... we went to the province and we said, Here is the situation we're in. Do you want people like these individuals who clearly have died of another cause?' ... They're getting end-of-life care so clearly they're expected to die imminently."

A spokesperson for Health Minister Christine Elliott said this account is inaccurate.

Hamilton public health did not reach out to the province but rather reached out to Public Health Ontario," said Alexandra Hilkene.

Either way, Harvey said the response was that there is a provision that if you have a clear alternative cause for the death that you don't believe is related to COVID-19 than you don't have to - and probably you shouldn't - designate them as COVID-19 deaths, which quite frankly was news to us. But it actually made sense."

Furness pointed out that provision can be a slippery slope.

Go to any long-term-care home and say, Well these people are ... past their life expectancy already so they were going to go anyway so let's just not count them.' And that sounds really wrong," he said. If we want to make sure these places are safe, we have to measure COVID in them even if they are places where people are really sick."

Harvey denied the change would apply to more than a small group" of terminally ill patients with COVID. Although he doesn't have an estimate on how many COVID deaths will be removed, saying the review is in the early stages and will likely take a few weeks to complete.

Furness pointed out that Hamilton is not the first or only region in Canada not counting all who die with COVID.

Let's stop trying to attribute that elsewhere," he said of the deaths. It really does feel like public health is able to claim it did a better job than it did when deaths from COVID stop being counted as deaths from COVID."

Joanna Frketich is a Hamilton-based reporter covering health for The Spectator. Reach her via email: jfrketich@thespec.com