space traveling warriors tier list : Canada compares well with other G10 nations in the COVID response

Canada’s response to the first two years of the COVID-19 pandemic compares favorably with other countries in the Group of 10 (G10), a new analysis shows.

For example, as of February 2022, 79.9% of Canadians were fully vaccinated, meaning they received all the doses of the original protocol (usually two). Thus, Canada had the highest proportion of fully vaccinated people of all the G10 countries.

“We can hypothesize that Canada’s high vaccination rate and good compliance with our stringent public health restrictions explain at least part of our strong performance in limiting the health burden of COVID-19,” study author Fahad Razak, MD, assistant professor of health policy, management and evaluation, University of Toronto, Toronto, Ontario, Canada, said Medscape Medical News.

the evidence were published online June 27 at Journal of the Canadian Medical Association.

Case counting

As the pandemic continued into its third year, the researchers sought to compare Canada’s response with that of other countries. They chose the G10 countries as comparators because they have similar economic, political and population measures compared to Canada. These countries include Belgium, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland, the United Kingdom, and the United States.

To compare country results, the researchers examined data from February 4, 2020 to February 8, 2022, from Our World in Data, the Organization for Economic Co-operation and Development (OECD), the United Nations Educational Organization, Science and Culture (UNESCO) and the International Monetary Fund.

The cumulative per capita rate of COVID-19 cases in Canada was 82,700 per million. All comparator countries except Japan had a rate at least two to three times higher than Canada. The Netherlands (313,000 per million) and France (312,000 per million) had the highest cumulative per capita rates.

Although Canadians were slow to get vaccinated, vaccination rates accelerated in the second half of 2021. As of February 2022, Canada had the highest proportion of people fully vaccinated (79.9%).

The US had the lowest proportion of people fully vaccinated (63.9%). However, the country had the fastest initial absorption of vaccines from December 2020 to June 2021.

Italy had the highest proportion of booster shots (58.8%). Canada was in the middle (43.1%) and Japan was the lowest (7.3%).

Low mortality rate

Canada’s COVID-19-related death rate was 919 per million, the second lowest among the G10 countries. The rate in Japan was 156 per million.

In all other G10 countries, the rate of deaths related to COVID-19 was over 1,000 per million. The US had the highest number of COVID-19-related deaths at 2,730 per million.

The cumulative excess mortality was lowest in Japan, which had a lower-than-expected death rate (-143 per million). The cumulative excess mortality was 456 per million in Canada, 2,450 per million in the US and 2,510 per million in Italy.

“All deaths by law have to be recorded. In places that do not fully document the number of deaths from COVID-19, the excess death rate per million population is a good way to estimate that number. If the excess mortality rate, i.e. deaths from all causes, is suddenly higher in the years 2020 to 2022 compared to previous years, this indicates that COVID has had an effect on increasing mortality,” Razak said.

Canadians have adhered closely to public health restrictions that have closed schools, restricted access to nursing homes, discouraged crowds and recommended masks to contain the pandemic.

“We use the Oxford Stiffness Index, which includes things like school closures, vaccine mandates, business closures, [and] travel restrictions. A higher score means the country was stricter,” Razak said.

Canada had the second highest average of the Oxford Stiffness Index (70.8). When all nine components of the Oxford Stiffness Index were disaggregated, Canada had one of the most stringent policies sustained in relation to restrictions on internal movement, cancellation of public events, restrictions on public gatherings, closure of workplaces and controls on international travel.

Economic Consequences


Dr Stephen Hoption-Cann

Commenting on this study for MedscapeStephen A. Hoption-Cann, PhD, clinical professor of population and public health at the University of British Columbia, Vancouver, Canada, noted that when the pandemic began, the main objective was to minimize the spread and reduce deaths from disease, but restrictive measures had other repercussions.

“This includes patients avoiding necessary medical care, canceled or delayed surgeries, and other health interventions, as well as increased unemployment, social isolation and an increase in domestic violence. So it wasn’t as simple as stopping the spread of the disease,” said Hoption-Cann.

Canada performed well, compared to its peers, but not without economic costs, he added. “Canada has employed some of the most stringent restrictive measures, including the closure of long-term schools and bans on public gatherings, as well as travel limitations. The benefits also came at the cost of higher debt to [gross domestic product] ratio, reflecting the high costs of pandemic spending to support businesses and individuals, with the economy contracting due to restrictions and business closures.”

Canada was also slow to remove travel restrictions that were ineffective against more transmissible variants of COVID, Hoption-Cann said.

“Why were the number of COVID-19 cases and death rates so low in Japan? Having a complete ocean boundary has its advantages, as has been well demonstrated in Taiwan and New Zealand, but it doesn’t completely solve the puzzle,” said Hoption-Cann.

“Japan had one of the slowest vaccine campaigns, behind all other countries until fall 2021, but quickly reached second place, 79%, in terms of people fully vaccinated, behind only Canada at 80%. Also, Japan has a sizable elderly population, which in other countries has led to high death rates, but not in Japan,” he said. These observations leave much to be considered for future researchers.

As current circulating variants appear to cause milder disease, many countries’ health priorities have changed, Hoption-Cann said.

“Health care dollars are always a limited resource. The pandemic has created a large backlog of patients who have lost needed healthcare due to restrictive measures, and other healthcare priorities need to be considered, including a potential smallpox pandemic that likely needs more attention than it is getting.”

Razak is Scientific Director of the Ontario COVID-19 Science Advisory Table and received a salary award as a Graham Farquharson Knowledge Translation Fellow from the PSI Foundation. He is an employee of Ontario Health and Public Health Ontario. He has received grants outside of current research from the Canadian Institutes of Health Research, the Canadian Frailty Network, the University of Toronto, the Digital Research Alliance of Canada and the Royal College of Physicians and Surgeons of Canada. Hoption-Cann reported no material disclosures.

CMAJ. Published online June 27, 2022. Complete text.

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