Doug Ford
© Nathan Denette /THE CANADIAN PRESS
Ontario Premier Doug Ford holds a press conference with his medical team regarding new restrictions at Queen's Park during the COVID-19 pandemic in Toronto on Friday, October 2, 2020.
The daily pandemic death counts in Ontario include people who have tested positive for COVID-19 but have not necessarily died from the virus.

The exact number of people who fit into this category is unknown by the government and not even being counted.

The Sun was able to confirm this information after speaking with three of the hardest hit public health units in Ontario — Toronto, Ottawa and Peel Region.

"The mortality data sent to the Ministry and reported in (Ottawa Public Health) dashboard/reports represents the number of Ottawa residents with confirmed COVID-19 who have passed away," an Ottawa Public Health spokesperson explained via email. "It does not indicate if COVID-19 was the cause of death, and we can't make that inference."

According to local health units, this reporting process is required by the province.

"Toronto Public Health continues to follow the provincial definition for how COVID-19 deaths are categorized," said Dr. Vinita Dubey, Toronto's associate medical officer of health. "This means that individuals who have died with COVID-19, but not necessarily as a result of COVID-19, are all included in the case counts for COVID-19 deaths in Toronto."

Toronto Public Health would not provide the number of persons who died with but not necessarily from COVID-19 and would not confirm whether or not they had tallied such a figure.

It may be that health units are not even attempting to put together such data.

"It hasn't been routine practice for public health units to get the death certificates or any follow-up physician and/or coroner reports that determine whether COVID-19 was the underlying or contributing cause of death," said a spokesperson for Peel Public Health. "The Ministry has asked health units, however, to report through our provincial reporting systems: all deaths who have died with COVID-19 whether or not it was the cause of death."

Part of the challenge is in how difficult it is in general to determine the cause of death in older persons who may be suffering from multiple ailments.

"The cause of death of someone with COVID-19 is not necessarily straight forward, as they may have died due to COVID-19 symptom complications, or may have died with COVID-19 but due to another health issue (this is especially true in settings like [long-term care homes] where there are multiple factors simultaneously at play)," explained Ottawa Public Health.

This means that of the almost 3,000 Ontarians whose deaths are included in the provincial COVID-19 case data, it is unknown how many of them did in fact die because of COVID-19.

But experts caution there are reasons why the numbers are counted this way.

"In a pandemic, it's better to overestimate than underestimate COVID deaths," said Dr. Prabhat Jha, an epidemiologist and Professor of Global Health at University of Toronto. "The U.K. and other country data show that COVID killed mostly people in nursing homes in the March-June peak months, but the excess deaths were seen not only where COVID was mentioned anywhere on the death certificate, but also in those where it was not (albeit a smaller peak than for COVID)."

Dr. Vivek Goel, a former President and CEO of Public Health Ontario, agrees.

"Generally, it can be difficult, even with a coroner's report to make the determination of whether someone has died from or with COVID-19," Goel explained in an email to the Sun. "For example, since COVID-19 is more severe in those with pre-existing conditions in someone with lung disease who gets COVID it will be hard to ascertain which contributed more."

"Being inclusive in counting all possible cases, as this suggests is the direction, seems to be appropriate to me," he added.