Context matters: Putting COVID Data and Public Policy in Perspective

In the information age, much greater importance has been placed on content than ever before. Big data is all the rage. And in the era of the global pandemic, scientific evidence and facts are reported with messianic zeal. But facts are essentially meaningless without context. Perspectives can change dramatically when content is placed in some type of context. (If you don’t believe me, read the following entertaining article: https://www.bhavanalearning.com/the-importance-of-context-in-listening-and-life/)

There are three common ways to add context to raw data or facts, namely, by providing cultural, historical or comparative perspective. With respect to culture,  one well-known example is the fact that in North and South America, Asia and Africa an individual nodding their head is commonly understood to represent agreement, but in southeastern Europe – notably in Greece, Turkey, Sicily, Bulgaria and Albania –the same gesture indicates the complete opposite,  disagreement. Another oft-cited example is the famous airport corridor ads of HSBC showing the different perspectives on the same subject by individuals of diverse backgrounds. In one, three subjects see a small decorative area rug as an item of home décor, a religious symbol or a tourist souvenir depending on their origins. 

For historical context a frequently cited example is the average life expectancy of a Russian male. In 2005 it was 65, far superior to the average age of 53 in 1950, but a dramatic decline from 74 in 1990, just before the collapse of the Soviet regime. Closer to home another good example would be the fact that, contrary to popular opinion, Canada’s military actually suffered more casualties during the First World War (61,000) than the Second (47,000). [i] And as for the comparative approach to data, we could note that the average income of a female full professor in Quebec in 2018 was roughly $133,000, an impressive figure unless compared with her male colleagues at the same university (+$20,340) or her counterparts in almost all other provinces except Newfoundland. (+$40,000).  [ii]

Clearly, adding context puts a different spin on many issues. Nowhere is this more important at the moment than with respect to the current pandemic. In the face of the most threatening and unprecedented development in their lifetime, most citizens have little or no way to evaluate their country’s situation or their governments’ policies to address the crisis. Here, more than ever, the role of political leaders, impartial experts and the media is essential in providing that context.[iii] Sadly, this is often not the case and, on occasion, there is also little or no attempt to counter misinformation.

Take, for example, the recent brouhaha over the federal government’s long-announced (November 2021) plan to require all truck drivers entering Canada to be fully vaccinated by January 17, 2022. (unvacinated Canadian drivers may re-enter but will be subject to a 14-day quarantine.) If one were to rely on some media coverage, or the comments of some opposition politicians and industry spokespersons, one might conclude this was a wrong-headed and sudden move on the part of the Trudeau government and one that will likely cause a crisis in the food supply chain or worse. Ignoring entirely the merits of the policy according to scientific experts, surely the average citizen’s potentially negative perspective on this initiative would change if they knew the Biden administration had already announced plans to do the same thing effective the following week. In other words, unvacinated Canadian drivers will not be able to enter the US in the first place, so that the issue of their return is rendered irrelevant. In reality, the two countries are simply aligning their border policies.

So how is Canada doing in this pandemic? Context can provide better answers.  Let us take three sets of data: total number of cases, vaccination rate, and death rate, and place them in various perspectives.

As of January 16, 2022, the percentage of the population that was fully vaccinated (2 shots) stood at 78.9 and nearly 89% had received at least one shot. At first glance this seems to be a pretty positive figure. Using a comparative perspective we can see that this viewpoint is reinforced by the numbers globally. Canada sits at the top of the wealthiest democracies in the world in the G7, virtually tied with Japan (and also with Australia), vs France and Italy (75%) Germany (73%) the UK (72%) and, bringing up the rear, the US (63%). Canada also has among the highest rates of booster shot take up, at nearly 40% of the population.

However this still means that 1 in 10 Canadians is not yet vaccinated at all. Another comparison, of vaccination rates within Canada by province, reveals more important differences. While the figures for Ontario, Quebec and B.C. are virtually the same as the national number, the figures for Atlantic Canada are significantly higher while the figures for the three prairie provinces and the north are significantly lower. [iv]

This context, in turn, provides at least one possible explanation for the disproportionate number of current cases in several provinces. For example, with 12% of the population, Alberta in the last reported 7-day period had 16% of the cases, while the Atlantic provinces, with 7% of the population had 6% of cases and B.C., with 13% of the population, had only 7% of cases. (As we see below, other contextual markers reinforce this finding.)

Another useful lens is the cultural perspective. On the one hand there is the case presented by Quebec, with 22% of the population but 32% of the cases. Premier Legault himself has speculated that a cultural context may provide a partial explanation for this disparity, over and above the known problems of LTC facilities in the province, citing the collectivist and family-oriented aspects of Quebecois society. Empirical support for this hypothesis was provided by David Coletto of Abacus Data, whose comprehensive polling data from late 2020 led him to conclude that francophone Quebecers “despite having one of the world’s highest death rates from the virus, feel less anxiety about contagion and more optimistic about how it will play out.”[v]  His findings were confirmed by a Leger poll conducted for the Association for Canadian Studies. As Association president Jack Jebwab concluded, francophone Quebecers were “outliers in North America, never mind Canada” because of their optimistic, somewhat laissez-faire attitude towards the pandemic, which the Leger poll attributed to their cultural emphasis on “joie de vivre,” and a greater level of trust in government to handle the situation.[vi]

On the other hand, several provinces – notably in the prairies and southwestern Ontario — have specific regions of their territory where vaccine uptake is extremely low, due to a variety of cultural factors such as the rural/urban divide, religious community opposition and scepticism over the science. Most noteworthy is Alberta, where a populist, libertarian political culture has polarized many aspects of the pandemic including vaccination. Meanwhile  large urban areas such as Toronto have been slow to respond to problems of perception and inequitable access among diverse communities, all of which have contributed to a situation in which more than 40% of their total population is not yet fully or partially vaccinated. As experts have repeatedly noted, this level is insufficient for any chance of herd immunity.[vii]  Finally, high vaccination rates in the Atlantic Bubble have been attributed in large measure to a culture of compliance and deference to government.

Turning now to the third factor, the number of deaths and the death rate, in terms of historic context the two-year Spanish flu of 1918-20 provides a clear example. It took the lives of 50,000 Canadians. Two years into the current COVID19 pandemic, the Canadian death toll stands at 32,000. But calculated on a level playing field, taking into account the different size of the population for those two events, the disparity grows. The earlier pandemic took the lives of 613 Canadians per 100,00, while the current one has exacted a toll of only 84  per 100,000, due largely to the presence of vaccines as well as far superior public health measures.

Comparatively Canada’s mortality numbers appear even more positive. At first glance Canada’s total of 32,000 pales in comparison with that of the U.S. (875,000) the UK (152,000), Italy (142,000), France (127,000) and Germany (115,000). But those countries all have far larger populations, so those raw figures may not be useful. Only when putting them in the context of deaths per hundred citizens will they be really useful for comparison purposes. Happily, our much lower death rate then becomes statistically very significant. With 10 times the population, for example, a comparable figure for the US death rate would be roughly three times higher, or 320,000, not 900,000. Meanwhile Germany’s number is three times greater than its population would indicate, while those of the UK, Italy and France are twice as high in comparison with our own.    

Still, in the face of the Omicron wave another more recent and negative historic context has emerged in Canada. The total number of those hospitalized and/or in ICUs during this fifth wave now far exceeds the previous high mark, set during the first wave in 2020. And, once again, internal comparisons among provinces provide even greater context as to the disparity in results. With 22% of the population, Quebec’s death toll to date of 12,453 far outstrips neighbouring Ontario, with 38% of the national population but a death count of 10,666. Similarly, Alberta’s soaring numbers are the third worst total in the country, at 3,412, with only 12% of the population.[viii] 

But to put the situation in proper perspective it is necessary once again to examine the same figures in terms of the rate per hundred citizens. The table below shows how dramatically the provincial situation is rearranged. The situation on First Nations Reserves now soars to the top, the worst by far, with Quebec close behind in second place. But it is the prairie provinces and Ontario that cluster next, with B.C and Atlantic Canada doing far far better.

Coupled with the informed context on vaccination rates and total cases, a significant pattern emerges in which the choices made by provincial governments can only be seen as having made significant differences.

COVID-19 Deaths by Region

COVID-19 Death Rates by Region

Notes:

1.  First Nations numbers included in provincial totals
2.  Death data from health-infobase.canada.ca (Jan. 20, 2022)
3. Population data from Statistics Canada (Q4 2021)

Why do we care about these various types of context? Because public health officials and politicians can utilize them to make better public policy choices. And Canadians will be better informed as to the performance of their elected officials. That is surely what all of us want at this point. 

[i] https://www.warmuseum.ca/firstworldwar/history/after-the-war/legacy/the-cost-of-canadas-war/

[ii] https://www.macleans.ca/education/comparing-the-average-salaries-of-canadian-professors-in-2018/

[iii] One journalist who consistently emphasizes context is Andre Picard of the Globe and Mail. See for example his excellent article “Context for COVID Data is Paramount”, January 18, 2022

[iv] https://health-infobase.canada.ca/covid-19/vaccination-coverage/

[v] Eric Andrew-Gee. “When it Comes to COVID-19, Quebec’s Francophones Aren’t Worryinig”. Globe and Mail. September 12, 2020.

[vi] Op cit.

[vii] https://www.ctvnews.ca/health/coronavirus/vaccines-not-enough-to-stop-fourth-wave-of-covid-19-in-canada-experts-warn-1.5560876

[viii] https://www.statista.com/statistics/1107079/covid19-deaths-by-province-territory-canada/