How your province has weathered the pandemic: MLI's Provincial COVID-19 Misery Index

The following is an analysis and methodology of the Macdonald-Laurier Institute’s Provincial COVID Misery Index. The analysis is relevant to results reported on May 24, 2021, though the methodology remains relevant to the updated PCMI. More detailed methodology, which applies principally to the national-level COVID Misery Index, is available here.

Click here to download the data, and click here to read the press release.

Introduction

In March 2020, Canada – in line with countries around the world – entered a state of lockdown in an attempt to arrest the transmission of COVID-19. For more than a year, our federal and provincial governments have wielded a range of tools to try to keep the disease at bay, with mixed results.

The Macdonald-Laurier Institute’s new Provincial COVID-19 Misery Index (PCMI) examines the impact of the virus in Canada and each provincial government’s response to it by taking a holistic view of the effects of the pandemic on our current, and future, well-being. This initiative is a supplement to our international COVID-19 Misery Index which ranks Canada’s overall performance dealing with the pandemic in relation to 14 comparison countries.

Jurisdictions in Canada have experienced different trajectories of COVID-19 and have implemented different responses to it. It is clear that COVID-19 has heaped misery on us all, but that misery has not been equally distributed across the country, with Atlantic Canada faring rather better than provinces to the west, particularly our two most populous provinces, Quebec and Ontario. And even as vaccine programs roll out to quell the third wave, our metrics show that elements of our misery will be with us for some time to come.

Data and Methods

For the new Provincial COVID-19 Misery Index, we identify 11 measures for each of the ten provinces and divide them into three broad categories: Disease Misery looks at data related to the direct impact of COVID-19 on populations; Response Misery reflects the responses and restrictions implemented by governments; and Economic Misery measures the financial impact of lockdowns and the costs of borrowing on individuals and governments. Each category is weighted equally to determine scores and rankings. Unfortunately, we were unable to include Nunavut, the Yukon and the Northwest Territories in this analysis as comparable data measures were not available.

While the measures in the PCMI do not encompass the totality of misery-causing factors, they do provide a good overview of the myriad ways in which our lives have been impacted by COVID-19 thus far. In future, we anticipate new measures will become available to show some of the longer-term implications of government response measures to the pandemic. Data on mental health and resilience will show the psychological toll taken. Measures of the disruptions to education and the ability of teachers, students, and parents to adapt to online learning platforms and home-schooling will demonstrate the impact on children’s future success.

For each measure, we create a point score: more points equals more misery. The scores are computed by conducting a standard normal transformation for each measure, then converting this figure to a percentile score between 0 and 100.

All data used in this Index comes from publicly available sources, as indicated below.

We would like to acknowledge and commend to readers the ground-breaking work of Australia’s Lowy Institute which earlier this year released a comprehensive ranking of countries’ performance in managing the spread of the pandemic. While we have taken a substantially different approach, this work builds on that excellent resource.

Measures

As noted above, we divide our Provincial COVID-19 Misery Index into three broad categories, with various metrics related to each.

Disease Misery

Cases of COVID-19 per 100,000 population¹
Deaths from COVID-19 per 100,000 population¹
Excess mortality per 100,000 population2 (number of deaths from all causes compared to the same period one year earlier)

Response Misery

Tests per confirmed case¹
Proportion of the population receiving a vaccination1
Restrictive public health measures³

Economic Misery

Change in GDP 2020⁴
Forecast change in GDP 2021⁴
Change in unemployment 2020⁴
Forecast change in unemployment 2021⁴
Increase in public debt as a proportion of GDP between fiscal 2019 and fiscal 20205

Results

Not surprisingly, the misery from COVID-19 has hit hardest in the provinces that have experienced the highest incidence rates of the virus. Those in Atlantic Canada, until now at least, have been spared the worst of the disease impacts. Prince Edward Island and Newfoundland and Labrador, as island provinces, were effectively able to close their borders and restrict the flow of people, thus limiting the transmission of the disease. Nova Scotia and New Brunswick have had comparatively higher case loads, but have managed the disease well using localized lockdowns and introducing the “Atlantic bubble” to prevent wider outbreaks.

West of Atlantic Canada, we see a different story. Ontario and Quebec have been hit particularly hard by all measures, with high incidence rates prompting strict lockdowns which, in turn, resulted in massive economic impacts. The Disease and Response measures in these two provinces have also exposed considerable structural failings in long term care facilities.

Alberta has experienced both high prevalence rates of COVID-19 and significant economic effects, with the resource sector having been hit particularly hard. Manitoba and Saskatchewan have very similar misery profiles, while the situation in British Columbia has been marginally worse than those two provinces.

Below is a summary of each province’s Misery Index results, presented in order from the one experiencing the least misery to that experiencing the most.

1. Prince Edward Island (Overall Grade: A+)

Canada’s smallest province had the lowest misery index score. Remarkable was their very low disease rate: zero COVID-19 deaths and a negative excess mortality rate, with fewer Islanders dying from all causes than the same time frame one year earlier. Given that the province adhered to a relatively tight lock down and had Canada’s best testing regime on a tests-per-positive-case basis, this result is not surprising. Being an island province almost certainly played a key role in their success at keeping the disease at bay, without compromising the non-COVID health needs of their population and minimizing the impact to their economy.

2. Nova Scotia (Overall Grade: A)

Although Nova Scotia is currently experiencing a surge in cases, overall they have performed admirably during the pandemic. COVID-19 caseloads and deaths were low compared to other provinces. As with PEI, Nova Scotia also had negative excess mortality, suggesting that the province was able to continue to provide care to those with non-COVID health needs. In terms of its response measures, Nova Scotia had one of the higher rates of testing per confirmed case and maintained relatively less stringent public health restrictions. However, its vaccination program does lag behind many other provinces. The economic impact was consistently less miserable than most other provinces, with relatively small declines in GDP and only minor increases in unemployment and government debt compared to other provinces.

3. New Brunswick (Overall Grade: B+)

New Brunswick experienced higher incidence rates than PEI and Newfoundland and Labrador, perhaps attributable to its more open borders. However their number of COVID-19 deaths remains well below the national average. Of greater concern is the high rates of excess mortality, which likely reflects challenges faced by residents accessing care during the pandemic. New Brunswick’s response has been middle of the pack compared to other provinces, with average testing regimes, public health stringency, and vaccination rates. The economic impact has been interesting, with a relatively lower fall in GDP in 2020 matched with a relatively lower expected recovery in 2021. NB has done a remarkable job limiting its increase in public debt, suggesting that the financial impact of COVID-19 may not linger quite as long in the province as elsewhere.

4. Newfoundland and Labrador (Overall Grade: B)

Canada’s eastern-most province undoubtedly benefited from approximately 90 percent of its residents living on the island and, as a result, being better able to control the coming and going of people. Caseloads in Newfoundland and Labrador were largely driven by two significant spreading events, but otherwise incidence rates and death rates are both very low. Of some concern is the high rates of excess mortality, which, when compared to COVID-19 mortality rates, suggest that lack of access to health care may have contributed to deaths for reasons other than COVID-19. The government’s response to COVID-19 has been reasonable, with a testing regime better than most provinces and a less stringent public health response. Their vaccination program has been better than its Atlantic Canadian peers, but lags behind the central and western provinces. Newfoundland and Labrador’s economic challenges were well documented before the pandemic hit, but the evidence suggests a steep decline in economic activity, a relatively slow recovery, and significant additions to public debt that, if not entirely attributable to the pandemic, have still created additional misery for Newfoundlanders and Labradorians.

5. Saskatchewan (Overall Grade: C+)

Saskatchewan has experienced a slightly above average incidence of COVID-19 and mortality, as well as higher than average excess mortality, suggesting the pandemic has hit the province relatively hard. Their testing regime has been on par with the national average, as has their public health stringency. It should be noted that Saskatchewan has, at the time of reporting, Canada’s best vaccination program. The economic impact in Saskatchewan has been muted, with a less severe decline in GDP and increase in unemployment than other provinces, but with slower than expected economic recovery as well. The province should be commended for its relatively low addition to public debt.

6. Manitoba (Overall Grade: C+)

Manitoba’s overall grade is just a fraction of a point behind Saskatchewan, although the underlying data reveals some important distinctions. The overall incidence rate of COVID-19 is lower than that of Saskatchewan, but their death rate due to COVID-19 is considerably higher, suggesting that Manitoba may not have done quite as well keeping COVID-19 away from their most vulnerable residents. However, the excess mortality rate of Manitoba is below the national average, indicating that the province did better than many others in terms of maintaining access to health services during the pandemic. With respect to response measures, Manitoba’s testing and vaccination programs lag slightly behind the national average, while their public health restrictions were less stringent than other provinces. Manitoba’s economic response was broadly on par with other provinces and similar to Saskatchewan, with a less severe decline and a less expeditious recovery. Additions to public debt were slightly below the Canadian average.

7. British Columbia (Overall Grade: C+)

By the narrowest of margins, British Columbia avoided an overall C grade. While the COVID-19 incidence and death rates are near the national average, BC fares far worse in terms of the excess mortality rate, indicating that efforts to foil COVID-19 may well have had other adverse health consequences. BC’s response measures to COVID-19 are very close to the Canadian average, with middle of the pack testing, vaccinations, and public health stringency. Their economic effects are a bit more extreme than many other provinces, as they have higher than average deterioration of GDP and unemployment, albeit with better than average recoveries expected in 2021. BC’s addition to public debt was more or less on par with other Canadian provinces.

8. Quebec (Overall Grade: D)

Quebec had, by far, the highest COVID-19 death rate compared to all other Canadian provinces, with Quebecers being greater than three times more likely to die from the virus than the national average. Their incidence of COVID-19 was second highest in Canada, behind only Alberta. Their excess mortality rate was also the highest in Canada, although conceivably could have been much higher, given the number of deaths due to COVID-19 in the province. Long term care facilities in the province were especially hard hit, exposing serious weaknesses in that sector. Quebec’s response to the virus has been better than average, with one of the better testing regimes and a very good vaccine roll-out. However, their public health measures have been amongst the most stringent in Canada, trailing only Ontario. The economic impact of COVID-19 has been a bit more extreme than many other provinces, with severe deterioration of GDP and unemployment, but better than average recoveries expected in 2021. Quebec’s addition to its public debt has been slightly less than the Canadian average.

9. Ontario (Overall Grade: D)

Ontario falls narrowly behind Quebec in terms of its overall grade. Their incidence rates of COVID-19 are well above the national average, as are their death rates from COVID-19 and levels of excess mortality. As with Quebec, residents in Ontario’s long term care facilities had high incidents of cases and fatalities, highlighting structural inadequacies that should come as a surprise to no one. Ontario’s response measures to COVID-19 have been mixed. They have a testing regime that is better than most provinces although they have been a bit slower in their vaccine roll-out. What is most remarkable about Ontario is their use of the most stringent public health restrictions in Canada over the longest period of time. Indeed, Toronto has the dubious distinction of being the most locked down city in North America. We suspect this may be due, at least in part, to the well-documented ambiguity in government communications resulting in public confusion about what activities people can or cannot do. So while restrictions may have been imposed, uncertainty regarding their application most likely has contributed to the longer lengths of time they have been in place. Ontario’s economic fall-out has been quite severe with one of the sharpest deteriorations of GDP and unemployment; however, a better than average recovery is expected. Ontario has taken on a significant amount of public debt during the pandemic, meaning that their bill for COVID-19 will likely require a long term for repayment.

10. Alberta (Overall Grade: D)

By our metrics, no province has experienced more misery during the pandemic than Alberta. Their incidence rates of COVID-19 are well above all other Canadian provinces. However, their COVID-19 death rates are not as high as some other provinces, suggesting Alberta has done relatively well in protecting its most vulnerable residents, despite the high disease rates in the province. Alberta’s response to COVID-19 has been moderate, with testing regimes and public health restrictions comparable to other provinces. Alberta’s vaccination roll-out program trails only Saskatechewan. The economic deterioration in Alberta has been severe, especially in the resources sector, and they have experienced one of the largest declines in GDP and largest increases in unemployment as compared to the other provinces. While some degree of recovery is expected in 2021, a return to pre-pandemic GDP and unemployment levels is not expected until 2022 at the earliest. Alberta’s increase in public debt is second only to Newfoundland and Labrador. These two provinces are most reliant on oil royalties and have seen severe declines in these revenues since the outset of the pandemic.

Conclusion

No Canadian province has been spared the misery of COVID-19, although our Provincial Index shows that its impact has been felt disproportionately across Canadian provinces. While the public health restrictions limited freedoms in Atlantic Canada, these four provinces have thus far been spared the worst of the disease. In the rest of the country, as with elsewhere in the world, large populations and numerous land border crossings, both between provinces and with the United States, make tighter lockdown levels, or “locking down to zero” as some have advocated, extremely unrealistic. Interestingly four of Canada’s wealthier provinces have experienced the worst misery, with Alberta, Ontario, Quebec, and British Columbia demonstrating high incidence, death and excess mortality rates as well as stringent public health restrictions. Canada’s vaccine roll-out to date has been relatively even across provinces, with the hardest hit provinces having some extra urgency to move more quickly. Having said that, Canada’s vaccination program has lagged far behind many other countries – most notably the United States and the United Kingdom.

Governments across the country initially responded to the first wave of the pandemic with a strong unified communications effort, mainly focused on messaging from the provincial and federal officers of health, appealing to Canadians to enter a state of lockdown in order both to control and better understand the spread of this new coronavirus. But what started as a fairly allied and amicable attempt to balance protecting public health with ensuring minimal impact on workers and business while maintaining civil liberties has devolved into a territorial blame game, at the expense of the collective well-being of Canadians. This situation is perhaps best illustrated by the war of words over the vaccine roll-out, with the federal government claiming that the provinces were slow to put the doses into the arms of citizens, while the provinces decry failures in federal procurement efforts resulting in shortages of the promised vaccines. The vaccination rates we are seeing in the provinces suggest that delays have been largely on the supply side.

No doubt, as the delivery of vaccines increases and the immediate health implications of COVID-19 begin to recede, there will be much to learn from the ways in which governments in various jurisdictions responded to the pandemic. And no doubt, some of the measures they imposed will ensure that Canadians continue to experience a degree of misery for years to come.

Data Sources

Richard Audas, Professor of Health Statistics and Economics Faculty of Medicine, Memorial University of Newfoundland. Senior Research Fellow, Macdonald-Laurier Institute.

How your province has weathered the pandemic: MLI’s Provincial COVID-19 Misery Index