Thread by @MoriartyLab

Dear @PremierScottMoe,

Attached, please find screenshots of my response to your characterization of the Royal Society of Canada's report on Canadian mortality during COVID-19 as "the most egregious misinformation of the pandemic".

The text follows in this thread.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen Dear Premier Moe,

Today you referred to the results of a peer-reviewed report from the Royal Society of Canada on COVID-19 mortality in Canada as the most egregious misinformation of the pandemic. You asked that journalists and peers push back against the results of this report.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen You may not know this if you haven’t read the report yet, but the peer reviewers included two of Canada’s leading epidemiologists, @DFisman and @cdavidnaylor. Dr. Naylor was the Chair of Canada’s 2003 National Advisory Committee on SARS, in case the name is not familiar.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor I am an Associate Professor and infectious disease researcher at the University of Toronto and the lead author on the report.

The report was discussed in the Saskatchewan legislature this summer, so is something with which your office is likely familiar.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor I recognize that the report is not an easy read and am happy to sit down with policy makers from provinces that would like to improve how they manage the COVID-19 epidemic and prevent future deaths.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor Unfortunately, Saskatchewan may still see more than 700 new COVID-19 deaths in the coming months. If you and your team would like to prevent these deaths and understand how past deaths have been missed, I would be sincerely happy to do this.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor The report can be found on the website of the Royal Society of Canada.

You can download it here:

rsc-src.ca/en/covid-19-po…

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor As for requesting pushback from journalists, I’m doing interviews today and tomorrow with multiple Saskatchewan journalists following up on your comments.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor I’m showing them where and how to find the publicly reported information that underlies the report, so that they can address death reporting issues themselves.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor I have more information that was not included in the original report that you may find useful for efforts to improve Saskatchewan’s COVID-19 response.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor 1.Detecting and reporting COVID-19 deaths relies on testing and contact tracing. When these collapse or are inadequate, post-mortem testing is crucial for determining if people died of COVID-19.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor Post-mortem testing likely contributes to the more accurate COVID-19 death reporting in neighbouring Manitoba and in Québec. If Saskatchewan is serious about accurately counting COVID-19 deaths it should adopt post-mortem testing.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor 2. Saskatchewan’s COVID-19 testing is worse than in most of the rest of the country and in high income OECD peer countries. The cumulative test positivity rate in Saskatchewan pre-Omicron (Nov 15/21) was 1.8X higher than the rest of Canada.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor Saskatchewan has conducted 25% less testing per capita than the rest of Canada, and 60% less per capita than OECD peers. Combined, these factors mean that Saskatchewan has almost certainly missed more COVID-19 cases than the rest of Canada and OECD peers.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor If people aren’t tested and they die and if you’re missing a lot more cases than the rest of the country, you’re also missing more deaths.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor Like failure to do post-mortem testing, inadequate testing for the size of the population and the size of the epidemic means that COVID-19 deaths are inevitably missed.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor If Saskatchewan cannot scale up testing to reach the Canadian average for tests/identified case and per capita testing, at the very least leaders should understand that estimates of cases and deaths are without doubt under-estimates,

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor and be aware of this serious caveat when discussing epidemic numbers.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor Now, let’s talk about the Saskatchewan COVID-19 deaths that might not have been missed, but have not been reported.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor 1.Saskatchewan COVID-19 deaths reported to the Canadian Vital Statistics Death Database (CVSDD) up to November 28, 2020 are 2X higher than deaths reported contemporaneously by the province.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor There are still deaths being reported to the database from March-August, 2020. This database is publicly accessible courtesy of Statistics Canada.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor I do have sympathy for the data reporting teams in Saskatchewan and every Canadian province. Getting these data out in an accurate and timely fashion is hard, and there can be mistakes and delays, especially when healthcare systems that report the deaths initially are in crisis.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor However, it’s hard to understand how deaths from the first wave are still being reported nationally in January, 2021. Saskatchewan and other provinces should prioritize completion of COVID-19 death reporting and death reporting in general.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor This would help with public trust in data reported by provinces.

2.As of January 2022, Saskatchewan’s death reporting for the epidemic up to October 2021 is only 70% complete. For comparison, Quebec death reporting to that date is currently 93% complete.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor Death reporting must be at least 95% complete in every province to estimate with reasonable accuracy how many people died untimely deaths during the epidemic and to accurately compare provinces.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor In Saskatchewan, death reporting has not been 95% complete since February 1, 2020, just before the first COVID-19 wave.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor Excess mortality estimates for Saskatchewan are therefore underestimates compared to many other provinces and will be for a long time until Saskatchewan death reporting catches up.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor Unfortunately, this means that estimates of COVID-19 under-detection and under-reporting in the province may still increase beyond what we found in the Royal Society of Canada report.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor Certainly, it means that excess mortality is likely considerably larger in Saskatchewan than is currently known.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor It’s also likely that more COVID-19 deaths will be registered in the publicly-accessible CVSDD over time, meaning that provincial reporting can readily be compared to national vital statistics reporting for accuracy.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor 3. Of the COVID-19 cases that were actually identified in SK pre-Omicron (Nov 15/21), there have been 2.5 times fewer provincially reported COVID-19 deaths than expected based on the numbers of cases in each age group and age-specific infection fatality rates for OECD countries.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor In fact, it’s likely that four times fewer COVID-19 deaths in Saskatchewan have been reported provincially compared to expected deaths for age-specific case numbers.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor This is because most of Saskatchewan’s reported deaths have been during waves of the Delta strain, which is about twice as lethal as pre-Delta strains.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor I hope this information is helpful for your efforts to protect the residents of Saskatchewan, and to plan how the province will manage COVID-19 going forward.

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor If you can overlook the understandable “snark” with which I have responded to your characterization of our report as the “most egregious misinformation of the pandemic”, I am, in full sincerity, happy to help decision-makers in Saskatchewan and other Canadian regions understand

@PremierScottMoe @thinktankSK @awong37 @DennisKendel @KatharineSmart @SMA_docs @picardonhealth @TemanSasha @AlexanderQuon @carolynstrom @angie_rasmussen @DFisman @cdavidnaylor past and future COVID-19 death tolls.

I am frank, but constructive and helpful. My priority, like yours, is reducing future COVID-19 deaths in Saskatchewan and every Canadian region, and I will do everything in my power to help.

Sincerely,
Tara Moriarty