Manitoba conservation officers provide COVID-19 information sheets to drivers of vehicles as they enter Manitoba from Ontario on March 28, 2020.JOHN WOODS/The Canadian Press
Manitoba has become the first province to track the ethnicity of COVID-19 patients in an effort to detect inequities in the toll of the pandemic, while Quebec and Ontario have announced plans to do the same – a major shift in how Canada measures and tackles the new coronavirus crisis, researchers say.
Countries such as the United States and Britain continue to see sharp racial divides in the impact of the virus, and while Canadian health authorities have typically been leery of gathering information about race, the coronavirus has pushed some to change tack. Toronto is set to join the Prairie province in collecting such data within about a week.
Numbers on the ethnic makeup of COVID-19 cases can help target public health messages and resources at communities in the greatest need, as well as shine light on inequalities in housing, labour market access and pre-existing health conditions, said Dr. Marcia Anderson, a Cree-Anishinaabe public health doctor and vice-dean for Indigenous health at the University of Manitoba.
She calls the growing effort to collect these figures "a huge success story.”
“I hope it sticks around in the future,” Dr. Anderson said, "to make visible the racism that exists in health care and other settings, and to make sure we intervene, measure our interventions and improve.”
Manitoba began asking patients their ethnic identity as part of its case investigation process on May 1. The move was meant to determine whether the virus was having a “disproportionate impact on certain communities,” the province’s Chief Public Health Officer, Brent Roussin, explained in a news briefing last week.
“Unless you collect that data, you’re not going to know,” he said.
Manitoba has had a relatively light outbreak so far, with 290 confirmed cases and seven deaths as of Tuesday, but other places that have borne the brunt of COVID-19 are seeing disturbing demographic patterns in the pandemic.
A massive British study published last week using health records for more than 17 million people found that black and Asian Britons were at a higher risk of death from COVID-19 than other groups. A separate study from the country’s statistics office, looking at cases from March 2 to April 10, found that black people in England and Wales were four times more likely to die from COVID-19 than white people, when factoring for age.
british study: minorities more at risk
of dying from covid-19
Canada does not yet have a picture of how
COVID-19 cases break down along ethnic lines,
though some provinces are moving to collect this
data. In Britain, research suggests black and Asian
Britons are more likely to die from the disease by a
wide margin.
Risk of COVID-19-related death by ethnic group
Risk and margin of error, England and Wales, March 2 to April 10
MALES
Comparison
group: white
Increased risk of dying
from COVID-19
Black
Bangladeshi/Pakistani
Indian
Other
Chinese
Mixed
Comparison
group: white
Increased risk of dying
from COVID-19
FEMALES
Black
Bangladeshi/Pakistani
Indian
Other
Chinese
Mixed
Just as likely
1.5x as likely
2x as likely
Liklihood of dying from COVID-19 as compared to white ethnicity
JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE:
uk office for national statistics (ons)
british study: minorities more at risk
of dying from covid-19
Canada does not yet have a picture of how COVID-19 cases
break down along ethnic lines, though some provinces are
moving to collect this data. In Britain, research suggests black
and Asian Britons are more likely to die from the disease by a
wide margin.
Risk of COVID-19-related death by ethnic group
Risk and margin of error, England and Wales, March 2 to April 10
MALES
Comparison
group: white
Increased risk of dying
from COVID-19
Black
Bangladeshi/Pakistani
Indian
Other
Chinese
Mixed
Comparison
group: white
Increased risk of dying
from COVID-19
FEMALES
Black
Bangladeshi/Pakistani
Indian
Other
Chinese
Mixed
Just as likely
1.5x as likely
2x as likely
Liklihood of dying from COVID-19 as compared to white ethnicity
JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE:uk office
for national statistics (ons)
british study: minorities more at risk of dying from covid-19
Canada does not yet have a picture of how COVID-19 cases break down along ethnic lines,
though some provinces are moving to collect this data. In Britain, research suggests black and
Asian Britons are more likely to die from the disease by a wide margin.
Risk of COVID-19-related death by ethnic group
Risk (purple dot) and margin of error range, England and Wales, March 2 to April 10
MALES
Comparison group: white
Increased risk of dying from COVID-19
Black
Bangladeshi/Pakistani
Indian
Other
Chinese
Mixed
FEMALES
Comparison group: white
Increased risk of dying from COVID-19
Black
Bangladeshi/Pakistani
Indian
Other
Chinese
Mixed
Just as likely
1.5x as likely
2x as likely
Liklihood of dying from COVID-19 as compared to white ethnicity
JOHN SOPINSKI/THE GLOBE AND MAIL, SOURCE:uk office for national statistics (ons)
The U.S. has produced its own patchwork of alarming statistics about COVID-19’s swath through the African-American community. In the early days of Louisiana’s pandemic, black residents accounted for more than 70 per cent of coronavirus deaths. In Chicago, fully 72 per cent of COVID deaths were among African-Americans by early April. The figures far outstrip the black share of the population, which is about 30 per cent in both places.
In a stark example of data’s power to change public policy, Chicago Mayor Lori Lightfoot used that figure as a spur to increase the city’s response in black neighbourhoods, said Andrew Pinto, a public health specialist and family physician at Toronto’s St. Michael’s Hospital.
“Right away, she said, ‘Based on this data, we’re going to move to do more outreach and more testing in African-American communities,’” said Dr. Pinto, who is also the founder and director of the Upstream Lab, an organization that does research and education on social determinants of health.
In a widely circulated report he co-authored last month, Dr. Pinto called on all Canadian jurisdictions to begin collecting data on the race of COVID-19 patients using a uniform questionnaire, to be able to compare results nationally.
“We need to recognize that crises don’t affect everybody the same,” he said in an interview. “Without the data, we won’t be able to see that and direct resources and effort to where they’re most needed.”
So far the country is moving toward a clearer picture of ethnic disparities in fits and starts, although the non-profit Canadian Institute for Health Information has endorsed Dr. Pinto’s report, and offered to help compile such data.
Toronto’s Medical Officer of Health, Eileen de Villa, said in an interview that the city’s public health agency will start gathering ethnic data as part of its COVID-19 case investigation process by the week of May 18, once it has the technical capacity. “We’re pretty much ready to go,” she said.
Ontario’s associate medical officer of health announced on May 6 that the province will begin collecting similar data at an unspecified future date. Quebec’s national director of public health made a similar announcement on the same day.
Not every province is joining the shift toward producing racial data. The chief health officers of Alberta and B.C. have said their provinces are considering the move, but neither has taken steps to do so.
Meanwhile, Manitoba hasn’t committed to making their data public once it is gathered. Dr. Roussin, the province’s Chief Public Health Officer, said releasing the numbers depends on whether the province feels it can be done without compromising privacy. “We have processes in place to analyze and to release if appropriate,” he said.
Data about the ethnicity of COVID-19 patients should be made public by default so that researchers can scrutinize the numbers freely, said Arjumand Siddiqi, the division head of epidemiology at the University of Toronto’s Dalla Lana School of Public Health.
“My big fear is that they don’t release the data; they pick a handful of people to analyze it," she said. "I think they need to do a better job of democratizing the process.”
Still, Dr. Siddiqi applauded the momentum toward gathering information about race and health in Canada, and said she hopes it doesn’t end with the pandemic, but extends to more routine analysis of racial disparities.
“It’s a very large shift – very substantial,” she said. “I do think there’s reason to think this could be a tipping point.”
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