How Alberta's COVID-19 death toll turned so grim, so quickly

Alberta recently recorded its 1,000th COVID-19 death, a grim milestone that arrived in a flash.

It took nearly nine months for Alberta to record its first 500 deaths; the next 500 came in just 34 days.

Katalin Lang's father, Jozsef, contracted the disease in his Calgary nursing home and died in late November. She said the sheer number of recent deaths can be numbing when considered all at once, but when experienced individually the loss of each person is "deeply, deeply felt" by those who loved them.

"I just wanted it to be clear that, for every number there is emotion attached, there are memories attached," she said.

"A thousand families just like mine are going through grief, just like ours — and that's a lot."

December has been, by far, the deadliest month for COVID-19 in Alberta, in a marked turnaround for a province that, for a time, seemed to have the disease under relative control.

In the spring, the province boasted about its low hospitalization rate, its nation-leading testing and how it had quadrupled its ranks of contact tracers.

Come winter, Alberta had the highest hospitalization rate in the country and test-positivity rates that were nearing 10 per cent. Thousands of people were told to do their own contact tracing after the provincial system was overwhelmed.

How did things go so wrong, so quickly? It's a lesson in exponential growth.

Medical experts and mathematicians tried to sound the alarm nearly two months ago about the trajectory the province was on. But the government was reluctant to impose new restrictions on Albertans' liberties and economic activity. It rebuffed repeated calls for stricter public-health measures — for a time.

Meanwhile, the exponential growth continued unabated, with the number of new daily cases doubling every two to three weeks. Whether in response to the physicians' warnings, or the fact that new case numbers were approaching the psychological barrier of 2,000 per day, the government eventually did act.

But by that time, the hospitalizations and deaths the province is now experiencing had been essentially baked in. Daily case counts have mercifully started to ebb, but the glut of disease that built up weeks ago is still filling more hospital beds and claiming more lives than Alberta has seen at any other point in the pandemic.

And, after some mixed holiday messaging, there are concerns about a fresh spike in cases in the new year.

Physicians' warnings

Back in early November, a group of 70 Alberta doctors wrote an open letter to the premier, calling for a "circuit-breaker" lockdown to blunt the looming wave they saw coming.

That was followed by a second letter, signed by hundreds of physicians, repeating the plea.

And then, on Nov. 22, a third letter was sent.

On Nov. 24, with case counts continuing to soar and intensive-care units filling up, the Alberta government announced new public health restrictions prohibiting all social gatherings in people's homes and making masks mandatory for indoor workplaces in Calgary and Edmonton.

Premier Jason Kenney called the plan "bold and targeted," while NDP Opposition Leader Rachel Notley described the restrictions as "half measures" that came too late. The first part of that criticism is debatable. The second is harder to deny.

These restrictions were far from the "circuit breaker" lockdown doctors had been calling for but, in retrospect, they did appear to have an effect.

It wasn't apparent until several days later but, around Dec. 7, new-daily case counts started to show a noticeable decline for the first time in weeks. The exponential growth had been interrupted, right around when one would expect the new measures to show up in the case data.

But on Dec. 8, before that trend was obvious, the province went even further and announced the toughest restrictions Albertans had seen since the spring.

Bars, barbershops and dine-in restaurants were ordered closed. Masks were made mandatory in public places provincewide — even in rural areas where Kenney had previously said he wanted to avoid such a mandate because he feared it would prompt a "backlash" and even be "counterproductive."

In his announcement two weeks earlier, the premier sounded reluctant — even pained — to be telling Albertans they couldn't get together in each others' homes. Now, with the province approaching nearly 2,000 new cases per day, he was unequivocal: even Christmas, in the traditional sense, would have to be cancelled.

"If we relax the public health measures to permit large family gatherings in just three weeks' time, we will, without a shadow of a doubt, see a large increase in hospitalizations and fatalities," Kenney said at the Dec. 8 news conference.

That rule was later relaxed, however.

Mixed messaging

Kenney convened yet another press conference on Dec. 22 to say Albertans who live alone would be permitted to attend one family gathering over the holidays.

This came shortly after the province launched a high-profile ad campaign that specifically instructed Albertans to not invite a fictional "Uncle Mike," personified as a human with a coronavirus for a head, over for Christmas.

But the premier described the new exception as "a small change" that "will make a world of difference for single Albertans who otherwise would not be able to visit their families over Christmas."

This sort of mixed messaging hasn't been unique to Alberta. Governments across the country have been criticized for public-health communications that have been confusing, if not contradictory, at various points throughout the pandemic.

The fear is that a lack of clear and consistent guidelines will reduce compliance with public health orders, which, while enforced to a degree, rely primarily on people voluntarily going along with them.

Especially over the Christmas holidays, there is concern that large numbers of Albertans will have misunderstood or outright ignored the orders.

Another spike in January?

Kenney admits compliance may be a problem.

"I am concerned, to be blunt, about what we might see coming out of Christmas," the premier said Tuesday.

"Because inevitably there will have been at least some degree of socializing here in Alberta that could affect our numbers, that we might see pop up in a couple of weeks."

His comments about the near future, however, came in response to a question that asked him to reflect on the recent past.

The premier was asked how many of the last 500 deaths might have been prevented if the public health measures had been adopted sooner, as physicians had been calling for. He didn't answer the question.

Instead, he noted that multiple jurisdictions have seen a "fall wave" of COVID-19 infection — and death.

"And so, unfortunately, that's affected Alberta, like so many other places," Kenney said.

It's true that, adjusted for population, Alberta's recent surge in COVID-19 deaths is smaller than what Manitoba has recently experienced, or what Quebec went through in the spring.

But for a province that had become accustomed to looking across the country and feeling pride in its pandemic response, Alberta now finds itself in uncharted territory. After keeping the disease relatively at bay for months, deferred decisions late in the year led to an unprecedented amount of illness and death.

Just as vaccines start to arrive.