Alberta's reporting of comorbidities questioned after boy, 14, removed from COVID-19 death count

Nine months after being diagnosed with a Stage 4 brain tumour and two days after his family says he tested positive for COVID-19, Nathanael Spitzer of Ponoka, Alta., died in hospital.

When Dr. Deena Hinshaw told Albertans earlier this week that the 14-year-old had died of COVID-19, the province's chief medical officer of health triggered a wave of controversy over how coronavirus deaths are reported.

Hinshaw told a news conference on Tuesday that the boy had complex, pre-existing medical conditions that contributed to his death. Her comments renewed a debate surrounding Alberta's practice of reporting on comorbidities.

The boy's family publicly called on Hinshaw to retract her statement, suggesting that Nathanael had died of cancer, not COVID-19. 

'We just want the truth to come out'

Simone Spitzer accused the province of spreading "fake news" about her younger brother, who had been in hospital since August.

"We just want the truth to come out," she said in a message to CBC News on Tuesday.

On Thursday, at another news conference, Hinshaw apologized to the family. She said that while an initial report had indicated that COVID-19 was a secondary cause of the teen's death, a subsequent review determined that not to be the case.

Hinshaw announced the province will no longer report COVID-19 deaths of children until a review process has been completed to confirm the actual cause of death.

Nathanael, described by his family as an entertainer with a quick smile, has now been removed from the list of more than 2,900 Albertans who have died of COVID-19.

The case highlights the intricacies of reporting comorbidities — such as cancer, diabetes, hypertension and dementia — that can contribute to the dangers of COVID-19.

Alberta started reporting comorbidities linked to COVID-19 deaths in December 2020, but the data doesn't tell the whole story. Experts say discussing the statistics without nuance can minimize dangers of the disease.

WATCH | Hinshaw says Alberta has changed reporting for pediatric deaths: 

Dr. Deena Hinshaw apologizes for mistake in cause of death of 14-year-old

3 years ago

Duration 3:44

'The pain of losing a child is terrible enough without having that loss compounded by a public debate about the circumstances,' Hinshaw said Thursday. On Tuesday, she had announced that COVID-19 was a contributing factor in the child's death. It was not.

Comorbidities are prevalent among all age groups, and the vast majority of Albertans who have died of COVID-19 will have at least one of these conditions listed on their death certificate.

Only 3.8 per cent of Alberta's COVID-19 deaths have involved no comorbidities. More than 74 per cent of all COVID-19 deaths in the province have involved three or more pre-existing conditions.

The most common comorbidities listed in Alberta are hypertension (82.9 per cent), cardiovascular diseases (52.2 per cent), renal diseases (49.7 per cent), diabetes (44.5 per cent), respiratory diseases (40.1 per cent) and dementia (40.1 per cent).

After a COVID-19 death is reported, each case is assessed to ensure the reporting is accurate. If fault is found, the case is removed from Alberta's COVID-19 statistics.

"If there is any question, the death certificate and file are reviewed by medical professionals post-mortem," Alberta Health spokesperson Tom McMillan said in a statement to CBC News.

"If the cause of death was unrelated to COVID — for a hypothetical example, if an individual who is a confirmed case of COVID-19 died in a car crash — the case would be subsequently removed from our death count."

An issue of classification

Dr. Noel Gibney, professor emeritus in the department of critical care medicine at the University of Alberta in Edmonton, says reporting on pandemic deaths is complex, and the data can easily be misunderstood.

Pre-existing conditions can range from severe to minor — and just because someone has a comorbidity does not mean they were likely to die before contracting COVID-19.

Gibney, who expressed sympathy for the Spitzer family, also noted that COVID-19 can trigger myriad lesser-known, potentially fatal health issues, such as a heart attack or stroke.

"The issue is: How does one classify, when they die, has someone died of COVID or with COVID?" Gibney said. "If you had COVID, would you have died on that day or could you have survived for another number of months or years?"

For example, he said, a terminal cancer patient who dies can still be categorized as a COVID-19 death if symptoms of COVID-19, such as pneumonia, are what ultimately proved fatal.

"If your condition was relatively stable and then you caught COVID and died, in most instances a doctor would fill out the death certificate as 'due to COVID' with your cancer as the underlying condition."

Gibney said tracking comorbidities can contribute to a broader understanding of the pandemic, but sharing the data publicly is problematic.

Without context, the statistics may undermine the public's understanding of the disease, he said, noting that the data also stigmatizes those with underlying health conditions.

Ubaka Ogbogu, an associate professor in the faculty of law and the Katz Research Fellow in Health Law and Science Policy at U of A, said Alberta's comorbidities reporting system should be scrapped.

"This disclosure started a long time ago, and it started from the time that Premier [Jason] Kenney really wanted to minimize COVID in general, as well as COVID deaths," Ogbogu said.

"People who have these comorbidities are going to live in fear.... And that anxiety is not being matched by any action from these governments to actually show that they're trying to protect those who are especially vulnerable."