CHAPTER EIGHT

The Pandemic and its Aftermath
The Lost Decade

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7 May, 2026

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A decade has elapsed since the original publication of this book on Mississauga, part of a broader effort that took in other major Canadian cities and urban centers across the continent, and five years since its web edition was last revisited and updated. 

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What follows is a continuation of website edits in Chapter Seven of the book, dedicated to the COVID-19 pandemic, as it developed in 2020.

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The pandemic was one of the most disruptive events of our time, rattling the social and economic structures that underpin life around the world. Now that the pandemic is all but over, it is time to take stock of how it affected individuals and society as a whole.

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Covid statistics

Canada, a nation of approximately 38 million people, lost somewhere between 52,000 and 59,000 lives to COVID-19 over the course of the pandemic. That translates to 1.4 – 1.5 deaths per one thousand inhabitants in Canada 1.

 

Those bearing the heaviest burden were older adults, frontline workers, Indigenous peoples, unhoused individuals, racialized communities, and those living with disabilities or mental health conditions. Long-term care facilities emerged as some of the deadliest environments, accounting for a disproportionate share of fatalities.

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Official confirmed death counts in Canada are generally considered an underestimate, due to limited testing, challenges in determining the cause of death, and disruptions during the pandemic.

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Worldwide, over 7 million people have died during this pandemic 2.

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The true global death toll from Covid is widely believed to far exceed the roughly 7 million deaths recorded by Worldometer, given severe gaps in reporting capacity across much of Asia and Africa, compounded by deliberate data suppression under authoritarian governments. China's official count of just 5,272 deaths is a striking example — a figure roughly one-tenth of Canada's total, despite having a population nearly 40 times larger. Applying Canada's death rate of approximately 1.5 per 1,000 to China's 1.41 billion people would yield a figure closer to 2 million deaths — nearly 400 times what Beijing reported.

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The implausibility of China's numbers is further underscored by the country's comparatively limited capacity to deliver the kind of intensive hospital care and widespread vaccination coverage that helped curb mortality in wealthier nations. Where medical infrastructure is stretched, and access to effective vaccines was uneven, death tolls would reasonably be expected to run higher, not lower — making China's reported figures all the more difficult to accept at face value.3  

Russia presents a similarly troubling picture. Its officially reported toll of 402,756 deaths — roughly 2.8 per thousand — already exceeds Canada's rate, yet is still considered a substantial undercount. A more troubling portrait of the pandemic's toll is rendered by excess death analyses: researchers estimated approximately 351,000 deaths above the historical norm in 2020 alone, rising to around 678,000 in 2021. Combined, those two years alone suggest a true toll approaching or exceeding one million — more than double the official figure, before even accounting for 2022 and beyond. Adding those two years alone gives roughly 1.03 million excess deaths, or about 7.2 per thousand people.

This pattern of undercounting through official channels while excess mortality data reveals the real scale of loss is a recurring theme among countries where transparency is limited and political incentives to minimize bad news are strong.

Russia, like China, had every reason to downplay the devastation — and the numbers suggest it did exactly that.

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There is little justification for assuming the world's poorer and more densely populated regions fared better than Canada — if anything, the opposite holds. Vaccine access in low-income countries remained severely limited well into the pandemic, hospital infrastructure was far less equipped to manage severe cases, and public health systems lacked the capacity to mount effective responses.

 

If Canada's death rate of roughly 1.5 per thousand is taken as a reasonable baseline, applying it globally to 8 billion people yields a staggering implied toll of around 12 million — and that assumes comparable healthcare, which much of the world does not have.

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The parallel to the Spanish Flu is sobering. That pandemic killed somewhere between 25 and 50 million people — with some estimates reaching as high as 100 million — when the world held fewer than 2 billion people, barely a quarter of today's population 4. Scaled to the current global population, even the conservative end of that range would represent an almost incomprehensible loss of life. While modern medicine has undeniably reduced mortality in wealthy nations, those advances are distributed unevenly. For billions of people in sub-Saharan Africa, South and Southeast Asia, and parts of Latin America, the experience of COVID-19 may have been far closer to the Spanish Flu era than to what Canadians or Western Europeans experienced.

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The true global death toll may never be known with. But the weight of evidence — implausible official counts from authoritarian states, stark excess mortality data, and the near-absence of adequate healthcare across vast swaths of the globe — suggests the real number could be multiples of the 7 million figure, and perhaps not far removed from the darkest estimates associated with the deadliest pandemic of the twentieth century.

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Infection rates

Apart from the death count, the sheer number of Coronavirus cases in Canada, that was approximately 5 million, provides an idea of the scale of the problem 5. 

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The younger and healthier people were lucky to recover in a matter of weeks, while most of the other patients required hospital care for extensive periods of time. Even after the discharge, they faced long times of recovery suffering from the so called long covid, when some of them ended with permanently damaged lungs and the immune system.

In the United States, the total confirmed Covid cases is estimated between 103–104 million 6. The US, with about  3.6 deaths per thousand, and a population of roughly 340 million in 2022, lost a staggering over 1.2 million people. It was the largest recorded toll in any single country, followed by Brazil with around 660,000 deaths7.

That figure surpasses even much more populous nations, which speaks to a combination of factors unique to the American experience: a fragmented healthcare system, deep political polarization around public health measures, vaccine hesitancy, and high rates of underlying conditions such as obesity, diabetes, and heart disease that made severe outcomes far more likely.

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Brazil followed with approximately 660,000 deaths — a toll reflecting similar fault lines of political leadership that resisted and at times actively undermined pandemic response, vast geographic and socioeconomic inequality, and uneven access to care across its enormous territory. Together, the US and Brazil accounted for a remarkable share of the world's officially recorded deaths, despite representing a relatively modest fraction of global population.

That these two countries — both middle-to-high income, both with functioning health infrastructure by global standards — suffered such devastating losses only deepens the concern for what was unfolding simultaneously in places with far fewer resources and far less reliable data. If nations with hospitals, vaccines, and functioning public health agencies lost people at that scale, the imagination is forced toward deeply uncomfortable conclusions about what the true toll looked like where none of those advantages existed.

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Issues with vaccination

Adjusted for population, Americans died at more than double the Canadian rate — a gap too large to explain away by demographics or geography alone8.

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Vaccination made the difference in the death toll in both countries. The United States launched vaccination programs first, thanks to domestic manufacturing capacity and a the Defence Production Act that prioritized American supply chains. By early spring 2021, the U.S. was administering roughly 15 million doses per week. Canada, by contrast, was entirely dependent on overseas supply and struggled to secure reliable deliveries. At the height of the disparity, the U.S. was vaccinating at approximately ten times Canada's rate.

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Then the story reversed. As supply finally arrived in Canada through the summer of 2021, uptake surged. By mid-July of that year, over 71 percent of Canadians had received at least one dose — overtaking the United States, which had stalled at roughly 57 percent. By the end of the campaign, over 84 percent of Canadians were fully vaccinated. The American figure never cleared 67 percent 9.

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Political unity made the difference. In Canada, all major parties backed the vaccine program. In the United States, the campaign became a culture war. Resistance hardened along partisan and regional lines, and in states such as Mississippi, Louisiana, and Wyoming, first-dose rates barely reached one in three adults — figures more reminiscent of vaccine-hesitant developing nations. That geographic and ideological fracturing contributed to the stark difference in death rates between the two neighbours, and stands as one of the more consequential public health failures of the era.

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The Vaccine Mandate

In Canada, vaccination mandates were introduced at both the federal and provincial levels for various categories of workers. In November 2021, the Public Health Agency of Canada announced that essential service providers — including truck drivers — would be required to be fully vaccinated by January 15, 2022. Foreign national truck drivers who were unvaccinated or only partially vaccinated would be barred from entering the country entirely, while unvaccinated Canadian truck drivers could still cross the border but faced a mandatory two-week quarantine upon return.

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The mandates were among the more contentious domestic policy decisions of the pandemic. For many Canadians, they represented a reasonable and necessary measure to protect public health and reduce transmission among workers who moved constantly across borders and communities. For others, particularly those in industries where physical presence was non-negotiable and remote work was not an option, the requirements felt coercive — an infringement on bodily autonomy that drew a sharp line between the vaccinated and unvaccinated in ways that affected livelihoods directly. That tension would soon spill dramatically into public view, as the trucking mandate became the catalyst for one of the most significant civil disturbances in recent Canadian history 10.

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The new restrictions potentially affected up to 16,000 drivers, though approximately 85% of Canadian truck drivers serving cross-border routes were already vaccinated.  The United States imposed a similar requirement on its side of the border around the same time.

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The Freedom Convoy

The vaccine mandate was opposed by a segment of cross-border truck drivers who organized protests that rapidly grew far beyond their origins. The movement quickly expanded into a broader demonstration against all Covid restrictions and mandates. Beginning January 22, 2022, hundreds of vehicles departed from locations across the country, converging on Ottawa on January 29 for a rally at Parliament Hill, joined by thousands of pedestrian protesters.

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For three consecutive weeks, life in the capital's core ground to a halt. Shops closed, streets were blockaded, and the relentless blaring of truck horns continued all day long, making daily life for residents of the surrounding neighbourhoods nearly unbearable. What had begun as a truckers' protest took on the character of an occupation, with demonstrators digging in and showing little intention of leaving voluntarily.

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The convoy drew international attention almost immediately. Former U.S. President Donald Trump voiced public support for the movement at a rally in Texas, and the protest inspired similar convoys and demonstrations in Australia, New Zealand, France, and elsewhere. To supporters, it represented a principled stand against government overreach and the erosion of individual freedoms. To critics, it was an unlawful occupation that held an entire city hostage while disrupting the lives of residents who had no say in the matter.

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The Emergencies Act

The standoff ultimately prompted Prime Minister Justin Trudeau to invoke the Emergencies Act — the first time it had ever been used since replacing the War Measures Act in 1988 — granting the federal government temporary powers to clear the blockades and freeze the financial accounts of protest organizers.

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When the Freedom Convoy protests escalated, enforcement shifted from border compliance to clearing blockades. A judge ordered an end to the blockade at the Ambassador Bridge, and Ontario Premier Doug Ford declared a state of emergency, allowing for fines of $100,000 Canadian and up to a year in jail for anyone blocking roads, bridges, and other critical infrastructure. 

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By February 21, most blockades and protests had been dismantled through large-scale police operations11.

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Since October 2021, proof of vaccination was mandatory for employees of the federal public service and federally regulated industries, including banking. By early January 2022, those unable to provide proof of vaccination — or a valid exemption on medical or religious grounds — were placed on unpaid leave.

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The compliance rate proved remarkably high. As of May 30, 2022, 98.5 percent of federal employees in the Public Administration — some 279,124 people, including RCMP members — were fully vaccinated. Only 2,108 federal employees, representing less than two percent of the workforce, were on administrative leave without pay, either for refusing vaccination or declining to disclose their status.

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The numbers told a clear story: when vaccination carried tangible professional consequences, the vast majority of workers complied. The mandate achieved near-universal coverage within the federal workforce with relatively little actual enforcement required — the threat of unpaid leave proved sufficient for all but a small fraction. Critics argued the policy was heavy-handed and unnecessarily punitive toward a minority with sincere objections; supporters countered that the results vindicated the approach, pointing to a compliance rate that far exceeded what voluntary programs had achieved in comparable settings. The federal experience stood in pointed contrast to the fractured, politically charged vaccination landscape south of the border, where no equivalent national workplace mandate was ever implemented.

Following a successful vaccination campaign in which nearly 90% of eligible Canadians had been vaccinated, the federal government suspended vaccination requirements on June 20, 2022. Employees who had been on administrative leave without pay for non-compliance were able to return to regular duties12

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Canada struggles to produce vaccines

In response to the urgent need to secure vaccines for the entire population, the Canadian government launched several initiatives aimed at building domestic production capacity — a vulnerability the early scramble for overseas supply had exposed with painful clarity. As discussed in the previous chapter, Canadians had been among the pioneers of the mRNA technology that would prove central to the most effective vaccines developed during the pandemic.

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At the height of the crisis, Prime Minister Trudeau committed multi-million dollar funding to establish a vaccine manufacturing facility in Montreal, with an ambitious target of producing Canadian-made COVID-19 vaccines by the end of 2020. Novavax, a Maryland-based American biotechnology company, agreed to produce its experimental vaccine at facilities operated by the National Research Council in Montreal, offering Canada a foothold in domestic production that it had long lacked.

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The National Research Council facility was built as planned, and Health Canada ultimately authorized the Novavax vaccine for use in Canada — but the regulatory and scientific process moved on its own timeline, indifferent to the government's ambitions. The deal unravelled before domestic production could deliver meaningful results, leaving Canada in the uncomfortable position of having invested enormously in an outcome it never fully achieved.

The financial fallout was striking. Canada paid Novavax nearly US$588 million in total yet stood to recover only approximately US$28 million in the event of cancellation. It was a costly lesson in the risks of pandemic procurement conducted under extreme urgency, where governments around the world signed contracts with limited leverage and enormous sums at stake, betting on scientific and regulatory timelines that no one could reliably predict 13.

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Novavax's story is itself a remarkable illustration of the globalized and precarious nature of modern pharmaceutical development. Founded in 1987 in the United States, the company ran into severe financial difficulty during the pandemic — the very crisis its vaccine was meant to address — and required rescue through two very different sources: the U.S. government's Operation Warp Speed program and funding from the Bill & Melinda Gates Foundation. Without that intervention, the company may not have survived long enough to bring its product to market.

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The road to full approval was long. It was not until May 2025 that Novavax received complete FDA authorization for its COVID-19 vaccine — years after the emergency use authorizations that had defined the pandemic's initial vaccination drive. The vaccine is now expected to be ready for the 2026-2027 season and will reach patients through a distribution partnership with Sanofi, the French pharmaceutical giant employing some 90,000 people worldwide.

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Perhaps most telling is where the vaccine is actually made. Despite being an American company rescued in part by American public funds, Novavax was unable to establish its own domestic manufacturing facility and relied instead on the Serum Institute of India — the world's largest vaccine manufacturer by volume — for its production needs.

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Novavax's story is about more than the fate of a single company. It is an example of how pharmaceutical innovation in the modern era transcends national boundaries at every stage — financing, research, regulatory approval, manufacturing, and distribution, each drawing on different countries and institutions. No single nation, including the United States, possessed all the resources and capacity required to bring this vaccine into existence alone. It is, in the fullest sense, a product of the global community.

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Novavax vs Pfizer

In the meantime, Pfizer — Novavax's American competitor — established itself as the dominant U.S. provider of COVID-19 vaccines, with production spread across multiple domestic facilities, each handling a distinct stage of the manufacturing process.

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The two companies represent fundamentally different scientific approaches to the same immunological goal. Pfizer's vaccine is built on messenger RNA technology — an innovative platform whereby genetic instructions are delivered directly into the patient's cells. Those cells then temporarily read the instructions and produce the COVID spike protein on their own. The immune system encounters this foreign protein, mounts a defensive response, and crucially, builds lasting memory against it. The mRNA itself breaks down within days and never enters the cell nucleus or interacts with DNA in any way — a point that became important to communicate publicly as misinformation about genetic modification spread widely during the rollout.

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Novavax takes a more traditional path. Rather than instructing the body to manufacture the spike protein itself, the vaccine delivers the actual protein directly. That protein is grown in insect cells in a laboratory setting and then combined with an immune-boosting ingredient known as Matrix-M adjuvant, which amplifies the body's response. The immune system recognizes the introduced protein as foreign and builds the same kind of protective memory — but the process involves no genetic material whatsoever. For patients who remained uneasy about mRNA technology, whether on scientific or philosophical grounds, Novavax offered a more familiar mechanism rooted in the same protein-based approach that has underpinned vaccines for decades.

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Both paths lead to the same destination — a primed immune system capable of recognizing and fighting the virus — but they arrive there by meaningfully different routes.

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The Moderna Laval facility

Equally delayed relative to its original ambitions, but ultimately more successful in its outcome, was a second Canadian initiative to establish domestic vaccine production capacity. In August 2021, the Government of Canada announced a memorandum of understanding with Moderna to construct an mRNA vaccine manufacturing facility in Quebec, to be overseen by the Institut National de la Recherche Scientifique — known by its French acronym, INRS.

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The work progressed surprisingly quickly. Moderna announced the completion of construction in February 2024, with the 100,000-square-foot facility having been built in just 15 months — a remarkable achievement for a biomanufacturing plant of that scale and complexity. Under normal conditions, facilities of this kind can take the better part of a decade to plan, approve, and construct.

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The plant has the capacity to produce up to 30 million doses of respiratory vaccines annually, with the ability to scale up to 100 million doses during a pandemic emergency. For a country of roughly 40 million people, that represents genuine self-sufficiency — enough to cover the entire population multiple times over in a crisis scenario, and to potentially contribute to allied nations' supply as well.

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Where the Novavax arrangement ended in financial loss and an unmet promise, the Moderna facility stands as a tangible and enduring piece of public health infrastructure — one that positions Canada meaningfully differently than it was in early 2020, when it found itself entirely at the mercy of foreign manufacturers and global supply chains it had no power to influence.

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Moderna's Laval facility received a Drug Establishment Licence from Health Canada, making it the first Moderna manufacturing site outside the United States to achieve that authorization — a milestone with a particular personal dimension given the company's origins.

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For Derrick J. Rossi, the Canadian co-founder of Moderna and the son of Maltese immigrants who had settled in the working-class community of Scarborough, the facility represented something of a homecoming. His journey from that blue-collar background to co-founding one of the most consequential biotechnology companies of the era is remarkable in its own right — and the Laval plant now stands as a concrete expression of that story on Canadian soil.

As discussed earlier in this book, Rossi's crucial contribution was recognizing the dormant potential in the work of Dr. Katalin Karikó, a Hungarian immigrant who had been patiently conducting research in molecular biology at the University of Pennsylvania since 1985. For roughly two decades, her investigations into messenger RNA technology had yielded little in the way of institutional recognition or research funding. Grant applications were repeatedly rejected, and her work was considered a scientific backwater by many of her peers. She persisted nonetheless.

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It was Rossi who saw the opportunity others had overlooked, and whose entrepreneurial vision helped transform Karikó's foundational science into a platform capable of producing vaccines at unprecedented speed. The rest is history — though Karikó herself had to wait until 2023 to receive her own measure of formal recognition, when she was awarded the Nobel Prize in Physiology or Medicine, sharing it with her longtime collaborator Drew Weissman. For someone whose work had been dismissed for so long, it was a profound, if long overdue, vindication.

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Moderna’s new facility in Laval started producing vaccines soon: as of August 2025, all Spikevax doses for the Canadian market are manufactured domestically — the drug substance produced at the Laval facility, with fill-finish completed by Novocol Pharma in Cambridge, Ontario14. This marked the first time Canada's entire pre-filled syringe (PFS) doses were produced at home. Canada does now have a functioning domestic mRNA vaccine supply chain, which it completely lacked before Covid.

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At the same time, other initiatives were advancing Canada's broader ambition of domestic vaccine self-sufficiency. In May 2024, Sanofi — the French pharmaceutical giant and Novavax's future distribution partner — opened a new vaccine manufacturing facility in Toronto, employing 200 people and backed by a federal investment of $20 million15.

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The facility significantly expanded Canadian capacity to produce essential vaccines against whooping cough, diphtheria, and tetanus, with its output destined for some 60 international markets — positioning Canada not merely as a consumer of global vaccine supply, but as a contributor to it.

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The Toronto opening was part of a larger and more ambitious investment relationship between Sanofi and the Canadian government. Ottawa committed $415 million to support the construction of an end-to-end influenza vaccine facility, scheduled to become operational in 2027. When complete, it will give Canada the ability to manufacture flu vaccines through every stage of production on home soil — a capability that carries obvious strategic value in a world that has now lived through the consequences of depending entirely on foreign supply during a global health emergency.

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Taken together — the Moderna mRNA facility in Laval, the Sanofi vaccine plant in Toronto, and the forthcoming influenza facility — these investments represent a meaningful transformation in Canada's public health infrastructure. The country that scrambled desperately for overseas vaccine supply in 2020 and 2021 is methodically building the domestic capacity to ensure that vulnerability is never repeated on the same scale. It is a quiet but significant shift, driven by the hard lessons of the pandemic.

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In June 2022, Sanofi took its Canadian commitment a step further by launching a global Artificial Intelligence Centre of Excellence in Toronto — a deliberate choice to tap into the city's deep reservoir of technology and data science talent16 . The hub focuses on data science, computational biology, and AI strategy, with the goal of improving healthcare delivery not just domestically but on a global scale.

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The initiative reflects a broader transformation underway across the pharmaceutical industry, where artificial intelligence is rapidly moving from a peripheral tool to a central driver of how drugs and vaccines are designed, tested, and produced. Sanofi has positioned itself as a pioneer in this shift, applying machine learning and computational methods to accelerate discovery pipelines, optimize clinical trials, and improve manufacturing efficiency in ways that would have been unimaginable a generation ago.

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Toronto was not an arbitrary choice. The city has emerged as one of the world's leading artificial intelligence research hubs, anchored by the University of Toronto and the Vector Institute, and shaped in no small part by the foundational work of Geoffrey Hinton — whose decades of research into neural networks earned him a share of the Nobel Prize in Physics in 2024. The concentration of AI talent, academic infrastructure, and technology investment in the city made it a natural home for an initiative of this kind.

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The Centre of Excellence adds an intellectual and technological dimension to Sanofi's Canadian footprint that complements its manufacturing investments, suggesting a long-term commitment that extends well beyond vaccine production into the future of how medicine itself is conceived and delivered.

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Deficit of healthcare workers

The pandemic bore down heavily on the entire healthcare system — on hospitals, on long-term care institutions, and above all on the men and women staffing them. Doctors, and particularly nurses, were pushed to their limits, enduring not only physical exhaustion but profound moral distress — the anguish of watching patients suffer and die while lacking the time, staff, or resources to provide the standard of care they had trained to deliver.

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The human cost within the workforce itself compounded the crisis. A significant number of healthcare workers contracted the virus on the job, further depleting already stretched teams at the moments of greatest need. Some, despite being ill or having been exposed, felt compelled to report for work regardless — a proof both of their dedication and of how desperately thin the margins had become.

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What might have been expected to ease once the acute phase of the pandemic passed instead lingered with stubborn persistence. The strain on healthcare personnel did not lift when case counts fell — it accumulated. Years of sustained pressure, grief, and moral injury left deep marks. A significant share of doctors and nurses chose to leave the profession entirely, whether through early retirement or by moving into less demanding fields, taking with them years of irreplaceable training and experience. The departures compounded shortages that had existed before the pandemic and left healthcare systems in Canada and elsewhere scrambling to recruit and retain workers in an environment that had become, for many, simply unsustainable.

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The family physicians who stopped working were more likely to be aged 75 or older, care for fewer than 500 patients, and worked less than other physicians in the prior year. The number of Ontario’s family physicians who stopped working doubled during the first six months of the Covid pandemic compared to previous years, accounting for more than 170,000 patients losing access to a primary care provider17.  

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A Canadian Medical Association survey found that nearly half of Canada's physicians said they were considering reducing their clinical work in the next 24 months, driven by burnout and dissatisfaction18.

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Among healthcare workers broadly — including nurses and personal support workers — retirement rates held relatively steady through the first two years of the pandemic, close to historical norms. But starting in 2022, the pattern shifted dramatically. Retirements accelerated sharply, cresting at roughly 28,700 departures in September of that year, a year-over-year increase of roughly 43%19.  

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Shortage of doctors

Patients in Canada face a serious access crisis:  at least 5.9 million Canadians did not have a family doctor as of December 2025. There is an estimated shortage of 26,800 physicians across Canada projected between 2024 and 203320.

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Across all of Canada in 2024, there were 99,555 physicians — representing 241 per 100,000 population. While physician supply grew 2.2% over 2023, family medicine growth (1.9%) lagged behind specialist growth (2.5%). For the first time since the mid-1990s, growth in the supply of family physicians lagged behind population growth, and this happened for two consecutive years starting in 2023. The number of family physicians per 100,000 people dropped from 124 in 2022 to 119 in 202421.

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This is a particular problem in high-growth urban areas like Brampton and Mississauga.

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Canada and the United States have roughly comparable numbers of doctors per capita, but the two countries distribute that medical workforce very differently. The U.S. skews heavily toward specialists, who make up more than 70 percent of its physician base, while Canada's ratio tilts the other way, with fewer than half of its doctors working in specialties — leaving family medicine access as a persistent challenge.

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Yet for all its structural gaps, Canada's system insulates patients from a burden the American model imposes routinely. Only 4 percent of Canadians reported skipping a doctor visit because of cost, against 22 percent of Americans. The disparity is even starker when it comes to medication — 21 percent of Americans reported skipping doses or rationing prescriptions due to expense, compared to 10 percent of Canadians. In the United States, the ability to see a doctor or fill a prescription is, for a substantial portion of the population, as much a financial question as a medical one22.

Among 47 OECD countries compared, both Canada and the U.S. rank in the lower third, well below countries like Italy (4.1 doctors per 1,000) or Denmark (4.4 per 1,000).

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Shortage of nurses

Apart from a growing shortage of doctors, the Canadian health system was burdened with a large number of nurses quitting their jobs due to burnout. 

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In Ontario, more than 9,800 nurses didn't renew their registration in 2023, nearly 1,000 more than in 2022, though this was partially offset by about 15,100 new registrants, many of them internationally educated nurses23. 

A 2021 survey on intentions of 5,200 nurses in Ontario found that over 75% were classified as burned out, and 69% said they planned to leave their position within five years24. 

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A broader Statistics Canada-based study found that 33.5% of Canadian nurses reported an intention to quit their current job within two years, citing stress or burnout (18.8%), mental health concerns (16.4%), and lack of job satisfaction (13.5%)25.

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Despite premier Doug Ford's investment in the sector, Ontario was projected to be short 33,000 nurses and personal support workers by 202826. 

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The situation was even worse in Quebec: more than 1,700 nurses working for 13 of Quebec's regional health boards left their jobs between mid-March and August 2020 alone, compared to around 1,300 during the same period in 201927.  By the end of the pandemic, approximately 4,000 nurses had quit their roles in Quebec — a 43% increase from 201928. 

It is worth noting that it was younger nurses, not older ones, who were most likely to consider quitting. Nurses aged 18–34 and 35–44 were approximately 9–10 times more likely to consider leaving due to job stress and burnout compared to those 55 and older29.

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By the fourth quarter of 2020, health sector job vacancies in Canada hit a record high of 100,300 — up nearly 57% from 2019 — with Canadian hospitals posting the highest vacancy rate of any sector30.

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What distinguished the nursing exodus from the physician one was who was leaving. While early retirees accounted for much of the doctor attrition, the nursing crisis was fuelled largely by burnout among those in the middle of their careers — with younger nurses abandoning the profession in numbers far out of proportion to their share of the workforce.

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Covid closures in Toronto

As the pandemic tightened its grip, governments moved to curtail transmission by shutting down the public spaces and gathering places where the risk of spread was highest.

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In March 2020, Ontario declared an official state of emergency by announcing the closure of all publicly funded elementary and secondary schools, initially from March 14 to April 5, 2020, followed by extending the closure to all private schools and licensed childcare centres. On May 19, 2020, Premier Ford cancelled in-person learning for the rest of the school year, shifting all students to online learning31 .

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The Schools reopened in September with a staggered approach. The Toronto District School Board pushed back the start of school to September 15 and required mandatory masks for students.

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In January 2021 amid a renewed surge in cases, schools in Toronto, Peel, York, Hamilton, and Windsor-Essex were kept closed to in-person classes. On April 12, 2021, all Ontario schools were ordered closed indefinitely. Altogether, from March 14, 2020, to May 15, 2021, Ontario schools were closed for 20 weeks in total — longer than any other Canadian province or territory32.  

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As a result, the COVID-19 pandemic led to significant education disruption in Ontario. This was particularly affecting low-income families, especially the racialized and indigenous groups, newcomers, and people with disabilities. In addition, there are health risks associated with closures, including significant physical, mental health, and safety harms for students and children. Modelling suggests long-term impacts on students’ lifetime earnings and the national economy33.

 

Lockups and mental health

Numerous studies have documented the significant toll exacted by prolonged social isolation. As a study of Statistics Canada indicated, the pandemic impacted self-reported well-being and mental health, especially among young Canadians.

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From March 2020 to October 2022, there were 7.9% more deaths than would have been expected, had a pandemic not occurred. In addition, the number of deaths attributable to alcohol and drug use proliferated during the pandemic. At the national level, there were 4,605 such deaths in 2020 and 6,310 in 2021. By comparison, at the height of the overdose crisis in 2017, 4,830 deaths were attributed to unintentional poisonings.

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Younger age groups made up a disproportionate number of deaths from overdoses. Among people younger than 45, there were 2,640 unintentional poisoning deaths in 2020 and 3,600 in 202134.  

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Economic impact of covid

Apart from school closures, a province-wide shutdown came into effect in December 2020, prohibiting all non-essential travel, in-person gatherings, and in-person operation of non-essential businesses35.

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Premier Ford declared a state of emergency and ordered the closure of daycares, bars and restaurants, theatres, and private schools in March 2020. The province recommended the closure of recreation programs, libraries, and churches36.

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Toronto Mayor John Tory declared a local state of emergency, announcing the closure of park amenities, including playgrounds and tennis courts.

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Restrictions on businesses like indoor dining continued until June 24, 2020, when Toronto was allowed to enter Stage 2 of reopening. Toronto entered Stage 3 on July 31, 2020.

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A third province-wide shutdown began in April 2021.  Toronto Public Health issued an order requiring all non-critical businesses linked to five or more COVID-19 cases within 14 days to close for 10 days, with employees required to self-isolate.

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More than 140 bars, restaurants, and venues closed over the course of the pandemic in Toronto, part of an estimated 10,000 closures across the country. Many retailers also closed permanently, with the pandemic coinciding with a broader retail decline that had begun a decade earlier37.

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Jobs and labour market

Ravaged by the pandemic, the Canadian economy experienced a steep downturn in 2020. Business closures more than doubled to 88,000 in April 2020, led by closures in construction, retail trade, and accommodation and food services. The number of active firms fell sharply, down 10.4% year-over-year in April and 13.5% in May.

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During the second quarter of 2020, household spending fell by a record 13% as families faced heightened job and income uncertainty, and employment earnings fell by almost 9%.38

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Real gross domestic product contracted sharply across Canada's major provinces in 2020. Ontario's economy shrank by 5.0 percent, while Quebec and Newfoundland & Labrador each recorded steeper declines of 5.3 percent 39.

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Alberta was hit hardest, where the real GDP contracted by 8.2% in 2020, compounded by the impact of Covid on oil prices due to a rapid drop in demand from lockdowns and travel restrictions40.

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On 20 March 2020, the federal government announced a dramatic increase in unemployment insurance applications, with over 500,000 Canadians applying in a single week — an 18-fold increase. Beginning April 2020, jobless claims reached around 2.13 million, representing roughly 11% of the labour force. By 6 April, 3.18 million Canadians had applied for unemployment benefits41.

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From February to April 2020, 5.5 million Canadian workers were affected by the economic shutdown. In March 2020, the federal government announced a dramatic increase in unemployment insurance applications, with over 500,000 Canadians applying in a single week. By mid April 6.73 million applications were submitted to the Canada Emergency Response Benefit (CERB) by workers who lost income or stopped working due to COVID.

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The economic situation improved gradually. By August 2020, the number of impacted workers had fallen to 1.8 million42.  By October 2021, employment levels recovered to pre-pandemic levels, but gains were primarily concentrated in part-time jobs. Approximately 100,000 fewer men held full-time positions compared to pre-pandemic levels, and there remained 400,000 fewer jobs relative to the pre-pandemic trend line.

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The number of active businesses fully recovered to pre-pandemic levels in late 2021, but business closures subsequently outpaced openings from the summer of 2022 onward as borrowing costs rose43.

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Close to half of all job losses were concentrated among workers in the lowest earnings quartile. The largest losses occurred in industries most affected by closures — such as accommodation and food services — and among workers who were younger, paid hourly, and non-union44.

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Canadian government took a proactive stance supporting both the affected individuals and businesses. Altogether C$624.2 billion was spent on pandemic-related measures45.

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The recovery came with a significant increase in inflation. Headline consumer inflation ran above 3% for 29 of 30 months following the pandemic's acute phase, with grocery prices up 5.8% year-over-year as late as September 2023..

On the positive side, Canada's GDP growth outpaced other G7 countries, from the second quarter of 2021 onward, and by December 2022, real GDP was 2.7% above pre-pandemic levels46.

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Population Growth

A significant contributor to elevated GDP growth was accelerated demographic expansion, evidenced by a 0.9% increase in population during the third quarter of 2022 — the most quarterly rise recorded since the late 1950s. Between 2020 and 2023, Canada received in excess of 1.2 million permanent and temporary immigrants, a cohort representing approximately 90% of aggregate population growth over the period. Annual population growth rates of approximately 3.2–3.5% in 2022–2023 positioned Canada among the fastest-growing economies within the G7, a trajectory attributable almost exclusively to im`migration policy targeting the admission of 400,000 to 500,000 new permanent residents per annum. Economy-wide output increased and was 2.7% above pre-pandemic levels in December 202247.

The influx of immigrants was broadly regarded as economically advantageous, owing primarily to the demographic composition of arriving cohorts, who were predominantly of working age. This facilitated the alleviation of acute skill shortages across key sectors, including healthcare, construction, technology, and the skilled trades, thereby enabling firms to expand productive capacity without precipitating labour market bottlenecks.

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Furthermore, sustained immigration served as a structural counterweight to the compounding pressures of an aging population and a persistently declining birth rate, mitigating the long-term demographic constraints on labour supply and economic growth.

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Growth Without Prosperity

The pronounced acceleration in immigration did, however, engender a set of emerging economic imbalances. While aggregate GDP expanded as a consequence of a larger labour force contributing to the production of goods and services, this growth did not translate into broadly shared prosperity. Critically, GDP per capita — a more precise indicator of individual living standards — exhibited considerable volatility over the period, suggesting that the gains in total economic output were largely a function of population scale rather than genuine improvements in productive efficiency or household welfare48.

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This phenomenon was characterised as population-driven growth, to be distinguished from productivity-driven growth — the latter of which necessitates sustained capital investment and the broader adoption of technological innovation, both of which had been notably deficient in Canada during the post-pandemic period. Rather than advancing output through efficiency gains, economic expansion was anchored almost exclusively in demographic expansion.

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Compounding these structural vulnerabilities, the substantial influx of immigrants generated considerable strain across key public systems and markets. Most acutely, demand pressures on an already constrained housing supply precipitated a widespread affordability crisis, while concurrent stress on critical infrastructure — encompassing hospitals, public transit networks, and educational institutions — underscored the extent to which existing capacity had failed to keep pace with the pace of demographic growth.

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Despite a construction boom, housing supply chronically lagged behind the population surge. An attempt to increase housing supply hit several roadblocks such as lengthy approval processes to acquire necessary permits, environmental reviews, community consultations which on average took 2–4 years before construction could start. As the city ran out of space for new developments, attempts of densification met with resistance from existing homeowners, who opposed new high-rises to protect their property values and neighbourhood character.

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Efforts to address the housing shortage were further impeded by a confluence of supply-side constraints within the construction sector. Labour shortages emerged unexpectedly and with particular severity among skilled tradespeople, driving up construction costs and curtailing productive capacity at a critical juncture. Simultaneously, the prices of essential building materials — including lumber, steel, and concrete — surged markedly in the post-pandemic period, compounding cost pressures across the industry. These challenges were further exacerbated by the elevated interest rate environment prevailing between 2022 and 2024, which rendered construction financing considerably more burdensome. As a consequence, numerous previously approved development projects were either significantly delayed or cancelled outright, having ceased to be financially viable under the prevailing economic conditions.

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In addition, rapid population growth in the Greater Toronto Area has compounded an already severe traffic congestion crisis. By 2024, GTA congestion ranked among the worst in North America, despite billions of dollars invested in road expansion. A TomTom study recorded average rush hour speeds of just 18 km/h on the 401 highway, while research cited by the Ford government estimated that congestion costs Ontario $56.4 billion annually — $44.7 billion of which is attributed to the Greater Toronto and Hamilton Area alone 48a.

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As the infrastructure could not keep pace with population increase, the government began scaling back immigration targets in 2024–202549.

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Supply Chain Disruption

Among the most consequential threats to economic stability during the pandemic was the severe dislocation of global supply chains underpinning international trade. In an increasingly interconnected and globalized economy, the uninterrupted flow of finished goods, raw materials, and partially processed inputs is an essential precondition for domestic productive activity. The complexity of modern manufacturing is perhaps best illustrated by the production of consumer electronics — mobile devices, for instance, rely on the sourcing of components across multiple national jurisdictions prior to final assembly and distribution to end markets. The imposition of lockdown measures, both domestically in Canada and critically in China — a principal node in global manufacturing networks — brought considerable volumes of international trade to a near standstill, exposing the systemic vulnerabilities inherent in highly integrated global supply chains.

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Container congestion in Vancouver and Shanghai

In spring of 2021, across the West Coast, there were record-breaking line-ups of container ships waiting to get to port transporting consumer goods from Asia to North America. 

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Hundreds of empty shipping containers were stacked in Vancouver’s port straining the supply chain because there was a larger demand for imports to Canada than exports. The backlog was hurting truckers which meant longer waits and higher prices for consumers50. 

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Normally, the empty containers were used to export Canadian grain from the prairies, seafood from the coast, and beef from Alberta back to Asia. 

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The lockdowns in China, with Shanghai's lasting for more than two months, paralyzed ports of entry for Chinese imports. They nearly doubled the number of container ships idling off China's coast. As of April 19, 2022, there were 506 vessels awaiting berthing at Chinese docks, nearly double the number of those halted offshore in February.

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Trade imbalances during the pandemic were partly attributable to an unexpected surge in Canadian consumer demand for imported goods. Counterintuitively, lockdown conditions enabled certain categories of workers — particularly those engaged in remote employment — to retain relatively well-compensated positions while simultaneously curtailing expenditure ordinarily allocated to retail consumption, dining, and travel. The elimination of commuting costs further augmented household savings, collectively giving rise to a substantial accumulation of discretionary income across a segment of the population.

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This suppressed consumption ultimately manifested as pent-up demand, which was directed toward online retail channels and the acquisition of durable and semi-durable goods whose purchase had previously been deferred. The resulting acceleration in goods consumption generated a pronounced increase in demand for imports, with China — as Canada's principal supplier of manufactured goods — bearing the primary burden of fulfilling this elevated demand. The asymmetry between robust Canadian import appetite and constrained global supply capacity thus emerged as a significant driver of trade imbalances over the course of the pandemic period51.

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The chaos that gripped global supply chains during the pandemic exposed just how deeply hyperglobalization has taken hold — a phenomenon in which national economies have grown intertwined with international trade to an unprecedented degree. A more recent illustration is the shockwave that spread across the world when the Strait of Hormuz was threatened during the Iran conflict. The disruption went far beyond oil: it choked off the flow of critical goods that the global economy quietly depends on, including fertilizers, pharmaceutical ingredients, and helium — a gas that may seem obscure but is indispensable both to semiconductor manufacturing across Asia and to medical facilities in Canadian hospitals52.

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Hyperglobalization is a term coined by Arvind Subramanian and Martin Kessler. In an often quoted 2013 paper, updated in 2023, Subramanian and Kessler noted that world trade had grown much faster than world GDP between the 1980s and the eve of the 2008 financial crisis53.​

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AI and the future of work​