Suicide and drug toxicity mortality in the first year of the COVID-19 pandemic: use of medical examiner data for public health in Nova Scotia

The COVID-19 pandemic and governmental responses have raised concerns about any corresponding rise in suicide and/or drug toxicity mortality due to exacerbations of mental illness, economic issues, changes to drug supply, ability to access harm reduction services, and other factors. Data were obtained from the Nova Scotia Medical Examiner Service. Case definitions were developed, and their performance characteristics assessed. Pre-pandemic trends in monthly suicide and drug toxicity deaths were modelled and the observed numbers of deaths in the pandemic year compared to expected numbers. There was a significant reduction in suicide deaths in the first year of the COVID-19 pandemic in Nova Scotia, with about 21 fewer non-drug toxicity suicide deaths than expected in March 2020 to February 2021 (risk ratio = 0.82). No change in drug toxicity mortality was detected. Case definitions were successfully applied to free-text cause of death statements and cases where cause and manner of death remained under investigation. Processes for case classification and monitoring can be implemented in collaboration with medical examiners/coroners for timely, ongoing public health surveillance of suicide and drug toxicity mortality. Medical examiners and coroners are the stewards of a wealth of data that could inform the prevention of further deaths; it is time to engage these systems in public health surveillance.