EXPERT REACTION: Australia is about to reach 10,000 COVID-19 deaths

Whether we look at the total COVID-19 deaths per case, or deaths per capita, Australia sits low on the league tables, together with New Zealand, Taiwan and Japan.

We are now experiencing a succession of Omicron variants during our winter that are holding our infection rates high, with over 8 million cases now, nearly half of those since Jan 1st this year with the arrival of Omicron.

Australia currently has a daily deaths per capita rate that is comparable to the UK and Canada, but less than France, even though these countries are in summer and have recorded a decline in cases over recent weeks.

The average daily death rate in Australia sits just below two people per million, and this will see us hit the terrible 10,000 deaths milestone in the next few days. The deaths are not evenly distributed across states though, with Victoria having up to three deaths per million since the middle of May, but NSW is now also on the rise.

The change in death rates may be the result of increases in infection that are not reflected in the reported case numbers as testing wanes, or a range of factors including the rise of new subvariants, especially BA.5.

It is critical that we learn more about those who are ending up in hospital or not surviving their infections, so that we can identify what needs to be done to avoid preventable deaths and bring the case fatality rate down, whether its access to the winter booster, or to antiviral treatment.

Ultimately the best protection is not to become infected, and the more everyone does to reduce their own risk through mask-wearing and distancing, the more likely it is we will be able to bring down both the case rate and the case fatality rate.

As we approach the 10,000 deaths due to COVID-19 here in Australia, we must remember that other countries have surpassed the milestone of millions.

Although initially a novel virus we are becoming way too familiar with the name. However, SARS-CoV-2 variants currently circulating can have serious sequelae [other health problems that follow a disease] after infection including death.

Although most of us in Australia have received three doses of the COVID-19 vaccines and the elderly four doses, we face the ever-present risks of living with this endemic virus in our country.

There are three options other than the virus being fatal; avoiding the virus, contracting the virus with recovery, and contracting the virus with chronic after-effects. Avoidance is still the ideal.

However, people may unintentionally infect others in the community due to being asymptomatic or pre-symptomatic.

On the other hand, we probably all know some who are knowingly sick and have tested positive for COVID-19 but chose to ignore seven days isolation and leave their household to carry out daily activities. We need to remind ourselves that chronic COVID effects include reduced lung capacity, alveoli lesions, vocal fold paralysis, pulmonary fibrosis, walking pneumonia, neuropsychiatric, cardiac/kidney inflammation, coagulation and chronic fatigue.

It is compassionate and kind to care for others by abiding by the isolation requirements if COVID-19 positive. This consideration will undoubtedly lower the risk of more people dying unnecessarily from this potentially fatal and dangerous virus.

Sometime this month Australia will pass 10 000 deaths from COVID-19.  With over 6.3m deaths world wide (https://coronavirus.jhu.edu) this may seem like a small number but if this current trend continues, COVID will become the second leading cause of death in Australia in 2022, only behind coronary heart disease (https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/leading-causes-of-death).  Moreover we are overall ranked 16th in terms of deaths per 100 000 over the pandemic (https://coronavirus.jhu.edu/data/mortality).  However, that statistic is a bit misleading because most of the deaths have occurred in 2022.  Here we rank #5 in the world for increased death with a 405% increase from Jan 1 till July 1 2022 (https://ourworldindata.org/coronavirus/country/australia).  The current 50 deaths per day is hardly noted and yet it is more than twice the daily road toll.  We need our public health leaders to rethink the approach to this disease.  We need Omicron-specific vaccines, wider use of antivirals and we need to wear our masks much more.

10,000 COVID-19 deaths in Australia - Are we doing enough to limit COVID-19 deaths?

Is the pandemic over?

The pandemic is not over! But with the virus mutating constantly, the pandemic is changing. In the present worldwide situation, the pandemic is driven by BA.4 and BA.5 in many places with cases on the rise in 110 countries, causing overall global cases to increase by 20% with an increase in deaths.

Since viruses spread where there are enough susceptible individuals and enough contact among them to sustain spread, it’s hard to anticipate what the timeline will be for the expected shift of COVID-19 to an end. It’s dependent on factors such as the strength and duration of immune protection from vaccination and natural infection, our patterns of contact with one another that allow spread, and the transmissibility of the virus.

So, the patterns will likely differ considerably from what we saw with the other pandemics because of the differing responses to COVID-19 across the world—with some places engaging in “zero-COVID” policies, others with limited responses, and widely variable vaccine availability and uptake.

Past pandemics generally began with infection fatality rates higher than observed in the years following their introduction as the viruses continued to circulate. While declining fatality rates after pandemics may be due to a number of factors, one likely key contributor is that the first round of exposure to a pathogen confers some degree of protection against reinfection and severity of disease if reinfection does occur.

Vaccines confer protection in much the same way, as the data from the COVID-19 vaccines has demonstrated.

On the other hand, hundreds of millions of people, including tens of millions of health workers and older people in lower-income countries remain unvaccinated, which means they are more vulnerable to future waves of the virus, especially with newer variants emerging.

Why is the death rate still high? Are we complacent?

One of the main reasons why the death rate is high may be due to increased community transmission rates which, in turn, contributed to the deaths.

The public lowering their guard, low childhood vaccination and third-shot booster rates, along with the relaxation of mask and isolation restrictions while still in the peak of the Omicron wave, may be the reason why the virus transmission is high.

While we are heading towards winter, when COVID19 rates could be higher, the public should be vigilant more than ever. The public should always keep in mind, since the beginning of the pandemic, the WHO has recommended comprehensive measures to reduce SARS-CoV-2 transmission.

Current vaccines by themselves are insufficient to stem transmission, and so increases in cases should be expected whenever public health and social measures are lifted, irrespective of vaccination coverage. We will need to continue with effective measures as we bring transmission under control. This includes, for example, wearing well-fitting masks (in the case Omicron, a N95 based mask) in crowded areas, hand hygiene, physical distancing when required, improving ventilation of indoor spaces, avoiding crowded spaces, and being supported to stay home if unwell.