Australia has weathered the COVID-19 storm

For the first time in years Australia recorded no deaths associated with COVID-19 for at least a week, and the number of admissions to hospitals is the lowest since January 2022.

The Australian Government Department of Health and Aged Care data reporting site shows that the rolling seven day average number of deaths fell to zero briefly in March.

The number of outbreaks in aged care homes also continues to decline, although there has been a recent spike.

And the number of COVID-19 cases being admitted to intensive care units in major hospitals, also remains low.

“It’s very different from 2021,” says Chris MacIsaac, director of ICU at the Royal Melbourne Hospital. “That was when we had a big spike, and when vaccination rates were just starting to get to 70%.

“Hospitals today are working well, we’re not running out of isolation rooms, and everyone is receiving the care they need.” MacIsaac credits the high level of vaccinations in Australia, which “have been spectacularly successful for the majority of patients when it comes to avoiding severe illness.

“Many patients we see in the ICU now tend to come in for another reason, and when we swab them they come up positive – it’s more incidental,” MacIsaac adds.

And while he says hospitals are seeing a large demand for mental health services, there doesn’t appear to be a huge spike in any particular form of critical illness.

Is it time to lose the term Long COVID?

Although it appears we have left the pandemic behind, the virus has not left us behind. Globally, the world is now entering its eighth COVID wave. Cases keep bubbling along, driven by an ever-expanding menagerie of viral variants. Hospitals remain busy, but, as insiders say, not as stretched as they were during the peaks of 2020 and 2021.

In the community, however, the story is different.

There was a spike in the incidence of COVID-19 infections in aged care homes in recent weeks.

“The toll is ongoing, but it’s happening in a group of people who are not visible to the average Australian,” says President of the Australian Medical Association, Professor Steve Robson.

A more-useful way of thinking about the data is in terms of capacity, as evidence shows when hospitals are overwhelmed we tend to see dramatic increases in mortality.

“It’s fair to say that demand on emergency departments has gone up an enormous amount since before the pandemic,” Robson adds. “Not only are people acutely affected by infection with COVID, but that effect on the health system has delayed a huge amount of routine care, such as operations and screening for either conditions.

“Death is just the tip of the iceberg — we are only starting to see now just how massive an effect COVID-19 has had on the community,” Robson adds.

Confusion around outcomes, terminology

It’s not just the acute consequences of COVID infections that menace us. For a long time, scientists have been aware the virus can have long-term health consequences.

Long COVID is perhaps the most well-known of these, but there are many others – some scientists have even taken to referring to the virus as a multi-system infection.

A new study, published in The Lancet, adds additional weight to those concerns.

The headline result: compared to people who caught influenza, older Americans who caught COVID-19 were more than 50 per cent more likely to die, and dramatically more likely to face a range of additional negative outcomes.

“Before the pandemic, I trivialised infections. [I thought] you get sick for a day or two or three, and then you bounce back, and it’s all over,” the paper’s co-author Dr. Ziyad Al-Aly, chief of research and development at the Veterans Affairs St. Louis Health Care System, told Time.

“We learned from COVID-19 that infections that are initially thought to cause only acute illnesses can cause chronic disease.”

The study is one of several into the long-term consequences of COVID-19 published by Dr Al-Aly’s team. They do not make for pretty reading.

Using a database of US military veterans, they published studies finding that for many people a COVID infection continues to impose a health toll even two years out from the acute infection, that some patients remain at elevated risk of heart problems even a year out from infection, and that each subsequent reinfection with COVID-19 increases the risk of negative outcomes.

For the latest paper, his team tracked 81,280 patients who had been hospitalised after a positive COVID-19 test between 2020 and 2022; as a comparison group, they selected 10,985 patients hospitalised after testing positive to influenza. Both groups were old — aged 70 on average — white, overweight, had underlying health conditions, and 95 per cent male.

The patients’ health records were then assessed across 94 different health outcomes, including the heart, the brain, and feelings of fatigue.

As you would expect, the risk of death from COVID-19 was dramatically higher than the risk of death from flu. But the multi-system effects reported are more eye-opening: across the range of health categories, in nearly all COVID-19 patients fared far worse than flu patients.

“Over the entire duration of follow-up,” the researchers wrote, “COVID-19 was associated with a significantly increased risk of all pre-specified health outcomes.”

But other scientists remain sceptical the data really shows what Al-Aly’s team claims.

“Firstly, it’s confusing that this study has been published in 2023, considering we proved COVID-19 was worse than influenza in 2020,” says epidemiologist Gideon Meyerowitz-Katz from the University of Wollongong.

He says the study has a few challenges, including the fact it used a veterans database, in addition to comparing people who were hospitalised during the COVID pandemic to those hospitalised for the fly before the pandemic.

“The authors did not compare those who were not hospitalised at all with either of the diseases,” Meyerowitz-Katz says.

“What they compared and reported was the cumulative risk — including the first 90 days. But if you look beyond the 90 days, the risk of COVID and influenza is similar. What this suggests,” he says, “is that most of the increased risk is in the acute period, and that the study did not demonstrate that COVID is much worse in the long term than influenza.”