Why are Victoria’s COVID-19 death rates the highest in Australia?

By any measure, Victoria has the highest COVID-19 mortality in Australia – in raw numbers, by case fatality and by population. 

Public health experts are trying to understand why this is the case.

The Australian Bureau of Statistics regularly reports COVID-19 mortality. Its most recent data reflects deaths up to 31 January. 

According to the ABS, in Australia there were 12,639 deaths where the underlying cause was COVID-19, from the start of the pandemic on 11 March 2020 through to 31 January 2023. That number includes COVID-19 deaths due to acute infection (12,447), long term effects (167) and suspected infection (25).

The vast majority of COVID-19 deaths (71%) occurred in two states, Victoria and New South Wales, ABS data shows.

Victoria has the greatest number and largest share of COVID-19 deaths. 

Infectious diseases physician, Professor Peter Collignon at the Australian National University says while the reasons might be difficult to unravel, he thinks understanding Victoria’s higher rate of COVID-19 mortality is crucial.

“I think is important because we’re likely to have things like this happen again.”

Collignon is particularly interested in the effectiveness of different approaches, like levels of restrictions, in limiting COVID-19 cases and deaths. 

“The whole point of intervening is to save lives and prevent deaths and hospitalisation,” he says.

Cosmos asked the health departments in New South Wales and Victoria whether they had done any analysis on the factors influencing different COVID-19 mortality rates, but did not receive a response.

Burnet Institute’s Professor Mike Toole has analysed death rates by state and territory calculating case fatality rates (proportion of COVID-19 deaths per 1,000 cases) and deaths per 100,000 population. 

On both measures, he says, Victoria is the highest in the country, followed by New South Wales.

“I have not seen anything published that seeks to explain the difference,” says Toole. But he thinks state chief health officers would be likely be discussing the reasons.

Toole says his analysis suggests two likely reasons for Victoria’s higher COVID-19 mortality:  the state’s higher death rate in the first two years of the pandemic; and the different ways deaths are reported in Victoria compared to other states like NSW.

“One of the reasons Victoria is ahead, is they got off to a very fast start, in a negative way.”

These two states also happen to be the only two jurisdictions to record deaths due to COVID-19 in all waves of the pandemic according to the ABS. In November, the ABS tallied state-based deaths by wave of the virus, Wave 1, Wave 2, Delta and Omicron.

Toole says his analysis shows in 2020, 87% of all COVID-19 deaths in Australia occurred in Victoria. 

The differences between Victoria and New South Wales narrowed following the Delta outbreak in both states in 2021. As a result, Victoria’s overall proportion of deaths went from 87% in 2020, to 61% adding in 2021 deaths, Toole says.

He says, looking at the raw numbers over 2022 and so far this year, there is very little difference between Victoria and New South Wales, but rates in Victoria remained higher.

Toole doesn’t think the differences can be explained by vaccine booster rates, given the two states are very similar in uptake. Nor does he think there’s much difference between states in terms of the quality of care.

In addition to Victoria’s high number of deaths during the second wave of COVID-19 in 2020, Toole says differences may be partly explained by different reporting systems. New South Wales only reports deaths after receiving a death certificate, while Victoria reports theirs sooner, he says.

“We don’t have a standard reporting system. NSW and Victoria define COVID-19 hospitalisations differently and they define deaths differently.”

He says standardised reporting would be one way the Australian Government’s proposed Australian Centre for Disease Control might improve the response to future pandemics.

Read more: COVID-19 in Australia by the numbers: Week ending 24 February

Collignon doesn’t think reporting differences are likely to be a big factor. Victoria’s figures might come in sooner, but any differences due to reporting would likely even out over time.

He says, New South Wales received a lot of criticism for not implementing lockdowns soon or hard enough, but in the end the state has probably done better overall than Victoria. 

“If you can achieve the same results with that with less restrictions, that is a good idea.”

But he adds, the politicisation of different pandemic approaches creates an unfortunate barrier in understanding the reasons underpinning the different outcomes. 

“The trouble is it has become so emotive. We somehow need to objectively look at the data,” Collignon says.