Why are Australia’s Covid case rates still so high and how can we prevent more deaths?

Australia has fared better than many countries throughout much of the pandemic, but despite high vaccination rates and the availability of antiviral treatments, people are still dying every day and case numbers are rising.

Vaccination means few people are becoming significantly unwell, but the virus can still take a toll, and ongoing outbreaks mean health and other essential services, and businesses are struggling to find staff.

Now, two years into the pandemic, can Australia still say it is faring well against Covid?

Australia had tough restrictions in place throughout much of last year.

While other countries were lifting restrictions and dealing with rapid Covid-19 spread, Australia took the approach of waiting for high vaccination rates before easing key restrictions.

"Last year, where the rest of the world was facing constant huge numbers, of course, we kept the numbers down," Australian Medical Association president Dr Omar Khorshid said.

"I don't think the fact that we have very high numbers now is evidence of failing to manage the pandemic, but our different approach is simply having a predictable consequence. When restrictions lift, cases go up."

Australia's spread, however, is occurring in an environment where 95% of people aged 16 and over have had at least two vaccine doses.

Not including small islands, Australia now has the highest number of per-capita Covid-19 infections.

But the Doherty Institute's Sharon Lewin, a professor of medicine and an infectious diseases physician and one of the experts at the forefront of the national effort against the pandemic, said comparing case numbers between countries is now "meaningless".

There are so many differences between countries in how they test for the virus, who they test, and whether tests are reported to health authorities, she said.

Australia requires positive rapid antigen test (RAT) results to be reported to state or territory health authorities, and is still encouraging PCR testing.

"Many countries do not count RAT testing, including the US where you are not obliged to report a positive RAT test," Lewin said.

"In Australia, two-thirds of our cases are detected by RAT testing. So when people say Australia has the highest number of cases in the world that data is meaningless.

"What we can do is track changes over time within Australia, and we see those numbers are steadily increasing as we head towards winter.

"We need more regular testing to accurately detect the case positivity rate, and we need a far higher awareness about how to protect people at most risk of hospitalisation and death".

A key form of protection now available includes antiviral drugs, Lewin said.

Advanced age and underlying vulnerability have contributed to high death rates, especially among Australians aged over 70.

Lewin said those ending up in hospital with Covid are "largely either unvaccinated, or haven't had their booster, or have co-morbidities".

"We know those populations benefit from antiviral drugs, but they have to access them largely within the first five days of symptoms," she said.

"We need a much, much bigger awareness campaign that antivirals help, antivirals are available, and that they prevent people from ending up in hospital."

Australia has access to antibody treatments that, when administered early after symptom onset, can prevent severe disease and hospitalisation. These have been available for Covid-19 longer than the newer antiviral drugs.

But these treatments do not work effectively against the currently circulating Covid-19 variants. They also require an infusion and need to be administered in a hospital.

"We are constantly chasing our tails with antibodies, whereas far more effective are the two newer oral antiviral drugs, which so far, have not been impacted by the variants of concern," Lewin said.

The first of those antivirals, Molnupiravir, was found in clinical trials to reduce the risk of hospitalisation for people at high risk by 30%. Paxlovid, the other antiviral, reduces this risk by 80%.

For GPs to prescribe a drug it needs to be on the Pharmaceutical Benefits Scheme (PBS). Molnupiravir has been on the PBS from March. Paxlovid was only listed on 1 May.

"Paxlovid is far more effective," Lewin said. "The downside is it is more complicated to prescribe. It interacts with other drugs so you need a lot of support for GPs prescribing it to allow them to work out those drug interactions safely.

"My concern is that many people at high risk of disease progression and hospitalisation may not even know about these antivirals or even think to go to the doctor if they test positive.

"We must put a lot more effort into making sure anyone eligible knows about them, and can access them easily."

Lewin said hospitals also need to better collect and report data from all Covid-19 deaths, including what co-morbidities that person had and whether they were offered antivirals early.

Rapid antigen tests work best when several tests are administered consecutively over several days. A one-off test is much less accurate.

"If you have been exposed and have symptoms and your RAT test is negative, I would recommend you have a PCR test anyway as we know it's a more sensitive test," Lewin said.

"If you really do have Covid and you test daily with a RAT test throughout your illness it will eventually show a positive; it is very unusual that it will stay negative throughout the course of the illness."

However, RATs are expensive and this option may not be financially feasible, so a PCR test is recommended when symptoms are present.

"Of course someone may also have something else other than Covid," Lewin said.

"We know influenza cases are rising as we head into winter. I think it is still important to know for sure though whether you have Covid or not. Because once you know you will act differently to protect yourself and others."

The US has hit 1 million deaths, the highest death toll of any country. Australia has reached 7,800 deaths, but Lewin said this does not mean Australia can become complacent.

As well as better awareness of early treatments, and better data collection and integration, Lewin said continuous promotion of the third booster shot is critical.

Khorshid said the federal government - whoever is elected come the weekend - must commit to funding 50% of the rise in costs of running hospitals.

The federal government has boosted its hospital spend, but this is due to end in September and was a measure to take hospitals through the pandemic.

But Khorshid said the pandemic won't be over in September and the entire hospital system is under strain.

"The impact of Covid on the health system is ongoing because the pandemic is certainly not over," he said.

"Even if we don't see another severe variant and we learn to live with the virus in a way that we're currently learning."