COVID-19 deaths and hospital admissions are breaking records in Australia – so what happens next?

Since the pandemic first found its way into our consciousness, Melbourne emergency physician Stephen Parnis has been working on the crest of every COVID-19 wave.

His job demanded long hours: treating patients, keeping across new therapies and life-saving strategies, while managing the impact of surging virus numbers and multiple lockdowns on overworked hospital staff and grieving families.

Every day as he went to work, Dr Parnis knew the virus could take the upper hand, and month after month he carried with him the weight of two questions: how many lives could be saved today? How many would be lost?

Then three months ago, Dr Parnis hit the wall.

“I was burned out. For most of us in healthcare, the pandemic has posed the biggest single challenge of our entire careers and mine began in 1992,” says Dr Parnis, a former vice-president of the Australian Medical Association. “I’ve done a lot of soul searching, looking at where my limits lie and asking how I sustain myself through this?”

For the first time since 1995, Dr Parnis took three months’ leave.

“I wasn’t myself and if I’d continued doing what I was doing I might have ended up having some sort of flame out,” he admits. “It was important to have time and space. My GP and my psychologist have been an important part of that time, but so have trusted friends and colleagues.”

The key lesson, Dr Parnis says, was understanding how to lower his expectations on himself: “I don’t have to be perfect. My colleagues don’t have to be perfect. We don’t have to have all the answers. We just need to know where to look for them”.

It is ironic that as Dr Parnis prepares to return to work tomorrow, Australia has the highest number of COVID-19 infections, hospital admissions and deaths of any time during the pandemic. His medical colleagues remain under pressure.

“My timing is impeccable,” he says with irony. “I’m coming back at it at a time when things are in some ways diabolical. I’m humbled by the support that my colleagues have given me and a little shocked by the numbers of people who have come to me saying they have felt the same way.”

On Friday, Australia recorded 44,203 new cases of COVID-19 in the previous 24 hours with the nation’s total caseload now nudging 10 million. The hospital system is juggling 5,122 patients with COVID-19, including 162 in ICU.

The saddest statistics of all are the deaths. A total of 157 people died with COVID-19 across Australia on Friday. The pandemic has taken the lives of 11,669 Australians so far.

“I would say the hospital system is holding its head above water, but only just,” says Dr Parnis, who met with hospital colleagues last week for an update before his return.

The experts contacted for this story — from frontline doctors like Dr Parnis, to epidemiologists, virologists and health policy researchers — agree that the trajectory of this wave of the virus is steep, and the peak could still lie ahead.

Modelling predicts August will see a significant further rise in cases before the curve begins to fall again.

Deakin University’s chair in epidemiology Catherine Bennett says the week ahead will offer a clearer idea of how long this wave may last.

“I think we will know in the next week or so whether these are true plateaus forming now,” she says, noting that every state is different,” Professor Bennett says.

BA.5 has rewritten the rules
COVID-19 has forced us to grapple with so much rapid change — from lockdowns to the “new normal” — that it is hard to believe only this time last year state premiers were still fronting the media each morning with detailed COVID-19 updates.

Double doughnut days remained the goal back then and lockdowns were an ever-present possibility. Australians under 40 were still not eligible for vaccination.

On July 31, 2021, in NSW for example, the state was deep in a lockdown that ultimately lasted more than 15 weeks. In the previous 24 hours, 210 cases were recorded and contact tracing was still attempted. The pandemic’s total cases in NSW had reached just 8,725 infections.

Fast-forward a year and, on Saturday, NSW had 177,013 active cases across the state, with 2,210 of those in hospital and 68 in intensive care. In the 24 hours to Friday afternoon, 46 people died with COVID-19.

In hindsight, concern over such low figures, when compared with our current situation, feels almost overblown.

Yet the disparity says a lot about both how far we have come, and how far we have to go.

Without vaccines and lockdowns, many, many more people would have died during last year’s wave, says Professor Bennett.

But this year, in spite of the rollout of vaccines and offers of third and fourth booster doses, the pressure on the hospital system is intensifying as the rise of the highly transmissible BA.5 variant — potentially as infectious as the most contagious viruses on Earth, measles and chickenpox — has rewritten the rules yet again.

New data suggests more than 46 per cent of Australians have had a COVID-19 infection, a figure that is likely to be a significant underestimation, Professor Bennett believes.

‘The next epidemic’
Notwithstanding the deaths — and those who have suffered as a result of their infections — many have been tempted to ask why we still worry about COVID-19, given widespread experience of only mild disease. The fear of what a COVID-19 infection might mean has dissipated for some who ask: “Isn’t it time to just get on with things?”

The experts are resolute that this approach remains cavalier. And the potential for pressure on the healthcare system is only one reason.

The most uncomfortable questions are:

-Who will become the casualties of this fresh wave?
-Will it be the elderly who, despite vaccination and the availability of new oral anti-viral medication, are not able to fight off the virus?
-Will it be the teens and 20 or 30-somethings who often drive virus transmission being infected for the second or third time with long-term ramifications still unknown?
-Will it be children receiving treatment for chronic conditions like rheumatoid arthritis that lowers their immunity?
-Will it be women who are emerging as the cohort most likely to suffer long COVID-19?

When you talk to these experts, leaders in their fields, who have devoted well over two years and thousands of hours to trying to understand SARS-CoV-2 it is uncanny how frequently one phrase continually comes up: “We just don’t know.”

“The fact is that we’ve got more people dying from this virus than any other virus. If things keep going in this direction COVID could be the single greatest cause of death, exceeding heart disease,” Dr Parnis says. “That’s unacceptable. How bad does it get? What are the long-term consequences? There are a lot of things we just don’t know.”

Sarah Palmer is a virologist — and co-director of the centre for virus research at The Westmead Institute for Medical Research and professor in the faculty of medicine and health at The University of Sydney — says it is the unknowns that harbour some of the greatest potential threats, arguing that, without care, rampant infection and reinfection threatens to make long COVID “the next epidemic”.

Professor Bennett agrees with Dr Parnis and Professor Palmer that, if COVID-19 numbers continue to explode, it is going to become an important cause of death and disability in Australia, driven simply by the maths: a small risk multiplied over a large, infected population still delivers concerning numbers.

“To say it’s disappointing is an understatement,” Professor Bennett says, pointing out the BA.5 variant that is driving the spike in infections is escaping the immunity built up — by those who contracted BA.2 — more efficiently than hoped.

“We’ve got more than half the population vaccinated but people who are in the firing line of the virus are getting multiple infections,” she says.

“That keeps the force of infection up and it pushes out into the community and is sustained. Although you might have very low risk if it’s sustained week after week, at some point you might have that unlucky exposure.”

What are we going to do, Professor Bennett asks.

“We want to encourage people to stop spreading the virus but we don’t want to go back into lockdown because what are you waiting for then? You have to stay there for the rest of your lives. It just doesn’t work.”

While the Omicron variants have proven persistent and resistant, Bennett says we should be grateful that “it’s not a brand new variant”.

“We’re not going through that moment when we have absolutely no idea how the virus is going to behave,” she says.

“Omicron is sitting in place longer than other variants have managed to do and that that may be a good thing. As long as it doesn’t evolve into something we’re more worried about.”

The problem, she points out, is that, while BA.5 is spreading rapidly through the population, the opportunity for the virus to mutate again remains a threat.