In 2024, the world at the threshold of its fifth year dealing with the COVID-19 pandemic, and the holiday season has coincided with the eighth major wave of infections.
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Most infections now are due to the globally dominant JN.1 type of virus. Its new variant - BA.2.86 - known as "Pirola" seems to infect the deep lung tissues with great efficiency just as the early, pre-Omicron, strains did.
As we experienced with the Omicron variant, these new strains have appeared in our communities unexpectedly and rapidly, and have spread quickly causing the current wave of infections.
As a result, hospitalisations required for COVID treatment continue to stress our hospitals, just at the time when health resources are at their thinnest.
To make matters worse, a study published in the prestigious medical journal The Lancet last week confirmed that long COVID could persist for up to two years and has potentially adverse health effects for many people who have suffered infections.
With information about test results - RAT swabs taken at home, or formal PCR tests through pathology laboratories - now unavailable, it is difficult to make assess just how common COVID infections are.
The results of wastewater testing, however, suggest that infection is widespread.
Many deaths are still occurring, with the Actuaries Institute estimating that 20,000 more Australians died in 2022 that would have lost their lives if there was no pandemic.
These excess deaths were still occurring in the first half of 2023.
Most of those who have succumbed are older and vulnerable Australians.
The cost of anti-viral medications for vulnerable Australians is approaching a billion dollars.
That is money that could well be spent on other areas of our stretched health system were it not for the pandemic.
With this gloomy news, many of us are asking - where do we go from here? What does the future hold for the COVID pandemic, and is there anything we can do about it?
While it seems very unlikely that COVID will disappear, at least any time soon, the good news is that there is plenty we can do to protect our health and reduce the effects of the virus on the most vulnerable Australians.
The first thing is to make sure that as many Australians as possible are up-to-date with their COVID vaccinations.
For various reasons, perhaps most importantly "vaccine fatigue", rates of vaccination boosters are dismal at the moment.
Indeed, mis- and deliberate disinformation about vaccination has been peddled to the community and this is undoubtedly affecting uptake, not only of COVID vaccines but others too.
This could well be part of the reason that countries like Australia are seeing cases of polio and measles, diseases which doctors like me had thought eradicated long ago.
COVID can have long term effects on the lungs, heart, brain, kidneys and blood vessels so protection from serious infection makes very good sense for all of us.
The newer COVID vaccines have been available to Australians since mid-December, so checking if you're eligible for a booster should be a high priority for all of us.
If you are vulnerable and catch COVID, then seek urgent treatment with anti-viral tablets.
Australian researchers have shown that timely treatment with antivirals in older Australians reduces the chance of requiring hospitalisation or dying.
What more can we do, though, to protect ourselves and - importantly - the millions of vulnerable Australians who are most likely to be harmed by COVID infection?
It seems very unlikely that an elimination approach to COVID could work now.
There is little evidence for the political will for a massive international effort such as occurred to deal with polio and smallpox.
However, control strategies can be very effective if used properly.
Beyond vaccination, these include the use of masks in crowds, sensible and practical social distancing, and ongoing education programs.
More broadly, our community needs to think carefully about increasing our resilience not only to COVID but to other serious infections such as influenza, RSV, and other respiratory viruses.
One area in which there is enormous scope for improvement is in the ventilation and airflow in our workplaces, social spaces, and homes.
This could well have an enormous pay-off for our health in the long term.
Since workplaces are very common sites for transmission looking at work-from-home options where practical for the obviously sick, and simply building a culture where people don't come to work if they're sick and risk infecting others.
For many vulnerable Australians, these infection-safe work options are not available.
Ensuring that those at disadvantage don't feel they have to come to work for financial reasons if they're infectious should be a priority for society.
None of us want to be having the same conversation about COVID in January of 2025. To avoid that, our community needs to come together now and make 2024 the year we all saw off the pandemic.
- Steve Robson is a Canberra doctor and the president of the Australian Medical Association.
