Twenty Australians are dying every day because of COVID-19 — five years after the pandemic that changed the world was declared and three years after the country largely ended restrictions.
The figure comes from a recent study comparing excess mortality before and after the pandemic declaration to account for deaths beyond those directly attributable to COVID.
That study indicated the toll is still mounting and is significantly higher than official figures — that concentrate on direct COVID-related deaths — indicate.
It also points to critical gaps in Australia's vaccination rates, indoor air quality and pandemic preparedness that require urgent action.
Overall, it found Australia's pandemic excess death toll was now more than 30,000 — and almost all of those deaths had been since the country 'reopened' in late 2021 and early 2022.
The official figure for COVID deaths during that period is lower than the excess with 26,000 deaths either from or with COVID.
The study found there were more than 7,600 excess deaths in Australia in the first 11 months of 2024 — surprisingly, about the same as in 2023. Without action, this level of mortality could become the new normal.
Excess deaths include deaths from undiagnozed cases, long COVID and indirect causes, such as delays in accessing care and health system strain.
The modelling allows comparisons between countries with vastly different population sizes, age range, life expectancy and cause-of-death reporting.
Had Australia experienced the same excess mortality rates as the United Kingdom or the United States, more than three times as many lives would have been lost between 2020 and 2023 — a total of 78,000.
These 'lives saved' in Australia were largely in the first two years of the pandemic where the country had very little COVID thanks to its strong public health approach.
Japan and Taiwan recorded excess mortality rates similar to Australia, despite having greater population density and older populations — two risk factors that lead to higher pandemic mortality.
Their approach offers key lessons Australia could adopt, including:
Maintaining high vaccine rates. In 2023, Taiwan administered 64 percent more vaccine doses per person than Australia, and Japan 91 percent more.
Cleaner indoor air. Taiwan offers certification incentives to businesses to improve air standards, offering a model Australia could adopt.
The air quality factor
Despite growing global recognition of the role of indoor air quality in reducing COVID transmission, it remains largely unaddressed in Australian policy.
Indoor air quality describes the condition of air inside and around buildings in relation to the health and comfort of occupants. Reducing exposure to common indoor pollutants can lower the risk of related health issues.
Taiwan's certification program recognizes the crucial role of indoor air quality, as does Hong Kong's certification scheme, which sets benchmarks for office buildings and public spaces.
Parts of the United States and Europe have also established frameworks to support improvements.
Australia has yet to establish accepted benchmarks for ventilation and air filtration — for example using HEPA filters commonly found in air purifiers and carbon dioxide monitoring — proven interventions that can significantly reduce the spread of airborne pathogens.
The benefits of cleaner indoor air extend far beyond COVID mitigation.
Improved indoor air quality reduces COVID, flu and other respiratory illnesses, enhances cognitive function and lowers exposure to harmful pollutants.
Exposure to pollutants can cause headaches, fatigue and respiratory issues such as asthma.
The COVID pandemic and its ongoing toll have highlighted the urgent need to rethink how air quality in indoor environments is managed.
Yet, without clear policies and investment, Australia risks missing lessons from the crisis and being left vulnerable to future outbreaks of respiratory illnesses.
Vaccination decline
Vaccination also plays a key role in Australia's COVID response. However, after achieving near-universal two-dose vaccination coverage, booster uptake has declined significantly.
Waning immunity leaves high-risk populations more vulnerable, yet vaccination rates in disadvantaged groups remain lower.
Increasing booster uptake, particularly among older adults, immunocompromised individuals and underserved communities is critical to reducing severe cases and mortality.
It's currently recommended that adults between the ages of 65 and 74 and those 18 to 64 who are severely immunocompromised have a COVID booster every 12 months. For people 75 and older it's recommended every six months.
There is strong evidence that vaccination also reduces the risk of developing long COVID, the chronic complications that can follow infection.
The excess mortality data shows deep inequities in society, with certain groups affected disproportionately.
People born overseas were 1.4 times more likely than average to die, while the death rate for Aboriginal and Torres Strait Islander people was 1.8 times higher.
The most significant gap was across socio-economic status. Australians in the lowest income areas faced a death rate 2.8 times higher than those living in the wealthiest areas.
It shows investment in clear, culturally appropriate communication that addresses concerns and engages communities is crucial.
Engagement strategies targeting Indigenous communities, people with disabilities, and those with lower health literacy should be a cornerstone of the ongoing vaccination campaign.
The future
The evidence supports urgent action being needed on COVID-19 and for future pandemic preparedness.
There are key actions governments could follow to be better prepared:
Establish an independent Australian Centre for Disease Control and invest in detection systems while collaborating internationally.
Implementing precautionary measures based on evolving evidence.
Target support and communications to at-risk populations.
Maintain public trust by combating misinformation and implementing passive controls such as clean indoor air.
Mortality is not the only clinical outcome of COVID-19. For every death, there is significantly more non-fatal severe disease and even more acute mild illness, leading to a chronic burden that is so substantial it has already been the subject of an inquiry by the Australian Government.
Reducing COVID-19 mortality will have a much greater impact beyond simply reducing deaths.
(West is Deputy Technical Director at Burnet Institute. He is a healthcare analytics leader with extensive experience in public health, data and technology and providing evidence-based advice to inform public health action. Adjoyan is the Director of the Pathway to Clean Indoor Air project at Burnet Institute. She is an experienced public policy and health leader with a strong background in health system reform, public health and pandemic management. Crabb AC is the Director and CEO of Burnet Institute and an infectious disease researcher. He played a major role in the COVID-19 pandemic, including advising governments and advocating strongly for public health action. This article was originally published under Creative Commons by 360info)
