What do rising COVID-19 case numbers mean for GPs?

In August last year, the Doherty Institute published COVID-19 modelling it had overseen as requested by the Federal Government.
 
The work was central to the National Cabinet’s pandemic response and informed the ‘road map’ to transition the country out of isolation.
 
However, the scenarios it mapped out were put together in very different circumstances before the emergence of the Omicron variant.
 
It predicted that assuming 70% vaccine coverage among adults, as well as ‘partial’ public health measures in place, there would be 385,983 symptomatic cases and 1457 deaths over six months – a figure they said that could be reduced further with more public health interventions.
 
‘In an average year of influenza, we would roughly have 600 deaths and 200,000 cases in Australia,’ a Doherty Institute press release stated last August. ‘Any death is a tragedy, but our health system can cope with this.’
 
Five months into 2022 and the situation is very different, with the Omicron variant and its sub-variants having changed the dynamic of the disease worldwide.
 
Australia is now being widely reported as having one of the highest infection rates in the world – although the true picture is more complex than the headline.
 
Some governments – such as Denmark, Norway and Sweden – have dispensed with the free PCR testing that used to be available, making infection rates even trickier to decipher accurately. Others have notably cut back on their use.
 
There is no doubt, however, that the number of deaths in Australia is very different to the scenario set out in earlier modelling.
 
In the past six months from mid-November – when inter-state travel restrictions began to be lifted –there have been 5906 deaths attributed to COVID-19, more than quadruple the amount that was predicted by the Doherty Institute modelling.
 
In April, the Australian Bureau of Statistics (ABS) reported that the number of deaths caused by COVID-19 in January was second only to cancer.
 
The total of 15,805 deaths for all reasons reported up until 31 January was 22.1% more than the historical average, the ABS said.
 
While the 1505 COVID-19 related deaths in January is the highest monthly total yet, it is still consistently higher than 1000 mortalities each month – with the current nationwide average close to 50 every day.
 
Australian National University Medical School Infectious diseases physician Professor Peter Collignon says that the difference between the current figure and the Doherty Institute’s prediction highlights the shortcomings of modelling.
 
‘I don’t disagree that the modelling hasn’t predicted the right numbers,’ he told newsGP.
 
‘One of the variables they were presuming is that there’d be a lot less transmission with such a high vaccination rate.
 
‘But equally, you look at modelling the other way, which was predicting 40,000–50,000 deaths a year and a half ago.
 
‘With more people getting it, you still end up with more death. It just shows with modelling you get variables that you put in, and they don’t hold out.’
 
For Professor Collignon, with the vaccination rate as high as it is, the case for bringing back more restrictive public health measures is hard to argue – even with the higher-than-expected mortality rate.
 
‘The reality is that once you have your population highly immunised, what are you going to do? Stay locked down for the next four, five, 10 years?’ he said.
 
‘All of us in my view are going to get infected with the virus. I would think half of Australia has been infected in the last six months.’
 
Meanwhile, Professor Adrian Esterman, Chair of Biostatistics and Epidemiology at the University of South Australia, believes the increasing case numbers and deaths may force a change in approach.
 
‘States and territories are very reluctant to reintroduce any public health measures, but they might have to when hospital numbers start going up, they might not have any choice,’ he told newsGP.
 
He also noted how little COVID-19 has featured in the public debate ahead of the Federal Election.
 
‘It’s now getting into the realms of being one of our major causes of death,’ he said. ‘You would think that the governments would actually do something about it.
 
‘But it’s an election period and no one’s talking about COVID-19 during the election.’
 
He also believes the mask mandate should not have been relaxed and warns of a heavier burden for general practice given the rising numbers and the likely knock-on impact of long COVID.
 
‘Of course it’s not all over,’ he said.  
 
‘We’ve got new subvariants hitting Australia, which are much more transmissible, we’ve got the potential for new variants coming along. We’ve got this very heavy case fatality rate, we’ve got this very heavy incidence rate of COVID-19.
 
‘It’s not over and the virus doesn’t know it’s over.’
 
With the swelling caseload of COVID-19 infections and hospitalisations, he believes general practices should brace for an increasing burden and predicts a ‘tidal wave’ of patients presenting with long-lasting symptoms caused by the disease.
 
‘I think one of the key problems will be [faced by] general practice. They will see increasing numbers of patients with long-term health problems,’ he said.
 
‘GPs are increasingly going to see more patients with long COVID.
 
‘Although we will have long COVID clinics, it will be the general practice that takes the brunt of all these patients with shortness of breath, major headaches, with brain fog.
 
‘They’ve got to work out what to do with them.’
 
Professor Collignon has an optimistic outlook on the likely case numbers in the mid-term, pointing to the behaviour of the Spanish Flu where most of the deaths occurred in the first two years of the worldwide pandemic.
 
However, he also believes the pressure on general practice is unlikely to ease in the immediate months ahead.
 
‘I’ll be surprised if there’s not more pressure in winter,’ he said
 
‘The pressure will be on [because of] people who aren’t sick enough to go to hospital… have to be kept an eye on because some of them deteriorate.
 
‘There will also be the pressure of who gets drugs? Who does all that assessment of the risk factors for who needs to get antivirals and who doesn’t?
 
‘With all the emotional and other physical problems of both COVID itself and the fear of COVID, [as well as] the social and economic repercussions, I do think primary care is going to be impacted for a while to come.’
 
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