Explainer: why are Covid infection rates in Australia so high compared with other countries?

As three new Omicron subvariants – BA.2.12.1, BA.4 and BA.5 – begin to spread in Australia, health authorities are warning of winter surges in both Covid and the flu.

Reported Covid infection rates in Australia are already among the highest in the world. As of data from 2 May, Australia’s average daily infection rate is 1,515 cases per million people – the second-highest in the world for countries with a population greater than 1 million, after New Zealand (1,566 cases per million).

On Wednesday, Western Australia recorded its highest-ever daily Covid figures with 9,782 cases.

Despite its dominance in people’s lives and daily press coverage over the past two years, Australia’s response to the Covid pandemic has not featured prominently during the election campaign.

Why are reported infection rates in Australia so high compared with other countries – and despite sustained transmission of the virus, why do many now feel apathetic about Covid?

Why are there so many Covid cases in Australia?

Prof Catherine Bennett, the chair in epidemiology at Deakin University, said Australia’s high reported infection rate may be the result of high “case ascertainment”.

Although PCR testing rates have dropped off in Australia, “we’re probably still doing it more so than anywhere else in the world”, Bennett said. “We still have free PCR testing. A lot of countries don’t.”

The number of confirmed Covid cases shouldn’t be relied on in isolation, Bennett said. “If you compare us to, say, the UK, they look much better for infection rates,” she said. “The UK’s confirmed case rate is 128 cases per million – less than a tenth of Australia’s 1,515 figure.

“Yet their hospitalisation rate per million is 209, and ours is 124. It suggests that they probably have twice as many [true] cases [as Australia].”

Prof Adrian Esterman, the chair of biostatistics at the University of South Australia, said the actual case numbers in Australia are still many times the number of reported cases.

“If we look at our PCR test positivity rates, they’re still very high,” he said. “In the whole of Australia … 20% of all PCR tests are coming out positive. It tells us that there is an awful lot of Covid that isn’t being diagnosed and we do require more testing – the World Health Organization wants that percentage to be less than 5%.”

Esterman believes the sustained high transmission is due to the removal of public health measures across the country. “It’s a ‘let it rip’ policy,” he said. “We’re getting more and more people reinfected.”

BA2.12.1, BA.4, and BA.5 are now in Australia. What does this mean for infections?

Three new subvariants of Omicron – BA.2.12.1, BA.4 and BA.5 – have been detected in Australia for the first time.

“All three subvariants are about 25% more transmissible than BA.2,” Esterman said.

Figures from South Africa and the US – where reported Covid cases have risen in the last month – suggest that the rates of hospitalisation from the new subvariants are roughly the same as for BA.2, Esterman said. The new subvariants “will almost certainly take over”, he said.

Covid numbers have plateaued at high levels around the country, and may subsequently rise again as the new subvariants take hold, Bennett said. “There is the real risk of reinfection with these new variants.”

Are people becoming apathetic about Covid?

Peter Lewis, the executive director of the research company Essential, said there seems to be “a broad desire for people to move on from Covid even as numbers rise”.

Essential polling from August last year showed that only 15% of Australians would find it acceptable to live with more than 1,000 Covid deaths annually as lockdown restrictions were removed. In 2022 to date, there have already been more than 5,000 Covid deaths.

“What we said we couldn’t contemplate we’re now shrugging our shoulders about,” Lewis said.

Aliza Werner-Seidler, an associate professor at the University of New South Wales and the Black Dog Institute, said Covid fatigue had been a major factor. “Over the last few years, there was a very genuine and appropriate fear and focus on Covid because of the potentially catastrophic outcomes.”

Now that the vast majority of the population is vaccinated, and many have also had Covid, “some people are checking out of the conversation”, Werner-Seidler said.

“The message that we’re getting in the day to day from our lack of regulation around this now … is that things are back to normal. People are booking cruises, people are planning weddings … if you don’t have a high-risk profile, it’s quite hard to resist this sense that this is something that we’re just going to live with now.”

In the shift to living with Covid, Werner-Seidler believes there needs to be more conversations about the impacts of the virus for high-risk groups, such as those who are immunocompromised. “It’s really important not to undermine the validity of these people’s concerns,” she said.

“The responsibility has been placed back on to the individual and in some ways I think it’s rather unfair.”

  • Sign up to receive an email with the top stories from Guardian Australia every morning

Werner-Seidler, a clinical psychologist, emphasises that social isolation is a risk factor for many mental health problems, and encourages at-risk people, if they are comfortable, to make plans for interacting with family and friends in Covid-safe manner.

“The general public has, by and large, said: no more of this, fed up, not interested,” Esterman said. “The trouble is we’re still getting hundreds and hundreds of deaths and each one of those is a grieving family.”

Bennett said it was important to reduce the number of cases and deaths. “Every time we learn something more about long Covid it’s a reminder that if you can avoid infection, do.”

But she believes Covid policies should encourage people to minimise individual and collective risk by wearing a mask or social distancing, without forcing requirements upon them.

“Public health messaging shouldn’t be about fear – either fear of the virus or fear of fines. In an emergency you might revert to that … [but] rules are not the way we manage infectious diseases normally.”

Related Posts