COVID-19
Citation
AIHW
Australian Institute of Health and Welfare (2024) COVID-19, AIHW, Australian Government, accessed 22 October 2024.
APA
Australian Institute of Health and Welfare. (2024). COVID-19. Retrieved from https://www.aihw.gov.au/reports/australias-health/covid-19
MLA
COVID-19. Australian Institute of Health and Welfare, 16 July 2024, https://www.aihw.gov.au/reports/australias-health/covid-19
Vancouver
Australian Institute of Health and Welfare. COVID-19 [Internet]. Canberra: Australian Institute of Health and Welfare, 2024 [cited 2024 Oct. 22]. Available from: https://www.aihw.gov.au/reports/australias-health/covid-19
Harvard
Australian Institute of Health and Welfare (AIHW) 2024, COVID-19, viewed 22 October 2024, https://www.aihw.gov.au/reports/australias-health/covid-19
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The first confirmed case of COVID-19 was reported in Australia on 25 January 2020 (Hunt 2020). By 12 March 2020, 140 cases had been confirmed in Australia (WHO 2020). A human biosecurity emergency response was issued, and a range of public health and social measures were established to contain the spread of SARS-CoV-2, the virus that causes COVID-19. The end of the emergency response was declared on 20 October 2023; however, COVID-19 remains an important issue, with a large wave occurring at the end of 2023 and into 2024 (Figure 1) (NSW Health 2024). Research including data linkage is underway to provide greater insights into the impact of COVID-19 on people in the community, workforce, and the health system.
For more information, see the COVID-19 Register.
Figure 1: Timeline of the COVID-19 response in Australia
Sources: ABS 2022; ANAO 2022; Andrews 2022; COVID-19 Epidemiology and Surveillance Team 2024; Department of Health 2020, 2021a, 2021b; Department of Health and Aged Care 2023a, 2024b; Government of Western Australia 2022; Parliament of Australia 2020; Prime Minister of Australia 2022; TGA 2024.
COVID-19 cases in Australia
As at 25 March 2024, there had been nearly 12 million confirmed or probable COVID-19 cases reported to the National Notifiable Diseases Surveillance System (NNDSS) since the start of the pandemic (Department of Health and Aged Care 2024c). Of these, most cases (95%) have been notified since 2022. Case numbers reported to the NNDSS have been underestimated since late 2022 due to a reduction in case detection, including changes to testing and reporting requirements.
During 2020, the highest notification rate per 100,000 people was seen in Victoria (314) corresponding to the second wave (Table 1). During 2021, New South Wales and Victoria had the highest notification rates (over 3,000 per 100,000 people), and by 2022 notification rates ranged from around 30,000 in Queensland to 50,000 in Tasmania and the Australian Capital Territory. By 2023, a marked decline in notification rates was observed across all jurisdictions corresponding with the drop in reporting of cases.
State or territory | 2020 | 2021 | 2022 | 2023 |
---|---|---|---|---|
NSW | 62 | 3,461 | 41,242 | 3,718 |
VIC | 314 | 3,045 | 39,534 | 2,334 |
QLD | 25 | 606 | 29,825 | 2,569 |
WA | 35 | 15 | 46,153 | 3,304 |
SA | 34 | 1,029 | 46,593 | 5,137 |
TAS | 44 | 287 | 48,974 | 6,009 |
ACT | 36 | 1,412 | 48,538 | 5,012 |
NT | 32 | 287 | 41,233 | 2,638 |
Source: Department of Health and Aged Care 2024c.
Other data sources, such as seroprevalence surveys and wastewater testing, complement notification data and help to inform the public health response. In addition, monitoring COVID-19 hospital activity provides useful information on recent trends, particularly as cases are no longer comprehensively reported.
Since the start of the COVID-19 pandemic, regular seroprevalence surveys have been conducted that tested residual blood samples from blood donors (aged 18 years and over) for antibodies to SARS-CoV-2 to track the proportion of people who have been infected. The latest data found that more than two-thirds (71%) had been infected with the virus by the end of 2022 (ACSN 2023).
Data from Western Australia demonstrates the close correlation between the number of genome copies detected in wastewater and clinical COVID-19 cases during most of 2022 followed by a widening gap between the 2 sources of information from October 2022, when mandatory reporting of Rapid Antigen Tests (RATs) ceased (Department of Health, Western Australia 2024). The transmission wave that occurred over late 2023 and early 2024 is also clearly visible in the wastewater data, but less so in the case notifications. This transmission wave is also apparent in COVID-19 case hospitalisation data reported by the Australian Government (Department of Health and Aged Care 2024a). For key terms, see glossary.
How many people were hospitalised with COVID-19?
Hospital separations involving a COVID-19 diagnosis represented <0.1% of all hospital separations during 2019–2020 and 2020–2021 (Table 2). In 2021–2022, there were 263,425 COVID-19 separations representing 2.3% of all separations.
The median length of stay fell from 9 to 5 days between 2020–21 and 2021–22 (Table 2). The proportion of separations with a severe outcome (intensive care unit stay, continuous ventilator support or death) was also less in 2021–22 than during the previous years.
Year | Number of COVID-19 separations | Per cent of total separations | Median length of stay (days) | Per cent involving ICU stay | Per cent involving CVS | Per cent died |
---|---|---|---|---|---|---|
2019–20 | 2,628 | 0.02 | 9 | 8.6 | 5.3 | 4.0 |
2020–21 | 4,718 | 0.04 | 9 | 7.0 | 3.8 | 10.3 |
2021–22 | 263,425 | 2.3 | 5 | 3.0 | 1.3 | 2.0 |
ICU = intensive care unit, CVS = continuous ventilatory support
Notes
- COVID-19 diagnosis of either ICD-10AM U07.1 or U07.2 in any diagnosis field. COVID-19 hospitalisations could be due to COVID-19 or an incidental diagnosis following admission for another cause.
- Total number of separations was 11.1 million in 2019–20, 11.8 million in 2020–21 and 11.6 million in 2021–22.
Sources: AIHW 2021a, 2022a, 2023a, 2023b.
COVID-19 hospitalisations varied among different population groups
In 2019–20 and 2020–21, COVID-19 hospital separation rates were highest for residents of Major cities and non-Indigenous Australians; by 2021–22 this pattern reversed and was highest for Aboriginal and Torres Strait Islander (First Nations) people and those living in Very remote areas (Table 3).
Rates of COVID-19 hospital separations were highest for people living in the highest socioeconomic area of usual residence in 2019–20 and switched to being highest for people living in the lowest socioeconomic area during 2020–21 and 2021–22.
Population group | 2019–20 | 2020–21 | 2021–22 |
---|---|---|---|
Remoteness area |
|
|
|
Major cities | 2.6 | 5.2 | 243 |
Inner regional | 1.6 | 1.1 | 180 |
Outer regional | 1.7 | 0.9 | 173 |
Remote | 0.5 | 0.2 | 219 |
Very remote | 0.2 | 0.2 | 411 |
Socioeconomic area |
|
|
|
1-Lowest | 1.5 | 4.8 | 306 |
2 | 2.0 | 4.1 | 214 |
3 | 1.8 | 3.7 | 224 |
4 | 2.9 | 3.3 | 213 |
5-Highest | 3.2 | 3.4 | 168 |
Indigenous status |
|
|
|
First Nations people | 0.6 | 0.5 | 337 |
Non-Indigenous Australians | 2.4 | 4.0 | 214 |
Australia | 2.4 | 4.0 | 227 |
Notes
1. Data for the ‘not reported’ categories have been omitted.
2. Data are not age standardised.
Sources: AIHW 2021a, 2022a, 2023a.
How many people have died from COVID-19?
In Australia since the start of the pandemic to the end of 2023, 22,315 people have died from or with COVID-19 (registered by 29 February 2024) (ABS 2024b). Of these, COVID-19 was the underlying cause of death for 79% (17,673). Deaths from COVID-19 in Australia were most common among males and older age groups (ABS 2024b).
In 2022, COVID-19 was the third leading cause of death in Australia accounting for 5.2% of all deaths (ABS 2024a). This was the first time an infectious disease had been in the top 5 causes of death since 1970 (influenza and pneumonia).
The age distribution of deaths due to COVID-19 has varied during the pandemic (ABS 2022). In all 4 waves, the highest proportion of deaths occurred in those aged 80–89. The Delta wave was the only wave where more than half (53%) of the deaths occurred in those under 80 years of age. The median age of death was also lowest during the Delta wave – 79 compared with 86 for Omicron. This distribution is reflected in burden of disease statistics: for example, in 2021, 30% of fatal burden was estimated to have occurred in those under 60, compared with 13% in 2022 (AIHW 2022b, 2022c).
COVID-19 age-standardised mortality rates (for deaths registered by 29 November 2023) were higher for those from lower socioeconomic areas (Socio-Economic Indexes for Areas, SEIFA) and for people born outside of Australia:
- In 2021, the age-standardised rate for deaths from COVID-19 was 6 times as high for those from the lowest socioeconomic SEIFA area as those from the highest area. This fell to 2.8 times as high in 2022 and to 2.4 times as high in 2023.
- People born in the Middle East had the highest COVID-19 age-standardised mortality rate overall (from 2020 to 2023) at 31.9 per 100,000 people – 2.8 times that for people born in Australia (11.2 per 100,000). The rate was highest in 2022 (60.3 compared with 26.7 for Australian-born) and fell to 11.4 in 2023, which was similar to the rate for all people born overseas (11.9) and lower than the Australian-born population (12.6) (ABS 2023c).
There were no deaths from COVID-19 among First Nations people before August 2021. Between August 2021 and September 2023, there were 226 deaths among First Nations people from COVID-19 and a further 120 COVID-19 related deaths (ABS 2023c). The age-standardised death rate from COVID-19 was 1.7 times as high for First Nations people as non-Indigenous Australians (30.1 and 18.0 per 100,000 persons, respectively).
Has COVID-19 led to more deaths than expected?
The ABS has developed estimates of excess mortality that are answering the question: 'How does the number of deaths which has occurred since the beginning of the COVID-19 pandemic (2020–2023) compare to the number of deaths expected had the pandemic not occurred?' From the start of the pandemic to December 2023, there was a net total of 13,259 excess deaths in Australia (after accounting for deaths above and below usual variation) (ABS 2024c). However, the pattern of excess mortality was different by year and peaks (above usual variation) generally coincided with peaks in the Omicron wave of the pandemic. In the first year of the pandemic (2020) there were 1,854 less deaths than expected. In 2021 there were more deaths than expected, with 369 deaths above usual variation which increased to 11,558 more deaths in 2022. In 2023 there was lower excess mortality than observed in 2022, with 3,186 deaths above usual variation. Between 2013 and 2019, the number of excess deaths has fluctuated between 59 (in 2013) and 475 (in 2015) deaths above usual variation, except for 2017 when it reached 2,335 during the last severe influenza season.
COVID-19 caused considerable disease burden in 2022
In 2022, the total burden from COVID-19 was estimated to be 151,400 disability-adjusted life years (DALY) (5.8 DALY per 1,000 population), ranking eighth among the specific diseases, the only year when an infectious disease has been in the top 10 leading causes of disease burden since 2003 (AIHW 2022b). The burden from COVID-19 was predominantly fatal (73%) and highest in males and people aged 75–84.
Post COVID-19 condition is an emerging health issue
The World Health Organization (WHO) defines ‘long COVID’ or ‘post COVID-19 condition’ as a condition in people with a history of probable or confirmed COVID-19, usually 3 months from the onset of COVID-19, with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis. Symptoms may be new onset following initial recovery from an acute COVID-19 episode or persist from the initial illness. Symptoms may also fluctuate or relapse over time (WHO 2021).
Long COVID is a multisystem disease with many subtypes ranging from symptoms such as brain fog and fatigue, which is most common in females and younger adults, to cardiovascular and metabolic sequalae observed more commonly in older adults and those with comorbidities (Al-Aly and Topol 2024). Prevalence of long COVID varies by symptom, with estimates (from international studies) ranging from 2.6% for dysosmia (change in sense of smell) to 0.5% for chest pain among unvaccinated, Omicron adult cases (Howe et al. 2023). The prevalence of all symptoms is higher among hospitalised COVID-19 cases.
Data on the prevalence of post COVID-19 condition in Australia are largely obtained from surveys, with estimates ranging from 5% to 10% of people who have had COVID-19 reporting symptoms lasting 3 months or more (Biddle and Korda 2022; Liu et al. 2021; Sax Institute 2022; Staples et al. 2023). These are likely to overestimate the prevalence of post COVID-19 condition due to the self-selected nature of participants, definitional issues of the condition and lack of comparison groups to be able to attribute symptoms to post COVID-19 condition (AIHW 2022e). Among people surveyed in August 2022, only a minority with post COVID-19 condition had impacts on their daily activities and quality of life (Biddle and Korda 2022).
Postviral syndromes are observed for other viruses such as influenza (AIHW 2022e). A recent Australian study found that self-reported functional impairment from ongoing symptoms at 12-weeks after infection with the Omicron variant was similar for COVID-19 (4.1%) and influenza (4.4%) patients (Brown et al. 2023).
The establishment of emergency use ICD-10-AM codes for post COVID-19 condition can be used to study hospitalisations and deaths due to long COVID (ABS 2023b; IHACPA 2024). However, these sources of data will be limited to reporting data for severe cases, (for example, that require hospital care) and depend upon the diagnosis of post COVID-19 condition being recognised and recorded on the patients’ medical record or death certificate (AIHW 2022e). Most people who access care for persistent COVID-19 symptoms are likely to do so via a general practitioner (GP) (VAHI 2023). Declining COVID-19 case detection will also lead to further uncertainty regarding diagnosis of post COVID-19 condition in Australian communities.
Indirect effects of the COVID-19 pandemic
Diseases and illnesses
Emerging evidence shows that measures designed to help protect people from the pandemic have also had an impact on mental health and wellbeing. Data collected from January 2020 to August 2022 found that increases in policy stringency of the government response to COVID-19 in Australia were associated with worsening mental wellbeing (Biddle et al. 2022). Findings were consistent across a range of indicators including life satisfaction, psychological distress and loneliness. The associations with COVID-19 policy responses were also greater for males and young people.
During the earlier years of the pandemic, there were changes in the trends for age-standardised death rates since 2017 for many of the leading causes of death:
- deaths from respiratory conditions, particularly influenza and pneumonia, fell sharply in 2020 with small increases in 2022
- deaths from coronary heart disease continued to decline during 2020 and 2021, but increased slightly in 2022
- deaths from dementia experienced a small drop in 2020
- there was a small decline in deaths from land transport accidents during 2020 and 2021
- deaths from intentional self-harm did not increase between 2020 and 2022
- deaths from accidental poisoning fell to their lowest levels in 2021 and 2022 (Table 4).
In addition, the age-standardised rate of injury hospitalisations (per 100,000 people) has fluctuated over the first 3 years of the pandemic, following several years of relative stability, falling to 1,980 in 2019–20 (from 2,050 in 2017–18), rising to 2,130 in 2020–21 then declining to 1,970 in 2021–22 (AIHW 2023i).
Cause of death | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 |
---|---|---|---|---|---|---|
Coronary heart disease (I20-I25) | 61.0 | 56.7 | 55.1 | 50.0 | 50.3 | 52.4 |
Cerebrovascular disease (I60-I69) | 32.6 | 31.3 | 29.7 | 27.9 | 27.9 | 27.2 |
Dementia (including Alzheimer’s Disease (F01, F03, G30) | 42.5 | 42.3 | 43.9 | 41.5 | 43.5 | 45.3 |
Lung cancer (C33, C34) | 28.1 | 28.7 | 28.1 | 26.3 | 26.1 | 26.5 |
Prostate cancer (C61) (males) | 24.9 | 24.1 | 25.3 | 24.4 | 23.6 | 23.9 |
Breast cancer (C50) (females) | 19.1 | 19.2 | 20.0 | 18.8 | 18.4 | 17.8 |
Chronic obstructive pulmonary disease (J40-J44) | 25.2 | 23.2 | 23.4 | 19.3 | 20.5 | 21.8 |
Influenza and pneumonia (J09-J18) | 12.7 | 8.8 | 11.3 | 6.0 | 5.8 | 7.5 |
Diabetes (E10-E14) | 16.2 | 15.3 | 15.5 | 15.8 | 15.8 | 17.1 |
Land transport accidents (V01–V89) | 5.3 | 5.1 | 5.2 | 4.7 | 4.9 | 5.0 |
Accidental poisoning (X40–X49) | 6.3 | 6.3 | 6.0 | 6.0 | 5.3 | 5.1 |
Intentional self-harm (suicide) (X60–X84, Y87.0) | 13.2 | 12.7 | 13.2 | 12.3 | 12.1 | 12.2 |
COVID-19 (U07.1, U07.2, U10.9) | . | . | . | 2.6 | 3.4 | 27.1 |
Notes
- Rates are age standardised to the 2001 Australian estimated resident population.
- Cause of death codes are from the ICD-10AM.
Source: AIHW National Mortality Database
Impact on the health system
General Practitioner attendances
The Australian Bureau of Statistics (ABS) 2020–21 Patient Experience Survey reported that 9.8% of people aged 15 and over delayed or missed health care from a GP when needed due to COVID-19 (ABS 2021). For comparison, 2.4% of people delayed GP care due to cost in the same year.
Analysis of Medicare data demonstrates how the number of visits to GPs changed over time (Table 5):
- In 2020, there were 166 million GP attendances which were similar to the pre-pandemic trend. New temporary telehealth items for GP attendances introduced in March 2020 played an important role in maintaining rates that were consistent with previous trends. Many temporary GP telehealth attendance items were made permanent from January 2022 (Department of Health and Aged Care 2022).
- In 2021, there was a sharp increase to 187 million GP attendances that coincided with GP attendances to assess a patient’s suitability for the COVID-19 vaccine. There were 19.5 million GP attendances for COVID-19 vaccine suitability assessment in 2021, which represented 10.5% of all GP attendances. This number fell to 9.6 million (5.5%) and 2.4 million (1.5%) attendances in 2022 and 2023 respectively. When excluding these attendances, the number of GP attendances in 2021 increased only slightly to 168 million attendances when compared to 2020.
- In 2022, the number of GP attendances declined to 175 million attendances, but still experienced a growth comparing to 2020.
- In 2023, the number of GP attendances fell further to 163 million attendances which was similar to the trend prior to 2021.
| 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 |
---|---|---|---|---|---|---|---|
Number of GP attendances (million) | 151.8 | 155.5 | 160.7 | 166.5 | 187.0 | 174.6 | 163.3 |
Number of GP attendances per person (ERP) | 6.2 | 6.2 | 6.3 | 6.5 | 7.3 | 6.7 | 6.1 |
Percentage of people receiving a GP service (%) | 87.1 | 86.8 | 87.5 | 85.2 | 88.5 | 87.4 | 83.9 |
Number of telehealth attendances (million) | 0.2 | 0.2 | 0.3 | 45.3 | 46.5 | 45.6 | 33.7 |
Number of telehealth attendances per person (ERP) | 0.01 | 0.01 | 0.01 | 1.8 | 1.8 | 1.8 | 1.3 |
Percentage of people receiving a telehealth service (%) | 0.3 | 0.4 | 0.4 | 48.6 | 49.2 | 49.7 | 40.9 |
ERP - Estimated Resident Population
Note: Telehealth attendances are a subset of services in GP attendances, specialist attendances, obstetrics services and some unlisted categories.
Source: AIHW analysis of the Medicare Benefits Schedule maintained by the Australian Government Department of Health and Aged Care.
Specific arrangements for telehealth varied over the pandemic period, including bulk billing requirements. For example, telehealth services were initially required to be bulk billed for concessional, COVID-19 vulnerable patients or children under 16. This requirement for bulk billing was removed incrementally and ceased entirely in October 2020.
Chronic disease management services
Following the introduction of new telehealth services in March 2020, 1 in 3 consultations for Chronic Disease Management (CDM) services were conducted using telehealth in April and May (AIHW 2022g). There were a higher number of claims for CDM services in 2020 compared with 2019 from June (AIHW 2022g). Potential reasons include:
- the availability of telehealth services may have improved access to CDM services.
- concerns around the higher risk of COVID-19 disease for patients with chronic illness may have led to prioritisation of these patients for assessment during 2020.
Hospitalisations
The total number of hospitalisations for admitted patients in public and private hospitals was lower than previous years in both 2019–20 and 2021–22 (2.8% and 2.1% lower respectively) (Table 6). In these years, hospitalisation rates were 401 and 405 per 1,000 population respectively – lower than the rate of 422 hospitalisations per 1,000 population in 2018–19, prior to the pandemic.
| 2015–16 | 2016–17 | 2017–18 | 2018–19 | 2019–20 | 2020–21 | 2021–22 | 2022–23 |
---|---|---|---|---|---|---|---|---|
No. of hospitalisations (million) | 10.5 | 10.9 | 11.2 | 11.5 | 11.1 | 11.8 | 11.6 | 12.1 |
% change from previous year | n.a. | 3.9 | 2.2 | 2.6 | -2.8 | 6.3 | -2.1 | 4.4 |
Rate per 1,000 population | 413 | 420 | 419 | 422 | 401 | 418 | 405 | 415 |
No. of days of patient care (million) | 29.8 | 30.9 | 30.2 | 30.9 | 30.2 | 31.2 | 31.8 | 33.2 |
Note: The rate per 1,000 population is the crude rate based on the estimated resident population as at 30 June at beginning of the reference period.
Source: AIHW National Hospital Morbidity Database
The number of patient days of care provided in hospitals declined by 2.2% in 2019–20 compared with the previous year and then gradually increased in each subsequent year of the pandemic (Table 6).
Elective surgery (admissions from public hospital waiting lists)
Elective (planned) surgeries were heavily affected by disruptions to hospital services in 2019–20 and subsequent years (AIHW 2023e). Prior to the pandemic, admissions for elective surgeries from public hospital waiting lists generally increased each year. For example, between 2015–16 and 2018–19, the number of surgeries fluctuated, with an overall average 2.1% increase each year (Table 7). For each year since then, the number of elective surgery admissions from public hospital waiting lists has been lower than that seen in 2018–19. The number of elective surgery admissions in 2022–23, while higher than the numbers for some of the preceding years, was still lower than the number of surgeries done in 2016–17 (Table 7).
| 2015–16 | 2016–17 | 2017–18 | 2018–19 | 2019–20 | 2020–21 | 2021–22 | 2022–23 |
---|---|---|---|---|---|---|---|---|
No. of admissions (thousand) | 725.3 | 748.1 | 748.8 | 758.1 | 688.3 | 754.6 | 623.0 | 735.5 |
% change from previous year | n.a. | +5.1 | +0.1 | +1.2 | -9.2 | +9.6 | -17.4 | +18.1 |
Rate per 1,000 population | 30.2 | 30.7 | 30.2 | 30.4 | 27.2 | 29.4 | 24.3 | 28.3 |
Notes
1. The rate per 1,000 population is the rude rate based on the estimated resident population as at 30 June at beginning of the reference period.
2. Admissions from public hospital elective surgery waiting lists includes private patients treated in public hospitals, and may include public patients treated in private hospitals (under contract).
Source: AIHW National Elective Surgery Waiting Times Data Collection
Reductions in elective surgery activity occurred as a result of:
- formal nationally-agreed restrictions in the initial stages of the pandemic that aimed to protect hospital resources (such as personal protective equipment (PPE) and ICU beds) and ensure staffing availability in the face of uncertain hospital demand
- local restrictions (at statewide or regional levels) that applied at other times in response to outbreaks, and
- broader disruptions to the health system (and particularly workforce availability) that arose in the face of increasing COVID-19 case numbers. For example, the lowest number of elective surgery admissions from public hospital waiting lists was in 2021–22. This coincided with a peak in the number of COVID-19 cases (early 2022) and occurred at a time when requirements to isolate were still in place affecting staff availability (Department of Health 2020; Kelly 2022; Watson et al. 2022).
The surgeries most heavily affected by these disruptions were those assigned to category 3 (the lowest urgency category) – where procedures are clinically indicated within a year. Between 2020–21 and 2021–22, admissions for category 3 procedures declined by 32%. Category 2 admissions (clinically indicated withing 90 days) decreased by 17%, and category 1 admissions (clinically indicated within 30 days) declined by 2.2% (AIHW 2023e).
By jurisdiction, the largest increases in admissions from public hospital elective surgery waiting lists between 2021–22 and 2022–23 were in Victoria (29% increase) and New South Wales (23.5% increase). Despite these increases, the number of admissions from elective surgery waiting lists in these states in 2022–23 (and the corresponding rate per 1,000 population) was lower than the number of admissions prior to the pandemic in 2018–19 (AIHW 2023h).
For more information and data visualisations for elective surgery, see Elective Surgery Activity.
Health expenditure
In 2021–22 compared with 2020–21, total health spending increased by 6% in real terms, from $227.6 to $241.3 billion, which was almost double the 10-year trend of 3.4%. Spending increased by 11% ($8.3 billion) on primary health care and by 5% ($4.2 billion) on hospitals (AIHW 2023f). Total health system spending on the response to COVID-19 over the first 3 years of the pandemic (2019–20 to 2021–22) was $47.9 billion and represented 7.2% of total health spending during the same period.
Spending on COVID-19 increased from 3.2% ($6.6 million) of total health spending in 2019–20 to 10.9% ($26.2 million) in 2021–22 when COVID-19 spending was highest (AIHW 2023g).
Of the total COVID-19 health spending in 2021–22:
- 49% was spent by the Australian Government and state and territory governments through the National Partnership on COVID-19 Response, with the largest area of spending for state public health activities such as PPE supplies, contact tracing, expansion of critical care capacity, additional cleaning in schools, hospitals and public transport, and the vaccinations program
- 48% was spent by the Department of Health and Aged Care with the largest area of spending on primary care including public health activities such as the vaccine response, protective and preventive measures, RAT subsidies and respiratory clinic services
- 2.7% was spent by individuals on COVID-19 related items such as RATS, masks and respirators and sanitiser (AIHW 2023g).
For more information, see Health system spending on the response to COVID-19 in Australia 2019–20 to 2021–22.
Cancer screening
National cancer screening programs were also disrupted in 2020 due to COVID-19 restrictions (AIHW 2021b).
BreastScreen Australia services were suspended from the start of the pandemic until late April or early May 2020. Key trends include:
- 140,844 fewer screening mammograms were performed through BreastScreen Australia between April and June 2020 than the same period in 2018 (250,446 versus 109,602)
- from June 2020, the number of screening mammograms recovered progressively to pre-COVID-19 levels until June 2021, with 254,721 mammograms performed between April and June 2021
- the number of screening mammograms performed fell between July and December 2021 – to 213,683 mammograms in the December quarter (October to December) – coinciding with further COVID-19 restrictions (AIHW 2023d).
The breast cancer screening participation rate for women aged 50–74 fell from 54% in 2018–2019 to 48% in 2020–2021 and recovered slightly to 50% in 2021–2022 (AIHW 2023d).
There was no suspension of the National Cervical Screening Program due to COVID-19 at any time during 2020 (AIHW 2023c). While GP services continued during the pandemic, there was an increased use of telehealth consultations and cervical screening tests require in-person consultations. The impact of the pandemic on cervical screening is currently unclear, although there is some indication that the number of tests may have been reduced.
There was no suspension of the National Bowel Cancer Screening Program at any time during 2020 (AIHW 2023c). There was a small decline in the 2-yearly participation rates for people aged 50–74 from 44% in 2019–2020 to 41% in 2020–2021 (AIHW 2023d).
Health workforce
The COVID-19 pandemic has also impacted the health workforce. The growth rate in total full time equivalent (FTE) for the health workforce (which includes practitioners registered with the Australian Health Practitioner Regulation Agency who are currently in the labour force) was higher during the pandemic period (3.9% between 2020 and 2022) than in previous years (3.4% between 2013 and 2019), mainly contributed by nurses and midwives (Department of Health and Aged Care 2023b). The experience with COVID-19 led to improvements in work practices that prioritise the mental wellbeing of the health workforce (AHHA 2022).
For more information, see Health workforce.
Medicines
To ensure the ongoing supply of medicines for consumers during the pandemic, several temporary changes to prescribing and dispensing were introduced, such as supply of a consumer’s usual medicine without consumers physically visiting a doctor for a prescription and use of image based prescriptions, in order to reduce the risk of doctors, pharmacists and consumers contracting COVID-19 (AIHW 2022d). There was initial concern and reports of medicine shortages, particularly in the early stage of the pandemic when in March 2020 there was a 23% increase in the number of prescriptions dispensed under Pharmaceutical Benefits Scheme (PBS) and Repatriation Pharmaceutical Benefits Scheme (RPBS) (31.0 million) compared with March 2019 (25.2 million) as a result of consumer stockpiling (AIHW 2022f). Pharmacists were consequently required to limit dispensing of prescription medicines and in April 2020, and prescription volumes decreased (22.7 million).
Prescriptions dispensed under the PBS and RPBS have been steadily increasing since 2017 (296.6 million dispensed in 2017 compared with 335.4 million dispensed in 2023), despite a brief increase in dispensing during March 2020 (Table 8). Key patterns include:
- Medicines for the respiratory system had a small increase in dispensing during 2020, before returning to normal patterns of use.
- While the dispensing of antiinfectives for systemic use have decreased since 2020, from 2022 the arrival of COVID-19 antivirals have contributed to increased utilisation of all antivirals.
COVID-19 may have had an impact on the overall decline of antiinfectives (ACSQHC 2023a) through decreased prescribing of some of these medicines by GPs, physical distancing restrictions resulting in fewer respiratory tract infections, and policy changes in April 2020 encouraging prescribers to issue repeat prescriptions for antimicrobials only when indicated (ACSQHC 2022, 2023b).
The Australian Government supported access to the safe and effective treatment of COVID-19. This included the listing of 2 oral COVID-19 antiviral treatments on the PBS Schedule in early 2022, molnupiravir (Lagevrio®) and the composite product of nirmatrelvir and ritonavir (Paxlovid®) for people who are vulnerable to severe disease, including older Australians and people with specified risk factors (Department of Health and Aged Care 2024b).
Variable | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 |
---|---|---|---|---|---|---|---|
Number of prescriptions dispensed (million) | 296.6 | 303.1 | 307.6 | 310.9 | 316.8 | 328.1 | 335.4 |
Number of prescriptions dispensed per person (ERP) | 12.1 | 12.1 | 12.1 | 12.1 | 12.3 | 12.6 | 12.6 |
Percentage of people dispensed a prescription (%) | 68.8 | 67.9 | 68.2 | 64.1 | 65.5 | 67.6 | 66.9 |
Number of respiratory system prescriptions dispensed (million) | 13.6 | 13.3 | 13.3 | 14.2 | 13.1 | 14.1 | 13.4 |
Number of respiratory system prescriptions dispensed per person (ERP) | 0.6 | 0.5 | 0.5 | 0.6 | 0.5 | 0.5 | 0.5 |
Percentage of people dispensed a respiratory system prescription (%) | 10.7 | 10.1 | 10.2 | 9.8 | 9.3 | 11.3 | 10.0 |
Number of antiinfective prescriptions dispensed (million) | 27.7 | 26.8 | 27.4 | 20.9 | 20.7 | 23.7 | 23.8 |
Number of antiinfective prescriptions dispensed per person (ERP) | 1.1 | 1.1 | 1.1 | 0.8 | 0.8 | 0.9 | 0.9 |
Percentage of people dispensed an antiinfective prescription (%) | 41.7 | 39.9 | 40.2 | 32.1 | 32.9 | 37.5 | 37.1 |
Number of COVID-19 antiviral prescriptions dispensed | 636,090 | 613,408 | |||||
Number of COVID-19 antiviral prescriptions dispensed per person (ERP) |
|
|
|
|
| 0.02 | 0.02 |
Percentage of people dispensed a COVID-19 antiviral prescription (%) |
|
|
|
|
| 2.3 | 2.0 |
ERP - Estimated Resident Population
Note: COVID-19 antivirals are included in the Antiinfectives for systemic use group
Source: AIHW analysis of PBS and RPBS data maintained by the Australian Government Department of Health and Aged Care
How does Australia compare internationally?
In the early stages of the pandemic, Australia performed well across the 38 Organisation for Economic Co-Operation and Development (OECD) countries in terms of the direct impacts of COVID-19 on health. From January 2020 to October 2021, Australia had reported:
- the second lowest prevalence of COVID-19 infections per 100,000 population
- the third lowest number of confirmed or suspected COVID-19 deaths per million population, among OECD member countries (OECD 2021).
By 31 December 2022, the total number of COVID-19 cases per million people was lower than several European countries, similar to New Zealand and higher than Canada and Japan (Figure 2) (Mathieu et al. 2022).
Figure 2: Total number of reported COVID-19 cases per million people since the beginning of the pandemic until 31 December 2022 for OECD countries
Bar chart shows Australia ranked 20th out of 38 OECD countries for the total number of COVID-19 cases per million people as at 31 December 2022.
Country | Total number of cases per million |
---|---|
Mexico | 57031 |
Canada | 116834 |
Colombia | 122318 |
Poland | 159780 |
Turkey | 199255 |
Hungary | 219299 |
Costa Rica | 225223 |
Japan | 234810 |
Sweden | 254066 |
Chile | 256704 |
Finland | 263020 |
Norway | 271546 |
Spain | 289221 |
United States | 293865 |
Slovak Republic | 329441 |
Ireland | 336872 |
United Kingdom | 358390 |
New Zealand | 396786 |
Belgium | 401933 |
Australia | 412018 |
Italy | 426313 |
Czechia | 436452 |
Germany | 446708 |
Estonia | 448106 |
Lithuania | 468507 |
Greece | 483692 |
Netherlands | 487705 |
Switzerland | 501170 |
Israel | 504137 |
Latvia | 524419 |
Portugal | 540421 |
Iceland | 555675 |
South Korea | 560819 |
Luxembourg | 563413 |
Denmark | 576044 |
France | 587831 |
Slovenia | 613632 |
Austria | 637706 |
Note: Our World in Data sources confirmed COVID-19 case data from the World Health Organization. Confirmed cases are defined as “a person with laboratory confirmation of COVID-19 infection”. However, countries may vary in how cases are defined and reported. Some countries have changed their reporting methodologies to include probable cases. The number of confirmed cases is lower than actual cases because not everyone is tested and not all cases have laboratory confirmation, and this may vary between countries.
Source:
OurWorldInData.org
Since the beginning of the pandemic, Australia has had one of the lowest excess mortality rates compared with other countries with available data (Figure 3). Australia has had lower excess mortality than the United States, United Kingdom and most European countries, and higher excess mortality than Japan and New Zealand (based on cumulative deaths compared with projected deaths based on past trends).
Figure 3: Cumulative excess mortality (%) since the beginning of the pandemic for selected countries
Line chart shows Australia’s excess mortality was lower than that for the UK and USA and higher than that for Japan and New Zealand
Year | Australia | Japan | New Zealand | United Kingdom | United States |
---|---|---|---|---|---|
2020 | -2 | -2 | -6 | 13 | 15 |
2021 | 0 | 0 | -4 | 11 | 16 |
2022 | 5 | 2 | 0 | 10 | 14 |
2023 | 5 | 4 | 0 | 10 | 11 |
Note: Data are the percentage difference between the cumulative number of deaths since 1 January 2020 and the cumulative expected number of deaths based on previous years (2015–2019).
Source:
OurWorldInData.org
|
Data source overview
In a number of OECD countries such as the United Kingdom and the United States, life expectancy fell by around one year during the first 2 years of the COVID-19 pandemic (Arias et al. 2022; OECD 2023; PHE 2021). Globally, life expectancy fell from 73.3 years in 2019 to 71.7 in 2021, however in Australia, life expectancy rose from 82.9 to 83.3 (GBD 2021 Demographics Collaborators). When 2022 data were included, life expectancy in Australia across 2020–2022 fell for the first time since the mid-1990’s by 0.1 year (ABS 2023d). This fall is likely to be driven by the higher death rates observed in 2022.
Where do I go for more information?
For more information on COVID-19, see:
- Demonstrating the utility of the COVID-19 Register
- Long COVID in Australia – a review of the literature
For more on this topic, see COVID-19.
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