The Australian Bureau of Statistics (ABS) published excellent data on deaths due to or with COVID-19 in Australia from 2022 to July 2024. Deaths dropped between 2022 and 2023, but they stopped dropping further in 2024. Is this baseline of death ‘living with COVID-19’?

Below, I’ve plotted the data from deaths due to COVID-19 – those where it is the “disease, condition or external event that started the chain of events leading to death.” The ABS also includes a dataset of deaths with COVID-19 if you are interested.

What might this data be telling us?

Twice a year, COVID-19 death peaks

COVID-19 mortality peaks in a biannual pattern in Australia.

The peaks of death for 2022 (blue line in the graph above) and 2024 so far (green line) occur in our summer (orange shared areas) and winter (blue shade area). For 2023, the peaks are also in summer, but autumn contains the peak rather than winter.

Each new peak was driven by SARS-CoV-2 variants that differed from those that drove the preceding epidemic peak. I am a strong proponent that variation is crucial to the SARS-CoV-2 ‘waves’; the variant doth make the epidemic.

Antibody and cellular immunity from infection by the previous variant is generated and long-lasting. But the subsequent epidemic variant has, by definition, largely escaped that old immunity, being more successful at infection and transmission to greener human-filled pastures.

Variants of a virus are all part of the same species of ‘the virus’, but they differ due to being selected as the fittest new mutant during an iterative, evolutionary process (many millions of ‘generations’ are produced in each infection) within a person. The new fittest variant will most likely succeed against competition in its current environment. For a new variant to thrive, it’s had to successfully avoid the hindrance of existing immunity. There are many mechanisms by which viruses do this. One way viruses do this is by changing their outward ‘appearance’ enough that the old immune response can’t impede infection and transmission.

2022, the year the gates opened.

In Australia (and New Zealand), we did a spectacular job of keeping SARS-CoV-2 out of Australia during 2021 through a mix of international and internal border restrictions and periodic (less periodic for some jurisdictions than others) lockdowns (stay-at-home orders). At least until we were all well-vaccinated and New South Wales set the schedule on our behalf. We also did a ton of testing, contact tracing, and quarantining. While we used masks (mainly surgical ones), they weren’t really put to the test because we had so few periods of sustained transmission.

In 2022, the floodgates opened, and we were off. Soon thereafter, the surge of hospitalizations and then deaths followed.

These new ABS data are fantastic because it’s very hard to find a trustworthy source of longitudinal COVID-19 data now.

Is 2023-2024 the ‘new normal’?

The 2023 (red) and 2024 (green; ongoing) totals clearly show fewer deaths than in 2022 (blue).

That aligns with an expectation that vaccination and immunity from infection protect against the most severe outcome, death.

Still, even with that protection, the red and green lines in the earlier graph showed that monthly mortality is tracking quite similarly each year after the first surge of a novel virus into the community.

Is this what the future looks like? The ‘new normal’? ‘Living with COVID-19’?

Perhaps this balance will change further as we develop immunity to more variants. But that’s copium (wishful thinking), not fact. What we know is that SARS-CoV-2 keeps coughing up new variants with an approximately six monthly regularity. And that rate powers these biannual epidemics. If that rate speeds up – or slows down – it makes sense that the epidemic rate will also change. In between, we have not returned to zero cases and deaths because SARS-CoV-2 is an endemic virus, even if any given variant only has a finite existence.

Trends in mortality and age.

Those dying from COVID-19 are mainly among older age groups.

According to the ABS data, 70-80% of all confirmed deaths due to COVID-19 were in those aged 80 years or older, while 17-19% of deaths were among 70-79 year olds.

Deaths in those aged 0-59 comprised 2-4% of all COVID-19 deaths, with 5-7% of 60-69-year-olds dying due to COVID-19.

Noting that 2024 is incomplete so this trend may change.

It’s also interesting to look at the trends among the total deaths in those older age groups. The trend is that the percentage of 60-79-year-olds has been decreasing each year, while 80-90+ year-olds have seen rising rates of mortality due to COVID-19.

Does this reflect that we were still protecting the oldest among us, those we knew were most at risk from death in 2022, but have increasingly removed those protections from 2023? Or is it about reduced ease, interest and pressure in getting boosted? Or perhaps this group is the canary in the coal mine, indicating that vaccine mismatch may lessen the protection for those most likely to die from COVID-19. Or is it something else entirely?

But death isn’t everything.

Death is a very harsh and also more rare outcome of SARS-CoV-2 than it was. Nonetheless, because this virus is still mutating apace and being allowed to spread uninterrupted, many people are infected during each epidemic in each jurisdiction. Even a rare outcome means lots of people are affected when many people are infected.

While the “bad cold” and more severe outcomes due to COVID-19 are still occurring and creating havoc for workplaces, schools, ‘the economy’ (where did all those dudes go?), and families, long COVID-19 is also ever-present. Despite resulting less often now [2] than early in the pandemic, widespread transmission keeps driving long COVID case numbers.

Better vaccines

We got our vaccines in record time, tested and rolled out new RNA technologies, and read many words about their flexibility. Disappointingly, they have not lived up to the promise of being rapidly updated or produced locally in more countries. Or rather, the promise is retained, but they haven’t been updated fast enough. In Australia, most of our COVID-19 biannual epidemics have been due to variants that aren’t well matched with the spike-gene-containing vaccines we have available.

Even when the vaccines inevitably become more effective, ongoing waves of misinformation, lost trust, and reduced public health communication will likely negatively impact vaccine uptake. There’s a lot of work to do here.

We need better vaccines or faster updates if we want to further push down deaths. We need vaccines that are updated twice a year or include conserved regions of SARS-CoV-2 – parts that don’t change rapidly or extensively but are still effective at generating immunity. We need vaccines that contain multiple pieces of different variants to cover the immunogenic spectrum. We also need those vaccines delivered to the site of infection—the upper airway. Thankfully, work on some of these strategies is progressing.[3]

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We could absolutely do more to prevent transmission, but we aren’t, and those most capable of improving our health and safety by organizing better education on masking and cleaning our air are absent, too concerned about other things, or simply taking advice from those unqualified to be in any advisory role.

For now, the numbers say that we are settling into a baseline of death and harm due to this respiratory virus. Some might call this ‘living with COVID-19’. But that’s not true for everyone.

References

1. Deaths due to COVID-19, influenza and RSV in Australia – 2022 – July 2024
   https://www.abs.gov.au/articles/deaths-due-covid-19-influenza-and-rsv-australia-2022-july-2024
2. Vaccination Dramatically Lowers Long COVID Risk
   https://www.scientificamerican.com/article/vaccination-dramatically-lowers-long-covid-risk/
3. An intranasal combination vaccine induces systemic and mucosal immunity against COVID-19 and influenza
   https://www.nature.com/articles/s41541-024-00857-5

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