If you’ve tried to look up the number of COVID cases in your area recently, you may have found it a frustrating exercise.
The reporting frequency in states and territories has been slowing down, from daily to weekly, and now fortnightly or monthly.
On top of that, what do the numbers even mean now? And how many are being missed?
It’s been a long time since we were asked to get a PCR test at the slightest sign of a tickly throat.
Now, the vast majority of cases are going undiagnosed or unreported.
That degradation in data quality is visible for everyone to see, and it’s no surprise: it would’ve been a big ask for us to keep up the COVID surveillance effort of 2020 and 2021 forever.
Likewise, behind the scenes governments have been steadily dismantling many other elements of a surveillance system that we were so reliant on in the emergency period of the COVID-19 pandemic.
Some public health experts think it’s a shame that we’re apparently returning back to the pre-pandemic ways we handled respiratory disease, after we’ve learned so much.
Weekly forecasting of COVID-19 has ended
The most recent thing to be discontinued is a weekly series of forecasts and “situational assessment reports” for federal and state officials.
The federal government had been contracting a group of mathematical modellers across multiple institutions to produce it, and it was one of the key regular pieces of advice they received.
The forecasts gave assessments of the COVID situation, including estimates for the effective reproduction number and transmission potential in each state and territory.
But the government has decided not to continue with that work, and in December, the contract ended.
The health department says the forecasting was in place for the emergency response phase, and has been ended given that COVID-19 is no longer a “Communicable Disease Incident of National Significance”.
Professor James Wood from the UNSW school of population health was one of the researchers involved in the work. “I’m not surprised,” he says. “For some time, the government hasn’t been changing its decisions based on the epidemiological or modelling reports.
“Whether or not cases were going up might be of interest in terms of planning to some extent but … hospital capacity wasn’t being continuously strained and so on, so I think the value of it in the short term was less for government.”
It’s a return toward our pre-pandemic approach to respiratory disease, and that’s precisely the strategy: ministers and health officers have been saying for a long time that COVID is now being managed consistent with other communicable diseases like flu.
But some experts argue that we could use the lessons from COVID to do a much better job of tracking and managing flu than we did before.
“It does leave a gap in terms of epidemic intelligence … and what’s happening not only with COVID, but flu and RSV and probably in the next year or two, whooping cough as well will be one we’ll want to watch,” Professor Wood says.
In 2022 the US went through a “tripledemic“, where COVID, the flu and RSV all circulated simultaneously in high numbers.
The reality now is that when respiratory diseases are putting pressure on health systems, it won’t be because of a single pathogen. It could be several at once.
Have we missed an opportunity to make the most of what we’ve learned?
In the journal Emerging Infectious Diseases this month, a group of public health experts called it a “critical time” to review disease surveillance practices, suggesting an “integrated model of surveillance” that considers multiple respiratory viruses.
“Resuming pathogen-specific surveillance approaches, such as those for monitoring influenza, would represent a missed opportunity to build on learnings from emergency response efforts,” the authors wrote.
And ongoing surveillance is important if you want to catch emerging waves, new variants of concern, and entirely new pandemics early.
In order to monitor trends you have to monitor the inter-epidemic period as well the emergency period.
If you only stand things up when concerns arise overseas, you run the risk of acting too late.
Professor Wood states it more clearly: “We don’t have a clear forward plan.”
“We’ve missed a little bit of an opportunity while COVID was in front of everyone’s minds to initiate more changes.”
The government says something is in the works, and that a National Surveillance Plan for COVID-19, influenza, and RSV is being developed.
“As part of this development process, a comprehensive review of national viral respiratory infection surveillance is being undertaken, including an assessment of current gaps in surveillance, potential novel and/or enhanced surveillance systems and data sources to fill these gaps, and the benefits and limitations of each,” the health department says.
“This will include an assessment of the cost-effectiveness and sustainability of population prevalence surveys within the Australian surveillance context.”
Professor Wood says this is all happening while COVID-19 continues to have a significant impact.
“Obviously, we’re very glad that it’s dropped from being something where we were worried about losing 100,000 lives a year in the initial phase, to 15,000 in the Omicron year to maybe 5,000 last year,” he says.
“It’s a lot better, but that’s still worse than flu, right?”
“I do think we have an opportunity here to take that a bit more seriously in terms of how we view it, how we measure it, and how we advise the community on how to deal with it.”
Other governments are investing heavily in disease forecasting. What’s Australia doing?
Outside Australia, governments have clearly recognised the value of forecasting in public health.
In the US, the Centers for Disease Control and Prevention announced more than US$250 million over five years to establish a network of infectious disease forecasting centres.
That’s one of the actions of the CDC’s Center for Forecasting and Outbreak Analytics.
It was launched in 2022, directly in response to the COVID-19 pandemic.
The European Union’s equivalent to the American CDC, the ECDC, also launched a respiratory forecasting program late last year.
It shows how other countries are investing in the intelligence that they saw had value through the pandemic, and seemingly prioritising it more than Australia.
The Australian government is in the process of setting up a CDC here. It exists in interim form right now, with staff recruitment expected to happen this year.
That body may have some role in respiratory forecasting, but it is still in its infancy.
The health department says it is now focusing on “the adoption of novel and cost-effective surveillance strategies, with a reduced focus on case notifications”.
“The use of sentinel surveillance, healthcare utilisation data, genomic sequencing, and wastewater analysis will allow us to shift our surveillance approach to a more sustainable and integrated system that is more appropriate to the current epidemiological situation,” the department said in response to the ABC’s questions.
Wastewater analysis was one of the big new developments of the COVID pandemic, but Professor Wood says there’s a bit of work to do before we can rely more heavily on it.
“Tools like wastewater or some of the surveys like flu tracking may be promising ways to do this, but they haven’t been validated,” he says.
“And until we invest in doing some actual prevalence surveys and comparing with a known technique where we know the percentage positive and so on, we’re not really confident that this is actually consistently a good measure.
“We don’t know. There’s been some slightly weird results to wastewater in Europe in the most recent wave.”
In the meantime, modellers and public health experts plan to continue some of their work.
“Myself and others in Australia are going to continue to do some forecasting this year,” Wood says.
“But we have to set up new data agreements with state carriers, we have to rely on them being interested, and we’ll have to find some way to make this something we can continue to fund.”