Health in 2020: setting the scene

Australians faced many challenges to their health and wellbeing during 2020. The year began with extensive bushfires leading to the loss of life, the destruction of homes and businesses and less direct health outcomes for many.

As COVID-19, a viral respiratory infection, spread across the world, the first cases were recorded in Australia on 25 January 2020. As the disease spread throughout Australia, a National Cabinet formed of all first ministers and federal and state and territory health systems responded with a range of measures to limit the spread of the disease and treat those affected. These included new or repurposed treatment facilities, procurement of additional protective equipment, testing facilities, contact tracing and quarantine systems, including hotel quarantine arrangements (‘medi-hotels’). By early December, more than 10 million tests for the COVID-19 virus had been conducted, with a range of pop-up and drive-through facilities established to allow widespread testing.

To further limit the spread of COVID-19, restrictions were put in place to contain its impact in the community. By the end of March 2020, non-essential businesses and activities had shut down, with Australians urged to stay at home.

As part of these restrictions, many health services were suspended or required to operate in new or different ways. While this may have limited people’s access to and use of these services, in some cases, new or additional services were made available to Australians through changes to health service delivery models, policies and programs.

Restrictions also affected other areas of people’s lives, including their employment, income, living arrangements and ability to spend time with friends and family. For some people, these changes may have meant they needed extra support to help manage their health, including mental health, and wellbeing.

Many agencies, including the AIHW, redirected resources to support the pandemic response over this period, including reallocating staff to support national and state and territory emergency response facilities, rapid data sharing and the operational response.

At the time of publication, most domestic restrictions had eased in Australia (with some exceptions and variation between states and territories), but the global pandemic was still active. However, there were growing positive signs about the likely success of vaccine programs in 2021 having a significant impact on controlling the spread of the disease

As 2020 comes to an end, the AIHW has reviewed the main impacts of the COVID-19 pandemic on the Australian health system—including on services delivered by states and territories—in a series of reports and updates released today.

Increased use of mental health services during COVID-19 pandemic

For some Australians, the COVID-19 pandemic and subsequent restrictions appears to have had a negative effect on their mental health, with data suggesting a rise in psychological distress and loneliness for young people and women in particular. More detail is available at The use of mental health services, psychological distress, loneliness, suicide, ambulance attendances and COVID-19.

Australian governments have closely monitored the mental health impact of the pandemic. In response, they introduced a range of measures including wider availablity of telehealth services, additional service capacity (for example, helpline funding) and additional Medicare-subsidised psychological therapy sessions.

Data across a range of mental health related services show heightened service usage since 20 March when COVID-19 pandemic restrictions were introduced.

For example, between 16 March 2020 and 27 September 2020, 7.2 million Medicare-subsidised mental health related services were delivered nationally ($791 million paid in benefits). Of these, 2.5 million services were delivered via telehealth. Telehealth services reached their peak in the week ending 26 April 2020 when half (49.9%) of MBS mental health services were provided remotely. In September 2020 (31 August to 27 September 2020), the number of services delivered was 15% higher than in the same period in September 2019.

Phone and online support organisations also reported substantial increases in demand for their services during the COVID-19 pandemic. In the 4 weeks from 31 August to 27 September 2020, almost 83,500 calls were made to Lifeline (a 15.6% increase from the same time in 2019), Kids Helpline received more than 32,000 contacts (14.3% increase from the same time in 2019) and more than 27,500 calls were made to Beyond Blue’s general phone service (21.3% increase from the same time in 2019).

The number of mental health-related prescriptions dispensed under the PBS has also increased during the pandemic. In the 4 weeks to 27 September 2020, the number of mental health-related prescriptions dispensed under the PBS was 5.9% higher than in the same period in 2019.

Find out more: Mental health impact of COVID-19

Elective surgery restricted, but more urgent elective surgeries appear unaffected

Following a decision by National Cabinet, non-urgent elective surgeries were suspended from 26 March 2020. A staged reintroduction of elective surgery began from 27 April 2020. In Victoria, non-urgent elective surgeries were also suspended during their ‘second wave’ of COVID-19 cases and subsequent restrictions.

With non-urgent elective surgery suspended, there was a significant fall in the number of surgeries performed during the COVID-19 pandemic. For example, in the week starting 16 March 2020, there were 15,300 elective surgeries performed in public hospitals. By the week starting 13 April, this had fallen to 4,800. As restrictions eased, the number of surgeries increased: in the week starting 22 June, there were 14,200 surgeries performed.

The fall in surgeries during the peak of COVID-19 restrictions drove an overall decline for the year. In 2019–20, the number of elective surgeries in public hospitals was 9.2% lower than in 2018–19. While non-urgent elective surgeries fell by 3.5%, urgent surgeries increased by 3.5%. This suggests that many less urgent surgeries were delayed or cancelled.

While many types of elective surgery were affected by COVID-19 restrictions, the three that saw the most significant decline in public hospitals were varicose vein treatment (fell by 30%), myringotomy (a procedure to allow fluid to drain from the ears—fell by 26%) and tonsillectomy (removal of the tonsils—fell by 22%).

The elective surgery restrictions also had a significant impact on the elective surgeries performed in the private sector, which ordinarily make up over half of all elective surgeries annually. While detailed data is not yet available on the nature of this impact, what is known is that governments partnered with the private hospital sector to assist with the COVID-19 response in a variety of ways. Dedicated funding was provided by the Australian Government to maintain the viability of private hospitals and private hospitals made facilities and staff available to assist state and territory hospital system.

The long-term health effects of cancelling or postponing non-urgent elective surgeries are not yet known, and it is unclear whether patients may have opted for alternative treatments if they were unable to proceed with surgery.

Find out more: Elective surgery waiting time 2019–20

Fewer presentations to emergency departments, with large decline in presentations due to injuries

The average number of daily presentations to emergency departments fell substantially in the early stages of the COVID-19 pandemic. Between the week starting 9 March and the week starting 30 March, presentations fell by 38%.

The number of presentations then slowly increased, though was still lower than in the comparable period in 2019. In the week beginning 22 June, average daily presentations were 8.4% lower than for the comparable period in 2019.

The average daily number of presentations for injuries decreased from 5,800 in the week beginning 24 February to 3,400 in the week beginning on 30 March.

These trends coincided with the restrictions on public and social gatherings and activities, including sporting events and travel restrictions.

The average daily presentations where the COVID‑19 virus was suspected peaked at 785 in the week beginning on 23 March. The number of presentations to emergency departments related to COVID-19 do not reflect the number of diagnosed COVID-19 cases in Australia.

Find out more:Emergency department care – 2019–20

Many changes were made to the MBS to ensure continuity of care

During the COVID-19 pandemic, changes to the MBS (Medicare) were introduced to ensure Australians could continue to safely access essential health care. From March 2020, many health practitioners were able to conduct consultations by telephone or video conference under the MBS. This included GPs, medical specialists and allied health professionals. There was also a temporary increase in the incentives to encourage bulk-billing of some items.

Overall, the total number of consultations was 16% higher in April 2020 than in the same period in 2019. There was a shift away from face-to-face consultations to telephone and video conference consultations with the introduction of new telehealth MBS items from March 2020. For example, in April 2020, 36% of GP consultations were delivered by telephone or video conference, while in April 2019, all recorded consultations were delivered face-to-face.

Between April and August 2020, bulk-billing incentive payments rose from $55.6 million in March 2020 to an average of $130.0 million per month.

Find out more: Impacts of COVID-19 on MBS service use

Prescriptions for respiratory conditions spiked during March 2020

During COVID-19, a range of measures were introduced to ensure patients could safely access the right quantities of their prescription medications through the Pharmaceutical Benefits Scheme (PBS). These included home delivery services, more flexibility in the way doctors and pharmacies could prescribe and dispense medications, and advice against supporting stockpiling of medications.

The overall number of prescriptions dispensed between January and August 2020 was similar to the year before. However, the number of prescriptions dispensed in March 2020 was 23% higher than in March 2019. This rise was most significant for the group of medicines used to treat respiratory related conditions such as asthma or chronic obstructive pulmonary disease (COPD).  It appears that some people, in particular those with respiratory conditions, filled additional prescriptions to ensure they had a sufficient supply of their medications during lockdown. This rise in respiratory related prescriptions came after a similar rise associated with the spread of smoke associated with the 2019­–20 bushfires (more detail is available at Australian bushfires 2019–20: exploring the short-term health impacts).

PBS data also suggest in-vitro fertilisation (IVF) services were impacted by elective surgery restrictions. For example, compared with April 2019, there was a 58% fall in the number of IVF medicines dispensed under the PBS in April 2020.

Find out more: Impacts of COVID-19 on PBS service use

BreastScreen Australia mammograms significantly fell during the COVID-19 pandemic, but numbers have now risen

To protect clients and health care workers from the spead of COVID-19, screening mammograms delivered through BreastScreen Australia were temporarily suspended from late March 2020. They resumed in late April/early May. Australia’s other national cancer screening programs (for bowel and cervical cancer) were not suspended.

The number of screening mammograms performed through BreastScreen Australia significantly declined as the COVID-19 pandemic worsened and tighter restrictions were put in place.

There were around 145,000 fewer screening mammograms performed through BreastScreen Australia in January to June 2020 compared with January to June 2018 (2018 is chosen as the comparison year instead of 2019, as BreastScreen Australia is a two-yearly program).

Following an easing of restrictions that included a lifting of the suspension from late April/early May 2020, the number of screening mammograms increased. There were around 12,000 more screening mammograms performed through BreastScreen Australia in July to September 2020 compared with July to September 2018.

Find out more: Cancer screening and COVID-19 in Australia​

Compliance to hand hygiene standards in hospitals remains high

Compliance with hand hygiene standards in Australian hospitals is generally good, with national benchmarks routinely met. This continued during the COVID-19 pandemic, with the latest data suggesting improvements in the early part of 2020 against already high standards.

Hand hygiene in hospitals generally refers to the washing of hands or use of alcohol-based rubs by healthcare workers. In the most recent audit period (1st April to 30th June 2020), the national hand hygiene compliance rate was 88.2%, higher than the benchmark of 80%.

The compliance rate for 5 hand hygiene ‘moments’ was: 85.3% before touching a patient; 91.5% before a procedure; 93.3% after a procedure or body fluid exposure risk; 91.2% after touching a patient; and 83.4% after touching a patient’s surroundings.

Find out more: MyHospitals: Hand Hygiene

What else do we know about the effects of COVID-19?

Throughout 2020, the AIHW has been releasing data and analysis on the impact of the COVID-19 pandemic on health and welfare issues.

Data provided by Victoria, Queensland and New South Wales from their respective suicide registers, and published on the AIHW Suicide and Self-harm Monitoring sub-site, present no evidence to date of any increase in rates of suicide over 2020 relative to previous years.

The Australian Bureau of Statistics has also released provisional mortality statistics to measure patterns of mortality during the COVID-19 pandemic.

The AIHW has also published information on the short-term health effects of the 2019­–20 bushfires: Australian bushfires 2019–20: exploring the short-term health impacts

Where to from here?

The AIHW will continue to monitor the impact of COVID-19 on the health and wellbeing of Australians over time. Several new reports are due for release early in 2021, examining the impact of COVID-19 on:

  • child protection services
  • antenatal care