The report covers the first year of the pandemic, to around April/May 2021. Where possible, the most recent data available at the time of writing is included, however due to the timing of different data collections, some data are only available for periods within 2020. It does not include data on the latest wave of cases that began in June 2021.
At the beginning of the COVID-19 pandemic, there were many uncertainties around how Australia would be affected: how many cases and deaths would occur; would the health system be able to manage; what other parts of society would be disrupted; and would mental health and various social factors be adversely affected. Now that the first year has passed, a number of these have been clarified; however, challenges continue to emerge. At the time of writing, key challenges were the emergence of new variants of the virus, and how quickly vaccines could be rolled out to the community. And while the severity of the situation in other countries continues, the risk of flow-on effects to Australia remains.
This report looks at the direct and indirect health effects of COVID-19 in Australia. This includes information on case numbers, deaths, burden of disease, impact on other diseases such as mental health, and changes in health behaviours. The impact on health services and on social determinants of health is also examined. It draws on data from a range of sources including disease surveillance systems, death registrations, hospitalisations, MBS and PBS, and surveys.
Direct health effects
The first year resulted in the following numbers of cases and deaths in Australia:
- Up to the end of 2020, there were around 28,500 cases of COVID-19, with 2 distinct peaks (or ‘waves’) one in March/April (affecting all states and territories with most infections being acquired overseas) and one in June to September (mainly affecting Victoria with most infections being acquired via community transmission). In 2020, the majority of cases were notified in Victoria.
- There were around 900 deaths from COVID-19 in Australia in 2020 (909 notified through surveillance systems and 866 registered and compiled by the ABS).
- 89% of deaths were in Victoria and 7% in NSW.
- The majority of deaths were in the older age groups: 24% in the 85–89 year age group and 34% in those aged 90 and over.
- By 20 June 2021, there had been just over 30,000 confirmed cases of COVID-19 and 910 deaths in Australia.
Hospitals were protected from being overwhelmed
- The key aim of protecting hospitals was achieved. During 2020, around 12.5% of people with COVID-19 were admitted to hospital for treatment of the disease.
The burden of disease from COVID-19 in Australia in 2020 was modest
- There were just over 8,400 disability-adjusted life years (DALYs) lost in 2020 from COVID-19 in Australia; 97% of this disease burden was from fatal cases. This is much lower than the burden due to leading diseases in Australia. For example, coronary heart disease (CHD) was responsible for around 312,000 DALYs in 2018.
Some groups in the population were more affected than others
- During 2020, 7% of all COVID-19 cases in Australia and 75% of all deaths were in people living in residential aged care facilities.
- Up to early July 2020, it was estimated that health care workers in Australia were 2.7 times as likely to contract COVID-19 as the general community.
- There were almost 4 times as many deaths due to COVID-19 for people living in the lowest socioeconomic group compared with the highest socioeconomic group, and age-standardised mortality rates were 2.6 times as high.
There were only a small number of cases in the Aboriginal and Torres Strait Islander community
- This community comprises 3.3% of the Australian population but only 0.5% of all cases despite being at increased risk of severe COVID-19 disease or death.
- As at 25 April 2021, there have been 153 confirmed cases and no COVID-related fatalities among Aboriginal and Torres Strait Islander peoples.
Australia is one of only a small number of comparable countries to have kept cases and deaths at a relatively low level
- If Australia had experienced the same crude case and death rates as 3 comparable countries Canada, Sweden and the United Kingdom there would have been between 680,000 and 2 million cases instead of the 28,500 that did occur, and between 15 and 46 times the number of deaths.
- If Australia had experienced the same rates as New Zealand, there would have been around 18,000 fewer cases and 780 fewer deaths.
Indirect health effects
There were fewer deaths from other causes
- During 2020, Australia recorded lower than expected total mortality rates (excluding coroner-certified deaths) compared with age-standardised mortality rates for the previous 5 years. This is in contrast to many other countries where excess mortality (higher than expected deaths) was observed.
- Age-standardised death rates for influenza and pneumonia, and chronic lower respiratory infections were lower in 2020 than the previous 5-year average, and were particularly low during the winter months.
Influenza notifications and injuries experienced declines
- During 2020, rates of laboratory-confirmed influenza were substantially lower than expected from April onwards.
- There was also a reduction in injuries due to falls and road traffic accidents, with fewer presentations to hospital emergency departments and road deaths
There were adverse impacts on mental health for young people
- The initial impacts of the pandemic in Australia appeared to have increased levels of psychological distress, particularly for adults aged 18–45. By April 2021, the average level of psychological distress had returned to pre-pandemic levels, however continued to be higher for young people.
- The proportion of people experiencing severe psychological distress also continued to be higher in April 2021 (9.7%) than in February 2017 (8.4%).
Suicide rates have remained at pre-pandemic levels
- The number of deaths by suicide in NSW, Victoria and Queensland have remained at similar levels to previous years.
There was a mixed picture for health behaviours, with some people improving and some worsening
- From data for the period April to June 2020:
- Similar proportions of people had increased as had decreased exercise and other physical activity
- Of those adults who usually drank alcohol, 20% had increased their consumption compared with before COVID-19 restrictions. Different data sources showed that between 13% and 27% had decreased it.
Impact on health services
There were many changes in how the health system operated and was used, for example:
- Elective admissions involving surgery in public hospitals decreased by 9.3% in 2019–20.
- Some services in the community had considerable reductions in April 2020 at the height of the initial restrictions. For optometry, this led to an overall 8.1% fall in the number of services in 2020 compared with 2019.
- There was a steady rise in the number of mental health services subsidised by Medicare between mid-March and mid-December 2020, which likely reflects increased need and increased availability of services during this period.
- From January to June 2020 there were 145,000 fewer mammograms through BreastScreen Australia compared with the same period in 2018. From July to September 2020 there were 12,000 more
Some areas maintained similar levels, for example:
- In 2020, there was a 3.4% increase in Medicare-subsidised general practitioner (GP) visits compared with 2019, a similar rise to those in recent years.
- Medicare-subsidised GP services for chronic disease management items showed falls in services at the start of the pandemic, followed by recovery to somewhat above previous levels of use.
New telehealth arrangements supported many areas
- Maintenance of visits to GPs was supported by uptake of new telemedicine provisions by April 2020, 36% of GP consultations were delivered by phone or video. This level continued until August, followed by some reductions towards the end of 2020.
- Telehealth services accounted for nearly 33% of Medicare-subsidised mental health services between mid-March and the end of December 2020
Impact on social determinants
Substantial changes in income and labour force for many people
- A number of government support programs were put in place during this period notably, the JobKeeper subsidy and the Coronavirus Supplement paid to recipients of JobSeeker. These payments contributed to reductions in poverty for some groups, such as single parent families (from 20% in February 2020 to 8% in June 2020), but many people did have falls in income.
- In April 2020, 20% of people in the labour force were either unemployed or underemployed. By June 2021 this had declined to 12.8%, below late 2019 levels.
- Unemployment increased from 5.1% in February 2020 to a peak of 7.5% in July 2020. It returned to pre-pandemic levels by May 2021, and by June 2021 it was lower (4.9%).
- By June 2021, employment was higher than before the pandemic (1.2% higher than March 2020)
The restrictions may have had an effect on family and domestic violence and child abuse and neglect
- An online survey of 15,000 women found that 5% experienced physical or sexual violence from a current or former cohabiting partner between February and May 2020. For 65% of these women, it was the first time the violence had occurred or the violence had increased in frequency or severity.
- An increase in suspected child abuse and neglect notifications after April 2020 was larger than in post school break periods in previous years, suggesting the COVID-19 restrictions may have had an added effect.
1. What we know now about the disease
- Disease characteristics
- Variants of concern
- Prevention, control and treatment
2. Direct health impact of COVID-19
- Cases in Australia
- Burden of disease
- Population groups
- Comparison with other countries
3. Indirect health effects
- Deaths from other diseases
- Incidence of other communicable diseases
- Mental health
- Changes in health behaviours
4. Health services throughout the pandemic
- Emergency department use
- Elective surgery
- Services in the community
- Supply of medicines
- Focus on chronic disease management
- Focus on mental health services
- Focus on cancer screening
5. COVID-19 impact on social determinants of health
- Income and employment
- Education and child care
- Family and domestic violence
- Child protection
6. Data development
- Innovative use of data during the pandemic
- COVID-19 register
Appendix A: COVID-19 mortality method
- Definition and coding of COVID-19 deaths
- Comparison of COVID-19 deaths data from NNDSS and ABS death registrations
- Associated causes of death
Appendix B: COVID-19 burden of disease methods
- Case definition
- Fatal burden
- Non-fatal burden
Appendix C: WHO region analysis
End matter: Acknowledgments; Abbreviations; Glossary; References; List of tables; List of figures; Related publications.