Winter strategy for respiratory diseases 2023 update; take-home messages

For more detailed information and the statistics, please refer to the recording of the video or the presenter’s slides.

Epidemiology - Covid, Influenza and Respiratory Syncitial Virus (RSV)

1. Covid waves:
   We are currently experiencing the 5th wave, and notifications have decreased over the last weeks.
2. Wave frequency:
   While the frequency of Covid waves was about every 3 months at the beginning of the pandemic, surveillance data indicates that the frequency has stretched out to every 5 months.
3. Outlook:
   “Future COVID waves are likely to become much more predictable and coincide with winter. While this is somewhat speculative, it is consistent with how other respiratory viruses behave.” We're in another COVID wave. But it's not like the others (unsw.edu.au)
4. Severity of influenza season – forecast:
   The rate of patients presenting to a GP with Influenza like illness symptoms (per 1000 consultations) is already above average. If this trend continues, the influenza season will likely be severe.
5. Death statistics – key message
   In 2022, Australia recorded 20,000 excess deaths above the pre-pandemic predicted level (5% higher than the expected for all age groups), and this trend is continuing in 2023. 66% of excess deaths were due to Covid or had Covid listed as a contributing factor.
6. RSV became a notifiable disease in Australia in 2021 and confirmed cases are now recorded in the National Notifiable Diseases Surveillance System (NNDSS).
   As of 21/06/2023 the number of confirmed RSV cases has plateaued. Highest burden in very young children, but also in people aged over 85, with reports of current RSV outbreaks in residential aged care facilities.

Control measures Covid & influenza

1. Immunisation – current ATAGI advice: ATAGI recommended COVID-19 vaccine doses | Australian Government Department of Health and Aged Care
2. Keynote on booster effectiveness:
   The recency of the booster is more important than the overall number of Covid vaccinations received.
3. In Australian adults aged 65 years and older, recent COVID-19 vaccination – a booster dose received in the last three months – reduced the risk of death from SARS-CoV-2 infection by as much as 93 per cent compared to those who were unvaccinated, a new national study of 3.8 million adults has shown. Recent COVID-19 vaccination highly effective against death caused by SARS-CoV-2 infection in older Australians | NCIRS
4. Changes to PCR testing: Reduced PCR availability from 13/05/2023. Most pathology providers now need request forms, or private fee.
5. Antivirals and PBS eligibility:
   Factsheet-paxlovid-nirmatrelvir-and-ritonavir-21-April-2023.pdf (pbs.gov.au)
6. Pre-assessment in Residential Aged Care remains important for therapy of influenza and COVID-19:
   Find the form here: gp-antiviral-pre-assessment-form-aged-care.pdf (nsw.gov.au)
7. Oseltamivir treatment of influenza:
   COVID-19 and influenza antiviral medicines - Fact sheets (nsw.gov.au)

Non-pharmaceutical control measures respiratory diseases

1. Masks:
   Masks are required to visit NSW hospitals and strongly recommended in general practices and medical centres.
   Practice owners are allowed to make wearing a mask a condition of entry to their premises. It is recommended to communicate this to patients in advance and have processes in place for patients who cannot wear a mask or cannot communicate with clinicians wearing a mask.
   Surgical masks for staff and patients recommended for clinical areas.
   N95 Mask + eye protection recommended for contact with patients with respiratory symptoms.
2. Health @ Home program CC: In response to increase of respiratory and gastrointestinal infections over winter.
   The CC LHD has implemented the program until September 2023.
   Virtual Care and triage team performing remote patient monitoring, Registered Nurses perform daily phone calls and escalate to GP if necessary.