As we head into the winter months, we are likely to see the usual prevalence of colds, flu, and viral infections increase, including COVID-19. 

As we head into the winter months, we will see increased prevalence of colds, flu, and viral infections increase, including COVID-19.

HMRI and University of Newcastle viral immunologist, Professor Nathan Bartlett said in a recent interview with the Newcastle Herald that

“COVID still hasn’t reached what we’d call an endemic virus. It’s still circulating at higher than acceptable levels. We’re a long way from having a predictable level of immunity and disease. We’re nowhere near that stage yet with COVID.”

In February 2023, a new subvariant of Omicron known as XBB.1.16 was detected in Australia and infections have been slowly increasing. Colloquially known as Arcturus, XBB.1.16 has been assessed by the World Health Organisation (WHO) as a lower risk strain on a global scale compared with other variants, however, has been designated as a variant of interest as cases have increased in other parts of the world. As with all Omicron variants, health officials have seen subsequent variants more transmissible than previous variants.
 

So, what is the current advice and recommendations from the Australian government and health professionals?

How can I reduce my chances of getting COVID-19?

The ongoing advice to help protect yourself, your loved ones, and your community still stands.

• Keep informed on the suggested vaccinations for COVID-19 and if you are experiencing cold or flu symptoms, stay at home and get tested. Combination Flu and COVID-19 self test (rapid antigen test RAT) are now available in Australia.
• Avoid indoor crowded spaces if possible. Wear a mask in crowded, indoor places – masks provide an extra layer of protection against COVID-19 and the flu.
• Talk to your doctor about protecting yourself and treatment options if you are at higher risk of severe illness.
• Don’t visit people who are at higher risk if you have symptoms of a viral respiratory illness (cold or flu symptoms).
• Wash and sanitise your hands.

Are there any COVID-19 public health orders or restrictions in place?
 

As of 30 November 2022, there are no active Public Health Orders in NSW to manage the public risk of COVID-19.

Do I need a COVID-19 vaccine booster?

The current advice from the Australian Technical Advisory Group on Immunisation (ATAGI) regarding COVID-19 boosters in 2023 is as follows:

• ATAGI recommends a 2023 COVID-19 vaccine booster dose for adults in the following groups, if their last COVID-19 vaccine dose or confirmed infection (whichever is the most recent) was 6 months ago or longer, and regardless of the number of prior doses received:
  • All adults aged 65 years and over
  • Adults aged 18-64 years who have medical comorbidities that increase their risk of severe COVID-19, or disability with significant or complex health needs.
  • ATAGI advises the following groups should consider a 2023 booster dose if their last COVID-19 vaccine dose or confirmed infection (whichever is the most recent) was 6 months ago or longer, and regardless of the number of prior doses received, based on an individual risk-benefit assessment with their immunisation provider.
  • All Adults aged 18-64 years without risk factors for severe COVID-19
  • Children and adolescents aged 5-17 years who have medical comorbidities that increase their risk of severe COVID-19, or disability with significant or complex health needs.
  • ATAGI advises that a booster dose is not recommended at this time for children and adolescents aged under the age of 18 who do not have any risk factors for severe COVID-19.

Who is eligible for COVID-19 antiviral treatments?

From April 1, 2023, eligibility for COVID-19 antiviral treatments expanded to provide greater access for people who are vulnerable to severe disease.

Antiviral treatments are taken orally and may help stop COVID-19 infection from becoming severe. It is important that a course of these antiviral treatments start as soon as possible after COVID-19 symptoms begin.

Who may be eligible?

• People aged 18 or older who test positive for COVID-19 and are moderately to severely immunocompromised.
• First Nations people, 30 years or older with 1 additional risk factor for developing severe disease or if they have had past COVID-19 infection resulting in hospitalisation.
• People aged 50 years or older with 2 additional risk factors for developing severe disease or if they have had past COVID-19 infection resulting in hospitalisation.
• People aged 60-69 years  or older with 1 additional risk factor for developing severe disease. 
• People aged 70 years or older, regardless of risk factors and with or without symptoms.

How do I get a COVID-19 antiviral treatment?

Speak to your GP to discuss your eligibility. Treatments work better the earlier (within 5 days of symptoms) you receive them so if you are eligible (higher risk of severe disease) test as soon as you have symptoms to determine if you have Flu or COVID  – there are different antivirals for each type of virus. You will need a prescription.

What is the advice for women who are pregnant, breastfeeding, or planning a pregnancy?

Pregnant women have a higher risk of severe illness from COVID-19. Their babies also have a higher risk of being born prematurely. COVID-19 vaccination significantly reduces the risk of becoming infected with COVID-19. Vaccination also reduces your risk of transmitting the virus to others, including to infants.

COVID-19 vaccination may provide indirect protection to babies by transferring antibodies through the placenta (for pregnant women) or through breast milk (for breastfeeding women).

Pregnant women who have already received a primary course should discuss with their doctor whether a booster dose is required during their pregnancy.

You can have a COVID-19 vaccination at any stage of pregnancy. COVID-19 vaccines are also safe for women who are breastfeeding, and if you are trying to become pregnant, you do not need to delay vaccination or avoid becoming pregnant after vaccination.

Should I still test for COVID-19?

You should test for COVID-19 if you:

• Have cold/flu symptoms, especially if you are at risk of severe illness. This is so you can quickly access antiviral treatments.
• You live with someone who has COVID-19, especially if you are at risk of severe illness.

If you have recovered from COVID-19 in the last 4 weeks, you do not need to test unless you have new symptoms. If you are at higher risk of severe illness and have any new symptoms within 4 weeks of recovering from COVID-19, talk to your doctor. Your doctor may recommend further testing including for other viruses such as influenza.

Changes to COVID-19 PCR Testing

From Saturday 13 May 2023, you will need a pathology referral to get a PCR test for COVID-19 in NSW. You can use a rapid antigen test (RAT) if you have COVID-19 symptoms, however a PCR test is recommended if you are at higher risk from COVID-19.

How do I know if I have long COVID?

Long COVID is defined by WHO as an illness that occurs in people who have a history of probable or confirmed SARS-CoV-2 (COVID-19) infection; usually within 3 months from the onset of COVID-19, with symptoms and effects that last for at least 2 months.

Some symptoms of long COVID include:

• Fatigue
• Shortness of breath or breathing difficulties
• Memory, concentration or sleep problems.
• A persistent cough
• Chest pain
• Difficulty speaking
• Muscle aches
• Loss of smell or taste
• Depression or anxiety
• Fever

There is no test for long COVID and doctors have to rule out other conditions. It is important you speak with your doctor if you experience any symptoms that are concerning to you.

Do I need to be concerned about the flu in 2023?
 

Influenza is high contagious and potentially deadly to some people.
Professor Bartlett says that “The incidents of cold/flu-like symptoms, as monitored by Flutracking, are definitely indicating an uptick at this point”. “There are increasing numbers of flu cases being detected in hospitals”. While it is unclear what the magnitude of the flu season will be, it certainly looks to be starting early.

Health officials are encouraging people to get their flu vaccine earlier than usual, especially if they are at risk of severe illness.
Flu vaccines are free for the following priority groups:

• Children aged six months to under five years
• Adults aged 65+
• First Nations people
• Pregnant women
• Those with serious health conditions

Both COVID-19 and flu vaccines can be safely administered on the same day.

On Friday 5 May 2023, the World Health Organization (WHO) issued a statement declaring COVID-19 is now an established and ongoing health issue which no longer constitutes a public health emergency of international concern (PHEIC). While COVID-19 is no longer a public health emergency of international concern, the pandemic does still exist and it is important to remain vigilant.

Sources:

• Australian Government Department of Health and Aged Care – Updated eligibility for oral COVID-19 antiviral treatments.
• NSW Government – COVID-19 guidance and support for people in NSW
• The Royal Australian and New Zealand College of Obstetricians and Gynaecologists – COVID-19 vaccination when pregnant or breastfeeding and for those planning pregnancy
• NSW Government – Long COVID