A short thread about relative burden of COVID we are seeing in residential aged care in Australia. So far across Australia, we have ~26700 case and 810 deaths. That's a case-fatality rate of 3.0% - but we know this rises strongly with age and frailty.

Our government publishes outcomes in cases in gov subsidised residential aged care https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/coronavirus-covid-19-current-situation-and-case-numbers. We are at ~2000 cases in these settings with ~600 deaths... a 30% case-fatality rate in settings where testing is pretty complete CFR of 0.8% outside of these centres.

Without vaccines or good antivirals, hard to reduce mortality - so focus should be reducing risk of infection in vulnerable groups. How are we going? 216K subsidised places in residential aged-care in 2018. So attack rate of ~2K/216K - let's say 0.9% as places would have risen.

For rest of population - ~24.7K/25.4K or 0.1%. So a relative risk of infection 9x higher in aged-care and a relative risk of mortality given infection 40x higher. I.e. our residential aged care population has been 9x40=360x more at risk of death than Australians on average.

At present we can't lower mortality risk. But we can reduce the relative risk of infection. If the same as that for the average Australian throughout, we would so far have had only 600/9=~65 deaths in aged care, full AU death toll of ~275 and 1.1% average CFR for whole population

So just to reiterate - reducing overall infections is great. But we've failed our aged-care residents by allowing an exposure risk 9x above average. Reduction to the same as pop. average would have saved more than 500 lives so far. We are going to face more outbreaks/waves.

Along with more efficient overall transmission control , we need a special focus on aged care to reduce the most severe burden of COVID over the coming months. Easy to justify spending $100s of millions on this for the health benefits alone - where is our commitment?