As Australians continue their transition towards living with COVID, doctors are warning respiratory illnesses this winter are expected to rise to levels not experienced since pre-COVID.
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According to the Australian Department of Health, influenza and flu-like illnesses during last year's COVID peak were only a fraction of the previous years.
In 2019 influenza across Australia was 2.7 times higher than the five-year average with 313,033 laboratory-confirmed cases recorded.
Conversely, in 2021 national data showed a total of 598 cases were recorded.
The Royal Australian College of General Practitioners Tasmania chairman Doctor Tim Jackson said closed borders and COVID-safe practices had helped stem the spread of influenza, but expected numbers this winter to rise as these relax.
"We've had the borders closed and everyone wearing masks and segregating and staying home when they're unwell for the last two years, so we really haven't seen that winter onslaught of respiratory infections that we normally get," he said
"With the borders opening and relaxation of some of the COVID measures, we wouldn't be surprised to see an increase in respiratory viruses, flu, croup and other respiratory viruses, and COVID will be part of that as well."
Newstead Medical practice partner Dr Toby Gardner said this year's flu season would see a generation of children three and under - an at-risk group - experience the flu for the first time.
"We have a group of probably up to three-year-olds in Tasmania and Australia who have actually never been exposed to influenza before," he said.
"We are particularly worried about that under three cohort."
Dr Jackson said one of the reasons viruses were more transmissible in winter was because of human behaviours that were hard to avoid.
"We're less out in the open, windows are closed, we're all huddled together really and we know that close contact, particularly inside where there's no ventilation leads to increased virus transmission of COVID and other viruses," he said.
Dr Jackson said meetings between primary health providers in the North and the Department of Health had begun, with the planning for an uptake in respiratory illness underway.
"Planning is underway on how we might manage this expected increase in viral illnesses over autumn and winter."
"I think we'll see a similar state, general practice and pharmacy coordinated response from both state and primary health care, like we have with COVID."
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Dr Gardner said the preliminary discussions included utilising existing COVID infrastructure to administer flu jabs, but said further education was needed amid vaccination fatigue and apathy in the community.
"Influenza is not a benign illness, people probably think it's not such a severe illness, but it still kills a lot of people every year, in pre-2019 times, particularly the elderly.
"We'd like to see educational campaigns reminding people because I'm sure people have forgotten about that over the last three years where they've been obsessed with COVID."
Director of Public Health Dr Mark Veitch said preparations were underway for the winter flu season with a focus placed on high-risk groups.
"As part of our winter plan, we will ensure we are able to support people at higher risk of severe outcomes from influenza and other respiratory illnesses through vaccination, testing and treatment," he said.
He said the government would use its experience of COVID-19 to identify other systems and services to support the management of winter illnesses.
Dr Veitch did not advise if the government would make any changes to mask or COVID-safe behaviour protocols with flu numbers expected to rise.
Earlier in the month, Premier Peter Gutwein said as part of the relaxing of the Check-in TAS app additional COVID protocols would be reviewed over four weeks, including the wearing of masks.
"We'll also be looking at other restrictions, including masks in that period as well," he said.