Just when you thought the worst was over along comes Omicron. Who would have thought the 15th letter of the Greek alphabet would turn out to be so much trouble.

From Sweden – very relaxed COVID response – to Singapore – not so relaxed – swathes of restrictions have returned. Masks, distancing, hand hygiene, capacity limits, vaccinations, tracing, isolation are all back in vogue. Even lockdowns have made a comeback – at least in the Netherlands.

And now, not very surprisingly, Australia is replicating infection rates in Europe and North America. The COVID numbers in Victoria and New South Wales have gone up like a hot air ballon on steroids over the past month as Omicron takes hold.

Vaccines were the hope of the side. Only a month ago everyone was sighing with relief as Australia reached 90 percent adult vaccination rates. We thought we could look forward to a return to relative normality. It all looked good when vaccinations halved the risk of catching Delta and the risk of serious disease and death by 10 fold.

Now it’s clear even double doses of vaccines are much less effective at preventing the spread of Omicron. Omicron is probably more than four times as infectious as Delta and probably a third as likely to put you in hospital. Omicron may result in much less serious disease, but it’s also much more infections.

Even if Omicron leads to only a third of the hospitalisations of Delta, if we get around a 20 fold increase in cases – as is happening in New South Wales – we could get around a six fold increase in hospitalisations. As it is, while he hospitalisation rate lags the case rate by about two weeks we are already seeing a significant increase in hospitalisations in New South Wales and Victoria.

The Australian COVID hospitalisation rate has already tripled since the middle of December and the ICU rate has nearly doubled. We are now nearly at the hospitalisation peaks reached at the height of the September Delta outbreak that lead to widespread lockdowns in Sydney and Melbourne.

Can the hospital system cope?

On current trends Australian case rates and hospitalisations could again double and reach the rates currently experienced in Europe.

In Australia big teaching hospitals have about 700-800 beds. So the equivalent of one major hospital is already taken up with COVID in each State. It’s likely this will increase and 10-20 percent of hospital beds will be filled with COVID patients in the next month.

That puts an enormous strain on a system that is already running hard. Inevitably less urgent cases have to be deferred. There are now thousands of patients waiting long periods for joint replacements, hernia repairs and cancer screening. The number is increasing every day.

Many hospital staff have already moved from their normal duties to work on COVID wards and they are tired. As omicron spreads, more health staff will catch it and have to take sick leave. Many have been in this situation for over two years.

Staff are tired. All this is happening over the holiday break. The risk is that they will begin to quit. There are already acute staff shortages in aged care.

If that happens, things will get really ugly. Overflowing emergency departments, ambulance ramping, temporary hospital wards, stressed staff, more waiting for non urgent care, and increased death rates. None of this is certain, but the data suggests it is wise to immediately put in place all the tried and true public health measures short of lockdowns – and they may yet be necessary as parts of Europe are finding.

We need a better plan

What is surprising is that Australia has repeatedly been late in anticipating and planning for what might happen. We were slow and disorganised with border restrictions, quarantine facilities, protecting aged care and disability facilities, basic public health information, contact tracing and isolation, procuring vaccinations, rolling out vaccinations, protecting indigenous communities, and vaccine putting in place sanctions and incentives.

And now we are late and disorganised with the booster program, we failed to anticipate the current testing crises, we failed to purchase and distribute rapid antigen tests and our planning for the use GPs and the primary care system to look after mild to moderate COVID patients is rudimentary and disorganised. This was all highly predictable months ago. Everyone knew that more infectious variants could emerge.

The Federal Government’s dreams of a smooth transition back to an open and booming economy are in tatters. Everything points to the need for fundamental medium to longer term change to manage COVID. It is a pipe dream to imagine that living with COVID will be smooth and seamless.

Most pressingly, much more effective national planning, coordination for health and aged care is needed. Why isn’t there a powerful, overarching joint Commonwealth and State task force to plan and coordinate action to back up the national cabinet?

We will need ongoing vaccination programs, targeted testing and isolation, community based treatment and support for COVID, focused public health restrictions and ongoing risk monitoring for new variants and other problems that may emerge. We are also going to need a plan to address the massive waiting lists that have already built up for non urgent care. All this means we are going to have to do things differently.

GPs currently provide about 120 million patient consultations a year. It’s entirely possible we will need 20 million vaccinations every six months (40 million boosters a year) for the foreseeable future. If all of that was to be done by GPs their workload would have to increase by a third. Of course some of the work is being done by pharmacies. But that puts stress on them too. The State hubs have been important but they are now winding down. New ongoing, longer term arrangements are needed.

If, as seems likely, the number of COVID patients who need health care increases dramatically, we will have to find ways of looking after people who don’t need intensive care at home to take pressure off the hospital system. That means teams of GPs, nurses and allied health staff. New referral organisational, funding and coordination arrangements will be needed to make that work. At the moment planning for these arrangements is confused, fragmented and chaotic.

More broadly, while it’s risky to make definite predictions, it looks like COVID is likely to continue to have a major impact on social and economic life for at least the next year. Short term measures are going to have to give way to medium term structural adjustment programs for COVID exposed industries like travel, tourism, hospitality and entertainment. Ongoing rearrangements of work and education are likely to be required as well.

Again, it is as though none of this has occurred to the Federal Government. While they have muddled along in crisis mode hoping COVID will fade away, there has been little evidence of longer term planning based on a prudent assessment of risk. So far we have been lucky. But our luck may be running out and the festive season has demonstrated that we are a long way from being ready. The current national coordination and management arrangements are not working – time for a rethink.